Professional Papers

The Borderline Personality Disorder and Gay People

(Published in the Journal of Homosexuality, volume 15, 1988. 9,800 words.)

The borderline personality disorder (BPD) is a diagnostic construct that originated in the modern psychoanalytic interest in object relations theory (Kohut, 1971). This theory proposes that pregenital problems, particularly during the phase of separation/individuation of the child (18 to 36 months of age), lead to severe personality disorders in adulthood. It is a theory that primarily implicates the mother as the culprit of the child's later problems by refusing to allow it to develop firm psychological boundaries between itself and others. She does this, it is hypothesized, by withholding love from the child if the child attempts to separate, or by over gratification at the symbiotic stage. This withdrawal produces an abandonment depression in the child, a type of depression that will be experienced throughout the child's life. The theory is an extension of Freud's description of anaclytic depression. Presumably, the child's attempt at separation is experienced by the mother as a parallel abandonment depression. As Rinsley (1982) noted, "The mother is available if the child clings and behaves regressively, but withdraws if he attempts to separate and individuate.”

Symptomatology

Perhaps the sina qua non, symptomatically, of the BPD, is the concept of splitting, whereby all objects, i.e., people, are bifurcated and identified as either all good or all bad. Good objects are safe ones, whereas bad objects are dangerous and bring on the reexperience of the early abandonment depression. This person's perception never allows for ambiguity or differentiation because that would lead to confusion, anxiety, and frustration. A bad object may change, and often does, but when it changes, it does so completely and at once, becoming good, so that the person experiences a series of alternations of perception, and hence, alterations of affect. Veridical perception of the assets and liabilities of another person is almost impossible, so that the good becomes bad, and back again. Technically, the person is said to lack object constancy. The same process is said to occur in self-perception as well, where a partial self-image inaccurately reflects the person's whole self. Therefore, the person relates to others as parts of a larger and unintegrated ego, rather than as a whole. Kernberg believes that this good/bad split was originally a simple defect of integration, which then in adulthood is used as a defense of the ego, protecting it from conflicts between libidinal and aggressive identifications.

Kernberg further stated that a person with a BPD fears his own aggression. Good objects protect the person from bad ones, so that he can't be destroyed by self-aggression. It is, therefore, a projection, and externalization of the all-bad aggressive self upon other people. While the borderline person may believe he's protecting himself from the attacks of others, he is really attempting to control them in order to prevent them from, as he sees it, attacking and destroying him. What he does not see is that the aggression he perceives in others is but a mirror of himself.

Kernberg suggested that the syndrome of the BPD is composed of four symptom groups: diffuse anxiety, multiple phobias, little constancy of sexual behavior, and impulsive and/or addictive states or both. In addition, the BPD person is perceived as compliant and dependent, but often alternates between dependency and self-assertion, depending upon his perception of the benevolence or potential harm of significant people in the environment. He further identified the BPD as a staple, yet pathological, form of personality disorder. To him the "border" was a state between neurosis and psychosis, but he also believed that under stress or the influence of drugs a transitory psychosis could occur.

In practice, people classified as borderline have tended to be quite varied, with some functioning quite well, and others holding on to the barest threads of ego strength. Therefore, Kernberg suggested a two-fold classification of the BPD into "upper" and "lower" levels. An upper BPD is one in which the principal fear is abandonment and the principal defense is clinging to another person. In the lower-level BPD, the principal fear is engulfment and the principal defense is distancing from others. The lower-level BPD person is clearly more disorganized of the two, with feelings of depersonalization and frequent but temporary psychotic episodes that include paranoid ideation. A good review of the dynamics of upper and lower-level borderline people can be read in Meisner. Through this dichotomous classification Kernberg noted that the borderline diagnosis includes an unusually large range of individuals, including those, as in the upper level, whose reality testing is fairly good and who learn to function acceptably, to those whose level of functioning is extremely limited, labile in temperament to the extreme, and in whom transitory but frequent psychotic episodes appear throughout life.

At this point even the casual reader may note that the invention of the BPD as a diagnostic category has led to diagnostic boundaries as diffuse as the people it is said to identify, and may soon be said to include an ever expanding segment of the population previously diagnosed as suffering from a variety of neuroses, character disorders, and psychotic reactions. There is potential for using the labeled as a waste bucket category for cases that are difficult to diagnose. Ziesat wrote:

If we are going to retain the word "borderline" as a diagnostic term describing this group of patients, we should be clear about which border we are referring to, to wit: Does borderline personality straddle schizophrenia and neurosis, as was originally thought, or affective disorders and character disorders? Or is it a mild form of schizophreniform illness? Or is it simply a type of affective disorder? The reason that such questions are important is that the answers may eventually point to practical treatment strategies.

It is beyond the scope of this paper to argue the validity of the BPD diagnosis, especially with respect to the etiological beliefs held by object relations theorists. As we find true of all diagnoses, we can use them as descriptors of behavior without ascribing to the etiological components suggested by theorists. That is precisely what is proposed for the rest of this paper and the case to be presented. Toward that end, we may accept descriptive statement of the BPD as a diagnostic category listed in the third edition of the Diagnostic and Statistical Manual of the American Psychiatric Association.

The essential feature is a personality disorder in which there is instability in a variety of areas, including interpersonal behavior, mood, and self-image. No single feature is invariably present. Interpersonal relations are often tense and unstable, with marked shifts in attitude over times. Frequently there is impulsive and unpredictable behavior that is potentially physically self-damaging. Mood is often unstable, with marked shifts from a normal mood to a dysphoric mood or with inappropriate, intense anger or lack of control of anger. A profound identity disturbance may be manifested by uncertainty about several issues relating to identity, such as self-image, gender identity, or long-term goals or values. There may be problems of tolerating being alone, and chronic feelings of emptiness or boredom.

The Cultural Background

What seems to this author to have been ignored by object relations psychoanalysis is the question of why the BPD has attained such prominence in the past 30 or 40 years. This question invariably suggests the introduction of cultural factors that have created environmental stressors that increase the likelihood of the kind of personality disorder we now called the BPD. This is not a unique idea. Diagnoses come and go as the times and theories change. While conversion hysteria was all the rage at one time, hardly any clinicians today meet "glove anesthesia" in a lifetime of practice. Nor is masturbation now listed as a mental disorder. In their places have gone mental disorders that were never listed before, such as anorexia nervosa and bulimia. Also listed are those behaviors, such as the sexual dysfunctions, that existed in the past but never labeled mental disorders.

The great increase in the use of the BPD within recent years is unlikely to be the product of inadequate mothering. Mothers are no less competent today than their mothers or grandmothers were in previous generations. It can even be argued that today's mothers are better educated and more knowledgeable of child-rearing practices. The effects of mothering (and, one would like to think, fathering) are certainly the foundation for adulthood. But other influences come to bear on the child that can ameliorate or aggravate the effects of early childhood. This is particularly true with respect to issues of sexual identity and gender identity. It is in these areas that our society has changed most severely, and this fact, it is maintained, is the reason for the increase in the incidents of the BPD.

Parenting has changed dramatically in the twentieth century. In previous generations parents were role models for their children, and this was as true of sexual and gender identity as it was for all other areas of adult behavior. In a sense, it was a vertical system where one generation modeled themselves after the generations that came before them. It produced stability and dependability within the family and throughout the social structure. Moral rules prescribed one's sexual behavior to a relatively small number of acts, with violations handled harshly. There were rarely conflicts of gender identity, and where they did occur, they were kept secret. For instance, there are accounts of women who led their lives as men, served in the army and in other traditionally male jobs. Their true identity was exposed only after their deaths. In a well-structured society that eschewed ambiguity, few personal choices were made, for few were required. Within the confines of such a system, the BPD was unlikely to appear because one's society created an external structure that ameliorated for family inadequacies.

Homosexuality As A Cultural Variation

Previous to the 19th century, homosexual behavior was not a significant problem for society. Whatever transgressions may have occurred, men and women (regardless of sexual orientation) married, had children, and fulfilled their social roles as parents. In 1869, the ground was broken to change all that. In that year the word homosexual (and its counterpart heterosexual) was invented. The implications of this fact are seldom discussed. Some writers have suggested that both sexual identities are artifacts of modern society. They suggest that a homosexual identity never existed before. A social role, in contrast to mere genital behavior, began to emerge for those men and women whose emotional and sexual desires were directed toward the same-sex. Confined almost exclusively in the late 19th and early 20th centuries to the realm of medical abnormality (if not curiosity), homosexual couples, what few there were, usually mirrored the social and sexual roles of heterosexual marriage, with one member of the couple playing a rigidly defined male role, and the other a female role, clothes and all. Many of these relationships lasted for a lifetime, although they would probably have been mystified by a word such as homosexual.

It was only after the Second World War that homosexual love became possible for most people, and the rise of the modern gay liberation movement created the environment that encouraged long-term coupling between gay people. Three forces combined to instruct men and women that personal choices would not only possible, but also necessary in our modern society.

Alfred Kinsey’s Research

The first was Alfred Kinsey, whose monumental sex research profoundly affected our notions of normal and abnormal sexuality. The sexual revolution that he and his colleagues helped to create is often misunderstood. The result is not that people had more or less sex after his work than before. He went after more dangerous game than the mere accounting of orgasms. He demonstrated the frequency of various forms of sexual behavior at different ages and at different socioeconomic and educational levels. The best example of this was his documentation of the normative aspects of masturbation at a time when many medical authorities still diagnosed it as abnormal, and the frequency of homosexual behavior, also condemned as pathological. From a psychological point of view, Kinsey's books were permission-giving for people to experiment sexually.

The Women's Liberation Movement

The women's Liberation Movement fought against the traditional social role of women and demanded the same opportunities as our society provides its men. Women were encouraged to join the professions and the business world, and to delay childbearing if they wished. At the same time, a concerted attack upon the traditional hard-nosed image of men was begun, and a new masculine standard was suggested, the androgynous man who developed his sensitive qualities as well as the customary masculine ones.

The Gay Liberation Movement

The changes initiated by the women's movement led directly to the modern gay liberation movement that began after the Stonewall riots in 1969. This was the third force in our discussion of sexual and social choices. The Gay Liberation Movement was at once an attack upon traditional notions of masculinity and femininity, and upon the sexual conservatism of the psychiatric profession. Gay liberation was instrumental in helping millions of gay people to come out, and in the organization of a gay service network throughout the country.

These three forces, the work of Kinsey and his colleagues, the Women's Liberation Movement, and the Gay Liberation Movement have been the foundations of the sexual revolution of the 1970s and 1980's. And this revolution, so supportive of individualism, has implicitly instructed the young that a myriad of choices are possible about one’s social and sexual roles throughout life. Models from the past have been judged archaic so that one cannot be instructed, but must learn them empirically through experience. But if the individual has been freed from outmoded social and sexual roles, he is nonetheless forced to exact a price for his freedom -- to make choices -- and this freedom invariably results in personal conflict and confusion.

One needs to remark here that traditional notions of male and female were constructive in society. Everybody knew what was expected of him or her, and knew what to expect from others. There may have been no choice, but there was certainly dependability. The reader should avoid judging this belief as an atavistic call for a return to Victorian standards. It is just the proposition that freedom is not "free,” and that some of us are incapable of creating empirical standards for ourselves and first become confused, and finally disoriented.

It is the point of view of this article that the BPD is a direct result of these changing social norms in the 20th century; that it is, in a sense, a social dilemma created by freedom.

The BPD has increased in frequency because the social structures present in previous generations have vanished. Individuals are now forced to make a considerable number of choices over sexual behavior, sexual identity, and gender. It is a task wherein a person is asked to create order out of confusion, and from that ordering of personal and social alternatives evolves a psychological structure that is the modern equivalent of the rules from, say, the Victorian era, but one that is empirically derived. Therefore, the most important responsibility for each person in today's society is to create this personal psychological structure as a replacement for the former social and religious regulations. If one fails to do so, then all subsequent alternatives will be met with even greater confusion. In those who suffer the greatest confusion, disorientation occurs and ego defenses are created to prevent total psychological breakdown. These ego defenses are the symptoms of what is now called the BPD.

This idea is not at all radical. DSM III notes that certain personality disorders "have a relationship to corresponding categories in this section Disorders Usually First Evident in Infancy." It goes on to associate the Identity Disorders of Adolescence with the adult diagnostic category of BPD.

DSM III states that the Identity Disorder is most common in adolescence, and further that:

The disorder is apparently more common now than several decades ago, however, perhaps because today there are more options regarding values, behavior, and life-styles open to the individual and more conflict between adolescent peer values and parental or social values.

What we see today from this perspective and call BPD is a group of people who are incapable of making choices and suffer confusion because of it. Most certainly childhood factors predispose them to confusion. The symptoms of BPD are unlikely to occur in loving and caring families. Disordered nuclear families are a necessary, but not sufficient, reason for the rising incidence of the BPD.

But let us now consider the life of a gay man, Gerard, and follow that with a discussion of his personality dynamics and their implications for all gay people.

The Life-Study Of Gerard

"The Train"
"It is dusk, even in my dream I can feel a cold wind blowing on my naked arms. I can remember feeling goose bumps even with my coat on. The cold seems like it will never end. I am alone on this grayish platform, with no destination. Where am I and why am I so aware of every detail of my position and yet so totally unaware of where I am? I am confused by the terrain around me.

(People enter the train and it leaves.)

"Now the trains are totally unrecognizable to me. They are definitely subway cars, but their destinations are mysterious. One goes to New London, the other to Boston. Somewhere there is a connection to 42nd Street. But I cannot remember where it is.

"I retreat to the men's room and take up residence there. The door is locked, so now I can sleep. It is safe, warm, and, when I wake up I can buy a toothbrush and some shampoo and cleanse my body.

"I awaken and try to recollect the dream. I only remember the train station and the John. And being lost. Everything is so easy, if only I could figure it out!"

Patient Information

Gerard is 32-year-old, white male, employed as an executive by a New York City firm, in psychotherapy for the past year. His entry into psychotherapy was by self-referral, and except for a brief hospitalization at the age of 14 for what appears to have been an adjustment problem of adolescence, this has been his first experience with psychotherapy. He has one brother, two years older, and a younger brother and sister. He was born into a working-class family who lived in a rural New England town. His father worked sporadically at a local mill where employment was seasonal, and at other jobs around town. There is no history of mental illness in the family.

Gerard is gay and has lived with a male lover, Allen, for the past six years. Previously he lived with his first lover, Tom, for twelve years. Gerard reports of no discomfort about his sexual orientation, nor does he remember feelings of guilt, low self-worth, or a desire to become heterosexual, although he did have an affair with a woman during late adolescence. Gerard's sexual behaviors are highly specialized. His typical form of sexual activity is S&M sex, where one party plays the role of the sadist , and the other, the masochist. Gerard is a masochist, and here, too, he reports his sexual experiences are ego syntonic.

Chief Complaints

Gerard brought to the initial interview one chief complaint from which a number of distressing problems had arisen, leading to his current feelings of discomfort. He felt deceived about love, and these feelings centered almost exclusively on Allen, his current lover. Gerard did not believe that Allen loved him, though the evidence for this was circumstantial. Gerard said that whenever he tried to express feelings of intimacy, Allen reacted coldly. For instance, Gerard would often prepare breakfast on weekends, but Allen would sleep until noon, or Gerard would plan interesting vacations and Allen would refuse to help in the planning, acting as if the idea of a vacation with Gerard was oppressive. Gerard is very organized about household responsibilities, while Allen is less so, and so cleanliness became another area of conflict. Occasions occurred every day where Gerard interpreted Allen's behavior as rejecting.

Though both hold executive positions and live modestly, they are always having money problems. Gerard is preparing for his retirement by making financial contributions to a fund that are so large that the monthly expenses are not covered by the remainder of their salaries. The excess is put on credit cards and the money conflicts occur as the bills come to. Gerard works hard to budget these bills, while Allen haphazardly throws his into a desk drawer and pays them only when the dunning letters arrive. Allen's laissez-faire attitude is hopelessly confusing to Gerard, who is obsessed with accounting for every dollar spent.

Gerard doesn't trust Allen. No one, Gerard believed, would want to hurt him so often, yet be in love with him. He reacted to these slights in two ways. At first, Gerard would react with rage accusing Allen of dishonesty. Allen remained silent during these assaults, refusing or fearing to engage Gerard in discussion, and these sullen responses of Allen's served as further proof to Gerard of his coldness. Then Gerard would ruminate all the more, become convinced that their relationship was a sham, and decide to leave Allen. At this point, some dialogue would occur and Allen would agree to change his behavior to suit Gerard. After awhile, Gerard's anger would mount once again and the cycle of feeling unloved, mistrustful, and hostile would occur once more. Gerard felt out of control, and because his feelings were so strong they were, he felt, destroying him. He could not clear his mind long enough to decide whether Allen did or didn't love him.

Gerard also had problems with his job. He felt that his boss didn't appreciate his work and was overly critical. Gerard typically reacted angrily, and ruminated about quitting. These periods of anger were cyclical, appearing and disappearing suddenly and mysteriously. While Gerard were sure that much of his anger was justified, he wondered at the intensity of it. The parallel affective reactions to lover and employer is obvious.

Gerard mentioned two other problems at his initial interview. The first was his relationship to Tom, his first lover. Gerard still spoke to him every day, saw him occasionally, and considered him someone he still loved. This, too, was a source of conflict because he sometimes felt that he should give up his need for Tom, but he wasn't sure. Finally, Gerard had problems with his family who still lived in rural New England. They didn't know that Gerard was gay, although he had been living with men now for the past 16 years. He wanted them to know. Gerard wanted to learn in therapy have to come out to them. When asked why he wanted to come out to them, he replied that he wanted to be able to take his lover home on family holidays, instead of leaving him in New York City. However, when pressed further, he admitted that Allen and didn't want to go anyway. Gerard looked confused at this point, knowing that the issue was important to him, but not understanding why introducing Allen to his family was so crucial.

Gerard was asked why he had decided to begin psychotherapy at this time. He responded by first describing some recent transient sexual activities in which he had allowed himself to be abused physically. He feared that he was losing control over his own sexual desires and was inching inevitably toward contacts with “S’s” who lacked impulse control. Gerard described himself as feeling like Sisyphus, the king of Corinth, who was forever doomed in Hades to roll uphill a heavy stone that always rolled down again. This image frightened him.

Developmental History -- Early Years

Gerard's memories of early childhood are mostly sad ones. He remembers how often his father hit his mother, and how often he and the other children would console her afterward. He can remember, too, how often, and with such suddenness, his father would physically attack him. One bitter memory is sleeping in bed and suddenly being awakened by his father, who beat him as punishment for running away from home.

He also remembers an unusual relationship with his mother. It was her daily routine from the time Gerard was age 5 to 15 to bring him into bed with her after her husband had left for work. With Gerard in either pajamas or underwear, and she in a slip, she would embrace him and hold him close to her. Gerard became aware of the potential sexuality of the situation, though he reports not being upset by it. There were times, as he entered adolescence, that he fondled his penis while lying in bed with her, though he states that at no time was there any overt sex between them.

Gerard felt like "Cinderella." He raised his younger brother, was required to sweep the house each day, make the beds, and wash the dishes. Before supper, Gerard ate in the kitchen with his mother, and then served the rest of the family in the dining room. He performed these tasks without complaint, although he seethed at its unfairness. He felt trapped by her, forced to spend so much time fulfilling her demands.

The image of the eroticized mother recently appeared in a dream. In it, Gerard and his mother were in bed together. She had an erect penis that Gerard recognized as his own, and he was sucking it. Interestingly, during the therapy session, he noticed that she was wearing long, nylon stockings and this reminded him of his recent fetish for pantyhose. The pantyhose fetish had begun a few months earlier, had ceased for a while, and had reappeared recently. He didn't know why, but during the discussion of the dream Gerard wondered (quite appropriately) whether he was trying to act like his mother, whether he had identified with her sexuality.

During this adolescence period, Gerard originated a unique fantasy concerning his parents. He believes that one day his father would come into the bedroom and show Gerard how to have sexual intercourse with his mother, and the sex act between mother and son would be completed with the father watching approvingly.

A number of significant events occurred between the ages of 12 and 14. On two occasions he tried to harm himself. The first one occurred one day as he was walking through the woods. He stopped for a moment, and then picked up a large rock and hammered it against his arm, trying, he remembers, to fracture it. He had no idea why, and ceased only when the pain became unbearable. To this day Gerard does not understand why he did it. Intellectually, he says that he wanted attention from his father (perhaps also to externalize the psychological pain as a sign that he was still alive).

Soon after, Gerard made the first of two suicide attempts. One Sunday morning, Gerard walk to a stone quarry. He tied himself to a rope and jumped into the water expecting to drown, but the water came up only to his chest. He dragged himself back to a boulder, took off his clothes, and, sitting naked under the warm sun, masturbated.

While sitting on the rock, Gerard decided to runaway to New York City. He did so the next day, but was quickly identified by the police as a runaway and sent home. His father was furious and Gerard was beaten and prohibited from returning to school where he had been an excellent student, and ordered to get a full-time job in a local mill. He complied, but with yet another resentment to be written on his long list of indignities suffered at home.

Gerard ran away a second time and, arriving at the New York City bus terminal, became a male prostitute. By having sex with men for money and spending the night with them, he lived a marginal but satisfying existence. He never felt abused, and claims to be profoundly grateful to these men who helped him. Within a few months he traveled to Washington, D.C., where he lived briefly with a group of gay college students, again "hustled," and then on to Myrtle Beach, South Carolina, where he swallowed a vial of pills in his second and last suicide attempt. He ended up in a psychiatric hospital for a few days and when his parents were called, they told the hospital authorities that Gerard was on his own. He was 15 years old. He returned to Washington, D.C., where he met his first lover.

Developmental History -- Adult Years

At the age of 16 Gerard met Tom, a man of 24. To Gerard, Tom was "a grown-up," a man of substance with an education, a responsible job, and a stable home. They became lovers and lived together for the next twelve years. Sex between them wasn't as exciting as Gerard had had with other men, but it wasn't as important as his needs for love, security, and a home of his own. In the protection of this environment, Gerard finished high school and eventually got his B.A.

For the first nine or ten years, they lived a comfortable life in a New York suburb. Gerard turned over to his salary each week to Tom (much as he had to his father). Gerard thought of this relationship as "we," an affair of intimacy and love. But much as Gerard tried, he could not ignore their sexual incompatibility, for Gerard was becoming more passive sexually, and Tom, increasingly distant. Gerard fled to anonymous sexual encounters, most often in "t-rooms," and almost every day. He never divulged this to Tom. Gerard's sexual fantasies also began to change from conventional to masochistic ones involving leather and humiliation. He mentioned these fantasies to Tom who became anxious and refused to discuss them.

Gerard's sexual fantasies continued to change over time. He found himself looking at men dressed in leather walking the streets of New York, wondering about the kind of sex they had, and soon these men appeared in his masturbation fantasies. Again Gerard tried to discuss his fantasies with Tom, who dismissed them as unimportant. Gerard said nothing more, though the fantasies persisted. Within a year their relationship ended.

Upon moving to New York, Gerard experimented with S&M sex. He knew after his first experience that he was a "bottom man." As he said, "It never occurred to me to be a top man." He had all the sex he wanted, but missed the intimacy of a love relationship.

A year later, Gerard met Allen. Allen was a few years older, and taught at a large urban university. Allen was a "top" and they were sexually compatible. They have lived together for the past six years. Neither asks for sexual fidelity in a lover. While they maintain a good sexual relationship with each other, they also participate in encounters with other men.

In some respects Gerard is tyrannical toward Allen. For instance, Gerard believes that lovers must eat all meals together. Nor does Gerard condone serving food at home that he doesn't like (even if Allen likes the food). Not only does he exercise a veritable veto over food served at home, but also he's offended if Allen orders a taboo food for himself at a restaurant, so that Allen is never allowed to eat any of the foods he prefers. Gerard does all the planning, including vacations, buying furniture, remodeling the house, and finances. In short, Gerard plans and controls all household and personal functions.

Personality Dynamics --

The Traditional BPD Syndrome

Let us first note that the case of Gerard is that of a reasonably well-functioning person, certainly a high-level BPD as described by Kernberg. There are none of the other psychotic episodes or drug addictions as one often finds in borderline people. He also illustrates many of the personality dynamics that are becoming more common in clinical settings, particularly in gay men.

Splitting -- The "Good/Bad" Dimension

Gerard's affection dimensions are bifurcated, consisting only of extremes and allowing for no differentiation of meaning; they are categorical judgments of either goodness or badness. Such affective dichotomies can be interpreted as developmentally primitive because they first appear in the earliest years of life, and only with later, more mature learning does differentiation occur, and with it a changed perception of the world and oneself.

Splitting refers to much more than just extremes of evaluative judgment. If we had, for instance, a person who was rigid and unyielding in perception, and who judged others as either good or bad, we would not have an example of splitting. Such a person would probably fall under the rubric of a character disorder. He would be certain of his judgments, experience problems as externally caused, and, most important, would not experience conflict. The bad person is bad -- period. But in the case of splitting as a personality dynamic, judgments are fluid, and a sense of certainty, impossible. He who is perceived as good during one moment in time may change suddenly to a bad person, someone who inexplicably is transformed from one who loves to one who hates or is dangerous in some way. A sense of psychological stability is therefore impossible because the world is ever-changing and always carries the potential for threat. It is a psychological plague -- and very painful.

Gerard's reactions to present and former lovers, to employers, and to transient sexual partners appear to be all of a kind. One gets the impression that they all are invested with the attribute of "father." There is a good/bad affective dimension attached to the concept of father, and Gerard appears to judge potential father figures on the basis of their goodness or badness. In Gerard's history we find an idealized image on a man, say, a lover. To this person, who we may assume has assets and liabilities as any other, Gerard attributes characteristics that represent a fantasy vision of the good and loving father, while ignoring any dissident information. The perceptual and affectual distortion is two-fold; on the one hand he attributes mythical characteristics to the person, and secondly he represses or ignores those characteristics of the person that are incongruent. Though perhaps not intentional, the process is hostile toward the other insofar as it denies to the other the right to his own individuality. The object of this distortion, in a sense, is a metaphorical prisoner of Gerard's search for the loving father.

The object of Gerard's affection, and most recently this has been his lover, Allen, cannot possibly know or understand that he is required to play the dual roles of the good father from the past and the good lover of today. He is bound to balk at the requirements, which are likely to be experienced as confusion, and to make some gesture of rejection toward Gerard. To this conflict, often over symbolic material, results in the instantaneous metamorphosis of the good father into the bad one, and having done that, Gerard reacts to the disappointment in his characteristic ways -- anger, attack, and running away to have sexual encounters.

Given this developmental sequence, we have every right to assume that the at affective dichotomy of good boy/bad boy occurred earlier than the good father/bad father. We may further suggest that "son" and "father" interact in such a way as to show that Gerard's judgment as to his, in contrast to his father’s to goodness or badness is in direct proportion to the perceived goodness or badness of the father. (See Figure 1.)

Box 1 represents the idealized and fantasized relationship between Gerard and his father, and also his perception of romantic and authority figures. Box 4, on the other hand, represents the perceived reality of his relationship to his father, and reasserts itself with each frustration or conflict with a lover or authority figure. Box 4 is also a statement of the genesis of depression because it is a hopeless situation where love, caring, and intimacy cannot exist. Boxes two and three are, for all intents and purposes, insignificant because not another individuation between father and son has occurred to allow for judgments to be made of the two independent people.


Figure 1

Father

Good Bad

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Box 1 Box 2

Good

Good father Bad father

Good son Good son

Gerard --------------------------------------------------------------------------------------

Box 3 Box 4

Bad

Good father Bad father

Bad son Bad son

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The Abandonment Depression

This repetitive pattern of disappointment in childhood leads to deep feelings of depression in Gerard, much as the disappointments in childhood led to depression during those early years. A chronic depression is, in fact, one of the most prominent aspects of Gerard's personality. The feeling of having been rejected by his father (who also failed to protect him from his mother) in his early years is not yet history because the feelings of rejection are continually re-experienced in adulthood. Though the relationship between any son and his father is important, it is possible that the relationship between a gay to be son and his father is even more important (Silverstein, 1981). Additionally there are the morning bed experiences with his mother, a seductive scene to which Gerard acquiesced and intertwined in the fantasy that his father would teach Gerard how to have sex with his mother. It would be hard to imagine those experiences and fantasies without the production of guilt. Though he rarely expresses guilty feelings, one might reasonably hypothesize that beneath the smokescreen of verbal attack lay low self-esteem and feelings of guilt. One therefore needs to explain how Gerard defends himself against the feelings of depression, guilt, low self-esteem, and the fear of abandonment.

The dynamics of depression suggest that it can be dealt with in at least two ways: It can be expressed, leading to reduced motoric activity and the feeling of helplessness, or it can be defended against through a form of reaction-formation, leading to increased motoric behavior and the pretense of domination over the environment. In the former, a passive orientation to the environment is suggested, while the latter suggest an active orientation. Of these two orientations to depression, Gerard has chosen the latter ego syntonic approach, whereby he defends himself against depression through acting-out behavior, convinced not that there is something wrong with him, but that he must protect himself from the malevolence of others.

Two events in Gerard's history show how early his defenses against depression began, and how they relate to current adult behaviors; the arm wounding and the suicide attempt. Self-harm was the result of depression and the feeling of extreme isolation. In the arm-wounding incident, Gerard remembers hoping that his father would take care of him, and so suggests a manipulation tied to depression. In the second, the suicide attempt, we have for the first time an association between depression and sexual excitement. One might hypothesize that by the age of 14 Gerard had learned to adapt to depression by transforming it into excitement, and then to release the excitement through orgasm. Because the masturbation, a motoric act, substituted for the affect of depression, we are entitled to call at an acting-out behavior and to hypothesize that adult sexuality may share the same characteristics as these early adolescence experiences; namely, manipulation of others by self-harm, and sexuality as an acting-out behavior to camouflage depression. Of course, we would also expect the origins of these dynamics to be placed much earlier chronologically, but those memories are still subject to repression.

This acting-out as a defense against the depression created by feelings of abandonment takes two forms; toward his lover, Gerard attacks, punishing Allen for reminding him of his feelings of early abandonment, and at the same time, Gerard acts out sexually, seeking a new transient love object. The alleviation of depression by sexual release had begun the day when Gerard tried to commit suicide in the quarry, and that dynamic continues. Confusion results because he is at once attacking one man (Allen) while showing love toward another (during anonymous sex). The totality of this behavior would have to be mystifying.

Identity Diffusion

Lack of individuation from both parents is one of the most significant variables in Gerard's depression and acting-out behavior. While he is clearly aware of his judgments towards his father, Gerard is less aware that they are also a projection of his feelings about himself, and that these feelings are the most significant, therapeutically speaking.

The identity diffusion involves the mother as well, and this is indicated by the incestuous fantasies, his dreams, and his current, though sporadic, interest in pantyhose. One gets the impression from Gerard did that ego diffusion toward the father concerns goodness and badness, while toward the mother concerns sexuality, sensuality, and sensitivity. One would also think that over time these ego diffusions toward both parents would lead to resentment on Gerard's part because of his perceived loss of psychological freedom, illustrated so poignantly by him in his recital of the myth of Sisyphus. Gerard reacts towards these identity diffusions differently; to those with power, as with lovers and employers, he acts aggressively, as if he were the bad son, and they, the bad fathers. Anonymous sexual partners, however, more likely represent the maternal diffusion and hence are more sensual, more pleasing sexually, and interpreted as more intimate. It is now clear why Gerard ran away from home at ages 14 and 15. It was an attempt to find his own identity and to define his own ego boundaries, although he would hardly have understood this act at the time. His running away behavior in recent years is merely a repetition of his search for his individuality.

The identity diffusion has markedly affected Gerard's experience of sexuality. While his sense of being a gay man has always been secure, his specific sexual behaviors have shifted over time. He began with "vanilla" sex, then turned to hustling, and, during a brief period in adolescence, to an affair with a woman. During his 12 year relationship with his first lover, he began the period of anonymous sex in t-rooms. After their breakup, Gerard came out once again, this time into SM sex as a bottom, and currently continues his outside sex while in his current love relationship. Most recently, he has experimented having sex while wearing pantyhose, a sexual variation that causes him a great deal of anxiety, perhaps because of the fear that a greater propensity toward "drag" lurks not too far from the surface of consciousness. It may also represent an embarrassing identification with his mother. For our purposes, is not relevant with the Gerard is in "the closet" with respect to women's apparel. His anxiety is caused by the feeling of helplessness over his own sexual fantasies.

One needs to be careful here because it's easy to fall into Victorian standards of sexuality. In the modern gay male community, versatility is valued. A gay man can voluntarily choose between a variety of sexual acts to please himself or a partner, or alter his sexual needs to complement a transient mood. Versatility is an asset when under voluntary control, but in the history reported here, it is not so much versatility as it is a dramatic change in sexuality, wherein a past mode is given up and replaced by a new one.

S & M Sex

Gerard's current sexual behavior appears to be another important dynamic in his search for a good father to take care of him. SM sexuality is ideally suited to Gerard's adoptive behavior because it creates a clear structure around sexuality. In the first place, the "slave" is taken care of by his "master," a responsibility that is taken very seriously by mature advocates of SM. To Gerard, who certainly plays a child-like, obedient role, the master, not unlike his father, instructs him as to proper behavior, punishes violations, and rewards obedience. All of this is done according to mutually agreed upon rules. Gerard is also punished physically by the "top," as he was by his father many years ago. Is therefore avoids any ambiguity as to status and responsibility. At the same time it allows Gerard to please his mentor for the night, which, in a sense, makes the top man less threatening. The punishment may also alleviate the feelings of guilt, and help Gerard to feel alive and worthwhile.

More recently, Gerard's need to be punished has gotten out of control, perhaps because depressed feelings have been rising to consciousness. His fear that he may allow himself to be seriously abused is well-founded. What has happened from a dynamic point of view is that Gerard has sought out impulse-laden sadists who lack control, whereas in the past he was quite adept at choosing sadists who were highly sensitive to Gerard's physical and psychological limits. The harmful SM experiences, then, are a result of the return of depressed feelings to which are attached to feelings of guilt, and for which extreme physical punishment for fantasize crimes are arranged. These fantasize crimes are likely to be incestuous mother/son feelings.

Problems in the area of independence/dependence affect all aspects of Gerard's current life, and this conflict is often acted-out in the drama of SM encounters. The forceful demand for independence from Alan is more likely a defense by Gerard against his own desire for, and fear of, passivity -- the desire to be taken care of, and a passively that is expressed sexually when he plays a dependent role, but not in his love relationship, where-in trust may lead to feelings of abandonment. As independent as he may pretend to be, and as far away as he may be from his family, for Gerard individuation is not yet an accomplished fact, which probably explains why he continues to hold onto former lovers. Another example of Gerard's conflict in the independence/dependence continuum is his compulsive need to return to his parents’ home periodically, trying to create a loving relationship to his parents, only to become disillusioned once again.

Finally, we might note the particular effect of anxiety on Gerard, which is, once again, common in the borderline personality. Such people are not more anxious than others, nor do they typically decompensate if they experience a high level of anxiety. Whether the person typically experiences high or low anxiety in day-to-day living, he becomes accustomed to it and copes well with it. It is only when the anxiety reaches a point much higher than the person's norm that anxiety leads to acting-out behavior. For one person, it may be a relatively low level of anxiety, whereas for another person, a very high level of anxiety is needed to lead to acting-out. In low-level borderline people, the overproduction of anxiety may lead to transient psychotic episodes or drug addiction. In high-level people, it leads to depression and, as in this case, to sexual acting-out. Seeking transient sexual experiences is Gerard's characteristic way of coping with higher than normal anxiety levels. The sexual experiences are a good palliative to anxiety, and afterward the anxiety level returns to normal. Without them, a slow but steady decompensation results. It should also be noted that sexual versatility is an asset in Gerard, so that his transient encounters are almost always pleasing for him and his partner.

Gerard From A Cultural Perspective

A shifting world is very unpleasant. Even when change is explicable, many people have a hard time feeling competent, but when the change comes from within the psyche, and is experienced as involuntary, confusion results.

Gerard is an excellent example of a person most vulnerable to external change. Early experiences make it difficult for him to perceive the world accurately. What are Gerard's alternatives when finding his experiential world constantly shifting, and when loved ones like family and lovers can take on the lineaments of Dr. Jekyll? How often such a person must wonder, "Can no one be trusted?" The experiential world is, for Gerard and for many gay people today, a dangerous place that must be controlled for the sake of personal safety.

No doubt Gerard has been difficult at home. He demands behavior from his lover that is unreasonable. This is not compulsivity. It results from two things: the first is his fantasy of creating a more stable home than the one he came from, and the other is a reaction against Allen's laissez-faire behavior. The tidiness that Gerard demands of Alan is a mechanism to control internal confusion by creating external order -- having everything out there in its proper place relieves the feelings of disorder within.

A metaphorical concept would be helpful now, the idea of an expanding ego. Those of us trained in traditional analytic theories are used to thinking of the ego -- the reality testing part of one's personality -- as a boundary between the person and the outside world. In textbooks it is most commonly illustrated by a circle -- "me" in the center, and everything else outside. We've been taught that the rigidity of this boundary, or its fluidly, typified either the neurotic or the normal person. But for each individual the size of the circle remained essentially the same.

No one can live in a psychological world composed of chaos. Such deterioration can only end in psychosis, suicide, or drug addiction. A person's self-esteem must be restored in some way. If a person's ego lacks the power to control its own impulses and feelings (some colleagues would insist on calling this an id/ego conflict), or it can expand into the outside world to control it, and thereby restoring the internal confusion for awhile.

It is not unusual for a person with a deficient concept of self to symbolize the internal disorder through projection of the self onto the environment. The boundaries of the self expand, in a sense, marching over the usual demarcation between self and the outside world, and end up treating the immediate external environment as if it were the ego itself. In Gerard's case, the untidiness of home is menacing because it becomes a vivid representation of his own internal untidiness. The laissez-faire behavior of his lover must be controlled because it might magically transport him back to his original home, the one he hated and feared so much. When Gerard no longer feels attacked, and internal order is restored, the ego contracts and he can experience feelings of love toward Alan and others.

Please do not be confused about the expanding ego. It is not an indication of psychological strength. For instance, it does not show the ability to experience intimacy. Intimacy results when an outsider is allowed through a person's ego boundaries and into the person's concept of self -- a potentially threatening thing -- creating an acceptable feeling of vulnerability. This is very different than an expanding ego, whereby the person throws a net around others to capture them, control them, and make them safe. Intimacy allows the other to be free, while an expanding ego encapsulates them like flies in amber.

What an exhausting process this is, remaining vigilant against any sign of external disorders. Someone less capable than Gerard would live a different lifestyle, fearing the danger of intimate relationships and therefore seeking only serial relationships with others. Gerard's solution is to have serial, time-limited, transient relationships in his outside affairs, in which his partners are experienced as all good, and a stable home life with his lover, who is experienced sometimes as good, and at other times bad.

From this cultural perspective, we can see Gerard's behavior as an attempt to create order in the world. To a large extent he has been successful. As a matter of fact, one might marvel at how well he has coped, given his early experiences. He has remained and been successful in his profession for many years, and is now an executive. Nor had Gerard given up in his demand for a loving gay relationship. His first lasted for 12 years, and his second is now in its sixth year. He may often want to walk out, but he's never so foolish as to actually do it.

Borderline Personality and Gay People

There is no question that the concept of the Borderline Personality has important consequences for gay people. It makes no difference whether the etiological theories suggested by object relations analysts are accurate. From a metaphorical point of view, the diagnostic category viewed from a cultural perspective highlights the problems of social change for many gay people.

We do not all come from loving families. Those who do not, and even those who do, are faced with a world that presents a confusion of alternatives. This is true of all of our citizens, homosexual as well as heterosexual. But the heterosexual world, as it is changing, at least is changing from a recognized standard, and the changes from the past can be chartered and evaluated. The heterosexual man, for instance, need only ask of himself, "What kind of man do I want to be?" It is unlikely that he would even think of asking, "What kind of heterosexual man do I want to be?"

But the gay individual must solve questions of both gender identity and sexual identity. The levels of potential confusion for gays are, therefore, twice that of heterosexuals. This obviously leads to considerably more alternatives, and hence, more painful confusion. We might hypothesize, therefore -- and this is my second point -- that the more the innovations in society favor the acceptance of variations in lifestyle, the greater the confusion in those groups that vary most from the norm -- such as gay people. Again, as discrimination is reduced, we should expect some gay people to experience more confusion. The Bell and Weinberg study showed that gays attempted suicide five times more often than heterosexuals, and experienced more depression and loneliness. One also tends to see this disorganization more clearly in the gay male world than in the lesbian one because men are more visible and open. One also finds it in the difficulty of some gay men to participate in an intimate relationship, and in some lesbians who cannot help from merging with a lover.

This itself may sound confusing. It may sound like the traditional argument that gay people are psychologically disturbed. But that is not the intention. The psychological problems of gays will be different after gay liberation than they were before it. Let's make the contrast in time periods more clear.

Before gay liberation, self-loathing and guilt were common enough in the gay community. Depression was probably the single most important psychological dynamic for a number of reasons, with suicide commonly the result. Society's oppression took an awesome toll in gay lives.

There is now less guilt in the gay world. More gay people are open with family, employers, and friends -- and reap the rewards of a person who removes the chains of fear from his or her body. Consequently, depression has become less of a problem than it was earlier. But if gays have few, if any, stable standards of behavior from the past and now have more internal problems to solve in order to create a sense of psychological stability, then it follows that more of them will experience confusion, and even sexual fluidity.

Does this argument suggests that gays are "sicker" than heterosexuals? No, it does not. The question "are homosexuals sick?" was specious 20 years ago, and is irrelevant today. A sexual orientation is not "healthy" or "sick." To perceive it in these terms requires acceptance of the medical model as the only arbiter of social behavior.

What we might expect to find in the gay population is a bimodal curve of social and personal adaptability. On the lower end of the curve are those people -- like Gerard -- whose early experiences limited their capacity to deal with conflict and ambiguity. There are probably many gay people, men and women, in this category.

But we are likely to find another group that gay people who learned to cope with a newly allowed freedoms, people who probably came from more nurturing families or who for reasons we ill-understand turned society's opprobrium into psychological strength. These gay people may even turn out to be more adaptable to social and psychological vicissitudes than the average heterosexual person.

From this vantage point, we might predict that overtime, as standards of conduct become more predictable in the gay community, the curve of adaptability between these two groups should change to a normal one. It further suggests that a homogenization will occur in the area of sexual identity.

A Final Note

What should we made of this new diagnostic category, the "The Borderline Personality Disorder?" Does it exist, and if so, what diagnostic areas lay on either side of the boundary? The question assumes that one diagnostic system is more accurate than another, when in fact diagnostic systems are themselves a reflection of the culture, the times, and, though many professionals dislike admitting it, political negotiation and compromise. The battle over the status of homosexuality in the psychiatric nomenclature is a good example of politics and negotiation in diagnosis.

What is of importance to those of us who work with the gay people is the idea that they are faced with a disproportionate number of problems. The new cultural belief in individualism has its price: taking responsibility and making choices within a confusing array of possibilities. Those gay people who come from disoriented families will face this freedom ambivalently, unconsciously missing the former social structures that ameliorated for family deficiencies. It is toward those people, like Gerard, who live and love in a hostile world that we need to direct our professional competence so that the cultural freedom becomes a personal one as well.

(NB) The idea of an expanding ego is a metaphor; it is not a real thing. It is not like a balloon expanding with the introduction of puffs of air. Nor is the ego a real thing; it too is a metaphor. The diagnostic system, our present one or previous systems, are also metaphors, albeit complicated ones, for the worries and concerns of a particular society at a particular moment in history. This is as true of early societies that explained human behavior in terms of dybbuks and demons intruding into the consciousness of the victim, as it is for our modern society that explains human behavior in intrapsychic terms. Descriptions of diagnoses, ego defenses, indeed, all psychological jargon, are not characteristics of the person being described. They are merely convenient, and one hopes useful, ways of organizing the observations of the perceiver.ZZ