The Narcissist & The Borderline

A woman sits across from me and says her husband is a narcissist.

She has done the reading. She can list the criteria, and she can match each one to an incident. The way he speaks about colleagues who have disappointed him. The way a conversation about her day becomes a conversation about his. The birthday when the gift was so precisely wrong that it seemed almost deliberate. His absolute inability, in twenty-two years, to say the words I was wrong about that without appending a clause that relocates the fault.

She is not being unfair. Much of what she describes is accurate, and some of it has cost her a great deal of pain.

Three weeks later her husband comes in alone, and within ten minutes he tells me his wife is borderline.

He has done the reading too. The intensity. The way an ordinary Sunday can become a four-hour excavation. The alternation between telling him he is the only person who has ever understood her and telling him he has never understood her at all. The abandonment terror that activates when he goes away for two nights. The way he has learned to watch her face the way you watch weather.

He is not being unfair either.

They are both, in the ordinary clinical sense, more or less right. And they are also, both of them, completely lost, because each has arrived at a label but mistaken categorization for understanding.

Taking the Diagnoses Seriously

I want to begin by saying plainly that I am not going to argue these categories away.

There is a genre of relational writing that dissolves diagnosis into vagueness, on the grounds that labels are unkind. I have never found this helpful. The patterns are real. They are describable. They recur across cultures and across decades with enough consistency that clinicians who have never met can recognise the same configuration from a description. Something is being named.

Narcissistic personality disorder, as the diagnostic manuals describe it, is a pervasive pattern of grandiosity, a need for admiration, and a lack of empathy. It includes a sense of entitlement, preoccupation with fantasies of success or brilliance, a belief in one's own specialness and that one can only be understood by other special people, a tendency to use others instrumentally, envy, and arrogance.

Borderline personality disorder is described as a pervasive pattern of instability in relationships, self-image, and affect, together with marked impulsivity. It includes frantic efforts to avoid abandonment, relationships that alternate between idealisation and devaluation, identity disturbance, affective instability, chronic emptiness, intense and poorly modulated anger, and, under stress, transient dissociation or paranoid ideation.

Read those two paragraphs side by side and something is already visible. One describes a person who appears to need no one. The other describes a person who appears to need everyone. They look like opposites.

I will be suggesting here that they are not.

What the Word "Diagnosis" Really Means

The word carries significant, and we have lost half of it.

Diagnosis comes into medical Latin in the 1680s from Greek diagnōsis, a discerning, from diagignōskein. The parts are dia, meaning through, and also apart, and gignōskein, to come to know. So the word holds two senses simultaneously. To know through. And to know apart, as separate or distinct..

A dentist named Ingersoll, addressing the Iowa Dental Society in 1878, put the first sense better than anything else I have read. He wrote that diagnosis means to know through, that it implies a knowledge which penetrates, a perception of the inside as well as the outside of things. Know your case, he said. Know it through and through before you attempt to treat it.

That is what the word was for.

What it has become, in ordinary use and increasingly in clinical use, is the second sense only. To know apart. To distinguish this from that, to sort, to assign the person to a category and, having assigned them, to consider the knowing complete.

The woman in my office has performed a diagnosis in the second sense. She has known her husband in part. She has distinguished him from the category of people one can reasonably remain married to. What she has not done, and cannot do from where she is standing, is know him through. The same can be said for her husband's perception of her.

The Border of What?

I find it so helpful to discover that how I use words and the words I choose actually matter so much. So let's look at the word borderline, too, which has a history that most people are unaware of, as well.

It was introduced by Adolph Stern, an American psychoanalyst, who observed that a large group of patients fit into neither the psychotic nor the psychoneurotic groupings used in analysis in the 1930's, and that this group was extremely difficult to treat by any available method.

The word referred to a gap in the professional understanding of human behavoir, not to the qualities or characteristics of the patients, directly.

These people were on the border between two categories that psychoanalysis had already established. They were too unwell for classical analysis and not unwell in the way psychosis was unwell. The term was a placeholder for the clinician's own limits of understanding, an admission that the existing system did not have a place to put them.

Interestingly, the placeholder stuck through decades and eventually worked its way into ordinary speech, where it now functions as a description of a person's personality and is often associated with their character.

A woman is told she is borderline. She understands this as a statement about who she is. But it is, in origin, a statement about where the edge of Stern's understanding was back in 1938!

I find this almost unbearably poignant, because of what the diagnosis actually describes. Here is a group of people whose central wound concerns not being held, not being reliably seen or understood in their most intimate relationships, and the name their wounding is given means we did not have a place for you.

Numbness

The word Narcissism carries layers of meaning as well, and it points to the same territory.

Narcissism is widely known from Ovid's telling of Narcissus in the Metamorphoses, but the etymology goes back to the Greek narkissos, the name of a flower first connected to narkē, meaning numbness, torpor, deadness, stupor. It is the root behind narcotic and narcosis.

In Ovid's story, Narcissus is not actually admiring himself, as is commonly thought. He is transfixed. He cannot eat, cannot rest, cannot turn away, cannot be reached. Echo is there, calling, and nothing she says can enter him, not because he is too full of himself but because nothing at all is getting in. He does not die of vanity. He dies of an immobility, a numbness so complete that the ordinary functions of a living body stop occurring in him.

The story we commonly tell about excessive narcissistic self-love is really the story of a young man who has gone numb, cannot be contacted, and who dies of it.

From a Clinical Perspective

It is worth noticing that when psychoanalysis looked closely at these patterns, by an entirely different route, it arrived at the same place the words had been pointing all along.

Heinz Kohut proposed what became known as the deficit model. Kohut suggest that grandiosity is not an overgrowth of self. It is a structure erected around an absence. Where a child's need to be accurately seen and accurately mirrored went chronically unmet, the ordinary developmental sequence did not complete. Grandiosity did not mature into workable ambition, idealisation did not mature into internalised values, and what remains is a construction held together by omnipotence over a self prone to emptiness and to sudden collapse when the construction is threatened. He named the collapse-response narcissistic rage.

Otto Kernberg, who disagreed with Kohut about nearly everything, described the same hollowness from the other side: he described a hungry, enraged and empty self, full of impotent anger and frustration, fearful of a world that seems hateful.

And Stern, in that same 1938 time period, attributed the borderline group's difficulties to what he called uninformed parenting. Crude by modern standards. Pointing in the right direction.

Three men, three frameworks, one finding. Not too much self. A self that never experiences the conditions in which a self becomes possible to develop. The person has erected walls around that unbearable empty space instead.

Knowing Apart vs. Knowing Through

Returning to the two people I mentioned at the start of this post . . .

She has a word for him. He has a word for her. Both words are, in the ordinary clinical sense, defensible, and both of them are using their word in exactly the same way. They are separate and objectified . . . knowing the other apart from themselves. They are sorting each other into categories and, having sorted them, stopped knowing one another any further.

But consider what each of them is actually holding.

She is holding a word that means numbness. He is holding a word that means we did not have a place for you.

Each of them has arrived, without any idea that they have done so, at an accurate description of a wound in the person they married. And each is using it as a verdict, a kind of death sentence to the relationship.

That is the missing half of the word, and it is not an abstraction. Knowing apart tells her that her husband meets the criteria. Knowing through would tell her what he is doing, and when he learned to do it, and what it has meant to become a man who cannot say I was wrong about that. Knowing apart ends a conversation. Knowing through is the beginning of one.

Significantly, knowing through is not the same as staying. Some marriages comprised of these complicated dynamics should end, of course. Understanding where a wound came from is not an obligation to keep absorbing the unresolved drama that can ensue. There are certainly people whose impact on those around them is destructive enough that leaving is the only sane response.

But even in the case of separation or divorce, there is a real difference between leaving a person you have understood and leaving a diagnosis you have assigned. The difference does not necessarily show up on the day you leave. It shows up in the years afterward, in what you continue to carry out with you, in what you find yourself repeating in future relationships. Your inner narative, the way to toak to yourself, the words you use to describe your experience, define you, not the other person.

So if you are holding one of these words about someone . . . a partner, a parent, someone you left years ago . . . you may want to ask yourself what you are holding on to it for. As the name of something you have come to understand? Or as the point at which you stopped trying to understand?

There is no wrong answer. There is only the difference between the two ways of knowing I've mentioned. Notice how you "know" and how that orientation feels. Consider your options.