I Hate You—Don't Leave Me (11 page)

Norman Mailer described the effect of an absent parent on Marilyn Monroe, who never knew her father. Though his absence would contribute to her emotional instability in later life, it would also ironically be one of the motivating forces in her career:

Similarly, Princess Diana, rejected by her mother and reared by a cold, withdrawn father, exhibited similar characteristics. “I always used to think that Diana would make a very good actress because she would play out any role she chose,” said her former nanny, Mary Clarke.
⁹

Raised in an orphanage during many years of her early childhood, Marilyn had to learn to survive with a minimum of love and attention. It was her self-image that suffered the most and led to her manipulative behavior with lovers later in life. For Diana, her “deep feelings of unworthiness” (in the eulogizing words of her brother, Charles) hindered her relationships with men. “I'd always kept [boyfriends] away, thought they were all trouble—and I couldn't handle it emotionally. I was very screwed up, I thought.”
¹⁰

Not all children who are traumatized or abused become borderline adults, of course; nor do all borderline adults have a history of trauma or abuse. Further, most studies on the effects of childhood trauma are based on inferences from adult reports and not on longitudinal studies that follow young children through to adulthood. Finally, other studies have demonstrated less extreme forms of abuse in the histories of borderlines, particularly neglect (sometimes from the father) and a rigid, tight marital bond that excludes adequate protection and support for the child.
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Nevertheless, the large amount of anecdotal and statistical evidence demonstrates a link between various forms of abuse, neglect, and BPD.

The “nature-nurture” question is, of course, a long-standing and controversial one that applies to many aspects of human behavior. Is one afflicted with BPD because of a biological destiny inherited from parents—or because of the way parents handled—or mishandled—upbringing? Do the biochemical and neurological signs of the disorder cause the illness—or are they caused
by
the illness? Why do some people develop BPD in spite of an apparently healthy upbringing? Why do others, burdened with a background filled with trauma and abuse, not develop it?

These “chicken-or-egg” dilemmas can lead to false assumptions. For example, one might conclude, based on developmental theories, that the causal direction is strictly downward; that is, an aloof, detached mother would produce an insecure borderline child. But the relationship might be more complex, more interactive than that: a colicky, unresponsive, unattractive infant may generate disappointment and detachment in the mother. Regardless of which comes first, both continue to interact and perpetuate interpersonal patterns, which may endure over many years and extend to other relationships The mitigating effects of other factors—a supportive father, accepting family and friends, superior education, physical and mental abilities—will help determine the ultimate emotional health of the individual.

Though no evidence supports a specific BPD gene, humans may inherit chromosomal vulnerabilities that are later expressed as a particular illness, depending on a variety of contributing factors—childhood frustrations and traumas, specific stress events in life, healthy nutrition, access to health care, and so on. Just as some have postulated that heritable biological defects in the body's metabolism of alcohol may be associated with an individual's propensity to develop alcoholism, so there may exist a genetic predisposition for BPD, involving a biological weakness in stabilizing mood and impulses.

As many borderlines learn that they must reject the either-or, black-or-white ways of thinking, researchers are beginning to appreciate that the most likely model for BPD (and for most medical and psychiatric illnesses) recognizes multiple contributing factors—nature
and
nurture—working and interacting simultaneously. Borderline personality is a complex tapestry, richly embroidered with innumerable, intersecting threads.

The Borderline Society

Where there is no vision, the people perish.

—Proverbs 29:18

States are as the men are; they grow out of human characters.

—From Plato's
Republic

 

 

 

From the beginning Lisa Barlow couldn't do anything right. Her older brother was the golden boy: good grades, polite, athletic, perfect. Her younger sister, who had asthma, was also lavished with constant attention. Lisa was never good enough, especially in the eyes of her father. She remembered how he constantly reminded all three children that he had started with nothing, that his parents had no money, didn't care about him, and drank too much. But he had prevailed. He had worked his way through high school, college, and through several promotions at a national investment bank. In 1999, he made a fortune in the dot-com stock boom, only to lose it all a year later after some professional missteps.

Lisa's earliest memories of her mother were of her lying on the couch either sick or in pain, ordering Lisa to do one chore or another around the house. Lisa tried hard to care for her mother and to persuade her to stop taking the pain pills and tranquilizers that seemed to make her so foggy and distant.

Lisa felt that if she was just good enough, she could not only make her mother better but also please her father. Though her grades were always excellent (even better than her brother's), her father always maligned her achievements: the course was too easy or she could have done even better than a B+ or an A−. At one point, she thought she might want to become a doctor, but her father convinced her she would never make it.

In her childhood and adolescence the Barlows moved constantly, following whatever job or promotion her father chased after. From Omaha to St. Louis to Chicago and finally to New York. Lisa hated these moves and realized later that she resented her mother for never objecting to them. Every couple of years Lisa would be packed up and shipped like baggage to a strange new city where she would attend a new school filled with strange new students. (Years later she would recount these experiences to her therapist as “feeling like a kidnap victim or a slave.”) By the time the family arrived in New York, Lisa was in high school. She vowed never to make another friend so she would never have to say good-bye again.

The family moved into a posh home in a posh New York suburb. Sure, the house was bigger and the lawn more manicured, but that didn't come close to compensating for the friendships she left behind. Her father rarely came home in the evenings, and when he did, it was late and he would start drinking and railing against Lisa and her mother for doing nothing all day. When her father drank too much, he became violent, sometimes hitting the kids harder than he intended. The most frightening time of all was when he was drunk and their mother was spaced out on pain pills; then there was no one to take care of the family—except Lisa, and she hated it.

In 2000, everything started coming apart. Somehow her father's firm (or her father himself, she was never sure which) lost everything when the stock market crashed. Her father was suddenly in danger of losing his job, and if he did, the Barlows would have to move again, to a smaller house in a less desirable neighborhood. He seemed to blame his family and especially Lisa. And then, on a clear, bright morning in September 2001, Lisa came downstairs to find her father lying on the sofa, tears streaming down his cheeks. Had it not been for a hangover from a drinking bout the night before, he would have been killed in his office in the World Trade Center.

For months afterward her father was helpless and so was her mother. They eventually divorced six months later. During this period, Lisa felt lost and isolated. It was similar to the way she felt in biology class when she'd look around the room and observe the other kids squinting into their microscopes, taking notes, apparently knowing exactly what to do, while she became queasy, not quite understanding what was expected of her and feeling too scared to ask for help.

After a while she just stopped trying. In high school she began to hang out with the “wrong kids.” She made sure her parents saw them and how freaky they dressed. The bodies of many of her friends were covered—almost literally—with tattoos and body piercings, and the local tattoo parlor became a second home for Lisa as well.

Because her father insisted she couldn't make it as a doctor Lisa went into nursing. At her first hospital job, she met a “free spirit” who wanted to bring his nursing expertise to underprivileged areas. Lisa was enthralled by him and they married soon after meeting. His habitual “social” drinking became more prominent as the months went by, and he began hitting her. Bruised and battered, Lisa still felt it was her fault—she just wasn't good enough, couldn't make him happy. She had no friends, she said, because he wouldn't let her have any, but deep down she knew it was due more to her own fears of closeness.

She was relieved when he finally left her. She had wanted the split but couldn't cut the cord herself. But after the relief came fear: “Now what do I do?”

Between the divorce settlement and her salary Lisa had enough money to return to school. This time she was determined to be a doctor and, much to her father's shock, was accepted into medical school. She was starting to feel good again, valued and respected. But then in medical school the self-doubts returned. Her supervisors said she was too slow, clumsy with simple procedures, disorganized. They criticized her for not ordering the right tests or getting lab results back in time. Only with the patients did she feel comfortable—with them she could be whomever she needed to be: kind and compassionate when that was needed, confrontational and demanding when that was called for.

Lisa also experienced a great deal of prejudice in medical school. She was older than most of the other students; she had a much different background; and she was a woman. Many of the patients called her “nurse,” and some of the male patients didn't want “no lady doctor.” She was hurt and angry because, like her parents, society and its institutions had also robbed her of her dignity.

Psychological theories take on a different dimension when looked upon in light of the culture and time period from which they emanate. At the turn of the century, for instance, when Freud was formulating the system that would become the foundation of modern psychiatric thought, the cultural context was a formally structured, Victorian society. His theory that the primary origins of neuroses were the repression of unacceptable thoughts and feelings—aggressive and especially sexual—was entirely logical in this strict social context.

Now, over a century later, aggressive and sexual instincts are expressed more openly, and the social milieu is much more confused. What it means to be a man or a woman is much more ambiguous in modern Western civilization than in turn-of-the-century Europe. Social, economic, and political structures are less fixed. The family unit and cultural roles are less defined, and the very concept of “traditional” is unclear.

Though social factors may not be direct causes of BPD (or other forms of mental illness), they are, at the least, important indirect influences. Social factors interact with BPD in several ways and cannot be overlooked. First, if borderline pathology originates early in life—and much of the evidence points in this direction—an increase in the pathology is likely tied to the changing social patterns of family structure and parent-child interaction. In this regard, it is worthwhile to examine social changes in the area of child-raising patterns, stability of home life, and child abuse and neglect.

Second, social changes of a more general nature have an exacerbative effect on people already suffering from the borderline syndrome. The lack of structure in American society, for example, is especially difficult for borderlines to handle, since they typically have immense problems creating structure for themselves. Women's shifting role patterns (career versus homemaker, for example) tend to aggravate identity problems. Indeed, some researchers attribute the prominence of BPD among women to this social role conflict, now so widespread in our society. The increased severity of BPD in these cases may, in turn, be transmitted to future generations through parent-child interactions, multiplying the effects over time.

Third, the growing recognition of personality disorders in general, and borderline personality more specifically, may be seen as a natural and inevitable response to—or an expression of—our contemporary culture. As Christopher Lasch noted in
The Culture of Narcissism
,

For many, American culture has lost contact with the past and remains unconnected to the future. The flooding of technical advancement and information that swept over the late twentieth and early twenty-first centuries, much of it involving computers, PDAs, cell phones, and so on, often requires greater individual commitment to solitary study and practice, thus sacrificing opportunities for real social interaction. Indeed, the preoccupation—some would say obsession—with computers and other digital gadgetry, especially among the young in what is commonly called “social media” (Facebook, MySpace, Twitter, YouTube, etc.), may be resulting ironically in more self-absorption and less physical interaction; texting, blogging, posting, and tweeting all avoid eye contact. Increasing divorce rates, expanding use of day care, and greater geographical mobility have all contributed to a society that lacks constancy and reliability. Personal, intimate, lasting relationships become difficult or even impossible to achieve, and deep-seated loneliness, self-absorption, emptiness, anxiety, depression, and loss of self-esteem ensue.