I Hate You--Don't Leave Me - Jerold J. Kreisman [25]
Tolstoy defined boredom as “the desire for desires”; in this context it can be seen that the borderline’s search for a way to relieve the boredom often results in impulsive ventures into destructive acts and disappointing relationships. In many ways the borderline seeks out a new relationship or experience not for its positive aspects but to escape the feeling of emptiness, acting out the existential destinies of characters described by Sartre, Camus, and other philosophers.
The borderline frequently experiences a kind of existential angst, which can be a major obstacle in treatment for it saps the motivational energy to get well. From this feeling state radiate many of the other features of BPD. Suicide may appear to be the only rational response to a perpetual state of emptiness. The need to fill the void or relieve the boredom can lead to outbursts of anger and self-damaging impulsiveness—especially drug abuse. Abandonment may be more acutely felt. Relationships may be impaired. A stable sense of self cannot be established in an empty shell. And mood instability may result from the feelings of loneliness. Indeed, depression and feelings of emptiness often reinforce each other.
Raging Bull
Criterion 8. Inappropriate, intense anger, or lack of control of anger, e.g., frequent displays of temper, constant anger, recurrent physical fights.
Along with affective instability, anger is the most persistent symptom of BPD over time.32
The borderline’s outbursts of rage are as unpredictable as they are frightening. Violent scenes are disproportionate to the frustrations that trigger them. Domestic fracases that may involve chases with butcher knives and thrown dishes are typical of borderline rage. The anger may be sparked by a particular (and often trivial) offense, but underneath the spark lies an arsenal of fear from the threat of disappointment and abandonment. After a disagreement over a trivial remark about their contrasting painting styles, Vincent van Gogh picked up a butcher knife and chased his good friend, Paul Gauguin, around his house and out the door. He then turned his rage on himself, using the same knife to slice off a section of his ear.
The rage, so intense and so near the surface, is often directed at the borderline’s closest relationships—spouse, children, parents. Borderline anger may represent a cry for help, a testing of devotion, or a fear of intimacy—whatever the underlying factors, it pushes away those whom the borderline needs most. The spouse, friend, lover, or family member who sticks around despite these assaults may be very patient and understanding, or, sometimes, very disturbed himself. In the face of these eruptions, empathy is difficult and the relation must draw on every resource at hand in order to cope (see chapter 5).
The rage often carries over to the therapeutic setting, where psychiatrists and other mental health professionals become the target. Carrie, for example, often raged against her therapist, constantly looking for ways to test his commitment to staying with her in therapy. Treatment becomes precarious in this situation (see chapter 7), and many therapists have been forced to drop borderline patients for this reason. Most therapists will, whenever possible, try to limit the number of borderline patients they treat.
Sometimes I Act Crazy
Criterion 9. Transient, stress-related paranoid thoughts or symptoms of severe dissociation.
The most common psychotic experiences for the borderline involve feelings of unreality and paranoid delusions. Unreality feelings involve dissociation from usual perceptions. The individual or those around her feel unreal. Some borderlines experience a kind of internal splitting, in which they feel different aspects of their personality emerge in different situations. Distorted perceptions can involve any of the five senses.
The borderline may become transiently psychotic when confronted with