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stressful situations (such as feeling abandoned) or placed in very unstructured surroundings. For example, therapists have observed episodes of psychosis during classical psychoanalysis, which relies heavily on free association and uncovering past trauma in an unstructured setting. Psychosis may also be stimulated by illicit drug use. Unlike patients with psychotic illnesses, such as schizophrenia mania, psychotic depression, or organic/ drug illnesses, borderline psychosis is usually of shorter duration and perceived as more acutely frightening to the patient and extremely different from his ordinary experience. And yet, to the outside world, the presentation of psychosis in BPD may be indistinguishable, in the acute form, from the psychotic experiences of these other illnesses. The main difference is duration: within hours or days the breaks with reality may disappear, as the borderline recalibrates to usual functioning, unlike other forms of psychosis.

The Borderline Mosaic

BPD is clearly becoming acknowledged by mental health professionals as one of the more common psychiatric maladies in this country. The professional must be able to recognize the features of BPD to effectively treat large numbers of patients. The layperson must be able to recognize them to better understand those with whom he shares his life.

While digesting this chapter, the astute reader will observe that these symptoms typically interact; they are less like isolated lakes than streams that feed into each other and eventually merge into rivers and then into bays or oceans. They are also interdependent. The deep furrows etched by these floods of emotions inform not only the borderline but also parts of the culture in which he lives. How these markings are formed in the individual and reflected in our society is explored in the next chapters.

Chapter Three

Roots of the Borderline Syndrome

All happy families resemble one another; every unhappy family is unhappy in its own fashion.

—From Anna Karenina, by Leo Tolstoy

Growing up was not easy for Dixie Anderson. Her father was rarely at home and when he was, he didn’t say much. For years, she didn’t even know what he did for a living, just that he was gone all the time. Margaret, Dixie’s mother, called him a “workaholic.” Throughout her childhood, Dixie sensed that her mother was hiding something, though Dixie was never quite sure what it was.

But when Dixie turned eleven, things changed. She was an “early developer,” her mother said, though Dixie really wasn’t sure what that meant. All she knew was that her father was suddenly home more than he had ever been, and he was also more attentive. Dixie enjoyed the new attention and the new feeling of power she had over him when he was finished touching her. After he was done, he would do whatever she asked him.

About this same time, Dixie suddenly became more popular in the family’s affluent suburban Chicago neighborhood. The kids began to offer her their secret stashes of pot and, a few years later, mushrooms and ecstasy.

Middle school was a drag. Halfway through a school day, she’d wind up fighting with some of the other kids, which did not rattle her at all: she was tough; she had friends and drugs; she was cool. Once, she even punched her science teacher, whom she felt was a real jerk. He didn’t take it well at all and went to the principal, who expelled her.

At age thirteen she saw her first psychiatrist, who diagnosed her as hyperactive and treated her with several medications that didn’t make her feel anywhere near as good as weed. She decided to run away. She packed an overnight bag, took a bus to the interstate, stuck out her thumb, and in a few minutes was on her way to Las Vegas.

The way Margaret saw it, no matter what she did, it always seemed to turn out the same with Dixie: her older daughter could not be pleased. Dixie had obviously inherited her dad’s genes, always criticizing the way Margaret looked and the way she kept the house. She had tried everything to lose weight—amphetamines, booze, even the stomach