I Hate You – Don’t Leave Me: Understanding the Borderline Personality by Jerold J. Kreisman and Hal Strauss is the new third edition of a book that was first published in 1989. It’s probably one of the more widely recognized books about borderline personality disorder (BPD).
There was a note to readers at the beginning about the language the authors use. The authors had chosen to continue using “the borderline” to refer to an individual with BPD. They acknowledged that it could be viewed as reducing a person to a stigmatizing label, but they couldn’t come up with anything better that was brief but didn’t suggest that the borderline personality was something that possessed the individual.
It wouldn’t have been my choice, but their explanation sounded like they’d put some thought into it. However, there may have been less thought than I was prepared to give the authors credit for, as the first chapter talked about a woman being “afflicted with” BPD, which pokes a big hole in the explanation. There were also repeated references to “the borderline syndrome,” which, if Google is any indication, is a term that was used in the 1970s and ’80s.
Some concepts were framed in ways that seemed unlikely to be helpful. The authors introduced the “borderline empathy paradox” by stating that people with BPD sometimes lack true empathy. They went on to explain that the empathy paradox involves heightened sensitivity to emotional cues from others, but decreased capacity to process that information and figure out what to do with it. Framing that as a lack of true empathy of the authors’ explanations miss the mark. In trying to explain the “borderline empathy paradox,” the authors stated that people with BPD sometimes lack true empathy. That’s really not a good way of putting it. The empathy paradox is basically that BPD involves heightened intake of the emotional stuff other people are putting out, but decreased capacity to process that information to know what to do with it. Framing that as a lack of true empathy seems unhelpful and likely to alienate readers with BPD, even though the concept itself is very relevant information.
The choice of descriptors often left a lot to be desired. For example, the authors used the term manipulativeness, which is unfortunate, as that type of framing of maladaptive attempts to get needs met is a key element of the stigma around BPD. The real-world examples of people with BPD that were presented tended to involve more subjective evaluation than necessary, including overuse of “attractive.”
The book offered the SET-UP system for effectively communicating with someone with BPD, and this was incorporated in example scenarios used throughout the book. SET-UP involves:
- Support (“I” statements of concern)
- Empathy (“You” statements that validate)
- Truth (the reality of the situation, emphasizing accountability for oneself, and starting to look for solutions)
- Understanding borderline symptoms and how they affect behaviour
- Perseverance (staying consistent in providing support)
SET-UP was also included in the tips for family members on how to communicate more effectively with the individual with BPD. The authors urged family members to always take suicidal threats seriously and seek professional intervention, which I thought was a very helpful recommendation.
While the first half of the book focused on the nature of the BPD, the later part of the book addressed treatment, including therapy and medication. This seems to be where much of the updating for this third edition, and the chapter on psychotherapeutic approaches covers the various specialized psychotherapeutic approaches that have been developed for BPD, including DBT (dialectical behaviour therapy), STEPPS (Systems Training for Emotional Predictability and Problem Solving), transference-focused psychotherapy, and mentalization-based therapy. It sounds like this part was brand new to this edition.
I thought these chapters on treatment were well done, and they represented a more modern, balanced view of BPD compared to the way it was represented in earlier chapters. I particularly liked the authors’ emphasis on the importance of helping people with BPD to learn to accept both themselves and their uncomfortable emotions, and the explanation of how this can start to short-circuit the feeling bad about feeling bad loop.
The book contains a somewhat odd mix of both cringeworthy and insightful. As an example of the latter, “Borderline personality disorder is a complex tapestry, richly embroidered with innumerable intersecting threads.” The sense of reading two different books in one made me wonder if the insightful bits are new in the third edition, while the cringier bits towards the beginning, are a holder from the earlier editions. Without having a copy of the 1st edition, there’s no way for me to know for sure. However, there did seem to be a pretty clear divide.
Looking at the 1- and 2-star reviews of the earlier editions on Goodreads, some of the criticisms still hold true with the new edition, but I get the sense that this edition has made substantial improvements. In a number of these negative reviews, the reviewers had given up reading partway through; with this edition, at least, I found the second half of the book substantially better than the first half, and the bits that people are most likely to find offensive are stacked heavily into the first two chapters. If you have BPD and read this book, I would suggest skipping those two chapters altogether, as they probably don’t have enough that will be of value to you to be worth the annoyance they will likely cause.
If, as I suspect, the earlier chapters were mostly left alone in the updating process, I think the book would have been better overall if the authors had brought some of the insights that could be found in the later chapters into the earlier part as well. If the first half of the book contains dodgy bits, there’s the risk of turning readers off, and perhaps losing them altogether. I think it also speaks to a need for further editing work that I came away from this book feeling like I’d read two different books combined into one: one part from 1989, and the other from 2021.
There are definitely strengths to this book, but the weaknesses detract from the overall usefulness, so on the whole, I can’t say that I recommend it.
I Hate You – Don’t Leave Me is available on Amazon.
I received a reviewer copy from the publisher through Netgalley.
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