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QUESTION: My MC (Andrew) exhibits many symptoms of borderline personality disorder, including splitting. With the splitting, he basically thinks of himself as a "good" Andrew and a "bad" Andrew.  In his thoughts, the good part of him (whom he calls Leif) talks with the bad part.  At first, it's just jumbled thought, sometimes doesn't make sense, and as it progresses, it develops two distinct voices.  He thinks the bad Andrew is just worthless and a street whore (he's a prostitute) and the good Andrew is who he is trying to change into, to fix his life.  I don't think this is split personality or multiple personalities because they are aware of each other, and it really is like two aspects of the same thing.  Does this make sense, psychologically?  Is it still borderline, or is this something else?

ANSWER: It sounds like you've got the gist of splitting, which is pretty commendable, since it's a tough concept. Typically, though, adult splitting is seen as a kind of defense mechanism, so people aren't really aware that they're doing it.

Let me explain splitting a little more, just so that makes sense, and then we'll talk about what might work well for your story.

According to object relations theorists like Melanie Klein, newborns essentially believe that the world is part of the same entity as them. In other words, they can't differentiate between themselves and the world. Later, they differentiate between "me" and the world, but Mommy (or Daddy, or whoever the primary caregiver is) is seen as part of "me." Still later, the child begins to understand that "me" and Mommy are different, but they have trouble seeing "good Mommy" (who acquiesces to them and fulfills their needs) and "bad Mommy" who says "no" or is otherwise frustrating or disappointing as the same person. This is splitting, and it's natural around 3-4 months of age. As we get older (i.e. around 6 months of age), we learn to see "good Mommy" and "bad Mommy" as part of the same person. That's why we can love and hate someone at the same time.

This natural process is interrupted in people who have borderline personality disorder, typically due to trauma of some kind (usually abuse). As a result, these children never stop splitting other people and either idealize or devalue them. They may swing back and forth very quickly from one side to the next, but they aren't really able to simultaneously integrate the good and bad.

People with borderline personality disorder never learn to regulate their emotions, so they have extremely tumultuous, even destructive relationships with others as they frantically try to get others to help them deal with a world they feel they can’t deal with alone.

You say Andrew has other borderline tendencies, but if splitting is the primary reason you’re using the borderline diagnosis, it might be simpler to move away from that diagnosis. (Borderline personality is an extremely painful disorder for the person who has it, and they often have depression, anxiety, PTSD, and incredibly disruptive behavior patterns, and that’s a lot to try to portray!)

At the same time, you’re right, it doesn’t sound like Andrew would qualify for dissociative identity disorder (multiple personality disorder). His relationship with his alter ego, Leif, isn’t dissociative enough.

It sounds to me like Andrew has just named a normal ego state and is relating to it in a way that works for him. Which is entirely possible and probably is not in itself diagnosable.

Everyone has multiple ego states. That’s normal. For example, the “you” that goes to Thanksgiving dinner with the in-laws probably acts a little different than the “you” that goes out for a raucous evening on the town with friends. Both parts are you, but they’re different sides or facets of you.

Some people are more aware of these different ego states than others, especially if they play very diverse roles in life. That sounds like the case for Andrew.

It’s even pretty normal for people to give their ego states names, though they may think of those ego states as “the party girl” or “the writer” or whatever. People also adapt their names based on the setting they're in. For example, an Andrew might be Mr. Whomever at work, but Drew with friends and Andy to his lover. And I know people who go by their given names (e.g. James) in formal situations but by a middle name or nickname that's completely different in informal settings (e.g. Tim).

If you want or need a diagnosis for Andrew, based on the brief description you gave me, I’d probably lean toward some kind of a mood disorder, maybe dysthymia (a chronic, low-grade, but extremely wearing depression) or a major depressive disorder (which is more crippling at its worst, but tends to get better and then worse and then better again over the years). An anxiety disorder is another possibility.

For more information on borderline personality, dissociative identity disorder, mood and anxiety disorders, treatments, therapies, and character-building, be sure to pre-order a copy of The Writer's Guide to Psychology: How to Write Accurately About Psychological Disorders, Clinical Treatment and Human Behavior at your favorite online bookstore today!

Reflections on Shutter Island

I finally saw Shutter Island last night. I didn't know a lot about it other than that it was Leonardo DiCaprio on an island that was an asylum for the criminally insane. I'd also heard that it was the same kind of mindbender as the 2000 film Memento, which I enjoyed.

I really enjoyed the movie, and if you haven't seen it, it's worth watching.  (And I'm going to be careful not to include spoilers below.) In addition to the story itself, it's an interesting study of psychology as it stood in the mid 1950s.  Psychotropic medications, most notably antipsychotics, had just entered widespread use, but earlier, more destructive treatments like lobotomies were still being widely used (and misused) on difficult patients.

It's too bad that they didn't place a little more emphasis on how mental institutions at the time were self-sustaining.  Patients helped do things like farm, and in addition to providing sustenance, it gave them purpose and responsibility and dignity and improved their overall mental health in many cases -- which makes a lot of sense when you consider that the alternative in many cases was to be stuck in a closed room.

One of the things I loved most about the film was the portrayal of DiCaprio's character's experiences as a soldier in WWII.  He was part of the regiment that freed Dauchau, and as the movie progresses it becomes clear that he has post-traumatic stress disorder (PTSD) complete with intrusive recollections, recurrent nightmares, amnesia for certain events, hypervigilance, and irritability.  And rather than using washed-out frames to portray the memories, Scorsese hyper-saturates the scenes, giving them a vibrant, even jarring hyper-realism.

The one thing that drove me crazy through much of the movie was the assumption that the new antipsychotics (chlorpromazine, or Thorazine, in particular) caused hallucinations and delusions when in fact they do the exact opposite.  But it was all explained in the end.  I promised not to spoil the film for you, so I'd better stop there...

Definitely worth a watch, though, if you haven't seen it.

I'm really looking forward to seeing another mindbending DiCaprio movie next weekend: Inception.  If that one has as much psychology as this one did, I'll be writing another one of these in a week! (But hey, if you've seen it, no spoilers for me in the comments, okay?  I wanna be surprised! :)

Need accurate and easy-to-understand information on antipsychotics, lobotomies, historical or modern mental institutions, and disorders like PTSD for your story?  I've got you covered with lots of information on all of those topics in The Writer's Guide to Psychology: How to Write Accurately About Psychological Disorders, Clinical Treatment and Human Behavior at your favorite online bookstore today!  Pre-order a copy now!

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