Are people diagnosed with BPD too needy? A grief and trauma perspective.

People with this diagnosis often find it intolerable to be alone, and many often reach out to others for help, support and connection more than may be considered socially acceptable. A lot of judgement and shame are often directed towards people diagnosed with 'Borderline Personality Disorder' for how much they tend to need others and how much they struggle to be alone, and, in fact, much of treatment aims to help people with this diagnosis become more self-reliant and develop more internal coping resources.

And, yet, we can't divorce this diagnosis and its pathologising of needs for external support from the hyper-individualistic nature of the neoliberal capitalistic culture that gave birth to it.

When someone diagnosed with BPD is in distress, they're mostly encouraged turn to their distress tolerance or emotional regulation skills. But what about turning to others? What about turning to relational support for distress? How often does treatment encourage them to turn to others when in distress and how much does it encourage turning to skills and individual resources?

How much does ‘BPD treatment’ measure 'progress' or 'recovery' by your ability to move through distress or crisis on your own?

I've spoken a lot about the individualistic nature of the BPD label, and how we can see it, in many ways, as a pathologising of collectivistic values. A lot of what we consider to be 'disordered' about people with this diagnosis is their 'excessive' needs for others, their difficulties feeling safe on their own, and their extreme distress and frequent suicidality. But in a collectivistic society, how much is 'too much' when it comes to needing others? How 'disordered' would it really be to feel suicidal, empty and depressed if you lack close, meaningful connections in your life? In a collectivistic culture, would struggling to feel safe on your own, particularly as a trauma survivor, really be seen as pathological?

Western culture is highly individualistic, encouraging self-care, independence, and individual pursuits of our needs, such as our need for safety. But this way of being in relationship with one another is not the only way. We have had societies that were much more relationally-oriented, rather than oriented around the self, and, in a society like that, would people with this diagnosis really be considered disordered? Or would their suffering be considered a natural result of their profound disconnection from others? Would they be encouraged to have their needs met almost entirely through individual means, or would society also look to what was missing in that person's life?

I also want to add some more context here to the suffering that people with this diagnosis face. I want to remind us that people diagnosed with BPD are often also carrying quite a lot of trauma and grief, and, in other cultures, these experiences have been historically processed in community.

In Western culture, we are taught that healing from trauma is a primarily individual pursuit, and we are also often taught to suppress our grief or to process it 'quickly' and just move on with our lives (see the DSM diagnosis of 'prolonged grief disorder' or the very short periods of 'bereavement leave' people are often granted). Grief is something we're not encouraged to take the time to tend to, and when it goes on for too long, it becomes pathological.

Western [Eurocentric] values also don't place much significance on community when it comes to healing from trauma or tending to grief, and it's hard to separate its cultural responses to trauma and grief from the ways that people diagnosed with Borderline Personality Disorder are expected, by and large, to heal from their suffering on their own.

In The Smell of Rain on Dust: Grief and Praise, Martín Prechtel illustrates the communal nature of responding to grief in a Native American community, and juxtaposes it to Western society:

"real communities are a necessity for people to grieve in a real way. In a real tribe there are no secrets; everybody knows everything about everybody and in exaggerated form. They simply aren’t ashamed of their changeable proud natures. Are there any real communities like that in the modern condition? Where your love of whom or what you’ve lost could fully praise what you miss with real grieving that isn’t just some vacant “unloading” in an anonymous therapy group? Maybe there are. But for most people they are left alone to swallow their grief and “just get on with it.” Terrible."

Grief is something often held by community in many Indigenous cultures-- and folks diagnosed with BPD are often carrying immense grief. Grief for loss of friendships, for the family that they either lost or never had, grief for who they could have been had their trauma not intervened, grief for the lives they could have had, grief for what their parents went through, grief for loss of home, and, for some, grief for loss of culture and ancestral ways. So much grief. So much for one person to be expected to carry.

What if instead of there being something "wrong" with people with this diagnosis for needing others so frequently, so intensely, their need for others are instinctive ways of seeking out what can help them heal? What if those needs for others, often deemed excessive or disordered, are a desire for community support to help hold their grief? I especially wonder this about people diagnosed with BPD who come from collectivistic cultures. 

Both of these things can be true: no one wants to find it intolerable to be alone, of course, and we also naturally need others. When grief and trauma are tended to in very individualistic ways in our culture, it makes sense that folks seeking ongoing support for both are considered to be doing something 'wrong'.

What if instead of trying to "heal" people out of their need for others, through skills and distractions and reframing their thoughts, we worked towards building a much more relationally-oriented society? We acknowledged the ways that we're often forced to rush through grief? Or to process trauma on our own or only through therapy?

Is this one relationship enough to help people hold the weight of years, maybe decades, maybe centuries of grief, when we consider ancestral grief as well?

Is this one relationship enough to hold us through the severity of our trauma, including the ongoing trauma of living under oppression?

Or do people need much more relational support than just one therapist can offer? Do we also need networks of support?

What would 'Borderline Personality Disorder' look like in a world that isn't in such a rush to 'move on' from their grief, but that acknowledges that grief is sacred, that grief is a normal and necessary part of life? That allowed people the time to be with their grief, and that honoured the fact that people often need community to do so?

I know that we're taught to see everything that's 'wrong' with people diagnosed with Borderline Personality Disorder, but what if instead of the individual, we looked to what was wrong with a society that is organised around capital and profit, instead of community care and support, as well as a chronic disavowal of their own pain and grief?

"To not grieve is a violence to the Divine and our own hearts and especially to the dead. If we do not grieve what we miss, we are not praising what we love. We are not praising the life we have been given in order to love. If we do not praise whom we miss, we are ourselves in some way dead. So grief and praise make us alive."

- The Smell of Rain on Dust: Grief and Praise, Martín Prechtel.

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