BORDERLINE: Abondement, Projective Identification, and Parental Provocation

“To be authentic we must cultivate the courage to be imperfect and vulnerable.” Dr. Brene Brown

Vulnerability is the royal road to encounter our authenticity. Without vulnerability, there is no core identity from which we can freely share genuine expressions of thoughts, emotions, and behaviors. There are individuals in our midst who are committed to this sacred path of living authentically and have much to teach us, but instead of learning from them, we have often diagnosed them. Paradoxically, these individuals can feel lost and be hiding in identities that are not fully themselves, struggling with self-harming behaviors like addictions and eating disorders. They may pass through inpatient and outpatient mental health services and encounter providers who experience their neediness and manipulation as a victimization mentality rather than the creation of a mental health system that benefits from their patient's illness. This perhaps is the near impossibility of changing the character of these individuals because they can be caught up in the performance of illness even learning the therapeutic language and sustaining diagnostic criteria, such as weight loss or substance relapse to find their way back to their mother, who is the clinic. So maybe our collective imagination needs to change so that the clinician's vulnerability shifts first and then their patient may follow.

ABANDONMENT

Abandonment lies at the core of many individuals with BPD, as they often experience intense fear of being rejected or left alone. This fear stems from early childhood experiences where they may have felt emotionally or physically abandoned by significant others. These individuals may struggle to form stable and secure relationships, constantly seeking reassurance and validation. Unfortunately, the misuse of the BPD diagnosis often leads to further abandonment, as they are labeled as difficult or attention-seeking rather than understood and supported. This perpetuates a cycle of invalidation, reinforcing their fear of abandonment and making it more challenging to develop authentic connections.

PROJECTIVE IDENTIFICATION

The concept of projection is the idea that we project what we don’t like about ourselves onto the vulnerable other who has little power to defend themselves properly. Instead of using defenses like humor, deflection, and disavowal, the person may identify with who they are suggested to be to avoid shame and guilt and their personality transforms into the person they are not authentically. Projective identification is another theme that emerges in the context of BPD diagnosis. As noted, projection is a defense mechanism that involves unconsciously projecting one's undesirable thoughts, feelings, or attributes onto others, often followed by a profound urge to control and manipulate them. While this behavior can be observed in individuals with BPD, it is crucial to recognize that it is a learned behavior. Caregivers, and therapists, can also project onto the patient this idea of borderline and the patient or client identify with this message and begin acting out the behavior in the room with the clinician and thus enacting a vicious cycle of inauthenticity and further abandonment of the patient.

PARENTAL PROJECTIONS/PROVOCATIONS

Abusive provocation by caregivers is a third theme that contributes to the misuse of the BPD diagnosis. The individuals I have worked with who have BPD symptoms have often experienced deep trauma in their life in particular the provocation to perform by caregivers. The intelligent child is often provoked to argue and debate with the parent. The attractive child is often provoked to manage her modesty and remain thin and attractive. The entertaining child is often provoked to regulate and manage the ever-changing moods of their caregivers. This trauma can result in difficulties regulating emotions and interpersonal relationships. However, the misuse of the BPD diagnosis can absolve caregivers of their responsibility, attributing all challenges faced by individuals to their supposed pathology. This perpetuates the cycle of abuse and denies individuals the opportunity to heal and reconnect with their authentic selves. True understanding and intervention should address the root causes of the distress, including the abusive environments in which individuals have grown up. And to be more disturbing, if we analyze their performance through the lens of projective identification, we may learn more about the clinician's unconscious mode of perverse enjoyment. This could mean, the patient has detected, by way of an uncanny ability to sense the desire of the other, and the clinician unconsciously perversely enjoys their illness and finds it entertaining.