Book Review: Borderline

Image: the cover of the book is an off white background with a pointilized ribbon of black descending down the page. In the middle in red letters is borderline. Below that inside a mustard circle with black letters is "the biography of a personality disorder." In the upper left in red is "Alexander Kriss, PhD."
 

This book was an interesting surprise. Usually going into any sort of pop psychology book I have somewhat low expectations. Part of this is because dominant culture is often woven throughout so much that it becomes frustrating. Part of it is that complex medical systems that are already problematic even at the academic level are simplified down too much. Part of it is that we sometimes get way too much of the author's bias or unethical oversharing.

The latter part ended up being a lot different than it usually is in this case. Borderline is a foray into history by Alexander Kriss that is composed alongside (mostly) a single case study. I often feel nervous about these sorts of things being shared even when identifying information is claimed to have been removed because psychological care should be 100% private. In this case though, it comes across that this was done quite thoughtfully and with consent and input from the patient whose case is at the center. There's even a clear discussion about the power dynamics at hand and if a patient can consent properly to something like this. I think the reason it works in this case is because the author is a psychoanalyst of the more classic type that spends multiple days a week over an extended period of time with their client. This results in a level of connection and intimacy that is inescapable. I found the accounts in this book to be honest in this regard as much as I can tell from the writing. The author was also open about his thought processes, mistakes, and shortcomings.

As much as my former advisors and professors would probably be disappointed, I love psychoanalysis. I love its fantastical focus on the unconscious and all of the things that we can't possibly measure. I love that it's near impossible to quantify and study like biopsychology or cognitive neuroscience, which is what most of my education was based on when I went to school for psychology.

I would say that this book is not really a biography of borderline personality disorder such that a complete beginner could pick it up and learn about it. I saw it as more of an expansion on the rather one-dimensional way that the disorder is viewed by many today. Kriss weaves together the long history of maladies attributed to women and argues that hysteria and related diagnoses of the past are older names for the same syndrome now known as borderline personality disorder. As a result, I think it will work better for folks with a foundational understanding of the current definition and manifestations of bpd diagnoses.

One of the best parts about how this book does history is that Kriss discusses the social position of the psychologists and theorists he is focused on. I went through years of school and psychology classes learning about dead men and their thoughts on the womens brains without ever learning which ones of them were slavers. We never discussed how Sigmund Freud being Jewish affected his place in the field and how he approached topics. We never discussed how American capitalism would be used to shape the direction of psychology when certain ideas arrived from overseas. There was rarely any discussion of patriarchy or privilege. Freud as a name was always attributed to Sigmund, not Anna, despite the latter having far more accurate and grounded beliefs albeit still problematic. I felt that I learned so much more about these various theorists by understanding their position in the world at the time.

One of the most surprising things to me is that Sigmund Freud, Sándor Ferenczi, and others were actually closer to reality in the beginning of their theories about why women are suffering (sexual abuse and exposure to trauma) before Freud decided to go extra misogynistic and buried his own history and Ferenczi's work. Through all of these histories, Kriss makes it pretty impossible to deny how current day treatment of borderline personality disorder isn't a whole lot better or more evolved than the treatment of Hysteria in the past. It might even be worse in terms of predicting the ability to heal because at least in the past it wasn't assumed that the patient was doomed as soon as the label was slapped on them.

Kriss also covers more modern day manifestations of care for borderline personality disorder and disorders related to traumatic experience. He has more favorable yet still nuanced takes on dialectical behavioral therapy and treatments around post-traumatic stress. He discusses as well the ways in which psychoanalytic concepts such as splitting were redefined as if they were new concepts with labels like multiple personality disorder. There is a case study he is careful to discuss with someone I would argue was manipulated by an internet "friend" into believing they have "dissociative identity disorder" and played the part. Kriss seems to argue more that people all have varying degrees of splitting into other personalities in one way or another, some of which are dysfunctional and some of which are just normal. It's more complicated than that, but that would make this a very long review.

Kriss has a lot to say about the DSM and modern day psychology centering it. Rightfully so. Something I learned in particular from this book was that PTSD being entered into the DSM was the first time that a disorder symptomology included an external event being the cause. Everything else is about problems with the individual. That is bananas to me. I knew this problematic aspect of diagnostic practices but had no idea that the environment was that absent from the DSM.

I will share one quote that stood out to me regarding how many paradigms claim we must create a new self while mourning the old one we somehow lost to a trauma or illness:
"We always add, never subtract. All the way down to the psychotic core, we can only be ourselves and the things that happen to us, that make us ill, also have the potential to serve as sources of empathy and ideas that challenge a toxic status quo."

Overall I really liked this compassionate psychoanalytic foray into the previously unknown to me long history of borderline personality disorder. I hope it will foster more empathy toward those with the label and lead to better outcomes for them and the world that we share.

 This was also posted to my goodreads and storygraph.