Dancing on the Borderline

Part 4

by Alicia Potter

The debate over BPD comes at a time of enormous change in the mental-health arena. Physiology is overtaking psychology as the popular explanation for our emotions and actions. Our inclinations toward happiness, shyness, violence, religiosity, and even divorce have been linked -- with much media fanfare -- to our genes. To judge by the press clippings, nature's got it all over nurture.

The view that brain physiology controls our mental health has been crucial in destigmatizing mental illnesses, especially schizophrenia, bipolar disorder, and depression. If mental illness is in the genes, we reason, how can it be the patient's fault?

Yet no physiological cause of BPD has been identified thus far. And without hard proof of biological causes, its sufferers are more easily dismissed. "We have this culture that believes you're either mad or bad," says Linehan. "And the idea that a person could be disordered and not be able to regulate emotions, but be neither diseased nor evil, is not a particularly American way of thinking."

In the case of BPD, the possible link to abuse clouds the issue even further. "There are kids who are abused and grow up fine. There are kids who are not abused and don't grow up fine," says Patricia Lawrence, president of the New England Personality Disorder Association and the mother of a borderline daughter with no known trauma history. "What about kids in wars? Do they all grow up to be borderline? It all depends on a person's personality to begin with."

Clinicians recognize the unfairly pejorative connotations of the BPD tag, and they've initiated a flurry of research to get borderline patients off the hook. The hope is that once BPD has been attributed to a misfired neuron or wayward chromosome, some pharmaceutical company will unveil a magic pill -- or, at the very least, insurance companies will begin covering treatment more frequently.

Some researchers theorize that BPD exists partly because of chemical imbalances in the brain; these imbalances evidently affect impulse control when stimulated by trauma. Others have linked BPD to the kind of neurological disturbance that lies behind inheritable conditions such as epilepsy and attention-deficit disorder. "My guess," says Linehan, "is that we're never going to find one thing causing it, just like we don't find one thing causing fever."

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Alicia Potter is a freelance writer living in Boston.