A Splitting Headache

In my blog post of March 11, 2010, I described what I believe to be an absurdity that has been promulgated by the mental health profession about patients with borderline personality disorder (BPD). These individuals were said by theorist Marsha Linehan to have “apparent competency,” by which she meant that they appear to have certain abilities in some contexts which they in fact do not possess. I wondered how they were able to demonstrate competencies through performance that they actually lacked, and I opined that it is much easier to fake incompetence than competence. Perhaps it is the incompetence that is more apparent than real, and is in fact a highly-motivated but well-hidden choice.

Another popular idea in the field about patients with BPD is that they engage in something called splitting. Anyone who has treated a patient with the disorder in psychotherapy has ample eyewitness evidence that they often talk about other people as if they were, in their essence, either Gods or complete piles of horse manure, with nothing in between. This is splitting behavior. The fact that they sometimes act this way is an extremely valid observation, but what does it mean?

First of all, “splitting” others into “all good” and “all bad” categories was originally presumed by psychoanalysts to be a defense mechanism. A defense mechanism is a mental coping maneuver meant to both partly express and to ward off any feelings that a person might experience, as well as any accompanying impulses, that they find unacceptable in themselves. For example, a person who does not like to think of himself as angry at his father might “take it out” on someone else. This is an example of a defense mechanism called displacement.

Whenever we are faced with someone who does something heinous or who inspires us, we all have a tendency to “split,” or think of the person as all or mostly good, or all or mostly bad. This is completely normal. Many of us feel that child molesters, to take a common example, are monsters with no redeeming qualities whatsoever. Mother Teresa, on the other hand, is viewed by some as a true and flawless saint.

What happens in a situation in which someone else does something wonderful one day and something absolutely heinous the next, or vice versa? For example, what if your own father raped you one day when you were thirteen, and bought you a pony the very next day? (This actually happened to a patient I know of). Even therapists have trouble putting something like that together. Some therapists even accuse patients of making things like that up. Is it surprising that our patients might have to think about these characteristics separately in order to avoid severe cognitive confusion?

Along came a psychoanalyst named Otto Kernberg. He began to talk about “splitting” not as a defense mechanism but as a deficit. He believed that patients with BPD literally lacked the ability to see both good and bad in others or themselves simultaneously. According to his theory, future patients with BPD failed to negotiate a childhood developmental stage called rapprochement, which, according to the theory, takes place around the age of two. “Normal” two year olds supposedly then develop the ability to integrate good and bad images.

The problem with this formulation is that social psychologists have actually studied children to find out when normal children develop this ability, instead of just sitting around theorizing about it. In fact, three different studies using three completely different methods [Donaldson, S., & Westerman, M. (1986). Development of children’s understanding of ambivalence and causal theories of emotions. Developmental Psychology, 22(5), 655-662; Harter, S. (1986). Cognitive-developmental processes in the integration of concepts about emotions and the self. Social Cognition, 4(2),119-151; Selman, Robert. (1980). The Growth of Interpersonal Understanding. San Diego: Academic Press] all came to the same conclusion. Normal children do not begin to develop this ability until they reach the age of about eleven and a half. They do not get especially good at it until they are about fifteen years old.

Of course, analysts never read social psychology, so they are unaware that their theory is utter nonsense. They also ignore evidence from their own observations which should cause them to doubt the veracity of their “ego deficit” theory. They will readily acknowledge that patients with BPD are master manipulators. The patients with BPD know how to size anyone up in a very short time in order to best figure out how to make him or her personally feel either helpless, guilty, or angry in dealing with them. How could they do this so well if they were not able to gauge other people’s strengths and weaknesses simultaneously? This is an easy question to answer. They could not.

I once mentioned to an analyst that when any of my patients with BPD are in the right mood, they are easily able to list other people’s good and bad points at the same time. He responded that this observation does not prove that they are really able to see good and bad qualities simultaneously! I wondered: how on earth could a patient ever prove to this therapist that he or she is capable of anything?

Another point about splitting that applies to everyone, not just patients with BPD, is that when you are absolutely furious with someone else, you never feel like bringing up all their best qualities. Likewise, if you wish to butter someone else up, bringing up all of their faults is not in your best interests! Heaven forbid we should think of any of our patients as smart enough to know this.

In my opinion, splitting is only sometimes a defense mechanism, and it is never an ego deficit. It is rather an interpersonal strategy designed to elicit specific reactions from other people in the patient’s important relationships.