The first thing to notice about boundaries is that they are not things, but processes. They are dynamic processes that change not only from season to season of our lives but from situation to situation in our lives. Both intra-psychic and inter-personal definitions and discriminations are implicated in boundary processes. Boundary processes depend on social cues and skills, social definitions of roles, on intra-psychic self and object representations and their differentiation. This list is just a beginning. Like borders, boundaries shape what passes back and forth across them, what kind of exchanges can be carried on and what materials, raw and otherwise. can be provided.

"Doc," said Walt, a burly manic depressive guy in his mid-twenties, "your medicine makes me sick. I’m fine until I see that pill heading for my mouth. I’m just fine. There isn’t anything wrong with me. Then I see your pill and it makes me feel sick. I’m telling you it’s hard to swallow. I’m doing my best, but I don’t know how long I’m going to be able to keep it up. I can’t help thinking I’d be a lot better off without the damn pills."

Why do we find it so hard to take medicine as prescribed even when we have sought out medical help and understand at least the surface rationale for the medicine? Why do we feel so often like the manic depressive patient quoted even if we don’t put it quite so baldly?

I.
One possibly quite useful way to think about shame is as an effort to ward off
imagined loneliness that can produce real loneliness, even lethal isolation. “I can not be or seem this way or I will lose everyone and everything. I will find myself floating on an ice floe. I will send this part of myself, this experience, this feeling into exile lest I be myself exiled.”

In a sense this is not so different than chopping off a leg in order to be free of the trap. Perhaps there is a short run freedom, even a life-saving freedom, but the leg is lost and that has terrible, crippling consequences. Shame is an ordinary and yet dire predicament for the self. It is hard to emphasize enough just how dire the predicament is.

Shame is an inner ostracism that not only sets the shamed one apart from others, but also alienates him from a part of himself. The drama of shame is such that any incursion near the forbidden territory renews the original insult, producing once more a situation in which neither flight nor fight is a viable alternative. The pain of shame can be intense and repeated endlessly without any clear outward indication of what is transpiring.

Shame is an anti-communicative stereotypy, the same pain over and over again without any real gain. It can set up particular experiences of hurt and rejection in the mind as institutions, engendering tenacious expectations of future hurt and rejection. Shame can spread, too, down associative pathways, until there is no psychic domain that is not under its sway. Shame can become a way of living.

I confess defeat at the very outset. I can not tell you what listening is, because listening is not a what, because listening is never the same from instant to instant, from person to person, from pair to pair, from stage of life to stage of life, because, in short, I do not know.

Yet, listening is what I do for a living, what I devote so much of my living to, as do so many of you. Listening is that particular set of mysteries in whose thrall, body and soul, we, psychotherapists, find ourselves. My purpose is to share with you both my fascination and my frustrations with the process of listening, the promise of listening, as well as the perils of listening, which are considerable.

Grief is an essential active internal process of emotional recycling that helps make us available for new living and new ways of living after loss, which is sure to come because it is part of the natural order of things. “Man is born to troubles as the sparks fly up from the fire,” says Job’s wise friend Eliphaz.

Grief is central to how we modify ourselves to meet changed circumstances, often ones that fly in the face of our wishes and that we never imagined. As a man who had lost his wife suddenly in a freak accident put it to me about a year later, “Doc, this sure ain’t the way that I drew it up.” Loss is the dark and difficult side of attachment, which is such a fundamental in human life. We attach because we are built to attach. We attach because evolution has shaped our genius for attachment out of the primary materials of the mother-child mammalian bond.

Striking footage exists of a group of elephants coming on their annual traverse of their territory back to where a female had died the previous year. One of the deceased elephant’s daughters, herself already fully grown, breaks away just a bit from the group and then lingers near the spot where her mother expired. With her trunk she nuzzles at a skull bare of flesh and bleached white, gently turning it over. So she makes contact with the remains of her mother, passes a few moments there with what is left of her mother - inside and out - and then submits to the necessity that life must go on and rejoins her group. Attachment gives birth to loss, whether you are an elephant or a human.

To great personal benefit and at great personal cost, I have worked intensively in both inpatient and outpatient settings and in schools with borderline persons over the past thirty years.. What drove me to do this? What have I gained from it? What did it cost me? I hope you will forgive my framing this essay about borderline patients in such personal terms. I even hope that you will find it useful. I am sure many of you have had encounters, longer and shorter, with borderline patients that have left you wondering not only about the patients but about yourselves.

A resident working with a borderline patient told me in supervision that she, herself, was holding her jaw so fiercely clenched that it hurt. “I’m so angry,” she said, “and this anger just isn’t me. “

I listened and thought, “No, it’s not,” and “Yes, I’m afraid it is.”

This was one of Sheppard’s outstanding residents, a leader in her class, a leader in the environmental movement, who went on to do good work under difficult circumstances for the Indian Health Services in the Southwest. Certainly, that clenched jaw anger was not part of her normal experience of herself. It was not part of her preferred experience of herself. But she had experienced difficult abandonment early in her life, existential hurts from which there was no appeal and to which response in modulated symbolic terms does not come easily. Actually, when we are little, such modulation and response are beyond us. This is why the care of very young children is so important. In caring for them we help them develop the tools for living that will be such important determinants of how they do later on.

“I don’t know when shame came to live in my house,” observed a woman in her early fifties, “but once it did, it moved from room to room until it had taken over the whole house.”

Although she did not say this in so many words, the implication was that once shame “had taken over her whole house,” there was no place for her to live. If we live in our minds, as surely we do, although not only there, then she was psychicly a homeless person, rendered so by her shame. Notice, too, that her shame is dynamic. It moves from room to room. It takes over. It grows and thrives at her expense. It is a very dangerous parasitic life form. Remember, too, that houses often stand for selves. These are often every bit as ramshackle as old homes, every bit as difficult to maintain.

Where might shame come from? How does it enter our homes, ourselves?

One place to start is with the name, itself, “shame.” The Oxford English Dictionary traces one speculative origin of the word “shame” back through a pre-Teutonic “skem” which in turn connects to “hame”, “A covering, esp. a natural covering, integument; skin, membrane, slough (of a serpent). It also quotes Darwin, in Emotions XII 321, “Under a keen sense of shame, there is a strong desire for concealment.” I am not learned enough to know if there is a word for shame in every language, but I can venture that most have such a word and if some do not, then the underlying cultures would be very interesting for the study of shame just because of their lack. So, at the very outset, we connect shame and the surface of skin, even sloughed snake skin, and concealment, all this without any reference to Eden.

The capacity to develop the sense of shame must be inborn, with the requisite physiological and neuro-physiological apparatus available to support this. Of course, some are constitutionally more prone to shame than others. Shame is often thought of as an affect that becomes prominent in the second year of life and plays an important part in the culturally appropriate molding of a young child’s behavior and internal sense of himself. But shaming and the response to shaming have their roots, too, in interactions of the first year of life. The threat that comes with shaming is a loss of love, a loss of connection, something that can be as drastic as ostracism. This threat can be internalized, too, making shame an important cultural tool in shaping personality. Seneca understood this when he said, “Shame may restrain what law does not prohibit.”

For those in the primate line, the loss of love, the loss of connection can be fatal. So the threat of shaming can be nothing less than a death threat. This can be conveyed absolutely quietly and habitually in the intimate flow of human relationships,
quite without any explicit labeling. without words. It can be conveyed without anyone noticing or knowing that they have noticed. Young children are fabulously plastic and fabulously vulnerable because achieving some sort of at least quasi-satisfactory fit with their primary caretakers is the central existential imperative of their budding lives. Their lives depend on catching hold of the essential and holding on once they have caught hold. This holds both physically and emotionally.

Blushing – shame’s characteristic mark on the skin surface, fainting, particular postures and muscular tones that convey both wishing to get out of the body to find a way to be anywhere else but here and hopelessness about succeeding, all are marks of shame. The experience of shame features a heightened parasympathetic tone. Hence the
vasodilatation of blushing, the tendency to reduced blood supply to the brain and so to fainting of the vaso-vagal type. Shame, if it is extreme enough, can kill immediately and suddenly as well as in the long term, as we see in our suicidal patients. It is fascinating to observe that depression produces shame, but also that severe shame, especially shame based character, may be an independent risk factor for suicide. Of course, shame can produce depression, too. Certainly, alcohol and drugs are used not just to mitigate depression, but also to try to tone shame down. We should remember, too, that shamelessness can be a mask that shame wears. Just as some are too mad to be mad, others may be too shamed to be shamed.

The central neurophysiology of shame is clearly a topic of great importance, about which we are just beginning to get glimpses. But clearly the brain activity involved in varieties of shame goes well beyond, “This brain area lights up and this brain area lights up and so does this one on functional magnetic resonance scans of persons reading shame evoking narratives.” Shame has vital connections with personal history and narrative, personal identity and social and cultural identity, Nor is it clear that shame experiences will be identically orchestrated in different persons, in men as in women, in Inuit as in Italians. There may be central final common pathways for shame in the brain, but they may be complex and not quite so utterly common as neuroscience investigators sometimes posit.

It makes no sense to talk about shame without talking about pride, because they are inextricably linked, two sides of the affective regulation of self-regard. Shame becomes prominent just in the phase of life where elation, too, comes to the fore. The toddler can go so high and go also so low, as most parents will have observed. In “The Antithetical Sense of Primal Words,” Freud made the point that Egyptian hieroglyphics paired opposites, being unable to express one without reference to the other, so that “strong” would be “strong-weak” and “weak” would be “weak-strong”. Priority, here, is determined simply by order, which of the paired opposite comes first. Humility, a very advanced personality disposition based on a realistic appreciation of our place in the universe, is the best defense against humiliation. We might as well say “Pride goeth before a shame” as the common, “Pride goeth before a fall.”

“What do you regard as most humane?” asks Nietzsche, who responds, “To spare someone shame.” “What makes the pain we feel from shame and jealousy so cutting is that vanity can give us no assistance in bearing them,” remarks the devastating La Rochefoucauld, who had, in the seventeenth century, a preternaturally well formed appreciation of the vicissitudes of narcissism. Shame operates within the defensive perimeter of vanity. It wounds under the armor. The surfaces on which it works are as near to us as our very skin

The major work of psychotherapy is in the “being with,” a task that inevitably calls upon our resources in being with ourselves, a process that is always in development, that is, always involved with struggle, impasses, reevaluation, creative surges, disillusionment and reillusionment. To be useful to our patients in large part depends on our capacity because of her capacity to stay with our own difficult and distressing affective experience, in therapy and outside of therapy. It is the “being with” that brings affects from what we might refer to as a vapor state to condense until they achieve representability, even crystallization. Where we speak so much about affect containment, we might do well, as Erna Furman has pointed out, to speak of affect attainment. Of course, attainment and containment are two aspects of a single process.

Our involvement with others is a mystery, not in the sense that we should remain quiet about it, following some dictum like Wittgenstein’s “Of that whereof we can not speak, thereof we should remain silent,” but in the sense that, whatever we may say about it, there is always more, something about what we have said that falls short, is wrong, does not fit, raises more questions than it answers, deeply unbalances us just when we thought settling the matter (and ourselves) might actually be in our grasp or at least almost in our grasp. Of this mystery of our involvement with others envy is a large and central part, a province teeming with life and hope and despair. Envy means lack, want, desire, insufficiency, incompleteness. Envy is a means, not just an end. Envy is a process for making meanings in an interpersonal and inner personal field.

I am sitting in my office on a bright winter’s morning, listening and musing. A redhaired young woman in her middle thirties sits opposite me. Her hair is a beautiful chestnut color, maroon. I have been seeing her for many years, since she was a very suicidal young woman and now I find myself wondering whether that hair color is natural, which I know it once was, or whether it has been maintained or revised by artificial coloring. I am wondering whether the gray hairs are being kept in exile, held at bay, refused, refuted by chemical means. Of course, my own hair, what there is left of it, is not so much gray as salt and pepper. I have never dyed it, this particular set of initiatives not fitting in with my own style of submission and denial by insisting on not disturbing the natural weathering process. But I do mourn for myself as I once was, dream impossible dreams of being restored to that youthful vitality I did not know how to appreciate at the time, so busy was I with my own sorrows and grudges and ambitions.

I watch her shoulders, the way she holds herself, how her breathing lifts her chest and then lets it lapse, the way she looks at me, checks on me habitually and unobtrusively. I am wondering how it feels to inhabit her body, how it changes the shading of all perceptions, all intentions, all inventions and I am wondering, as I do habitually, what she is wondering about, what the flavor of her wondering and wandering is. She is telling me, in great detail, as she always does, a story of her everyday life, a simple interaction that is anything but simple, charged with color, texture, doubt, confusion, anxiety, hope, a tangle at once impossible and enjoyable. She is entertaining me, holding on to my attention, keeping me right here, now, also keeping herself both busy and beset in the process.

I am enjoying being entertained, finding myself glad to be with her, yet all the while aware that I have no way to convey this to her except just to go on being entertained and enjoying it. I can not step out of the frame, abstract, interpret. But it always is with me that her mother was, as she once put it, “over it” by the time that she was born, that the psychiatrist she first worked with killed herself in the midst of that treatment, that she has, although she is mostly very discrete, even polite about it, doubts about whether it is worth being involved with other people that are not only grave and deep, but also subtle, shy, elusive. I know she is lonely and that not being lonely is perhaps even more frightening to her than being lonely, because she can imagine it no other way than as merger.

But where and how, you will ask, does envy come into all this? If I were to answer something like, “Everywhere, in myriad ways,” this would be, while possibly truthful, too vague to be either helpful or instructive. So let me try to be a bit more specific, starting with my own envy. To work with envy, we must know ourselves as both envious and enviable, capable of envying as well as of being envied. My envy is present to me, first of all, as an awareness of her youth, her beauty, her vitality, even as an awareness of her lack of awareness of these things, how they are natural parts of her existence, to be taken for granted. I am only too aware of my own different state with its implications of inevitable decline. Perhaps I have lived well, but living well has taken its toll. How many regrets I have and how much I would like to have done differently and to have others have done differently as well. Regret is in my every breath, along with much else.

What of the sensual, the sexual dimensions or tensions? I wonder what it is like in her body for her. I wonder very specifically about her physicality. I watch her and enjoy watching her, even as I suspect she relishes being watched, I imagine something like being her, but am aware of how separate we are, how my imagination must necessarily fall short. There are sparks of desire, perhaps born of a wish to join, a wish to merge, stimulated not just from her side but from my own, too, a mutual longing for consolation, separate desolations, half acknowledged, starting down the pathway of revolt. I wish, at some level, I could be her, so as not to be me, knowing as I do how very inconvenient being me is. Does she long for the same thing, a way to be me as an escape route from being her? I know she has chosen boy friends like this, men she found enviably thin, a bit androgynous, but free from the weight of womanhood, artistic as she insisted for so many years she was not and could never be.

But my envy neither begins nor ends here. Like many of you, I hope, I have been the fortunate recipient of imperfect, irritating, nurturing, even lifesaving and inspiring psychotherapeutic attention. I have been listened to, listened with, spoken to in ways I only dimly imagined as a child struggling with my own limitations and confusions, with my parents and their histories and history, itself, a monstrous hobnailed boot on all our tongues, with a wider world more bent on ignorance than anything much else. I envy my patient, above all else, her subtle, persistent, insistent utterly legitimate and yet also sad and tragic claim on my attention. I know what it costs me when I am tired, when I am worried, when I am grieved, on the days when I have even so silly and banal a reminder of my mortality as a common cold. I envy her the care I give her, which emanates at least in part from the care I have gotten which I needed, which is, inevitably, no more what it once. I envy the good I give (which I always fear may not be good enough) because my greed shows me to myself always poorer than I actually may be. So a bit more self admiration might free me from the toils of this envy, or at least loosen their shackles, but I fear becoming fatuously vain, which I would like to be, if only because I imagine it to be simpler.

From her side, it seems to me that she sees me as more assured than I am, that she both loathes and loves me for this peculiar way of seeing that she has, so that I feel at once compelled to disillusion her and barred from doing so, except gently, at least when my patience holds. Over the years, she has proposed over and over again that some other, usually a figment of her imagination, was more favored than she in my eyes, putting me in a devilishly difficult position. If I disagreed with her she doubted my word., accused me of a familiar sort of insincerity, namely, saying what I imagined she wanted to hear. If I simply let the argument pass and watched what she did with it, she took this as a tacit confession of disfavor on my part and responded with a degree of hurt that was life-threatening. In a sense, she wanted to give me life and death power over her, then envied me desperately for my imagined possession of such power and my calm about possessing it. Only very recently has she made a start on talking on how neglect may be a blessing because it allows a clear field for realistic observation.

She is at work this particular morning on telling me a facet of a very complicated story about a woman friend of hers who was enormously, even unforgivably helpful to her last summer while I was on vacation. She had not imagined that this woman could envy her her warmth, her creativity, her effort to articulate a life of her own. She envies the other woman because she has the two things my patient herself most wants, an apparently successful relationship and an apparently successful career. She does not doubt appearance until I ask her whether it is possible that her friend somehow helps her to be so envious because the friend herself may doubt the reliability of relationship or career. It is not lost on me (nor, I am sure, on her) that I have both a relationship and a career, myself. My patient is able to talk about distrusting her friend for trying to get her to feel things the friend can not bear. She talks about the friend’s excessive curiosity about her and her romantic life, as if she wished to participate vicariously in it, or, even beyond that, to steal it. My patient tells me she has been able to thank her friend for being so helpful last summer, even as she debates within herself whether the price is not too high to justify continuing the relationship.

The patient’s relationship with her mother, a woman who was too interested and not interested enough, hard to hold on to and never willing to let her out of her grasp, stymied internally and demanding that her daughter re-supply her with her own warmth and creativity, is scattered throughout this morning’s session. It might even be fair to say it is scattered through this session of mourning, with me taking the role of the mother in a variety of ways, feeling envious of the care I was giving her, feeling over the hill with a sense of my own diminishing vitality, feeling a diffuse discomfort with the patient’s claim on me. Hopefully, awareness of this as well as awareness of my own genuine pleasure and interest in the patient make important differences.

Elsewhere, using material from this same treatment, I have discussed issues involved in learning to come to grips with the complex other, what I called there resolving the Other complex, so that instead of the shadow of the object falling on the ego, the ego can grow in the light of the object. Envy always involves a comparison that finds the self wanting. It can be very helpful if it guides us by telling us what we want, what we lack, without rendering us so desperate that we need to try to steal from others. A certain degree of stability in self and other representations is essential to the fruitful experiencing of envy. Conversely, a certain capacity to buffer the bitterness of envy is required to produce this stability. Working with envy requires our being able to listen and speak, to receive and transmit both from near enough and far enough so that the patient and the therapist are together and apart in the metabolism of envy, without falling into endless shamed and shaming silences that make secrets out of what both feel. What makes the fundamental difference is not so much what we say but how we are with ourselves and with our patients. This, of course, is our fundamental interpretation of life, something so variegated and integrated that our embodiment of it is the only name worthy of it.