Transcendent Luminescence, Ravaging Flames: On Alexander Kriss’s “Borderline”

EARLIER IN MY LIFE, receiving a “borderline personality disorder” diagnosis would have been destructive. The label itself—borderline personality disorder—does little to illuminate the disorder’s actual content, and so I would have been left with a stock image: faintly female, offensive like a pungent airborne toxin. The borderline is the manipulative and irredeemable “crazy girl” of our dreaded clichés—like the deceased but ever-looming mother of The White Lotus’s flailing Tanya (who sobbingly spurts out her own mother’s diagnosis while clinging to her ashes in a mid-ocean meltdown). Or she’s the malign presence that torments and humanizes the antihero for whom we’re actually rooting, like Tony Soprano’s impeccably despicable mother (whom Dr. Melfi armchair-diagnoses with BPD before proclaiming “these people have no love or compassion”). Or she’s the cookie-cutter horror villain, like Glenn Close’s character in Fatal Attraction (1987), whose brief affair with a married man devolves into her unhinged and ultimately deadly attempts to keep him. The borderline is never, in other words, the subject to be understood, only the object to overcome. Basically, receiving a BPD diagnosis would have indicated to me that I was—and would only ever be—the antagonist in other people’s lives and stories.

In his new book Borderline: The Biography of a Personality Disorder, Alexander Kriss acknowledges early on that this really is the perception of BPD, even among mental health professionals: that, as far as others are concerned, those of us with borderline are toxic, manipulative, and irredeemable. Strangely, I found Kriss’s acknowledgment to be a relief. We borderlines are not wrong in feeling vilified by the world. Kriss, an assistant clinical professor of psychology at Fordham University with a private psychotherapy practice, aims to demystify the diagnosis. His book is thereby a thoughtful corrective for a thin and grim extant literature. The two most prominent works on the disorder—Hal Straus and Jerold J. Kreisman’s I Hate You—Don’t Leave Me: Understanding the Borderline Personality (1989) and Paul T. Mason and Randi Kreger’s Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder (1998)—manage to flatten BPD in their titles alone.

What exactly is borderline personality disorder? Importantly, Borderline lays bare the ways in which this question is itself fraught. Reconstructing the history and evolution of BPD, the book traces its origins to female hysteria, a “condition” that was recognized as early as 500 BCE and remained a common diagnosis through the early 20th century (it was removed from the third edition of Diagnostic and Statistical Manual of Mental Disorders, or DSM-III, in 1980). In its common understanding, hysteria might cause an array of disparate symptoms including anxiety, sexual desire, fainting, irritability, insomnia, and fluid retention. It only afflicted women, and because it was believed to be caused by malfunctioning female organs, it was often treated with hysterectomies. Although hysteria is no longer a recognized medical condition, BPD remains inextricably ensnared in its thorny roots. It doesn’t help that the overwhelming majority of BPD-diagnosed patients are women.

Dubious roots aside, though, there is a “there” there—and Borderline illuminates it by interspersing Kriss’s historical, clinical, and critical analyses with his patients’ intimate insights and experiences. In particular, the book centers on the story of a young woman named Ana, recounting her treatment over the course of six years. Kriss describes how Ana often would sit silently on the couch in his office while her facial expressions cycled through entire sequences of wildly disparate emotions—all palpably intense yet causally opaque. He reflects on the ultimate impenetrability of these whirlwinds of feeling, to which I’d add that these borderline whirlwinds are just as bewildering from within. In one passage, Kriss recounts experiencing an intense panic attack of his own, and emerging to realize that he had just felt a wave of—and been afforded a glimpse into—the borderline experience:

The thought occurred to me: this was how Ana felt. She lacked something I had. The skill, learned through experience, to differentiate between what is real and what feels real in a moment of acute distress. To trust that, at the end of the day, she was not actually at risk of falling apart. That reality could not break and, even if it did, it would not stay broken.

Dysregulated emotions lie at the center of my own borderline experience much as they do for Ana. Unpredictable, and often inexplicable, they might careen from one extreme to another in the blink of an eye. At their most intense, they cease to be mental states I am experiencing and seemingly transform into the very fabric of experience: they become everything. Borderline episodes can be stunningly swift, cyclical, and severe, submerging us into the darkest depths of dread and then exalting us into the rosy buoyancy of joie de vivre, and then dragging us right back down to repeat it all again, sometimes within a single day.

When I scan the nine diagnostic criteria for BPD listed in the DSM-V—which, as Kriss explains, evolved to use external or behavioral “symptom clusters” in characterizing disorders—they don’t strike me as false so much as merely peripheral. The BPD criteria are not describing what BPD is but rather the shadows that “it” casts: the outward reverberations rather than what seethes inside. It’s true that borderlines behave in impulsive and destructive ways toward others, just as they do toward themselves. But what’s less known is that these behaviors are not cruel, callous, or calculated. Rather, they are desperate and compulsive attempts at alleviating pain. BPD is believed to be the single most agonizing psychological condition, with the highest rates of suicide (10 percent) and suicide attempts (70 percent). And at its very worst, the distinct agony of BPD becomes unbearable to us, as though we are being pressed to death from within. The destructive actions of borderlines do not, I think, stem from antisocial instincts or an absence of empathy, but from an all-consuming desire to escape our pain—and when our episodes pass, they often leave us feeling profoundly weak, guilty, and ashamed.

Toward the end of Borderline, Ana looks back on the start of her therapeutic journey and reflects: “I was a mystery to myself. I can’t explain how terrifying that feels. I wanted to die […] but I felt that I should know who I was before deciding to act.” To live with dysregulated emotions is to live with profound discontinuity. Borderlines face the ever-looming threat of an intensely immersive new reality swallowing them whole, and that new reality can be incompatible with who they are now. Our emotions, in other words, can evolve so quickly and completely that we are recurrently alienated from the person we just were, whose essence evaporates like the figments of a vivid dream.

¤

Kriss describes the conversation in which he first diagnoses Ana with BPD. Far from finding relief in this clinical label, Ana responds with tearful and dejected self-deprecation. “Great. So, I’m a psychotic basket case,” she says, before going on to criticize “a couple of women she had met in the past who’d said they had BPD, how unstable and needy they were. The exact word she used was ‘hysterical.’” I suspect that most borderlines react to their own diagnoses in similar ways. The flattening image of BPD in the media and in everyday conversation leaves us little room for hope or grace.

It is well known that the narratives around mental illnesses often feed back into or aggravate the symptoms of those who are diagnosed with them. This “looping effect”—so dubbed by the philosopher Ian Hacking—emerges when a classification system interacts with the people it seeks to classify, and its effects in shaping identity are especially striking in the mental health context. In Rachel Aviv’s Strangers to Ourselves: Unsettled Minds and the Stories That Make Us (2022), which explores this interplay, she tells the story of a woman named Laura Delano who is initially diagnosed with bipolar II. Laura finds immense relief when she receives this diagnosis, as it feels to her like being told, “It’s not your fault. […] You are not irresponsible.” Laura tearfully calls her father to share the “good news [that they have] figured out the problem.” Eventually, another psychiatrist changes her diagnosis to BPD, and Laura instead becomes deeply ashamed. Unlike bipolar II, “borderline personality disorder didn’t feel blameless to her. […] She interpreted the diagnosis as her doctors saying, ‘You are a slutty, manipulative, fucked-up person.’”

BPD is regularly described as one of the most difficult psychological conditions to treat. And although efforts to cultivate mental health awareness and empathy have been increasing, they still invariably leave borderlines behind. Borderlines are instead given the message they most fear: they are the antagonists and have already been abandoned. I can only wonder whether more of us would find relief—and if our condition would remain the most “difficult” to treat—if this collective vision of BPD could shed its vilifying skin and instead center our pain.

In her own review of Kriss’s book for The Wall Street Journal, Dr. Sally Satel, a psychiatrist and lecturer at Yale School of Medicine, offers a first-pass description of borderlines as “manipulative people who are apt to violate personal and professional boundaries,” before rightly observing that Kriss displays “immense empathy for borderline patients, putting him in a select group of therapists.” And yet, stunningly, Satel’s closing remarks describe the book as “of interest not only to students of psychology but also to the millions of people with family members and co-workers whose lives have been roiled by the afflicted.” A revealing omission is that borderlines themselves might be among those with something to gain from this book—and, just as importantly, that they might have something to add.

¤

My own path to diagnosis began gently and kindly, when I was draped across my partner’s couch in the autumn of 2021. I’d been puzzling aloud about how strange it was that—despite having finally settled into a stabler version of life than before—my inner chaotic darkness had obdurately remained intact (if anything, it was only more salient in its inexplicability). It was at this moment that my partner suggested that perhaps borderline personality disorder was worth looking into. At first, my body seized, and my mind raced with dizzying thoughts—Why would he say that? Does he think I’m crazy? Does everyone else?—and I spiraled wildly in a tornado he could plainly see. “I just mean,” he calmly went on, “you suffer through so much, and the pain is so intense and comes on so suddenly, even when you just felt great. So, I wonder if it’s just ordinary depression-related pain. And I think intense and sudden pain is common for people with BPD. But it’s just a thought.” He then shrugged, smoothly transitioning away from the topic with a perfectly calibrated nonchalance. My settling mind slowly processed his words. It was the first time I had heard anyone even mention that borderlines are suffering individuals.

The seed was planted. I found myself researching BPD online, scrolling in secrecy. I slowly penetrated the membrane that separates defensive instinct from honest self-examination, and I confronted the possibility that what I was reading was not merely describing someone else. My own buried memories surfaced, suffused with searing guilt and shame, as I increasingly recognizing glimmers of myself in the descriptions I read. I recalled how I had viciously lashed out at those from whom I most wanted love, how I had fought with others when the prospect of loss was too excruciating to bear, and how—on some level—I knew my “fighting” was manipulative. I saw my splitting, swinging sense of self, which might balloon with blissful or fanciful grandeur before utterly collapsing into disillusionment or disdain, and I saw my self-sabotaging instincts. Slowly at first, and then all at once, my memories coalesced, and clarity emerged. By the time a psychiatrist actually diagnosed me, it felt like a mere formality.

For a while, I was in a daze, wandering through the story of my life under a strange new light. I saw certain things differently, wondered how many others I couldn’t see at all, and was moved to explain myself anew to those I’d known. It wasn’t long before I realized that some part of me had always noticed that others lived with their feelings far better than I did or could. They could set them aside when the occasion demanded it. They could cope with the slings and arrows of life without needing to hurt others or themselves. I’d simply resigned myself to thinking I wasn’t strong or good enough to do the same. But it slowly occurred to me that, maybe, I was never weak at all, and had just been carrying a different sort of pain—and if I could somehow learn how to really live with this different pain, then maybe I wouldn’t be all that bad. Maybe I would be redeemed. It was midnight in Brooklyn, and as I walked down 4th Avenue, I could almost feel these thoughts rewire my brain.

I’ve come to accept that being borderline means I sometimes cannot trust my instincts. Inextricably entangled with my dysregulated emotions, they do not always protect me, and they routinely trick and lure me toward my own destruction and pain. I know this, and yet I keep falling for their alluring tricks. Still, the knowledge alone has been a validating and liberating gift. I can now see that my inner intensity and chaos are both very real and wholly illusory. I understand that I should step back when waves of emotion crash around me rather than simply letting them sweep me away, and that I can be critical of my inner tumult while being compassionate toward myself for having to ride these waves at all.

¤

In Borderline, Kriss examines how the contemporary understanding of BPD might be enabling the misrepresentation and dehumanization of borderlines to persist. The last three decades’ recognition of “trauma” as a cause of psychological conditions marks a cultural shift, he argues, that has left borderlines behind. It has created a distinction between those bestowed with trauma-centered diagnostic labels (e.g., PTSD or complex-PTSD) who are “worthy” of compassion, and those bestowed with vilified diagnoses (such as borderline or narcissistic personality disorder) who are dismissed as toxic or hopeless, notwithstanding the fact that trauma is widely regarded as among the causes of personality disorders as well. To my mind, the most troubling issue surrounding BPD concerns the label itself. What does it mean, and what good does it do, for BPD to be classified, and thus differentiated, as a “personality disorder”? While Kriss addresses this question toward the end of his book, he describes BPD throughout the rest of the book as the “fracturing” of an identity, the “lack” of a self (or sense of self), and the “absence” of a history. These descriptions suggest that Kriss himself understands BPD as a personality disorder, but also—more strikingly—it does not mean that borderlines have disordered personalities. Rather, it seems to mean that we are disordered as persons.

If I’m puzzled by the language of “personality disorders,” this is not because I reject that my own identity is “disordered” or “fractured.” Indeed, it is hard to understand myself as a continuous thing over time, as I weave in and out of emotional worlds and sometimes look back to see an unfamiliar self. That said, what I reject is that this is what differentiates borderlines from everyone else. It seems to me erroneous and dangerous to suggest that any identity is not fractured, disordered, or otherwise dynamic and conflicted in innumerable ways, let alone that some fantasy of stasis and uniformity is the “gold standard” of what a person ought to be. The more I reflect on my own mystifying interiority, the more I can see glimmers of the very same traits in everyone else. Frankly, I now think everyone could use a taste of the bitter, humbling medicine that I’ve had to take myself.

Toward the end of Borderline, Kriss expresses thoughtful ambivalence about certain movements to “reclaim” or even celebrate BPD, not as a disorder of one’s personality but as a part of one’s identity. Particularly within online discourse (such as Reddit’s r/BPD community), some of these movements have gone too far. Kriss explains: “BPD is often presented online as an identity unto itself, something that just is, to be accepted but not necessarily understood. Diagnosis is perverted into a shield against criticism. Invariably, people have invoked a BPD identity in order to justify their abusive actions.”

Kriss is right that this form of reclaiming BPD is deeply misguided, but not because BPD cannot be legitimized as a part of one’s identity (rather than the “lack” of one, as Kriss describes it). Rather, it’s because using BPD as a shield against criticism misconstrues what it means to be, and to be treated as, a person. We cannot have it both ways. Recognizing that we are not disordered or fractured requires acknowledging that we are worthy of compassion and capable of growth, but also—at the very same time—that we ought to be responsible and accountable for the persons we are. It is not only that both of these things can be true, but also that they must both be true because they go hand in hand with what it means to have humanity.

I often say that I identify with my BPD diagnosis, and what I mean is that I can now see how my dysregulated emotions have complicated my ability to understand myself. But my diagnosis also revealed to me how many other people in my life had already long seen and understood my inner tumult. When I told my closest friends and family about my BPD diagnosis, no one was surprised. Many had even suspected it. But they explained that this didn’t change the story of my life or the person I was, even if it changed the way I understood myself. They already knew me, already accepted me—all my intense emotions, and all the chaos I brought in my wake—and already loved me not despite but rather in part because of it all, as it was all inextricable from who I was.

Life on the borderline is indeed a life of intensity, but this intensity needn’t only take the form of ravaging flames. It also presents as a transcendent luminescence: an explosive euphoria that shatters our minds as it floods us with bliss, and exudes an infectious warmth that can, I’m told, be enchanting and electrifying to others. It can also, contrary to the stereotypes, manifest as an astonishingly deep capacity for empathy, cultivated precisely by so routinely traversing the spectrum of emotional possibility. For some of us, the borderline intensity emerges in the form of a passion so powerful that we believe it to be the entire purpose of our existence, and which thus imbues our lives with a shimmering sense of meaning that—illusory or not—many others long for. But above all, I suspect that most borderlines express their singular intensity in the way they love: effusive, uninhibited, devoted, even when it hurts. And while it’s true that this way of loving can be destructive, it can also be beautiful.

I’ve always thought that a person’s greatest strengths are often their greatest weaknesses. Like two sides of the same coin. Maybe my “borderline personality” is both the very worst and the very best thing about me.

The post Transcendent Luminescence, Ravaging Flames: On Alexander Kriss’s “Borderline” appeared first on Los Angeles Review of Books.