An intimate, compassionate, and expansive portrait of Borderline Personality Disorder that rejects the conventional wisdom that this condition is untreatable, told by a psychologist who specializes in BPD
Mental illness is heavily stigmatized within our society, and within this already marginalized group, folks with BPD are deemed especially untreatable and hopeless. When, as a graduate student, Alex Kriss first began working as a therapist in the field, his supervisors warned him that borderline patients were manipulative, difficult, and had a tendancy to drop out of treatment. Yet, years later, when Kriss was establishing his private practice and a borderline patient known as Ana came to his office, he felt compelled to try to help her, despite all of the warnings he’d heard.
Borderline is the story of his work with Ana—how his successes with her led him to open his doors to other BPD patients and advocate for them. Borderline is also the story of the disorder itself: Kriss traces accounts of the condition going back to antiquity, showing how this disease has been known by many names over the millennia, most of them gendered: possession, hysteria, witchcraft, moral insanity. All referred to a person—usually a woman—whose behavior and personality were seen as fractured, unstable, unpredictable, and uncontrollable. Kriss guides us through this history up through the emergence of psychotherapy, the development of the modern diagnosis, and attitudes toward treatment today.
“Insightfully and plausibly rendered . . . an illuminating survey of the prominence of the disorder in the history of psychology and psychiatry . . . A revealing exploration of borderline personality disorder and the future of therapies addressing it.”
—Kirkus Reviews
“[A] stimulating study . . . this is an enterprising and in-depth exploration of who decides what it means to be ill, how mental illness is framed in cultural narratives, and who gets shut out of those narratives. It’s an ambitious reassessment of an understudied condition.”
—Publishers Weekly
“In a world where we now diagnose ourselves on TikTok, rare is the occasion to actually see what these diagnoses really mean. Beyond labels, beyond any idea of sickness or psychopathology, diagnosis is the starting point for a long conversation between a therapist and a patient about what makes for a life. Kriss’s book is not only beautiful; it demystifies and educates.”
—Jamieson Webster, author of Conversion Disorder: Listening to the Body in Psychoanalysis
“Alexander Kriss’s Borderline: The Biography of a Disorder is a dialectical treat, with alternating chapters that provide original musings on the history of psychoanalysis and that present a six-year case study of his work with a patient. The two strands come together in Kriss’s feminist reading of the borderline construct, where he appreciates past and present efforts to understand it as a form of psychopathology but encourages us to face underlying sexist assumptions and to question the boundaries of ‘normal’ human life. Kriss deftly shows us why some patients require and benefit from long-term treatment. His book is strikingly successful in underscoring the relevance of a contemporary psychoanalytic approach to psychotherapy but will be of interest to anyone who is curious about what happens in psychotherapy.”
—Elliot Jurist, PhD, author of Minding Emotions: Cultivating Mentalization in Psychotherapy
“Borderline is a gripping, humane, brilliantly prismatic inquiry into the peculiarities of the mind, at once a case study, an intellectual history, and a reckoning with the education of a therapist. Alexander Kriss treats every subject he takes up—his patients, his field, himself—with penetrating rigor and scrupulous honesty.”
—Adam Ehrlich Sachs, author of Inherited Disorders: Stories, Parables & Problems
“One would be hard-pressed to find a more intimate account of a practiced clinician’s experience of working with patients with a diagnosis of borderline personality disorder than what Dr. Alexander Kriss so generously offers us in his new book, Borderline: The Biography of a Personality Disorder. Kriss walks us through his training in a psychiatric hospital and onto his work in private practice to show how he helps his patients develop more stable and integrated relationships. He writes with empathy, thoughtfulness, and—yes—circumspection, mindful of the fact that the manifest content of his patients’ communications is often just the tip of the proverbial iceberg. Thoroughly researched and beautifully written, Borderline will be of value to anyone interested in what is to this day one of the most challenging and complex psychiatric disorders.”
—Christopher Christian, PhD, editor in chief, Psychoanalytic Psychology
“Alexander Kriss’s Borderline is nothing short of a revelation. In lucid and intensely readable prose, Kriss brings us into the world of his patients who live ‘on the borderline,’ illuminating a profoundly misunderstood condition with rigor and humanity in equal measure. Pairing personal narratives with historical research, Borderline offers a compassionate and deeply insightful analysis of the ways that such patients have been dismissed, wronged, silenced, and deemed ‘untreatable’ by medical systems for many centuries—and, perhaps most importantly, it provides clear reasons why there is hope for such patients going forward.”
—Marin Sardy, author of The Edge of Every Day: Sketches of Schizophrenia
INTRODUCTION
Collective Psychosis
1
Prehistory: The First Session
2
Splits, Hysteria, and the Invention of Psychotherapy: Fifth Century BCE–1885 CE
3
Psychic Death: Sessions, Weeks 2–19
4
Seduction and Fantasy: 1896–1923
5
Fears: Sessions, Months 6–10
6
Confusion of the Tongues: 1908–1933
7
Love: Sessions, Months 10–12
8
Identity Crises: 1939–1980
9
Self-Discovery: Sessions, Year 2
10
Diffusion: 1973–2011
11
Normality: Sessions, Year 3
12
Integration: 1980–2023
13
Borderline: Sessions, Year 6
Acknowledgments
Notes
Index