The Taproot Podcast - What is BPD as a Diagnosis and How did it Get Here?

Episode Date: January 14, 2026

can change all. Hey guys, it's Joel. Welcome to the Taproot Therapy Therapy Collective podcast. And one of the things that a lot of people have requested in the break that I talk about is borderline personality disorder. And I'm not like a BPD expert, so I kind of resisted that topic. I treat a lot of borderlines. I like treating borderlines.

I don't really love it as a diagnosis. I think it's kind of useless. So I'll say that I treat a lot of people that fall into the, have been diagnosed with borderline personality disorder. the way that it is used. I don't really think works very well, so I'm not, yeah, anyway, soft critic of a lot of things. And one of the things about BPD, your borderline personality disorder is it's part of something that used to be, I guess what you would call the Axis 2 and the DSM4, and they got rid of the axes.

And they replaced them with, well, nothing, I guess. But what was nice about those is that they kind of grouped histrionic personality disorder, narcissistic personality disorder, and borderline personality disorder, and a couple of others together in this way that was useful because they share features a lot of the time. And one of the things that was helpful to me when I was in the way, school and I was learning about a personality disorder is you go to social work school and you read

the book that they assign and then you go in and you talk about it and you listen to the lecture and you take a test on what you read or whatever and um and they told us before we took the test for the personality disorders especially the cluster B they told us when you read these you're going to say oh my god I have all of them because we all do all of these things some of the time you know a narcissist may do that but We all do it because we all get pulled into these deflection and defense mechanisms. And so maybe some is smarter than me or they're more wealthy than me. And so I talk about a thing that I own that's nice that I know they don't have or I talk about a thing that I know that I know about.

I'm not a narcissist because I'm not doing that all the time. But I still did it. It's still bad. I may be just so desperate to not deal with something, to not know how to handle a part of my emotional experience that I aggravate my wife and I pull her into my anger so that we're angry together and I'm not alone. That doesn't mean that I'm borderline.

You know, I might just need attention really badly because I don't know to express how alone I am. And I do this thing that means that people pay attention to me. that's kind of crazy or inappropriate, that doesn't mean that I have histrionic personality disorder, you know, so on and so on. But the thing about it is that the conception that I have now of like what a true, what I would, you know, call a personality disorder, I try not to be pathologizing as a clinician, but what I would conceptualize as a dysregulated personality is when someone has no room

for a sense of self or an identity under the defense mechanism. because the whole personality has been replaced with a personality game about inferiority, about attention seeking, about attachment, about loneliness. And there's no room for an authentic self. And that means that I have to switch identities all the time. It means that I don't really know who I am. A long time ago, I was doing therapy with somebody, and they were doing brain spotting. and they were someone who had gotten that personality disorder diagnosis from a lot of other people.

And I told them, you know, I don't really think that way. You meet criteria for some other things. You know, I try and you give you the least pathologizing diagnosis that's accurate. And I don't know that you meet criteria for that now. I think if we deal with trauma, that that will come down. But they definitely had that thing where they were trying to figure out what other people wanted so that they could be that. all the time. And I could have pointed that out.

And they would have said, oh, no, that's not true because I disagree with people or whatever. It's a deeply held implicit emotional belief in the brainstem, you know, in the subcortical brain about how we make predictions about what we need to survive,

not a conscious understanding, not a conscious awareness. I mean, some, and so pointing out that that was happening, it never would have worked. But one of the things during brain spotting, this person had a experience where they said, I realized that I was angry with you because I wanted you to tell me

what to do and you were just telling me to look at the pointer. And you wouldn't tell me what you wanted me to do. And I was so panicked because I needed to be what you needed and you didn't need anything. And then I felt a snap and I became separate from you and I realized I'm my own person. I can do what I want. And then I felt another snap. And then I became separate from everyone in the world and I became my own person. And I realized I'm able to just do what I want. And I said, that's great. I appreciate that insight. That's really beautiful. But I didn't, they felt something, you know, like Eugene Glendon would say in the felt sense, or a neuroscientist would say in the interoceptive.

It was a truth that I couldn't have explained to them, that they would have resisted because they couldn't see it. The game prevented that. And that's why, especially Cluster B, personality disorders are so stigmatized. And so easily judged is because everybody likes to get on knowledge fight and listen to Alex Jones and be like, can you believe it? Like they just show the evidence to him. And he says, oh, that's not real.

And then they say, well, yeah, it is real. And he said, oh, well, it was made up by somebody else, even though it is real. And they say, well, here's proof that it wasn't made up. And then he says, oh, well, you know, and on and on and on. Like it's all deflection. And people just get so angry that this person can't see it. But that's kind of what therapists feel all the time. Because when you come into the room, most intuitive therapists kind of know what's going on,

but they can't quite tell you yet because you're not ready to hear it on a felt emotional level. And it's the job of the therapy modality or the therapist to lead you into the place where you can tell yourself. Because you're the only one that can. can. And that's how you treat somebody with an attachment disorder that, you know, the DSM 4 or 5 would call a personality disorder is when there's somebody who's playing a game all the time that they don't even know it's a secret even from themselves, where they're in competition or in anger and aggression or in desperate need of other people's emotional participation in their inner world because they feel completely incapable of regulating that inner world themselves.

That is something that happens. You know, what you want to call it if you want to say, it's BPD or whatever. That is how those Cluster B personalities disorders work in my head when I'm doing therapy. And those things are a system. In the last podcast episode, I talked about how we need to understand that these aren't a checklist. Because the problem with BPD is that most people that are diagnosed with it don't actually have it. They're not even close to criteria. It's also used in a very sexist way.

I think in the DSM2, it was passive, a great. progressive personality disorder. And it was almost entirely women because a lot of times, especially when the DSM 2 is out, I mean, not that we've made a ton of progress on, you know, feminism, but like the people who don't have, you know, external power, hierarchical power, systems power will develop a system of passive power. And that at that time was going to be mostly women. And then it got merged into DSM, what, three?

I think they got rid of passive aggressive and they made it on borderline. But one of the ways that that system works is that it needs to kind of be felt out. Why is this person doing the behavior? Because like I said, we all do some of those behaviors some of the time, sometimes for good reason and sometimes with understandable circumstances that led up to them. And if you go to the ER and you are a woman and you have good reason to be in crisis because you're being abused. because you're being attacked because bad things have happened because you're at the worst point in your life, whatever led you to go to the ER with a psych diagnosis. You'll be clocked with a BPD diagnosis a ton of the time. I see that so much on these ER discharges. And that doctor,

you may be more emotionally intelligent than the person who diagnosed you with that, the resident who's working the psych ER because they didn't have time to figure out what's going on. They just knew that you were suicidal or you're a crisis, it's an easy diagnosis. They put it on the sheet. It's not accurate. You know, you may be had good reason to do that. I see people that are nowhere close to criteria for BPD that have been diagnosed with it multiple times because they encountered medical situation in crisis. And I just want to say here too, like if you have a diagnosis, there's not like one system that shows that to everybody. It's in the hospital. You know, it's like a lot of people are afraid this like goes into some national registry and they track it or

whatever. Like there's no way for me to know unless you give me permission to ask for your medical records because you want me to and then another doctor finally fulfills the request and sends them over. It's not like a lot of people are afraid of the diagnosis because they're afraid that once they get it, it can't change or something. You can go to 10 psychiatrists and you can get 10 diagnoses. You just can. If these systems worked consistently, then I think maybe people would be more willing to consider them a hard science. But they don't. You know, there's all these catch 22s in health care that are kind of absurd. I mean one of the things that drove me nuts. You can say this now because I don't ever have to work at the hospital again, I hope.

But like, who knows at the hospital? They're always like, I mean, some people would have 30 diagnoses in the system and would be like, they'd be like, you have to delete all these. Well, why? Because they're wrong. They're not, they're not right. Well, a doctor diagnosed him with it. Why are they wrong? Oh, they know, they just come and they pick up these diagnoses in the ER were in the psych, but we know the person and they don't have that. So, just delete all these from the treatment plan. Okay, well, I'll delete them from the treatment plan, but they're imported like every single time. So can we just delete them from the system so that it doesn't do that because you're always mad when

somebody forgets to delete them? No, no, you're a social worker. You can't delete a doctor's diagnosis, but it's 13 years old and you just told me it's wrong. No, but you're a social worker, you can't delete a doctor's diagnosis. Okay, fine. Can a doctor change the diagnosis? Oh, yeah, a doctor could. Okay, can we get a doctor to do that?

No, doctors don't change other doctor's diagnoses. I mean, I heard that so many times. And what? It's wrong. Get it out of the computer. You know, these catch 22s riddle health care and they're absurd. You know, I talked about the Stardee scandal last time. And I'm not going to go over that one again, but like look up.

You know, the body of science that says the system should work this way and how that body of science actually work so that you can have an informed critique and also protect yourself while getting what you need out of it because we still have to participate in psychological. health care we need to know these things um you know a lot of borderline it's an interesting diagnosis because it happened at this time where they were trying to put things into categories and the people who came up with them they were like well you know there's these people that are psychotic like they see ghosts and spirits and hear voices and they you know think that they're talking to aliens or whatever and that's

not real and then there's these people that are neurotic and they just have fixations anxiety fits um anger you know different things uh but they still are oriented in reality in a way the psychotic people aren't but these things that they were trying to define that would later be called you know a borderline group in 1938 i think stern was the guy that that one i think it was adolf stern don't quote me um you know he was like these patients are in this borderline group because they're relatively oriented to reality. Like they're in the same reality as us more so than the reality that the person was schizophrenia is in. But they sometimes aren't. So what do we do with them if they're not psychotic and they're not neurotic? Because I'm doing

therapy with this person. And while I'm doing therapy with them, they're telling me about all this stuff and it's real. And then all of a sudden we get into emotional territory and then I'm attacking them. They just they won't answer the question because I lunged across the room and I said I leaned forward slightly but I don't know no no you did you did this and you're just something you dad and I will now have a boundary against you or you know whatever and then you're like well and then other times well four other people were there and we're doing family therapy and they all said that this person just said this kind of slight criticism of you and you're saying that they yelled at you and attacked you and well you're they're all in a conspiracy against me but I they don't have a psychotic paranoia like paranoid schizophrenia. but only around these things, they lose all touch with reality. Reality becomes plastic when you have an emotional need, an emotional narrative that is so deep and so true to you, that when it is challenged, all of a sudden, your mind confabulates ways that the narrative that is more important than any other system in the brain has to be real.

And that's what a personality disorder is doing, but it's only around certain things. It's not all the time. You can still have a good day. You can still go into a Walmart and get a coffee. well you know like coffee at Walmart but uh whatever you can go to a restaurant and do different things and your beliefs are not being challenged these issues are not coming up and then all of a sudden maybe somebody comes to me and they say something and then then it comes up but it wasn't traditional psychosis because it wasn't endogenous to the brain it was part of a story they were telling and then

you have like auto kernberg who comes in and plays with the idea and he says you know they can reality tests most of the time but only have primitive, this is their language, not mine, defenses like splitting and exaggerated affect, you know. And when the modern diagnostic system came about in 1980, when the DSM3 came out, you know, borderline personality disorder became this formal diagnosis that it focused less on psychosis and more an emotional instability and identity disturbance and fear of abandonment, impulsivity, and the border concept. was never renamed, it's still there.

And in contemporary trauma-informed models, most people would say it's an attachment disorder that comes from like really early childhood wounds, you know, one or many, where somebody is playing this game of trying to be safe all the time, but they don't know that the world actually is safe now. And unlike someone with PTSD that's having flashbacks or physical emotionally experiencing,

they're having, I mean, you can have both. You can have BPD and PTSD. Most people do, and those disorders, one of the reasons I don't like them is that they probably should be three or four, you know, overlapping, you know, whatever. But that idea that this person is on the border of sanity, but certain things knock them off the edge of tolerable emotional experience out of the window of tolerance and then things become not real for them.

And one of the things these early guys noticed is like, these patients don't respond to psychoanalysis. You can give them so much insight. You can give them so much relationship. You can give them so much love. And all that happens is that they need more and more and more, which is why a lot of people say that BPD, you sense it in their room as somebody having a black hole.

Also, I notice that a lot of borderline patients around the chest, they have a feeling of a black hole sucking or a burning heat. There is kind of a void that shows up in semantic work with that. And a lot of that, those early clinicians were sort of trying to figure out what it was. And that's the history of. of it that we forget because let's remember how many times the DSM changed its entire idea because the DSM kind of changed. I have an article about like how America changes psychology and psychiatry to fit its own

identity of what itself, what the how we define self, what self it is like in any era. And the DSM rebranded essentially three times. It's interesting to me that in the first DSM, they said this will never be used for insurance billing for classification. only for research and medical treatment, and that lasted about two weeks. But the DSM, you know, it rebranded three times, basically. So at first it's looking at reactions. It's looking at these systematic, dynamic systems that are out of balance.

And then you get, you know, the empty, dull thud experiments that Rosenhand did. A lot of the DSM3 was a response to that, where, you know, he said, We never solved this problem, by the way, too. Somebody should do the Rosenen experiment again. You'd probably go to jail and lose your license at this point. You wouldn't be able to teach at Harvard. But what Rosanan did was he told all of his graduate psych students, we're going to go get committed.

We're going to do an experiment. We're going to go in and we're going to say, we heard a voice say empty dull thought. We hear a voice that says empty dull thought. And everyone says the psychiatrist is this genius who's able to, you know, just detect what's going on in the person. And we're going to prove that that's not right. And they went in and they did it and all these Harvard graduate clinical psych students get committed.

And then they can't get out. And then eventually they get out and they publish a paper and they say, this is bullshit. You don't know what people have. We just went in and said this. And then you also have people like R.D. Lang, who are incredibly critical and of organized psychiatry. And they lead the anti-psychiatry movement in the 60s and the 70s.

And so the GSM says, okay, fine, we're going to take away all of that subjective intuition to detect systems and things out of balance and whatever. And the psychotius is no longer allowed to trust their autonomy. They're no longer to trust subjective intuition. And a lot of psychiatry at this time was abusive. There should be checks on that. But, you know, the history of this profession is corrections and way over corrections in the wrong direction, you know, because we can't identify like what needs to change.

We just change everything. and we could but we don't and so after that they said they'll just be checklist they'll be checklist for everything and if you check these boxes you have this diagnosis

now it's scientific now it's based on numbers now it's based on order and because it's based on that so you get this checklist model that keeps the borderline name even though it's no longer about system so it doesn't quite make sense because what is it on a border between the neurosis

and psychosis things, not how they want to conceive of it anymore. And now, you know, the DSM-4, they acted like they were going to get further with the human genome project and all these different research studies. And they were going to understand the brain-mind problem where consciousness really was what it was doing. We'll find more biological variables that are the, because they keep trying to turn psychiatry into the germ theory. Like, we have to find a thing that causes these. We can't look at the environment at all.

Like, it's not any of those things. We don't want to talk about what your mom did. We don't want to talk about, you know, trauma. We don't want to talk about racism. We don't want to talk about systemic problems, access to health care. We just want to find the biological variable. That's the reason why you are defective. But suffering is a part of making meaning.

It's part of us. We can't, you know, that project didn't really work. And so the DSM4 is kind of rushed out and highly criticized and not well. And it starts with the DSM4 TR and then furthered by the five to move to this spectrum model. They're like, okay, well, it's a diagnosis. But then the diagnoses are like all wrong and don't work. work. So we're going to put it on a spectrum where you have a little bit or a lot of it, which also doesn't really work. You know, they did that with autism too. And they wanted to,

you know, not change that underlying assumption that suffering is a biological defect. They didn't want to change that it could be this meaningful response to life that could be engaged with because that's too messy. And so it makes this persistence of of BPD this kind of deeply strange diagnosis that's like a fossil from the first era that is prevalent enough that it sticks around but that all the assumptions about it and how to treat it and even its name don't make any sense in the three errors and eras in which it has lived and so it now sits kind of awkwardly in the spectrum model but we can't really link it to trauma because PTSD is different but like you had to have the trauma to get the B that hasn't I mean read the DSM 5 entries I

on these things, they don't explain that relationship well because they still need it to be a diagnosis that's a code for insurance and not a system of trauma when? You know, 40 years ago and now you have a personality disorder, you know, what is the, so, you know, the result is this diagnosis that pathologizes a person's survival mechanism that was useful at one time or they wouldn't have it. You know, we tend to not do things for no reason as humans. It doesn't make sense in the time that they're doing it now in the present, but it's this permanent internal defense that the person forgot why it existed.

But it's not a disease that comes from a germ. So you're still trying to blame the patient's biology for their adaptation to this chaotic environment, which is one of the reasons why I don't really like the diagnosis is it doesn't really spell that out. That all has to be inferred clinically. You know, you get it at a training. But it's not part of the actual conceptualization. that's supposed to be undergardeing the profession. And so, you know, that term comes from 20th century psychology,

and those clinicians were noticing these patients that didn't fit into the categories at the time, and they tried to make them fit into the categories for the next cycle, and the next one, and it hasn't really fit, because on one side of the border was neurotic disorders, and the other side of the border was psychosis. And the borderline people were, they were saying basically they're sort of in the middle of psychosis

some of the time, because reality can become plastic them. But remember what I said about social work school, though, right? Like, we all do some of these things, some of the time. And we do them when we're at more stress. So if I'm in an environment where I lose my job, I have no money, and then I'm out of my window of tolerance all the time, and I start acting worse,

Do I have BPD all of a sudden? I said I do that stuff to my wife some of the time. My life gets worse. Maybe I do it more. If I'm rich enough that I can insulate myself from all the consequences of doing it, then do I not have it? Does the person who is poorer have more BPD because they're in an environment that is activating the symptom more of the time? I mean, I don't know. You guys tell me because it's not in the DSM.

That is still roughly a checklist, even if they tried to make. it, you know, spectrum differential diagnosis, it doesn't really explain how to handle those things well at the conceptualization phase. And the DSM is supposed to be how we conceptualize things. So I don't know. You tell me how to do with it. I've asked this question in a lot of conferences. And people are like, yeah, yeah, well, the DSM says that. And then you just go do your own thing. Okay, why is it there? You don't have to take my word for it. I'm not the first person to make this argument or the best person. I mean, you know, Thomas Zazz is mates the myth. You know, in the 60s argument and says, like, you know, disease is a physical thing in the body.

So saying mental illness is stupid because mental illness is just a metaphor for problems in living. And we should just view them as that, not, you know, they don't need to be diseases at all. You have, you know, Thomas Encel is the biology argument where he's like, you know, the DSM is at best, it's just a dictionary. It's a weakness because it has no validity. You know, other medicine has a blood test that tells you if you have a disease. this one is just this stuff that changes all the time. Even patients that we're screening regularly are getting different disorders. So like I don't really think it works.

We're going to move our funding away from it. You know, Alan Francis said, you know, he argued, I think saving normal was his book. But he said, you know, the DSM5 process was sloppy and it led to this diagnostic inflation because you're putting people on the spectrum. And now all of a sudden you're putting more people on it because you've broadened by the definition. by the definition of spectrum, it's not one destination. It's now this range. You've broadened it.

Now everybody is like meeting these categories, which I think that's kind of true. I mean, I have a lot of people that write me and try and get me to say that I have autism or that I have ADHD. And I definitely have, you know, some traits that are ADHD and autistic like.

But I, and I'm not saying one way or the other. Mainly I just kind of don't care because those things are things that I use in life to be successful and they're not detracting from anything. I'm not having problems getting things done that I want to do. And so I don't really need treatment for it, but they're like, but you still have to identify with that and live it to be a mental illness informed clinician or not informed, what do they call it? I don't know. You're representing the community or something. And my thing is that like if you want to say that I have autism, I'm not saying I don't,

then you're saying that everybody who is a little bit intuitive, everybody who can kind of understand the way these systems work in a way that they're unimpressed with like hierarchies and they're able to read behavior and they're able to be, you know, deeply recognized patterns and synthesize information and they maybe have like a wandering focus of interest that's very specific.

I'm not saying that is or is an autism that I am I'm not autistic, but what I'm saying is that if you want to make that the diagnosis, how many people is that in the country, right? Like these spectrums, you know, had these huge ranges, which is what Francis is pointing out. You have Kerry Greenberg. You know, and he says that the DSM is basically a work of fiction. It's this noble lie that insurances making clinicians tell, even though a lot of them when they pull them anonymously, they don't want to.

And these are just voted into existence by a group of psychiatrists that says, hey, this exists this year. I got in, I blocked, I think, by this person in Australia or somewhere, psychiatrist. And she was talking about how it was so important to have a diagnosis and we didn't have one, you couldn't get better, whatever. And I was just like, okay, thought experiment. Why? And she was like, because that's what lets you love yourself and accept all the parts of

yourself and understand how you think and then heal. I was like, okay, no, I think loving yourself, accepting yourself and understanding the parts of yourself and then healing and. raising your window of tolerance are the thing that matters not the code like if i did that for reactive attachment disorder as an adult in the dsm 2 and got learned how to do all those things and then all of a sudden the dsm 3 said never mind anyone over 14 can't have reactive attachment disorder does that mean what that was a useful diagnosis i wish i kept that one around like then why um does that i mean that i don't have those three things all of a sudden that i have to like be like

oh, I got to go treat another diagnosis. I don't love myself anymore. I don't understand how I think, and I definitely can't accept anything or act effectively. Like, no. Like, that was the point. The diagnosis was arbitrary. She blocked me.

She didn't response. I don't know. And I said it nice. I said it like that. But the French philosopher who, you know, Foucault, like he said, you know, mental illness is not really scientific fact, but it's this cultural tool.

And then it's used to silence and control people who don't fit the rational, productive norms. I largely think that I don't lean into those kind of arguments that they get made a lot on kind of fringy podcasts and things. Because I don't think it's that intentional. Like I don't think that the psychiatrists think that they're doing this evil thing and that like hoodwinking everybody. I think there's a system that is an incentive structure. A lot of it has to do with the profit motive.

And that what that system does is it plays on everybody's blind spots and everyone's insecurity. siloing information and making sure everybody only knows a little bit in academia about one thing. I mean, you can't have 12 PhDs. And then you can't talk about anything that you don't know and you can't see the whole picture. And then you also have to do this financial investment. Then you also have to jump through these hoops to win. And then that filters out a lot of the accountability and the insight for people to see this thing intentionally. I mean, there's so many people who work very, very high up in health care, in mental health care policy.

making that I've talked to who don't understand how these things work and they're interested for a minute and then they get angry and are like well that can't be true and I'm like it's in a book not a opinion book like a book book like that just has things that happened in it like you can read the history of the profession like you don't have to just start at the point in history in which you were born because we can write things down yeah you have you know David Rosenhan who we already talked about who and he you know said you know being sane and say in places his book and he said that like you know writing in a journal or you know writing things about yourself those were normal and he did those all the time and he was the Harvard professor there I don't know he was Harvard but he was like he was in California

anyway he was he was big school at the time and he was like that all got pathologized by doctors and they said that I was crazy and they were analyzing these normal things that I do just because I was in a psych ward not in my house You have, you know, Joan Amon-Amene Krife who says, like, that the chemical imbalance theory about low serotonin and all that, that's just this myth. There's no evidence. That's actually really precise. She had a lot of foresight because the stuff that's coming out now, they paid for all of this research about 10 years ago that started coming out about, I don't know, six, five, six years ago. And most of it was kind of confirming that all of the, we had a guess.

we thought about why an antidepressants worked and what they were doing in the brain because we don't really understand. And then we tested all of those theories neurobiologically and actually most of them are probably wrong. So we spent a whole lot of money to find out that we know less about why they work. You know, James Davies, he talked about the DSM committees. When they voted on definitions, they often admitted that they had no scientific proof at all. They just sort of thought that was a good way to move the information around.

They were doing it more like quantum physicists work where they just look for holes in the math and then kind of plug the hole. You know, to draw the line to be normal and disorder was really hard. And even in these rooms where these people are supposed to be doing the most scientific thing, they're just kind of like, oh, this is what I think. And what's scary is a lot of them have no patient contact for many, many years. I mean, a lot of psychiatrists have never been in therapy. And a lot of psychiatrists have never done therapy. I would say most of them. If they've done any, it's like CBT or DBT group or, you know, I volunteered at the student counseling.

Center, which there's a gap between working at the student counseling center and what I do. There's also an enormous gap between doing any kind of therapy at all and doing your psych rotation in the ER, you know, which I mean psychiatrists spend more time at psych than that, but you normal doctors, like their encounter with psychology and psychiatry during their, you know, training is that they're in the psych ER or the ER just. doing psychic mission. But, you know, um,

the R.D. Leng is an interesting one. It won't go on any more about history people and I've talked about him before, but, you know, he talked about just making a profound connection with people and so, because this was so healing and it was our humanity and our story. And even if it was psychotic, if you participate in somebody's story,

it starts to ground them and relationally invigorate them. And I think that's true because I've had a lot of dissociative identity disorder patients. It's really overdiagnosed some places. So if you ever meet somebody that's like, oh, I see 30 DID people, unless they're in some kind of like specialized treatment facility. They're over diagnosing. I mean, you maybe get one a year or something. But I've seen a lot in my career. And one of the things that with the ID is that a lot of times they feel so unsafe, they are so activated that they don't remember 40 minutes of a 50 minute session with me. And then they start to remember more because it's not an intellectual logical thing it's that their body is

starting to be more safe they're starting to trust me and they're starting to calm down and it doesn't matter if there's an intellectual memory of it because the safety is the point and the session is still productive you know without me delivering a whole lot of information that they remember because therapy is not really just like raising children or a lot of our communication it's not what we tell our kids to do it's not what we say a lot of it is what we do and embody and are um is is what makes the connection i mean there's those are the old people there's a ton of newer people like alan horwitz and bessel van der Kolk and goormate i think's kind of reductive in some areas but you know there's if you don't want to if you say like your only evidence for why

depth psychology is good is you know people from the 60s which people say a lot you know and Harrington, what, 2020, you know, Richard Bentall, Robert Whitaker, Owen Huli, like, these are big, big modern figures who know a lot more than me and make the argument probably a lot better than I can do, you know, in this hour. But I think that there's this kind of like two-pronged problem where there's this belief that BPD patients have this unfair explanation on that clinician. and they don't benefit from therapy because they can't have insight, which I don't think it's true. I think a lot of times when you just treat trauma and you build a lot of somatic and relational safety,

a lot of those symptoms come down. That's been my experience with most people. I mean, there's some people where you have to have very firm boundaries because they're going to try and contact you out of session or cross lines. And that would be what I think, you know, the people that, you know, basically can't function well enough in the therapeutic relationship. to get better in therapy, that may not be a bad line to draw if you want to keep BPD around as a diagnosis and say, you know, this is BPD and this isn't. It may be the line where individual therapy just doesn't work because the person is not able to obey the rules of a relationship enough to benefit in individual therapy. And they need, you know, group therapy, a DBT group, or something that is a little

but more structured where they're not allowed to have to make these decisions that they can't make yet about relationships and interaction and appropriately. If they're going to violate the rules of what is acceptable behavior in a therapeutic relationship enough that therapy just won't work, if you're going to keep that disorder around, let's draw the line there, not like a woman went to the ER one time. Like, I don't think that's, I don't think that's, uh, tenable or, or scientific. Um, so, I mean, if you want to look at BPD as a diagnosis, you know, the thing that I was saying about autism, like if you want to make the spectrum big enough to include me, how many people are we

including there? You know, how many people become autistic? And I'm not saying that that's wrong or not the direction to go. I'm just saying that if you look at the way that they're going with the DSM5, it's going to say that a lot more people have a spectrum disorder, albeit still a disorder, if you continue to innovate on it in the direction they're taking it. Look at the symptoms, though, of BPD, you know, frantic efforts to avoid real or imagined abandonment. You know, look at American like foreign policy and obsession with exceptionalism and that we somehow are this exception to all the rules or this

deep-seated geopolitical anxiety that we have all the time that we have to make sure that everyone in the entire world is doing exactly what we want is that BPD not everybody in America believes that but enough people participate in those things you know criteria to this pattern of unstable and intense interpersonal relationships you can't have any relationship with someone as an equal you're either above them and they're wonderful or you're below them and they're terrible splitting i mean the political polarization you know i don't even know if i need to say anything about that one you know idealizing people as mezzanic saviors and then saying oh actually they're terrible um and using some acronym to

write them off how many people in politics not like politicians i mean them too but have been actually consistent if you look at what they say they want and believe you know three identity disturbance this market and persistent pattern of unstable self image or sense of self does america and most americans have a stable self-image you know impulsivity in at least two areas that are potentially self-damaging our systems are spending our national substance abuse are died in health, the things that we agree are self-evident in the point of a country. Are we doing anything that is impulsive or potentially self-damaging? Can you think of any? Recurrent suicidal behavior gestures or threats or self-mutating behavior? I mean, I don't know,

ecology, ignoring clear warnings about things that are destructive to our citizens of If we do them, you know, number six, BPD criteria. Effective instability due to a marked reactive, uh, a period. I'm sorry. Effective instability due to a marked reactivity of mood. Something something, something 24 hour news cycle. Chronic feelings of emptiness. Number seven.

Look at Instagram or TikTok, especially like some of the mental health or alternative mental health advice. Number eight, inappropriate, intense anger or difficulty controlling your anger. Hmm. Nine, transient stress related to paranoid ideation or severe dissociative symptoms. Does anybody seem paranoid?

Does anyone seem like they are so worried about a big problem that is real, or their own suffering and they are hurting. And so because they're hurting, they're maybe misattributing who's hurting them. They think it's an imaginary thing, you know, instead of a very obvious system. We're doing that anywhere?

You know, there's a documentary. Joel Bacon made it a long time ago called The Corporation. I think Bacon wrote the book and Mark Akbar directed the movie. the movies, you know, like follows the book. But the premise of it is this analysis about how under the 14th Amendment, you know, corporations have been granted the legal right of being a person. And so Bacon in his book says, if a corporation is a person, what kind of person is it? And to answer that, let's compare corporate behavior to the world health organizations or the ICD10 or the DSM, their criteria for any. antisocial personality disorder, you know, being a sociopath or a psychopath.

And the diagnosis that Bacon and the filmmakers argue is that the corporation is not just bad by accident, but it's institutionally mandated to be a psychopath by the laws that govern it. You know, by a law, a corporation's primary duty is to its shareholders, and it must prioritize profit above all else. And if a CEO acts out of genuine altruism at the expense of profit, they can be sued. And so there's a scene in the movie, where a bunch of protesters are like, you're making kids, I think it's like the Nike CEO maybe. And they're like, you're making kids knit sneakers in Cambodia for 10 cents an hour

and their fingers are getting cut off and like you're terrible. And the CEO and his wife invite everyone in and they like have coffee with them. And the CEO's like, I agree with you. It's wrong. And if I don't do it, they'll fire me and they'll get somebody who will. So y'all should make it illegal because all, of the shoe companies do this. I don't know if it's really the CEO of Nike. I saw that movie when I was in 11th grade, I think, I don't know, 20 years. Anyway. Um, and so like, he engages with him. It's like,

basically I agree with you, but I'm powerless because I'm an agent of the system. And even if you kill me or I go away, somebody else just comes in and takes my place. So to really do this, you have to say it's self-evident that we should not let corporations make kids get their fingers cut off, making shoes for 10 cents. Maybe shoes could just cost a little. little bit more or the corporations could take a little bit less profit off, you know, the three, four hundred dollar Jordan that costs a dollar to make. And there's this callous unconcerned for the feeling of others that he documents that, you know, corporations basically have to act in because they're not concerned with anything but money. If you're going to call them a person legally,

then let's look at the mental health of what you just called a person. You know, an incapacity to maintain a during relationships. A reckless decision. regard for the safety of others, a deceitful repeated lying or conning of profit and an inability to either notice or respond to the truth, an incapacity to experiences of guilt, failure to conform to social norms with respect to law or behavior. I mean, how many corporations just build into their bottom line that they're going to break the law and that they're going to kill people or they're going to do something terrible with poison that affects, you know, people forever and I mean, what is it?

We lit, you know, when the train fell off the tracks in Palestine, Ohio, they, the domestically, I'm not talking about Palestine, I'm talking about the Palestine, Ohio, where the train came off the tracks, and there's giant tankers full polyvinyl chloride. They didn't try and clean it up. They said it was probably too dangerous. So they blew it up and just let black smoke of this chemical that is awful, that we don't even begin to understand what it's doing, not just to people, but to the entire environment for hundreds of years and pour into the groundwater. And that was the solution. You know, and the argument is not that

the people are psychopaths. I mean, I'm talking about the CEO who's at the very top because the people aren't. It's that the structure makes these things happen. The structure itself, you know, the legal mandate to pursue profit at all costs creates a pathological pursuit of profit. And that forces an entity to act without a conscience. So when you're looking at BPD, when I'm saying like, we all do some of these things, some of the time.

But when we're unconsciously doing these defense mechanisms all of the time, and it's all that we're doing, and it's all that we are, and that we have another part of ourselves, sure, you know, that's good or that knows it's wrong or that wants a greater good, but just wasn't able to, you know,

see the truth or act on, you know, whether it was a healthier, effective behavior in that moment, which is, you know, what you do in DBT therapy to treat BPD a lot of the time. Yeah, we have it, but it was secondary and we weren't embodying it. We were living within a defense mechanism. And we're talking about mental illness being on this spectrum instead of being in its checkbox.

How many people are on that spectrum in America? And where is America on that spectrum? Hey, guys. I'm hoping that you enjoyed that episode. wanted to remind you if you're in the market to check out gethardy.com and to use offer code taproot if you would like to try some vitamins. I didn't hear about Hardy from clinicians. I didn't hear about it from advertising. I heard about it from multiple patients. Usually with dopamine disorders that said, hey, I'm treatment resistant. I've tried everything.

I've gone all these places and this is what worked. And so I looked them up because I was is skeptical of supplements and they had paid for a lot of really strong randomized controlled trials proving that their product worked for autism and ADHD and children. It works for a lot of other things too. You know, I'm a clinician, so my focus is on mental health. But Hardy sent me a box after we did a podcast with them. And they, uh, I started to take them because I take vitamins. I went trying to treat anything and I felt a lot better. My I was like, I really like these. I'm into it. I'm going to see if I can get these, you know, wrapped through our company. or something and my wife was making fun of me because she thought I was going to be like a

radio vitamin guy and then she started taking them and I'm pretty cheap like I don't I don't pay a lot for stuff Hardy's more expensive than CBS you can save 15% with my offer code but um I didn't like think that uh you know I just don't spend money on a lot of stuff and I do pay for Hardy because I feel like it it works um I use the same offer code that I'm offering you and um I I don't know I They have some really strong evidence on their website. If you don't want vitamins or they're not effective for you, even if the research says this thing works, if it doesn't work for you, it's your brain.

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