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The Courtship Dance of the Borderline — A Review

Thursday, August 1, 2002

by Anthony Walker, M.D.

ISBN: 0-595-19712-4

Paperback, $13.95 US

Rewritten and republished as The Siren's Dance

About 2% of the general population is estimated to suffer from borderline personality disorder (BPD) defined by DSM-IV 301.83. If that estimate is in the ballpark there are roughly 4 million adults in the United States affected by BPD. Currently 75% of all diagnosed cases are female and psychiatrists have told me they've never seen a male borderline. While the 75% female ratio is probably somewhat affected by the fact that women seek therapy more commonly than men, available data suggest between 2.5 and 3 million American women suffer from BPD.

BPD patients comprise about 10% of individuals seen in outpatient mental health clinics and roughly 30% of psychiatric inpatients, and comprises between 30% and 60% of clinical populations with personality disorders. Though some have claimed successful treatment of this disorder, most regard it as untreatable. While the majority of individuals with BPD attain more stability in their relationships and vocational functioning as they enter their 30s and 40s that is not to say they are cured.

The courtship dance begins as the author is making his rounds as a medical student at Johannesburg General Hospital, South Africa, in August, 1984, shortly before he graduates. And nowhere have I seen the human side of BPD better portrayed.

Jacqueline is a 22-year-old single white female who is in the hospital because she attempted suicide in response to the breakup of a previous relationship. She was known at the time to suffer from BPD and the diagnosis is never in doubt.

He picks Jacqueline, who is never described as anything but beautiful, for a case presentation he must give as part of his training. He is planning on, and in fact ends up in a career in psychiatry.

She exhibits the wild, uninhibited sexuality that such women often use to attract the attention their disorder requires. He is young and idealistic and believes he can help her. As he later jokes, he is thinking with the wrong head.

They elope when he finishes medical school a few month later and move to Windhoek in the Namibian desert, where his destruction of self begins. The loss of one's own points of reference in such relationships is breathtakingly captured.

This will be a hauntingly difficult book to read for anyone who has ever lived with someone they loved who suffered from mental illness, or watched as their beloved went mad. But such readers will probably find it as cathartic for them to read as it was for the author to write.

Characteristics of BPD include inappropriate, intense, often uncontrollable anger, a proclivity for intense relationships, and fear of abandonment. Jacqueline exhibits all of these. Individuals with BPD also show frequent displays of temper and are involved in recurrent physical fights that they almost always initiate. When Jacqueline was angry she threw things, punched her husband, bit him (one time to the point he required stitches and a tetanus booster), scratched, and kicked him. He would dodge, block, run, and sometimes attempt to restrain her. On such occasions she would scream bloody murder and tell others he was attacking her.

Because all of her previous boyfriends (she became sexually active at 13) had ended up hitting her, she makes him promise never to hit her. But, as the marriage continues while he faces the incredible demands of a medical internship, one evening he comes home exhausted after having been up for more than twenty-four hours and goes to bed. Jacqueline attacks him in his sleep with scissors and he slaps her, shocking them both. Of course, today in America he would be immediately arrested for domestic violence for such an act and her behavior would be excused as "self defense."

By the time Jacqueline nearly puts out his eye with some keys on a ring toward the end of his internship he has decided the relationship must end or her behavior must change.

If this sounds familiar to many of you, it is. Currently the Equal Justice Foundation receives at least one request for help a week from a man in a relationship where the most likely diagnosis is that the woman suffers from borderline personality disorder. Sadly, under current laws, the only advice we can offer is to get as far away from the woman as he physically can, as quickly as he can, and stay away. We also suggest he review Erin Pizzey's description of an Emotional Terrorist (see Chapter 12), where she makes the same recommendation.

Infidelity, or the threat of infidelity as used by Jacqueline, are common in such relationships and we continually encounter cases where the woman has filed charges of domestic violence against her partner to cover up her sexual transgressions.

In the courtship dance, Dr. Walker is able to escape from Jacqueline by taking a residency in Boston and leaving South Africa, where he goes on to become a psychiatrist as he originally planned.

After leaving Jacqueline he exhibits the virtually universal symptoms of post traumatic stress disorder (PTSD) found in such cases, e.g., p. 126 "...I jumped and startled when the phone rang or a car backfired," as though he were shell shocked.

But most men we hear from haven't such options. And because the male is always blamed for the violence, most of them have been arrested and imprisoned for crimes their partners committed. And sometimes these men have lost control when attacked, as did Dr. Walker, and struck back. The most common report, though, is that they were simply trying to defend themselves, or restrain her.

The situation is most tragic when the couple have little children because the borderline personality will lash out at anyone around them when they are angry. So oftentimes we hear from men who were trying to protect their children from a mother who has gone mad. Yet when the police were called, he was arrested and jailed. And because of the DV charges (he's male, he's guilty) she will be given custody of the children and he will only be able to see them during supervised visitation (for which he pays) for several years, if ever as family courts in such cases frequently deny all contact with their father. In the meantime, the children are the only ones left for the mother to vent the anger inherent in her disorder upon. But, one can rest assured, any signs of abuse of the children will be blamed on the father or her new boyfriend.

Dutton, 1995, p. 140-155, and Gelles, 1997, p. 80, among others have found that borderline personality disorder (BPD) is strongly associated with male battering of women. Despite the fact that BPD is predominantly a female disorder, I am not aware of any research linking BPD with women battering men, though we certainly have plenty of stories of such. But advocacy research, political correctness, and feminist ideology don't admit of the fact that women assault men as frequently as the reverse. With 2.5 to 3 million American women suffering from BPD we certainly have sufficient numbers of women to more than account for all the reported abuse, however.

While America has largely reverted to the barbarous practice of warehousing the mentally ill in jails, where family violence is involved we ofttimes now imprison the sane one if he is male. And without benefit of any semblance of due process or civil rights. We cannot long continue these practices and survive as a free nation.

Charles E. Corry, Ph.D., F.G.S.A.

References

Dutton, D. G., with Golant, S. K., The Batterer, A Psychological Profile, Harper Collins, 209 pp., 1995.

Gelles, R. J., Intimate Violence and Families, 3rd Ed., Sage Publications, Thousand Oaks, California, 202 pp., 1997.

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