Crossing Borderlines: Theory-Building with Fonagy and Associates

P-HOLE Lecture #3

Welcome back! Let’s roll.

We’re going to start out in a slightly different register today. You’ve read what I think is a compelling work of theory from Fonagy et al; it doesn’t read like the sort of theory many of us like best, aesthetically speaking, but it’s powerful theory-building nonetheless. Fonagy et al are helping us understand, from first principles, the genesis of borderline personality. In so doing, they are illuminating fundamental processes that shape how one becomes a person, a subject. There are lessons for all of us in the story of how the borderline person comes to be as they are.

And, importantly, there is room for improvement. The theory that Fonagy et al develop in this pair of papers presents us with an opportunity to synthesize our emerging theory of social character across biological, psychodynamic, interpersonal, social, and structural levels of scale. Fonagy et al are sincerely interested in social processes, but they only really consider the social at the smallest level of scale, that is, the interpersonal. What happens when we ramify their framework out to considerations of how large-group dynamics influence the development and operation of the self, in personalities generally and in putatively disordered personalities in particular? They are holding some pieces of the puzzle; we are holding others. My ambition—and it is ambitious!—is to put the puzzle together today, or at least find all the corner pieces and build a frame that we and others can continue to fill in.

[But first—we realized that, given the vast diversity of the P-HOLE audience, it was important to slow down and explain common understandings of what borderline personality is from first principles. We spoke about McWilliams’ understanding of the developmental levels of personality organization, neurotic to psychotic with borderline as the knife’s edge between; the DSM’s faulty understanding of borderline personality; ways in which attachment theory more generally can help us see different shades and variations of borderline character structures, stemming variously from ambivalent and disorganized attachment. We spoke about the role of self-directed violence, like self-injury and suicide, in the defensive and communicative structures of people with more “severe” expressions of borderline personality. This teed us up to think deeply about the argument Fonagy et al make about the etiology of borderline personality]

Let’s start with a review of what I take Fonagy et al to be arguing. Most broadly, they are encouraging us to understand borderline personality not as a problem of individual psychology, but as a problem of social relations. There are aspects of the subjectivity of the person we can call borderline, characteristic vulnerabilities that are extreme examples of more universal difficulties. But these vulnerabilities are activated in the context of social relations; they are the product of how people were (mis)treated in their past, and they are evoked in the present by particular relational dilemmas. The problem does not reside in the borderline person; it resides in the interstitial space between that person and the world, in the ways in which they are primed to experience the world and the world is primed to experience them. The solution to the borderline predicament—Chaim, is that your phrase, or did I make that up? I don’t want to do the thing where Freud plagiarized Fliess thinking he’d made up his own thing!—operates primarily at the level of social relations.

But again—Fonagy et al make this argument based on only the narrowest understanding of social scale. They propose solutions to the borderline predicament that operate only relationally, and really at the level of the relational encounter between an expert professional and a borderline patient. Surely we can be more imaginative, think bigger!

What do Fonagy et al demonstrate about the social causation of borderline personality? Here’s my best effort at a synthesis.

We are only able to develop due to our facility with social communication. At the most basic level, attachment bonding is an exercise in communicating to the infant (via actions like feeding, soothing, eye contact) that they are, in the first place, a being. And not only that—a safe being, a loved being, a being that is seen and understood and cared about. A being who matters, matters to somebody.

Preverbal social communication is the stock in trade in a parent’s relationship with the infant. The infant, language instinct or no, must rely for communication on ancient neurobiological systems of preverbal communication, the modes of communication available to our prehominid ancestors before they developed language. This preverbal communication is spoken about in psychoanalysis in various terms—as transference, as projection. I like Kernberg’s phrasing of communicating on channels two and three, but I want to update it for the 21^st century. In psychoanalysis, when we talk about preverbal (i.e. transferential, i.e. projective) communication, we are really talking about AirDropping.

I expect most of you know what I mean. Your iPhone is capable of zapping contents from its “brain” directly into the “brain” of another compatible phone, provided the other phone is set to accept these communications. This is, basically, how our brains work; an actual neuropsychoanalyst would balk at how much I am oversimplifying, but they can suck it. We use our mirror neurons to AirDrop mental material into the brains of others; any of you who have been in psychoanalysis have probably experienced how uncanny our ability to do this can feel. Once the information is AirDropped, the receiving party needs to use a wide range of cognitive skills to interpret this information and decide how to make use of it. This sense-making process is what Fonagy et al describe as mentalizing.

The capacity to mentalize is innate, at some elemental level, in humans, but we are not all equally adroit at it; indeed, some of us find it extremely challenging, whether in specific situations or in general. When we are babies, we lack the cognitive capacity to make sense of the things that are AirDropped into us, so they float around in our heads as fragments, pre-sense. Different psychoanalysts describe these fragments differently; Bion spoke about these as beta elements, more contemporary thinkers use the language of unformulated experience. These are inherent to the experience of infancy.

The best-case scenario is that an infant’s caregiver will be excellent at mentalizing, and this will have numerous salutary effects. Because they can mentalize themselves (i.e. make sense of their own experience) effectively, they are less likely to AirDrop their own unformulated material into the infant, although to some extent this is inevitable. Its inevitability, not incidentally, is also what Avgi and Ann are theorizing as the enigmatic sexual kernel of all of our genders. Infants are adaptable; they can deal with some degree of unformulated experience, because they must. But there are limits.

When a parent is too challenged or disorganized, when they cannot make sense of themselves or the infant, the infant is left adrift in a storm of beta elements, without anyone to exert what Bion calls alpha function—that is, no one to make sense with them, no one to digest what they cannot. These limitations, in the parent, create a breakdown in social communication. In the midst of that breakdown, the infant is left alone with more than they can bear, and they often come to experience the social situation itself as very frightening, because it is in the social relation that they receive the AirDrops. Of course, the absence of the social relation is no less frightening. They are in what Bateson famously called a double bind.

Bateson thought that double binds like this cause schizophrenia; that has proven to be incorrect. They do, nonetheless, cause a more fundamental psychosis, an inability to make sense of or connect with social reality without major injury or sacrifice. Breakdowns in social communication cause the infant to be unable to securely attach, and this in turn requires them to develop some profound compensatory strategy. They have to learn to deal with the parents they have, by any means necessary.

This task is so monumental, and the little person tasked with it so limited in their abilities, that it can only be done in a brutally inflexible way¹. The infant cannot risk curiosity, because curiosity means novelty, novelty means uncertainty, and uncertainty means danger. They cannot hope for a different outcome than the usual; they must always plan for the worst.

Last week, as I was preparing for today, I also happened to be teaching Bion’s Attacks on Linking. This line leaped out—“The disturbance of the impulse of curiosity on which all learning depends, and the denial of the mechanism by which it seeks expression, makes normal development impossible.” Fonagy et al have empirically confirmed what Bion understood from clinical experience. The infant who is insecure or disorganized in their attachment style has had their curiosity corrupted, made dangerous; it has broken the essential evolutionary function of human curiosity, which is to make us better at exploring and learning about our environments and the other people in them.

Importantly, this curiosity is a more recent evolutionary adaptation on our part, and the nature of the evolution of the human brain means that older systems act as failsafes, remaining in place for when newer brain structures and capacities become impaired. Your P-HOLE colleague Ava Hoffman has described the human brain as consisting of “haphazard stacks.” What we see, in the development of insecure or disorganized attachment, is the top of the evolutionary stack—curiosity—falling off.

It’s here that we need to return to Fonagy et al’s notion of epistemic trust. Curiosity and epistemic trust go hand in hand. For the infant to hazard curiosity—and “hazard” is the right word—they need to trust that their caregiver is an honest broker of important information about the world. They need to believe that the parent knows what their feelings are, what is safe and unsafe, in order to begin their own stepwise exploration of the wider world. The security of the parent as a base is not just in their ability to maintain a safe holding environment; it lies in what Winnicott, writing of the characteristics of the good enough mother, described as handling and object presenting, the ability to introduce the infant to experiences and information that they need.

The parent’s struggles with effective social communication produce a breakdown in epistemic trust. If that breakdown is prolonged, not effectively repaired, the infant’s capacity for epistemic trust collapses. That is why they cannot sustain curiosity, tolerate novelty or uncertainty, and the like—because they do not trust themselves, nor do they trust the parent. In this state of epistemic mistrust, in Fonagy’s terms, they revert to an older mode of mammalian relating, one more in the middle of the haphazard stack—wariness.

The wary mammal is in an adversarial, insecure relationship with its environment and its fellows. It is too nervous to learn, because learning requires receptivity to new information, conveyed socially, that in turn requires a quality of psychic openness to the other; learning requires you to have your settings open for AirDrops. Because the infant received a bunch of scary AirDrops—think gore, porn, horror—from the unconscious of the disorganized parent, they learn, Pavlov-style, that the ding that signals an AirDrop is to be feared, and that they must try very hard not to look at (that is, recognize or interpret) what follows the ding. The ding causes them to dissociate, usually, or to find some other way to flee from what they experience as the internal stimulus.

A word about the ding. Fonagy et al describe a key facet of social communication as involving what they call, chunkily, “ostensive communicative cues.” These are the question marks and exclamation points and italics and underlines of interpersonal communication; they signal, at a brain level, things it is especially important to pay attention to. For the insecure or disorganized infant, their persistent experience has been that they receive an ostensive communicative cue, and what follows is something horrible, like an AirDrop of parental lasciviousness or terror or rage. They therefore become conditioned to resist or ignore ostensive communicative cues. In later childhood and adulthood, this takes the form of the person learning to “turn off” mentalizing in the context of particularly close relationships, ones that resemble the original traumatic relationship, and/or in particularly challenging situations, i.e. ones which resemble the circumstances or experiences of the traumatic relationship.

This resistance or ignorance of ostensive cues is adaptive in the moment; it’s harm reductive in real time. But, as a strategy for living in the world, it is terribly ineffective². It makes it impossible to be receptive to social learning, which in turn makes it impossible for the growing child to develop the resources they need to live in an ever more complex world. One of the key capacities they lose out on is what Fonagy et al call reappraisal—once they have read a situation one way, they cannot reevaluate it in light of new information, because there isn’t an easy way for new information to get in. For these and other reasons, they become developmentally stunted, in the manner that all psychoanalysts of all theoretical persuasions have observed deeply injured people become developmentally arrested or fixated—because at a certain point, they ceased to be able to learn, and they are therefore stuck with some fundamentally infantile modes of understanding and relating to the world.

Anyone who has struggled with borderline ways of relating, whether personally or interpersonally, knows this dilemma too well. All this early life trauma has conduced to a very pronounced rigidity—rigidity in thought and schema, rigidity in emotion and (re)action. The flexibility that is supposed to counterbalance our human tendency to rigidify our personalities has not developed, because we learn that flexibility through the trust, rupture, and repair of reasonably good attachment relationships; in their absence, we ossify.

The piece the borderline person contains is the difficulty with epistemic trust that leads to epistemic hypervigilance, lapsed mentalizing, and a concomitant rigidity in cognition, affect, and behavior. But these traits don’t emerge in a vacuum, of course, we’ve now seen where they came from. And we can see what sorts of social situations precipitate them—situations full of ostensive communicative cues, demands for mentalizing, uncertainty, stress, and challenge. Because these things characterize many normal situations, the borderline person is being hit in their weak spot constantly. And, when they react in the only way available to them, it is difficult for the other person (or people, or institution) triggering them not to respond, self-servingly, in a pathologizing or hostile way that reinscribes the borderline person’s basic adaptation.

For Fonagy et al, borderline is a socially produced problem that requires social solutions. Their mode of treatment, Mentalization-Based Therapy, is a relational project. The therapist’s primary role is to mentalize as well as possible; respond well to their inevitable failures to do so and to effectuate repair as much as possible; and offer themselves as a kind of test dummy for the patient, someone to mentalize (often poorly) without inviting major social consequences, in order to learn how to do so more effectively. This requires considerable flexibility, honesty, and self-criticism on the therapist’s part, because the patient will inevitably mentalize all manner of things the therapist would probably prefer not to cop to (e.g. hate in the countertransference; erotic countertransference).

I am more or less a believer in MBT, as a psychotherapy practice. I think the evidence is compelling, the theory is pretty sound, and that it makes certain theoretical improvements on psychoanalytic understanding of essential issues, e.g. in recognizing that transference can, in fact, contain a substantial degree of cognitive distortion, and that it can be constructive for the therapist to correct the distortions when they can be confident that’s what they are, rather than simply letting the transference play out indefinitely, which I think can be cruel to borderline patients in particular. I also think that it is afflicted with a failure of a sense of scale and a sense of imagination.

Team MBT make a consistent mistake—when they want to address the social, they become technocratic, proposing acronymic, patented, institutionally-based psychosocial interventions. They are seeing like a state, in the words of James C. Scott—or, rather, seeing like state-funded researchers. They don’t really talk about political ambitions; they talk about AMBIT. Their solution to alienation from the social system is a keyworker (case worker, in the United States) who quarterbacks their interactions with other state institutions. They recognize, in principle, that we need friends, fellows, solidarity, esprit de corps, in theory, but nowhere, to my knowledge, do they engage the kinds of social movement theories—like anarchism—that actually have ideas for how to operate at this level of scale.

Here’s where I think we’re holding the other pieces of this puzzle. We’ve spent the last two weeks exploring issues of social character as they relate to character disorder, considering the role of large-scale social, political, structural, and historical forces in shaping human characters. We do not really have the room here to fully develop the argument for how these larger-scale forces bear upon the psychodynamic and interpersonal ones that Fonagy et al describe, but I think we can at least identify the corner pieces of the puzzle and begin to fill in the edge.

The theory Fonagy et al are developing concerns how infants become traumatized by the lapses and failures of their caregivers. This necessarily implicates all the background conditions that conduce to these lapses and failures. Why, in other words, are children abused and neglected in ways that contribute to the insecure and disorganized attachments that precipitate adult personality disorders?

This is hardly a mystery. Fonagy et al note that higher levels of wealth inequality are correlated with higher levels of personality disorders, and all personality disorders are rooted in attachment insecurity in early life. Numerous factors could be said to influence that correlation, but several jump out at me. People who are more economically precarious are more vulnerable to abusing and neglecting their children; economic precarity is hugely stressful and humiliating, and the beta elements of stress and humiliation tend to flow downhill towards whichever target is the most socially vulnerable (which children always are). And—when I speak of economic precarity, I am not just talking about being objectively poor, I’m also talking about the pervasive fear of falling (to quote Barbara Ehrenreich) that characterizes staunchly capitalist economies and often afflicts the professional-managerial classes especially acutely.

I used to practice at a community mental health center in an unusual town that had a lot of public housing and also a lot of millionaires and billionaires. [There ensued a story of me staging a, shall we say, private anal-expulsive protest on the lawn of one such billionaire, which I expurgate for reasons of self-preservation]. One pattern I observed clinically is that abusiveness and negligence towards one’s children seemed to be fairly evenly distributed across class status, but that it was especially pronounced at the extreme ends of the scale. It seemed obvious why those with the least resources would also be the least resourced and primed to act out. I came to realize that, in order to win the capitalist game well enough to buy a multimillion dollar mansion in this rich town, one often had to, at minimum, act antisocial much of the time, and that a lifetime of acting that way can amount to a personality disorder in its own right. In other words, the rich parents were often rich because they could be comfortable being abusive and negligent, and it was then no great surprise that they struggled to treat their children differently.

Capitalism is a low-trust system in numerous respects. As compared to anarchist forms of social relations that tend to operate on systems of gifts, credits, and sharing, capitalist systems rely on immediate and narrowly defined transactions. Think of how rarely you get to operate on an IOU in your day-to-day life that doesn’t just indebt you to others with interest; think of the difference between a credit card and the account I have at my local hardware store where the owners are my neighbors and friends. The normative modes of relating and transacting that make life possible under capitalism all presuppose a lack of trust; is it so shocking that, within our families, trusting becomes difficult?

All of this is to say that capitalism creates conditions that conduce to the abuse and neglect of children by making most every class feel a sense of precarity (real or imagined) that creates a mental burden of stress and humiliation that it is too easy to inflict on one’s children. How are you to make your children feel secure in the world if you struggle to feel secure yourself? It is not impossible, but it is very difficult.

One might also ask—how are you to help your children cultivate epistemic trust when you yourself are constantly subjected to epistemic fuckery? We are increasingly living in epistemically destabilized societies, because it serves the interests of certain empowered cohorts in our societies to destabilize our shared sense of what is true. To wit—we are in the frightful situation we are with climate change because of massive propaganda campaigns waged by fossil fuel interests, and those who rely on them, that sought to drastically distort our collective sense of reality, so we wouldn’t realize we were going over a cliff, and then so we would believe we couldn’t do anything about it anyhow.

This amounted to a kind of epistemic arson that emboldened other malign actors. Our current fascist regime in the United States has found, like other fascist regimes before it, that the demolition of a sense that one can know what’s true, let alone agree on it widely, is a winning strategy if one wants to divide and conquer. Epistemic violence and psychological warfare have been the tools of authoritarian destructiveness since, I suspect, forever, but we are living with a particularly invidious version right now. Epistemically speaking, bullshit is the order of the day under fascism.

Epistemic trust is not just vital at the interpersonal level; it is vital at the larger societal level. When you begin to build a society that relies on various forms of epistemic violence in order to fulfill will to power, you put all of us in an environment in which our epistemic trust is compromised, and in which epistemic hypervigilance and rigidity become understandable effects. Psychic equivalence reigns under fascism—I feel it, so it must be so. Propaganda, paranoia, are operating in what Fonagy et al think of as the pretend mode.

In this respect, living in authoritarian capitalist societies makes all of us more like the borderline people Fonagy et al describe, but many of us are fortunate enough to have arrived in this version of reality late enough in our development that it cannot fundamentally mess with the development of our brains in the manner it does for borderline people thus afflicted in early life. But we might wonder, and here I think our friend Chaim Rochester points us in the right direction—is it perhaps that borderline people are just the canaries in our societal coal mine, dying (psychically or literally) in a way that shows us what ails all of us?

I do not wish to argue that there was some halcyon era during which everyone agreed on facts because Walter Cronkite said we should, that is bullshit. To say that our epistemic environment has been degraded badly is not to say that it was amazing before. And indeed, speaking from the vantage point of the United States, my society has always had profound epistemic dilemmas because of its sheer diversity, and because of the ways in which it has always been organized along authoritarian lines for many minoritized groups.

Familial attachment is just one important opportunity of a myriad of different social learning opportunities. Children don’t just live in their homes, they live in society. In a pervasively anti-Black social context, Black children are liable to get all sorts of epistemically untrustworthy information about themselves from authority figures throughout their growing up. Your teacher’s ostensive communicative cues—the sigh, the raised eyebrow, the sneer—do much to injure Black and brown youth. Per Vaughans and Harris, the willful inability to mentalize Black and brown boys, in particular, is a frequently fatal failing of white police officers and other authority figures. So it is for queer and trans kids; we receive countless signals that we are reprobate, disgusting, unlovable. This is well known to have a devastating effect on our psychological health, to traumatize us.

To have a marginalized identity is, for the most part, to have a childhood in which this kind of epistemic violence is a feature.

1. Winnicott would call it ruthless.

2. This also echoes what Marsha Linehan argued about self-injury in BPD. In the moment, it works a treat! As a long game, it sucks, because you fail to actually solve your problems and just anaesthetize yourself instead.