Does the mode of “failure to mentalize” determine the ineffective behavior of the borderline?

A few days I got a comment on my post “How mentalization and attachment might explain ‘high functioning’ Borderline”. The comment was from a self-proclaimed “quiet borderline”. I have gone back and forth on this blog, through posts and comments alike, on whether the term “high functioning” or “invisible borderline” is a myth, a reality or a made-up category. As I said in “The Myth of the High Functioning Borderline,” I have yet to discover a researcher or clinician using these terms. Until now. Dr. Margaret Cochran guest-blogged on Randi Krieger’s “Stop Walking on Eggshells” blog and used both terms (invisible and high-functioning). I really don’t know what her familiarity with BPD is, but that really doesn’t matter. The combination of the comment I received and her post made me think about how mentalization failures translate into ineffective behavior and how the type of mentalization failures that are prevalent might explain the different “categories” (or levels of functioning) of someone with BPD.

Before I go into this, however, I would like to note something about my (unscientific) polls. I have been told that by certain “experts” in the non-BPD area that this “quiet”, “invisible” or “high functioning” borderline is much MORE common than the (presumably) “loud”, “visible” or “low functioning” borderline. Except… my poll numbers don’t bear that out. I really assumed that these poll numbers would reflect that the “invisible” borderline was more common. However, what my numbers show is that around 75% of borderlines report suicide attempts, substance abuse and self-injury. There seems to be an assumption that there are many, many invisible borderlines, suffering in quiet desperation and known only to their loved ones (and themselves – maybe). I’m not even going to bother to go into the assumption that there are also a large percentage of borderlines with NPD too. Personally, I think this is a fallacy (that there is a large %) and, although there are some for sure (even though my comments reflect that the borderlines feel that these ways of thinking are at opposite spectrums), the skills to effectively interact with someone with BPD and someone with NPD are not the same. I focus on what I think are the vast majority of borderlines – those without NPD.

Now back to the mentalization failures:

Pretend Mode – I believe that this mode is the one in which my commenter was operating often. In pretend mode, you have a sense that you are “faking your way through it” and that you’re pretending “as if” things are ok. This is also the nature of bull-shitting and with BPD, people seem to be able to bullshit their way through about anything, including therapy, relationships, and careers. This mode seems to be the “default state” of the quiet/invisible/high-functioning borderline. However, as evidenced by my commenter, that view of the borderline is from the outside only. From the inside, they feel fake, alien and on the verge of a breakdown and as she says: “I should say the appearance of ‘all is well’ has been going on since then [her in-patient stint]”. It’s all about appearances. For me this can cause the non-BPD to lack compassion for the borderline, because the non-BPD feels that the borderline can “turn it on and off”. What’s missing in the understanding of the non-BPD is the inner view of the borderline which is why in When Hope is Not Enough, I focus on internal features of the disorder (shame, emotional dysregulation and impulsivity).

Psychic Equivalence – this is the “feelings = facts” mode, in which the contents of the borderline’s mind are equivalent with the outside world, other’s thoughts and reality in general. It seems to cause the raging, the paranoid thoughts, the “you’re being mean to me” (on purpose) behavior, and the suspicious behavior, such as stalking, badgering and accusation of affairs, accusations of evilness and “black splitting”. The borderlines that spend a lot of time in psychic equivalence are the aggressive ones (to others). It seems to be the “what if” (in a very negative, “waiting for the other shoe to drop” variety) way of thinking.

Teleological – this is when only physical manifestations of support and soothing matter. Teleological modes seems to manifest in cutting and other forms of self-injury (I bleed so I can stop the hurt), over-deserving behavior (like over-spending, “I deserve a new dress even though I can’t afford it”), and demanding of physical examples of being soothed, such as sex, moving to a new place (“if only I lived in X place, I’d feel better”) and demanding of new things (“if you really loved me, you’d buy me a car”). It causes a very concrete and inflexible way of thinking in which only physical demonstration of self-worth matter.

While each borderline is different and probably spend time in each of these modes, the “default” mode (or conditioned mode) of thinking seems to affect the behavior of the borderline. At least this is what I am postulating regarding the question of “invisible” versus “visible” borderlines. Comments are welcome. For more on modes of thinking (according to me) click here.