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The title of Rachel Louise Snyder’s eye-opening, powerful, page-turner of a book, No Visible Bruises, refers to strangulation [No Visible Bruises: What We Don’t Know About Domestic Violence Can Kill Us, New York: Bloomsbury Publishing, 2019: 309 pp, $28(US)].
Some sixty percent of domestic violence (DV) victims are strangled at some point during an abusive relationship (p. 65). Turns out that only some 15% of the victims
in one study had injuries visible enough to photograph for the police report (p. 66). Most strangulation injuries are internal – hence, the title.
Since 2012 when I completed the 40-hour training in Understanding Domestic Violence (DV) at the community organization ApnaGhar, several important innovations have occurred. Snyder presents the reader with these, including the distinctions of (1) a Fatality Review Board for Domestic Violence; (2) initiatives to provide treatment for the abusers; (3) the Danger Assessment (which leads back to the role of strangulation).
Lack of oxygen to the brain can cause micro-strokes, vision and hearing problems, seizures, ringing ears, memory loss, headaches, blacking out, traumatic brain injury (TBI) (p. 69). As the victim in near death due to strangulation – but so far there would only be red marks around the neck – the nerves in the brain stem lose control over sphincter muscles. So the urination and defecation were not mere signs of fear. They were evidence that the victim was near death (p. 67).
Such victims may have poor recall of the event. They may not even be aware that they lost consciousness. The victim is not being difficult or drunk in being incoherent. The victim is fighting the consequences of a life-threatening event and may not know it at the moment.
Even medical professionals may overlook the signs of serious injury by strangulation unless they are altered to the circumstance of the visit to the emergency room. Fact: DV victims are not routinely screened for strangulation or brain injury in the emergency room. They are discharged without CT scans or MRIs. The assaults and injuries are not formalized and abusers are prosecuted under lesser charges, say, misdemeanors rather than felonies.
“What researchers have learned from combat soldiers and football players and car accident victims is only now making its way into the domestic violence community: that the poor recall, the recanting, the changing details, along with other markers, like anxiety, hypervigilance, and headaches, can all be signs of TBI” (p. 70).
Now the ultimate confronting fact: Strangulation often is the next to last abuse by a perpetrator before a homicide. The correlation is strong, very strong. Strangulation is a much more significant marker than, say, a punch or kick that the abuser will escalate to lethal violence. Strangulation dramatically increases the chances of domestic violence homicide (p. 66).
This leads directly to an important innovation in the struggle against DV, the Danger Assessment. Jacquelyn Campbell has quantified the Danger Assessment, which is especially effective when combined with a timeline of incident. In addition, to strangulation high risk factors in any combination that portend a potential homicide include: gun ownership, substance abuse, extreme jealousy, threats to kill, forced sex, isolation from friends and family, a child from a different biological parent in the home, an abuser’s threat of suicide or violence during pregnancy, threats to children, destruction of property, and a victim’s attempt to leave anytime within the prior year. Chronic unemployment was the sole economic factor (p. 65). None of these cause DV; but they make a bad situation worse – much worse – and add to the risk of a fatal outcome.
You can see where this is going. First responders, police, medical professionals, family, friends need to ask the tough questions – perform the assessment and have a safety plan ready to implement to get the potential victim out of immediate danger. Hence, the need for Snyder’s important book and its hard-hitting writing and reporting to be better known at all levels of the community.
Snyder reports on a second important innovation in the struggle against DV: the Fatality Review Board (FRB) for DV Homicide. Air travel has become significantly safer thanks to the Federal Aviation Administration commitment to investigate independently every airplane crash. The idea is to find out what sequence of things went wrong without finger pointing. No blame, no shame. The idea is to perform an evidence-based assessment of all aspects of the system – human, administrative, mechanical, procedural.
In a breakdown big enough to cause loss of life, multiple errors, anomalies, and exceptions are likely to have occurred in the system. Rarely is there is single cause of a disaster big enough to cause loss of life. “If systems were more efficient, people less siloed in their offices and tasks, maybe we could reduce the intimate partner homicide rate in the same way the NTSB [National Transportation Safety Board] had made aviation so much safer” (p. 85). The Fatality Review Board is born.
For example, the authorities knew the perpetrator. They had visited the home multiple times. The abuser was released from detention without notifying the potential victim. An order of protection was denied due to a paperwork error, or, if granted, the police could not read the raggedy document that the woman was required to have on her person at all times. The prosecutor was unaware of a parallel complaint by the victim’s mother because it was filed in the same docket and dismissed when the victim recanted in the hope of placating the abuser and saving her own life.
For example, multiple touch points occur at which victims and perpetrators interact with social services, healthcare facilities, community organizations, the veteran’s administration, law enforcement, and the clergy. The FRB is tasked with determining how the fatal outcome could have been avoided.
Chase down all the accidental judgments, missed cues, and blind spots. Talk to everyone able to talk. Gather all the data. Someone knew something, had actionable information that was not acted upon. Formulate recommendations to avoid repeating the mistakes.
That means building formal lines of permissioned communication between administrative siloes. For example, there as a restraining order against the abuser but it was in another state and the local authorities did not know about it.
In the age of the Internet there needs to be a central clearing database that preserves such data. Or, for instance, the shooter had no criminal record, but the victim had expressed fear for her life to the local pastor at church based on his statements. Who can he (or she) call? Who can intervene with a safety plan?
No one single factor can be singled out as causing the fatality; instead a series of relatively small mistakes, missed opportunities, and failed communications. The FRB looks for points where system actors could have intervened and didn’t or could have intervened differently (p. 86). Today more than forty states now have fatality review teams. Though the violence continues, this is progress.
Snyder makes an important contribution in clarifying why the victim does not run leave the abuser and the abusive relationship. Why does she return to the abuser, or recant her testimony in the police report, frustrating the attempt of the prosecution to get a conviction?
Though every situation is unique, Snyder builds a compelling narrative that often the victim is trying to save her own life. The system works much slower than a determined abuser, and the victim knows it. In short, the abuser knows how to work the system; and all-too-often the victim cannot rely on the system to protect her when she most needs protection. In addition, her judgment may be impaired due to being called every name in the book and slapped, punched, or strangled.
As the abuser senses he is losing power and the victim is getting ready to leave, the risk of violence to regain control escalates. The abuser is strangling her, escalating to deadly violence, and yet he is charged with a misdemeanor. He will be out on $500 bail in 24 hours – buying a gun and gasoline to burn down the house after killing her and the children. In fear for her life, the victim is makes up a story about love to try to placate the abuser – she is recanting to try to buy time – while she accumulates enough cash or school credits to escape and have a life. The victim recants her narrative in the police report and says she loves him because she wants to live.
A third major strong point of Snyder’s work is her report on interventions available for abusers. Incarcerating an abuser to protect the community is necessary. But that does not mean the abuser does not need treatment. He does. Absent treatment, jail just makes the abuser worse. The entire middle section of the book is devoted to the dynamics of perpetrator treatment.
At another level I found Snyder’s deep insight to be an extension of Simone de Beauvoir’s assertion circa 1959 that woman is not a mere womb. The enlightened man adds to de Beauvoir’s statement (which is notquoted by Snyder): man is not mere testosterone. In both cases, biology is important, but biology is not destiny. I repeat: biology is not destiny. Some men have not been properly socialized and need to get in touch with and transform their inner uncivilized cave man.
The recovery programs in jails on which Snyder reports sound rather like “boot camp” to me. The emphasis is on “tough love.” This is a function of the close association, if not identification, of masculinity with violence.
In some communities, violence is how masculinity gets expressed. This extends from “big boys don’t cry” and if he hits you, hit him back all the way to a misogynistic gangster mentality that uses devaluing language to describe woman as basically existing for the sadistic sexual satisfaction of men. It may also be common (and justified!?) in a military context. As near as I can figure – and this is an oversimplification – the treatment groups are given lessons in cognitive or dialectical behavioral therapy: skills in emotional regulation, distress tolerance, self-soothing, and interpersonal negotiations.
For those perpetrators, not incarcerated or suffering from post traumatic stress disorder (along with their victims), but rather brought up in relative privilege or affluence, Snyder has less to say. While the poverty, crime, and substance abuse of the inner city can intensify DV, DV is an equal opportunity plague, occurring in affluent neighborhoods too. Only here we are dealing with “snakes in suits” – think: Harvey Weinstein or Bill Crosby (“date rape” drugs) [granted, these individuals were sexual predators, not necessarily DV perpetrators]; perpetrators who are quite sophisticated in using the system to isolate and disempower their victims financially, legally, emotionally as well as physically (violently). This is an incompleteness rather than a flaw in an otherwise compressive study. Another chapter – or book – may usefully be written about DV scenarios among the rich and famous – or at least affluent. DV lives there too.
On a personal note, when I started reading this book, I knew it was not for the faint of heart. I said to myself: “Ouch! This is like the ‘ketchup scene’ in Shakespeare’s Hamlet.” At the end of Hamlet, the entire family gets killed. To deal with something as disturbing (and hope inspiring) as Snyder’s book, I had to go to Shakespeare.
Indeed Hamlet begins with domestic violence. Hamlet’s uncle kills his own brother, Hamlet’s father, to seize the throne by marrying Hamlet’s mother. The latter is not technically DV, but a boundary violation. (This is the original Game of Thrones if there ever was one.) In turn, Hamlet perpetuates verbal and emotional abuse, whether fake insanity or genuine narcissistic rage, against his fiancé, Ophelia. Hurt people, hurt people. Sensitive soul that Ophelia is, she commits suicide. Ophelia’s brother then seeks revenge. Hamlet kills her brother as the brother simultaneously kills Hamlet with a rapier tipped with a deadly poison. The mother drinks the poisoned goblet, intended for Hamlet, and the uncle is run through by Hamlet – also with the poisoned rapier. The point?
Horatio’s provides a summary at the backend of Hamletwhich also forms a review of Snyder’s work: “So shall you hear – Of carnal, bloody, and unnatural acts – Of accidental judgments, casual slaughters, – Of deaths put on by cunning and forced cause, – And, in this upshot, purposes mistook, – Fall’n on the inventor’s heads. All this can I truly deliver.” Just so.
All too often the events seemed to me to unfold like a Greek tragedy – or in this case a Shakespearian one. You already know the outcome. The suspense is enormous. You want to jump up on the stage and shout, “Don’t open the door – therein lies perdition!” But everything the actors do to try to avoid the tragic outcome seems to advance the action step-by-step in the direction of its fulfillment.
Snyder provides a compelling narrative – and actionable interventions – of how to interrupt the seeming inevitability and create the possibility of survival and even, dare one hope, flourishing.
Wilson, K. J. (1996 ). When Violence Begins at Home: A Comprehensive Guide to Understanding and Ending Domestic Abuse, 2ndEdition. Alameda, CA: Hunter House (Publishers Group West).
Websdale, Neil. (1999). Understanding Domestic Homicide. Northeastern University Press.
Campbell, Jacquelyn et al. (2003). “Risk Factors for Femicide in Abusive Relationships: Results from a Multisite Case Control Study. American Journal of Public Health93, no. 7 (July 2003).
Agosta, Lou. (2012). A Rumor of Empathy at Apna Ghar, the Video: https://tinyurl.com/y4yolree [on camera interview with Serena Low, former executive director of Apna Ghar about the struggle against DV]
Agosta, Lou. (2015). Chapter Four: Treatment of Domestic Violence inA Rumor of Empathy: Resistance, Narrative and Recovery in Psychoanalysis and Psychotherapy. London: Routledge.
(c) Lou Agosta, PhD and the Chicago Empathy Project
I am catching up on my reading. Christine Ann Lawson’s Understanding the Borderline Mother is a classic in its field, with a whopping 396 Amazon reviews (Q1 2019), enjoying a rating of 4.7 out of 5.0. Impressive. (See the bottom of this review for bibliographic information on the book .)
Numerous readers have remarked that this book opened their eyes to what they had to survive growing up. These survivors were not bad,
crazy, or broken in the way they were led to believe by what was fundamentally an invalidating child-rearing environment. The vignettes and analyses in Lawson’s book provided them with a transformational “Ah ha!” moment. For many survivors this was a tad like Saul becoming Saint Paul on the road to Damascus – a bolt of lightening out of the blue. They then could begin the hard work of incremental change needed to restore the self-soothing, emotional regulation, and distress tolerance capabilities needed to feel like whole persons again – or for the first time ever.
So up front and considering this is not a “soft ball” review, I acknowledge the importance of Lawson’s contribution and recognize that her work made a profound difference for many survivors. It is especially important to keep that in mind, given that I express significant reservations and criticisms.
The technical details? The borderline personality disorder (BPD) gets precisely defined as a psychiatric entity in 1980, entering the third version of the Diagnostic and Statistical Manual (DSM-III). However, long before that signal event “borderline” was understood to be a person whose personality structure (or lack thereof) is characterized by a compensatory but problematic defensive structure that guards against a psychotic breakdown.
Here “psychotic” means “out of touch with everyday reality.” The implication was that such borderline individuals were at risk of completing losing contact with the world of everyday life, decompensating into a full-blown psychotic breakdown. In particular, if the borderline person were treated with psychoanalytic methods, itself encouraging a mild form of regression back to the childhood fixations, whether real or imagined, the risk was of causing the borderline treatment to “go off the rails” into explicit mental illness. In a different, allegedly humorous context, the description “borderline” has come to mean that the patient is hard to work with, difficult, or simply “the therapist doesn’t like the patient.”
A bit more background will be useful. Innovations in treating personality disorders by Heinz Kohut, MD, including new forms of transference such as self-object transference, made narcissistic personality disorders (NPD), arguably on a continuum with borderline personality in a pre-1980 sense, accessible to psychoanalytic methods. (See footnote  below.) However, NPD remains distinct from BPD. The treatment of NPD is relevant here since the children of BPD parents do not necessarily acquire BPD themselves, but sometimes suffer from a pervasive narcissistic vulnerability.
In contrast with Kohut’s deficit model of the narcissistic self, Otto Kernberg, MD, developed a formulation that posited actual defects in the structure of the borderline personality – aspects that were not merely missing but broken. The resulting borderline behaviors need to be confronted and rooted out by a kind of “tough love” on the part of the therapist.
Meanwhile, Marsha Linehan, PhD, a self-styled radical behaviorist, is the innovator who created a treatment approach called “Dialectical Behavioral Therapy” (DBT) that often is effective in treating BPD while other approaches have been [are] less successful. No short description of Linehan’s program is available, but a suitable over-simplification may be useful: DBT combines cognitive behavioral therapy (CBT) within a framework that emphasizes mindfulness, empathic listening, and validation of the grain of truth in even the BPD person’s most perplexing distortions to restore the BPD individual’s capabilities for emotional regulation, distress tolerance, self-soothing, interpersonal skills, and self-esteem. DBT is not for the faint of heart and requires an entire team, including both one-on-one counseling and extensive work in groups. It is different than boot camp, but sometimes not by much. Substantial evidence-based, peer-reviewed publications support the effectiveness and validity of the approach.
Lawson, gets matters right with her use of Marsha Linehan, Heinz Kohut, Otto Kernberg, and Ernest Wolf, even when these innovators are not specifically addressing borderline personality disorder (DPB). As noted, Kohut and Wolf have done a deep dive on narcissistic personality disorders. In comparison to BPD, though related, neither the symptoms nor the treatments options are the same. This points to the hazards of broad-brush stroke labeling segments of suffering humanity, albeit with the worthy end of expanding our empathy and understanding for the survivors.
Lawson gets the Diagnostic and Statistical Manual(DSM) criteria right in terms of the BPD person’s fear of abandonment [“I hate you – don’t leave me!”], volatility of relationships, volatility of emotions, volatility of self-image, self-injurious (para suicidal) behavior, impulsivity and acting out, and physiological symptoms. People have different ways of expressing their suffering and the suffering of the BPD person can be intense, so engaging with them is not for the faint of heart.
One strong point. Lawson’s is perceptive in the use of Christina Crawford’s searing memoire, Mommy Dearest, about Christina’s Academy Award winning movie star mother, Joan Crawford (1905 – 1977). This paints a convincing picture of growing up with and surviving the BPD mother (in this case, Joan Crawford). Once again, such material is not for the faint of heart. It turns out that many Hollywood movie starts are good actors both in front of the camera on stage and off of it. “Acting” is different than “faking,” but to a child of tender age the distinction is not always clear. “All the world is a stage,” but when one is a child of tender age, one cannot simply walk out of the show if one does not like it or is being traumatized by it. The lives of the rich and famous are as susceptible to mental and emotional disorders as anyone.
The criticism? To generalize from the example of the tortured genius of Joan Crawford to the run-of-the-mill perpetrations, self-deceptions and manipulations of the standard, working class BPD mother is to go from the sublime to the ridiculous or at least to tear a passion to tatters. It makes for bad theatre, but then again so does real life. I would have liked to hear more about how Christina and her brother dealt with the worst of the perpetrations and escaped the disorder themselves, even if it did leave them with a pervasive narcissistic vulnerability.
Christina describes an invalidating environment, one of the principle causes of BPD. Yet she retained powers of self-expression and freedom that allowed her to overcome [some of] the worst consequences of her environment. This is not to say she did not suffer. She did. What made a difference? What enabled her to compensate – acquiring the distress tolerance, emotional regulation, and self-soothing skills in which mother was so dramatically lacking? Strange to say, maybe Christina got these life saving skills from the nuns at the religious boarding school where she was sent. No doubt the matter is more complex.
Thus, the help promised in the subtitle “Helping her children transcend the intense, unpredictable, and volatile relationship” is mostly targeted at the grown ups who have survived childhood with a BPD mother. It is not clear what such help would look like for a child of tender age other than to turn to the other parent, relative, or mentor-like friend of the family for the mirroring and recognition needed to acquire skills in emotional regulation, distress tolerance, and self-soothing. In some cases cited by Lawson, the abuses rises to a level at which intervention by the state (Children and Family Services) would be appropriate, though such is sometimes like going from the frying pan into the fire.
For example, Lawson’s examples of the mother who drowned her two children, strapped into their car seats in her SUV (Susan Smith (1994)), and the mother who shot her three children at close range (Diane Downs (1983)). These examples result in the reader feeling vicariously traumatized. I am not saying these are not horrific examples of criminality, insanity, or both. They are. I am saying these examples in the book are symptomatic of Lawson’s rhetorically “over the top” approach.
DBP is properly distinguished from manic depression (Bipolar I), post partum depression that reaches psychotic proportions, psychopathy, or paranoid schizophrenia. My concern is that Lawson gathers wide-ranging and provocative examples of trauma, deceptions, perpetrations, manipulations, lies, dangerous half-truths, and total nonsense – and attributes them to BPD. BPD is characterized by boundary issues – and violations – and so are the distinctions in this book.
In short, BPD mother is straight out of Grimm’s fairy tales – now the waif, now the hermit, now the queen, now the wicked witch. Well and good. This is not a treatise on fairy tales; yet Lawson misses the point about the uses of enchantment. To the child who is being weaned, the loving (not BPD!) mother who is temporarily withholding the breast in favor of a Sippy-cup, this standard mother suddenly seems like the devouring witch. She is now and will be the loving caretaker again once the crisis of weaning has passed, but with an enriched personality that includes both positive and negative aspects instead of the splitting and extremes of early childhood. In short, there is nothing wrong – but something is missing – empathy.
For example, Lawson does a nice job marshaling a nightmare and candidate BPD mother from the ancient Greeks, Euripides’ Medea. When Medea’s faithless husband, Jason, proposes to leave Medea for another woman, the gates of chaos are opened. In revenge, Media kills her children and the other woman. This is perhaps the literary origin of the expression “hell hath no fury like a woman scorned.” From another perspective, a common place exists that when people do not get the empathy or dignity that they feel they deserved, they become enraged. But this takes rage to new, heretofore unprecedented levels. Medea “acts out” her revenge with chilling effectiveness. Medea’s pending loss gets transformed into psychopathic, psychotic, criminally insane rage. Does anyone besides me think that to attribute such perpetrations to BPD would be overstating the case?
One of Lawson’s commitments is to expand the reader’s empathy for the child of a BPD mother. Of course, to the child it is not BPD. It is just behavior that leaves the child bewildered, confused, in semi-shock, or even traumatized. By definition, the diagnosis of BPD cannot be applied to anyone younger than adolescence. Personality disorders usually show up in puberty or adolescence.
The BPD person’s behavior is a study in invalidation, misuse, abuse, emotional disregulation, boundary issues, boundary violations, lack of empathy, lack of recognition, lack of mirroring, lack of response to the child as a whole person, and inconsistent, intermittent, low quality parenting. When the environment is sufficiently invalidating and the child lacks resilience or another sane adult model to help compensate, then the result can indeed be a perpetration of generational BPD.
Ultimately Lawson shocks, shifts, and shakes our complacency about BPD. She may even leave some vicariously traumatized by her narratives of child abuse and boundary issues. However, she fails to enhance our empathy with the BPD person by sensationalizing and “demonizing” the worst excesses of BPD.
I hasten to add that BPD can be described as lying a spectrum with demonic behavior. This is especially so if one is describing BPD from the perspective of the child of tender age. But, once again, that is the issue. The devouring witch of Hansel and Gretel is a representation of the standard mother who is withholding the breast from the child as the latter is being weaned. But the standard mother is usually not suffering from BPD.
The fairy tale narrative informs our empathy with the child. Within the story, the story teller inspires empathy with the children (Hansel and Gretel) such that it seems to them alternatively like a death sentence by starvation, leaving a hunger big enough to eat a house (which is how the children first encounter the gingerbread house). It is of course neither of these, but the narrative enables the grown up empathically to get inside the child’s experience.
The issue with Lawson’s book is that it does not distinguish between BPD, child abuse, and criminality. Yes, BPD mothers’ relationships with their children sometimes cross the boundary between “mere” BPD and even more severe forms of loss of reality testing, psychosis, and sheer insanity. However, BPD is distinct from narcissistic exploitation, manipulation, and criminality. It takes more than BPD to produce the kinds of horrific results that occur when a parent murders her child, but we only hear about BPD as if it were the only “cause.”
No one is endorsing using a child as a narcissistic extension of the parent’s defective grandiosity. The mental health consequences of the latter are severe, especially when occurring habitually. No one is endorsing everyday, run-of-the-mill bad parenting. There is not a lot of good news here. However, all these failings are different than child abuse and criminality.
Lawson rides the slippery slope from perpetrations and emotionally traumatizing behavior all the way down to dehumanization and homicide. Granted it may seem to the survivor of a BPD mother as if she or he were a Holocaust survivor – nor should anyone devalue the suffering of what anyone else had to survive, including the Holocaust – but a significant difference between the two still exists.
Lawson’s best guidance for surviving the BPD mother, whether as a child of tender age or a grown up survivor, may be summarized: set limits, deploy different ways of setting limits to inbound aggression, insist on respect for boundaries, drain the emotion out of emotionally fraught situations, deconstruct upsets, do not personalize accusations, call out “crazy making” behavior. These are all ways of managing manipulation, bullying, emotional perpetration, and so on. All are easier said than done.
The most critical remark I can think of? Lawson deploys the main psychological mechanism underlying BPD, splitting, resulting in a black and white representation of the BPD mother – only there is no white. In short, the BPD mother is literally described as a “witch” (as well as a queen, waif, and hermit). This satisfies the definition of “demonization,” both literally and metaphorically.
I am just getting warmed up here. Granted Lawson does not aspire to evidence-based peer-reviewed research. Her argument is narratively and rhetorically strong. However, how is Lawson’s argument that the BPD mother is the cause of the child’s suffering any different than that the “ice box” mother (usually attributed to Bruno Bettelheim (but the matter is debatable)) is the cause of childhood autism?
In both cases, as the mother enters the narrative – or the room – the audience expresses its negative opinion of the mother by breaking out in hisses and boos. Well and good. You have got to blame someone. Blame the mother?! Still, as usual, correlation is not causation; and the correlation is indeed compelling in the case of BPD in the ways that escape the “ice box” mother description.
Lawson documents that the BPD mother enacts a long list of behaviors that are manipulative, perpetrating, and out-and-out boundary violations. This is not disputed. Unacceptable. From the perspective of the child of tender age, the behaviors are particularly appalling.
What Lawson may usefully have acknowledged is people have different way of expressing their suffering. The BPD person’s dramatic, para suicidal behavior – cutting, substance abuse, acting out – inevitably gets our attention. That is the effect of the behavior – it gets our attention. But that is not the reason why the person misbehaves in this way.
The BPD person is trying to regulate her emotions, deal with the distress she is experiencing, or sooth herself. The person is trying to survive her life – survive the distress of the moment. That one can attain emotional equilibrium in an emotional emergency by carving up one’s upper arm with an Exacto knife is hard for the non mental health professional to get one’s head around. Indeed it is hard for anyone to get their head around it; but that is what needs to happen to understand the BPD person.
Lawson properly directs such empathy as is available in the conversation at what the children have to survive. I am not proposing at this late point that Lawson needs to have expanded her empathy for the BPD mother. Rhetorically and narratively that is not in the cards. However, this may be a moment to hate the sin and “love” – or at least provide treatment for – the sinner. That someone ends up in jail for child abuse does not mean that the perpetrator does not need treatment. She does – as does the child.
By the time the survivor of the BPD mother shows up at the door of Lawson’s clinic, it is too late for early intervention. It is too late for empathy lessons in child development. It is too late to teach parenting skills. It is too late. Period.
Still, I came away persuaded, identifying and devaluing the BPD mother as the cause of the survivor’s suffering, too – fully enrolled in Lawson’s project and interpretation. However, what did not happen was creating a space of validation, toleration and acceptance in order to engage the tough issues of recovery, transformation, change, and mourning one’s losses.
Borderline personality disorder remains stigmatized even today. Lawson’s account does nothing to remove the stigma, and, in several ways, reinforces it with devaluing labels such as “witch.” Once again, I hasten to add there is no excuse for bad behavior on the part of anyone, including BPD persons or those committed to treating them.
Truth and reconciliation commissions are in short supply in the political world; and, likewise, such is the case in the milieu of psychotherapeutic treatment. Rare is the instance in which a BPD mother says, “I did it – I was the perpetrator – no excuses – I was a shit. This is what happened [….]” And the survivor then gets to say whether or not she accepts that as the truth and can go forward on that basis. However, I would have appreciated Lawson’s at least calling out the value of such interventions in the context of community mental health – prior to referring the subjects and survivors to Dialectical Behavioral Therapy.
 Christine Ann Lawson, (2004), Understanding the Borderline Mother: Helping Her Children Transcend the Intense, Unpredictable, and Volatile Relationship. New York: Rowan and Littlefield. 330 pp. $46.92 [“free” Audiobook with (Amazon) Audible Subscription].
© Lou Agosta, PhD and the Chicago Empathy Project