Posted by fallsfall on December 3, 2003, at 8:24:58
In reply to Re: borderline pd and bipolar, posted by ramsea on December 3, 2003, at 5:03:10
Like you, I've done a lot of reading. I am diagnosed Borderline and Major Depression (though my dad and sister are diagnosed BiPolar - so maybe my turn will come). I have friends who are BiPolar, who are Borderline, and who are both.
I think that my sense of the difference is mainly one of cause. BiPolar is very genetic. Borderline (in my opinion) is more environmental. I get that mostly from Linehan's book where she talks about invalidating environments. Also other authors (I don't remember who right now) talk a lot about Borderlines and Splitting (Black and white thinking). Splitting is caused by environmental factors very early on. I personally think that splitting is the essence of Borderline. The behaviors that result from splitting can be different for different people. For many it is the impulsive self destructiveness that we associate with Borderline people. But I'm not impulsive (and only minorly self destructive) - yet I "feel" borderline - because of the splitting and the lack of self. I call myself a non-typical Borderline, because I have the underlying Self issues, but I display them differently (my therapist calls it "intensely dependent").
I have been doing some reading on Psychology of the Self (the best is "The Restoration of the Self" by Kohut). This psychology talks about the way that we create our Self when we are growing up (or later in therapy) - by finding someone to "mirror" (finding out what it means to be human, what are emotions, etc. Think of the infant who sticks his tongue out at you when you stick yours out.) and by finding someone to idealize (to decide what we can be when we grow up, sort of putting all that mirror information together). In another book ("How Does Analysis Cure") he also talks about twinship/alterego, but I'm not really clear on how that is different from the mirroring (an example is the little girl kneading a hunk of dough next to her mom). So Kohut is talking about how we learn to be ourselves - how we create our Self. He says that if our models (usually parents) failed us when we were growing, that we will be missing "structures" in our Self. The lack of these structures is the root of our psychopathology. The behaviors that we do as a result are the symptom, but not the cause of the problem. Self Psychologists give us another chance to mirror and idealize and twin, and by doing this, they let us pick up where we stopped while growing up and try to grow up again. There is also the concept of "optimal frustration" where they (or our parents) would make mistakes and we learn to be strong and adapt as a result. Note the word "Optimal" - not too many frustrations, not too few.
This is very different from Freud's philosophy which says that our behavior is based on "drives", and our psychopathologies are a result of the conflicts of the drives.
Somehow, the Self stuff just makes more sense to me. Anyway, the Self Psychology supports (in my mind) the idea that splitting (which is a defect of the Self) causes loads of problems. I have done a session of DBT, and my therapist (although not a DBT therapist) worked with me and supported the DBT philosophy. I found it quite helpful. I learned a bunch of coping skills, and some education about what really is appropriate behavior (rather than just how it was done in my disfunctional family), and a sense of the types of issues that cause me problems and how to think about them. I'm really glad I did the DBT stuff, and I'm glad I did it first. But, DBT (and CBT) taught me only how to survive with the problem that I have (a defect of the Self) - and while that is a big improvement, that isn't enough for me. I don't want to have to "cope" with everything forever - I want to "fix" it. That is where my Psychodynamic therapist (who practices Psychology of the Self) comes in. I am hoping (and praying) that working with him will allow me to build the structures that are missing, and that someday I won't need to cope so much. So far, the therapy is VERY different from the CBT I had (for 8 1/2 years). I can't tell yet if it will really "fix" the problems - create the structure that is missing in my Self - but I've been seeing him for less than 6 months, so I think it is too early to tell.
That's my philosophy of Borderline. For BiPolar, I think that there is a chemical issue, which causes mood instability (which can be a SYMPTOM with Borderlines, but in my opinion is not a CAUSE). This chemical issue makes life very unpredictable for the person (in many of the same ways that a Borderline's environment makes their life unpredictable), and so the person has trouble learning how to grow up right. I suppose that if the instability is sufficient when the child is very young, that it (rather than the environment) could cause defects in the Self. I guess I think that you can have BiPolar people who have intact selfs, but the fact that their "world" (as seen through the filter of their mood instability) is so chaotic, they have trouble seeing things the same way that "normal" (whatever that is!) people do.
I guess that I would sum up by saying that I think that the causes of Borderline and BiPolar are different, but that they can have the same effect on the learning (and development of the Self) and on the behavior of the adult, and that is what makes them look similar. I do believe that there are Borderline people who are not BiPolar, and BiPolar people who are not Borderline.
Thank you so much for bringing up this topic. It is helpful to me to put down what I am learning - kind of lets me consolidate things. I am interested to hear what you think of my "theories".
poster:fallsfall
thread:286142
URL: http://www.dr-bob.org/babble/psycho/20031202/msgs/286165.html