diagnosed with Borderline Personality Disorder have a reputation for being
extremely difficult, impulsive, explosive, and angry people. It makes sense
that growing up with a parent who exhibits symptoms of BPD would also be
difficult. This book explains how BPD is experienced from the child's point of
view, discusses short- and long-term effects on the developing child and adult,
and sets out ways to heal from a chaotic, confusing, and frightening childhood.
a general self-help book, it has some redeeming qualities. The purpose of this
book, according to the authors, is to help readers "identify patterns that
affect your life today" (p. 27). To this end, the book has sections called
"Stop and Think" and numerous exercises that can be useful to
readers. For example, one exercise asks readers to think about characteristics
they had as a child that helped them build resilience. The authors say,
"If what you read resonates with your experience, and the exercises get
you thinking about new ways to handle vexing belief systems and behaviors, we think
you'll benefit, regardless of a formal diagnosis (or lack of one)" (p. 6).
This claim is especially relevant to the second half of the book, which offers
some practical suggestions for change that apply fairly generally to problems
it is the very generality that is its weakness and, in fact, presents a serious
problem. A significant percentage of the population in the Western world has
been diagnosed with Borderline Personality Disorder (BPD). Ten percent of the
patients seen in outpatient mental health facilities and twenty percent of
those seen as psychiatric inpatients are diagnosed with BPD.
John Gunderson reports that "[I]t is easily the most widely and commonly
used diagnosis for personality disorders in modern clinical practice".
So widespread is this diagnosis that Theodore Millon has characterized
Borderline Personality Disorder as an epidemic.
(An epidemic, according to the Center for Disease Control, is the widespread
occurrence of more cases in a place and time than expected.) Medical epidemics
are quantitatively measured but, as we know, when a new illness proliferates,
the public can start seeing symptoms inaccurately. For this reason, it is
crucial that authors who want to discuss a widespread mental illness be very
careful to be precise about their subject. Readers must be reigned in from a
tendency to diagnose others.
In the preface, the authors do warn readers that
diagnosis should be left to professionals. However, they proceed to present a
list of thirty-two characteristics for readers to ask themselves "Does
this found familiar," after which they declare "If you relate to many
of these experiences, chances are you may been raised by a parent with BPD or
BPD-like traits" (p. 3). Chapter One is entitled "I Never Knew It Had
a Name." The authors discuss each criterion, give examples, and set out
what they call "take-aways"—the messages that children receive as a
result of behavior associated with that criterion.
problem with this chapter and the rest is that much of what the authors claim
about BPD parents is not unique to them—in other words, their remarks are so
general that far too many readers could conclude that they were raised by a BPD
parent. They say, "Parents with BPD may not accept responsibility for
their behavior" (p. 19), but this is true for a number of parents.
Likewise, when they give a list of "lessons" children may learn, most
items on the list can be found in any dysfunctional family. For example,
"It's unsafe to express your true feelings," "You can't trust
yourself, since your perceptions are usually corrected," and "People
manipulate; gifts come with strings attached," are rules learned in many,
many families. Parents, whether mentally ill or not, can be narcissistic,
demanding, insensitive, critical, and quite sure they are right.
are overly general in other ways as well. In a chapter on guilt, the authors
write that "People with emotional challenges may induce feelings of guilt
in others through their attempts to control their own environment and minimize
unknowns, illicit a desired result from others or a desired outcome to a
situation, or avoid taking responsibility for their actions, accepting their
own feelings, or facing their own thoughts" (p. 69). This is also true of
drug addicts. Internalized but irrational guilt, which the authors say is
"common for adult children of a parent with BPD," is common for
thousands of others as well, most of whom are not mentally ill. A readiness to
blame others or think ill of them is true for alcoholics as well as BPD
parents. Chaos in families can be caused by several different things, not only
having a BPD parent. Projection, to some extent, is just a human problem, as it
is a primary defense mechanism that people sometimes revert to. The authors never
acknowledge any of the ways their statements apply to other conditions, which
gives readers room to make inferential leaps about BPD in their own family that
may be unwarranted.
though Surviving a Borderline Parent is a self-help book and not an academic
treatise, it could have used some rigor. "Revealing the Truth"
suggests that the reader "write a letter to your parent telling your
truth" and to "write your truth" (p. 51; emphasis added). Is
truth subjective then? It certainly sounds like it here—but if that's the case,
how can an argument be persuasively made that BPD parents have done so much
wrong? Aren't they living "their" truths as well? This theme comes up
again in a chapter on "Grieving a Lost Childhood," where authors
discuss "Telling Your Truth to Family and Friends." Readers would
have benefited from an explanation of what "your truth" means in the
context of experiences like abuse or neglect. Are there no facts of the matter
about what happens in families?
section on forgiveness is not very nuanced or sensitive to the wide range of
moral wrongs possible for people to commit. The authors say "forgiveness
does not entail expressions of remorse, regret, or contrition on the part of
the person who hurt you." This rather astounding statement goes against a
significant body of literature on forgiveness that grapples with these
questions rather than merely asserting that remorse is irrelevant to
concept left unexplained is central to this book, and that is the concept of
trust. If self-trust is such an important tool for healing, it deserves at
least a definition. The authors suggest that the way to learn to trust oneself
is to "follow your feelings," which amounts to saying that you learn
to trust yourself by trusting yourself. Furthermore, if one's childhood was
really as awful as the authors are trying to portray, it doesn't seem like
one's intuition would be a very firm foundation on which to rely. The authors
do suggest that readers also check things out with their friends, but doing so
will require that readers know what being trustworthy is and how to identify
trustworthy others. No discussion of this thorny problem is offered.
books exist that discuss how loved ones can cope with a mentally ill person. An
example of a family support book for a mental illness that is successful,
helpful, and specific to the illness is Mondimore's book on bipolar disorder.
Others who want to write in this genre should draw on a model like his. As I
say, there is helpful information in Surviving a Borderline Parent, but
it is misleading in so many ways that its usefulness is undermined. I fear it
will contribute to the already-much-maligned patients who are diagnosed
with BPD and will foster armchair diagnosing that undeservedly constructs
others as personality-disordered.
2004 Nancy Nyquist
Nyquist Potter is the author of How Can I Be
Trusted? A Virtue Theory of Trustworthiness (Rowman-Littlefield Press
2002) and is currently writing a book on a philosophical analysis of Borderline
Personality Disorder, to be published by Oxford University Press.
 American Psychiatric
Association. 2000. Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition, Text Revision. Washington, D.C.: American Psychiatric
 Gunderson, John. 2001. Borderline
Personality Disorder: A Clinical Guide. American Psychiatric Publishing, p.
 Millon, Theodore. Sociocultural
Conceptions of the Borderline Personality. The Psychiatric Clinics of North
America 2002; Vol 23(1): 123-136.
 Cf. Before Forgiving: Cautionary
Views of Forgiveness in Psychotherapy. Ed. Sharon Lamb and Jeffrie Murphy. Oxford: Oxford University Press, 2002.
 Mondimore, F., M.D. 1999. Bipolar
disorder: A guide for patients and families. Baltimore
and London: Johns Hopkins