On The Borderline: An Exploratory Study on the Narratives of Borderline Personality Disorder and the...

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The University of Chicago !!

On The Borderline: An Exploratory Study on the Narratives of Borderline Personality Disorder and the Contestations of Psychomedical Discourse and

Power !!

By John Li

December 2013

Masters Thesis submitted in partial fulfillment of the requirements for the Master of Arts degree in the Master of Arts Program in the Social Sciences

Faculty Advisor: Professor Morris Fred PhD Preceptor: Muh-Chung Lin

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Abstract

Borderline Personality Disorder is a painful psychological condition that is largely

limited in psychosocial theory. This exploratory paper examines borderline personality

disorder through the theoretical lens of social, anthropological, and critical theory. First I

will discuss the important psychomedical conceptualizations and explanations regarding

Borderline Personality Disorder. Second, these dominant discursive thoughts regarding

Borderline Personality Disorder will be dissected and deconstructed through social,

anthropological, and critical theory. Third I will be using Internet ethnography, narrative

analysis, and discourse analysis to analyze the narratives of individuals with Borderline

Personality Disorder as they engage in Internet communication and in virtual

communities. The goal of this exploratory paper is to critically analyze the construct of

Borderline Personality Disorder and the degree of its validity as a psychological

classification.

!KEYWORDS: Borderline Personality Disorder, Narrative Analysis, Critical Psychology, Subjectivity, Identity Disturbance, Lived Experience, Pain and Suffering, Late-Modernity !!!!!!!!!!!!!!!!!

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TABLE OF CONTENTS !

I. INTRODUCTION…………………………………………………………….4

II. LITERATURE REVIEW……………………………………………………10 Borderline Personality…………………………………………………...10 The Borderline: On the Contestations of Cause and Cure……………… 15

III. METHODS…………………………………………………………………..21

Narrative Analysis……………………………………………………….21 Internet Ethnography…………………………………………………….23 Discourse Analysis……………………………………………….………26 Integrative Multi-methodology………………………………….……….27 Hypothesis and Expected Findings…..…………………………………..28

IV. FINDINGS…………….……………………………………………………..28

Self, Identity, and Subjectivity…………………………………………...29 Pain and Trauma…………………………………………………………37 Embracement, Resistance, and Creativity……………………………….49

V. DISCUSSION AND CONSIDERATIONS FOR FUTURE RESEARCH….55

Meaning Making and the Borderline…………………………………….56 Illness and Subjectivity…………………………………………..56 Identity Disturbance and the Subject…………………………….59 Suffering, Self-Injury, and Meaning……………………………..62 Resistance and (Anti)Synthesis…………………………………………..67 Where there is power, there is resistance………………………...67 Embracement and Discourse Reappropriation…………………...69 Limitations and Future Research………………………………………...71

VI. CONCLUSIONS…………………………………………………………….71

VII. APPENDICES……………………………………………………………….73

Appendix 1: DSM-IV-TR BPD Diagnostic Criteria………….………….73 Appendix 2: DSM 5 BPD Diagnostic Criteria……..…………………….74 Appendix 3: Excerpts of arts from Facebook group ‘Creation on the Borderline’……………………………………………………………….76

VIII. REFERENCES………………………………………………………………77

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“I'm walking down the line That divides me somewhere in my mind

On the borderline of the edge And where I walk alone

Read between the lines

What's fucked up and every thing's all right Check my vital signs to know I'm still alive

And I walk alone…” !

- Billy Joel Armstrong, Boulevard of Broken Dreams

Introduction

Whereas it is true that modern psychiatric sciences have made significant strides

towards understanding the mechanisms of the mind, by and large, much of the human

psyche remains relatively unknown. Borderline personality disorder (BPD) is one

psychological problem that continues to baffle mental illness professionals (Cloud, 2009).

As a form of mental illness, BPD is characterized by extreme mental distress and chronic

persistent psychological pain. Borderline personality disorder (BPD) is a serious mental

illness marked by unstable moods, behavior, and relationships (NIMH, 2013). For those

affected with it, BPD can be greatly debilitating and seriously reduce the quality of life.

In addition to the ‘internal’ psychological effects of BPD, there are also ‘external’ social

effects from the labeling of BPD such as stigma and discrimination. This psychological

condition has been difficult to understand, and even more difficult to provide treatment

for, even though it has been nearly half a century since its official appearance in the

classification system of the DSM1. As a psychiatric classification, BPD is one of many

anomalies and contestations, in theory and in practice.

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!1 DSM stands for Diagnostic Statistic Manual, the “official” manual published by the American Psychiatric Association that lists and explains mental illnesses. This manual is written and primarily used in the United States, but has also been adopted as a standard in many other nations as an official guide to mental

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For many psychiatrists, BPD brings confusion into even veteran practitioners.

(Yalom, 1989; Cloud, 2009; Siever and Koenigsberg, 2000). BPD is the “wild west” of

modern psychology, with its causes and treatments still greatly unknown. It can be a

terrifying condition, both to those affected by it, and those close to affected individuals.

NIMH (2013) explains:

“Because some people with severe BPD have brief psychotic episodes, experts originally thought of this illness as atypical, or borderline, versions of other mental disorders… People with this disorder also have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides.”

!Further complicating the picture, BPD is also commonly mistaken with other

psychiatric conditions such as bipolar disorder (Paris, 2004). While there are many

commonalities and even co-morbidities between the two mental illnesses, BPD is distinct

in that it is far less biologically or neurochemically driven as Bipolar Disorder. Whereas

psychiatric medications can greatly relieve the symptoms of Bipolar Disorder for many of

those affected, medication is seldom useful in treating borderline personality disorder

(Lieb et al, 2010). This observation alone provides strong evidence that BPD is less a

neurochemical imbalance, and that further research into the psychosocial and the

psychocultural dimensions of BPD should be considered. Furthermore, much of the

empirical data that have been gathered on BPD show that BPD is a deeply subjective

experience – one that is distinctively different from that of other psychological disorders

with broad subjective experiences such as bipolar disorder.

Adding more to the confusion, the formal name of the mental condition as

‘borderline personality’ is itself a misnomer, as the contemporary psychiatric

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!illnesses. Its fifth edition was released this year, May of 2013 (DSM-5). This paper thus comes at an important time of criticality.

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understanding of the illness is no longer about an individual’s personality on the

‘borderline’ of psychotic and neurotic personality types, but that it is a dysregulation and

disruption of an individual’s personality on multiple levels and dimensions - biological,

psychological, somatic, and social. Still, the confusing and stigmatizing label of

Borderline Personality Disorder remains in the most recent (May 2013) publication of the

DSM 5, even after many suggestions to reexamine, change, or remove the BPD label

(Pfohl, 1999; Porr, 2001). Because BPD is such a confusing and contested term, many

psychiatrists and mental health professionals have also misused the label as a catchall

term or throwaway disorder to describe patients who are too difficult to deal with (Mason

and Kreger, 2010). With these mislabels, it can be extremely psychologically and socially

detrimental and damaging to the patient looking for help.

Some important questions arise. Why does BPD continue to be used as a

psychiatric label even though it is misleading and even damaging to patients that are

labeled as such? What makes the borderline personality persist as a psychomedical

definition, against the suggestions for more major reevaluation? What underlying social

function(s) does the borderline personality hold? These questions encapsulate what

makes the borderline personality – its prognoses, diagnoses, and syntheses – such a

significant site of critical sociological examination. It is not enough to rest easy on the

definitions and hypotheses provided by the psychomedical field alone. Psychological

phenomenon are interconnected and intersected by the sociological, anthropological, and

philosophical . In particular, the field of psychiatric diagnosis is a fertile one for

sociological critique (Whooley, 2010). Critique is deep and longstanding, challenging the

premise for psychiatric nosology overall and questioning the utility of specific diagnoses

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(Parker et al, 1995). The diagnosis of BPD is among the most vexed (Koehne et al, 2013).

Furthermore, in an era where medical consultations are expected to be frank

communication of diagnoses, psychiatric diagnoses remain stigmatized and

communication is often problematic (Gallagher et al, 2010).

It is undeniable that people experience distress (Martens, 2008). However, how

both the nature of the distress and the experience of it come to be understood is

contingent on multiple factors including sociocultural conditions of the time in which it is

theorized. The discourses, practices, and technologies that support and naturalize

particular meanings of distress shift through time and place acquiring and losing meaning

(Martens, 2008). The genealogy of modern psychology shows that continual fluxes and

shifts in the social discourses and personal narratives of mental illness as it fit different

functions for different social spaces and times. During the 19th century, then again during

the mid and later 20th century, the concept of “true” insanity, understood as mental

“illness”, was conceptualized as biochemical, corporeal, and etiologically explainable

(Horowitz, 2002; Hacking, 1995), while “moral” insanity has, until the late 20th century,

been identified as a moral disorder of behavior reflecting the social maladjustments of the

individual (Busfield, 2002; Micale, 1995). On a sociocultural and sociolinguistic level,

the blurring of boundaries between illness and behavior, between normal and abnormal,

“true” and “moral” gains momentum during this time of significant economic, societal,

and cultural change, and psychiatry itself struggles between a dynamic inclusion of the

“normal” in its gaze, and a diagnostic discipline seeking to reinvest itself with the

legitimized mantel of science (Lunbeck, 1994; Horowitz, 2002). The process of confining

‘normality’ and situating distress with disorder and illness can be seen as a social artifact

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of ‘medicalization’; a process by which nonmedical problems become defined and treated

as medical problems, usually in terms of illness of disorders (Conrad, 1992).

Furthermore, Conrad (1992) writes how the increasing medicalization in late modernity

functions as a form of social control by setting the rules for what is ‘normal’ and what is

‘deviant’, and furthermore rationalizing and enforcing these constructs.

By and large, the predominantly psychomedical perspective is one that largely

ignores the social and the subjective. Furthermore, the psychomedical worldview is

highly hegemonic and sets the precedent of how matters of ‘psychology’ must be

approached. For example, throughout this paper, I will be referring to the DSM as a

frame of reference as it is the dominating definer of mental illnesses. My research itself

faced unprecedented difficulties as it began at the end of the DSM-IV and ended at the

beginning of the DSM 5. As a matter of research standard and legitimacy, much of the

information I had gathered from the DSM-IV-TR had to be thrown out as the DSM 5

rendered them moot and obsolete. Furthermore, the purist psychomedical viewpoints

seem far more predominating and driving of research within the United States than

outside of it. During my literature review, I received far more articles from a critical

psychiatry viewpoint from scholars and institutions outside the United States. This has

far-reaching consequences, from the theoretical to the applied. The predominating

psychomedical worldview is also severely limiting in scope as it limits the legitimacy of

methodology to positivistic quantitative studies of biology and neurology, greatly

ignoring the social etiologies of a disorder. Even the term disorder itself stands as an

artifact of the psychomedical worldview under the social force of medicalization, as

disorder simplistically means a negative unwanted quantitative anomaly that needs to be

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treated. By solely rationalizing and medicalizing psychological phenomenon, the

psychomedical sciences largely fails to capture the enormously complex social

relationships of knowledge production and performance behind the constructing and

labeling of psychological disorder. By examining psychological anomalies from outside

of the psychomedical perspective, we allow ourselves to get a clearer description of what

we are trying to see. From this ‘outsider’ perspective, we are not just aiming for accuracy

and precision, but also validity.

On the practice level, there are also many drawbacks on methodology based on

the orthodox psychomedical perspective. One of which is that the research is greatly

limited to the confines of a laboratory research setting, severely limiting flexibility and

external validity. When it comes to human interaction, psychiatrists examine the subject

at the clinic or within controlled environments, and usually for short periods of time. Far

less considered are the narratives of those that have been labeled with the mental illness.

In this paper, I will explore the formation of borderline narratives in Internet

communities. While Internet communities and research on them is nothing particularly

novel, the integrative approach of using the Internet as a site of narrative analysis

regarding a primarily psychomedical topic is. In this paper, I will show that those with

BPD have narratives that cover a wide spectrum; there are personal stories from those

that have just received the label, those coming to terms with the label, and those

challenging and even embracing the label. From these narratives, we see how ever one-

dimensional it is to view BPD solely as an anomalous disorder to be rid of.

In sum, this exploratory paper has several goals. One major goal is to carefully

explore and deconstruct the theoretical conceptualizations of the borderline personality;

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to adequately capture as much of the object, as well as subject, of borderline personality

as possible, in all its multiplicities and idiosyncrasies through social time and space. The

second goal is to explore borderline personality where the psychomedical sciences have

greatly skimmed over, that is, the narratives of those with borderline personality. I will

utilize narrative and discourse analysis to observe and examine the subjective lived

experiences and stories from those with BPD who utilize Internet mediated

communication and/or take part in internet communities to make meaning about the

mental illness and their relationship to it. The third goal is to see how these empirical

findings relate to the lingering topics of modern social science such as identity and the

subject. These goals listed here serve as a brief and simple map to the rugged terrain of

this paper and its subject. Ultimately, this paper serves as more than just solely exploring

the borderline personality or as an addition to existing bodies of research on the

pathology and treatment. This paper’s focus on the construction of borderline personality

serves a larger motive, that is, to better understand illness, pathology, and suffering in the

context of power, performance, and the production of subjective text and knowledge.

Literature Review

Borderline Personality

Borderline personality disorder (BPD) is a persistent psychological condition

characterized by chronic psychological pain and suffering, continual persistent feelings of

profound ‘emptiness’, as well as pervasive instabilities in mood, relationships, and

identity (Fallon, 2003). To borrow an analogy made by Marsha Linehan, noted researcher

and therapist of borderline personality, “Borderline individuals are the psychological

equivalent of third-degree burn patients. They simply have, so to speak, no emotional

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skin. Even the slightest touch or movement can create immense agony and suffering”

(Linehan 1993). As a major classified group of disorders, personality disorders are

defined by the DSM as enduring and pervasive patters of inner experiences and behavior

that create impairment and distress (DSM-5; APA, 2000; Ogrodniczuk and Kealy, 2010;

Paris, 2005). In the now obsolete DSM-IV-TR, diagnosis of BPD is made when five out

of nine of the diagnostic criteria are present (Appendix 1). In the current DSM-5,

diagnosis of BPD is met when six out of eleven of the diagnostic criteria are present

(Appendix 2). As both DSM’s note, BPD consists of pervasive instability of self-image,

affect, and interpersonal relationships. This may include impulsive and often self-

destructive behavior, unstable and intense relationships, inappropriate and intense anger,

and suicidal or self-mutilating behavior (Ogrodniczuk and Kealy, 2010). Unfortunately,

those with BPD are also highly likely to kill themselves – about 1 in 10 patients

eventually succeeds in committing suicide (Paris, 2005). The conditions of BPD have

been defined as maladaptive personality characteristics beginning early in life that have

consistent and serious effects on functioning (DSM-IV-TR, 2000). BPD is commonly

seen in clinical practice, and the high emotional turmoil and chronic suicidality (suicide

ideation and attempts) make this type of personality disorder as some of the most difficult

and troubling problems in all of psychiatry (Skodol et al., 2002; Paris, 2005).

Quantitatively, BPD has some distinctive qualities as well. The prevalence rate of

BPD in the general population has been estimated to be approximately 1% - 2% (DSM-

IV-TR, 2000; Ogrodniczuk and Kealy, 2010). It is diagnosed three times more frequently

in women than men (Skodol and Bender, 2003; Korzekwa et al., 2008). Furthermore,

those who received therapy are disproportionately women – about 80% of patients

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receiving therapy for BPD are women (Skodol et al., 2002). This gender differential will

become important in our later discussions. BPD affects people in their 20’s more than

any other age group. As a whole, people with BPD are significant users of psychiatric

services; epidemiological studies estimated a range from 11% of outpatients to 19%

inpatients (Fallon, 2003; Linehan et al., 1991) to be BPD. Zanarini et al. (1989) state that

15-40% of inpatients and outpatients and Miller (1989) state that 10-25% of psychiatric

hospital admissions meet the diagnostic criteria for BPD (Fallon, 2003). BPD has a high

lifetime prevalence rate (lifetime prevalence being the proportion of a population that at

some point in their life – up to the time of assessment). The lifetime incidence of BPD is

estimated to be 5.9% of the general population, occurring in 5.6% of men and 6.2% of

women (Grant et al., 2008). These rates are far greater than the lifetime incidence of

schizophrenia (0.3% - 0.7%) and bipolar disorder (2% – 4%) (van Os and Kapur, 2009;

Hirschfelt and Vornik, 2005; Ketter, 2010). Furthermore, in the clinical setting, there is

an association of BPD with chronic suicidality. In a recent study involving patients in an

emergency department who had attempted suicide showed that 41% of those with a

history of multiple suicide attempts met the DSM-IV criteria for BPD (Forman et al.,

2004).Consequently, BPD is multi-dimensional.

While BPD is distinct in its own light, it can be difficult for clinicians to diagnose

because of the wide range of symptoms seen in BPD that are also typical of other

disorders, such as mood and anxiety disorders, substance abuse and eating disorders

(Zanarini et al., 1998). Furthermore, BPD may be comorbid with other mental illnesses,

with one disorder eclipsing the other. Doctors may feel that their patients have one of

these other conditions while the BPD goes undetected. The most common disorder

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associated with BPD is depression, but in BPD, symptoms are usually associated with

mood instability rather than with extended and continuous periods of lower mood seen in

classic mood disorders (Gunderson and Philips, 1991). Also, because of characteristic

mood swings, BPD is often mistaken for bipolar disorder (Paris, 2004). However,

patients with BPD do not show continuously elevated mood but instead exhibit a pattern

of rapid shifts in affect related to environmental events, with “high” periods that last for

hours rather than for days or weeks (Paris, 2004). BPD may be mistaken for

schizophrenia; however, instead of long-term psychotic symptoms, patients with BPD

experience “micropsychotic” phenomena of short duration (lasting hours or at most a few

days), auditory hallucinations without loss of insight (patients with schizophrenia do not

recognize that a hallucination is imaginary, whereas patients with BPD do), paranoid

trends and depersonalization states in which patients experience themselves or their

environment as unreal (Zanarini, 2000). It has been observed that patients with BPD are

at increased risk of substance abuse, which forms part of the clinical picture of

widespread impulsivity (Skodol et al., 2002). In concepts and in symptoms, BPD also

shares many commonalities with Post-Traumatic Stress Disorder (PTSD) (Gunderson and

Sabo, 1993). Trauma is a mainstay in both conditions. In both illnesses, affected

individuals experience profound psychological pain and suffering. Neither illnesses

respond well to psychoactive medications; both are intensely felt by the affected

individuals.

BPD is a deeply subjective experience for those affected and labeled (as is with

many mental illnesses). This quality of BPD makes it difficult for objective

appropriation, yet there have been many attempts and findings. In psychology, affect

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refers to the experience of feeling or emotion. The affective symptoms in BPD involve

rapid mood shifts, in which emotional states tend to last only a few hours (Gunderson and

Phillips, 1991). When affective instability is monitored with standardized instruments,

emotions are found to be intense but reactive to external circumstances, with a strong

tendency towards angry outbursts (Henry et al., 2001). Levels of affective instability are

most predictive of suicide attempts (Yen et al., 2004). Impulsive symptoms include a

wide range of behaviors and are central to diagnosis (Links et al., 1988). The

combination of affective instability with impulsivity in BPD helps account for a clinical

presentation marked by chronic suicidality (suicide ideation and suicide attempts) and by

instability of interpersonal relationships (Siever et al., 2002). Finally, cognitive symptoms

are also frequent. In one case series, about 40% of 50 patients with BPD had quasi-

psychotic thoughts. In another study, 27% of 92 patients experienced psychotic episodes

(Miller et al., 1993). In a third study, psychotic symptoms were found to predict self-

harm in patients with personality disorders (Dowson et al., 2000).

Core to BPD is disturbances with the ‘self’. As Manning (2011) explains, “people

with BPD tend to have trouble seeing a clear picture of their identity. In particular, they

tend to have a hard time knowing what they value and enjoy. They are often unsure about

their long-term goals for relationships and jobs. This difficulty with knowing who they

are and what they value can cause people with BPD to experience feeling "empty" and

"lost."” Furthermore, people have emotional ‘dysregulation’, that is, their emotions are

not processed correctly or not processed at all, resulting in intense emotional reactions or

little emotion where emotional reactions are socially expected. This intense emotional

dysregulation experienced by individuals with BPD can make it difficult for them to

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control the focus of their attention—to concentrate (Manning, 2011). At times of intense

distress felt by those with BPD, individuals may experience ‘dissociation’,

‘depersonalization’, or ‘derealization’. Dissociation is one of the most mesmerizing

symptomatic phenomena of BPD. It is one of the more rare symptoms noted in

psychiatric conditions. Dissociation is a highly subjective experience and can be

described as intense “zoning out”. In psychological terminology, dissociation describes a

wide array of experiences from mild detachment or disconnection from immediate

surroundings to more severe detachment from physical and emotional experience (Dell

and O’Neil, 2009). Those experiencing intense dissociation may feel that the self or the

world is unreal (depersonalization and derealization). During these periods of

dissociation, those affected may have a temporary lapse or loss of memory (amnesia).

Furthermore, individuals experiencing dissociation may forget their identity, have a

severely ‘fragmented’ identity, or even assume a completely different identity. Periods of

dissociation can last a few minutes or hours, or last days. For external observers, signs of

dissociation can be either easily detected or barely noticeable. This break in cognition is

one of the most fascinating and frightening characteristics of BPD. While these findings

are multifacetedly complex and interesting, they tell us little about the etiology, or cause,

of BPD.

The Borderline: On the Contestations of Cause and Cure

What sets BPD apart from other typical psychiatric disorders is that it is largely

unresponsive to psychomedical interventions such as psychoactive medications. The

pharmacological treatment of BPD remains limited in scope. By and large, the result can

be described as a mild degree of symptomatic relief. Although the use of psychoactive

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drugs can be used to provide some help with managing symptoms of BPD or “taking the

edge off” symptoms, they do not produce remission of BPD (Paris, 2005). This makes

BPD a great challenge to provide therapy for. A number of agents including low-dose

atypical neuroleptics, specific serotonin reuptake inhibitors, and mood stabilizers,

somewhat alleviate symptoms of impulsivity (Zanari and Frankenburg, 2001, 2002, 2004;

Bogenschutz and Nurnberg, 2004; Salzman et al., 1995; Coccaro and Kavoussi, 1997;

Rinne et al., 2002; Hollander et al, 2005). Furthermore, antidepressants are much less

effective for mood disorders in BPD patients without a personality disorder (Shea et al.,

1990). Also, while Benzodiazepines can be a helpful sedating drug in treating anxiety,

agitation, insomnia, amongst others, they are not very useful in BPD and carry some

dangers of tolerance, physical dependence, and abuse (Paris, 2005). The failure of

psychoactive drugs to offer much relief or treatment for BPD has led to regiments

involving multiple medications, on the assumption that these drugs are needed to target

all aspects of the disorder. The results are highly ineffective treatment, and could even be

considered rather cruel, as many patients receive four to five agents – with all their

attendant side effects – in the absence of evidence from clinical trials supporting the

efficacy of such combinations (Paris, 2005; Zanarini et al., 2001). All of these findings

consistently show that the biomedical psychoactive treatments for BPD are highly

ineffective, and provide little relief or help for those affected by BPD. Thus far, these

findings suggest that the causes of BPD are less so biological or neurochemical in nature

and more so psychological and social. However it is entirely possible that the biological

and neurochemical causes of BPD are simply not well understood yet.

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What, however, are the biological explanations for BPD and its etiology? It is

believed that the biological factors in personality disorders consist of temperamental

(inborn or heritable) characteristics that emerge in adulthood as stable personality traits:

patterns of thought, affect, and behavior that characterize individual and are stable over

time (Rutter, 1987). Heritable factors are said to account for about half of the variability

in virtually all traits that have been studied. Specifically, both affective instability and

impulsivity have a heritable component of this magnitude, and twins studies have

demonstrated that BPD itself shows a similar genetic influence (Livesley and Jang, 1998;

Hinshaw, 2003; Torgensen et al., 2000). Studies of family history have found that

impulsive disorders such as antisocial personality and substance abuse are particularly

common among first-degree relatives of patients with BPD (White et al., 2003). Note that

these types of studies seldom take into account the social factors, such as race and

socioeconomic status, which can greatly confound the findings of heritability within a

local family unit. Studies regarding human heritability should always be questioned

sociologically. On the neurochemical and molecular biological level, studies of central

neurotransmitter activity have shown that impulsive traits, a major component of BPD,

are associated with deficits in central serotonergic functioning (Paris et al., 2004).

However, the biological correlates of affective instability are unknown, and no markers

specific to the overall disorder have been identified (Gurvits et al., 2000). Furthermore, it

is unknown if impulsivity is solely biological in nature, or brought on by and influenced

by external social interactions and conditions. Impulsivity is a psychological and

biological response much like stress. While we may not know about the social-biological

connections and effects of impulsivity, we do know that stress has highly social

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components and causes, and that persistent socially caused stress can change the

biochemical environment within the body and the brain (Carlson, 2013).

There are many in the psychomedical field who argue that with BPD, it is more

important to focus on the psychological factors rather than the biological. The

psychological factors of BPD can be striking but are not consistent (Paris, 2005). BPD

first presents clinically in adolescents, at a mean age of 18 years (Zanarini et al., 2001).

Although many patients describe adversities such as family dysfunction as well as mood

and impulsive symptoms that can be traced back to childhood, longitudinal data are

needed to determine the precise influence of early risk factors (Paris, 1997). There is a

high frequency of abuse and traumatic events during childhood in the BPD population.

However, those with BPD also show extensive resilience following trauma (Paris, 1997).

Psychosocially, the most careful studies have shown that a quarter of patients with BPD

describe sexual abuse from a caretaker and that about one third of them report severe

forms of abuse (Zanarini, 2000; Paris et al., 1994). Child abuse, while clearly a risk

factor, is not specific to BPD – child abuse, and abuse in general, is a risk factor to many

forms of mental illness. In general, adverse life events are not consistently pathogenic by

themselves but rather, produce sequelae in vulnerable populations (Monroe and Simons,

1991).

The primary treatment method for BPD is through psychotherapy. Paris (2005)

explains that, to diagnose BPD in practice, clinicians must first establish whether a

patient has the overall characteristics of a ‘personality disorder’ described in the DSM;

that is long-term issues that affect mood, cognition, impulse control, and interpersonal

functioning that only begin early in life and are associated with maladaptive personality

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traits, such as neuroticism (being easily prone to anxiety or depression, or both) or

impulsivity (Paris, 2005). The reason that patients are screened for personality disorders

is that personality disorders are considered good markers for the multiplicity and

chronicity of symptoms than can other diagnoses such as mood or anxiety disorders. The

next step is taking a patient’s ‘personality assessment’. This assessment requires a good

history of the patient. Most practitioners are able to obtain the information that they need

from patients during a routine visit. Practitioners may also wish to speak with family

members of friends for more information. With the information gathered, the clinician

then determines whether or not to make the diagnosis of BPD for the patient.

The most popular mode of psychotherapy for BPD is dialectical behavior therapy

(DBT), which derives its therapeutic methodology from cognitive behavioral therapy

(CBT). DBT is a form of CBT that targets affective instability and impulsivity, using

group and individual sessions to teach patients how to regulate their emotions (Paris,

2005). This form of therapy has been shown to reduce suicidality in the short term, but it

is unknown whether this method is effective in the long term. Furthermore, DBT can be

very expensive in terms of resources and extremely time consuming.

While the biological and psychological perspectives are useful in describing some

of the symptoms and effects of BPD, the perspectives greatly lack in explaining the

highly subjective nature of BPD as well as the social factors behind BPD. To date, while

the subjective aspects and social factors of BPD are occasionally mentioned in major

psychomedical discussions about BPD, they are mostly relegated to the footnotes. Within

the psychomedical field, sparse theorization has been made about the subjective and

social factors of BPD. As a whole, the psychomedical field has largely either ignored or

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put off social research into BPD and other mental disorders to the side. Why is this? It

could be said that those within the psychomedical field largely ignore the social factors of

psychological phenomenon because it is not their area of expertise. It could also be said

that psychomedical theorists fail to see the connections between grand macro sociological

theories with the micro manifestations of the individual and the brain. True, but these are

rather simple explanations. There are deeper reasons why the psychomedical field and the

sociological field “just don’t get along”. First, there is the element of differences in

ontologies and epistemologies, which in turn direct differences in approaches towards

theory and methodology. Furthermore, the psychomedical fields place evidence to

explain phenomenon on a ‘hierarchy’ of positivistic objectivity. Thus in the production of

knowledge regarding phenomenon of the body, behavior, and the mind, the

psychomedical field more or less so discards the invaluable theoretical perspectives

sociologists employ such as social constructivism, qualitative inquiry, structural theories,

and critical theory. Second, and perhaps more saliently, the sociological perspective and

imagination is one that continually utilizes critical self-reflexivity to measure and

question the reliability and validity of ‘objective’ claims, classifications, and

categorizations, and also work towards deconstructing background assumptions, norms,

expectations, and so on and so forth. While I am not claiming that such critical self-

reflexivity does not exist within the psychomedical disciplines, for the most part it is far

less utilized as an analytical tool, nor is it as vital an ‘ethic’, as it is in the field of

sociology. Thus, the findings made by sociology regarding psychological phenomenon

may be put off as ontologically inapplicable, inoperably critical, or even too activist for

most researchers in the psychomedical sciences.

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On the same page, the field of sociology is not without faults and flaws. Social

scientists have generally not deeply examined issues such as psychiatric disorders and

pain. Even in an age where post-modern and post-structural thought is prevalent, many

social scientists believe issues such as psychiatric disorders and pain are exclusively

medical issues, thus somehow falling outside the apparatuses of social analysis. For most,

a sociologist studying issues predominantly covered by psychomedicine and the

neurobiological sciences may appear to many natural scientists, as well as some social

scientists, to be paradoxical, contradictory even. On one hand, the mode of quantitative

analysis is supposedly universal and concrete. On the other hand, the mode of qualitative

inquiry, regarding ‘disorders’ and pain (and other traditionally quantitative subjects) as

also social phenomenon, is regarded with suspicion and at times even with opprobrium.

These dual modes of analysis should be neither paradoxical nor contradictory (Lie, 2009).

Only by dialectically transcending the limitations of the two modes of inquiry can we

strive for a more satisfactory understanding of phenomena within the mind and body.

Methods

Narrative Analysis

As I have discussed, while the biological medical model provides a strong useful

framework towards understanding and treating psychological conditions that are highly

neurochemically driven, this dominating paradigmatic framework more or less fails in

elucidating the nature of highly subjective psychological conditions of BPD. With this in

mind, it may be concluded that it may not be so much that the condition remains

impenetrable to our analysis, but that it is our theoretical foundation and experimental

apparatuses that need to be reassessed.

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BPD researchers can greatly benefit from exploring and adapting analytical

approach of other disciplines. Because BPD is a condition highly defined by its

subjective characteristics such as intense durations of mental anguish, pain, and suffering

experienced by those who have it, researchers can greatly benefit from the sociolinguistic

method of ‘narrative analysis’. Narrative analysis is a broad qualitative method used by

many sociologists and anthropologists to inquire about a narrative. What, then, is a

narrative? A narrative can carry multiple meanings. In the simplest form, narratives can

be thought of as the retelling of connected events through time – an account, an

experience, or a story. Whereas the predominant methods of psychological analysis have

been greatly quantitative, narrative analysis is highly qualitative. This method and the

data gathered might be discomforting and taking some getting used to for some

psychology researchers who are more grounded in quantitative research, though it would

be great error to discount this approach just because it does not fully fit the confines of

classical definitions of “objectivity”. How and why, then, is the highly qualitative

narrative analysis important to us when examining BPD? The answer is twofold. Firstly,

narrative analysis provides a powerful methodological and theoretical framework to more

validly understand the subjective experiences that individuals with BPD face. The

second reason is more sub-textual, that is, through the examination of narratives from all

who are somehow affected by BPD (the patients, close family and friends, psychiatrists,

doctors, nurses, and other medical professionals, etc.), we can more resolutely see the

social dynamics and power relations at play. Narrative analysis offers us a way to

examine the subjective social world from the small individual scale to the large societal

scale: from the micro, to the meso, to the macro, and vice-versa.

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Narrative analysis can be a powerful method as it allows us to interpolate a larger

picture from a large amount of data. From the analysis of spoken and written words of

one BPD patient, we are able to shed light on many other real experiences. Narrative

analysis not only reveals the close relationships between the words in a story and between

a story and other stories, narrative analysis brings out the relationships between people –

stories do not just index a relation between words and between stories, but between

stories and social reality (Franzosi, 1998). Ultimately, narrative analysis provides us with

a systematic and rigorous method to examine the important subjective experiences and

stories felt and told by those with BPD. Through this expansive data collection and

methodological examination, we will be able to more validly understand the experiences

of BPD individuals, and more importantly, be able to develop new and more effective

and empathic forms of assistance.

Internet Ethnography

For most of us, the Internet is by now a very familiar place. Yet, the wide expanse

of the Internet still holds a peculiar sociological mystique as to how the self becomes

‘embodied’ and ‘manifested’ onto the ‘virtual world’. Performing research on Internet

has its unique set of qualities. For me, analytically stepping into cyberspace was both a

challenging and enduring research experience. Furthermore, my experience with

performing Internet ethnography and exploring the possibilities of gathering and

analyzing data from virtual sites has made me want to express how crucial and powerful

the Internet can be as a research tool. For me, having been so used to using the Internet as

a personal instrument, a kind of radical reflexivity occurred when being forced to step

back to view the virtual world in a more objective ethnographic lens. This feeling of

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liminality and social strangeness and unease was similar to my initial experience of going

to my field site as a student researcher rather than purely as a participant. Davies (2008)

highlights many excellent points on how and why the Internet ethnographic methods have

the abilities to transcend the limitations of “classical” physical ethnographic sites. In a

symbolic interactionist and social psychological vein, the Internet allows for a space for

anonymity and “back stage” where one can more authentically release their inner

struggles and identities without fear of embarrassment and societal controls. The internet

is a space of not only reality, but hyper-reality. Hypothetically, in this space, the

researcher may have a glimpse of the truest social dialogue and discourse possible, under

a liminal space of anonymity and relative absence of social controls. Through Internet

ethnographic research, I have gained highly expressive narrative data (thoughts, insights,

beliefs, etc.) of the BPD population with the short time limitations of my research

schedule. While I will be using Internet ethnographic methods, the Internet is more

importantly my field site where I will be looking for and analyzing narratives.

My virtual field sites include three popular online communities of social

networking and social media. Perhaps the most popular of my virtual communities is

Facebook. Currently, Facebook is the most popular social networking/media site in the

world, with over one billion users. Facebook has become a household name and the verb

‘facebooking’ is used in common everyday language. In this sense, Facebook is the de

facto standard of social networking/media. Facebook allows users to create groups or

pages of shared interests. Among the countless special interest groups and pages on

Facebook, there are several devoted solely to BPD. Among the most generalized and

popular of these that have the most members are ‘Borderline Personality Disorder’ and

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‘Borderline Personality Disorder Community’. In addition to these general BPD groups,

there are more specialized groups such as ‘Creation on the Borderline’, which is about

creativity and artistic outlets from those with BPD, and ‘Borderline and Beautiful’, which

is a page about embracing and having pride of the label of BPD with similar regards to

LGBT Pride.

The second social network/media online community I examined is Reddit.

Announcing itself as “the front page of the internet”, Reddit is a site that is structured less

so as a social networking site per se and more so as a social media site with a focus on

social news, entertainment, and more specific subjects such as BPD. Similar to Facebook,

Reddit also allows for users to congregate and form virtual groups. From my preliminary

research, I noticed that there was less censorship and control on Reddit than there was on

Facebook. Posts and discussions on Reddit can be more ‘raw’ and expletive, with less

monitoring or interference. I found this virtual site far more interesting than Facebook

groups, which sometimes seemed overly moderated.

The third social network/media internet community I examined is Experience

Project. Experience Project has similarities with both Facebook and Reddit. However, the

Experience Project is distinct as it is a site based on connecting people through shared life

experiences. Experience Project serves for individuals to discover other individuals and

communities that share similar deep personal experiences and/or beliefs. Users can

submit personal stories, confessions, blogs, groups, photographs, artwork, and

videography. Conversations and discussions are situated around life events and

experiences, both positive and negative, and are usually very frank and genuine. Similar

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to Reddit, there is little monitoring and interference. [ML: You did not discuss BPD

patients or families involved in this project.]

While the three social network communities share many similarities as well as

differences, members of all sites are able to either ‘log on’ as themselves or anonymously

under a pseudonym. In addition to examining personal posts and extended communal

discussions on social networking and social media sites, I observed and analyzed posts

made by individuals on their respective personal blogs. Often times, these personal blogs

resembled a diary or journal structure, with posts about individuals’ daily happenings

along with individuals’ experiences, struggles, thoughts, and critiques on BPD. Personal

blogs posts can have a space for reader’s responses. Bloggers as well as users on the

various online communities vary on their individual degrees of anonymity, writing style,

and use of expletives. All the Internet sites I examined for my research are open to the

public and the data is within the public domain.

Discourse Analysis

Discourse analysis is related to narrative analysis and shares many qualities. The

biggest difference is that discourse analysis is broader in scope as well as analyzing

thoughts and use of language on a more macro level. I use discourse analysis as an

addendum to narrative analysis, which is more micro focused. As an analytical device,

discourse analysis traces its roots back to the field of critical linguistics. Critical

linguistics emerged as a movement to include the analysis of ‘hierarchy’, ‘structure’, and

‘power’ (Wodak, 2001). Methods of discourse analysis encompass diverse theoretical

influences and approaches to data (Koehne et al., 2013). The discourse-analysis

methodology I utilize uses the pivotal work of Foucault, through his studies of discourse,

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medicine, and governmentality. Furthermore, I utilize post-structural thought to guide my

discourse analysis. The reason I use post-structuralism as a guidance system is because

post-structuralism enables a critical examination of language, and located power as

constituted through language (Faiclough, 1989; Fox, 1993). Furthermore, the theoretical

stance of post-structuralism draws upon broader existential and postmodern philosophies

that offer theoretical devices that challenge modernist notions of truth, rationality, the

individual and social structure (Fox, 1993). I utilize post-structural, post-modern, and

existential philosophy to challenge the diagnostic construct of BPD as well as to reflect

upon the ‘subject positions’ and ‘object positions’ created by the diagnosis such as the

clinician and the client, the DSM and the clinician, the film and the public that views it,

and so on and so forth.

Integrative Multi-methodology

In sum, I use an integrative method of narrative analysis, internet ethnography, as

well as discourses analysis to examine discussions, personal stories, and art from various

virtual sites on the Internet to better understand the meaning of BPD by those who have it

as well as those who do not, but have friends and loved ones that do. Through examining

these narratives, I examine the lived experiences of people who have BPD and the deep

subjective knowledge embedded within those lived experiences, expressed through open

journals, communiqués, and simple blog posts and online utterances. To discursively

relate the analyses of the micro, subjective, and particular to the macro, I use discourses

analysis as form of theoretical connection making. The methodological processes that I

utilize are ‘integrative’ as I employ multiple qualitative methodologies to examine a

multitude of themes and ideas.

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Hypotheses and Expected Findings

By gathering and analyzing data from Internet ethnography, narrative analysis,

and discourse analysis, I expect to find rich formations of subjectivity regarding BPD, as

well as serendipitous findings on deeply BPD intersected issues such as self injury, pain

and trauma, creativity, as well as other closely related psychological conditions such as

eating disorders and bipolar disorder. In regards to subjectivity, I hypothesize that there

will be an abundant amount of narratives and conversations upon the ideas and themes of

self and collective identity, meaning making, and community. Further upon subjectivity, I

expect to find many posts about the short-term immediate feelings and the long term

lived experiences of psychological pain and suffering. Drawing from previous research of

coping mechanisms to help relieve psychological anguish, I also expect there to be

narratives about personal creative processes for coping.

Findings

The data I collected affirmed some of my expected findings, but also challenged

many of my prior hypotheses. Although the ideas and themes of subjectivity and coping

with psychological anguish did indeed show up in the data, they did not show up in the

arrangements I had hypothesized. Two salient examples of this from the data are

narratives of ‘wanting pain’ and of ‘pride and affirmation of having BPD’. Furthermore,

after reading through and coding the narratives, I found a great deal of overlap and

entanglement of themes within the narratives that made summarizing and analyzing the

data more challenging. On the whole, through the process of coding, three general

categories emerged from the narrative data I gathered. Coalesced, collated, and

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condensed, these three general categories form to be ‘Self, Identity, and Subjectivity’,

‘Pain and Trauma’, and ‘Embracement, Resistance, and Creativity’.

Self, Identity, and Subjectivity

One of BPD’s most defining characteristics is its high degree of subjective

experience in those affected by it (though the diagnosis is also one that is highly

subjectively bounded). One core diagnostic profile of BPD is ‘identity disturbance’, a

label that has to do with subjectivity, while being a highly subjective issue in and of

itself. Subjectivity is a term used to refer to the condition of the subject – the ‘individual

being’ or the consciousness of the self, the individual. Subjectivity, and the notion of the

self, is one of many ideas. The subjective experience of a self influences and informs an

individual’s ‘look’ and ‘feeling’ of ‘reality’ and ‘truth’. Subjectivity and selfhood can be

seen as the internal collection of perceptions, experiences, feelings, expectations,

understandings of the self and others, of cultures, and beliefs central to an individual.

Subjectivity can be contrasted with ‘objectivity’ that is a view of reality external of the

any one individual. The understandings of subjectivity and objectivity are deeply

discursive and contested and we will examine them further in the discussion section of

this paper. The notion of ‘identity’ is a central one connected and entangled with the

ideas of subjectivity and the ‘self’. Furthermore, identity can be seen as a reified

manifested form of the notions of subjectivity and the self. Even though identity cannot

be measured in the way one can measure the mass of a rock, one’s self identity is none

the less one of the most vital artifacts in our struggle to clarify the perplexing ideas of the

subject and subjectivity. I examine what identity means to those with BPD. What does

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‘identity disturbance’ mean, what is it like for those that have experienced it, and what

does it have to say about subjectivity and the notion of the self?

The question of what is ‘identity disturbance’ is asked by anonymous Reddit user

‘einssein’ in the BPD Reddit group:

I'm struggling to understand this concept clinically as well as in others. I'm not sure what I feel is what is typically meant by "identity disturbance". I feel very fake. That's the best word I can think of. When I'm around others, when I'm speaking to others, I just feel incredibly fake in how I act and in the things I say. I find myself thinking, "This isn't you. Why are you saying things like that?" I use words/slang that I think others would use, and pick up hobbies and tastes based on what I assume others would like. I get confused about who I really am. I only feel myself when I'm alone. Is this "identity disturbance"? Any help with this would be appreciated. For einssein, ‘identity disturbance’ is unsureness with one’s own ‘authenticity’ or

one’s ‘realness’. For einssein, who was is struggling to understand what ‘identity

disturbance’ is, ‘identity disturbance’ is akin to the loss or break in selfhood, in that when

einssein experiences a disturbance with his/her identity, einssein does not feel being

him/herself. In response to einssein’s question of what is ‘identity disturbance’, an

unnamed anonymous user asks:

Are you diagnosed formally?...Identity disturbance deals with patients experiencing changes or conflict in preferences, lack of insight when making decisions or disability to make those decisions in an informed manner and later having conflict with the poor, uninformed choice. So, yes, there is the element of "why am I doing this?," detachment from your own actions. With the emotional dysregulation of BPD, you get the sense that a patient disagrees with their own choices or does not recognize or respect the fact that the decisions were their own…I am not an expert, but I am a student with some pretty accurate sources to draw from. I also have my own neuroses and through them I can sort of generalize to what others are experiencing. That being said, this is why I asked if you are diagnosed because a) if you are, given the nature of BPD, even if what you are experiencing is EXACTLY what I have described, you may feel that YOU do not identify with it/it is impersonal and unreal or b) if you aren't, you may be searching for some label to apply to your feelings in which case I would not recommend that but instead to seek some guidance before subconsciously attaching to a supposed symptom you believe you are experiencing…Oh, and to

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add a bit of insight, you said you only feel yourself when you're alone; typically in BPD alone time is marked by lack of identity, boredom, impulsivity. Typically a BPD patient needs someone else to help them regulate and keep occupied (this is why sometimes those with BPD are seen as parasites or vampires of emotion, they really need the energy of others to direct them).

!For this responder, ‘identity disturbances’ are the result of ‘detachment from

one’s actions’ that results in feelings of ‘unrealness’. Furthermore the anonymous

responder has an opposite perspective of ‘alone time’ when compared to eissein. In

response to the unnamed anonymous responder’s comment, eissein adds:

I guess you can say I was. I saw a therapist last year for exactly one appointment. I told her all of my issues, she ran me through some tests, and told me that it sounds like I have BPD. She said she couldn't help me, gave me a list of DBT specialists in the area, and sent me on my way. I was unable to follow up with any of the other therapists though, so I've never had someone tell me specifically, "Yes, you have BPD, no doubt about it."…I don't think I'm subconsciously attaching symptoms to myself. I've been experiencing this for years, but never knew it might actually be something, whether it's a symptom of BPD or something else. Based on what I've read about the disorder and based on what that therapist said, I'm trying to learn as much as I can, so that I can help myself.

!Here in eissein’s response, we see the subjective nature of BPD when eissein

comments that his/her therapist could not help him/her. Eissein is referred by his/her

therapist to Dialectical Behavioral Therapy (DBT) specialists. DBT is a long and

expensive psychotherapy program that has evidence of benefits, but which processes are

still largely unknown. Furthermore, eissein proclaims his/her uncertainty of even having

BPD or not. We come across an interesting thought experiment here, that is, how would

have eissein internalized ‘identity disturbance’ any differently if he/she had never learned

about BPD. In other words, what are the possible effects of diagnosis and labeling?

Further down the post thread, Reddit user ‘oapatu’ also contemplatively responds

to the post of “what is identity disturbance?” eissein started:

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i've been diagnosed with bpd for only a year, so granted a lot of other people may have much more helpful advice. but my therapist has explored my identity disturbance a lot and mine is a little different than what you're describing. granted, bpd is extremely hard to diagnose because people do express these things differently. but if its helpful i'll describe my identity disturbance a bit. i find myself "morphing" to the people that i'm around. i always feel that i'm being myself and have never thought of myself as "fake", but i have had friends tell me how i'm a completely different person depending on which group of friends i'm with. and this is not necessarily a bad thing. its just with some groups i'm extremely outgoing and demanding of attention, others im the outside loner who listens in. other's i'm all about sports, and other's i'm all about the arts. not sure if this is making sense but i never feel like i'm pretending and not being ME, its just that i feel like i have so many different sides to myself that they're hard to keep track of. which is why when people ask me to describe myself i usually draw a blank because my therapist has told me it seems like i dont' have a definite ME. just a me with friends, a me with family, a me with my boyfriend. and all of these sides of me react in completely different ways. sometimes it has gone so far as to if i watch a tv show for too long i start mimicking a certain character's behavior. my sister has actually been the one to notice this the most. i'll start picking up on the character's way of saying things and general speech patterns. again, i don't know if this is common for anyone else with bpd, but along with my therapist we've been looking into the identity disturbance a lot. it's extremely tangled up with abandonment issues. hope that helped a bit?

!Oapatu states his/her length of being diagnosed and labeled BPD, which is only around

one year. While we can not tell directly whether or not and how this length of time being

labeled as BPD might have influenced how oapatu feels about ‘identity disturbance’, we

can tell from his/her narrative that ‘identity disturbance’ for oapatu is comparatively

different from how ‘identity disturbance’ was felt for both eissein and the unnamed

anonymous commenter, opposite even. For oapatu, ‘identity disturbance’ is markedly

different from the feeling of profound ‘inauthenticity’ or feeling a ‘fake’ sense of self, as

was eissein’s personal narrative of ‘identity disturbance’. Further still is the feeling of

being separated from one’s actions as was described by the unnamed anonymous

responder. For oapatu, ‘identity disturbance’ meant the taking on of different or ulterior

identities. However, this ‘morphing’ of identity, and further personality, is not completely

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made aware to the subject him/herself (internal subject) but is seen more ‘completely’ by

his friends [external subject(s)]. Most remarkably, in oapatu’s narrative, oapatu reflects

that he/she is always feeling him/herself, even when external subjects describe that

oapatu is behaving differently, or like another person. This part of oapatu’s narrative

stands in great contrast to the feeling of ‘not being oneself’ as was described by eissein

and the unnamed anonymous responder. Another key part of oapatu’s narrative to note is

that these different identities and personalities that external subjects describe oapatu

exhibiting is referential and relative to different social situations and milieus. The internal

subject, or oapatu him/herself, does not immediately attribute negative sentiment to this.

Furthermore, oapatu emphasizes that he/she never feels ‘inauthentic’ or ‘fake’, but does

find it difficult to ‘describe’ him/herself when asked by external subjects, in other words,

other people. Oapatu attributes this difficulty in describing him/herself with his/her

therapist who has told oapatu that he/she does not have a ‘definite self’ – a ‘disturbed

identity’. Oapatu describes that sometimes his/her internal reactions to situations can

even occur when he/she is watching a television show and he/she will start to mimic

characters’ behaviors from the television shows. Once again, however, oapatu points out

that it is not him/herself that necessarily notices a change is his/her own behavior, but that

is it his/her sister that notices this. Oapatu explains that his/her therapist has been

focusing a prodigious amount on oapatu’s ‘identity disturbance’ and the therapist

hypothesizes that oapatu’s identity disturbance has to do with abandonment issues.

! The shortest entry on the ‘identity disturbance’ post started by eissein was written

by Reddit user ‘evover’:

There is no me. Even when I’m alone, I am still a product of what I think I should be

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Evover’s short comment is profoundly deep, poetic, and perplexing. Evover’s entry is a

riddle that challenges the Western psychological notion of a singular stable identity. We

feel confused and unsettled by Evover’s entry because it questions the dominant silent

and automatic presupposition of a stable identity in and of itself for every individual. In

evover’s entry, evover first negates the concept of the self. After this, evover describes

that, under the conditions of when he/she is alone and without others around, evover still

finds his/her identity ‘unstill’ and in a state of flux. From evover’s short narrative, we can

assume that evover expects that when he/she is alone, his/her identity should not be in a

state of flux, or in a ‘disturbed’ state, but in a ‘stable’ and ‘singular’ state. Evover views

his/her identity as being in a state of disturbance because it is always influenced and

always in motion, an ever-reforming ‘product’ with no stillness but filled with change

and anxiety, even when evover is not under the influence of external subjects, but alone

with only his/her internal subject. Thus, for evover, there is no singular self, but plural

selves. From all these narratives, we see mostly many differences, juxtaposed by some

similarities, on ‘identity’ and the disturbance of it.

In close relation to the ‘identity disturbance’ is the phenomenon of ‘dissociation’.

When individuals dissociate, they become momentarily ‘detached’ from their identity and

selfhood. Furthermore, during a period of dissociation, which may last from seconds

onward to days, an individual may be described as ‘out of touch with reality’. Though not

explicitly stated, the experiences of temporarily ‘losing oneself’ in the above narratives

could be understood through dissociation. Dissociation is mostly a deeply subjective and

abstract experience, and the clinical literature has scant objective definition or empirical

measurement regarding the phenomenon. For those who experience dissociation, the

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experience may be totally confusing, frightening, and unsettling. ‘Arpil’, a Reddit user

speaks to this on the BPD Reddit group in his/her narrative titled “How often do you

dissociate? How do you handle it? (me and my pocket mirror)” (verbatim, narrative

concatenated):

Sometimes people accuse me of being vain because I'm always looking at myself in the small mirror that I keep in my jacket pocket. I tell them, "no, I'm just checking if I'm still there". They think I'm joking and chuckle some, when I don't chuckle back I guess they just think I'm super deadpan. Once in a blue moon, someone is smart or experienced enough to realize that I'm telling the truth… Anyhow, for me, the dissociation spells have been happening since I was 13. They have always fascinated and terrified me. I used to try to append meaning to them, or find commonalities in the circumstances in which they occurred, but came up dry most of the time. I remember once in my early 20s reading about Buddha's first "enlightenment" under a tree and thinking it was the same thing as dissociation, maybe it was. It wasn't until that week that my shrink decided to condescend to tell me that the phenomenon was actually known and it had a name. I think he just liked to let me try to figure it out for myself; in hindsight, he was right…The Dissociations used to happen pretty infrequently. I'm writing this now because in the past few weeks they have begun to happen fast and loose, all of the time! Why? WHY. I'm actually doing well for the first time in my life, happiest I've ever been, starting a new life in a new city where the other artists are actually good, and I'm in good company more than I ever ever thought I'd be. Can I really just not believe it? I keep my pocket mirror close at hand…Edit: I was just talking to myself and I informed myself that I can remember dissociating from when I was much younger than 13, maybe when I was about 5, in an elevator in a science museum.

For Arpil, dissociation is a multifaceted experience. First, Arpil explains that he/she had

developed a routine to reassure him/herself that his/her material body is still in existence

with the help of a pocket mirror. At present, Arpil still carries a pocket mirror with

him/her. Second, Arpil explains that he/she is no stranger to dissociation, experiencing

them since his/her teens, and even possibly much earlier in his/her life than that.

Furthermore, dissociation is something that Arpil both fears as well as reveres. Arpil’s

self describes his/her dissociative occurrences as mystical experiences that instilled both

terror and transcendence. Arpil tried to find patterns and make meanings from the

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episodes of dissociation and likened his/her dissociative experiences to that of the fabled

story of Buddha finding enlightenment. In response to Arpil’s narrative, Reddit user

‘Picklebush’ tell his/her own account with dissociation:

I find your pocket mirror idea interesting. When I get dissociative I find mirrors very strange, because it's not 'me' looking back.

Picklebush’s narrative also brings up the topic of mirrors, though in a different light.

When Picklebush experiences dissociation, he/she finds mirrors peculiar, as he/she

cannot recognize the figure in the mirror that is his/her own reflection. In other words,

during dissociation, Picklebush is ‘seperated’ with his/her identity.

‘Runawayrandi’s’ response to Arpil’s post echoes greatly Arpil’s questioning of

one’s very own existence or being:

I'm not sure if I'm dissociating, depersonalizing, or what? Lately I have been feeling like I don't exist, like I'm in a dream almost. Memories, feelings, things I have learned or read aren't as accessible to me. I don't feel as bright, which causes anxiety because I can't articulate myself or gather thoughts as well. I don't know how I am feeling, what I am thinking, if I have told someone something yet, or what I like or don't like. I go through my daily activities as though it's a memorized script and nothing more, I will check my locks five times because I can't remember if I locked them a second before. My mind just goes blank, like I am not paying attention to anything I am doing. I also sit in front of a mirror to just see myself and feel real. I keep people close so I am not alone, but I feel so detached from them. It scares me because I feel like I am losing myself in such a fog. When I look back at my life - a month, year, decade ago, it doesn't seem real. It is as though I am talking about someone else. I've also been sleeping a lot lately too, which probably doesn't help, but this is leaving me quite exhausted.

In Runawayrandi’s narrative, it is possible that he/she is experiencing ‘hypo-

dissociation’, or a lighter more transient form of dissociation. There is the feeling of ‘not

existing’ and an air of the surreal and absurd. The hypo-dissociation that Runawayrandi

experiences seems to have also a negative effect on his/her cognition as he/she reports not

being able to process information or remember thoughts during the dissociation. The

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dissociation also affects Runawayrandi somatically as he/she reports not being able to

recall or describe how he/she is feeling physically and mentally. When Runawayrandi

encounters dissociation, he/she feels as though reality is a fabrication and phony.

Furthermore, he/she sees his/her selfhood and identity as forged. Runawayrandi explains

how he/she feels distant from other people but nonetheless tries to keep other people

close to him/her as a way to affirm existence. Furthermore, for Runawayrandi, the mirror

is used as a physical device to assess his/her material continuation in the real world.

Runawayrandi closes his/her narrative that when he/she looks through his/her interludes

of dissociation, and reflects upon his/her life, he/she is aghast and abashed from how

unreal and phantasmagoric his/her life has been. Furthermore, Runawayrandi tells us that

the entire experience of long bouts dissociation is physically tasking and exhausting.

While the high degree of subconscious action and auto pilot behaviors associated with

dissociation may be highly distressing for those experiencing it upon awareness of the

dissociation, it is highly possible that dissociation has a vital function in the

unconscious’s handling of severe stress such as pain and trauma.

Pain and Trauma

One of BPD’s symptoms that has very physical manifestations is from pain and

trauma. For some people with BPD, intense self-harm and parasuicidal acts can result in a

suicide. It is not uncommon for those with BPD to have serious bouts of suicidal

thoughts. While pain and suffering can take on a very physical presence in the body, pain

and suffering also has a subjective property, existing in individuals as deeply subjective

experiences embedded in meaning, memory, and lived experience. By examining the

subjective lived experience of ‘psychological pain’, we come closer to understanding one

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of the most perplexing issues about BPD: Why are those with BPD more likely to harm

themselves to such serious degrees that sometimes extensive tissue reconstructive

surgeries are required? How are those with BPD who seriously self harm able to phase

out the feeling of physical pain that occurs during serious self-harm? From the narratives

I examine, clues emerge to these baffling questions – it seems that those with BPD will

often harm themselves to feel physical pain as a way to mitigate or control psychological

pain and anguish – often stemming from persistent trauma and abuse, either from the

past, recent in life, or both. ‘Driftinghope’, a British female Experience Project user in

her mid teens spoke to this. In her post (“I’m 16 And I Have Emerging Borderline

Personality Disorder, And This Is My Story”) in the Experience Project page ‘I Have

Borderline Personality Disorder’, she vividly narrates the long chain of painful pieces

from her life history2. At the end of her narrative, she shows how she has thus far

attempted suicide 14 times. In between the attempts of suicide, driftinghope engaged in

long episodes of self-injury, as a method of handling past and present psychological

trauma. Driftinghope details her earliest memories of traumatic change when her family

relocated around one hundred miles north to a new city – here are excerpts of her

extensive post near verbatim:

…I started life in November 1996 in Warwick hospital. I don’t really remember any of my early life. When I was 6 I moved from Warwickshire to Lincolnshire, and that’s where I really remember problems starting. After I had moved I remember starting to get very anxious all of the time, I became very shy. I remember getting increasingly paranoid and started hallucinating. I used to see a girl, she used to follow me, she didn't speak to me back then, I named her 'Abby'.

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!2 Here ‘driftinghope’ refers to the term ‘Emergent Borderline Personality Disorder’ because she is under 18 years of age. Presently, BPD is a diagnosis that can only be assigned to patients 18 and over. However, those with symptoms that fit the DSM diagnostic criteria for BPD are assigned the unofficial label of ‘emergent BPD’. The American Psychiatric Association discourages clinicians from diagnosing anyone younger than18 with BPD, due to the normal ups and downs of adolescence and a still-developing personality.

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I was convinced I was constantly on camera and thought I was stalked by birds and I just thought everyone was looking and laughing at me. I had sleep problems then as well, I didn't sleep a lot and I had a lot of nightmares. I was bullied while I lived there, a girl, my 'best friend' used to say horrible things and bend my fingers back really far and she nearly broke them a few times… Relocating can be a traumatic experience for many adults, and can be even more

so for younger children. For driftinghope, the trauma and the effects from relocating were

rather severe as she started to have symptoms of intense paranoia, hallucinations, and

psychosis. However, at this point in her life, it is still too early to make judgments and

assignments of psychopathology. Feelings of illogical and indescribable fear, such as

‘monsters under the bed’, and having imaginary friends are common for children growing

up. For all accounts, driftinghope could have just had a very vivid and creative

imagination. Aside from the trauma of relocation, she also mentioned that she was

severely bullied at the new location, with many incidents of another girl masquerading as

a close confidante sadistically abusing her. Just four year later driftinghope’s family

relocated again, this time two hundred miles southwest, to a city close to London. After

her second relocation, life became even more troublesome for driftinghope:

…I left there when i was 10. I moved to Wiltshire, where I still live today. Wiltshire is where my life basically fell apart and everything got a lot lot worse. the problems first started a year after I moved there, my dad left. i later found out he'd been having an affair for 6/7 months. a month later, on my 11th birthday, my parents had a giant drunken argument, I didn't see my dad for 4 months afterwards, not Christmas, not new year. when I saw him again I met his girlfriend, the women he had an affair with, Leanne, and her daughter, Ffion. I immediately hated them for ruining my life…

!After her second relocation, her family situation became unstable. As if the trauma of

another relocation was not enough, the strain within the family placed even more stress

on to the young girl. Driftinghope’s father’s unsteady presence and extramarital

relationships with another woman would add to the fears of driftinghope as she was

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growing up. We could hypothesize that the prolonged unstable relationship driftinghope

had with her parents – her primary caregivers – would intensify feelings of insecurity

amongst others. Long and harrowing loneliness is another feeling that driftinghope tells

us through her narration:

…I then didn't get into my secondary school so I went somewhere I had no friends, which was really hard for me, I then moved to where all my friends were, but they had all made new friends and didn't want to know me anymore, I was left friendless…

!From driftinghope’s narrative, we see that relocation is not a simple rational objective

individual economic action, but that relocation has deep and lasting consequences on

people’s psychological and social stability.

Driftinghope’s family environment became increasingly unstable as both her

parents started pursuing relationships with other partners. Furthermore, driftinghope’s

father became increasingly emotionally and vocally abusive towards her mother.

Driftinghope’s parents’ delicate dance of insanity would end in divorce. However, the

volatile relationship between driftinghope’s mother and father seemed to recreate itself

between driftinghope and her boyfriend:

…I was in an on/off abusive relationship, it started as physically and emotionally abusive, and progressed to sexually abusive. The memories of this time still haunt me. Eventually, my parents split for the last time. I stopped eating, because I wanted to be perfect, I thought if I was skinny and pretty, he might treat me better, he might love me, and my parents might love me. I got increasingly depressed and lonely, a few months later, in December, I started cutting. I then lost all my friends and the boy who abused me and his new girlfriend and friends, my old friends, started to bully me. They followed me, barking at me, sent me nasty messages, left dog food outside my house, they broke into my house, shouted horrible things at me, and it went on really bad for months, eventually it slowed down and now they do it indirectly, except for the boys who still shouts thing…

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Severe bullying from classmates only worsened the period of persisting and increasing

physical, mental, and sexual abuse from her boyfriend. During this period, driftinghope

would begin to injure herself as a way to cope. An eating disorder started to emerge as

well. After this period of painful abuse and bullying, driftinghope explains how the

circumstances of her life began to look better. However, this brief spark of light would be

quickly put out by heavy darkness:

…Eventually i made some new friends. However, my depression quickly spiraled out of control as did my anxiety. My hallucinations and paranoia got so much worse. My self harm got worse. I barely stopped crying and was just so low. I started to scratch when I was anxious, which at this point was most of the time. And school found out, and a month later they found out about my cutting, my mum got told, 4 days before my 15th birthday. She took my to my GP, who then referred my to CAMHS. CAMHS didn't want too see me at first, but as my assessment progressed, the decided it was essential I see CAMHS…I first tried to kill myself a few weeks later, in mid December, I tried to hang myself,my girlfriend at the time, saved my life. For about 6 months before and after this I was smoking and drinking a fair bit, attempting to destroy myself. My eating and self harm got worse again, my arms were destroyed and I refused to eat more than 300 calories and exercised for 3+ hours a day and purged most things I ate. I went to an ed clinic and was told I was in the early stages of anorexia. I saw them for a little while and my eating improved with the help of my mum and my lovely therapist…

!Just when things seemed to get better for driftinghope, things grew even more dismal.

Around her fifteenth birthday, every symptom driftinghope told us about from earlier in

her narrative became the worst they had ever been. Her GP (general practitioner) referred

her to CAMHS (Child and Adolescent Mental Health Services – the British name for

‘child and adolescent psychiatry’). Professional mental health services seemed to benefit

driftinghope very little, as her self-injuring and eating disorder only worsened. By the end

of the year, driftinghope would attempt her first suicide. Her first suicide attempt was

only known be herself. Driftinghope’s second suicide attempt would occur only a few

months later:

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…I then tried to kill myself again, it was mid February. This time I overdosed. I was very sick, but I didn't go to the hospital until two days after. By the time i went, CAMHS and the hospital didn't really care, they thought this was the first time. I continued cutting a lot but didn't really smoke anymore as i had lost the friends who provided me with it…

!Because the hospital had thought that this was driftinghope’s first suicide attempt (she

did not tell about her first attempt), the hospital did not place her in intensive care, for

better or for worse. Driftinghope continued to self harm, and would attempt another

suicide only a couple months later:

…I tried to kill myself the third time in April. I overdosed again and this time had a night in hospital and CAMHS were very concerned. I was almost sectioned, I agreed to go into a psychiatric ward at the last minute, and on the 1st may I was admitted for a month. During my stay there I made friends, managed to catch up with all the school work I had missed, after having missed 1 month of school before I was admitted. I also attempted to kill myself twice, both times, I ran away from the unit by jumping over the fence and trying to throw my self in front of a car but they caught me. i was discharged early June. After my admission they diagnosed me with depression, panic disorder and generalized anxiety disorder, after many months of confusion about my diagnosis. After my discharge I continued cutting worse and worse, but after about a month I found a form of happiness I think, and for 10 weeks, i was clean, and in, 'recovery'…

!On her third suicide attempt, CAMHS recommended driftinghope to stay at a psychiatric

hospital facility. Driftinghope agreed. It was bittersweet. She was able to catch up with

her schoolwork as well as make some friends. However, at the facility, she attempted to

kill herself two more times. For better or for worse, it was also at the facility when mental

health professionals formally diagnosed driftinghope. Learning of her diagnosis and

label, and being confined to a psychiatric facility may have been simultaneously relieving

and bewildering. Many people are both calmed and confused at the same time when they

learn of what they have been diagnosed. It certainly seems to be the case with

driftinghope that the time immediately following her diagnosis was one of bewilderment

as her self-harm increased with more magnitude as well as frequency. At the same time,

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driftinghope reports finding a form of contentment in her life. This proves to be an eye of

a storm, as conditions worsen once again:

…I then started to cut again, deeper this time, to the point that, I've needed stitches, but never got them. I tried to commit suicide, for the sixth time while drunk, i tried to throw myself out of a window and my brother, who was twelve at the time, had to hold me down, and calm me down…I tried to kill myself, for the seventh time in December 2012, whilst at school. I overdosed on paracetamol. I was admitted to hospital and on a drip for 36 hours. I lied to CAMHS and told them I felt much better, so nothing was done…i continued on a downwards spiral, attempting suicide for the eight time, at school, i tried to hang myself with a tie. i was seen by CAMHS immediately, but they again, didn't do very much at all…I went to my dads days after my suicide attempt, where I proceeded to drink a bottle of red wine and three quarters of a bottle of Dissaronno. I went out while drunk, and next thing i knew i was in a&e, covered in sick, I attempted suicide, that day, by drinking and once I was drunk I tried to throw myself in a river but was stopped by a member of the public who called an ambulance, apparently. This was my ninth suicide attempt…

The peace that driftinghope found after her first hospitalization was indeed a temporary

peace. Driftinghope would attempt suicide six more times before her second

hospitalization. She would attempt suicide three while in the hospital:

…Shortly after i was referred back to the psychiatric ward. I went through a long process, a planned admission to the ward. A few weeks before my admission i was diagnosed with Emerging Borderline Personality Disorder, the diagnosis for people who fit present as Borderline but are under the age of 18…I attempted suicide, for the tenth time, in February. I tried to hang myself, but my parents and CAMHS didn't know…Days before my admission to the ward, I attempted to hang myself again…I was then admitted to the ward, for the second time. I was there for 3 months this time. There was many ups and downs. I made some of the best friends I have ever had. I had my bad days, I self harmed. Attempted suicide, 3 more times, However I was caught every time by a member of the nursing staff. I had attempted to kill myself 14 times.

Before her second hospitalization, driftinghope would learn of her diagnosis and label of

Borderline Personality Disorder (emergent). Driftinghopes’s second hospitalization was a

deeply ambivalent experience. Long struggling with loneliness, driftinghope was able to

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find some true friendship at a strange place. Driftinghope closes her narrative with a

heavy air of uncertainty, but also a glimmer of hope and camaraderie:

…I am now pretty much going through the struggle that comes with every day life... I have been dissociating a lot more, struggling with the anxiety and self harm…Oh, and I'm on Citalopram now, after being on Fluxotine, Risperdone, Sertaline, Abilify and Melatonin…I guess this details most of my lows, obviously there were highs, I guess I can only remember the lows…I'd just like to add, I'm here for anyone suffering with any form of mental illness or just struggling…

!It seems that in addition to engaging in parasuicidal behavior to ‘consciously’ cope with

her psychological torment, driftinghope is also dissociating, and driftinghope reports that

she has been having more dissociative episodes. To a degree, it could be said that

driftinghope’s unconscious is engaging in automatic processes to help driftinghope cope

with her psychological pain. Throughout driftinghope’s narrative, we find paradoxes and

contradictions in how she felt, perceived, and acted in circumstances of pain and trauma.

In many instances, we see that driftinghope is at once both in a state of pure misery, but

also unexpected harmony. However, by and large, driftinghope’s experience with

psychological trauma has been a deeply tormenting one. Through driftinghope’s

insightful and informative narrative, we realize the importance of narrative analysis for

psychological research as narratives help contextualize and realize patterns in social life.

If we were not aware of driftinghope’s narrative, driftinghope’s acts of self-injury and

suicidality would have no context and would have falsely appeared as random acts of

self-harm and suicidal behavior. Furthermore, driftinghope’s self-injuring and suicide

attempts are ‘texts’ where driftinghope is trying to tell us a message, through using her

body as a medium. We still speak to this point in more depth in the discussions section.

The pain and suffering that is core to BPD is spoken in another way in the

narrative of Experience Project user ‘JustLazyLittleMe’. JustLazyLittleMe is a woman in

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her late teens. In an Experience Project post, she poetically questions and wonders

(original prose formatting kept):

Does It Only Get Harder? Is this the end? I don't know. When did the pins become razors, when did the food become alcohol? When did the room become my sanctuary and my prison? I don't get it, I don't want to die, but I don't want to live either. I want to wake up, and have this pain be gone. Nothing Has Changed (It Infuriates me) Everything Has Changed (It brings me down) I don't think I belong here.

We find in JustLazyLittleMe’s short narrative the repetition of paradoxical feelings

similar to those of driftinghope. At the same time, we sense the feelings of despair and

hope. JustLazyLittleMe feels psychological pain to such a degree that she questions the

meaning of her existence and longs for the pain to diminish. When we compare the

characteristics of driftinghope and JustLazyLittleMe, we see many similarities in

narratives as well as physical identities. Both are adolescent women in the teens. Both

seem to experience pain with paradoxical moods and opinions. Is it possible that both

women’s experiences of mental anguish are really just effects of a rougher adolescence

and not from psychopathology? Does the intense psychological pain of BPD continue as

a person grow older and for how long? Or does the psychological pain that comes with

BPD diminish with age?

‘Perplexe’ is an American woman in her mid fifties. Her narrative shows that

while she is an older person with BPD, the psychological anguish she experiences is still

very extreme. In her post, titled in the form of a question (“Is there anything more deeper

that the pain or anguish of having Borderline Personality Disorder?”), perplexe narrates

her intimate struggle with BPD:

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My mind screams, my heart aches. My only temporary comfort and relief I achieve from the pain... is to inflict pain on my body and watch the blood flow freely from my arms and/or legs...then break down and weap uncontrollably to my soul in my solitary isolation.

!In her short narrative, perplexe does not mince words to explain how she harms herself

and desires the physical pain as a means to pacify her intense inner turmoil. She also

explains about her experience with loneliness. More importantly, perplexe is an older

person that seems to suffer as greatly as driftinghope and JustLazyLittleMe. This may

suggest that the psychological pain of BPD does not diminish with age.

In a similar vein, Christine posts a concise narrative about her self-harm

experience on the Facebook group ‘Borderline Personality Disorder”. Christine

Wiatrowski is an American woman in her early forties. Christine is university educated

and works as a pharmacy technician. Though Christine has a university degree and holds

a relatively stable vocation, life is still very rough for Christine as she struggles with the

tasks of daily life whilst having a mental illness. To complicate the picture, Christine

struggles through relationship abuse with her partner that she is also financially and

emotionally dependent upon. Christine narrates her feelings with self-harm:

…I just cut myself. It calms me when the blood drips. I must be crazy.

Several members of the Facebook group replied to Christine’s post in solidarity and

support:

Stella Sue (female, estimated age - early 30’s, American, married, mother of three sons): Are u OK? I always feel better after cutting. Then I feel bad…how bad is your cuts? Do u need medical attention? Zen C Kelly (female, age unspecified, American): I feel better after cutting. Someone told me to get a red magic markers and draw on myself. Like make a line. It might work, I'll keep in mind for the next time. Riann Norris (female, estimated age – early 20’s, American): I’m the same way,

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you’re not alone. I cut a few days ago, and me and a bunch of AA friends are going swimming tomorrow and they are not that bad but I have to make up some lie about where they came from… Kat Wilson (female, estimated age – mid 20’s, Canadian): I feel the same way. It takes the pain from my head and put it on my body.

In the responses written back to Christine, we see similar short but powerful narratives of

self-harm. There is the pervading motive for self-harm, that is, it helps transmute the deep

persisting psychological pain into a physical manifestation – not unlike a small form of

embodiment. Stella responds with a concern for Christine’s cutting, asking if Christine is

in need of immediate medical attention for her cuts. Zen’s response to Christine is

interesting as she offers a suggestion of an alternative physical relief of psychological

pain to cutting, that being using a red marker to draw lines on herself to emulate the

visual and to and extent the carnal effects of cutting skin. Riann responds to Christine

with support, telling Christine that she is not alone with using cutting as a physical

response to psychological pain. Riann also mentions how she is worried how she will

conceal her cuts when she will be with her friends. Kat’s short response to Christine helps

to sum the idea that Christine was making, that is, the physical act of cutting is a form of

embodiment that helps relieve the psychological anguish.

One of the most fascinating narratives I came across during my preliminary

cyberethnography was the Reddit post of “Why do I want emotional pain” created under

the Reddit group ‘BPD’. Creator of the post, ‘sorosa’ narrates:

For some reason I enjoy feeling emotional pain the worse the better so much so I've tried to convince people to just insult me and make me feel horrible does anyone know the reason for this? And if not is anyone up for the above?

Sorosa’s rather paradoxical narrative caught my eye as I was searching through countless

posts regarding how to escape from psychological pain. Sorosa relishes the experience of

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deep emotional pain and being harshly subordinated. However, sorosa is unsure why

he/she feels this way. Reddit user ‘neketa1’ attempts to solve the mystery laid out by

sorosa:

My therapist and I have discussed that I engage in activities that will bring emotional pain because that pain and situation is familiar to me, so I know how to deal with it (whether I'm dealing with it in a healthy or unhealthy way is irrelevant). It's easier to behave in a way where I know the outcome, whether it's positive or not, than to behave in a way that the outcome is foreign to me

!Neketa1 explains about his/her experiences of desiring emotional pain and suffering

because it is a feeling and situation that he/she is accustomed to. It is possible that

neketa1 has been experiencing psychological torment for so long that she has been

conditioned to it and the feeling is no longer one that is novel or unwanted but familiar

and desired. For Reddit user ‘whiskeyflashback’, the desire psychological pain is also one

of feeling something familiar. On sorosa’s post, a conversation starts about the wanting to

feel psychological pain:

whiskeyflashback: I find it better to feel something rather than this overwhelming nothing I'm feeling atm, pain is the only way I know out. At least when I'm home alone. sorosa: That does make sense but I want to feel the pain all the time not just when I'm alone whiskeyflashback: Sorry, what I meant was that the only fix when I'm alone is emotional pain. At work I have methods to fill it with more productive feelings that works most of the time. sorosa: Ah okay, what way do you use to cause yourself emotional pain? whiskeyflashback: Rather not discuss it, not because the answer but the destructive nature. sorosa: I understand

In the conversation narrative between whiskeyflashback and sorosa, we see again the

recurring elements of loneliness and self-harm. In relation to self-harm, some feel release

from psychological pain by acting out anger. ‘Gotja’ also speaks to this:

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when I release destructive rage I feel better, its like the intensity releases some reward circuit, the only reason I control it because it feeds on itself, I feel either a letdown after or terrible, which brings the rage back stronger and the need for release. the more rage I feel the more intense the release and the more intensely I bottom out…I short the loop by not releasing, I remind myself of the consequences and hold out till the wave passes, reminding myself of the negative consequence keeps me from acting on it, and reminding myself how much better it is that I didnt act on it gives me some relief…I havent figured out how to get rid of the rage or its source yet, lately ive been caving into it in other ways and im trying to find a way to shortcircuit that as well so I break the cycle again, b3cause I can feel it starting to build. I basically need to find ways to let the wave pass until I find the source and eliminate it, at least that is my understanding.

!Embracement, Resistance, and Creativity

While clinicians have interpreted ‘borderline’ individuals in many ways, the

individuals being interpreted have also been interpreting the interpreter and his

interpretations. While the psychomedical complex by and large solely views BPD as a

mental illness, for those that have been diagnosed and labeled, the view towards the

condition of BPD can be more nuanced. Some of those diagnosed make their own

meanings and explanations of the condition that they carry. Others embrace, critique, and

subvert the label and the stigma that often carries with it. Many of those labeled with

BPD use imaginative and artistic creativity as a method of pride and resistance.

Echoing the 1960’s civil rights cultural movement of ‘Black is Beautiful’

spearheaded by African Americans, ‘Borderline and Beautiful’ is a Facebook group that

exists as a positive and progressive online community for people with BPD to feel safe,

unashamed, and positive of their condition. This group’s goals can be seen as resistance

to the wide misunderstandings and discrimination of BPD, both inside and outside of the

medical community. The group’s information and author’s welcome section explains

this:

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This is a support and advocacy page for Borderline Personality Disorder and Bi-Polar Disorder. It's a place for people to vent, ask questions, and find comfort in people that understand what they're going through… Hey, Everyone! My name is Anna and I have Borderline Personality Disorder. I run this page with the help of my wonderful friend, Candiance, who has Bi-Polar Disorder. There is an overwhelming amount of stigma and ignorance in this country in regards to mental illness. We're here to make a difference! While we are just one page on Facebook, we think that every ounce of information is crucial. We want to create a page that people can come to and find support and comfort, and know that nothing they say is going to be thought of as 'crazy' ... we're not crazy! We're beautiful!

For the creators of this Facebook group, it is their hope that the group could increase

awareness about stigma reduction. Furthermore, the creators want to reject the stigmatic

view of BPD as ‘crazy’. Often the creators will post on the group page encouraging

quotes as a way to offer emotional and mental support for those struggling with BPD and

Bipolar Disorder, though many of the posts could be useful for anyone struggling with

mental illness or in difficult times. Here are a few posts of quotes from the ‘Borderline

and Beautiful’:

On particularly rough days when I’m sure I can’t possibly endure, I like to remind myself that my track record for getting through bad days so far is 100% and that’s pretty good (Anna) I am strong because I’ve been weak. I am fearless, because I’ve been afraid. I am wise because I’ve been foolish (Anna) I may not be, who I ought to be. I know I’m not all that I want to be. But I’ve come a long way, from who I used to be. And I won’t give up on becoming, what I know I can be (Jeff)

From these posts, we see words of reassurance and inspiration. Other posts on

‘Borderline and Beautiful’ are ones of ‘folk critique’ of popular culture and BPD:

anyone catch tonight's episode of 'Body of Proof'? The plot was about a girl with Borderline Personality Disorder who kills her little sister, and, after she's committed, her roommate. Borderline Personality Disorder is commonly used as a 'scapegoat' diagnosis, and it's portrayed negatively, typically on an extreme level, in TV and movies. I was diagnosed with BPD 2 years ago, and I have come into

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contact with so many others that have the same diagnosis: we are not evil, we are not sociopaths, we are no worse than anyone else, we are capable of no more and no less than anyone else. Stop the stigma! (Anna)

In this post, Anna critiques how BPD is portrayed in the media, specifically how popular

media warps and greatly misconstrues what BPD is like. Furthermore, Anna points out

how the media’s extremely negative and vindictive representation of BPD gives rise to a

highly biased public image and understanding of BPD and those with the condition.

Furthermore, Anna explains that the media’s untruthful depiction of BPD leads the public

to view and associate BPD with sociopaths, violence, and moral depravity. On the whole,

‘Borderline and Beautiful’ is an online community that serves many functions: BPD

support and awareness, stigma and discrimination reduction, celebration of self-

affirmation and positivity.

‘Borderline and Beautiful’ is also a personal post on Laura Paxton’s blog “Carmel

Heart”. Laura has written a self-help book for those with BPD titled “Borderline and

Beyond”. Her blog post ‘Borderline and Beautiful’ is a narrative of positive affirmations

and resistance against the negative stereotypes that hauntingly hover around the label of

BPD:

Since I believe every hardship has a hidden blessing somewhere inside of it, I will say that borderlines are more aware of their connectedness to nature, feeling intensely connected with the environment, including the effects of subtle changes in weather. Borderlines are often more sensitive to children and animals, understanding their experience and naturally finding grounds to identify with them…Professionals agree that treating borderline personality disorder is one of the most challenging things they do. Even after all this time, when people have come forward without symptoms for years, who believe they may be cured; Even after all this time when public campaigns have been done to decrease stigma- Still, professionals often discuss borderline personality disorder among themselves with dread and derision…So, why do I say, "borderline is beautiful?" What's so "beautiful" about people who seem desperately needy and self-destructive, some who are "cutters," and some who make "manipulative" threats? What's even mildly attractive about that?…Every negative "disorder" has

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a flip-side. Nothing is all bad. When an organism suffers in one area, it compensates in another. As far as creativeness and sensitivity, borderlines have it in spades!…People with borderline personality disorder need to know about the beauty they have inside in order to fight the problems people see on the outside. Without awareness that they are beautiful souls, what motivation is there to recover?…Borderline is Beautiful!

!Laura’s blog post is a narrative of defiance against the nugatory descriptors of BPD.

Laura points out that individuals with BPD have many positive qualities such as having

high degrees of empathy and sensitivity with themselves, other people, and the world

around them. Laura also mentions about how those with BPD are more likely to be very

creative individuals. Laura optimistically and peacefully turns the negative qualities of

BPD on their heads and emphasizes that there are two sides to every coin. While Laura’s

narrative serves to tranquilly challenge the negative qualities and labels of BPD, others

are more activist and militant in protesting the discourse surrounding BPD and seek to

reclaim terms used by the psychomedical ‘complex’. The strong voice of dissent can be

detected in a powerfully poetic introductory post on the blogzine (a magazine written

online in a blog format) “Practice of Madness” by ‘scarsarestories’ (prose and form

preserved as close to original as possible):

Borderline Personality Disorder…Every move I make is madness, and with each movement I redefine my label, and my label redefines me. My mind shifts again about the whole thing. Maybe I should try ECT [Electroconvulsive Therapy]. Maybe Effexor [a strong antidepressant] is God. Maybe I am.

Maybe we all are. I don’t know. I do know one thing, though: Once you are called “crazy” it will not wash off. Did you realize when you walked into that doctor’s office that you would

never again… I believe this magazine offers something to all marginalized peoples –

everyone, really, if you keep reading – as we navigate a mad world and share this experience.

We might as well talk about it. It could even be interesting! !

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In her narrative, scarsarestories unsettles the label of BPD, and to a further degree, mental

illness as a whole, by showing how BPD is a lived experience and that those that have it

are not merely objects of scientific objectification. Furthermore, the author of the

“Practice of Madness” blogzine creatively dissects discourses constructed by the

psychomedical field by posting vintage psychoactive drug ads on her blogzine and

subverting them with bellicose digital image manipulation and seditious captions.

The voice of dissent and discourse reclamation could also be felt in Caroline’s

narrative in her post “BPD Pride” written on her blog “downthecenter”:

…Just as I can so easily keep my BPD diagnosis hidden, I realized that I am part of another "invisible group" that has been stigmatized throughout history. While I was born and raised in a secular environment, I also am 100% Jewish by birth. However, while this is in no way obvious from meeting me, I make no effort to keep this fact hidden. Both Jews and those with a diagnosis of BPD have experienced stigma throughout history, yet I treat these two pieces of my identity very differently…Why is this?…I have been taught to be proud of my Jewish heritage. While a religion and an Axis II psychiatric diagnosis are very different, there is no reason why I should choose to keep one invisible group hidden yet be so comfortable with the other…There is absolutely nothing inherently shameful about Borderline Personality Disorder…In order to fight the stigma associated with BPD and make people comfortable being open about their diagnosis, we must recognize and treat it as something that is not shameful…In order to fight the stigma associated with BPD, we must recognize the positive aspects of this community and instill a sense of pride. We can't ask for respect from the outside world until we have respect and pride for ourselves…That bears repeating: We can't ask for respect from the outside world until we have respect and pride for ourselves. Looking back over the last 100 years, many groups went through their own fight against stigma and for civil rights. Whether you look to African Americans, the physically disabled, the deaf, or even those with breast cancer, each group created a positive self-image that they spread to the general public… let me remind you of just a few reasons why you should be wear the label of BPD as a badge of honor: 1. You are a survivor. 2. You are unusually empathetic towards others. 3. You care about and love other people intensely…It's time to let people know that BPD is not something that should cause shame!…

!Caroline compares the struggle to break and change the largely negative and stigmatizing

public discourse of BPD with the Jews’ and African Americans’ historic struggle of

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fighting ethnic discrimination. Caroline parallels the essentiality of creating positive self-

images for BPD with how other marginalized populations and disability movements

spearheaded and created positive discourses. Caroline calls for those with BPD to break

negative public discourses as well as private narratives such as shame and self hatred.

This call for public and personal discourse reconstruction is also heard in Joyce’s

narrative in her blog post “I Have Borderline Personality Disorder and I’m Proud of It!”

written in her blog “makebpdstigmafree”:

Many people with BPD and accompanying mental illnesses write their posts about their co-morbid illnesses, but not their BPD, because of the stigma. People with say that they have physical illnesses rather than BPD. Even with their therapists, they’re stigmatized because of their BPD. Students studying Psychology are too ashamed to admit that they have BPD because of stigma – by people in the profession of mental health, no less! Therapists, professors, doctors and nurses crack jokes about BPD sufferers as “just another Borderline”. How do we stop this? By coming forward with our Borderline Personality Disorder and not being ashamed of it. By shouting it from the rooftops “I HAVE BORDERLINE PERSONALITY DISORDER AND I’M PROUD OF IT!” We are good people. We have more empathy than most people. We are creative, passionate, loving. What we have to endure every day of our lives – the intense emotions that others will never feel, give us a strength that they can only dream of…Are you ready to tell the world about your BPD? Wear your BPD with pride! I love all of you out there who have struggled along with me.

The Facebook group ‘Creation on the Borderline’ is one such (virtual) space that

allows for the proliferation of positive self-narratives. In this virtual space, a community

formed and is gradually changing the private and public discourse of BPD. In this virtual

space, all forms of creative expressions of narratives are encouraged. There are poems

and photographs of artwork made by members of the group (Appendix 3). Richard’s

poem shared on the virtual group vividly captures the internal struggle and somberness of

BPD, as well as strong tones of persistence, perseverance, pride, and liberation:

!

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“No more tears”: There’s a rusted cage in my mind A safe place where I can hide I’ve lived in here for many a year No more tears for them to hear Once a child happy and free Now only emptiness wanting to flee Hide away hide away is all I can do The reason I’m here is from what you do No one can find me in my old cage Or treat me bad or take out their rage Time have changed and so have I I now know the truth I’ve seen through the lies From the darkness I flew like a moth to a light You cannot hurt me I won the fight

Discussion and Considerations for Future Research

While the notion of subjectivity has been brought up in previous research into

BPD, by and large, subjectivity has not been theoretically touched upon. Yet, as we can

see from my findings, nearly all the defining symptoms and effects of BPD organize

around the elusive entity of subjectivity. The implications of my findings are twofold.

First, we need to theoretically discuss the notions of subjectivity to make sense of the

data. Second, we need to critically analyze BPD as a subjective social construct. In

addition to subjectivity, the social aspects of BPD are also greatly theoretically lacking.

BPD as a social construct means that it is socially situated within social structure and

human power relations. As such, BPD cannot be understood merely as a biological,

medical, or psychic phenomenon. BPD is closely entangled with the social, cultural,. In

our discussion here, we will explore BPD through such diverse theoretical perspectives.

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Meaning Making and the Borderline

Illness and Subjectivity

Subjectivity is central to the discussion regarding BPD, but what exactly do we

mean when we talk about subjectivity? Subjectivity is a complex and entangled subject.

Subjectivity is a broad and expansive term used in the social sciences and

interdisciplinary studies. Anthropologists use the word ‘subjectivity’ loosely, often to

refer to the emotional life of the political subject (Luhrmann, 2006). Furthermore,

subjectivity is broadly used by sociologists to explain the subject and its shared ‘inner

life’, feelings, responses, and experience.. However, some scholars have pointed out that

it would be in vain to view subjectivity and the subject as neutral forms. Biehl et al. is

radically against the simplistic idea of a lone subject. Biehl et al. point out that

subjectivity implies the ‘emotional’ experience of a ‘political’ subject. In this perspective,

the subject is caught up in a world of violence, state authority, and pain, and subjectivity

exists as the subject’s distress under the authority of another (Luhrmann, 2006). Biehl et

al.’s unorthodox definition of subjectivity is vitally important as we dissect my data as

well as the construct of BPD.

Slowly, the theorizing of the ‘subject’ is moving away from its stagnant

definitions and towards more dynamic and activistic understandings. Byron Good is a

medical anthropologist and explains that issues of subjectivity – of the lived experience

of those suffering illness and search of healing – have long been central to the discipline

of medical anthropology (Good, 2012). Good (2012) makes four important claims about

where we are and how we might proceed in theorizing subjectivity. First, Good (2012)

argues that the analytic term ‘subjectivity’ denotes a set of critical issues for social

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scientists working in contemporary societies, issues that differ from those raised by

classic studies of ‘self ’ or ‘person and emotion’ characteristic of earlier generations of

psychological and cultural anthropologists, opening different domains for ethnographic

investigation and suggesting alternative modes of inquiry. Furthermore, Good (2012)

writes:

The term ‘subjectivity’ signals awareness of critical writings related to the genealogy of the subject, and to the importance of colonialism and the figure of the colonized ‘other’ for writings about the emergence of the modern subject. It denotes new attention to hierarchy and exclusions, to violence and modes of governance, to new forms of ‘citizenship’, and to subtle modes of internalized anxieties that link subjection and subjectivity. It indicates the importance of linking national and global economic and political processes to the most intimate forms of everyday experience. It places the political at the heart of the psychological, and the psychological at the heart of the political…

!Good’s second claim is that viewing subjectivity through the lens of the ‘postcolonial’

provides a language and analytic strategies valuable for the investigations of lives,

institutions, and regimes of knowledge and power in the setting in which many

anthropologists and sociologists work today (2012). While my paper is not about

colonialism or even postcolonialism, Good’s perspective of examining subjectivity here

helps us sociologically situate BPD in social power relations and the psychomedical

system as a form of ‘colonizing’ force that appropriates subjects. Good’s third claim is

vitally connected to my research, that is, attention to ‘disorders’ is critical to the

ethnography of subjectivity, in particular for medical and psychiatric anthropologists.

Good explains this claim in detail:

The term ‘disorders’ is obviously a broader category than illness, marking an enlarged scope of the work of many medical anthropologists today. On the one hand, it bridges the individual and the societal, linking the madness of the state and of individuals, collective and individual memories, repressions, and remembering. On the other, it denotes that which is set off as threatening to ‘order’. Historians have shown that the strategic assemblage of ideas, institutions,

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and forms of domination that constituted colonialism – in the name of God, Science, and Capital, or under the rubric of Christianity, Civilization, and Commerce – all functioned to establish and maintain distinctive, local ‘orders’, modes of social life, and an enactment of ‘the Real’, characteristic of a particular Enlightenment vision of reason, progress, and freedom. Indeed, the very origins of the modernist equation of disorder with the mad, the primitive, and the bestial – all characteristics of ‘the Other’ – are found in the efforts to enact and instantiate a bourgeois colonial order (e.g. Biehl 2008). Attention to disorders thus forces attention to the establishment of very particular political, moral, and epistemic orders, often through mechanisms of state violence… Recognizing, labeling, studying, and responding to social pathologies are thus located in complex terrains of postcolonial histories and relationships. Linking ‘disorders’ to ‘subjectivity’, however, has the potential for increasing understanding of the lived experience of persons caught up in complex, threatening, and uncertain conditions of the contemporary world.4 It provides a focus on the historical genealogy of normative conceptions associated with order and disorder, rationality and pathology, and it brings analytic attention to everyday lives and routine practices instantiated in complex institutions. Addressing such issues lies at the heart of much contemporary work in medical anthropology.

Good’s fourth claim is also in direct connection to my research, that is, closely examining

that which is spoken as well as that which is not spoken – reading between the lines to

not just understand the text, but the rich sub-text locked within the narratives. Good

explains:

Finally, my fourth claim, perhaps more controversial, is that studies of subjectivity need to pay attention to that which is not said overtly, to that which is unspeakable and unspoken, that which appears at the margins of formal speech and everyday presentations of self, manifest in the Imaginary, in dissociated spaces and individual dream time, and in traces of the apparently forgotten, coded in esoteric symbolic productions aimed at hiding as well as revealing. This suggests close attention to memories and subjugated knowledge claims that are suppressed politically but made powerful precisely by their being left unsaid, attention to that which speakers strategically refuse to talk about in settings of surveillance and danger, to painful secrets and ‘poisonous knowledge’ (Das 2000), and to traumatic memories and hidden transcripts, which may fade from everyday awareness but have explosive power when evoked (Scott 1990). It suggests attention to forms of knowledge coded in highly symbolic art or in theatrical performances, as well as to that which is embedded so fully in everyday practices and assumptive worlds, shaped by contemporary assemblages of knowledge/power, that they become invisible to subjects, depending on their positions of power. And it suggests the special importance of the uncanny, of the ghosts and spectres that haunt political and social life, as well as individuals,

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linking studies of subjectivity to what Derrida calls ‘hauntology’. Discussion of the secret, the hidden, the unspoken, and the unspeakable as qualities of subjectivity, of the ir-rational and incomprehensible forms of violence and aggression, of the motivating force of longing or desire, of loss, mourning, or revenge, of remorse or guilt, of sensibility disrupted by displacement and social disintegration, all disguised more than revealed by rational discourse, obviously has resonance with a wide range of psychoanalytic theories.

Identity Disturbance and the Subject

Many of the narratives that I analyzed had the topic of identity disturbance in

them. From the narratives I gathered, identity disturbance carried many meanings to

different individuals. Furthermore, the experience of having a disturbance in one’s

identity was felt differently amongst the few individuals’ narratives I had analyzed. Some

narrators were afraid of the experience and described their disturbance in identity

negatively while others felt it was a treasure and felt very positive about their identity

disturbance. We see here a myriad of subjective definitions for ‘identity disturbance’.

Intriguingly, this uncertainty of definition is also the case within the clinical literature.

The clinical literature offers little in the way of understanding identity disturbance, or

even what the constructs of ‘identity’ and ‘identity disturbances’ are (Potter, 2009).

Indeed the clinical definitions regarding ‘identity’ and ‘identity disturbance’ from various

key scholars of BPD are highly varying. For Gunderson (2013) and Goldstein (1995),

identity disturbances include such sensations of feelings of emptiness or unintegrated and

contradictory self-images. The majority of literature on BPD refers to identity disturbance

as fragmentations, boundary confusion, and lack of cohesion in identity. These concepts

are highly subjective and difficult to objectively operationalize. This trouble with

psychiatric definition and operationalization echoes the work of Foucault. In Foucault’s

“History of Madness”, Foucault attempts to trace and uncover the origins of modern

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psychiatry. In doing so, Foucault raises many questions about the meaning of psychiatry

and its validity. One of Foucault’s major points in the expansive “History of Madness” is

that psychiatric practice is based upon implicit moral assumptions fused with explicit

empirical systemizations. In this unholy fusion, psychiatry’s treatment of mental illness

and the increasing move towards mass medicalization is simply society’s way of

controlling what it views as immoral or irregular, different and deviant. To have

‘disturbances’ in one’s identity certainly challenges the predominating Western notion of

identity as a stable singular unified individual system. It is entirely possible then that

BPD is a pathologization of sociocultural deviance. In this sense, the label of BPD serves

a social function, particularly by binding those with differences in self-regulation of

identity with the label of psychological deviance. Once individuals are ‘bound’ by the

psychomedical system, they can then be fed into the ‘machine’ of medicalization. It is

possible that once learning of their label (BPD) and interacting with the clinicians,

individuals like eissein, oapatu, and Arpil internalized and introjected (psychologizing

concepts into the mind) the label, its ideas and binds, and began to ‘believe’ and

‘perform’ the construct BPD and identity disturbance. It is possible that the discomfort

and feelings of confusion that these individuals felt were actually the feeling of deviance,

against the pressures of normative forces from society, but that the feelings were masked

with the label of psychiatric disorder and the specificity of identity disturbance. Could it

then be possible that the pain and suffering from identity disturbance are actually

responses to contradiction and conflicts deeply engrained in post-industrial late-modern

heavily capitalistic Western society? Is identity disturbance inherently painful and

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suffering causing or is the psychological anguish the product of the quotidian societal

enforcements of structural constructs?

In the Western construct of identity, which Westerners view as core to the

individual subject, there are many social and cultural assumptions. For most Westerns,

these subjective assumptions are seen as universals, that identity as a singular unified

form has existed through all cultures and times and that anything different from this

universal form is deviant and should be ‘corrected’. This view of identity and identity

disturbance completely misses the greater problems of ever increasing constructions of

deviance and medicalization in post-industrialist Western societies. Furthermore this

view is highly socially and culturally insensitive and dismissive.

By analyzing identity disturbance, we are brought to many other topics such as

Western social and cultural expectations. Furthermore, we become more aware of other

Western constructs and how deeply they penetrate into defining our realities. Early on in

this paper, I mentioned a statistic that BPD affects women far more than men. Could it be

possible that the construct of BPD, of identity disturbance, is gender-biased? Females are

more easily diagnosed as having disturbances in their identity and then receiving the label

of BPD. However, could it be that the label of BPD functions to shroud the greater

societal issue of increasingly setting impossible identity expectations for women? After

all, uncertainty about self-image, choice of friends, and other life issues is commonplace

among adolescents and the adolescent girls have an especially difficult time – at least in

American life – sorting out what kind of women they want to become (Potter, 2009).

Girls at the time have been observed to lose their vitality, their resilience, their immunity

to depression, their sense of themselves and their character (Brown and Gilligan, 1992).

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As Simone de Beauvoir wrote in “The Second Sex” (1972), “Girls have a harder time of

feeling part of a larger community and society without experiencing painful double-

binds, contradictory demands, and the threat of not being recognized and valued as a

subject: women’s social position as a class is that of the other.” Furthermore, all women

in our society are confronted with a double-bind – they may either conform to “proper”

feminine conduct, reinforcing their subordination and powerlessness, or they may rebel

by adopting supposedly “masculine” traits such as independence, and face chastisement

and alienation (Reimer, 2009). Both choices may merit a psychiatric diagnosis, and the

more “extreme” one’s conduct is, in either direction, the more likely it becomes that she

will encounter sanctions (Reimer, 2009). Could it be possible that the symptoms of BPD

become emergent when a girl reaching adulthood is depleted or ‘shattered’ of her sense

of self and identity because of the pressures of a patriarchal society?

Suffering, Self-Injury, and Meaning

In driftinghope’s narrative, we see a girl coming of age. However, her coming of

age story is a sorrowly heartbreaking one filled with psychological torment. She wrote

the hurt on her body through self-harm. In this sense, was driftinghope trying to tell us

and others around her something through the codes of cuts written on her body?

Self-injury (or self-harm) is another complex activity of BPD. Clinicians are often

at a loss to understand the actions of indviduals who self-injure (Potter, 2009). While I

have mentioned before in my findings that self-harm is utilized by individuals as a means

to endure mental pain and suffering, self-harm has even more complex explanations.

Before examining the explanations however, what is self-harm? Potter’s (2009) critical

analysis of BPD asks what self-injury even is or means. The question what is self-injury

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is trickier to answer than what one might think (Potter, 2009). Self-injury can be

summarized as acts that are done to oneself, performed by oneself, physically violent, not

suicidal, and intentional and purposeful (Alderman, 1997). While a helpful starting point,

Alderman’s definition contains ‘too much’, that is, it already assumes what is culturally

sanctioned. The literature distinguishes between ‘delicate’ or superficial and severe self-

mutilation, which is defined as ‘the deliberate infliction of direct physical injury on one’s

own body…that involves cutting, maiming, destroying or altering a part of one’s own

body in a socially unacceptable fashion, and [which] may result in permanent

disfigurement’ (Parrot and Murray, 2001; Potter, 2009). But even this definition holds

social assumptions, that being, it states the rubric of social unacceptability. Potter (2009)

pushes us towards seeking a definition of self-injury that is most free of assumptions.

Though this is a difficult task, Potter nonetheless makes a solid attempt. Potter (2009)

suggests in order to truly understand self-injury we must situate it in the context of the

broader discourse of body modifications where the body is being used as a text.

That self-injury is a form of symbolic expression, ritual, and meaning making is

not entirely new, though still, these are comparatively unorthodox angles at looking at

self-injury in medical literature. However, these angles of perspective allow us to deeply

theoretically examine the meaning behind the self-injury of individuals such as

driftinghope. While driftinghope herself may not say it, explain it, or even know it, her

self-injury could very well be of sign making, ritual, and meaning making through the

medium of the body. Let me expand upon this thought. The usage of the body as the

medium where symbols and signs are made to communicate thoughts, ideas, and

knowledge is not unique to BPD, mental illness, and certainly not late-modernity.

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Throughout human history, human have used self-injury to modify their bodies for

aesthetic, religious, or political reasons. Today, people tattoo themselves, get body

piercings, breast and penile enhancements, dye their hair in different colors, darken or

lighten their skin, go on starvation diets, and utilize plastic surgery to change the

appearance of body parts such as features of the face. In many cultures in various parts of

the world, body modification holds cultural or religious value as rites of passage and

ceremonial significance. The Native American Lakota tribe in the North American Great

Plains would have sacred ritual piercings of the skin during the ceremony of the Sun

Dance. The purpose of the Sun Dance is to offer personal sacrifice as a prayer for the

benefit of one’s family and community. Throughout history, people have fasted,

flagellated themselves, and formed stigmata as signs of deep religious or spiritual

conviction and as a means of ‘transferring’ spiritual and mental pain and suffering that

has affected individuals and communities onto the physical body. In some cultures,

amputation of body parts is a form of mourning those that have died. Members of the

Dani Tribe of Papua, Indonesia would smear their faces with ash and clay and then

ceremonially cut off parts of their fingers as an expression of grief and sorrow. In late-

modern Western capitalistic societies such as in contemporary America, some individuals

will cut themselves, not for social, ceremonial, or traditional reasons, but for more

personal spiritual reasons. Some ‘cutters’ would refer to the scars on their body as

‘beauty marks’. In all these cases, the body is being used as a text and in all cases, some

degree of risk-taking and pain is involved (Potter, 2009). We must examine

driftinghope’s cutting of herself in the context of her narrative and the happenings of her

life. Through her narrative, driftinghope shows us that she has been through many

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traumatic experiences such as relocation and abuse from close people. At the time when

she shows us that she has been cutting, she is in her teens and coming of age as a woman

in late-modern Western society. Across cultures, such as the ones mentioned above, the

teenage years is a common one when ceremonial body modifications occur, in many

cases to show that one can endure pain and is fit to be accepted as an adult in their

respective societies. Through her cutting, it is possible that driftinghope is trying to signal

to those around her a story that she is a survivor of trauma and abuse, and that she is

ready and hopeful for what the future has to hold. However, these subtle signals are lost

through the psychomedical worldview, a worldview that is deeply influenced by Western

capitalist and patriarchal systems of thought. Reimer (2009), who has been diagnosed

with BPD herself, unravels the entanglement of thoughts and biases within the

psychomedical sciences:

Women represent the Other in psychiatric discourse (Rimke 2003, Smith 1975) – unstable compared to the “rational norm” (Wirth-Cauchon 2001). Our culture’s binary logic, dualistic and hierarchical, is at work. “Female” traits are not only devalued and placed in a subordinated position, but have been medicalized and pathologized, as is evident in the Personality Disorder criteria. The Cartesian subject embraced by our society values thinking over feeling, which is associated with the feminine, and pathologized in psychiatric discourse.

!We can read even deeper into the subtext, that is, driftinghope’s self-injury could be

‘micro’ signs and physical manifestations of ‘macro’ social and cultural maladies of late-

modern Western capitalistic societies where all around society are mixed meanings and

confusing symbols of body commodification. Thus, in this case and context, self-injury

symbolizes and signifies more than pathologies of the individual, but pathologies of the

social and economic systems where the individual is located.

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From another angle, it is possible to interpret self-injury as a form of existential

self-affirmation – that one exists. We feel this interpretation through the narratives of

Perplexe, Christine, sorosa, and others. Psychological pain may be a form of existential

questioning. Self-injury may be a deep form of meaning making to relieve that existential

questioning, by leaving permanent marks on an increasingly impermanent and

meaningless body. By impermanent and meaningless body, I mean that the body, and

particularly the female body, is increasingly made superfluous and feckless through

commodification. We see aspects of this in driftinghope’s narrative when she mentions

how she is becoming anorexic so to appear beautiful and to win friends. The

commodification of the body has amplified through late capitalism (Mitlitsh, 1998). As

the global economy becomes increasingly consumer oriented, and the body is

conceptualized as another commodity to market and re-make as desirable, the body is

susceptible to objectification as never before (Potter, 2009). In the context of an economy

and culture where body commodification and objectification proliferates, women become

increasingly alienated from their bodies; hence, the need increases for women to

experience their body as real (Potter, 2009). By and large, late-modern capitalistic society

is one that negates the existential body and meaning making. Meaning is increasingly

manufactured elsewhere, away from the self, and then ‘worn’ on the body. This

‘artificial’ meaning gives rise to antagonisms within the self. These antagonisms are

arduous for the human conscience to process, and for some, a physical outlet such as self-

injury is needed to preserve the health of the conscience and to feel ‘real’ and ‘existing’.

This can be somewhat counterintuitive to understand. In a Marxian sense, self-injury is

feared because it is a transgressive and subversive act. However, it is precisely this

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transgression and subversion that acts as a form of praxis to resist objectification and

commodification. Furthermore, in a Durkheimian sense, this praxis may be seen as the

making of form in an increasingly formless world – an unconscious struggle against

anomie. In sum, those that self-injure may make the most meaning of all as they are

commoditized the least. And in this sense, psychological pain is a resistance against the

pressures of capitalism and self-injury is a political act.

Resistance and (Anti)Synthesis !Where there is power, there is resistance

In the massive volume of “The History of Sexuality”, Foucault (1976) notably

forms the postulation that where there is power, there is resistance. In consequence,

Foucault also notes this resistance is never in a position of exteriority in relation to

power. Within a number of the narratives that I examined, there is the lingering sentiment

of resistance. This heavy air of resistance and conflict is particularly felt in the narratives

of Caroline, scarsarestories, Laura, and Anna, among others. In relation to Foucault

postulation, where there is resistance, we can expect there to be power. But in the context

of these narratives and BPD, where is the power coming from? This is a difficult question

to answer in the Foucaultian perspective, as power for Foucault is not monolithic but

relational. For Foucault, power is coercive, but not in the sense of direct threat of

violence. Instead what Foucault seems to be trying to convey is that power exists as an

unbalanced asymmetrical set of social relations. It is within this asymmetrical set of

social relations that there exist particular points where resistance can materialize. While

ever discursive, Foucault’s conceptualization of power nonetheless allows us for

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productive deconstruction of narrative, discourse, and psychomedical conceptualizations,

such as BPD, located within a greater set of highly complex social power relations.

The strong voice of resistance that flows through the personal narratives of those

with BPD and their advocates I examined beckons us to re-examine the proclaimed

‘neutrality’ of the psychomedical sciences such as biology, neurochemistry, and

particularly psychiatry. Psychiatric classification matrices, such as the DSM and the ICD,

constitute as Foucault’s ‘grid of intelligibility and promote two assumptions: first that a

grand theory of health determined through positivist rigor can ultimately explain/contain

distress; and, second, that distress, in its myriad forms, is pathological (Martens, 2008).

Additionally, in order to account for scenarios outlying the contemporary classification

matrix, the grid maintains a plasticity that enables it to shift and redefine contradictory or

inexplicable behaviors through revisions to current criteria, the creation of new

classifications, or, in the case of many personality disorder classifications, a dismissal of

the behavior as patient resistance (Martens, 2008). The reconstitution of classifications

within the DSM can help explain the statistic of ever increasing cases and diagnoses of

BPD. Furthermore, Foucault’s conceptualization of power helps us explain the origins of

stigma towards BPD and the stigma’s prevalence both within the psychomedical sciences

as well as within Western society. Recall that stigma and discrimination, and the struggle

against these societal pressures, was a theme that resonated throughout many of the

narratives I examined. The stigma that is put onto BPD, and other mental illness, can be

seen as forms of social and moral regulation. This social and moral regulation can be

related to Foucault’s notion of ‘governmentality’. ‘Governmentality’ can be understood

as the social condition where individual members of society voluntarily govern

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themselves. Under this panoptic social condition, a centralized governmental entity no

longer must exist to take coercive measures to necessitate the submission of the citizenry.

In the place of a monolithic centralized system of power, there exists a multiplicity of

supposedly independent, objective, and benevolent institutions to ensure discipline and

docility amongst members of society. The governance of our mentalities takes place as

our minds and ideas are shaped by schools, hospitals, prisons et cetera, and indeed the

psychiatric establishment (Foucault, 1978). Because in many ways the borderline

personality strikes bells of social deviance and alternativity upon the subject, it is defined

as an undesirable ‘disorder’ through the institutional powers of psychiatry and further,

psychomedicine. In this sense, psychiatry and psychomedicine indeed act as hegemonic

coercive governing forces as they approach mental difference and neurovariance as

societal malice. In terms of social discrimination of the mentally ill, stigma is a social

weight that is produced as a byproduct of psychomedical and psychiatric theorization and

practice. Whether the psychomedical sciences realize this is unknown, but the existence

of critical psychiatry and critical neuroscience means that there is still hope in reducing

the harm of the largely socially uncritical psychomedical field.

Embracement and Discourse Reappropriation

That we find narratives of ‘borderline pride’ means that there is a positive

embracement and reclamation of a term (borderline) that has been largely used with

negative and marginalizing connotations. This can be seen as the beginning of discourse

reappropriation. What is reappropriation? Reappropriation can be understood as the

cultural process by which a group reclaims – re-appropriates – terms of artifacts that were

previously used in a way disparaging of that group (Croom, 2011). In nearly all the

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narratives under the “Embracement, Resistance, and Creativity” section of this paper,

reappropriation is occurring as individuals such as scarsarestories, Caroline, Laura, and

Joyce, among others embrace and use the term ‘borderline’ and ‘BPD’ on their own

terms and voices. These individuals proudly use the term on themselves, for themselves.

While there is a great amount of pain in being borderline, there is just as much pain being

labeled, pathalogized, and marginalized. By positively embracing the term ‘borderline’,

labeled individuals challenge both the label as well as the system that created and judges

that label. By reappropriating the marginalizing label, these individuals seek to

renegotiate and rebase the meaning of the word, changing it from something

marginalizing to something empowering. The reappropriation of the term ‘borderline’ –

and the discourse behind it – by those who have been labeled as such can be compared to

Foucault analysis of the how the term ‘gay’ became embraced by those that are

homosexual when ‘gay’ was once a derogatory remark. Foucault (1978) writes:

There is no question that the appearance in nineteenth-century psychiatry, jurisprudence, and literature of a whole series of discourses on the species and subspecies of homosexuality, inversion, pederasty, and "psychic hermaphrodism" made possible a strong advance of social controls into this area of "perversity"; but it also made possible the formation of a "reverse" discourse: homosexuality began to speak in its own behalf, to demand that its legitimacy or "naturality" be acknowledged, often in the same vocabulary, using the same categories by which it was medically disqualified.

Reappropriation of terms and discourses has occurred throughout history. A major pre-

modern example includes the reappropriating of the shunning term of ‘Christian’ by early

Christians. Some more contemporary examples of reappropriation include as

aforementioned the term ‘gay’, and other terms once used as derogatory definitions, or in

a belittling or shaming matter, such as Obamacare (originally a right-wing slang for the

Affordable Care Act which the left and President Obama himself endorsed), tree huggers

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(by environmentalists), Mormon (members of the Church of Latter Day Saints), and

Witch and Wizard (by Wiccans and other neopagan communities), among others. Queer

studies and Queer theory embraces the once pejorative term of ‘queer’ and has used the

term in a radical and liberation manner. Perhaps the reappropriation of ‘borderline’ by

borderlines will lead the way to a ‘Mad studies’ in the near future.

Limitations and Future Research

While this present research project and the discussion around it has been

admittedly ambitious, it nonetheless serves an exploratory function. One of the major

limitations of this research is its use of only narrative and discourse analysis. Another

significant limitation is the use of solely Internet ethnography where there is always the

question of data reliability. However, despite these limitations, I believe that my research

here has gathered data and reached discussion beyond what I had hoped and hypothesized

for. In this manner, this exploratory project has been a great success. In future research, I

would like to utilize ethnographic and interview methods to gain a more thorough

understanding of topics found in this exploratory paper such identity disturbance and

embracing the term ‘borderline’. Furthermore, in future research, I would like to more

deeply engage BPD in the context of Marxian and Existential theory.

Conclusions

At the bottom, every human being knows very well that he is in this world just once, as something unique, and that no accident, however strange will throw together a second time into a unity such a curious and diffuse plurality: he knows it, but hides it like a bad conscience – why? From fear of his neighbor who insists on convention and veils himself with it… (Nietzsche, 1874) Through this exploratory paper, we see that Borderline Personality Disorder, and

the Borderline Personality, are incredibly complex constructs. Furthermore, the

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discursive issues that surround them are also highly complicated. We see that, in many

instances, there are enormous theoretical limitations to the current psychomedical

construction of BPD. Utilizing socio-anthropological methods such as internet-

ethnography and narrative analysis are only the beginnings of using new approaches to

examine old constructs. Throughout this paper, we have examined the possibility that

Borderline Personality Disorder, more than a pathology of the individual mind, is a

malady of the our current social order and condition. At the bottom of all this

examination and theorization lie the subject and its attempt to understand and live

through the thick maze of social existence. Through the analysis of the borderline, we

arrive at some particularly dark conclusions that, in many ways, ignore the confines of

science. That it may be in utter bad faith to escape anguish and anxiety is a relatively dim

realization. But in a universe devoid of meaning, and where the individual must resist

ever increasing governmentality and psychological coercion, the construct of the

borderline begins to make sense. However grim this realization and theorization may

linger in the mind, it remains the task of the social sciences to steadfastly engage in and

explore the limits of human existence. Thus, the analysis of the borderline is only arriving

at the border, and we can only go forward.

!!!!!!!!!!!!

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!Appendix 1

DSM-IV-TR BPD Diagnostic Criteria

Borderline personality disorder is defined as a pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by 5 or more of the following symptoms:

Affective symptoms:

• Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days)

• Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

• Chronic feelings of emptiness

Impulsive symptoms:

• Recurrent suicidal behaviour, gestures or threats, or self-mutilating behaviour

• Impulsivity in at least 2 areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)

• A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation Interpersonal symptoms

Interpersonal Symptoms:

• Frantic efforts to avoid real or imagined abandonment

• Identity disturbance: markedly and persistently unstable self-image or sense of self

Cognitive symptoms:

• Transient, stress-related paranoid ideation or severe dissociative symptoms

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Appendix 2

DSM 5 BPD Diagnostic Criteria

A. Moderateorgreaterimpairmentinpersonalityfunctioning,manifestedbycharacteristic difficulties in two or more of the following four areas:

1. Identity: Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self-criticism; chronic feelings of emptiness; dissociative states under stress.

• Self-direction: Instability in goals, aspirations, values, or career plans.

• Empathy: Compromised ability to recognize the feelings and needs of others associated with inteφersonal hypersensitivity (i.e., prone to feel slighted or insulted); perceptions of others selectively biased toward negative attributes or vulnerabilities.

• Intimacy: Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with real or imagined abandonment; close relationships often viewed in extremes of idealization and devaluation and alternating between overinvolvement and withdrawal.

B. Four or more of the following seven pathological personality traits, at least one of which must be (5) Impulsivity, (6) Risk taking, or (7) Hostility:

1. Emotional lability (an aspect of Negative Affectivity): Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.

2. Anxiousness (an aspect of Negative Affectivity): Intense feelings of nervous- ness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibili s; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling

apart or Iosing control.

• Separation insecurity (an aspect of Negative Affectivity): Fears of rejection by— and/or separation from—significant others, associated with fears of excessive de- pendency and complete loss of autonomy.

• Depressivity (an aspect of Negative Affectivity): Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feelings of inferior self-worth; thoughts of suicide and suicidal behavior.

• Impulsivity (an aspect of Disiniiibition): Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consid- eration of outcomes; difficulty establishing or following plans; a sense of urgency and

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self-harming behavior under emotional distress.

• taking (an aspect of Disiniiibition): Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences; lack of concern for one’s limitations and denial of the reality of personal danger.

• Hostility (an aspect of Antagonism): Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults.

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Appendix 3

Excerpts of art from Facebook group ‘Creation on the Borderline’

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