Okay, now where were we?

Sorry for erratic posting, I'm dealing with a family emergency. It may take me off line for a few days, but I'll let you know.

Anyway, Borderline Personality Disorder is terrible nomenclature and I really wish they'd change it. The name comes from a time when they thought BPD was somewhere on the borderline (get it?) between the historic constructs of psychosis and neurosis. (Those terms are still used, but the meaning has evolved somewhat.) The idea is that people with the diagnosis stubbornly interpret reality in ways which differ from the perceptions of others, i.e. there is something close to delusional about them, it just drives you nuts trying to get them to have useful insight into their own behavior.

Specifically, and this is my personal description, it's not by the book, people -- who are mostly female -- with this diagnosis have a powerful aversion to being alone and a pervasive fear of loneliness and abandonment. This causes them to develop extravagant crushes, romantic or otherwise, on people who may not reciprocate the attraction -- or who may exploit it -- and to be highly manipulative, clinging and needy in these relationships, whether the relationships exist largely in their own heads or have some mutuality. Naturally, this excessive neediness and the passive-aggressive manipulativeness that comes with it has the effect of driving its objects away, whereupon the person develops a narrative of victimhood and cruel abandonment, putting all the blame on the formerly beloved object who is now utterly contemptible. Along this path there may be an episode of stalking behavior.

This pattern repeats over and over, accompanied by extreme emotional lability (possibly buying a co-diagnosis of bipolar disorder), and often substance abuse, suicidal ideation and gestures (though uncommonly real suicide attempts), sexual promiscuity, self harm, crying fits and tantrums.

As you can see, the people who are most likely to be attracted to this person include narcissists and sociopaths, so you may have some very ugly situations.

The conventional etiological story about this is quite Freudian sounding, and also intuitively fairly convincing. The idea is that it comes from a failure to internalize objects, specifically the protective and nurturing adults of infancy. Babies eventually get the idea that even though Mommy isn't here right at this moment, she still exists and will come back. We learn to comfort ourselves with the dependable love of people even when they aren't with us. As adults, even the deceased are still a part of us. But if you can't do this, you have a problem.

And indeed, people with the diagnosis have a higher than usual prevalence of lack of nurturing during infancy and childhood, even of abuse. It doesn't have to be there, but it's a pretty good indication if it is.

Now, here's my argument for the essential validity of classifying this as inherently a deficit in a human personality, whether or not you like the term "disease," and why this is not similar to labeling homosexuality as a pathology. It turns out that the only reason homosexuals have historically been unhappy and even suicidal is because they have been despised and persecuted. Take away the stigma, and you take away the problem. We now know, from ample experience, that it is perfectly possible to be happy and functional as a homosexual so long as you are in an environment which is sufficiently accepting and affirming. Take it from me, I live in Jamaica Plain and work in the South End. (I'm not gay, but I'm fabulous anyway.)

But the problem with BPD or whatever you want to call it is not moral stigma. People who behave that way are inherently difficult and burdensome to others. It is very difficult to imagine a human society in which BPD is not dysfunctional and a continual source of grief and pain, for the sufferer and those around her. Human social organization is hugely variable, but it is built out of a finite set of elements that work something like Lego blocks -- they link together in a specific, limited way that gives you the freedom to create great, complex edifices.

There is a natural social grammar, if you will, analogous to the natural syntax on which our vast diversity of languages is built. Children who are not autistic quickly acquire this social grammar as easily as they acquire language. It is intuitive, and it is also universal. Although politeness rituals and taboos vary across cultures, these can be described for us by an etiquette book or a human guide, and armed with this intellectual understanding we can readily associate with people of any culture and form friendships and even intimate attachments. We understand that relationships require reciprocity, recognition of the other's needs, boundaries, how much emotional availability they have for you, and whether or not they feel like spending time with you at this particular moment, among other kinds of limits. We get that demanding too much of other people is counterproductive.

The word normal has 3 meanings. It can mean corresponding to moral norms; it can mean average or typical; and it can mean "as we would desire things to be." Whether a person is average or typical in some way often just doesn't matter, or a person can be deviant in a good way, e.g. abnormally intelligent. Homosexuality is abnormal in the sense of being a minority condition, but whether it is abnormal in either the first or third sense is entirely dependent on circumstances. We can just decide that it's not immoral and that's the end of that, and after that the only reason I can think of offhand that it might conceivably be undesirable is if we are in danger of extinction, which we aren't. But BPD is inherently abnormal in the third sense. It just doesn't work.

Finally, there is a lesson here for all of us. Even if we don't merit the diagnosis, there may be a little bit of the maladaptive behavior in most of us. It's easy to slip into dependency, or demanding more of people than they can comfortably give, not giving enough in return, making a relationship more about ourselves than about each other. It's always good to think about that.