It is commonly argued that for one to be morally responsible, one must have control over one’s actions (see here for a run-down on arguments for that claim). Now, one does not generally concede that a person is moral pariah simply because the person is in the deepest stages of love, even if we do tend to lose our heads in moments of undeniable passion; but one might wonder whether some additional factor might play a role for when love nullifies moral responsibility. I want to entertain such a possibility by highlighting the fact that there are certain underlying disorders, such as Borderline Personality Disorder, or BPD, that can affect one’s capacity to form romantic relationships and sustain them. I suspect that in some cases, BPD might undo moral responsibility. Here is my reasoning.
The primary features of BPD are unstable interpersonal relationships, affective distress, marked impulsivity and unstable self image. The neurobiology of BPD suggests that there are specific dysfunctions to areas of the brain of persons with BPD that regulate emotions and actions. Therefore, if one were to peer into the brain of a person with BPD, it would appear to be the brain of a person primed to lose control. Men or women with BPD typically have impairment in the anterior cingulate cortex (ACC), the frontal part of the cingulate cortex, a brain area associated with regulating emotions (Minzenberg, Fan, New, Tang, & Siever, 2008). In conjunction with dysfunction and decreased activation in the ACC, persons with BPD have also been attributed with an overactive amygdala, which is strongly associated with the processing of emotion (Herpertz et al., 2001). Dysfunction in the orbitofrontal cortex has also been associated with BPD. In a study by Heather Berlin and her colleagues, orbitalfrontal cortex lesions were correlated with disinhibition, socially inappropriate behavior and emotional irregularities; thus, the impulsive characteristics of BPD was associated with orbitofrontal cortex dysfunction (Berlin, Rolls, & Iverson, 2005). Furthermore, since dysfunction in the orbitofrontal cortex has also been linked to compulsive behavior, the orbitofrontal cortex dysfunction could reflect the compulsive features one often sees in impulsive disorders, like BPD (Torregrossa, Quinn, & Taylor, 2008). The brain abnormalities observed in borderlines are interpreted as corroborating the behavior and subjective experiences of persons with borderlines; firstly, borderlines typically report very intense and slowly subsiding emotions even in lower-level stress situations; secondly, borderlines often lack the cognitive tools to actually override their responses to emotions or appropriately deal with the intense emotions that they feel; and finally, borderlines tend to display behavior that is accompanied by little or no forethought, reflection or consideration of the consequences. It is with the aforementioned underlying brain abnormalities and dysfunctions that borderlines take into their romantic relationships.
Dysfunction within romantic relationships is a common characteristic of BPD. One study by John Gunderson notes that borderlines have a characteristic interpersonal style marked by abandonment fears and vacillation between idealization and devaluation (Gunderson, 2007). Another study on the relationship between attachment styles, BPD and romantic dysfunction indicates that BPD symptoms are specifically associated with romantic dysfunction (Hill et al., 2011). To be specific, BPD symptoms have an impact on several important aspects of couple functioning including: low levels of relationship satisfaction, higher degrees of intimate violence, attachment insecurity, and problematic sexual functioning (Bouchard & Sabourin, 2009). There are a number of explanations on offer for the problematic sexual behavior of persons with BPD. One explanation is that in cases of individuals with histories of childhood abuse, the BPD individuals find themselves re-enacting the abusive dynamic within a romantic relationship (Wiederman & Sansone, 2009, p. 279). In other cases, for some individuals with BPD, having sex may trigger post-traumatic anxiety because of past abuse, and therefore he or she is expected to avoid sexual activity when in a romantic relationship (Wiederman & Sansone, 2009, p. 279). Both explanations of the sexual dysfunctions of persons with BPD suggest that not only does BPD symptoms affect relationship dynamics, but also being in a romantic relationship is a significant factor that can exacerbate BPD symptoms.
Recent research on the effects of oxytocin on persons with BPD corroborates the hypothesis that romantic relationships, and perhaps love, is a factor that can exacerbate BPD symptoms. Oxytocin is a hormone that acts as a neuromodulator in the brain that has been specifically associated with sexual reproduction, pair bonding and romantic love. Not surprisingly, the neurochemical that we commonly associate with love has deleterious effects on persons with BPD. In one study by Jennifer Bartz and her colleagues, the effect of intranasal oxytocin on BPD was studied. Bratz concluded that oxytocin impedes trust and pro-social behavior on those with BPD and others who have chronic interpersonal insecurities (Bartz et al., 2011). Therefore, BPD is associated with relationship dysfunction in the sense that BPD symptoms affect the way that a person loves, and romantic love effects BPD symptoms. The romantic dysfunction characterized by BPD is, therefore, best understood as a reciprocal relationship between BPD symptoms and the dynamics of the romantic relationship. Therefore, when borderlines become out of control is frequently when they are in romantic relationships, and love can attenuate moral responsibility when the lover happens to be a person with BPD.
One final consideration is warranted regarding control and BPD: it is not the case that BPD individuals are equally disturbed, rather there is a continuum of borderline psychopathology which implies that those on the one end of the BPD continuum may be in more control than those on the other pole of the BPD continuum. Mary Zanarini, in “The Subsyndromal Phenomenology of Borderline Personality Disorder” suggests that on the one end of the spectrum, patients have mild cases of BPD have more control over their behavior, and on the other end of the BPD continuum patients have less control over their own behavior. Describing patients who have a mild case of BPD, Zanarini says, “These patients manifest the same dysphoria, and same cognitive disturbances, and the same interpersonal difficulties as more severely ill borderline patients. However what distinguishes them is their lack of impulsivity, particularly in the areas of self-mutilation and suicidal efforts, and their greater ability to use treatment relationship to enhance their functioning in the wider world.” (Zanarini, 2005)
Some worries arise about the accuracy and clarity of Zanarini’s characterization of less severe BPD patients. One item that remains unexplored and unmentioned by Zanarini is whether persons with less severe BPD actually have the exact same interpersonal difficulties as more severely ill borderline patients. I suspect that the BPD symptoms and relationship troubles would be more severe in more severely ill borderline patients. Furthermore, there is no indication that less severe borderline patients are impulsive in other areas like sex, reckless driving, spending of money or binge eating. It is my suspicion that persons with less severe symptoms may display some impulsivity, yet may be impulsive to a lesser degree. On the other end of the BPD spectrum, persons with BPD are described as being in less control. As Zanarini writes, “(These) patients lead very chaotic lives, with areas of strength intermingled with wide-ranging and chronic pattern of self-defeating behaviors. These patients typically use a tremendous amount of psychiatric treatment and over the course of their disorder, may well give up both their determination and ability to function in the real world. More specifically, many of these patients abandon the structure of work or school and end up supporting themselves on disability. Many relinquish important relationships such as those with spouse or children and end up living lives of almost complete social isolation.”
(Zanarini, 2005)
Because of the plurality of degrees on the BPD continuum that appears to exist, my original thesis must be qualified to suggest that those with less severe conditions of BPD may experience more control over their behavior and hence may be more morally responsible. On the other hand, those with conditions on the other end of the BPD continuum may experience less control over their actions, and hence may be less morally responsible. While the BPD continuum may imply that persons with BPD can still be, to some degree, morally responsible, it can still be plausibly argued that BPD does have implications for whether one is more or less morally responsible. When a person with BPD falls in love or is in a romantic relationship, he or she can experience a loss of control to such a degree, that one can plausibly assume that the person with BPD is not morally responsible for their own actions. So what do you think? Can love, in conjunction with conditions like BPD undo moral responsibility? What do you think?
-Ray Aldred
Ray is a doctoral student in Philosophy at the University of McGill. Follow him on twitter @Ray_Aldred
Works Cited and Consulted
Bartz, J., Simeon, D., Hamilton, H., Kim, S., Crystal, S., Braun, A., Hollander, E. (2011). Oxytocin can hinder trust and cooperation in borderline personality disorder. Social Cognition & Affective Neuroscience, 7(8).
Berlin, H. A., Rolls, E., & Iverson, S. (2005). Borderline Personality Disorder, Impulsivity and the Orbitofrontal Cortex. The American Journal of Psychiatry, 162(12).
Bouchard, S., & Sabourin, S. (2009). Borderline personality disorder and couple dysfunctions. Current Psychiatry Reports, 11(1), 55-62.
Bray, A. (2003). Moral responsibility and borderline personality disorder. Australian and New Zealand Journal of Psychiatry, 37, 270-276.
Cozolino, L. (2006). The Neuroscience of Human Relationships. New York: Norton & Company.
Gregorios-Pippas, L., Tobler, P. N., & Schultz, W. (2008). Short-Term Temporal Discounting of Reward Value in Human Ventral Striatum. Journal of Neurophysiology, 101, 1507-1523.
Griffin-Shelley, E. (1991). Sex and Love: Addiction, Treatment and Recovery. Westport: Praeger.
Gunderson, J. G. (2007). Disturbed Relationships as a Phenotype for Borderline Personality Disorder. The American Journal of Psychiatry, 164(11).
Hayden, B. Y., & Platt, M. L. (2010). Neurons in Anterior Cingulate Cortex Multiplex Information about Reward and Action. The Journal of Neuroscience, 30(9), 4874-4809.
Herpertz, S., Dietrich, T. M., Wenning, B., Krings, T., Erberich, S. G., Willmes, K. & Sass, H. (2001). Evidence of Abnormal amygdala functioing in borderline personality disorder: a functional MRI study. Biological Psychiatry, 50(4), 292-298.
Hill, J., Stepp, S. D., Wan, M. W., Hope, H., Morse, J. Q., Steele, M., & Pilkonis, P. A. (2011). Attachment, Borderline Personality and Romantic Relationship Dysfunction. Journal of Personality Disorders, 25(6), 789-805.
Minzenberg, M. J., Fan, J., New, A. S., Tang, C. Y., & Siever, L. J. (2008). Frontolimbic structural changes in borderline personality disorder. Journal of Psychiatric Research, 42(9), 727-733.
Nigg, J., Silk, K., Stavro, G., & Miller, T. (2005). Disinhibition and borderline personality disorder. Development and Psychopathology, 17(04), 1129-1149.
Torregrossa, M., Quinn, J., & Taylor, J. (2008). Impulsivity, Compulsivity, and Habit: The Role of Orbitofrontal Cortex Revisited. Biological Psychiatry, 63(3), 253-255.
Wiederman, M. W., & Sansone, R. A. (2009). Borderline Personality Disorder and Sexuality. The Family Journal, 17, 277-282.
Yang, Y., & Raine, A. (2009). Prefrontal Structural and Functional Brain Imaging findings in Antisocial, Violent, and Psychopathic Individuals: A Meta-Analysis. Psychiatry Research, 174(2), 81-88.
Zanarini, M. C. (2005). The Subsyndromal Phenomenology of Borderline Personality Disorder.In M. C. Zanarini (Ed.), Borderline Personality Disorder. New York: Taylor & Francis Group.
A Philosopher's Take 
Justin Caouette
January 22, 2014
Nice post, Ray. I have a few questions to pose after I teach this morning.
Cheers!
-Justin
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Ray Aldred
January 22, 2014
Reblogged this on Thinking….
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trueandreasonable
January 23, 2014
It was interesting to read about this disorder (or borderline disorder). I tend to think of this as I would any other sort of mental condition that might mitigate culpability. Let me take a shot at your questions.
“When a person with BPD falls in love or is in a romantic relationship, he or she can experience a loss of control to such a degree, that one can plausibly assume that the person with BPD is not morally responsible for their own actions. So what do you think? Can love, in conjunction with conditions like BPD undo moral responsibility? What do you think?”
Although the legal standards tend to be somewhat hamfisted I think there is some truth in the neighborhood of what they are getting at. As a blogger that I follow said the Law apes at morality.
In Illinois, for example, there is the idea that someone might be “not guilty by reason of insanity” and there is “guilty but mentally ill”. I think these 2 standards on the whole are good guides.
First is the question whether there is any culpability at all. In most states this comes down to whether the person was so mentally disturbed that they could not recognize that there action was right or wrong. So evidence that they did know there actions were wrong would be actions that show they are trying to hide what they are doing before after and even during the crime. If the person was in such a mental state that they couldn’t even realize what they were doing was wrong they then they are deemed to not be guilty.
Now this is somewhat different than saying they lacked “the will” or control over their bodily actions, but I think understanding what is right and wrong and the will to do what is right and wrong are closely linked. I am not sure there is an material distinction to be drawn.
But even if they still have some understanding of the wrongness of their action they might still have their culpability mitigated by mental illness. I would think that is the category we are dealing with here. Without a specific example though its hard to say.
But I think allot of the posts here should understand that culpability is more of a sliding scale. Those who are fully in control and have full knowledge of their actions and do wrong are more culpable than those who who are less in control and have less knowledge.
I think this is an illustration of a principle Christians accept and is identified in the Gospel of Luke 12:47:
“The servant who knows the master’s will and does not get ready or does not do what the master wants will be beaten with many blows. 48 But the one who does not know and does things deserving punishment will be beaten with few blows. From everyone who has been given much, much will be demanded; and from the one who has been entrusted with much, much more will be asked.”
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Ray Aldred
February 9, 2014
Hi trueandreasonable,
First, thanks for the interesting reply. It is difficult to say whether BPD is exactly like other disorders that might mitigate moral responsibility. In fact, there is a lot of literature for why psychopaths might not be responsible, that offers very different reasons for why they aren’t. Psychopaths, in contrast to persons with BPD, are in total control of their behavior, so different reasons are given for why they might not be responsible. For example, one might think that because psychopaths can’t empathize with others, or feel emotions like we do, they lack some sort of moral perception. I offered no such reasoning for why we might think persons with BPD are less morally responsible. I suggest that to be morally responsible you need to have some control over your actions, and the ability to reason about your actions. Both the former and latter are affected when you have BPD.
You seemed to think that the legal standard for these things are a good guide for determining whether a person is guilty, and presented two verdicts “not guilty for reasons of insanity” and “guilty but mentally ill.” I guess I’m unsure what you meant here. What counts as insanity here? Could a severe case of BPD be considered insanity? Moreover, the verdict of “guilty” but “mentally ill” I have some reservations about too. This verdict suggests that one is less culpable because they are mentally ill, and are ordered to undergo treatment. They will not feel the full wrath of the law, because they have an underlying condition. Another problem is what conditions warrants each verdict? As such, I’m not sure how this can be a good guide for how we can determine which conditions undo moral responsibility and which don’t and how these verdicts guide us.
You have an interesting idea about understanding and moral responsibility. I think you might be right here, because there are epistemic notions linked to moral responsibility. Understanding, I think, is an epistemic notion. In this context, it’s about what one knows or grasps to be right or wrong. Now this is interesting, but what if one is overcome with intense emotion, and simultaneously has a dysfunction in the area of the brain that normally stops you from acting on that emotion? What if you could grasp what was right or wrong after you acted, but in the case of high emotional contexts, you simply don’t consider the rightness or wrongness of your action. You have an intense emotion, then act (because of your illness). You don’t grasp the rightness or wrongness of your action in highly emotional situations, but outside of these situations, you can actually demonstrate some capacity to do so. I’m just not sure what a thesis about moral responsibility and understanding would make of a situation like this. On the one hand, the person has the capacity to understand. On the other hand, highly emotional stimulus might severely affect this capacity for persons with BPD. It’s even more confusing, because BPD is highly treatable, and persons with BPD can learn to develop the cognitive skills to handle intense emotions. Do we hold the person with BPD responsible post therapy, but not before therapy? Or do we hold the person with BPD responsible even before therapy, because they should have been in therapy sooner? Because BPD is highly treatable, and the condition is flexible, things become more complicated.
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trueandreasonable
February 11, 2014
Thanks for your reply. You definitely raise many questions that are very hard to answer.
I say the law apes at morality because I think that is what it is trying to get it right, but it really can’t give the sort of perfect justice we all would like. On the whole here, regardless of the law, I do think there are different grades of culpability that relate to our mental states. How well we can know them and to what extent the law should try to distinguish them are different issues.
This discussion reminds me of the fact that although the Catholic Church has officially declared some people saints it has never officially declared anyone is in hell. This is despite the fact that it also teach that if you die with an unconfessed mortal sin you go to hell. If we consider the case of suicide, Catholics teach that can be a mortal sin. But a mortal sin requires a mens rea (mental state) that might not be present in someone seriously contemplating suicide. Only God can judge whether that full culpability is there in those last moments leading to the person’s death. Even if we have perfect knowledge of someone’s mental state it might still be hard to correlate how much culpability is there.
Take the sociopath. I think most people (myself included) would agree that the law should not be easier on them. Nevertheless I think our guilty conscience does help us keep moral in a way their mind apparently does not. Would a perfect Judge take that into account? I think so, but I’m not exactly sure how. At one point are we just simply creating a “rotten person defense?“ At what point do you say someone’s makeup doesn’t excuse their conduct and just say that is what they are so they deserve punishment?
But anyway, I think it would be hard to get a not guilty by reason of insanity for the condition you describe in your post. But then again the burden of proof varies from state to state.
As far as the guilty but mentally ill, the person is found guilty but the Jury has to find that defendant’s mental illness contributed to the crime. But even if that is found the Judge can often give any sentence that someone not found mentally ill could get – including the death penalty. Do the courts give the same sentence? I am not sure what the statistics show. It seems that verdict was introduced not to give lower sentences but to require a certain amount of psychiatric follow up.
http://articles.chicagotribune.com/1985-04-30/news/8501260304_1_mental-health-illinois-department-guilty
I have to chuckle because it’s so much like the cook county public defender’s office to say a finding of “guilty but mentally ill” is about as helpful for the defendant as a finding of “guilty but ugly.”
Whether mental disability might fall under some other mitigating circumstance might depend on the Judge:
http://www.ilga.gov/legislation/ilcs/fulltext.asp?DocName=073000050K5-5-3.1
I haven’t regularly practiced in criminal law for about 15 years. You would really need to ask people who regularly practice in this area if mental illness comes into play here. I do not know how “intellectual disability” is defined. I do know that allot of dirt was kicked up on this issue after the Hinckley case. It was due to that case that many states and the federal government decided that the state no longer needed to prove the defendant was sane beyond a reasonable doubt and started imposing the burden of proof on the defendant.
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BH
September 8, 2014
Ray, if I may,
I think that this is a super interesting project, and that it has a lot of promise as a strategy for thinking about the boundaries that we draw around moral (and indeed, epistemic) responsibility. But I’m wondering if you’ve thought much about one factor in BPD that I think really pushes hard on our notion of the ‘agent’; that is, the cyclic nature of BPD symptoms.
One of the things that makes BPD the hardest to live with, both for the person lover and for the loved, is the fact that it seems unpredictable when a stereotypical BPD response is going to emerge (for the Borderline person and for their partner). The standard response of the partner is to feel like they must ‘walk on egg shells’ to prevent the Borderline person from ‘flipping out’; but often the Borderline person often experiences this behavior as *distancing*, which exacerbates the sense of abandonment, which can then trigger the stereotypical BPD response. This is a complex, and interconnected set of forces, which are not really under anyone’s control. It’s the construal of the situation by the Borderline person that generates the response, but they have no control over how they construe the situation. Even worse, the stereotypical BPD response is likely to cultivate the situations that lead to actual abandonment. Yielding a situation where they feel justified in their worries about abandonment. This is part of the reason why it’s such an awful mental illness, both for the partner and for the Borderline person.
Ok, now here’s the rub. Most of the time, in most interactions, the Borderline person will have control over their actions. They will be able to see that their partner loves them, recognize that their partner is committed to them, etc. They will be able to seek help and consider ways of making things better. But epistemically, the forces that lead to an episode will often feel unpredictable and as if they are coming from nowhere. Even worse, from the inside, they may well feel justified at the time, even if on reflection it is clear where they went wrong. As a consequence, within an episode, the Borderline person may not be aware that they are exhibiting problematic behavior.
Maybe I’m mischaracterizing the Borderline experience. But I’ve read quite a bit on this disorder, and been close to a few people who really suffered with it, and this seems about right to me. Do you think that these facts complicate the picture that you want to paint? I don’t think that they cut against your main hypothesis. In fact, I think that they make it stronger.
Any thoughts?
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Ray Aldred
November 6, 2014
Hi BH,
Thanks for the interesting response. There are a few interesting claims you make that I think are worthy of thinking about.
First, regarding the cyclic nature of BPD. I do think that there is a sense in which BPD responses to events are “unpredictable.” I agree that the partner feels like they are “walking on egg shells,” and this seems to be a very common experience of partners who have BPD. I can agree with this. One aspect that I’m not quite sure of is that it is solely the construal of the situation by the person with BPD that generates the responses that they do. If this is true, then they simply have a wrong set of beliefs, and it is this wrong set of beliefs that causes a person with BPD to behave the way that they do. But, I think BPD is a bit more complicated than that. Firstly, I think BPD is very much a disorder associated with highly intense emotional experiences. While we might feel joy, anger, hope, dispair and sadness in our everyday lives, a person with BPD might experience these to a very intense degree. I heard one therapist liken a person with BPD to a burn victim who’s flesh is constantly exposed to the world. We can imagine how a burn victim might be incredibly sensitive to touch or accidental bump. Presumably a person with BPD is similarly sensitive, but in a hidden and emotional way. Second, a person with BPD may have difficulty with impulse control. Someone without BPD might have emotions, but they can also stop themselves from acting on those emotions. BPD, on the other hand, is a disorder whereby a person can have very intense emotions, and have difficulty not acting on those intense emotions. So, in a relationship, where you are in close emotional quarters with someone with BPD, a person with BPD can feel the full range of highly intense emotional experience and lack the ability to stop themselves from acting on them. A so called “episode” would be such an event. For example, suppose you are in a relationship with a person with BPD. You might say or do something that pricks a person with BPD the wrong way; they feel an intense emotion, and won’t stop themselves from immediately reacting to that emotion in an impulsive way toward you. You might rightly think this behaviour is beyond a normal emotional response to what you did, and might pull away or distance yourself out of fear, then the person with BPD senses this, and feels the intense emotion that they are being abandoned (another heightened emotional response to you pulling away), and then they respond to this new intense fear of abandonment in a characteristically impulsive way. I think this is the cyclical dynamic that you are alluding to. With a dynamic like this, the partner might come to feel like they are walking on egg shells, because they don’t want to trigger the wrong emotions and have their partner with BPD spin out of control. The general therapy recommended for persons with BPD, I think, is designed to develop cognitive skills to address these aspects of the disorder: identifying and feeling the emotion they are having through mindfulness, and responding to those emotions appropriately. I don’t think it’s just about correcting cognitive distortions of particular events.
Now, the second idea that you present is that the person with BPD has control over their actions in most other interactions. I do think this is right, but I still wanted to suggest that a person with BPD has the type of disorder that primes them to lose control, particularly in highly emotional situations, like being in love or nearing a breakup. This also highlights the fact that in more lucid moments a person with BPD can still seek therapy to help them gain back more control over their lives, and perhaps even live harmoniously in a relationship. To answer your question, I don’t think your points “complicates” my picture of BPD, but it may fill in some gaps about what might epistemologically be going on with a person with BPD. In sum, I don’t think I disagree with you, but I’d probably add a few qualifications to your intuitions.
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miss elizabeth
November 24, 2014
Hello,
Thank you for starting this discussion. I am a BPD sufferer.
This is one of the most thoughtful, considered discussions around ‘my issues and disorder’ that I have encountered on-line so far; I am especially impressed that no-one here is a sufferer or a Psychiatric Dr, nurse or therapist.
I choose to remain without a partner, sacrificing my want for children and companionship, due to the severity of my responses when I am ’emotionally stressed’.
I had to make a ‘moral judgment call’ in my late 20s, due to my levels of harm to self (and emotionally to other) at moments when I could not stop impulsive, reactive responses.
I know ‘right from wrong’, by reputation, the people in my world view me as ‘analytical’, ‘compassionate’ and a ‘people person’.
It is horrifying to ‘come back to awareness’ after a flood of emotional response, has lead me to commit harm to myself, bring fear to those that love me…if I could catch even a split second of my ‘rational mind’ at the beginning of that response, I would not have spent the last 12 years without an intimate-romantic relationship. I truly had ‘no awareness’ of my actions.
For myself, that means, I have to be a different kind of culpable, I can never take the risk of being ‘in love’ again. I truly had zero awareness of much of my actions in my twenties, until I would either wake up in hospital, or come around from medication, completely oblivious to what I had said or done.
I hope one day, to be able to structure, my thoughts and insight into my condition, and share in a constructive way which further informs people such as yourselves, for now, I can only share my individual truth.
Regards, Miss Elizabeth
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Ray Aldred
March 19, 2015
Hi Miss Eizabeth,
Thanks for sharing your story, and compliments. Some of my PhD work is on BPD, so I’ve tried to do as much research as I can on the topic. The discussions on BPD often turn towards demonizing sufferers, so I try to stick to the facts, and remain sympathetic towards all sides.
I also think your choice to remain single is an important and considerate one. Many persons choose not to have romantic relationships, because they seem to function better that way. Indeed, some literature on treatment of BPD even recommends not getting in a relationship, until one has found meaning and purpose in a career, education or cause. I appreciate your difficult choice. And thanks again for your story.
-Ray
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Mega Mellons
January 14, 2015
Interesting article. After spending 5 years in a relationship with a borderline lawyer I can confirm they (borderline lawyers) should be held responsible from a legal standpoint. Their education and experience enables them to become the perfect covert sociopath. They should be neutered as to not pawn more of the same offspring and placed naked in an electrified cage in the center of town where their exes can visit with copper poles with thick rubber handles. What do you think about this Ian from Hamilton, MA?
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ST
May 5, 2015
Ray,
Very interesting and important topic. I’ve written a lot on the website to which I’ve linked this comment, as well as elsewhere, about BPD, NPD, psychopathy and other conditions and the ethical quandaries associated with them. We seem to have many common interests.
Here’s the question I’d like to raise.
You said in an earlier comment in this thread:
“You have an intense emotion, then act (because of your illness). You don’t grasp the rightness or wrongness of your action in highly emotional situations, but outside of these situations, you can actually demonstrate some capacity to do so. I’m just not sure what a thesis about moral responsibility and understanding would make of a situation like this.”
The question to me is this:
If someone has a condition like this and has times, when not in the heat of emotional situations, at which they are firmly aware of their tendency to act out damaging behaviors – whether or not they’re aware of their actual specific diagnosis – are they morally obligated to either avoid the triggering situations (such as by not engaging in romantic relationships as in the case of Miss Elizabeth who commented above) or to warn any potential partner before the relationship gets to a dangerous point in its development?
I tend to agree that once a relationship becomes intense enough, situations are bound to arise in which it is very difficult for someone with a condition like BPD to control their behavior. So at that point the moral responsibility is blurry. But to me the moral aspect comes in long before that situation even arises when they allow a relationship to keep developing without informing the other person of these tendencies and the likelihood of such behavior emerging in time even when they know it. Granted, some people don’t know it and therefore can’t be held responsible for not giving fair warning. But there are plenty of people with BPD that are so aware of it that they write entire blogs about their experience with it and yet fail to inform potential partners about it until after the situation evolves into these intense points.
P.S. Have you ever seen AJ Mahari’s work on BPD? She is a former sufferer who claims to have recovered and is remarkably insightful about it.
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Ray Aldred
June 18, 2015
Hi ST
You raise a very interesting question, and one that seems to naturally arise from what I wrote.
Initially, I saw no problem suggesting that a person with BPD might be morally obligated to either avoid the triggering situations (and perhaps not engage in a romantic relationship) or worn a potential partner before the relationship gets to a dangerous point in its development. I think this would allow a potential partner to at least have the ability to consider whether or not they want to enter into the relationship. However, while this looks fine on paper, it would likely be more difficult to implement in practice.
Consider the case of someone who has no intention of letting a relationship develop past a dangerous point, but who enters the relationship anyway. We can hardly blame this individual, since the desire for human connection is a fundamental human drive. We all want friendships and love, and the thrill of a potential new friend or partner often fills us with joy(perhaps it is even more palpable for a person with BPD). However, perhaps once the individual enters the relationship, they have difficulty gauging when to disclose their disorder, and at which point the relationship will reach that threshold when the relationship might become dangerously dysfunctional. Gradually and slowly the relationship develops more deeply, and characteristic signs of dysfunctionality begin to emerge. I don’t think I can blame the individual for wanting a relationship with another person, but at the same time, they didn’t really appear to fulfill the stated obligation to disclose to their partner information about their disorder. Now they are fully in their relationship, and have lost control. I suspect this is rather common, and why a person with BPD might enter into a relationship and it gradually enters a territory where it is mutually painful.
There are also other cases where the potential partner fully knows that the person has BPD, but lacks any sort of intimate knowledge of the disorder. They then enter into the relationship with some knowledge of the disorder, and it soon spins out of control. In this case, the partner was warned, but they lack the epistemic foundations for understanding BPD, and didn’t really seem to make a knowledgeable decision about their potential partner.
Perhaps one can propose that we can track responsibility back to more lucid moments: when a person with BPD might have been able to disclose some sort of dysfunctionality. The thought appears to be the following: since the person might have been able to disclose some sort of dysfunctionality or opt out of the relationship, and perhaps didn’t, they are therefore responsible, even when they do eventually lose control. The idea seems to be that we can track responsibility to when they did have control, far before the relationship actually develops.
The problem I have with this sort of idea is that a person with BPD might lack the knowledge and cognitive skills to predict when they might lose control to actually warn a potential partner, and the thrill of a new relationship might be all-consuming. Furthermore, disclosing to a new person a mental illness, or any disability for that matter, is more difficult than many would assume, given the social stigma and shame attached to mental illnesses like this. Do we really want to say that the person has a strong obligation to disclose to everyone new in their life about their disorder? I’m also not sure I would readily recommend a person with BPD not form friendships and partnerships with others, since it seems rather harsh. Given these difficulties, I’d be more comfortable with the idea that what you describe is supererogatory and not a strong moral obligation for the person with BPD. However, on the other hand, I do think there might be instances where a knowledgeable potential partner of a person with BPD has an obligation to avoid or get out of a relationship to avoid harm to themselves and their potential partner. Not every instance, mind you, but some instances.
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ST
June 19, 2015
Ray,
We can agree that there are some complexities involved in putting this idea into practice. Perhaps a starting point is to phrase the principle like this:
“A person with BPD who knows that they have a tendency to lose control in a dangerous way in certain highly intimate relationship situations has a moral obligation to either preemptively avoid those situations or proactively warn partners/potential partners of this tendency at an appropriate time to the best of their ability.”
Now that last phrase “at an appropriate time to the best of their ability” seems to be where all the complexity comes in. But can we agree that this is a reasonable starting point? If so, then we can get into what constitues “appropriate time” and “best of their ability.”
I like this way of thinking about it because it accounts for the fact that the level of responsibility changes as a person becomes more aware of their condition and has more experience to which they can look for guidance. And it also specifies that this only applies to “highly intimate relationship situations” so we are not talking about disclosing to every person someone meets or even necessarily to people who are just friends or acquaintances.
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Ray Aldred
October 26, 2015
Hi again St,
I think that’s an interesting and reasonable starting point, although there are a few additional worries you might want to think about.
One worry I have is how individuals might know they have a tendency to lose control, and be able to identify which situations might spark that loss of control, when those situations arise. Additionally, there is a lot of stigma about the condition of BPD, such that it might be difficult to warn partners or potential partners about their condition. In fact, a natural reaction to such stigma is to try to “pass” as if one didn’t have the condition. Now, I don’t think I’d want to pass judgement on someone for wanting to do that, since it’s somewhat encouraged in our culture to hide ones disorder, or even fight the diagnosis of a disorder.
That being said, there is something right and praiseworthy about avoiding certain situations or warning partners or potential partners of ones own tendency, since it does affect them.
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ST
October 29, 2015
Ray,
You say you are worried about how individuals might know they have a tendency to lose control and be able to identify the situations that might trigger them. I don’t understand how, given my phrasing, that is a worry since that would be covered by “to the best of their ability.” If they are unable to recognize their tendency or triggering situations, then they would not be morally accountable.
However, I am sure both of us are aware of plenty of cases where someone with BPD is keenly aware of their tendencies and triggers – may even talk at length about them to people – and yet then does nothing to warn the next person affected ahead of time. They do not act to the best of their ability, but far below their ability. I can only assume they do this because they value the comfort they will get from their next partner so much that they are willing to put that partner at risk of paying a high price without the chance to make a conscious informed choice.
There are a number of conditions that have a stigma associated with them, but which put other people at risk. Do we find it moral in these cases for a person to hide their condition and put the other person at risk just to avoid their own risk of stigma? I agree that it is not a pleasant position to be in. And it is sad that the only way to completely avoid facing the stigma may be to avoid relationships (at least until sufficient treatment is received). But does the desire to avoid potential stigma – and it is only potential since many people who get in relationships with people with BPD are extremely understanding and forgiving almost to a fault – justify putting the other person at risk of serious mental and emotional agony without a chance to consciously consent?
It sounds like in the end, after expressing your hesitations, you do ultimately believe that appropriate avoidance or warnings do make sense. So I think we’re basically on the same page in the end.
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conca
July 25, 2015
Fascinating discussion. The last few contributions hit on what I wanted to explore. That is, how this condition is cyclical, as mentioned earlier, and a dynamic between two people in an intimate relationship. Moral responsibility goes both ways.
I love someone with BPD. We had a very difficult time at the beginning when I expected he “meet me half way”- “show some care” etc. It has been painful (and enriching I think) for both of us to find ways to keep coming back to one another.
I have come to let go of expectations about what he will and will not do and try to take what he has to offer (which is a lot) when he has it to offer it. He has said and done some hurtful things but when I can, with some affection and specificity, tell him how it impacted me, he has shown increasing signs of responsibility for his actions. In other words, I see him working at understanding consequences. Clearly, it is hell for him to continually undermine intimacy with someone he loves. i’ve learned to see that and to take things less personally.
Equally important is that I am learning the consequences of my interactions and responses to him. Everyone wants to be loved and accepted for who they are regardless of their challenges and idiosyncrasies. To expect what cannot be offered is going to contribute further to shame and anxiety. That’s not to have idiot compassion or self-abuse either but there is a middle ground and sliding development, I truly believe. But it takes those who love someone with BPD the mutual moral responsibility of being there. Being clear about borders and hurt, consequences. But still really being there.
Morality is a social phenomenon.
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Ray Aldred
October 26, 2015
Thanks for sharing your experiences, conca! I like the fact that you highlight that sometimes there is a sliding scale of development, and sometimes individuals with BPD can rightly take responsibility for his or her actions. I have recently been re-thinking this article to highlight some of these nuances in growing to be more responsible for actions through mutual engagement, and therapy (DBT approaches, in particular). While I still think many individuals with BPD may lack moral responsibility for their actions, I also think that they can grow to be more morally responsible in exactly the way you’ve articulated.
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beverley ebeling
August 20, 2016
I have been in a relationship with a bpd sufferer for years. His illness and lack of impulse control rips through every wish and every act of moral standards. He explains dissociation and an awareness of inappropriate behaviour and is highly affected by the power his illness has like an intelligence of its own. He has to drown in shame and guilt and has tried countless times to take charge of his destructive behaviour . It is a law unto itself and it presents itself as and when it chooses. He explains the toxicity he feels inside and the desperation of losing someone he cherishes. Nothing he cando i n his own strength works and has undertaken intensive for a year and this maintenance programme continues. This condition is so corrupt that sustaining a relationship is multi faceted and any romantasising needs to be erased. Having said that his empathetic side is more than i hVe witnessed before and he explains the power his illness has to show him as a facade and ugly inside. What he knows however is he is loved .. that is he is loved not his symptoms .. this is where therapy is helping and to be honest the mans life is a living hell.
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awilife43
October 20, 2015
Yes, Borderlines like myself are so set on self-destruction and drowning in loneliness that despite being educated and qualified to work, at least part-time, do not pursue employment because of the hopelessnes, and feelings of being useless that we feel. I have morals in almost every area I can think of, but I have no moral responsibility to make sure I am contributing something to the world. Simply because I experienced life so intensely that I rather not be a part of it, or be an inactive part.
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Ray Aldred
October 26, 2015
I don’t think anyone here argued that individuals with BPD are set on self-destruction and drowning with lonliness and so on. Although, some do find themselves lonely, as one commentator with BPD had articulated prior to you. What was argued was that sometimes individuals with BPD lose control, due to their condition, and might be less blameworthy for their actions, particularly in romantic relationships. Many individuals with BPD do find meaningful work, employment, and contribute to the world. I don’t think I argued that they don’t.
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Angie
December 2, 2015
I found this article really interesting. I was diagnosed in 2014 at age 22 (24F now) and believe my case is milder. My friendships and work life are normal, although work can be affected when I’m in times of stress like a break up. But relationships is where I go off the deep end. I would like to know more about the effects of oxytocin and other hormones on my BPD brain. I have often thought that the hormones in my body and brain mess me up when I fall in love. Reading some of the article back sounds word for word like me. I can be completely normal until I get into a relationship (or, even if I just MEET a guy) and then the abandonment fears, the dissatisfaction, the urges to cut and low moods come in. I’m fine when I’m single but I get very lonely and CRAVE love and connection, as well as sexual attention. It seems that love is the only thing I want, but love is no good for me…
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Brandie Nicely
May 12, 2016
I pray you have learned more about BPD and how each individual can be affected with unique individual variances. I believe education and environment may play a role in the “degrees” you sited. Reading your article, I felt “my people” were being referred to as a science experiment, a mere case study and we were all but inflicted with leprosy. You included no positive attributes of one inflicted with BPD. Rant over…more could be said, pointless to go on.
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Ray Aldred
August 22, 2016
Hi Brandie,
Thanks for sharing. I believe that nothing I had written is inconsistent with what you had said about individual variances. There are many roads to BPD, and I certainly didn’t want to suggest there is one universal way to experience it. When I had suggested there are degrees to BPD, I wanted to suggest there are differences.
In case it wasn’t clear, I don’t view individuals with BPD as a case study. Many of my friends have it, some of my colleagues have it, and a few of my family members have it. The question I wanted to explore is whether we should hold individuals with BPD fully responsible for their actions. A common assertion is that BPD sufferers are, in fact, morally responsible, and are then demonized for their behavior. I wanted to challenge this thought.
I agree that there are many positive attributes of those who have BPD. They are complex people, after all, and people tend to have a mixture of good and bad. In any case, I appreciate your perspective and experiences of BPD on the matter. I’m not entirely sure where we disagree though. In fact, I think I can agree with a lot of what you wrote.
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Daphne
October 10, 2016
Hi, this is an interesting and thoughtful discussion but I am troubled by your conclusions. I am the longtime partner of a man who I strongly suspect has undiagnosed BPD. I was in the relationship for several years before I heard about BPD and put two and two together. A lot of your discussion seems to be operating on the assumption that the person with BPD will know that they have behaved inappropriately went once they have calmed down after losing control. However, this is often not the case. A particularly problematic feature of my partner’s condition is his failure to take responsibility for his actions. I’m afraid that he takes the classically abusive stance of blaming his actions on me including when he shouts at me, or when he threatens me. He does this regularly, and always justifies its using some spurious reason such as my tone of voice. He seems to lack either the insight or the willingness to take responsibility. Even when he has calmed down. So my blood is boiling slightly to read that you think that he is not morally responsible?! So if one day he violently attacks me, he will not be responsible? Come off it. I read that 50% of violent domestic abusers have BPD, so what, none of them are responsible?! Don’t get me wrong, I am all in favour of supporting people with BPD where possible, and making treatment available to them . I love my partner very much despite his considerable imperfections and would love love love for him to be mentally healthier. Of course. I realise that you are considering this matter from a totally different perspective to me, i.e. that of a philosopher, where is my perspective is more relating to my lived experience. But I think at some point, I think you have to hand responsibility to these people. Otherwise how will they ever face up to their shortcomings and deal with them? By handing over responsibility, to a degree you are expressing confidence and hope that they will get better and become more than just their condition. Borderlines do tend to go through life with a massive victim complex and feeding into this is just enabling their behaviour. This is something I have learnt the hard way! I hope this contributes something to your discussion.
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Bev
October 14, 2016
I think that if the bpd symptoms manifest, impulse control goes off the radar tbh and I think it has an intelligence of its own so I don’t think they have much choice but to anchor themselves in intensive therapy and relearn and examine what triggers their symptoms. Their thought patterns like black and white thinking anger mgt self destructive behaviours and substance misuse etc all exhuberate their symptoms .. without intensive therapy what tools do they have to revisit and reflect relearn and apply more healthy behaviours.. they must be accountable because their behaviour impacts others .. without understanding this what incentive is there to change . They are accountable if they choose not to accept the help that is available to them and over the long term therapy should be effective. Having said that personally I am not accountable for my partners actions and if I am tolerating behaviour that affects my emotional welfare I need to explore why in therapy aswell. I’m not here to examine the where’s and whys of his behaviour .. that’s his job and if he chooses not to what motive do i have for staying in the relationship.
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Bev
October 14, 2016
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