Compersion, a word invented fewer than fifty years ago by a polyamorous community in San Francisco, has found its way into mainstream media. It is possible to believe that this rapid adoption, as with any neologism, has something to do with the ability of the word to tap into a fundamentally human experience — our capacity to resonate with others’ joy. Indeed, before compersion there was mudita.
So long as you were attuned to what he wanted to share. So long as it was his choice to share what he shared about his life.
I don’t remember the teacher’s name, now, several years later, a Western white man with a lifetime of experience in Buddhist practice, but I did appreciate his point and it stayed with me. The teacher was helping a Zen Hospice Project volunteer caregiver learn to be deeply with someone who was dying, to listen softly, wholly to a man’s expressions about the meaning of his life. The teacher was encouraging the volunteer above all to be guided by this man’s agency and choice. It was an important lesson. He was calling us all home to mindfulness. Mindfulness of another’s beingness, of another’s total experience, and of the whole context facing this man — a uniquely self-sovereign transition — in his present life path.
We were in the room of an old and airy house with high ceilings and about thirty volunteers, staff, and other attendees interested in learning more about the world and the wisdom and the grace of zen hospice work. I came with a friend who was a regular volunteer. I came because she invited me to visit this place where she volunteered and in that way know her more deeply, and I came because the discussion topic sounded interesting to me. But I was surprised when I found a familiar part of myself there.
That part of me showed up right before the teacher reassured this volunteer that attuning to the resident’s choice was core to her volunteer work. Right before that my eyes lit up listening to the volunteer share her story.
So I have been visiting with a resident regularly for a few weeks now, and listening to and being present with him. And every time we meet he tells me stories about his life. He has these wild fabulous and sometimes hard stories. He has done so much with his life. And the way he tells his stories. Well. It’s like the room turns into a movie set and I can see the whole thing going on like a beautiful film. And he laughs and he sighs and then wags his head low and sometimes he cries. And then he lifts his head up and laughs again. And all the while I know he’s dying.
The whole room was tuned in to her story about this dying man with the many stories.
He knows he’s dying, too.
And I just wonder if I’m doing it wrong.
She paused again.
I wonder if it’s ok to be laughing so much with him, to be enjoying him so much.
And that’s when I lit up. Sitting there on my pillow, my whole body rose up a bit and my shoulders rolled back.
These years later, I still appreciate the teacher’s response. It certainly mattered that this dying man make his own choices about how to spend his final days.
And yet I noticed something that the teacher seemed to miss. The volunteer caregiver appeared to me to be particularly concerned with the question of whether it was appropriate for her to feel enjoyment — to laugh and feel joy when she visited with this resident.
In that moment, my head was abuzz, wondering how joy was important for this man, how his stories brought him joy, again, how his whole life was a mix of great joy and sorrow, and how important it was for him to be with all of himself at the end. And I recognized this volunteer’s natural gift. To me it seemed a great power of hers to be able to follow both his joy and his sorrow. She did not stop his laughter, did not turn a stern or baleful face toward him, overly burdened by her own sorrow for his current circumstance. She joined with him, fully. She laughed with him when he needed to laugh.
This is mudita. One of the four Brahma-viharas, or “sublime states,” mudita is an other-oriented joy, a joy that wells up and resonates with another’s joy when witnessing their good fortune. There are yet other names for this human process . . . firgun, symhedonia, and celebratory love.
The volunteer was witnessing the man’s good fortune, the richness of a life well lived and well enjoyed, even in the end. She was resonating with parts of him that were deep and meaningful to him, with his ease and flow and laughter.
I wanted to speak out and tell her that what she was doing was not just attuning to him and his choice, but was affirming him in a way that so often in challenging times can get overlooked — the part of him that could still feel joy and still needed to feel his joy.
I wanted to speak out, but I was listening to the teacher say many wise things about choice and the depth of listening to residents’ agency, things that volunteers needed to hear and to bring to bear in their work. I listened until the time was up. We all got up and quietly smiled around to each other. I was grateful for what I had learned.
And as I left that beautiful old Victorian house with my friend, I was thinking deeply about choice. I was thinking deeply about that volunteer making contact with that man through the startling energy of pure joy. And I was thinking deeply about how to choose to bring more attention in my own life — and in my work as a counselor and psychotherapist supporting others — to the rightness of joy resonance.
This blog post is part of a series, Exploring Joy Resonance in Psychotherapy Practice. What happens when a psychotherapist makes a conscious decision to include and attend to "the joy in the room”? What Barbara Fredrickson calls “celebratory love” is a personal and professional aspect of any psychotherapy with process outcomes, consultation considerations, and ethical imperatives. Through each anecdotal process encounter, the author’s writing journey reveals greater understanding of joy resonance in psychotherapy practice than can be attained by an analytical discourse alone.
Originally published at Grateful Heart Holistic Therapy Center's blog.
Artwork by Anna D. Hirsch.
Game of Holons: Understanding the Mental Health of the Houses of the Known World Through a Transpersonal Family Systems Lens (essays from graduate school)
“I don’t need saving.” — Arya
In 2014, as fans were becoming even more enamored with their then 3-season-old TV favorite, Game of Thrones (GoT), PsychologyToday.com contributor Jonathan Fader, Ph.D., gave us the headline, “Diagnosis Game of Thrones: What’s Ailing Westeros?” followed by the snarky subhead: “In the Game of Thrones, you win or you find a therapist.” A year later in 2015, Kat Rosenfield suggested that, in fact, “Everyone on ‘Game of Thrones’ Has Serious Issues.” And by 2016 Travis Langley had devoted an entire book to the subject: Game of Thrones Psychology: The Mind Is Dark and Full of Terrors. These popular analyses have remained focused on the innate mental health of individual GoT characters, without a systems theory approach. Licensed marriage and family therapists (LMFT), however, are trained to bring to the therapy a cogent, applicable, and integrated family systems theory, knowing that who we are in relationship with has an important role in our mental health outcomes. As the new season launches this month and fans get ready to offer the Internet another round of CouchPotatoPsychology.com, a fresh look at the different Houses of GoT may help psychology fans to examine this haunting and memorable world in a manner more salient to the real work of psychotherapists, and maybe also for our society’s collective understanding of better therapeutic interventions generally.
down this worn and dusty
Kingsroad. Come along
with me, Colleague, Friend, Reader,
into the mystical world of the seven kingdoms,
a land of magical believing and otherworldly incarnations,
of historical allusion and fairytale realism,
dragons and White Walkers,
and the imaginative dreamspace of author George R. R. Martin,
side by side with the messy truths
of mortal hope, duplicity, loss, grief, passion, and retribution,
against a grisly backdrop of death and survival,
charmed nonetheless by the devotion
that therapists must deal in,
a devotion to curiosity about the motivations of people --
here, may we become, if briefly,
healers in the Game of Thrones.
Here on the brink of Season 6,
we strive not just to diagnose, but also
to broaden our comprehensions
in the arts of repairing rupture and stimulating growth.
May our efforts be a unifying experience,
blessed with a few precious gems at the end of the road,
insights from the Lord of the Light within,
and also from the light between us --
between you, Reader, and I, your humble Writer.
So that it may be,
along the way we ask, Where must we go?
What must we know and not know? What can we hope to see?
And what will we do with our sight?
Perhaps, as attendants in the land of Westeros,
we ought to go armed
with a theoretical approach to match this extraordinary place.
As Above, So Below:
Toward a Transpersonal Holonomic Family Systems Theory
Sometimes we must go somewhere new, unfamiliar, maybe even unknown. On April 24, 2016, fans went into the new season of GoT not knowing what each intertwining scene would reveal in the epic stories of Westeros. But we didn’t go alone; we shared the ride on chat boards and through blog posts, many even gathering around a screen with loved ones nearby. A family of fans, we are unique in how we express our fandom, but we are also bound together in our rallying cry for “more!” GoT is at once a personal folly and a transpersonal problem of modern society — TV junk. But this basic aspect of reality, an acutely known personal anguish perfectly nested within often indiscernible larger social forces, is not something we’re that good at noticing, though there is a pretty good reason why we’re not quick to see the macrocosm.
What we could call, perhaps imperfectly, “the collective field of family systems theories” has itself in part suffered from a lineage (of which many of us are a part) of Western-style individualism, such that many of these person-plus theories still tend to view the goal of all therapy on individualistic terms. As detailed in the work of McGoldrick, Gerson, and Petry, the genogram may help map multi-generational family patterns, but from the start, the genogram was also intended to be a therapeutic tool to explain, diagnose, and treat the presenting problem of a single person. The genogram has since been frequently employed in the context of individual psychotherapy, sometimes with the family present or involved in the individual’s process, but retaining a focus on curing or changing a problem inherent in the client’s self-contained, personal psyche.
Historically, this makes sense since Western psychology has tended to frame therapy as the treatment of an abnormal, ill patient, aimed at brining the individual back to a normal state of health. Freud, after all, wanted the patient to experience the analyst as a tabula rasa — blank slate — in order to allow the patient to use the relational space between herself and the analyst to work out and undo the personal psychological dynamics (read: damage) caused by the patient’s family, without the influence of the analyst or other outside forces getting in the way. In other words, the patient, while dependent on the analyst for the analysis, was also left alone in the task of becoming well again. Though benefit may occur for others in the family while the patient is being treated, focusing on the ego development of one person at a time and as distinct from other interactive egos resonates with our fanatical focus on “getting right” the individual ego states of the characters of GoT. Joffrey the sociopath, Ramsay the sadist, and Cersei the borderline — check, check, check.
But even during Freud’s time, Western and Eastern psychologies were fast coming together to describe an alternative view of human development, invoking a mutuality of experiencing, client and counselor together in the healing process. Carl Jung, Abraham Maslow, and William James, the last of whom became well known as the first person to use the term “transpersonal” in 1905, all pioneered the scientific study of consciousness, mystical experience, and interpersonal psychological phenomenon, in the context of evolutionary biology. By the 1950s, transpersonal psychology took off as a modality of its own, distinguished from other Western psychologies by the way it infused a systematic, scientific focus, within psychotherapy, of that which exists when flesh is stripped away and the self cannot be defined as a corporeal body — focusing on, in a word, spirituality.
Where symbolic interactionism theory, born of the 1900s industrial revolution, brought the scientific method to the study of social interaction, transpersonal psychology allowed for the integration of spirituality and philosophy within this scientific framework by assuming that psychology is shared among interacting people, not isolated in the body of an individual — a psychological conceptualization that neuroscience has finally begun to corroborate. What Edward Bruce Bynum has called the “family unconscious,” like Jung’s collective unconscious, consisted of a “shared family emotional field . . . a shifting, interconnected field of energy that does not obey the conventional rules of space and time in the waking state” (Psi). Bynum further pointed to sub-atomic physics to explain how energy, experience, and learning (much as Daniel Siegel has shown in his biopsychosocial neuroplasticity research of the brain / mind / relational matrix) form interconnected, mutually-influencing shared space. We truly are connected in space and time, one great sea of connected energy, and it is this fact that transpersonal psychologists believe we must come to know in a deeply personal way.
In this alternative, if somewhat estranged, branch of the family of Western psychology, transpersonal psychologists are asking us to further consider a family systems approach that defies the primacy of the individual psyche, or the singular modality. Irene Lazarus openly hopes, “that we are growing toward” a very special kind of community, a community of healing, in which “dark parts are seen and accepted, intimacy is increased, there is support for appreciation of differences, as well as an increased feeling of being understood and accepted” (p. 13). In order to build this healing community, Lazarus has found “working many levels at once” beneficial (p. 13). In other words, it may be necessary to have a tool flexible enough to work the individual aspects of therapy while simultaneously engaging the interpersonal and transpersonal aspects of Bynum’s family unconscious.
So, as we go into the unknown, shifting our paradigms and our minds, sometimes we must paradoxically also know, to some degree, something about how to proceed in — to have a framework for exploring. Welcome, Jenny Wade. In her book, Changes of mind: A holonomic theory of the evolution of consciousness, Wade gives us such a tool. While transpersonal theory describes how science and spirituality combine to form the basic makeup of the world, Wade fittingly locates the origins of this theory in a medieval mystical text, the Emerald Tablet. Wade notes that alchemists based the writing of the Emerald Tablet on a simple opening concept: “as above, so below” (p. 262). As god is in paradise, so man is on earth, a microcosm of all of god’s creation. Similarly, biological science has now shown the cell to be its own unique microcosm of a uniquely larger system, a tree leaf or a human tissue. Physics has shown the same concept to hold for the atom. In human terms, the holon, as defined in the governance model of holarchy, has been used to demonstrate a similar pattern, that the human, like a cell or atom, is a unique, stand-alone entity, but also part of something larger. A family, a community, a species, contains many holonomic personhoods. This fundamental paradox of all things, things human and inanimate, corporeal and metaphysical, is understood in transpersonal holonomic psychology to be the true nature of all things — all things all the time, each being, at once a uniquely self-sufficient system, while also inexorably part of something larger. Holarchy is simply the way the world is. A key question for people, then, follows: Do we understand and accept this natural order?
Transpersonal psychologists have used holarchy for decades to explain human embededness in the natural world, suggesting a personal psychology that simultaneously extends beyond the personal, personal plus, trans-personal. Wade’s description of holarchy offers a particularly clear explanation of the predicament of the human holon. Like one of Zeno’s paradoxes, people might not be able to conceive of their true holonomic nature, and yet it is still what is. As Wade puts it, “the whole, perfectly realized person is in the partially evolved [S]elf” (p. 262). However, suffering may come about from a lack of awareness of what is. A progression of consciousness development (reprinted from Wade in Table 1) can facilitate evolutions out of suffering and ultimately lead to a path free of emotional, cognitive, and behavioral turmoil with regards to what is. At times, people also stagnate or even regress as well. As Wade notes, “the world does not change; the way in which the world is understood does” (p. 262), and sometimes that change is in the negative direction.
Along with the primary terms and concepts of holonomic family systems theory described in Table 2 (below), Wade’s stages of holonomic consciousness requires a few basic assumptions on the part of the clinician / healer. For continuity of the theory, making explicit the first assumption is paramount. Only under this primary assumption, that the true nature of the whole person is a holon, can the therapist make sense of the rest of the theory. Even as the Self is continuously, partially evolving, the whole person’s true nature is still and always will be also perfectly realized, regardless of which stage of consciousness the Self has yet attained. At the same time, embodiment and Self-awareness — consciousness — of the true nature of the whole person as a holon promotes mental health, which includes the health of the personal and the transpersonal psyche. Although the partially evolved Self is already also the perfectly realized whole person, how unconscious or conscious the Self is of its true holonomic nature can lead to suffering and pain or greater peace and joy. These feeling states may have an impact on the holon’s capacity to enjoy life and succeed with everyday challenges. In other words, how far along the Self is in the stages of consciousness may contribute to better survival and thriving outcomes. Perhaps rather obviously then, denial or lack of awareness of the true nature of the whole person as a holon stifles healthy development of the Self’s holonomic consciousness, creates “mental illness,” and can even lead to the death of the Self. Additionally, holons are living, transforming processes, such that change and impermanence are constant, and perhaps the only constant. This suggests that growth is constantly available, as well as imperative. And finally, holons are fundamentally relational, neither fully merged, nor fully individuated. Rather, holons are perfectly both, merged and individuated, at any given moment, regardless of what appearances may suggest in the temporal narrative of the Self. And as such, holons are perfectly both Self-reliant and dependent — perfectly interdependent.
Uncovering the Biopsychosociospiritual Realm
If we look across Game of Thrones at the different characters, focusing especially on the Season 6 opener, we can begin to place them in Wade’s stages of holonomic consciousness. Jaime, of House Lannister, says sternly, “Fuck prophecy. Fuck fate. Fuck everyone who isn’t us. We’re the only ones who matter, the only ones in this world. And everything they’ve taken from us we’re going to take back and more. We’re going to take everything there is.” As with the first stage, reactivity, Jaime believes he is the world, and that his needs will be or at least ought to be met as they arise. But even with his daughter dead by his side and the obvious opportunity he has to face the transitional dilemma that perhaps he is not the world, well, he cannot face this fact. Jaime’s awareness will not allow him any other viewpoint, even when Cersei tells him that fate is stronger than they are. Cersei, a level up from Jaime, naïve, speaks of the pureness of her daughter, Myrcella. Cersei likens Mrycella to her moral guide, her conscience personified as her daughter, in hopes of being one with Myrcella: “I thought if I could make something so good, so pure . . . maybe I'm not a monster.” Cersei’s transitional dilemma is in seeing that she and Myrcella are not one, and Cercei’s contemplation of Myrcella’s dead body suggests that Cersei will in fact be able to see that her leader and her Self are not one. This suggests that Cersei might also be able to leave the naïve stage of consciousness and in fact may be working right through the egocentric stage as well, believing that death is inevitable due to prophecy. It will be interesting to see what Cersei does next, and what she would do at the conformist stage, since she has not typically been a character to do good and it is hard to see her believing that the universe is fair.
House Bolton, in the next stage of holonomic consciousness, typifies the belief that if you are tough enough you never die. Roose Bolton seems to think this when he says to his son Ramsay, “I rebelled against the crown to arrange your marriage to Sansa Stark.” He did this to ensure that they would have “the entire North” behind them when their reckoning day comes. He also threatens Ramsay with making his next son heir to the throne, with a veiled message that Ramsay has been weak, playing games with Sansa and Theon, and so may lose out on the chance to live on through a son of his own. Ramsay is in the same stage of consciousness, and responds obediently, “I have a team of men after them with some of my best hounds. They won't get far,” also using force to assure his place. Neither Roose nor Ramsay yet believe that their own lives are in much peril, because of their certainty that they are tough — you get the sense that they’re even kind of assholes to each other, and if need be, would take each other down.
The Night’s Watch, though not representing a House of Westeros, behaves similarly, with members who access the ladder of holonomic consciousness. Davos, invoking Jon, says to the Night’s Watch who would fight for his honor, “I didn't know Lord Commander Snow for long, but I have to believe he wouldn't have wanted his friends to die for nothing.” Because of Jon’s murder, these men, gathered around and allied with Jon’s cause, may all be facing the transitional dilemma that life is not fair, and trying to ascend together to the next level, seeking to try on the belief that they may master their world through their own initiative.
Then there is House Targaryen. Daenerys, being capture by the Dothraki, tries to master her fate by speaking up boldly to the Khal who has captured her. She uses a litany of her collective stations to try to master the situation and sway Khal Moro: “Do not touch me. I am Daenerys Stormborn of the House Targaryen, the First of Her Name, the Unburnt, Queen of Meereen, Queen of the Andals and Rhoyanar and the First Men, Khaleesi of the Great Grass Sea, Breaker of Chains and Mother of Dragons.” This does not work, however, as Khal Moro responds simply, “you are nobody.” Daenerys must face that her words, her Self-action may be futile, as she again faces the transitional dilemma that some forces, like her dragons, may not be mastered. She tries again anyway, naming her Self as widow of Khal Drogo. This time she gets the response she wants, at least at first. Having glimpsed the volatility of the Khal and to secure her position, she tries on the next level of consciousness, appealing to whatever heart Moro might have by offering him a gift: “If you will escort me back to Meereen, I will see that your khalasar is given a thousand horses, as a sign of my gratitude.” But an unforeseen-to-Daenerys Dothraki law of returning widows to Vaes Dothrak, the Dothraki Sea, gets in the way, and Daenerys is left yet again contemplating another transitional dilemma, that love cannot redeem every situation.
Finally, in House Stark, Sansa, while trying to escape her captivity at Winterfell, is at first found by the dogs and guards sent by Ramsay, but then almost immediately she is saved by Brienne. Mustering all her strength after nearly being returned to the torturing clutches of Ramsay, Sansa uses her voice for the first time to sound more like her mother in order to properly accept Brienne’s service: “And I vow . . . that you shall always have a place by my hearth and . . . meat and mead at my table. And I pledge to ask no service of you that might bring you dishonor. I swear it by the old gods and the new. Arise.” This is a big step for the once whiny, pitiful Sansa, who much on her own has found her way through many trials to end up here, finding her Self, and standing strongly in her newfound sense of purpose. Sansa does not yet appear to have imagined the next transitional dilemma of needing to give her Self up in order to reach her potential, and we may wonder how she will continue to transform to be ready for this stage. Arya, however, has already given her Self up to the Many Faced God and has already declared her Self “no one.” Yet, while being beaten by the Waiff, Arya’s pleas that she cannot see could suggest that she is stuck in the stage of consciousness that is beholden to the Ground, reliant on the concrete, known world, when what she must become is unknown to her Self. We are left wondering if Arya can meet the next transitional task of continuing to fight back against the seduction of sentience, to fight for her holonomic whole person, regardless of the Ground on which her Self stands.
Overall, the Stark girls appear to find more purpose and meaning in life than the other characters. They are also able to gain position and power in innovative ways, through arranged marriage and joining occult groups. And though some have argued that Arya suffers with PTSD, her thirst for justice, if also vengeful, seems to have a directed, Self-realizing action and lacks the intensely diseased and dysfunctional qualities exhibited in some of the other characters.
On the Couch with Ned
With Ned Stark’s ghost (and Catelyn and Robb’s, too), almost certainly present for the Stark children, his spirit breathing through their beings and his slaughter long hanging like a dark cloak over the rest of Westeros, Sansa and Arya and the rest of the Starks and their people in the north are tied together through the family unconscious, through the superbeing of Ned’s memory, visions, and perhaps even his dispersed soul. As viewers, we may be keenly interested to see the return of Bran and Rickon, how the boys will reconnect to the story, what their stages of holonomic consciousness will be, and if they will be similarly infused with Ned’s lasting life force. Indeed, we even wonder what is next for Jon Snow, who lies unburied and unburnt at Castle Black, and if he, too, in some way may rejoin the field of energy shared by his half-siblings.
As such, we also begin to see how each House acts as a holon, as well, within the larger society, each House with an interpersonal and shared, transpersonal holonomic consciousness, developed in mutuality among and by family members, and subject to the larger holon of Westeros. Arya and Sansa, even without seeing each other for years, echo each other a great deal, energetically. So do other family members of other Houses vibrate similarly with each other within that House, seeming to cluster together, up and down one or two stages. It may even be such that, as defined by the true nature of the whole family as a holon, members, aspects of the family-holon level, would have a biopsychosociospiritual pull to resonate together through the stages of consciousness. If your family or House members, in other words, were mostly stuck around stage three, that might create a strong enough holonomic context for you to mostly remain stuck there as well, or to regress to that stage.
In the end, getting transpersonal with the GoT season 6 opener offers psychology fans at least three worthwhile takeaways: 1) greater understanding that characters mostly lack spiritual, holonomic awareness and ascendance, reinforced by the holon of the House they belong to, lets us as brief healers in the land of Westeros see how family forces are at play in the mental health of the collective family unconscious; 2) greater awareness that unevenly and mostly unevolved holonomic Selves plague the Houses of Westeros, and so greater empathy for how some of the characters seem to act so poorly from a place of suffering in their unconscious stuckness because of the system in which they are perfectly stuck; and 3) greater sense of how to help avoid stigmatizing and that the whole system may need attention for any of the individual holons to experience relief.
Perhaps we cannot depart again
having actually done any healing work
for our agonizing friends in Westeros.
Or perhaps, participating in our own healing,
returning to our own grounded and ungroundedness
has effect — at least on our neighbor
whose hand we may be clutching a bit too tightly as we watch.
Bynum, E. B. (n.d.). Psi, the shared dreamscape and the family unconscious. Amherst, MA: University of Massachusetts Health Services. Retrieved from: http://www.obeliskfoundation.com/articles/artpsi.html
Canes, M. J. (2012). Introduction to family constellations. Toronto, Ontario: Transpersonal Therapy Centre. Retrieved from: http://www.epccanada.ca/wp-content/uploads/2012/09/transpersonal-therapy-centre.pdf
Jordan, J. V. (1986). The meaning of mutuality. Retrieved from: http://www.wellesleycentersforwomen.com/pdf/previews/preview_23sc.pdf
Lazarus, I. S. (n.d.). A transpersonal feminist approach to family systems. The International Journal of Transpersonal Studies. Retrieved from: http://www.transpersonalstudies.org/ImagesRepository/ijts/Downloads/Lazarus.pdf
McGoldrick, M. Gerson, R., & Petry, S. (2008). Genograms: Assessment and intervention, 3rd Edition. New York, NY: Norton.
Smith, S. R., & Hamon, R. R. (2012). Exploring family theories, 3rd Edition. New York, NY: Oxford University Press.
Transpersonal Lifestreams. (2011). Holons — the structure of transpersonal relationships in living organisms and social organizations. Hobart, Tasmania. Retrieved from: http://www.transpersonal.com.au/transpersonal-theory/holon.htm
Wade, J. (1996). Changes of mind: A holonomic theory of the evolution of consciousness. State University of New York Press: Albany, New York.
Last fall, at the beginning of a large online, undergraduate course in abnormal psychology, I was warned that after reading the textbook I should not attempt to diagnose mental disorders in friends, family, myself, or anyone else.
I immediately thought about a friend who had recently lamented to me that a dating relationship of hers had ended because she had discovered that the man was narcissistic, and maybe mildly autistic, too. She was not as certain on the latter part, because, she assured me, it might take more medical assessment to know that. I was transfixed by her use of the word “more.” Was her perusal and interpretation of MedWeb articles, I wondered, sufficient medical assessment for a diagnosis of narcissistic personality disorder? I realize now that as I stared at her with wide eyes I was beginning to formulate a question—reaching well beyond the personal opinion I surely also had of her at the time—a question that already had a deep yearning in me: I wanted to know what institutional and cultural trends in personality theory had led us as a society to treat the self so casually that a supposedly significantly disruptive pattern in personality function could be correctly perceived, labeled, and pathologized as readily as a common cold.
Let me pause a moment.
What exactly is “wrong” with his/my personality anyway?
And take a breath. A deep breath.
My great discomfort in moments like this one with my friend in which I am told in all seriousness--and much clearly stated fear and pity—that so-and-so has blank personality disorder or is mentally unstable, psychotic, or completely nuts, is symptomatic of a personal trigger--MY trigger. I hate the idea of being “that crazy girl” so much that one of the first things I often tell people about myself when we get close is that I might be the sanest person they’ve met—and then I do my damnedest to prove it. Internalized sexism much? In that trigger is also a projection and a judgment. Parts of me actually want to both distance myself from and better understand people who toss terms like narcissist and borderline into friendly conversation, because some part of me also thinks there’s something important in understanding how and why we aren’t better at talking about personality. I might call this something like “personality THEORY disorder.”
Personality theory disorder is something we’re all going through, as a society, on our own and together. It’s the natural outcome of being violently assaulted by large-scale social and economic forces that don’t care for the people being most affected. Because of this assault, we’re desperate for a theory of mental illness that helps people, but that same desperation is disorienting and distracting us from understanding how to help well. We want to put people first, but we keep putting applications first, thinking that we have to, that we don’t have the means to actually put people first. But we think that we don’t have the means, because we’ve internalized powerful messages that say caring about whole, integrated people requires limitless resources and there just isn’t enough time, love, money, food, counseling, you name it available for everyone. This is just a simple acknowledgment of a history—our history—of plunder and brutality, a history with long arms that keeps sending these messages out, actively and passively. Generations of trauma and disenfranchisement contribute to the ongoing stealing of power from our best intentions to help ourselves, let alone each other. You can see the great loss in this personal and interpersonal ransacking of hope in the huge fights among scientists, researchers, and theorists about impossible problems—an academic stance of powerlessness and a truly disordered approach to personality.
But we can change that; we can put people first again.
At the time of my friend’s lament, it seemed clear to me that she might have an easier time grappling with a failed love connection if there was a sure reason outside herself that the other person was simply too “damaged” or “dysfunctional” to be in a good relationship. There may actually be some utility to this line of thinking. Framing the other person as clinically maladaptive provides an escape from owning our own vulnerability or working on own shortcomings first—and that may be a necessary defense for her. Moreover, calling this sort of escapism out in others, as well as in myself, has certainly contributed to the work I’ve done in community and on myself over the past half decade to create access points to more personal power, and to more skillfully sharing power.
But what do clinicians do on the ground to accurately and compassionately understand, evaluate, and treat for better mental health outcomes in a way that puts the person first?
To be sure, as I work with more people in clinical settings on their relationships, on love and intimacy, on connection and partnership, and on community and cooperation, I will need a more coordinated, strategic approach, based in science and ethics, in order to answer that question, as well as to be with people, non-reactively, seeing clearly the context of popular beliefs about mental illness that may arise, uniquely, in each client’s narratives and dynamics as well. I will likely also need to keep revisiting my own judgments and gaps in understanding as to how and why lay diagnoses occur in the ways they do, including understanding the larger historical context of how personality has been understood, codified, and policed in our country as ill versus healthy. In other words, I will need to confront my own personality theory disordering, and I will need to pay attention to opportunities for healing and liberation.
And you may ask yourself, well, how did I get here?
In 1980, at the same time that David Byrne asked the world to consider the existential nature of standard American success, Reagan defeated Carter, Lennon was shot dead in New York City, and a Norwegian polio survivor gave birth to a girl in Chapel Hill, North Carolina, and named her Anna. Fifteen years later, threading her career through the independent living movement across the American South, my mother hired me one summer to enter data for her from a massive well-being survey into a database at the Missouri Institute on Mental Health. Has car, has food, feels happy, feels sad—I ticked off a long list of self-reported indicators that seemed both profound and meaningless on the computer screen, and I wondered how in the world this information could be used. How could this litany of survey questions make up the whole picture of a person’s well-being?
From my vantage today, this memory is not surprising. From 1980 to 1995—my whole life at that point—not much had changed in the official method of the American Psychiatric Association for assessing mental health. But before 1980 things looked much different.
For more than sixty years, the Diagnostic and Statistical Manual of Mental Health (DSM) has been a main site of power in articulating and enacting theories of “personality illness” across our institutions and woven through our culture in the United States. How the DSM defines disordered and medically significant personality deviation is still being heatedly argued about today and provides an important anchor for understanding how personality has become typed and treated as ill, even beyond the overtly therapeutic setting. The history of the DSM is also an incredible storyteller and reflection of the narrative of our shared personality theory disordering.
The first (1952) and second (1968) editions of the DSM, “reflected Sigmund Freud’s idea of psychodynamics: that mental illness is the product of conflict between internal drives” (Adam, 2013). According to Mayes and Horwitz, “these manuals conceived of symptoms as reflections of broad underlying dynamic conditions or as reactions to difficult life problems” (2005). But in the 1970s, for much good reason, Freud was being heavily criticized and challenged by multiple other schools of thought in psychology, including the humanists, the cognitive behaviorists, and even the human potential movement. With scathing critique form the new feminists and Freudian classical psychoanalysis in the doghouse (Robinson, 1993), the third (1980) and fourth (1994) editions of the DSM flipped the “dynamic” approach on its head, opting for a theory of discrete, categorical buckets designed to meet a supposed need for easily diagnosable, uniquely treatable, and statistically viable mental ills. The DSM-III’s categorical approach, which was billed as a clear and straightforward classification system, handily “imported another role model from central Europe: psychiatrist Emil Kraepelin” (Adam, 2013). Kraepelin was famous for saying that conditions had “unique sets of symptoms and presumably unique causes” (Adam, 2013). With Kraepelin, asserts Nature writer David Adam, the DSM-III erected “solid walls between conditions,” listing out symptoms, which writers like Ronald Levy coached a generation of clinicians to interpret and apply (2013; Levy, 1982).
“In a very short period of time,” write Mayes and Horwitz, “mental illnesses were transformed from broad, etiologically defined entities that were continuous with normality to symptom-based, categorical diseases” (emphasis added) (2005). Concurrently, “a descriptive approach” to the language was purposefully applied to provide “a medical nomenclature for clinicians and researchers” (psychiatry.org), making it easier for clinicians to diagnose and prescribe treatments, as well as for statisticians to collect data on diagnoses. Unfortunately, this shift toward increased diagnosis was “neither a product of growing scientific knowledge nor of increasing medicalization” (2005)—though it certainly led to increased medicalization.
It wasn’t just pressure to reject Freud either. Larger social and economic forces leading up to the 1980s contributed to this rapid and sweeping change in how personality theory and mental illness were forced into a new standardization. According to Mayes and Horwitz (2005),
"This standardization was the product of many factors, including: (1) professional politics within the mental health community, (2) increased government involvement in mental health research and policymaking, (3) mounting pressure on psychiatrists from health insurers to demonstrate the effectiveness of their practices, and (4) the necessity of pharmaceutical companies to market their products to treat specific diseases."
Certainly public scandals like the Rosenhan experiment, published in 1975, in which “patients” who claimed to have a mental illness but did not were successfully admitted to an institution and kept there against their will contributed some pressure to the field of psychiatry to avoid improper diagnoses (Rosenhan, 1975). But shifting views of the legitimacy of psychiatry in the United States were more likely fundamentally affected by human rights challenges to mental “health” institutions that forcibly indentured populations, kept sick and healthy people locked up in unsanitary living conditions, and committed multiple forms of torture, some under the dubious banner of “science” (Deegan, 2011; Souder v. Brennan; ACLU, 2010). At the same time, as government and communities scrambled to treat people in the face of large-scale desinstitutionalization, the 1970s saw a surge in the influence of the health insurance industry, privatized care, and big pharma all of whom—watching their bottom lines—were making it increasingly important to neatly label and put patients into exact boxes or categories of mental health in order to medicalize and monetize the fields of psychiatry and clinical psychology (Lyons, 1984). By the time the Regan administration pulled the plug on funding state mental health care, clinicians had to follow along in order to get patients any kind of treatment at all (Torrey, 2013). By 1994, the DSM-IV “simply added and subtracted a few categories” to this picture.
The 1980s and 90s were terrible years for people with acute mental health problems. But it was also the proving ground for a new movement—bringing the DSM back from the grips of the categorical approach.
Fired up, ready to go!
The categorical approach clearly had some big problems. As David Adam writes, “even as walls between conditions were being cemented in the profession’s manual, they were breaking down in the clinic” (2013). People found that they needed a better way to understand how multiple diagnoses or intersecting diagnoses should be treated. Adam also notes that a persistent problem has been that “biologists have been unable to find any genetic or neuroscientific evidence to support the breakdown of complex mental disorders into separate categories” (2013). Professionals in the field were coming to understand with greater clarity that a different answer, a new proposal, was needed. The establishment considered what the reform movement came up with—a “dimensional” approach—to be dangerously radical.
But as gender studies, race studies, disability studies programs, and other interdisciplinary focuses flourished across institutions of higher learning, the idea of a spectrum of identity became increasingly popular in academic settings. And the idea that mental health might also exist on a spectrum, along with new science about the brain and human biology, became an exciting new area of research. This new approach to the DSM, combining a goal of accurate diagnosis with a throwback to the Freudian view of “dynamic” personality, was lauded for its unique inclusion of 21st-century research technologies, as well as leaving open questions that remain about what is know-able about a “spectrum of personality” (Adam, 2013).
Enter the DSM-5.
In 2009, Obama supporters were fired up and ready for the president to go to work on real progressive change—with great hope comes great reality checks? The Great Recession was in full swing and I had just moved to the Bay Area from Louisiana. And in 2009, Lisa Cosgrove, Ph.D., and Harold J. Bursztajn, M.D., noted that,
"the fact that 70% of the [DSM-5] task force members have reported direct industry ties—an increase of almost 14% over the percentage of DSM-IV task force members who had industry ties—shows that disclosure policies alone, especially those that rely on an honor system, are not enough and that more specific safeguards are needed."
Since the DSM-5 was published in 2013 it has received sweeping criticisms. Some say that it is not much different than the DSM-IV, that it didn’t do enough to change the categorical approach. But others, like Allen Frances who led the development of the DSM-IV felt dubious to say the least about the ambitions of the DSM-5, attacking the new edition in a Mother Jones interview as liable to cause new epidemics of over-diagnosing and over-prescribing (Mechanic, 2013). Today, the National Institute on Mental Health (NIMH) is apparently so discouraged with the whole DSM system that they have replaced it with something called Research Domain Criteria, an initiative aimed at being a biologically-valid framework for understanding mental illness:
RDoC research starts with basic mechanisms and studies dysfunctions in these systems as a way to understand homogeneous symptom sets that cut across multiple disorders, rather than starting with clinical symptoms and working backwards. (National Institute of Mental Health)
The NIMH has not given up on the dimensional approach, but it is clear that they believe more research is needed.
But maybe we’re still missing something big in the DSM-5 debacle, maybe “madness” doesn’t exist on a single-person spectrum either. As the Association of Humanistic Psychology asserts, it may be that “nourishing environments can make an important contribution to the development of healthy personalities” (2014). It may be that a nourishing clinical setting can make a contribution to how we grapple with our own and each other’s mental health and well-being. If that’s true, maybe what we need, along with brain science, advances in biological knowledge, and money pouring through pharma, insurance companies, and privatized care, is to develop a whole-person, whole-society spectrum approach to mental health, and to teach it widely to clinicians, as well as beyond the formal clinical setting. If we are paying attention, we might notice that there is a movement in our country right now that is already putting people first.
Complicate the narrative.
No matter the causes of the adoption of the categorical approach in the 1980s, it was misguided and inadequate, and it wreaked havoc on our ability as a people to care for each other. But a dimensional approach to diagnosing personality disorder, if it remains in the hands of “scientists,” may not do any better at helping our society treat people clinically, or at helping us treat each other better interpersonally—and that is a gamble we can’t make.
In 2015, this too remains true: “no one has yet agreed on how best to define and diagnose mental illnesses” (Adam, 2013). But it seems clear and vital that we need to stop putting people in boxes—literally, our country needs to stop using prisons to throw people with mental illness away, and as a society we need to stop using any number of institutions to foster madness, both in a physiological and an emotional sense. We also need to think hard and take action so that we don’t let people succumb to “the hands of the drug companies” (Mechanic, 2014) or structural racism and other forms of oppression.
When Freud says that “we are confronted with the conclusion that there is indeed something congenital at the basis of perversions, but it is something which is congenital in all persons, which as a predisposition may fluctuate in intensity and is brought into prominence by influences of life” (1920, p.34), I hear in his insight an understanding of how we might pervert theory itself in our influence-able development as a relatively young society. We can ask specifically how we are raising our young people—what kind of nurturing do they receive? In 2015, young people still face industrialized schooling, a military industrial complex, a prison industrial complex, poverty, racism, gender oppression, and more—these are all things that no doubt contribute to a disordering of personality at a young age. But they are also things that might disorder a theory of personality, making it not that surprising that the DSM has been such a hot mess for so long. One might even joke that the DSM, with Freud in mind, has some daddy issues—and tragically not be so far off.
In Jung (1970) we find the seeds not just of the individual dynamic personality, but of the spectrum of collective experience:
"The dynamism of instinct is lodged as it were in the infra-red part of the spectrum, whereas the instinctual image lies in the ultra-violet part. . . . The realization and assimilation of instinct never take place at the red end, i.e., by absorption into the instinctual sphere, but only through integration of the image which signifies and at the same time evokes the instinct, although in a form quite different from the one we meet on the biological level."
What is the collective will of our society today? What are we creating? And what do we need to heal, together? Putting people in boxes and categories, making judgments based on some essential characteristic, using each other, making profit off the backs of some, slavery, hierarchy—these are all deep societal wounds that we are still waking up from. The categorical approach to the DSM may have been one cycle of unfolding consciousness in response to these woundings—but it was also a product of that same trauma. You can see this in its aim to regulate human experience and human bodies as much as it attempted and failed to regulate the actual care of humans by responding to human rights violations or by growing compassion, empathy, and equity in our society. The DSM-5, perhaps another botched attempt to change this, is another sign that personality theory and systems for understanding mental health in our country yearn for and need a lot of healing right now—healing and liberation.
Intersectionality, a word that hasn’t made it into the dictionaries yet, is a feminist concept that sees the study of intersecting identities as critical to social well-being. Intersectionality assumes that selves exist on a spectrum, that our various identities are dynamic and multi-storied. But it also tasks us with grappling with additional vectors—including each other, how we are viewed and affected by our social rank and our cultural backgrounds. In other words, maybe dimensionality doesn’t exist along a single spectrum—maybe the dimensionality of mental health is already a spectrum, one that includes race, gender, ability, etc. Every time you assess a person or a mental health concern on a spectrum, the act of connecting those dots already creates another spectrum of meaning. Another way to say this is that my being Jewish and a woman is uniquely meaningful to my sense of self and to my mental health. My “womanhood” exists on a spectrum and my “Jewishness” exists on a spectrum, and at the same time my social identities exist on yet another uber spectrum. And me being a Jewish woman married to a black man further complicates my narrative. And that’s exactly as it should be.
In 2014 when a white officer, David Ried, shot and killed Aura Rain Rosser, the media, in a too-familiar shock, took a breath to acknowledge “the deadly intersection of mental illness, race, class, and gender” (McCoy, 2015). But in January of 2013 when Ried was let off without any charges, #BlackLivesMatter did not shy away from the case or from making it a central party of their ongoing rallying cry (Adamopoulos, 2015). They did not say, no, we cannot stand up for this life—it is too insane, too black, too poor, and too female to matter. Instead, they took to the streets, only adding fuel to their cause.
The power of the #BlackLivesMatter movement is palpable, and that’s because they’re doing one thing absolutely right—they’re putting people first. With every protest step, they’re saying that what matters right now is the preciousness of life, and in the common refrain, “we’re sick and tired of being sick and tired” (and dying) because we’re black, they are literally saying life is what matters. And they’re saying, as one recent Twitter post that was retweeted over a thousands times states, “3 black women started #BlackLivesMatter. 1 is Nigerian-American, 2 are queer. Complicate the narrative… Because all #BlackLivesMatter.”
As a clinician I will always have access to many tools: the DSM—all five versions, a sea of other publications and research in psychology and psychiatry, new technologies and new scientific discoveries, experts and veterans in the field, and even the insights and shortcomings of our global parents in the healing arts. I also have all of human experience, including art and social change activism, to bring to bear on my whole self as I work to have a healthy and empowered theory of personality. And I absolutely need all of me to do this work.
When my friend told me that her ex was narcissistic, I did not shut her down. I did not pathologize her experience by prescribing her a course of therapy that I wasn’t sure she needed, and I did not shame her for being exactly where she was in that moment in her own theory of personality. I took all of me and I gave it to her in that moment by getting really curious, listening to her, loving her, and making damn sure that I never lost track of her as a person first.
ACLU. (2010, September 1). “ACLU history: Mental institutions.” Retrieved from https://www.aclu.org/aclu-history-mental-institutions
Acton, G. S. (1998). “Classification of psychopathology: The nature of language.” The Journal of Mind and Behavior, 19: 243–256. Retrieved from http://www.personalityresearch.org/acton/language.html
Adam, D. (2013, April 24). “Mental Health: On the spectrum.” Nature. Retrieved from http://www.nature.com/news/mental-health-on-the-spectrum-1.12842
Adamopoulos, A. (2015, January 31). “Protesters march in Ann Arbor after prosecutor declines to press charges against officer.” The Michigan Daily. Retrieved from http://www.michigandaily.com/news/protesters-march-following-aura-rosser-decision
Association of Humanistic Psychology. (2014). “Humanistic Views & Methods.” http://www.ahpweb.org/about/what-is-humanistic-psychology/item/33-humanistic-view--methods.html
Cosgrove, L., Ph.D., & Regier, D. A., M.D., M.P.H. (2009, January 1). “Toward credible conflict of interest policies in clinical psychiatry.” Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/articles/toward-credible-conflict-interest-policies-clinical-psychiatry
Deegan, P. (2011, August 30). “Lead Shoes and Institutional Peonage.” Retrieved from https://www.patdeegan.com/blog/posts/lead-shoes-and-institutional-peonagewww.patdeegan.com/blog/posts/lead-shoes-and-institutional-peonage
Ebert, A., & Bär, K-J. (2010). “Emil Kraepelin: A pioneer of scientific understanding of psychiatry and psychopharmacology.” Indian Journal of Psychiatry, 52(2): 191–192. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2927892/
Freud, S. (1920). “The sexual aberrations.” Three contributions to the theory of sex. Nervous and Mental Disease Publishing Co.: New York.
Jung, C. G. (1970). “On the nature of the psyche.” Retrieved from http://frithluton.com/articles/what-is-an-archetype/
Lyons, R. D. (1984, October 30). “How release of mental patients began.” The New York Times. Retrieved from http://www.nytimes.com/1984/10/30/science/how-release-of-mental-patients-began.html?pagewanted=1
McCoy, A. C. (2015). “Police brutality, mental illness, and race in the age of mass incarceration.” Nursing Clio. Retrieved from http://nursingclio.org/2015/06/30/police-brutality-mental-illness-and-race-in-the-age-of-mass-incarceration/
Mechanic, M. (2013, May 14). “Psychiatry’s New Diagnostic Manual: ‘Don’t by it. Don’t use it. Don’t teach it.’” MotherJones. Retrieved from http://www.motherjones.com/politics/2013/05/psychiatry-allen-frances-saving-normal-dsm-5-controversy
Robinson, P. (1993). Freud and his critics. University of California Press: Berkeley, CA.
Rosenhan, D. L. (1975). On being sane in insane places. Retrieved from http://www.bonkersinstitute.org/rosenhan.html
Souder v. Brennan. (1973). Retrieved from http://www.leagle.com/decision/19731175367FSupp808_11075.xml/SOUDER%20v.%20BRENNAN
Torrey, E. F., Ph.D. (2013, September 29). “Ronald Regan’s shameful legacy: Violence, the homeless, mental illness.” Salon. Retrieved from http://www.salon.com/2013/09/29/ronald_reagans_shameful_legacy_violence_the_homeless_mental_illness/
Fatalistic Attraction: Re-thinking Hollywood’s Influence on Borderline Pedagogy (essays from graduate school)
Fatal Attraction has been recognized as THE silver screen portrayal of borderline personality disorder (BPD). As one Psychology Today blogger notes about the movie, “Viewers watched Alex Forrest and began to link the behavior and inner life of this troubled figure with BPD in a process that continues to cement in the mainstream mindset to this day” (Clyman, 2012). The film’s impact on popular beliefs about BPD now extends beyond regular entertainment consumption and into clinical psychology practice, both indirectly through clinicians’ background cultural knowledge and directly by gaining acceptance and applause as a useful tool for teaching about BPD in the field. It is this pedagogical use of the film that this essay attempts to take a critical look at, considering the risks involved in using a Hollywood dramatization to teach about BPD.
This essay begins what should be a much larger discussion on cinema pedagogy in clinical disciplines, outlining preliminary interpretations only and taking a brief, but closer look at our culturally-situated viewer biases especially toward sex/gender. The conclusion of the author is that using Fatal Attraction to teach clinicians about BPD may be highly problematic. In what seems to be a dramatically (pun intended) fatalistic lesson on BPD—mad women are bad women—what is being sold to a generation of developing clinicians is a missed opportunity to widen our empathy for BPD clients, the very thing we need to do in order to recognize, diagnose, and treat this disorder effectively.
Considering the short history of BPD as a mental health diagnosis (first introduced in 1980 in the DSM-III), it makes sense, in 2014, for clinicians to first ask to what degree viewer interpretation of this 1987 film drives the film’s available BPD analysis, as opposed to the film or psychological knowledge driving the analysis. As it turns out, the film’s “analysis” of BPD is almost non-existent, with little to no psychological content offered. Fatal Attraction’s fairly simple plot relies heavily on exaggerated affect and the dramatization of unknowable psychological undercurrents to move the story along. For much of the movie, the audience must guess at the emotional and rational states of the characters. Even when concrete information is presented (Dan finds out that Alex’s father did in fact die when Alex was young; Beth tells Alex to leave her family alone), interpreting how the characters, namely Alex, process the information is mostly a guessing game for the viewer. (What motivates Alex to lie about her father’s death? How does Alex feel after Dan tells Beth about the affair?) This interpretation-rich environment leaves ample room for bias that may already exists in the audience to contribute to how we make sense of the inner world of the film and its characters. As viewers of this drama, we bring all of our self-interest and conditioning to bear on our critique of Alex, and in turn, on our understanding of BPD via the Alex character.
Importantly, the considerable room the film leaves for audience bias matters as an initial indicator of just how much the viewer may be making up meaning about the characters based on prejudgment. Even the most basic elements of the storyline must be conveyed carefully so as not to distort the facts: Dan, a (happy? successful?) lawyer is married to Beth, a (stylish? attractive?) mother of one. Dan has an extra-marital affair with Alex, an (enchanting? unpredictable?) editor. When Dan (finally? angrily?) breaks things off with Alex, she displays a number of behaviors (ranging from annoying to frightening?), including—we must actually infer—killing Dan’s daughter’s bunny rabbit. The movie ends with Alex attacking Beth in her bathroom. Ultimately, Dan and Beth kill Alex. Any of the above parenthetical details might be considered important and good writing for advertising copy for the film in order to elicit interest from a known, culturally-situated audience so that we the consumers will be inclined to pay to watch it—“know your audience” as the adage goes. These same details if included but left unconsidered, could contribute to clouding the clinician’s ability to accurately recognize, diagnose, and understand BPD or to hold the empathy needed to treat a client with BPD. Indeed, with a little further digging, it becomes clear that the weight of our viewer bias is really quite heavy.
A specific area of potential viewer/therapist bias that deserves deep and broad ongoing critical attention is sex and gender. The critical step of considering sex and gender in Fatal Attraction, a Hollywood-ized depiction of mental illness, must be the responsibility of any professional using the film to speak accurately or usefully about BPD. To take this step, we must look closely at how the sexist and gendered filters available to viewers of the film—all of us—may be present in us when considering Alex as a case study for BPD and also how these filters may distort how we learn about BPD and how we approach BPD clinically, both for diagnosis and for treatment.
Despite the larger problem of viewer bias, in 2011, Francine Goldberg published the second edition of Borderline Personality Disorder: A Case Study of the Movie Fatal Attraction, which aims to map Alex’s character and behaviors in the film to “clues” and “evidence” for a teachable case of BPD. Goldberg’s lesson plan, now easily accessible on the Internet, has been lauded by the Employee Assistance Professionals Association (EAPA) as, “a unique teaching method that allows EA professionals and other clinicians to acquire clinical skills and earn PDHs and CEUs” (p. 1). The EAPA cites some evidence for the effectiveness of Goldberg’s work as a teaching tool, but offers no critical framework of Goldberg’s analysis. While it may be true, as the EAPA reports, that after seeing the movie and discussing it, “EA professionals had acquired a more sophisticated understanding of psychopathology and were more likely to refer individuals with psychiatric symptoms to a psychiatrist or a specialized counselor” (p. 2), at what cost do these gains come? Perhaps it is simply easier to keep graduating students, handing out certifications, and not looking too closely at this question—yet looking closely is certainly what clinicians must do.
In making her case for a BPD diagnosis in the Alex character, Goldberg (2011) asserts early on that, “People with BPD cannot tolerate being alone” (p. 12). Elaborating on this point, Goldberg cites Synopsis of psychiatry, behavioral sciences, clinical psychiatry: “To assuage loneliness, if only for brief periods, they accept a stranger as a friend or are promiscuous” (Kaplan & Sadock, 1991, p. 534). Goldberg’s mapping of Alex’s character to the DSM-IV’s criterion #4 for a BPD diagnosis, impulsivity, subsequently hinges largely on a prejudgment of Alex’s sexual behavior as “promiscuous.” Goldberg (2011) notes the following: in scene two, Alex shows, “interest in a man who is (a) married and (b) has not really expressed an interest in her which may be indicative of criterion #4, impulsivity” (p. 9); in scene three, “seducing a man that she barely knows and who is not available for a relationship with her may be indicative of criterion #4, impulsivity” (p. 11); and in scene eight, “the news that Alex is pregnant is additional evidence to support criterion #4. Not only did she have sex with an unavailable man that she does not know, the sex was unsafe” (p. 25). In all three instances, Goldberg’s conclusion that Alex is “promiscuous” is the central (and really only) argument for Alex meeting the DSM-IV’s criterion #4 of BPD, impulsivity. Consider Goldberg’s assessment again in sum: Alex, the potential BPD client, is interested in a married man, who does not overtly share back about his interest in her, seduces him anyway, even while she also barely knows him, but does know that he is already “taken,” and chooses unsafe, condom-less sex on top of it all. As Janet Wirth-Cauchon noted back in 2001, “No mention is made of Dan’s ‘impulsivity’ in doing the same with a woman that he barely knows” (p. 170). But beyond this one-sided view of the sex shared by Dan and Alex that Goldberg continues to espouse in 2011, notions such as female seduction, adultery, sexual ownership, and sex as a weapon (tricking a man into pregnancy) are deeply entrenched sexist attitudes that exist in contemporary cultures, including our own, and that have been relied on to control female sexuality and female choice. Surely, these attitudes in ourselves must be considered before applying them to criteria for diagnosing BPD in any client.
Indeed, it is unclear after uncovering the sexist trope of “promiscuity” so readily available to us, whether Alex having sex with Dan is impulsive behavior for Alex at all. Though that is exactly the inquiry that a clinician would need to make with a client before diagnosing BPD. We do know that in the seduction scene Alex offers that she is trying to make up her mind about sleeping with Dan, which could be a “clue” (using Goldberg’s system) that Alex is in fact strategic about choosing her sexual partners—the opposite of impulsive. Interestingly, Goldberg (2011) also notes that for a diagnosis of BPD, “the symptoms must be pervasive, not just in response to one relationship or one event” (p. 11). But from the film we know of no other lovers who Alex has “promiscuously” (read: “impulsively”) slept with.
It is also worth noting that the DSM-IV criteria for BPD, used by Goldberg, refer to sex only once; criterion #4 states, “impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)” (APA, 2000, p. 710). (The DSM-5 criteria for BPD do not mention sex at all.) The sexist trope of “promiscuity” that Goldberg relies on to demonstrate DSM-IV criterion #4 in Alex’s behavior, therefore, assumes that non-monogamous, casual sex is not only impulsive behavior, but is also unhealthy and maladaptive. Not only, then, must we ask if Alex’s sexual behavior is impulsive for Alex, but we must also consider what the potential her sexual behavior in fact creates for self-damage, or if this is also Goldberg’s prejudgment. To what degree the sexual tryst shared by Alex and Dan was an act of self-damage by Alex may also be an important question for the plot of the film. But let us not get those two inquiries confused!
Let’s look at Alex’s own words for a moment: “Because I won’t allow you to treat me like some slut you can just bang a couple of times and throw in the garbage? I’m gonna be the mother of your child. I want a little respect.” Is it worth at least considering that in a world where women are often left with impossible choices to make, they may face their non-rational circumstances with non-rational attempts to reclaim their power? Dan, having participated in the condom-less sex, offers no emotional support or legitimacy to Alex’s position upon learning about the pregnancy. Of course, by this point in the movie we wouldn’t expect him to do so. The movie has made a hard turn toward following Dan as the primary sympathetic character—it is Dan who we sweat with whenever the phone rings; it is Dan who we rush to the hospital with when Beth gets in a car accident; it is Dan who we beg with for help from the police. And Dan does not want Alex in his life, so neither do we. Though the movie stays close with Dan, is it at all possible for the clinician—for any of us—to imagine that Alex’s attacking behavior is not so much self-damaging, an element of BPD, as Goldberg argues, and rather a non-rational attempt by Alex to wrangle some power from her spiraling situation? And if we cannot consider this, why not?
Goldberg seems knowingly convinced that at every step in the entanglement and the unraveling of the affair that Alex is actually compelled to make choices that create situations that are harder on her. This is not relegated to her sexual behavior alone. Per Goldberg (2011), Alex displays, “undermining of self,” “recurrent self-injury,” “constant state of crisis,” and “self-mutilating behavior” (p. 4–6). All of this self-damaging behavior adds up to an overall inability to self-regulate. In fact, it is important for Goldberg’s case for a BPD diagnosis that we view Alex’s tendencies to self-damage as a strong indicator of a larger pattern of being emotionally out of control, aka hysterical. For Goldberg, in fact, the main evidence for a diagnosis of BPD is Alex’s “emotion dysregulation” (2011, p. 22), which Goldberg suggests may have its origins in Alex’s father’s death when she was very young. There is no further mining of the origin of Alex’s BPD, however, either by Goldberg or in the film. Instead, the film’s focus (and Goldberg’s) is on the reel-time execution of Alex’s “madness” in and after her affair with Dan. As Wirth-Cauchon (2001) notes: “The maneuver is the age-old one of dismissing righteous female wrath as hysteria, and by ignoring it, transforming it into actual hysteria” (p. 172).
Perhaps further illuminating is the fact that, when trial screened, Fatal Attraction had a different ending. The film’s first audiences were also left to grapple with Alex’s death, but in the original version she dies by her own hands, slashing her throat with a kitchen knife like the one she used previously to attack Dan. Dan is then arrested for Alex’s murder. The discomfited, even angry response from these first viewers, who having to deal with Alex’s suicide and Dan’s apparent punishment for his part in Alex’s downfall, however, may have prompted the producers to change the final scenes. Whatever the causes of the changes, the new ending ensures that at the final curtain the complex, nuanced experiences of BPD do not live and breathe in Hollywood’s captivating melodrama. In the end, the vast majority of Fatal Attraction’s viewers were given a more familiar, culturally relatable ending of sane, male good guy versus mad, female bad guy. As Wirth-Cauchon (2001) argues, this is “particularly disturbing” in that “a fictive and misogynist cultural image of a woman is presented as reality, and as an accurate picture of a woman with borderline personality disorder” (p. 171).
It is truly unfortunate that by using Fatal Attraction to teach about BPD, what we get is a dangerously static story about BPD, a story given to us first by the filmmakers as an option for understanding the character of Alex, and then endorsed and solidified by Goldberg (and others) as useful tool in working with BPD. Goldberg, ironically, is acutely aware that “clinicians often find themselves…judging rather than sympathizing” (2011, p. 39). But Goldberg does not extend this interpretive lens to herself by considering the potential for the sexist and gendered nature of the “clues” and “evidence” she gleans from the film. Nor does Goldberg turn a critical eye on the overly sympathetic position of Dan in the final version of the movie. After all, the movie does not ask us after confronting Alex’s madness to love her anyway; instead, we get to love Dan and Beth who—and maybe because of this—kill Alex. The mad person is stamped out, and Dan and Beth and their representation as peaceful and good members of “normal” society maintain a monopoly on the audience’s empathy.
Even though Goldberg warns her readers that clinicians must be careful to work with BPD clients to be empathetic and non-judgmental, perhaps the most alarming aspect of Goldberg’s case study is a failing to widen the reader’s capacity for empathy by failing to address sexism and gender-typing in the film. Goldberg gets it right when she keenly notes, “empathy is an essential ingredient in delivering mental health treatment successfully” (2011, p. 38). But if we continue to see people with BPD as villains, can we also see them as ill and deserving our empathy? At present, the best treatment known for BPD, dialectical behavior therapy (DBT), is built on the clinician’s capacity to empathize with the client. To be empathetic one must be able to “be with” someone else’s experience in a loving way. Fatal Attraction does not offer this experience to the viewer with Alex; if anything it offers us empathy with Dan. By missing out on critiquing sex/gender and other potential biases in Fatal Attraction, it is almost as if Goldberg is admitting defeat to what is possible for how deeply we can go with empathy for the BPD client—Hollywood does it good enough. For clinicians that is a catastrophic lesson.
If Fatal Attraction continues to be used to teach about BPD, it seems necessary at the very least to include additional attention to and information about the lenses of sexism, gender typing, and accurate, non-judgmental empathy for the client at every step of the analysis. In order to be an effective therapist for a person who may be diagnosed with BPD, like any mental health diagnosis, uncovering potential bias in the diagnosing clinician and in the proposed treatment plan is mandatory. Likely the most important bias that we must overcome for folks with BPD is our own capacity for empathy, which may come about for varied reasons, not least of which may include sexism and gender stereotypes. Even Glen Close, who has apologized for her portrayal of mental illness as directly linked to violent crimes, might do well to extend that apology to include the misguided, potentially disastrous notion that mental illness may be somehow fundamentally un-empathetic.
American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders, fourth edition, text revision. Washington D.C.: American Psychiatric Association.
Clyman, J. (2012). Young Adult: The new borderline personality disorder in cinema. Retrieved from http://www.psychologytoday.com/blog/reel-therapy/201203/young-adult-the-new-borderline-personality-disorder-in-cinema
Employee Assistance Professionals Association. Counselor creates unique multimedia method for acquiring clinical skills. Retrieved on December 7, 2014, from http://www.eapa.info/ChaptBranch/webdocs/Beneficial1108.pdf
Goldberg, F. R. (2011). Borderline personality disorder: A case study of the movie Fatal Attraction. Retrieved from http://img-srv.dtcbuilder.com/engine/Builder/images/2/9/0/8/6/0/file/7.pdf
The Guardian. (2013). Glen Close says sorry for her portrayal of mental illness in Fatal Attraction. Retrieved from http://www.theguardian.com/film/shortcuts/2013/jun/05/glenn-close-apologises-mental-illness-fatal-attraction
Kaplan, H. I., & Sadock, B. J. (1991). Synopsis of psychiatry, behavioral sciences, clinical psychiatry, sixth edition. Baltimore: Williams & Wilkins.
Wirth-Cauchon, J. (2001). Women and borderline personality disorder: Symptoms and stories. Rutgers University Press: Piscataway, NJ.
In response to the fight-flight-or-freeze model of human reactions to threat and trauma, positive psychology offers a broaden-and-build theory for practicing and developing ourselves in the periods in between actual and perceived threat. This blog is dedicated to unpacking, exploring, and participating more fully in the potential of human broaden-and-build response to life.