The subject of our inquiry is not her, but everyone and everything external to her. In this way, my patient shuts me down. I have no identity as the therapist. Yet she comes to me for help. Week after week, she implores me to explain to her why her chi is so unforgiving. How can I tell her that she has offended her chi. Am I her chi? I am beginning to wonder.
I am thinking about my borderline and narcissist patients and this contract that happens before we are even born, this contract we make with our chi. I had asked my colleague yesterday who she thought might be there to stand up for my own self-interest when negotiating with my chi? Obviously, the chi is practiced in this contract-making. What is the chi’s story? Is it like the Tooth Fairy or Santa Claus? There for the many, or like a private fairy godmother, there for the one? Did the chi have someone else before we were together? And after I leave my earthly shrine, my body, do I return to the sun or to my chi?
Is this like the last act of McTeague—me and my chi chained together under the blazing noonday sun, my chi melting into the spot, doomed by the weight of my immobile corpse? What is the cosmology of caring in all this? If one’s fate is indifferent, then why make a contract at all? I believe that we are each unique and that there is something ineffable that intersects with our context —social, historical, familial. The sum of which becomes our story. Chi speaks to this idea: “one mother gives birth; two chi create.” We can look to Cain and Abel for precedent. This is a cosmology that is concerned with outcomes, not with ethics, not unlike psychotherapy.
In more classical Kleinian thought, we might speak of splitting—of the mother as an internalized representation of the all-good and all-bad breast. The nurturing vs. its antithesis. the dissociated parts that are born of mis-attunement or trauma have their own set of ORs that get activated under stress, under threat of annihilation. What is the down-regulated version of these object relations if healthy or can a healthier aspect of these internalized partial objects be engaged by self-understanding in the political identity realm?
Social theory, which is concerned with ethics, and psychoanalytic theory have long shared similar territory–although the full integration of the two has persistently been frustrated by the need to defend the very boundaries the intersection of these disciplines necessarily threatens. Is the field to be a psychoanalytically informed sociology or a socially contextualized psychoanalysis? I will suggest a synthesized working model of an integration that can be applied to borderline personality structure in the clinical process in such a way that sociological context can be an implicit element of the dialogical inquiry that is at the heart of therapeutic healing.
The etiology of borderline personality disorder (BPD), a condition that is marked by poor impulse control, emotional dysregulation, disorganization, self-harm, risky behavior, and a variety of interpersonal and relational problems, has roots in both trauma and attachment disorder. Recent research correlates the two so strongly that BPD is now being framed in the literature more narrowly as an attachment trauma. The dangers these personality disorders pose for both individual and general social welfare can be lessened through an approach that assists individuals in gaining a sense of realistic self-efficacy in navigating their relationships in the larger social field.
