The Hollow Self by James F. Masterson, M.D.

"I’m afraid I’m about to make a mess out of a romance." Said Jennifer, thirty-five, an attractive blue-eyed actress. She wasn’t referring to the domineering character she played on a daytime soap opera, whose talent was making messes out of other women’s romances. She meant her own. Afraid of being rejected, Jennifer wasn’t able to tell her boyfriend what she wanted to do, where she wanted to eat, what movie she wanted to see. When her partner had interests she didn’t share, she’d conceal her true feelings and go along just to please him.
When dating someone new, Jennifer seemed to spend hours wondering, "Is he going to call me?" She’d have a semi-panic attack if a man didn’t constantly reassure her of his interest. She’d then become demanding and drive him away. Romantic attraction became a trap because it fed into her wish to be taken care of at the cost of giving up herself.
After receiving a big promotion, Penny, twenty-eight, a junior marketing executive, experienced feelings of panic and helplessness. "I don’t think I can manage myself," she told me...This was the first job in which Penny held substantial responsibility, and she felt incapable of showing initiative and setting goals for herself. "I never had to do that before," she said. "I want others to plan for me."
Both of these women suffer from what psychiatrists call borderline personality disorder, which is characterized by feelings of inadequacy. The word "borderline" comes from the fact that these patients are on the border between neurosis (an emotional disorder due to unresolved conflicts) and psychosis (characterized by a loss of contact with reality). Many of these people are successful, bright and seem to have everything going for them; however, inside they feel hollow and incomplete.
These patients struggle with feelings of depression, loneliness and isolation; they’re caught in a spiral of self-destructive behavior that eventually sabotages their lives. Lacking a stable sense of self, they attempt to compensate by seeking satisfaction in material possessions, superficial friendships and impersonal sexual encounters. They substitute empty lifestyles for real lives and shy away from channeling their energies into personal growth and fulfillment.
In all, I estimate that ten to fifteen million people suffer from borderline problems - many more than were diagnosed fifty years ago, though there are no comprehensive studies, so nobody knows for sure. In contrast, according to the National Institute of Mental health, depression affects about ten million adults each year.
Women are believed to be affected more than men. The problem is that many therapists are quick to diagnose women as having passivity and dependency problems but are reluctant to diagnose these symptoms in men.
Finding meaning in life, of course, isn’t an easy proposition for anyone. Personal satisfaction isn’t a given but must be created through testing and experimentation. A healthy person does this through love and work, by discovering a partner, projects or pastimes that satisfy her needs. Borderline patients neither test nor experiment. They lack the capacity to meet the challenges of an ever-changing world.

Birth of the False Self

When we think of someone who is strong and independent, what we admire is her strong sense of self, that vital part of the personality that allows her to have a positive self-image, to identify her own wishes and maintain her self-esteem by asserting herself with other people.
The lack of this inner development is the key to borderline problems, which occur when a young child fails to separate her own self-image from that of her mother. This happens roughly between the ages of two and three, often because of a parent’s own emotional problems. A mother’s encouragement of a child’s self-assertion is vital. When the mother suffers from low self-esteem, she has difficulty encouraging her child’s emerging self. The child experiences this absence as a loss of self, creating feelings of abandonment that lead to depression. To deal with the depression, the child gives up efforts to support her emerging self. Instead, she relies on her mother’s approval to maintain the esteem of a "false self."
Some experts argue that the disorder is genetic; certain children simply are born lacking the capacity for an independent self. Others say environmental trauma plays a role; any life event between the ages of two and three that seriously affects the child’s ability to experiment or the mother’s availability can be a precipitating factor.

Thwarted Relationships

One of my patients described her life this way: "I’m not doing what I want because my ideas - about how I work, how I think, how I dress - and even my hobbies and how I relate to men are filtered through the perception of what others want. I’m good at perceiving what pleases other people and giving them what they want, but I feel trapped, like I’m suffocating inside my skin."
Most of us have occasional doubts about our identities and self-worth and wonder if we’re making the most of our lives. What prevents us from falling apart, though, is the ability to realistically assess these moments rather than resort to the borderline’s self destructive behavior.
People dominated by false self adopt an illusion of coping, which substitutes for genuine self-assertion. They depend on others to constantly provide them with a sense of internal security, a way of relieving feelings of worthlessness.
The borderline personality is constantly on the defensive, guarding against intimacy out of a twin fear of being engulfed and abandoned. While it’s natural to feel anxious about a new relationship, most of us realize that we need love in our lives. The borderline, however, is incapable of handling closeness and substitutes inappropriate relationships with unavailable partners.
The threat of intimacy may lead a borderline patient to become promiscuous. Since her fears make her unable to make a lasting commitment to one person, she goes from one lover to another, acting out the fantasy of somebody taking care of her. Sex tends to be mechanical, in order to avoid the powerful drive to emotional intimacy that accompanies sex. What she seeks is not orgasm but being held, as if to compensate for her not having been held as a child.

Confronting the Defenses

...There are two effective therapy options. In a shorter approach, a patient is seen once a week for about six to eighteen months, with the goal of finding more constructive ways to respond to relationships and work. In longer psychoanalytic therapy, three- times-a-week sessions with a therapist take place regularly over a period of three to five years.
The central goal of the therapy is what we call the flowering of the individuation - a feeling akin to becoming a new person. Breaking down artificial defenses can liberate the borderline’s real self and enable her to complete her development. All the qualities of the undeveloped real self that had been kept in the closet because of the need to defend against depression come out and mushroom. This brings profound change. Many people become more creative on the job and begin to look forward to challenges. As they develop a sense of inner security, they often break off unrewarding relationships. And when they date on a new basis, they look for mutual sharing, not for dependency and internal security.
In a sense, borderline-personality problems can teach all of us about the crucial balance between independence and the need to share our lives with others. Connections - in family, friendships, love and work - are healthy, but building a separate sense of self is critical. While life may involve compromise and some working toward others’ goals, it also requires forging one’s own individual and unique identity