Thursday, September 20, 2012

The borderline society and its discontents

This post is taken from a talk i once gave. The notes were only on paper and have been lost in the earthquake. So you may need to imagine that these ideas once had some research behind them, and there were once footnotes and a bibliography all proper-like. Moreover, this topic will take two posts to cover. i don't like long posts on blogs and i do want a good go at a difficult subject.

Borderline personality disorder is a mental disorder on Axis II of the DSM IV, which means it is not considered to be a 'brain disease' like schizoprenia, but more of a problematic way of being which has been learned in early life. The features of borderline personality disorder are emotional instability, a sense of emptiness and a shaky or non existent sense of self, self destructive behaviour, addictions, intense and unstable relationships, and sometimes transient psychotic breaks. Naturally these features are all controversial and as a label it is often considered pejorative, both by people diagnosed with it and by clinicians. i don't consider it pejorative.(You will find out why.) Originally it was called borderline because it was thought to straddle the border between psychosis and neurosis, and i think that is a useful framing.

i state here that i am agnostic about mental illness, but i am not agnostic about suffering, and some of the borderlines i know are those who suffer the most. This keeps me interested.

The question is this: Is BPD a feature of modernity? Does it come only from the affluent self indulgent upbringing we tend to criticise (mothers often get the blame)? Are there borderlines in other cultures where poverty and war keep our psychological selves at survival level? What happened to borderlines in the past? Were there any?

i start with a story about the past, about my mother. i found these things out only as she was dying and my relatives began to talk to me with uncharacteristic frankness.

My mother's early attachments were very compromised, and her late teens and early twenties were characterised by suicidality and problems with managing stress. A psychiatrist gave the family some surprisingly practical and rather un-psychiatric advice. He said they could not have her on suicide watch all the time and if she wanted to wander around the town in the middle of the night making suicidal threats they just had to let her get over herself. So they did. Then one morning she set out for work, fell into some sort of fugue state, drove her motorbike all day into the country and collapsed in a field. She was found by a farmer and put in hospital. This alarmed my father, to whom she was engaged, but he perservered with the marriage and really he held her emotionally until he died. She had the stability and containment in him that she could not find in herself.

When i heard about this, some things i knew about my mother gained context, and i was relieved and able to feel compassion. She was a borderline, by today's standards. She was creative and witty and hot tempered and forgiving and spiritually adventurous and occasionally wise, and she was a borderline. We all know one and may even be one.

So, if there were borderlines back then, what about further back? And how did they do in the world around them?

This is my hunch. Up until late last century most of the world was rural. People have lived in villages up until even one generation ago. Our ancestors lived in small circumstances, often not travelling, surrounded their entire lives by the same people. We married our neighbours and worked and played with them, and our immediate social circles involved our extended families.Work would have been often physically hard and governed by externals such as the seasons and the markets.  Borderlines are high maintenance. With borderlines there is always drama, always intensity and behaviour that takes attention. There is a need to be cared for that can never be fulfilled. i suspect this would not have been tolerated in village settings. And relationships would have been more stable simply because there was less choice. There are fewer people to fall in and out with, and if you fall right out of your village there is nowhere else to go. Ostracism could mean poverty or even death. For borderlines to survive in their borderline-ness, there needs to be social mobility and a large social context such as in a city. So while i suspect there were always emotionally high maintenance, dramatic, difficult people around, the conformity of social expectations and the grind of work and care possibly suppressed the more extreme expressions of BPD.

However, alongside our ancestors were urbanised, wealthy, educated people who took on the thinking of the day. i wondered how history has viewed those who struggled with negative and self destructive thoughts and feelings. There has at different times been a socially sanctioned form of psychological suffering, at least among the highly literate classes. In the early modern period, it was fashionable to adopt a debauched and self destructive life style in order to express dissatisfaction with the increasingly materialistic and scientific thinking that was becoming prevalent. It seemed an appropriate protest to be miserable. Later, the Sturm und Drang period of German romanticism reached its tragedarian apogee in Goethe's partly autobiographical The Sorrows of Young Werther. Werther is in love with an unavailable young woman and kills himself. The book was seen as sparking a rash of suicides among impressionable young men, and caused the kind of minor moral panic we saw with bands like Joy Division in the 1980's and the Emo phenomenon of 2005. In the nineteenth century a fashionable London suicide club was formed and its members promised to kill themselves before they turned 30 or went bald, whichever came sooner. The stated aim of the club was to provide consternation to clergy and pharmacists. Again, ennui and disaffection with societal norms seemed the best response to the psychological exigencies of the age.

This is all less superficial and hipster than it sounds. For some, life hurts. Suffering is not to be overcome or learned through. It is the fulcrum of personal experience and meaning. Sometimes you can spark and wire and catch fire with it.  Sometimes it is just too hard to manage the shit storm in your head. It can change in thirty seconds. Thirty seconds between the party and the abyss. Me, i don't have the courage for it.

Since BPD-type phenomena and the romance around suffering and death seemed to be so embedded in the thinking of the times, i thought about our own society and what about it might be problematic.

Some thinkers have gone as far as diagnosing the whole of society. Christopher Lasch wrote about the narcissistic society, where he emphasised the desperate shallowness of the narcissist rather than the arrogance. Anne Wilson Schaeff less convincingly diagnosed the whole of society as codependent. Freud, in his book Civilisation and its Discontents (from which the title of this post is gleefully pinched), talks about how the whole of society is unable to resolve the tensions between thanatos and eros and thus languishes in inevitable sickness.

So for my next thought - is our society sick? And how? And how can we tell if an individual is mentally ill if maybe the whole of society is?

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