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Monday, May 2, 2011

Psychology in Fiction Q&A: Splitting and Alter Egos

Disclaimer: The information provided in this post is intended for writing purposes only and does not represent psychological advice.

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

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

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

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

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

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

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

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

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

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

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

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

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

For more information on borderline personality, dissociative identity disorder, mood and anxiety disorders, treatments, therapies, and character-building, check out my book on psychology for writers, The Writer's Guide to Psychology: How to Write Accurately About Psychological Disorders, Clinical Treatment and Human Behavior!

Remember, if YOU have a psychology in fiction question you want to see answered here, use the Q&A form on the Archetype site or send an email using my QueryTracker email address to the right. (Please use Q&A in your Subject Line!).  

Carolyn Kaufman, PsyD's book, THE WRITER'S GUIDE TO PSYCHOLOGY: How to Write Accurately About Psychological Disorders, Clinical Treatment, and Human Behavior helps writers avoid common misconceptions and inaccuracies and "get the psych right" in their stories. You can learn more about The Writer's Guide to Psychology, check out Dr. K's blog on Psychology Today, or follow her on Facebook!


Amber said...

Hey, this was unexpectedly helpful. In my WIP my heroine lives a very responsible life as a young single mother, but she engages in rare risky behavior (casual sex with strangers she deems dangerous or rough). A crit partner mentioned that behavior like it didn't quite fit with her profile but to me it made perfect sense as an outlet for her femininity and her pain. I tried to explain it in my own words, but now I have some terminology to go along with it...

Karen said...

As the parent of an adopted son with BPD, I'd like to point out that the statement that abuse USUALLY plays a part in the development of BPD is much too broad and, I believe, generally discounted. Yes, some of those with the disorder have been abused, but it is not a given any more than that old myth that a "cold" mother causes autism. The parents I know who have children with the disorder NEVER abused their children in any way. They are simply loving parents desperate for answers as to why their children are behaving as they do, and desperate for knowledge as to how to help these loved ones. However, abuse is often reported to therapists by the client with BPD. Therapists must remember that the disorder can cause their client to misinterpret reality. Yes, the clients believe they have been abused. That's their reality. The truth can be an entirely different matter. That's only one of the many reasons why it's so important to include the family in the treatment process. For more information on BPD, go to www.TARA4BPD.org.

Stina said...

I love these psychology posts, Carolyn. Very informative. :D

Carolyn Kaufman | @CMKaufman said...

In response to Karen -- I feel like you grabbed onto one little piece of the discussion and ran with an agenda.

I took a look at the website you noted, and a glance at the "about BPD" section told me it isn't saying anything, overall, that's different from what I was saying, other than it emphasizes that people with BPD need to be treated appropriately, which is always laudable. (And I agree with that -- but since the Q&A wasn't really about how to make sure people with BPD get good treatment, we didn't get into that.)

Many, many people, including Marsha Linehan, who developed the DBT (Dialectical Behavioral Therapy, for people who are just reading along here) the TARA site so adamantly recommends, believe that BPD starts out as (or just flat-out IS) post-traumatic stress disorder. And in many people, that PTSD is due to abuse, often sexual abuse.

You say that that has been "discounted." By all means, please share that research. Here is one of the sources I am basing my statements on: "The prevalence of childhood sexual abuse in the histories of women meeting criteria for BPD is such that it simply cannot be ignored as an important factor in the etiology of the disorder. Of the 12 hospitalized borderline patients assessed by Stone (1981)...75% reported a history of incest. Childhood sexual abuse was reported by 86% of borderline inpatients compared, [sic] to 34% of other psychiatric inpatients, in a study by Bryer, Nelson, Miller, and Krol (1987). Among borderline outpatients, 67 to 76% report childhood sexual abuse (Herman, Perry, & van der Kolk, 1989; Wagner, Linehan, & Wasson, 1989), in contrast to a 26% rate amoung nonborderline patients (Herman et. al., 1989). Ogata, Silk, Goodrich, Lohr, and Westen (1989) found that 71% of borderline patients reported a history of sexual abuse, compared to 22% of major depressive control patients...[Another] study found rates of reported childhood physical abuse to be higher among borderline patients (71%) than among nonborderline patients (38%) (Herman et. al., 1989). Furthermore, there isa positive association between physical and sexual abuse (Westen, Ludolph, Misle, Ruffin, & Block, 1990)...Bryer et. al (1987)...found that whereas early sexual abuse predicted the diagnosis of BPD, the combination of sexual and physical abuse did not. Thus, it may be that sexual abuse, in contrast to other types of abuse, is uniquely associated with BPD."

Research in this vein goes on and on, and I'm quoting from Cognitive-Behavioral Treatment of Borderline Personality Disorder, by Marsha Linehan. In other words, I'm quoting from THE treatment manual on DBT for BPD, which is the treatment advocated by the TARA site that *you* recommended.

It actually sounds like you're suggesting that people with BPD have false memories, or are delusional. And while some people with BPD may have periods of dissociation or even some psychosis if they decompensate badly, BPD is neither a dissociative nor a psychotic disorder. I think it's extremely dangerous ground to suggest that a therapist shouldn't believe a client's assertions without corroboration from the family, and I'm disturbed by the implication that a client's reality is less important than the family's.

Eric W. Trant said...

I always like your psych posts. Reminds me of growing up and who I am now.

I think there was some confusion in the comments, though.

This post is NOT about real-life. It is not about reality or true statistics.

It is about writing realistic crazy people in your books.

With rare exception, the crazy person IN FICTION requires an event that changed them.

People ~born~ crazy are neither interesting nor desirable, and we reserve them for villains and low-key nutjobs who may surround our Main Character.

MC, however, needs a triggering event. They need a ~reason~ to be crazy.

Think Mel Gibson in Mad Max (lost woman). Think Mel Gibson in the Lethal series (lost woman).

Think Mel Gibson in Braveheart (lost woman) and Ransom and The Patriot (lost kids) and Hamlet (faking it) and Chicken Run (he was a delusional chicken).

The character faces a triggering event that TURNS them crazy. They usually aren't born that way.

In fact, let's let Mel write the next psych article. Carolyn, give him a call!

- Eric

Carolyn Kaufman | @CMKaufman said...

Amber -- I'm really glad the post was helpful for you. Sometimes a little terminology makes all the difference to help us clarify what we meant all along!

Eric -- You make an EXCELLENT point, ie that we are talking about fiction and not real life.

It's hard for me not to say something when someone makes an assertion that is misleading since the whole point of the posts is to help writers get their psych right, but we did get off-topic.

As for Mel -- haha, I bet I could get a lot of material out of a phone call with Mel! ;) (And there definitely seems to be a pattern with that lost woman thing...though delusional chickens are nearly as much fun!)