Borderline personality disorder,neuroscience and responsibility

To the Editor

Biological advances, including a larger than expected heritability (Gunderson et al., 2011), raise questions as to whether the person with borderline personality disorder can reasonably be held responsible for, or realistically change, their behaviour. The theoretical debate over whether we are ‘merely victims of neuronal circumstances’ took centre stage with an elegant series of experiments.

Those studies suggested that electrical activity in the brain occurred before the person became aware of their intention to act, to move their fingers, and the question arose as to whether we do have free will. Considerable debate followed (Vincent, 2013). Various writers note the complex, intersecting and overlapping domains of the brain, the body and the environment. That is, the brain, although necessary, was not sufficient to account for all the physiological and psychological properties that make each of us a unique person. They note in particular the difficulty for a neurone-alone system to adequately explain the feeling of being ashamed, of being able to forgive or to receive and accept praise. Nor does an electrical model allow for thoughtless, automatic and habitual actions or, because a person has an urge, or image or idea, they will necessarily act rather than resist the impulse.

Investigative techniques will undoubtedly improve and continue to define a biological difference in people with borderline personality disorder. However it is unclear whether this will be sufficient to convince, for example, a court that such findings are responsible for their behaviour. There will be a need to demonstrate in what way any specific difference may have affected the mental capacities to inform intent. Further, in order to excuse responsibility, it must be argued that each person with those findings will behave similarly on each occasion without a capacity to do otherwise.

Rather than resisting, biological advances should be welcomed. If neuroscience confirms clinical experience, we are on safer ground, the corollary being that discrepancies should stimulate further enquiry. Secondly, it has been suggested that all forms of therapy are successful to the degree that they have found a way to tap into processes that build and modify neuronal structures within the brain. Thirdly, the likely scenario is that the person with borderline personality disorder can have both neurocognitive differences and be responsible and able to change (Little and Little, 2010).