Borderline

January 15, 2024
Borderline personality disorder, defined today as a “pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity,” was misunderstood long before its 1980 addition to the DSM, contends Fordham University assistant psychology professor Kriss (The Gaming Mind) in this stimulating study. According to the author, the disorder has remained elusive partly because of the medical establishment’s reluctance to acknowledge links between societal power imbalances, trauma, and mental illness. Meanwhile, BPD’s prevalence in women—who represent roughly 75% of diagnoses—further drove its stigmatization. Kriss details how the condition is unfairly typified in popular culture by “wild, promiscuous people... who abuse substances, threaten suicide and fly into rages,” when for many, the borderline experience is a subtler, “chameleon-like” one, and often leads sufferers to slip through the cracks of established diagnostic and treatment practices. While the history of the disorder’s “status as an outlier” from fifth century BCE to 1885 (before the birth of psychoanalysis) is dispatched in a single, breakneck chapter, on the whole this is an enterprising and in-depth exploration of who decides what it means to be ill, how mental illness is framed in cultural narratives, and who gets shut out of those narratives. It’s an ambitious reassessment of an understudied condition.

February 15, 2024
The evolving status of a misunderstood mental illness. In this probing study, Kriss, author of The Gaming Mind, traces the history of what is now known as borderline personality disorder, alongside a detailed account of the author's therapy sessions with a young female patient diagnosed with it. A psychologist with extensive experience treating BPD, Kriss argues that its sufferers have generally been mischaracterized and neglected by health professionals; that it seems to arise via particular environmental stressors encountered in childhood; and that, contrary to popular belief, there are real possibilities for treating it successfully. More broadly, he contends that the insights he has gained in treating his patients are relevant to everyone, for the dysfunction seen in people diagnosed with BPD is simply a pronounced version of a universal human condition: "The borderline experience exists, to some degree, in all of us." The author's account of his interactions with his patient are insightfully and plausibly rendered, as are the challenges involved in intervening in a disorder that often leaves patients resistant to treatment and prone to self-disabling behaviors. Kriss provides an illuminating survey of the prominence of the disorder in the history of psychology and psychiatry, and readers will gain a keen appreciation of how sexist assumptions have led to useless or damaging interventions. The author presents a compelling case for a revision of how BPD is categorized and for the value of innovative therapeutic approaches. As he concludes, the lessons we learn by studying this disorder are profound, with far-reaching implications. "BPD, for its millennia-old status as an outlier, can teach us how to be a healthy kind of normal, if we are willing to listen," he writes. "It is the story of how one moves from chaos to stability." A revealing exploration of borderline personality disorder and the future of therapies addressing it.

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