The Books Objective

Lawson’s book takes a psychodynamic look at Borderline Personality Disorder, particularly in relation to mothering. Lawson outlines the effects on the children of “borderline women”, of the borderline’s intense separation anxiety and hostility in relation to abandonment and criticism. She creates a taxonomy of borderline subtypes, and examines the behaviours typical of each, and how their intense all consuming emotional co-dependence can be transcended by their children. The borderline world as depicted by Lawson is a frightening one – leaving little space for concrete reality or emotional reliability – threatening to annihilate the child, and passed on through the intergenerational transmission of pathology (pp4). The borderline experience is an expressionist one – where internal reality is far less vivid than interior drama, cognitive distortion, overwhelming emotion and paranoia.

The Book’s Usefulness for Therapists

The typology of borderline subtypes described by Lawson provides a way of understanding presenting symptoms, and client childhood experience in therapy. She vividly coveys the volatility and splitting of borderlines and their typical preference for one child over another; since the disturbed relationship they had with their own mothers makes parenting a uniquely difficult relationship for them (pp5). Borderlines ignore the ordinary social norms and boundaries that prevent us from emotionally (and physically) assaulting and manipulating those close to us, feeling threatened to destruction by their children’s growing independence (pp9, 40). Lawson specifies a typology of borderline mothers – based on which internal feeling dominates their experience – the Waif (helplessness), the Hermit (fear), the Queen (emptiness), the Witch (anger) (pp39).

The Waif is a lonely, victimised, addictive, self-denying, anxious, hypersensitive fantasist, her helplessness concealing rage at her neglectful childhood (pp57), alternately indulgent and neglectful of her own children. The waif seeks help, but cannot accept it, since her helplessness is a basic protection (pp58). Her children can become caretakers or exploiters (pp3), and her self-destructive extremes may be aimed at them (pp68).

The Hermit is introverted, defended, controlling, driven, hoarding, perceptive, defensively hostile and terrified (pp80). Incapable of close relationships, possessive, projecting guilt and relying on ritual, signs and meanings to ward off fear, the hermit may leave her children denigrated, lacking a certain sense of reality, and incapable of autonomy (pp83). Unsafe alone or with people, the hermit is vulnerable to deep isolation and inner persecutory rumination (pp84, 89). Her paranoia may fixate on disease and illness, or the dangers of the world (pp96, 97).

The Queen seeks attention, is entitled, ambitious, manipulative and volatile, preoccupied with loyalty, status and possessions, and seeks external validation to ward off her all consuming inner emptiness (pp102) and worthlessness stemming from emotional deprivation (pp105). She may use her children as symbols of her attainment, invade their privacy and split from them and others when challenged (pp114).

The Witch creates for others a prison of fear (pp121), out of her punitive cruelty (pp138). She feels persecutory envy, derives self-esteem from other’s fear (pp128), born out of submission to childhood sadism (pp131) and a fundamental belief in her own evil nature and the badness of others (pp137). Her children may be subject to invasion, betrayal, denigration and humiliation (pp131, 141); and may respond with violence, self harm, emotional instability and mental illness (pp132). The witch’s ‘annihilatory rage’ at abandonment may become psychotic, resulting in violent or sexual abuse, or even the murder of her children (pp123, 140). The witch can be a state, rather than an identity, a more extreme aspect that may lie dormant in the other borderline persona (pp130). Lawson’s description of the witch is close to the DSM diagnosis of anti-social personality disorder (related to, if distinct from) psychopathy (DSM, 2000).

The inconsistent parenting environment borderline mother’s inner chaos and acting out engenders, leaves their children with a basic existential insecurity (pp8), accompanied by feelings of chronic anxiety, guilt and rage (pp 18). Lawson cites evidence of the long term neurological damage and stress vulnerability accompanying this inner experience (pp14, 49). Children can easily internalise the shaming and guilt projected onto them by their borderline parent (pp16), a concept elaborated by John Bradshaw’s concept of ‘toxic shame’ (Bradshaw, 1988). She compares BPD to Post Traumatic Stress Disorder, as an acquired, neurologically deficit reaction to intolerable external turmoil, neglect and abuse (pp49). This strongly suggests that a combination of medical, psychological and behavioural interventions may be the most effective treatment for BPD. Lawson argues that the psychotherapeutic component of borderline treatment may need to be lifelong management rather than cure (pp50).

Lawson’s depiction of the childhood of children of borderline parents – exposed to the whirlwind of emotional demands, invasion and manipulation, and even psychosis (pp25); should help us be more empathetic to their suffering and uncontainable emotions in adulthood.

Although it’s not the book’s emphasis – the portrayal of the dynamic cycles of destructive behaviours and dissociative responses that develop in families, both exaggerating and normalising the behaviour of a sick parent (and often resulting in the labelling of the child as the ‘identified patient’), is valuable (pp29).

The explanation offered for the father’s passivity in the borderline mother’s exploitation – either schizoid distance or co-dependent narcissism, helps to show how pathological family dynamics can obscure / permit the destructive behaviour of one partner (pp179). However the subtypes Lawson provides of men who marry borderline women are defined more by their relation to the borderline, than their internal characteristics.

What use would you make of it as a practitioner?

Lawson’s citation of Otto Kernberg helped me understand how clients are motivated to avoid the painful cognitive dissonance of their contradictory love and hate feelings about themselves and their borderline parent – and how this can motivate paranoid-schizoid splitting (pp14).
It’s useful to remain aware of the facade that borderlines can create – of efficacy and normalcy, obscuring the pain of their interior worlds and their family life (pp20, 40). I would look for the unstated, implied reality behind criticism of others and emotional turmoil.
Working with young people, I would be more aware of the potential familial strife and dichotomous labelling underlying self harming behaviours, hypervigilance, anxiety and negativity (pp21, 170).

Working with adult clients, I would be more sensitive to cycles of abuse / remorse (pp155), the ‘turn’ (pp133), rapid switches in emotional valence and relating, threats of suicide etc, in response to perceived betrayal; as cues to a potential borderline state. In treating borderlines, and their children – I would seek to ameliorate the effects of their invalidating, denigrating childhood (pp46), by modelling tolerant, reflective containment.

I found the concepts of the ‘all-good’, ‘no-good’ and ‘lost’ child – children treated as projective elements of the borderline’s split internal object relations, (153) useful in understanding roles within the family dynamic. I question Lawson’s conviction that the ‘all-good’ child is necessarily protected from disorder & likely to become a professionally successful, guiltily self abnegating caretaker (pp163, 165). It seems just as likely this child’s lack sense of self and agency could result in passivity and dissociation, or a pathological inability to tolerate the impositions of others. Indeed the ambivalent nature of borderline object relations is likely to lead to children with polarised internal good-bad self representations / object relations – evidenced by the higher prevalence of disorganized attachment in children of borderline mothers (Middelton-Moz, 2006). Similarly, I question the inevitability of borderline development in the ‘no-good’ child. The behaviours Lawson describes seem valuable, but the rigid categories are questionable.

Lawson suggests the validation of dialectical behavioural therapy as an effective treatment for the internalised degradation of borderlines (pp51), I’m interested in learning more about this form of therapy which has shown efficacy in the treatment of this disorder (Palmer, 2002).
Lawson’s recommendations on the treatment of borderlines and their children are pragmatic, and help to explain the fear many clients have of dependency (pp202). She recommends teaching the children of waifs how to support without attempting to save their mother (pp203), by being emotionally direct (pp206, 210), setting boundaries (pp213), and learning to understand their mother’s exaggerations and cognitive distortions, projections, unreliability, negativity and manipulative use of guilt (pp217). Teaching adult children to behaviourally condition their borderline parent into more healthy norms, she suggests, can improve their relationships and independence (pp218). Finally, by reconnecting with their own feelings, they can gain a more certain sense of self (pp224).

In dealing with the hermit mother, her children must manage their reactions to her projected anxiety and fear (pp230), tolerate her distortion, denial and ambivalent treatment (pp233), as well as her paranoia, isolation and rituals (pp 235). Learning cognitive problem solving strategies can help them manage their introjected anxiety (pp238). Some adult children may need to project themselves by cutting off the borderline parent altogether, all will need to create and maintain healthy boundaries (pp241, 244).

Children of the Queen need to resist the urge to curb her excessive behaviour, while developing their separateness and sense of self, and resisting her invasiveness (ppp251, 255, 262). They must set limits on their obedience – while preparing for potentially severe and even psychotic retaliation (pp254). They must resist being pushed into inappropriate financial and emotional indebtedness, or manipulates into family arguments.
Lawson is less encouraging about the children of the Witch, who struggle with feelings of annihilation, and internalised degradation (pp273). Feelings Lawson compares in their severity to that of holocaust survivors (pp275). Their rage may become suicidal or homicidal, and protecting themselves from their mothers provocation may necessitate separation (pp278). These children need to heal the severe defilement they have been subjected to, and avoid giving in to the desire for revenge (pp282). If they cannot, physical illness and potentially severe psychological disorder will result (pp289). They need to learn to manage their interaction with the witch parent, to protect themselves and provide the opportunity for escape (pp285).

The experience of the children of borderlines is one of being disbelieved (pp 298), of being made to feel unworthy. Lawson argues that long term depth psychotherapy can help to rebuild at strong self identity, at a neurocognitive level through synaptic plasticity (pp304), and an interpersonal level, through love.

If you were writing this book, what would you add/subtract?

No space is given in the book to critiquing / reinforcing the construct validity of borderline disorder or personality disorders in general. These disorders are highly co-morbid, and their objective reality has been questioned (Clarkin et al, 1992). Lawson points out that men with ‘borderline’ symptoms are more likely to be violent, and dealt with via the criminal justice system (pp xv), but fails to address the complex social and cultural factors that frame criminality and psychological disorder – demonstrated by the fact that American has the highest incarceration rate in the world (Tsai & Scommegna, 2012), and the overwhelmingly risk and worse outcomes of maternal poverty in mental illness (Saraceno & Barbui, 1997).

The social components that defuse or exacerbate borderline tendencies, whether it be family culture, or social stratification, are largely unexamined. This is particularly relevant with regard to the powerlessness of women historically, Lawson cites Silvia Plaith, Mary Todd Lincoln and other historically noteworthy women, doomed by their gender to exist in the shadow of their husbands. Lawson takes an easy out, arguing that borderline males are more likely to be ‘treated’ by the criminal justice system, but later describes abusive males as ‘borderline’ (pp155). If this is the case, it seems likely that a borderline parent of either sex, can be as damaging an influence.

Lawson argues for the utility of loving relationships (in meeting emotional developmental needs) as a resilience factor in traumatised childhood (pp43). She frames the typology of borderline as pathological attempts to satisfy unmet childhood needs. It would have been useful to have had a more thorough examination of the many and varied resilience processes that have been found to underlie healthy emotional and cognitive functioning; and how they can be supported in the therapeutic work. Nonetheless, the concept of the ‘invalidating environment’, and the compulsive search for unmet needs are useful (pp26).

As I read Lawson’s book, I’ve been working with a client whose mother fit Lawson’s profile of the Hermit mother almost exactly. This served as empirical confirmation of the books typology, and helped me understand the childhood experience and ‘no-good’ internal world of the client. Although Lawson’s classification of borderline subtypes seems to lack research backing – its vivid depictions and many examples from client journals really do help to understand the almost unimaginable suffering experienced by the children of borderline parents.

Any other comments?

Borderline Personality Disorder has been criticised as a patriarchal concept (Bjorklund, 2006), both because of its relatively high diagnosis in women, and its reinforcement of negative female stereotypes (emotional liability, narcissism, helplessness etc). Although Lawson doesn’t suggest that men do not suffer from the disorder too, by focusing primarily on the borderline mother, she arguably reinforces this perspective.
Similarly, the effect of cultural norms on the development and expression of borderline traits remains unexamined. This is relevant because the model of a separate adult child navigating a relationship with an aging parent, while maintaining their own nuclear family, is unique to Westernised cultures. Lawson’s explanation of the frustrating effects of self help texts, abdicated from behavioural change and individual understanding, is useful (pp263). With its emphasis on positive adaptation to the results of borderline parenting, Understanding the Borderline Mother makes a welcome change from defeatist accounts of personality disorder. Lawson vividly conveys the agonisingly imprisoned inner lives of borderlines and their children.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Bjorklund, P. (2006) No man’s land: Gender Bias and Social Constructivism in the diagnosis of borderline personality disorder. Issues in Mental Health Nursing. Vol. 27(1), pp3-23.

Bradshaw, J. (1988). Healing the Shame that Binds You. USA: Health Communiciations.

Clarkin, J.F., Marziali, E., Munroe-Blum, H. (1992). Borderline Personality Disorders: Clinical & Empirical Perspectives. UK: Guilford Press.

Lawson. C.A. (2004). Understanding the Borderline Mother. Helping Her Children Transcend the Intense, Unpredictable, and Volatile Relationship. USA: Jason Aronson.

Middelton-Moz, J. (2006). How a Mother with Borderline Personality Disorder Affects Her Children. Graduate Student Journal of Psychology. Vol. 8.

Palmer, R.L. (2002). Dialectical behaviour therapy for borderline personality disorder. Advances in Psychiatric Treatment. Vol. 8, pp10-16.

Saraceno, B. Barbui, C. (1997). Poverty and Mental Illness. Canadian Journal of Psychiatry. Vol. 42, pp285–290.

Tsai, T., Scommegna, P (2012). U.S. Has World’s Highest Incarceration Rate. Population Reference Bureau. Retrieved 25th April, 2012
Available: http://www.prb.org/Articles/2012/us-incarceration.aspx