Borderline personality disorder:

A mal du siècle?

Sonja Snyman and Robyn Fasser

The aim of this article is to contextualise borderline personality disorder within broad societal processes, and to ask the question whether it is a mal du siècle or illness of our times. More specifically, the processes refer to (1) the shift away from a modern paradigm to a postmodern condition and the concomitant effect of fragmentation on the individual and family; and (2) the move to return mental illness to the fold of society away from the conceptual binary of health/pathology. The hope is that by taking cognissance of the current context, which is mirrored in borderline personality disorder, the mental health professionals’ understanding of the disorder and repertoire of interventions will be broadened.

Introduction

In academia and in popular Western culture there is much debate about what postmodern is and whether it is a useful concept or just a fad. Whatever the outcome of this debate, most writers agree that contemporary society differs radically from the pre-World War II modern world of control, predictability and truth. They point out that as a result of continuous accelerated transformation, momentous changes are taking place that distinguish the present moment from the previous modern one (Gottschalk, 2000). It is our contention that these changes have brought about a condition in which the questioning of the basic modern belief in certainty, progress and grand projects and its social sequela has created a context in which a psychological disposition is emerging that is more open to fragmentation than the previous search for essence and stability.

Modernism, postmodernism and mental illness

In order to understand this shift, both the modern and current postmodern contexts need to be investigated. The modern paradigm is based on objective knowledge, absolute truth, a subject-independent reality and the quest for developing isolated areas of expertise in order to uncover the foundations of this reality. The modern view of mental illness is consequently causal and deterministic, and pathology is viewed as an "object" or something "alien" (Fee, 2000) that can be isolated and studied through “dispassionate positivist inquiry” (Foucault, 1965, in Fee, 2000). More specifically, the modern view of mental illness as an object has created conceptual binaries of normal/abnormal and health/pathology to the exclusion of the "real" contexts in which these perceived dichotomies exist.

Furthermore, in the endeavour to develop a science of human behaviour, specific treatable syndromes are isolated and demarcated, and in the process a language of pathology has came about: a new vocabulary has entered our language, drawing attention to specific problems and incapacities, and thus colouring our understanding of human behaviour. Gergen (2000, pp 14-15) explains: “As psychiatrists and psychologists try to explain undesirable behaviour, they generate a technical vocabulary of deficit. This language is slowly disseminated to the public at large, so that they too can become conscious of mental-health issues … The new vocabulary enters the culture, engendering still further perceptions of illness, and so on in a continuous spiral of infirmity.” Examples of this include the way in which constructs such as depression or obsessive-compulsive disorder have become commonplace vocabulary in Western conversation; or how individuals, with the help of internet sites, "diagnose" themselves and others quite indiscriminately according to whichever pathology they happen to stumble across while surfing.

At the heart of postmodern thinking lies its challenge to the modern paradigm. Where modern thinking saw knowledge as independent and objective, postmodern thought acknowledges the entwinement of knowledge and social conditions. Specifically with regard to mental illness, the postmodern tenet is to shift the focus from pathology as something "out there" to the contexts in which it "lives" and in so doing to “reconnect the pathological to the rapidly shifting material, cultural and psychosocial realms of life” (Fee, 2000, p 3). A case in point of how the official nosological classification (DSM) reflects societal thinking is the inclusion, or not, of the category "homosexuality". Until recently homosexuality was classified as a diagnosable and treatable pathology. In line with changes in thinking regarding sexual identity, it was left out from the revised edition of the DSM and is no longer "officially" viewed as a pathology.

By returning mental illness to the fold of society, the reciprocal nature of discourses on health and pathology are brought to the fore. As such, concomitant struggles and changes within the society in which they manifest are connected to various mental illnesses (Fee, 2000, p 13). By suggesting that “different epochs and societies foster distinct types of mental disorders in its members” (Gottschalk, 2000, p 18), both the modern aetiology and reification of pathological categories are challenged. If “every age develops its own peculiar type of pathology” (Lasch, 1978, in Gottschalk, 2000, p 19), then one can ask what psychological correlates and expressions are currently evident. And, to use Lyotard’s term (1984), one can ask: Is there is a postmodern condition and if so, what is it?

 

 

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