Borderline

The Biography of a Personality Disorder

De: Alexander Kriss PhD

Narrado por: Max Newland

An intimate, compassionate, and expansive portrait of Borderline Personality Disorder that rejects the conventional wisdom that this condition is untreatable, told by a psychologist who specializes in BPD

Mental illness is heavily stigmatized within our society, and within this already marginalized group, folks with BPD are deemed especially untreatable and hopeless. When, as a graduate student, Alex Kriss first began working as a therapist in the field, his supervisors warned him that borderline patients were manipulative, difficult, and had a tendancy to drop out of treatment. Yet, years later, when Kriss was establishing his private practice and a borderline patient known as Ana came to his office, he felt compelled to try to help her, despite all of the warnings he’d heard.

Borderline is the story of his work with Ana—how his successes with her led him to open his doors to other BPD patients and advocate for them. Borderline is also the story of the disorder itself: Kriss traces accounts of the condition going back to antiquity, showing how this disease has been known by many names over the millennia, most of them gendered: possession, hysteria, witchcraft, moral insanity. All referred to a person—usually a woman—whose behavior and personality were seen as fractured, unstable, unpredictable, and uncontrollable. Kriss guides us through this history up through the emergence of psychotherapy, the development of the modern diagnosis, and attitudes toward treatment today.

Great performance

The performance really added to the engagement. A great mix of case study and historical information.

Pretty wokey but worthwhile

This is one of the better contemporary books on BPD, especially in its relationship to other Cluster B disorders like NPD. Compelling clinical vignettes and good, thorough history of the concept of BPD. Like most work in this field though, it is thoroughly infused with the language and assumptions of what some would call Cultural Marxism and Critical Theory (various lenses of privilege, capitalism is bad, lived experience, and all the rest). Personally, that’s an annoying turn off, but I still found it worthwhile.

Trying to bring back psychoanalysis? Why?!

In the first half of the book, the author mentions 3 BPD patients who “fell in love with him”. The author seems to have weak boundaries with his patients and seems to enjoy the extra attention he gets from his BPD patients (why on earth do you need to meet with a patient 4 times a week?). He even admits to being jealous that he’s not the most important man in Ana’s life anymore once she finds a healthy relationship. Why are some men like this?!

I have LOTS of thoughts. However, what prompted this was that the author says that based on the DSM 5, abused children cannot be diagnosed with PTSD because it doesn’t explicitly mention child abuse. As someone who works in this field, this is NOT true. Just because the DSM doesn’t mention child abuse explicitly, clinicians know that these things are traumatizing and will diagnose a child with PTSD or adjustment disorder if they show the symptoms.

As a clinical psychologist, he probably only has trained with adults and doesn’t know this. But it’s so easy to ask a colleague. Or read a research paper about childhood ptsd. Like I can’t. I agree the DSM generally needs major improvements and many disorders share marked similarities and overlap (ie transdiagnostic traits). I also understand this author is on the fringes of psychology. I appreciate the neurodiversity approach, but he made not mention of other diagnoses that look a lot like BPD, like autism or ADHD, other than trauma.