Reader’s Question

I have been reading Dr. George Simon’s blog article that he wrote in October, 2008 on Understanding “Splitting” as a Psychological Term. I have been a registered nurse working in acute psychiatric services in New Zealand and have also been a patient who was diagnosed with Borderline Personality traits while receiving treatment for severe postnatal depression. I am constantly surprised as to the misuse of the term ‘splitting’ and then what that label means to the subsequent treatment the patient receives as a result.

I simply can’t understand why a nurse can moan or gossip about colleagues or a doctor make a comment about a staff member, and this is not regarded as “splitting staff.” Yet when a patient does the same thing once in the context of the therapeutic relationship, it’s labeled splitting. When a staff member does it, we all think they are simply offloading or ranting, and it’s a momentary issue that gets no negative attention. But a patient typically doesn’t get the same courtesy. Instead, their behavior gets labeled and they come away from the situation angry, stigmatized, and feeling blamed as well as being treated like a child.

If a doctor or other staff member were to address the issues raised head-on, within the same framework as clinical supervision, looking at validating and seeing what is triggering those feelings in the patient and how they can manage those feelings etc., and then write in the notes about the incident the feelings triggered instead of simply presuming that “the patient is splitting staff,” then I’m sure people would come away feeling a lot more empowered, rather than unfairly judged.

Anyway, I really just wanted to know whether you think that changing the label and meaning of splitting has played a large part in the stigmatizing of people with Borderline Personality Disorder, especially when this “splitting” behavior may be considered “normal” in other contexts.

Our Clinical Psychologist’s Reply

The misuse of psychological terms causes problems not only with unfairly stigmatizing others, but also with communicating effectively and accurately. Those problems in communication can occur between professionals as well as between professionals and staff. And not being careful about the the labels we apply can compound these problems. So, when a person who has some legitimate gripes or concerns openly shares them, yet caries the label “Borderline Personality,” those concerns might tend to be discounted and categorized as instances of something else, including splitting (which, by the way is an unconscious mechanism employed by borderline personalities more often than other personality types).

It appears that you have really raised the red flag for two separate but equally important issues. One is the issue of being careful to use scientific terms as they were originally defined and intended to be used so that our professional communications can be clear, effective, and ultimately of a constructive nature in our efforts to help people. The second is of being on guard not to write off legitimate and potentially highly informative statements by patients as merely manifestations of their pathology. Hopefully, this post will help with both aims. And thank you.