Thursday, April 21, 2022

Borderline

Borderline (pronounced bawr-der-lahyn)

(1) On or near a border or boundary; a border; dividing line; line of demarcation.

(2) Uncertain; indeterminate; debatable; an indeterminate position between two conditions.

(3) Not quite meeting accepted, expected, or average standards.

(4) In psychiatry, as Borderline Personality Disorder, a descriptor of a personality disorder characterized by instability in many areas, as mood, identity, self-image and behavior and often manifested by impulsive actions, suicide attempts, inappropriate anger, or depression. The abbreviation is BPD.

1847: A compound word (also as border-line), created to describe a "strip of land along a frontier" as distinct from the actual line of a border, the construct being border + line.  Border was inherited from the Middle English bordure, from the Old French bordure & bordeure, from border (to border), from bort & bord (a border), of Germanic origin akin and to the Middle High German borte (border, trim) and the German Borte (ribbon, trimming); doublet of bordure.  Line, influenced in Middle English by the Middle French ligne (line), was from the Latin linea, from līneus (flaxen; a flaxen thing) from līnum (flax).  The Middle French ligne was from the Old Danish likna, derived with the inchoative suffix -ne from lig (similar) and was related to the Swedish likna, the English liken and the Middle Low German līkenen.  It replaced galīkōną, an older verb without -n, hence the Old English ġelīcian, the German gleichen and the Gothic galeikōn.  As an adjective meaning "verging on" it is attested from 1903, originally in medical jargon to describe various conditions but from the 1930s, it became most associated with metal health, the diagnosis of the condition Borderline Personality Disorder beginning in 1938 and evolving over several decades.

Borderline Personality Disorder

In clinical psychiatry, although the number of borderline conditions has increased, it’s only the concepts of Borderline Personality Disorder (BPD) and the Schizotypal Personality which are claimed to have adequate diagnostic reliability, the parameters of both first codified in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III (1980)).  The fourth edition (DSM-IV-TR (2000)), established the most commonly followed criteria for BPD and in DSM-5 (2013), these were extended to a remarkable sixteen headings in seven (A-G) categories in what appeared to be a kind of clinical mopping-up of symptoms suffered by those not able, for whatever reason, to be diagnosed with something more specific.  Indeed, the all-encompassing taxonomy appears rendered superfluous by Criterion E which seems just about to sum it up.

Criterion A: Moderate or greater impairment in personality functioning; two or more of the following criteria: (1) Identity: Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self-criticism; chronic feelings of emptiness; dissociative states under stress. (2) Self-direction: Instability in goals, aspirations, values, or career plans. (3) Empathy: Compromised ability to recognize the feelings and needs of others associated with interpersonal hypersensitivity (i.e., prone to feel slighted or insulted); perceptions of others selectively biased toward negative attributes or vulnerabilities. (4) Intimacy: Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with real or imagined abandonment; close relationships often viewed in extremes of idealization and devaluation and alternating between over-involvement and withdrawal.

Criterion B: Four or more of the following seven pathological personality traits must be present: (5) Emotional liability: Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances. (6) Anxiousness: Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control. (7) Separation insecurity: Fears of rejection by and/or separation from significant others, associated with fears of excessive dependency and complete loss of autonomy. (8) Depressivity: Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feelings of inferior self-worth; thoughts of suicide and suicidal behavior. (9) Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing or following plans; a sense of urgency and self-harming behavior under emotional distress. (10) Risk-taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences; lack of concern for one’s limitations and denial of the reality of the personal danger. (11) Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults.

Criterion C: (12) The impairments in personality functioning and the individual’s personality trait expression are relatively inflexible and pervasive across a broad range of personal and social situations.

Criterion D: (13) The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time with onsets that can be traced back at least to adolescence or early adulthood.

Criterion E: (14) The impairments in personality functioning and the individual’s personality trait expression are not better explained by another mental disorder.

Criterion F: (15) The impairments in personality functioning and the individual’s personality trait expression are not attributable to a substance (eg, a drug of abuse, medication, exposure to a toxin) or a general medical condition (eg, severe head trauma).

Criterion G: (16) The impairments in personality functioning and the individual’s personality trait expression are not better understood as normal for the individual’s developmental stage or the socio-cultural environment.

The wide BPD net cast in DSM-5 pleased the psychiatrists but in recent years, there’s been interest in changing the name of BPD, a movement led not the profession but by those diagnosed with the condition, the creation of pressure-groups now greatly assisted by social media.  The objections seem to be that BPD (1) somehow marginalizes the sufferers in the hierarchy of mental illness, (2) fails to capture the underlying issues and mechanisms involved in producing its symptoms and (3), denigrates and even invalidates the very existence of their condition, the word “borderline” suggesting their symptoms aren’t sufficiently severe to be a “real” condition.  In that sense, the word does have loaded connotations, “borderline” used first by 1930s psychoanalysts to describe patients whose symptoms lay between psychosis and neurosis but to modern lay-persons, a common interpretation is that the condition “borders” on being a “real” illness.  Some even object to “disorder” but most accept it; they’d just prefer to be diagnosed with a more significant, and fashionable, depressive disorder.

Although it seems hardly more respectable, Emotional Intensity Disorder emerged from a survey as the popular choice of patients, beating out Emotional Regulation Disorder, Emotional Dysregulation Disorder, Emotionally Unstable Personality Disorder, Impulsive Personality Disorder & Impulsive-Emotional Dysregulation Disorder.  The clinicians liked Emotional Regulation Disorder but were out-voted.  Unimpressed by either, the committee working on the revision of DSM-5 proposed Borderline Type (which sounds like a sceptical psychiatrist’s casual dismissal of emos), but noted “no decision has yet been made.”

Checkpoint Charlie and the Berlin borderline, 1961-1990 

Konrad Adenauer (1876–1967; FRG Chancellor 1949-1963) at Checkpoint Charlie in 1962; car is a Mercedes-Benz 300d (W189).   The 300 was produced in four generations (W186 1951-1957 & W189 1957-1962) and became known informally as the “300 Adenauer”, the association prompted by the chancellor using six (cabriolets, sedans and a landaulet) 300s during his long term in office.  The 300d is also associated with Pope John XXIII (1881–1963; pope 1958-1963) who was presented with one in 1960 and it served as the official papal vehicle until 1965 when Paul VI (1897-1978; pope 1963-1978) took delivery of a Mercedes-Benz 600; both cars were high-roofed landaulets.

Although the most famous, the crossing point in the Berlin Wall (1961-1989) on the borderline between East and West Berlin and named Checkpoint Charlie (Checkpoint C to the military) was one of three, all known by their designation drawn from the NATO phonetic alphabet, the now forgotten pair being Checkpoint Alpha at Helmstedt and Checkpoint Bravo at Wannsee.  The Soviets (officially) didn't use the NATO designation, instead calling Checkpoint Charlie the КПП Фридрихштрассе (KPP Fridrikhshtrasse (Friedrichstraße Crossing Point)) while the government of the GDR (German Democratic Republic (East Germany)) listed it as the Grenzübergangsstelle (Border Crossing Point) Friedrich-Zimmerstraße.

Checkpoint Charlie, 1963.

In one of the charming coincidences of the Cold War, Checkpoint Charlie was located at the intersection of Friedrichstraße, Zimmerstraße & Mauerstraße (which for historical reasons means "Wall Street").  It became the only well-know crossing point because for reasons of security and administrative convenience, it was the sole designated crossing point (whether for foot or vehicular traffic) for foreigners and members of the three Allied (the France, the UK & the US), (previously occupying) forces stationed in the Federal Republic of Germany (FRG (West Germany)).  The manned structures associated with Checkpoint Charlie were also in a location which lent itself to photography from a number of angles and replicas were built by film studios producing the many productions made during the Cold War.  The Cafe Adler (Eagle Café), adjacent to Checkpoint Charlie was for decades one of West Berlin's tourist hotspots.

Checkpoint Charlie, 1982 showing the larger aluminum building which that year replaced the original wooden hut.

To those accustomed to seeing the gargantuan installations the US military tend to erect wherever they take root, Checkpoint Charlie must have been a surprise, a modest (though enlarged in 1962) and obviously temporary wooden hut was for more than twenty years all that stood on the western side, the little building replaced in 1982 only because it had become so dilapidated it was literally falling down around the guards stationed within and even then, the metal structure which replaced it, while larger, was no more permanent.  However, if people were surprised, it’s doubtful many were disappointed, the compact architecture providing a single point of focus and even in the pre-selfie era at one glance what tourists could take in was evocative of the Cold War cinema with which so many were familiar.

Checkpoint Charlie, 1970.

The attitude of the allied powers reflected their political position that while obviously a line of control, the Berlin Wall was not a legitimate international borderline and thus only small, temporary buildings were required.  To the authorities in the Kremlin and the GDR, whatever some might suggest was the position in international law, the Berlin Wall was a borderline and thus on their side the infrastructure quickly grew to include watchtowers, a military barracks and a multi-lane, enclosed clearing zone in which those wishing to cross could be interrogated and searched.

Checkpoint Charlie, 2020 showing replica “1961” hut and sandbags.

The Berlin Wall “fell” in November 1989 and the checkpoint booth was removed some six months later although, because East and West Germany remained legally separate countries, the checkpoint at the point of the borderline was retained as the designated official crossing-point for foreigners and diplomats an arrangement ended in October 1990 when German reunification was formalized in law.  Checkpoint Charlie has since remained one of Berlin's tourist attractions and, just as some parts of the once demolished wall have been re-created because supply of the real thing wasn’t enough to meet demand, the municipal government soon erected an almost exact replica of the checkpoint as it stood in 1961 although the quality of the construction is said to be rather more robust than the original and it’s expected to enjoy a longer life.  Better to capture the flavor, even the sandbags which gradually were removed during the 1970s are carefully stacked in place.  During the tourist season, selfies are now taken by the thousand.

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