Category Archives: Borderline Personality Disorder

Icarus Project Seeks New Flight Plan for the Mentally Ill

In a 1963 clipping from the New York Daily Mirror, passers-by were asked, “If a Woman Needs It, Should She Be Spanked?” Strangely, none of the four interviewed were women.

It’s this kind of selection bias the Icarus Project stands against.  The Project is a San Francisco-based collective promoting the voices of the mentally-ill..  They organize peer support,  create on-line art galleries, and rally clients to speak out on their own behalf. One thing they don’t do? They don’t accept the idea that mental illnesses are solely impairments.

The Icarus Project’s logo: falling or flying?

Normally, mental health staff face-palm over calls to, “challenge standard definitions of psychic difference as essentially diseased, disordered, broken, faulty, and existing within the bounds of DSM-IV diagnosis.” Too often, treating mental health issues as a “dangerous gift” means a client goes off their meds, lands in the hospital, and disrupts their progress towards recovery. The  Icarians’ language is counter-cultural, but there’s nothing mindless in their anti-authoritarianism.  They aren’t against meds, diagnosis or treatment – only the belief we mental health professionals know the whole story. This balance is reflected in their name; Icarus, you’ll remember, perished when he flew too close to the sun.

Sophie Crumb’s self-care flyer for The Icarus Project

Talk of “societal oppression” and “urban shamanism” may induce woozy flashbacks of 1970s identity-politics and the backlash that followed.  Should we worry their printable pamphlets on self-mutilation  don’t urge clients to stop? A close reading shows the pamphlet promotes harm reduction, including many safer substitutes Marsha Linehan would endorse. When project members critique profit-seeking drug companies’ influence on mental health treatment, they have company in the highest and most respected levels of  psychology.

The project celebrates an impressive tenth anniversary this year. Whereas decentralized collectives usually veer from dialectical moderation to the ditches of extremism, Icarus continues to walk a narrow path: meds and therapy are okay, self-care and community are crucial, and mental illness, while no blessing, is not necessarily a curse. This quote from Scatter sums up the project best:

Our society still seems to be in the early stages of the dialogue where you’re either “for” or “against” the mental health system. Like either you swallow the antidepressant ads on television as modern-day gospel and start giving your dog Prozac, or you’re convinced we’re living in Brave New World and all the psych drugs are just part of a big conspiracy to keep us from being self-reliant and realizing our true potential. I think it’s really about time we start carving some more of the middle ground with stories from outside the mainstream and creating a new language for ourselves that reflects all the complexity and brilliance that we hold inside.

In the 1960s and 1970s, the Whole Earth Catalog provided tools for those ready to challenge social and economic norms. Today, Icarus does the same for those who question psychiatric norms. It also challenges mental health professionals to make “empowering clients” and “person-centered diagnosis” more than platitudes. “Mentally disturbed,”  is synonymous with “unreliable witness”, and yet  no one else can tell us what the experience is like.   If Freud hadn’t analyzed himself, would there be a field of psychology today?

@ 2012 Jonathan Miller All Rights Reserved

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Filed under Bipolar Disorder, Borderline Personality Disorder, The Client's Side

Where Borderlines Excel

If you’ve worked with clients who have borderline personality disorder (BPD), you’ve probably had a conversation like this:

Therapist: How did that make you feel?

Client: I dunno.

Therapist: How do you think that might have made someone else feel?

Client: I dunno.

Therapist: Take a look at that list of feeling words and see if there’s anything that fits.

Client: Oh God. I can’t face that list today.

Therapist: Well… hm.

Client: You’re getting worried. You’re thinking about referring me, aren’t you?

Can people really be so oblivious to their emotions when they’re so well-attuned to yours?

Carina Frick, Simone Lang, et al answer at least half of that question in their  new study. They asked clients with BPD to receive an MRI while guessing the emotions others displayed in photographs.  The BPD clients out-guessed the control group of healthy subjects. The fMRIs showed they actually used different parts of the brain.  They were so skilled at identifying what others feel that the mentalization term ‘mind-reading’ seems eerily appropriate.

The researchers suggest this serves as empirical evidence for Alan Krohn’s 1974 paradoxical theory. Krohn noted people with these issues usually grew up with unpredictable parents and inconsistent rules; what Marsha Linehan would later dub the invalidating environment.  The clients he studied had to hide their feelings and read their guardian’s mood quickly to avoid punishment. Clients with BPD are often alert to your emotions and blind to their own, because that kept them safe through childhood.

Neurologists will be titillated by the differences in the brain activity. The fMRIs showed BPD clients’ amygdala, medial frontal gyrus, left temporal pole and the middle temporal gyrus were more active when guessing others’ emotions. The members of the control group lit up in the insula and the superior temporal gyri.  Therapists will be excited that even very low-functioning clients with these issues have a common strength to build on. Two possibilities:

  1. Clients with BPD often feel hopeless about their abilities. We can validate and encourage them by reminding them of this skill, and how useful it is in the work world.
  2. When clients talk about times where it was obvious what someone else felt, I’m going to ask just what they saw. What posture did that person take? How did their face look? What tone was in their voice? What happens in the client’s throat and mouth when they reproduce that tone?

Here’s to the hope these ‘mind-reading’ abilities can be reverse-engineered towards greater self-awareness.

n.b.: If you’d like to test yourself on ‘mind-reading’,  Simon Baron-Cohen‘s “Reading the Mind in the Eyes” test is available here.


Frick C, Lang S, Kotchoubey B, Sieswerda S, Dinu-Biringer R, et al. (2012) Hypersensitivity in Borderline Personality Disorder during Mindreading. PLoS ONE 7(8) e41650. doi:10.1371/journal.pone.0041650

@ 2012 Jonathan Miller All Rights Reserved


Filed under Borderline Personality Disorder