The other day I was studying for the test I had today (in which, apparently, I did good) and I found a rather interesting little thing in one of my books. I was at my ophthalmologist’s reading First Aid for the USMLE Step 1, which is pretty much the Bible for said test (see Dictionary). Out of curiosity I skipped past the Musculoskeletal section and looked for the Psychiatry section.

I looked up Major Depressive Disorder and Borderline Personality Disorder, and they were both aptly defined in short sentences. Then, after flipping a few pages I came across the definition for “splitting”. It says: “Belief that people are either all good or all bad at different times due to intolerance of ambiguity. Seen in borderline personality disorder.”

I was surprised at how accurate this definition is, especially the part about being intolerant of ambiguity, because that’s really what splitting is all about. Usually definitions only talk about “seeing in black or white” or “all or none”, but they never talk about why splitting happens. It’s the ambiguity what makes us borderlines so uncomfortable. I, for one, cannot tolerate not knowing whether a person is “good” or “bad”. A person is never just “OK”, they’re either “good” OR “bad”, and I must know under which category they fall, otherwise I’ll be very uncomfortable.

Now, what comes next is where dear First Aid truly lost me. They write an example for splitting: “A patient says that all the nurses are cold and insensitive but that the doctors are warm and friendly”….


OK, I don’t know about other borderlines, but at least the way I experience splitting is within a same person, not a group of people. In other words, one second I’ll believe you’re the all encompassing crap of the world and put you on a pedestal, while the next I might think you’re just not that big a deal.

A good example of splitting actually happened to me today. I was at the mall and I ran into a girl from my med school who I consider “bad” and can’t tolerate. Out of courtesy I said hello and struck up a conversation with her. She corresponded, and was polite. Instantly I could feel the splitting happening in my brain. I started seeing her all “good”, simply because she was polite. I could hear the questions in my brain: Is she good or bad? Can I trust this person? She might, in fact, be the worst person ever, but just because she was polite I’ll be thinking that maybe she’s “good”.

Still, a more appropriate description of splitting, is what happens with how I view M. I always have her on a pedestal, that’s my baseline. However, depending on my mood and whether or not she lives up to my infinite expectations, one day I might feel like she failed me and that maybe she’s not all I thought she was. So, I’m constantly on guard waiting for that moment when she might let me down and turn from “good” to “bad”. That’s what happened with the psychologist I stopped seeing last year (see this post).

All of this honestly causes a great deal of distress. It’s not just about seeing people in black or white, it’s also about how seeing people in black or white affects me. And the closer the relationship with a person is, the more intense is the splitting. The way I split with M is not the same as the way I split with your average Joe. Splitting with M affects me more, it distresses me more, because the closer I am to a person, the less I can tolerate the possibility of ambiguity….the less I can tolerate the possibility of that person abandoning me.

So, roughly, that’s what splitting is, to all those unsuspecting medical students reading First Aid for the USMLE Step 1.

Are you good or bad? Am I good or bad? 


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