I Hate You--Don't Leave Me - Jerold J. Kreisman [105]
• Projective identification—a more complex form of projection in which the projector continues an ongoing manipulative involvement with another person, who is the object of the projection. The other person “wears” these unacceptable characteristics for the projector, who works to ensure their continued expression.
For example, Mark, a young, married man who is diagnosed as borderline, finds his own sadistic and angry impulses unacceptable and projects them onto his wife, Sally. Sally is then perceived by Mark (in his black-and-white fashion) to be a “totally angry woman.” All of her actions are interpreted as sadistic. He unconsciously “pushes her buttons” to extract angry responses, thus confirming his projections. In this way, Mark fears yet simultaneously controls his perception of Sally.
Pathological Concept of Self
“Identity diffusion” describes Kernberg’s conception of the borderline’s lack of a stable, core sense of identity. The borderline’s identity is the consistency of Jell-O: it can be molded into any configuration that contains it, but slips through the hands when you try to pick it up. This lack of substance leads directly to the identity disturbances outlined in criterion 3 of DSM-IV’s description of BPD (see chapter 2).
Pathological Concept of Others
As “identity diffusion” describes the borderline’s lack of a stable concept of self, “object inconstancy” describes the lack of a stable concept of others. Just as his own self-esteem depends on current circumstances, the borderline bases his attitude toward another person on the most recent encounter, rather than on a more stable and enduring perception grounded in a consistent, connected series of experiences.
Often, the borderline is unable to hold on to the memory of a person or object when he, she, or it is not present. Like a child who becomes attached to a transitional object that represents a soothing mother figure (such as Linus’s attachment to his blanket in the Peanuts cartoons), the borderline uses objects, such as pictures and clothing, to simulate the presence of another person. For example, when a borderline is separated from home for even a brief period, he typically takes many personal objects as soothing reminders of familiar surroundings. Teddy bears and other stuffed animals accompany him to bed, and snapshots of family are carefully placed around the room. If he is left home while his wife is away, he often stares longingly at her picture and her closet, and smells her pillow, seeking the comfort of familiarity.
For many borderlines, “out of sight, out of mind” is an excruciatingly real truism. Panic sets in when the borderline is separated from a loved one because the separation feels permanent. Because memory cannot be adequately utilized to retain an image, the borderline forgets what the object of his concern looks like, sounds like, feels like. To escape the panicky sensation of abandonment and loneliness, the borderline tries to cling desperately—calling, writing, using any means to maintain contact.
RESOURCES
Printed Materials
OVERVIEWS
“Borderline Personality Disorder.” Journal of the California Alliance for the Mentally Ill, Vol. 8, No. 1, 1997. Comments from experts, families, and persons with BPD.
Sometimes I Act Crazy: Living with Borderline Personality Disorder, by J. J. Kreisman and H. Straus. Hoboken, NJ: John Wiley & Sons, 2004. Detailed review of BPD symptoms, many from the patient’s perspective, and recommendations for coping; directed toward families.
New Hope for People with Borderline Personality Disorder, by N. R. Bockian, V. Porr, and N. E. Villagran. Roseville, CA: Prima Publishing, 2002. A readable book for the layperson emphasizing better prognosis.
Understanding and Treating Borderline Personality Disorder: A Guide for Professionals and Families, by J. G. Gunderson and P. D. Hoffman. Washington, DC: American Psychiatric Publishing, 2005. A readable review for clinicians and families.
Borderline Personality Disorder: A Clinical Guide (2nd ed.), by J. G. Gunderson. Washington,