The 3 Levels of Emotions found in Borderline Personality
Pages 32-37 of John G. Gunderson's
Borderline Personality Disorder
This formulation emphasizes the degree to which the borderline person's manifest psychopathology can be understood in terms of relationships to major objects.
The term major object will be used to
refer to any significant current relationship perceived as necessary . In the following section, the borderline person's current relationships to the three levels of psychological functioning are observed. Lower levels of psychological function emerge regressively and act to preserve a sense of contact with and control over major object relationships.
LEVEL I
When a major object is present and supportive, the depressive, bored, and lonely features predominate. Here the borderline person is at the first and best level of function. It is characterized by considerable conscious longing for closer attachment but considerable passivity and failure to initiate greater sharing within the context of the relationships. There
is a capacity here to reflect on past failures and to identify conflicts and resistances realistically. There remains, however, considerable concern about the object's fragility and concurrent fears of being controlled by becoming dependent. As Kernberg (1975) has pointed out, such concerns reflect fears of projected hostility. the wary expectation of being controlled can be used as an active attempt to gain control over others. The result
is that a dysphoric stalemate exists in relationships, which is periodically disrupted by regressive efforts to provoke reassurance from the other or by progressive initiatives to acknowledge what they want and feel they need from that person more fully. Two major organizing and sustaining beliefs are "Should I want more from you, or should I be angry with you, you will leave" and "If I'm more compliant, something will be given to me that will make me invulnerable and less destructive." The nature of this "something" is generally not well defined. Behind these conscious beliefs are concerns with the destructiveness of their own aggressive wishes and wishes to find a powerful protector. In any event, the basic tension between wanting more
from the object and fearing that less will be received accounts for the sustained dysphoria characteristic of borderline functioning at this level. Within treatment contexts, these features of the borderline's personality disorder will be evident during uninterrupted phases of therapy (even more
evident in the middle of hours, and likewise when such patients are offered considerable autonomy within supportive residential treatment settings. During these periods, patients will generally be able to work collaboratively with an active therapist toward fuller affective expression and insight
i.e., accept interpretations). The resistances most commonly encountered are the patient's passive compliance, accompanied by failure to initiate contact, bring in new material, and so on. This often occurs in response to activity by the therapist that is experienced as directive or helpful. Such compliance and failures to initiate often contain a covert demand that the therapist do more. Another resistance arises after having shared
new material or affect; then the patient withdraws and becomes defiant. Such sharing is accompanied by fears that there will be a loss of control, that they will give in to their passive wishes, and that, if either of these fears is actualized, the therapist will then respond exploitatively. These represent threats to the illusion of control over the therapist which
sustains the patient on this level. The overt expression of these concerns is an increased fear of being controlled and an openly defiant posture. Within residential settings, impatience and fears of giving much gratification (secondary gain) are common feelings among staff working with borderline patients who are functioning within this level. Treatment personnel are
likely to overestimate a patient's strengths and try to stir patients into better social functioning and more independence. There is frequently a failure to recognize and interpret, especially to less verbal patients, the degree to which their passivity reflects fears of loosing control over their affects and the degree to which their compliance silently hides their
belief that their object is under their control. Under such circumstances, it is difficult to appreciate and anticipate the extreme sensitivity to rejection that becomes evident when either greater autonomy or separation is encouraged.
LEVEL II
When a major object is frustrating to borderline persons or when the specter of their loss is raised, a second level of psychological functioning and a different constellation of clinical phenomena are evident. The angry, devaluative, and manipulative features predominate. Although the affective
tone of anger is pervasive, it is only occasionally expressed as open rage. More frequently, it takes a modified form such as biting sarcasm, belligerent argumentativeness, or extreme demands. The anger is modified to alleviate fears of losing the object (in reality as well as its mental representation),
while it still communicates the wish to maintain a hold on the person. Failing this, the patient can attempt to deny the fear of loss by dismissing the felt need for the object (i.e., devaluation) or attempt to prevent loss by dramatizing the object need. Manipulative suicidal gestures are frequent under these circumstances. At its extreme, when there is danger of the anger becoming too uncontrolled, the rage gets projected onto the object and paranoid accusations occur. All of these reactions are best understood as efforts, often conscious, to control or coerce the object into staying. These issues - to feel the need for a reliably available other and to feel able to control that person - have not changed from the higher level. Rather it is the repertoire of defenses and their behavioral expression that undergo regression and are most specific to the borderline patient. These reactions continue as long as the object is still perceived as accessible or retainable. The disabling effects of anticipated loss can frequently be seen as the patient struggles to find some acceptable expression of its attendant affects. This can take the form of rather elaborate
and poorly connected affective states - giggling, bland dismissals, sudden rages, and, of course, extreme lability. The distinctive feature is the dissembled unsustained quality of the affects. Within treatment contexts, these features of the borderline's psychopathology become evident only when the treating person, or institution, has assumed the role of a major
object (i.e., is felt as needed by the patient). When the object is felt as needed, these regressive phenomena emerge whenever separations are imminent (i.e., terminations, vacations, and end of hours). They also take place within the psychotherapy hours themselves whenever the inaccurate. The borderline patient's elaborate efforts to prevent separations and sudden anger at or withdrawal from frustrations are critical features in the treatment of borderlines. These features have been a focus of most authors who have primarily been concerned with analytic therapy (Adler 1975; Giovacchini 1973; Kernberg 1968; Masterson 1972.) Under these circumstances, borderline patients will frequently dismiss a therapist's interpretative or clarificatory
efforts (i.e., to one). The therapist's primary task is to interrupt the patient's anger enough to draw attention to the provoking incident. This often requires confrontation or limit setting. Such responses address the change of feeling and attitude as a regressive retreat from some reality that the patient wishes to avoid. It preserves and calls on the patient
to utilize still intact ego functions of reality testing and self-observation. It is not that the expression of anger at the therapist's failure are not critically important in themselves; it is that the transformed rage (i.e., devaluation, manipulation, or paranoid accusations) utilizes defenses of
denial, acting out, and projection, which prevent the patient's recognition of the feeling response and its reason. I believe this helps understand why many experienced therapists have found it futile to allow borderline patients to spend much time in this preferred mode of angry expressiveness.
Once the regressive efforts are interrupted, interpretative work directed at the devaluation ("You're working hard not to know what you want" or "You're afraid to want things from me which you can't control"), the manipulation ("You're trying to exert control over me without risking that it will provoke my anger" or "You want to prevent me from being unavailable"), or the projection ("You're mad at me for not always being available" or "You're afraid of how enraged you might be with me") can be accepted and worked with. An insistent examination of the importance a patient places on the therapist's presence brings to fears of experiencing the important helplessness that
are a psychological function occurs within the therapeutic context, and while the object, the analysis of its purpose and form is a critical part of psychotherapy.
LEVEL III
When a borderline person feels an absence or lack of any major object, then a third level of psychological function becomes predominant. The phenomena during such periods include the occurrence of brief psychotic episodes, panic states, or impulsive efforts to avoid such panic. These phenomena
each represent efforts to ward off the subjective experience of aloneness (Adler and Buie 1979a) and, I would add, total badness. Under ordinary circumstances, this aspect of the borderline around - even if without any evident emotional contact, in using radio and television as hypnotics, or in heavy reliance on transitional objects (Arkema 1981; Morris et. al.
1984). Under the more extreme circumstances when there has been a loss of a specific and essential object relationship, dangerous impulsive acts occur that most commonly consist of taking drugs or alcohol. These serve both to numb the panic and to initiate social contacts. Fights and promiscuity occur under these circumstances - often assisted by the disinhibiting influence of alcohol - and reflect desperate efforts to establish contact with and to revive the illusion of control over some new object. A second major type of reaction against the experience of aloneness is a prolonged dissociative episode of either the depersonalization or derealization types. These detach the borderline person from either the reality of bodily distress or the reality of the environmental situation that evokes that intolerable distress. During dissociative episodes, nihilistic fears occur ("am I dead, has my body dissolved"), and these may give rise to self-mutilation in order to confirm being alive by feeling pain. Frequently, such self-mutilation is
accompanied by restitutive fantasies in which the absent object is either believed to be performing the act or is being punished by the act, but in either event, is still involved. These self-mutilative actions are quite different in their intent and subjective experience from the suicidal gestures that occur when ongoing contact with a specific object is still being sought.
Sometimes nihilistic ideas slip from dystonic fears to become beliefs; they then take on aspects of psychotic depressions. The conviction of being evil and nihilistic beliefs are two extremes that the borderline patient achieves when the usual defenses of action and substitutive objects are not that Kernberg (1967) refers to the borderline's very primitive underlying, generally avoided, abandonment depression as central to his formulations.
Perhaps because of the amount of interpersonal involvement and the borderline person's dramatic responsivity to such involvement, sustained depressions of psychotic proportions are unusual in borderline patients, particularly for those who are in treatment settings. Occasionally, bizarre imagery,
simple hallucinatory phenomena, or transient somatic delusions occur. The object restitutive aspect patient who developed the belief she was pregnant, or the patient who developed anal and urethral retentiveness requiring emergency room care). The most common delusional experience is ideas of reference. Not only do these project unacceptable self-judgements, they sustain a sense of involvement with nonspecific others where none exists.
The general point here is function (desperate impulsivity, substance abuse, dissociative episodes, brief psychotic episodes, and ideas of reference) represent efforts to manage the fear of aloneness and the sense of badness. This badness is related to beliefs that they have failed or wronged their object. These experiences of alone-badness and the panicky reactions to it are seldom seen within the hospital or psychotherapeutic context. As described subsequently (Chapter 7) they do, however, often come to the attention of clinicians as a reason for seeking treatment or as phenomena described retrospectively by borderline patients. Understanding the context in which they occur is important so that their recurrence can be anticipated and avoided.
Restoration
