Thursday, August 8, 2013

Speaking of Identity: Watch This Little Girl Become What She Is Told Every Day

We've been talking about identity and this came up. This is video is very short but it comes with a TRIGGER (painful words) warning because it is painful to listen to even though the words aren't anything that most of us probably haven't heard before. It illustrates just how easily, just how impressionable, people are as children. Children take in what they are told and take in everything in their environment. People with the more sensitive temperament towards rejections and abandonments don't necessarily need something so extreme to be so harshly effected either. This is in no way meant to downplay anyone else's experience, please don't take it that way. My point is only to illustrate that when you also have a temperament that is so sensitive on top of being so impressionable, you're less likely to be able to recover in a way that is adaptable and healthy. And even things like, "don't be a baby," or "that could have been better", or "toughen up" can effect you more strongly than they might otherwise have. 

Sound familiar? Take a look and tell me what you think. 


Watch This Little Girl Become What She Is Told Every Day

The things that we say to kids are internalized by them on a daily basis. This powerful 30-second clip from Ireland makes us understand that so clearly, it hurts.



Transcript:

I’m a stupid little bitch.
I should shut up moaning when I’m left on me own at night.
I’m fat and ugly and useless.
I cry like a baby when I’m slapped
I’m horrible to have around.
I don’t deserve to have any friends.
I never do anything right.
I’m not just a stupid little bitch.

I’m a nobody.

This clip was made by ISPCC.


Tuesday, August 6, 2013

Disturbed Sense of Identity in Borderline Personality Disorder: Part 5

Final installment time. So what have you thought about this series? Enlightening? I’ll definitely try to find some things on how to strengthen identity in BPD, because there have been inquiries, but don’t be surprised when some of it is going to be…. Talk to a therapist and battle out those demons!

Carsten Rene´ Jørgensen, PhD

IDENTITY DIFFUSION AND CULTURAL CHANGES

Personal identity is ‘located’ at the crucial interface between the individual and society and, as argued by Erikson (1968, p. 23), we cannot separate “the identity crisis in individual life and contemporary crisis in historical development because the two help define each other and are truly relative to each other.” Nevertheless, much of the theory and research about BPO and BPD has severely underestimated or even ignored the influence of social organization and

culture. Traditional psychoanalysis and clinical theory cannot fully grasp human identity and identity disorders because they have not developed profound models to conceptualize culture. Early on, Horney (1937) claimed that some of the typical problems recurring in psychopathological individuals are not qualitatively different from the problems experienced by smoothly adapted individuals living in contemporary culture. What is normally interpreted as manifestations of individual psychopathology must also—in part—be understood as a reflection of societal dynamics. One of the remaining questions is of course, as Horney writes, why certain persons develop psychopathological symptoms while others, living under similar conditions, are able to cope with the difficulties they experience. Similarly, in their early investigation of ‘the borderline syndrome,’ Grinker et al. (1968, p. 171) concluded that it is highly likely that ‘the sick borderline’ “represents an exaggeration of a contemporary problem in all civilized mankind.” Thus, from a social psychological perspective, the identity diffusion often found in borderline patients can be interpreted as an illustration—albeit in a radical and pathological form—of the impact the momentous social changes in western culture have on the human psyche. “As the pace, extension, and complexity of modern societies accelerate, identity becomes more and more unstable, more and more fragile” (Kellner 1992, p. 143) and the syndrome of identity diffusion in part reflects problems and discourses in late modern culture. Thus, identity diffusion cannot be reduced to an individual psychological problem alone.

Hmmmm. While I definitely think personality is influenced by society and culture I’m not sure I would go so far as to say it wouldn’t exist without it (in regards to where it’s located.) However the drawing a cultural parallel between BPD identity diffusion and the potential impact of momentous social changes in western culture on the human psyche is interesting. Limiting, but interesting. I say limiting, because clearly BPD is found all over the world, and is not limited to western societies.

Even though sociology and social psychology, on the one hand, and clinical psychology and psychoanalysis, on the other, focus on different parts of identity and identity development, representing different perspectives on issues of identity, it is interesting to note the significant similarities between the descriptions of ‘late modern man’ in contemporary sociology and what has been described as the core—and primary manifestations—of borderline personality disorder. The point is not that there should exist something like a direct cause and effect relationship between contemporary culture and borderline disorders, including clinical cases of pathological identity diffusion, rather that in order to arrive at a satisfactory conceptualization of borderline disorders our established clinical models must integrate an understanding of late modern culture and how trends in contemporary culture affect human psychology. In particular, focus should be given to how identity diffusion is related to the prevailing zeitgeist and cultural change (Jørgensen, 2006).

DSM-IV emphasize that the essential feature of borderline personality disorder is “a pervasive pattern of instability of interpersonal relationships, self-image and affects.” Similarly, Bauman (2005, p. 33) has suggested that what will result from contemporary culture, characterized by continuous change, is a “permanently impermanent self.” “Identity building has taken the form of unstoppable experimentation” (Bauman, 2004, p. 85) and has become a never-ending process, characterized by instability and perpetual change. In modern societies self-chosen identities and commitments predominated, whereas some form of ‘adaptive’ identity diffusion (lack of stable, long-term commitments) appears to be emerging as predominant in late-modern societies (Cote, 1996, p. 421). Identity problems have become “more than a rare condition of mental patients or a passing condition of adolescence” (Bauman, 2001, p. 148). And some of the identity problems we observe in our borderline patients reflect experiences that are relatively common (though in moderated forms) among people living in late modernity.

            I like that – a permanently impermanent self. A walking, talking contradiction.

Breakdown of the cultural mechanisms that formerly provided individuals with prefabricated, culturally constructed, and a priori validated and recognized identities is part of the process that has made identity a problem in late modern societies (c.f. Westen & Cohen, 1993). Social structure that formerly provided a buffer against psychopathology has been weakened and the risk of developing psychopathology, including identity disturbances and borderline disorders, has increased. In some cases the weakening of social institutions and structures presumably contributes significantly to the borderline patient’s characteristic identity problems.

Too much choice and freedom is apparently the problem. Back in ye olden days when the oldest ran the family business, the middle child went to seminary, and the youngest went into the military it was all easy and shit. You didn’t have to think. You knew exactly who you were supposed to be. If you were a woman even easier! Parents picked you out a husband, you shut up and let your husband do all your thinking. It’s these modern time freedom shenanigans that are causing all these problems.

Rapid social changes, intergenerational discontinuity, unclear and rapidly changing social roles, and decreased family and community cohesion (Paris, 1998), which characterize modern western culture, constitute risk factors for identity diffusion and the development of borderline pathology.

Okay, look, I get the impetus behind this, but we only live one life at a time. I wasn’t even alive when all that stuff happened or these traditions were in place, so I was programmed to respond to things that way. The freedoms of my modern society aren’t shifting rapidly for me. It’s just how they are. It’s a cute analogy, and I get that social change is upheaving, but social change is also radically necessary. I for one like not being discriminated again and having the vote. Bleh.
           
Additionally, borderline personality has been conceptualized as an impulsive spectrum disorder associated with under-controlled emotions and dysregulation of the self. Even though affective instability/dysregulation and impulsivity is partly constitutional (Stone, 2005) and has been related to significant others repeatedly invalidating the self (Linehan, 1993), the unfolding of personality traits related to instability and impulsivity is probably sensitive to the prevailing relative absence of external structures (Paris, 1998), invitations to almost limitless self-expression and self-realization, unstable and unclear social roles and unpredictable, rapidly changing social expectations. In all likelihood, cultural changes intensify the development of maladaptive behavior in brittle individuals. This possibly leads to the establishment of malignant vicious circles where maladaptive behavior is followed by social exclusion, shown to enhance anxiety and proneness to regressive and maladaptive behavior. In addition to this, social exclusion and marginalization deprives the borderline patient of important sources of identity building and the means to stabilize a fragile identity (work, resource-full, and enduring social communities, etc.).

I think cultural norms and stigmas that are forced on us based on race, religion, gender, sexual orientation, etc. that go against how we feel and would like to act or be perceived are enough to make anyone that acts against them in any way be perceived as impulsive or odd. That’s before you add even a little bit of BPD into the equation. Cultural and societial norms when a person doesn’t feel they apply appropriately to who they are can be oppressive and fighting against them is stressful especially when you’re trying to get people within the norm to understand and accept you though you may be a bit different. Going against the grain creates negative feedback from a person culture. Many people (myself certainly included) have very little interest in following the preordained societal norms of expression not because of BPD, but because that’s just not who we are. So yeah that leads to social exclusion, and anxiety, etc, but is that because of BPD? Or is that because of the culture and society being unaccepting?

Lifton (1993) describes how people living in late modern culture develop a protean self, a sequential and fluid self-characterized by ever changing involvements with people, ideas and activities. Similarly, Bauman (1997, p. 24) has suggested, “instead of constructing one’s identity, gradually and patiently, as one builds a house” late modern man constructs a palimpsest identity; “a series of ‘new beginnings,’ experimenting with instantly assembled yet easily dismantled shapes, painted one over the other” (p. 24). The restless late modern culture, ruled by short-term goals and commitments, threatens to corrode psychological character, “particularly those qualities of character which bind human beings to one another and furnish each with a sense of sustainable self” (Sennett, 1998). Flexible or short-term capitalism (p. 27) emphasize flexibility and people are “asked to behave nimbly, to be open to change at short notice, to take risks continually” (p. 9). “Failure to move is taken as a sign of failure, stability seeming almost like a living death” (p. 87).

In a world that demands flexibility in self-presentation and behavior “the most adaptive form of selfhood may be a loose confederacy of multiple self-conceptions” (McAdams, 1997, p. 51). “The hub of post-modern life strategy is not making identity stand—but the avoidance of being fixed” (Bauman, 1997, p. 89) and the most adaptive life strategy is probably a moderate and controlled form of the protean self. Some of the requirements of classical identity theory, notably the ideas of inner sameness and continuity over time and across situations, are partly at odds with the fluidity of predominant culture and experiences (Lifton, 1993, p. 26). “In our age of hyper-individualism—which stresses instant transformation, flexible reinvention and creative renewal—conventional assumptions regarding the solidity and durability of identity are increasingly disrupted” (Elliott & Lemert, 2006, p. 31). Inner plurality has become an adaptive answer to contemporary plurality of values, forms of life, and social contexts where the individual is expected to navigate competently (Bilden,1997). The essence of the protean self “is a linking—often loose but functional—of identity elements and subselves not ordinarily associated with one another,”(Lifton, 1993, p. 50). Similarly, post-modern theorists (Cushman & Gilford, 1999) have claimed that western society is moving towards a state of mind where the individual, in order to survive, must contain ‘multiple selves’ or have multiple identities. Gergen (1991) has described how late modern man develops a ‘pastiche personality.’ He becomes “a social chameleon, constantly borrowing bits and pieces of identity from whatever sources are available and constructing them as “useful” or “desirable” in any given situation” (Gergen, 1991, p. 150).

As pointed out by Lifton (1993, p. 190), the protean self is always confronted with the danger that the combination of identity elements will not cohere and there is an “ever-present danger of diffusion, to the point of rendering the self-incoherent and immobile.” ‘Negative proteanism,’ as described by Lifton (1993, p. 190), is characterized by “fluidity so lacking in moral content and sustainable inner form that it is likely to result in fragmentation.” Lifton hypothesized that commitment to proteanism may cause the person to respond to emotional problems by accelerating the shifts between fragments of identity “while clinging to an illusion of salvation via perpetual transformation.” It is interesting to note, how descriptions of contemporary social character and life strategies resemble those we find—in more maladaptive forms—in borderline patients. Some of the severe identity problems found in borderline patients can be understood as pathological forms of prevailing life strategies and strategies to handle important identity themes that have become out of control. Identity diffusion can partly be conceptualized as a radicalization of the protean self or pastiche personality where flexibility and perpetual shifts between different identity elements have become maladaptive and pathological.

This idea of the Protean Self I find interesting. The concept of being different people in different situations; mirroring or projecting but they make it seem like it’s a conscious effort. I’ve never noticed any real conscious thought going into things when I’ve found myself mirroring or projecting (which is what this reminds me of but to a more extreme degree). Being in character(s), for different people, in different places.

One of the things that differentiate pathological identity diffusion in borderline patients from ‘normal’ identity problems in late modernity is the borderline patient’s inability to integrate the multiple identities and assemble the many identity fragments in a coherent identity or self-narrative.

In conclusion, one must assume that dynamics in late modern society will contribute to a rising prevalence of borderline personality disorders. (Or simply the fact that we have a booming population and more dysfunction families.) Additionally, cultural changes have made it increasingly difficult for people with borderline disorders to navigate and act competently in daily life. (I’m not sure I entirely agree with this statement either. BPD is a spectrum of lower-to higher functioning and it’s the higher functioning of us that don’t always come out of the psychological closet to get help so how do you know? When would it have ever been easy for someone with BPD to navigate daily life?) Contemporaneous with the weakening of outer structures that hitherto stabilized and gave meaning to life, the need for a strong, stable and mature personal identity has been radicalized. As a consequence of this, borderline patients and others with identity deficits will experience difficulties of increasing severity. They have not developed the inner psychological resources, which ‘normally’ compensate for the consequences of liquidation of social institutions and those cultural practices that generate meaning. Therefore, they urgently need durable social structures and normative social roles to stabilize the self. (Normative social roles? No. Stable social roles. Yes. Sometimes I think that people that have never lived outside of normative society shouldn’t write about cultural pressures.) When the access to such stable outer structures is limited, they will experience more serious difficulties in navigating and making necessary choices of daily life than hitherto experienced. The German sociologist Niklas Luhmann (1968) has argued that trust is an important psychologically founded mechanism to reduce social and societal complexity. In order to live and flourish in late modern societies one must be able to rely upon more or less anonymous others and social systems, and its representatives. The conception of the world seen in borderline patients, however, is typically based on mistrust. Because of deficits in basic trust and fundamentally insecure attachments, borderline patients do not have access to essential psychological resources in their attempts to handle social complexity. Instead, they are overwhelmed by the complexity they experience and recourse to primitive defense mechanisms and invalid attempts aimed at reducing complexity (idiosyncratic understandings of the self and interpersonal processes, simplistic models of the world, etc.).

As if it were a choice ::sigh::. It is often very overwhelming.

In order to understand borderline pathology and identity diffusion in particular, we must operate on at least three different levels. In our future investigations we must focus on how borderline pathology is related to:

(1)   individual vulnerability and resilience (rooted in genetic, temperamental and historical factors);
(2)   current strains, including traumatic experiences, loses and normal developmental transitions; and
(3)   tendencies in contemporary culture that affect human psychology and impede the normal development of human identity.

Hitherto, our understanding of borderline conditions have focused almost exclusively on the first two levels, while our understanding of possible connections between elements of contemporary western culture and identity diffusion have either been ignored, or confined to theories of limited specificity. Given that modern psychoanalytic theory (and psychology in general) represents a sustained endeavor to understand human experience and psychopathology in specific social and cultural contexts, it is essential for our ongoing attempts to understand borderline pathology that we try to appreciate how borderline pathology is related to elements of contemporary culture. We must look beyond the problems of the individual borderline patient to the social structures that aggravate or even contribute to the creation of his or her problems. This will inevitably imply that clinical theory and psychotherapeutic practice acquires/reacquires a distinct moral and political dimension (Jørgensen, 2002). In addition to this, some of the symptoms and dysfunctional behaviors seen in borderline patients reflect elements of late modern culture and could be of significance for our ongoing attempts to understand the problems and experiences which confront humans living in late modern culture. Therefore, we should not only try to integrate theories of contemporary culture in our understanding of the borderline conditions, but also acknowledge the invaluable information concerning contemporary culture that we have access to when we work with borderline patients.



Well I think it’s pointless to only study the impact of Western culture when people in Eastern, Middle Eastern, African, Asian, Australian, Southern Hemisphere, etc cultures experience BPD as well. Egads. BPD is not just an American and European problem.

Don’t get me wrong, I do think culture does have an impact but I don’t think you’re going to get an accurate representation of how it’s affected by culture if you limit your cultural representation. I would think that you would want a cross cultural representation to find similarities between cultures that could contribute. Something along those lines.


So I’m not sure how I feel about this last installment. I think it’s seriously underwhelming and a lot more research and care in the research needs to be done. And no more of this needing Normative stability crap. There is no norm, no normal, no normative. Get rid of that concept. I think that concept of “normal” is part of the problem. 



Snarky Haven is snarky today. 


Monday, August 5, 2013

Disturbed Sense of Identity in Borderline Personality Disorder: Part 4

Here’s the part that I get really interested in. Psychological Causes for Identity Diffusion. I know many of you are probably more interested in how to strengthen a flexible and weakened identity. We’ll get to that when I’m done with this series (Hint: Tomorrow is the last day).

Carsten Rene´ Jørgensen, PhD

PSYCHOLOGICAL CAUSES OF IDENTITY DIFFUSION




Apart from the primarily descriptive conception given above, identity diffusion can be viewed from at least two other perspectives: namely a developmental and a dynamic perspective (Akhtar, 1992). Developmentally, identity diffusion is often related to problems in the growth and maturation of basic trust(Erikson, 1968) and insecure attachment(Bowlby, 1988). Identity diffusion has been conceptualized as the result of problems in the separation-individuation process, especially the rapprochement sub-phase of early childhood (Mahler, Pine, & Bergman, 1975) and the second individuation process in adolescence (Blos, 1979). The common psychological tasks of these two critical periods in human development, characterized by a heightened vulnerability of the personality organization, are centered round an endeavor to disengage and separate from inner (internalized) and outer objects. Adaptive transformation and maturation of the personality organization occurs as the result of a normal separation-individuation process. If the process fails, separation, individuation and disengagement from internal and external objects is replaced by a maladaptive polarization of them (Blos, 1979), or alternatively a complete detachment from inner and outer objects. Masterson (2000) has speculated that the significant others of the future borderline patient are unable to support the child’s emerging self during the rapprochement stage of individuation. Malignant interactions with significant others are internalized and give rise to separation anxiety and abandonment depression, which will inhibit self-activation and development of personal identity. Similarly, insecure attachment and deficits in the development of basic trust inevitably inhibit the establishment of a stable and mature identity.


As described by Blos (1979, p. 148), “the incapacity to separate from internal objects except by detachment, rejection, and debasement is subjectively experienced as a sense of alienation” and emptiness. During the normal separation-individuation process, attachments to significant inner and outer objects are maintained at increasingly mature levels. Up to adolescence, parental egos will normally be available to the child and—in assistance with social structures—give organization and structure to its ego.

Normally things should happen this way, as we know though, this isn’t how things typically go for us.

In adolescence this alliance is disrupted and “ego regression lays bare the intactness or defectiveness of early ego organization” (Blos, 1979, p. 157).

Adolescents with problems in the first separation-individuation process and resulting deficits in personality structure will be more vulnerable to problems in the second individuation process and more prone to develop a maladaptive, diffused identity. Identity diffusion can manifest itself throughout childhood but because childhood normally occurs in a relatively structured and protective environment, the symptoms of identity diffusion usually become evident when, in the course of adolescent development, the structure of the parental home environment decreases (Kernberg, 2004) and demands from the environment increase.

So parents may notice things in their smaller children that could indicate something off or unusual behaviorally, but odds are it won’t be until adolescence, when things become a little more unstructured, a little more unpredictable, that it becomes very apparent that something is actually wrong.

The development of severe and persistent identity problems in adolescence is the result of several interacting factors, including genetically determined traits and behavioral dispositions, individual vulnerabilities (structural deficits, etc.), immediate strains, and insufficient support from the environment. Similarly, problems in attachment relations must be understood in their social and interactional context. The strains of modern life affect the family and significant other’s ability to contain and react appropriately to the patient’s behavior. Parents who are under great stress, unemployed, socially excluded, divorced, etc. are often disadvantaged when it comes to taking care of children and adolescents. Moreover, “development is determined by the dynamic interaction between the child’s individual temperament and the environmental experiences and demands which the child encounters” (Thomas & Chess, 1977, p. 35). Healthy development depends upon a ‘goodness of fit’ between temperament and environment. ‘Goodness of fit’ describes the degree to which “the properties of the environment and its expectations and demands are in accord with the organism’s own capacities, characteristics, and style of behaving” (Thomas & Chess, 1977, p. 11). From an interactional perspective, environment and temperament are not independent entities. Temperament or constitution and environment are not necessarily constant over time, they constantly interact and can modify each other in a dialectical process. Especially in infancy, parental responses are significantly influenced by whether the child has the temperamental constellation of what Thomas, Chess, and Birch (1968, p. 75ff) has called the ‘difficult’ or ‘easy’ child.

It is reasonable to hypothesize, that biologically based deficits in self and affect-regulation and biologically determined temperamental dimensions like high harm avoidance and, especially, high novelty seeking (including impulsiveness, disorderliness and easily being bored), which have been related to borderline personality disorder (Svrakic et al., 1993, 2002), in many cases destabilizes attachment relationships in childhood and adolescence and—secondarily—contributes to disturbances in identity development. The environment will often experience children with temperamental traits like these as difficult and react in ways that are negative and have adverse effects on the psychological development of the child. Similarly, character dimensions such as low self-directedness and low cooperativeness, often found in borderline patients (Svrakic et al., 2002), are likely to compromise social relations in adolescence and adulthood and destabilize personal identity. Additionally, parents under great stress are less likely to be able to handle ‘the difficult child’ in ways that are ‘good enough.’

No chance to turn out well. Sorry. 

As I’ve said over and over ad nauseum… nature AND nurture. Yes there is a biological element that predisposes us to a certain temperament, however, that temperament can be abated or exacerbated depending on the environment and how we are encouraged by our environments.

Start this next paragraph thinking about lack of object constancy and consistent sense of self and sense of others (the jargon is confusing).

Psychoanalytic theory has related identity diffusion to the presence of un-metabolized introjection and an insufficient integration of contradictory identifications and representations of self and others. Deficits in evocative memory imply that the BPO-patient does not have the access to memories of good objects, which is required for self-soothing and continuous stabilization of the self. Absence of a good, reliable and caring other, or an accessible representation of one, precipitates the loss of a coherent sense of identity (Westen & Cohen, 1993). In addition to this, cognitive development has an impact on the level of differentiation and integration of personal identity (Harter, 1999) and one could speculate that splitting and incoherent identity sometimes are related to not only dynamic processes but also cognitive immaturity. Cognitive development is also related to factors in interpersonal relationships and contemporary culture. As argued by Harter (1999), developmental changes in cognitive processes during adolescence “typically require greater scaffolding by the social environment in the form of support, experience, instruction, as so on, for individuals to function at their optimal level.”

A diffuse sense of personal identity can be related to deficits in the ability to mentalize (Fonagy, Gregely, Jurist, & Target, 2002). The ability to mentalize represents a capacity to understand one’s own and others’ mental states, that is to say thoughts, needs, feelings, wishes, and intentions.

Furthermore, it is the ability to attribute mental states to the self and others and thereby gain a valid understanding of one’s own character and behavior and the behavior and personal character of others. Competent mentalization enables the person to predict behavior and reactions of the self and others. This capacity for symbolic representation and valid understanding of one’s own mental states (and the mental states of others) is an essential pre-requisite for a sense of identity (Bateman & Fonagy, 2004, p. 85). Those who lack this ability “will lack an authentic, organic self-image built around internalized representations of mental states”(p. 85) and they are unable to predict and understand reactions and behaviors of the self and others. Failures in the capacity to mentalize is manifested in several ways, including “poor organization of self-states leading to a breakdown in the sense of identity that is rooted in the appropriate interpretation of subjectivity” (Fonagy, Target, Gregely, Allen, & Bateman, 2003, p. 442).


What this means is that it being able to understand how others perceive us, helps us understand ourselves. So if we don’t have a clear understanding of how to interpret others reactions consistently, our own perceptions will feel unfamiliar and even vaguely hostile. Everything will always be up for interpretation and nothing will feel firmly implanted or steady.

The capacity to mentalize is developed in early attachment relations. In order to develop a coherent and stable sense of identity, people need to feel understood, validated, accepted and mirrored by significant others in their subjective experiences. Accurate, consistent and clearly ‘marked’ (Bateman & Fonagy, 2004) mirroring of the constitutional self contributes to the development of a coherent and stable sense of identity. Conversely, inaccurate, inconsistent and insufficiently marked mirroring from significant others impedes the development of a sense of identity that is coherent, consistent and clearly differentiated from others. One could assume, that identity diffusion also is related to what Fonagy and colleagues (2002) has called the pretend mode of experiencing in which fantasy and conceptions of the self is fragmented and cut off from the real world and the ability to mentalize is compromized. Pretend mode is marked by simultaneously held contradictory beliefs (Bateman & Fonagy, 2006, p. 8).

Individuals with an insufficiently developed capacity for mentalization will experience interpersonal relationships and find the world in general as unpredictable and frightening. They will often need to use controlling and manipulative strategies to establish a coherent sense of self (Bateman & Fonagy, 2004). Through projective identification and other primitive defense mechanisms, parts of the self are evacuated and attempts to control these parts of the self ‘in the other’ are initiated. Transactional defense mechanisms, like these, inevitably jeopardize interpersonal relationships.

Genuine intimacy is only possible if issues of identity are reasonably well resolved and interpersonal relationships are not dominated by attempts to construct or stabilize one’s own identity or ward off parts of the self.

In some cases identity diffusion can be related to the development of a ‘false self.’ In an attempt to survive defective self-object experiences, repetitively experienced empathic failures, lack of validation, and the insufficient attunement of significant others to the needs of the self, the borderline patient submits to expectations from the environment and his or her self-concept becomes dominated by projective and invalid representations of the self, internalized in interactions with significant others. When this false self is weakened, as often happens in successful psychotherapy, it is revealed how the false self has been part of a (pathological) defensive strategy, established in an attempt to organize and stabilize the self and to protect the ‘true’ or constitutional self. Typically, what is found ‘behind’ the false self or foreclosed identity (an identity chosen and imprinted on the self by significant others) is for the most case emptiness and a profound inability to answer psychologically important questions like: ‘Who am I really, if I am not the person others have always told me that I am?’ ‘What do I really want and need?’ ‘What are my personal boundaries?’

Deeply seated identity diffusion has been masked by a false self and when this false self is peeled off, in the course of psychotherapy, the underlying identity problems are revealed.

So the ‘false self’ is either meant to be a protector or is a projection developed because the real self is so weakened that that the person just subverts the ‘real self’ and adopts the identities that they think others need them to be.

For me, most of my flexible sense of self issues have been more of sense of protection, protection from abandonment. Structure, stability, these things I’ve reached for and tried to cling to until I was practically choking the life out of myself!

So what do you think? One last installment in this series…. 

Tips from the Borderline: Take A Vacation

I'm back from vacation and I feel better than I have in ages! Which has inspired this tip: 

Tip: Take a break from the real world as often as possible. 

But there's more to it. 

Do it without people that stress you out.... away from places that stress you out. Sometimes that not entirely possible as often it's family that stresses out out, but maybe arrange to take a day or an evening to yourself or whatever you can. 

This was probably my first real vacation in almost 2 years. I had time off last year, but it was spent mostly with family (stressful/triggering) and spending time running around doing stuff for Zoe's wedding (fun but busy busy busy!!!). This was all for me and soooooooo relaxing and fun! Exactly what I needed. 

Let's face it. We often live high anxiety, high stress lives. Who needs a break from it all more than us? If you can manage it, take advantage of vacation time. 

This is what I woke up to every morning! 


P.S. Bigger, better, Real post to come and we'll finish up that series I had started. 
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