Dr. John Gunderson was training in psychiatry at Harvard Medical School in the late-1960s when he encountered a “group of patients that didn’t have a diagnosis, but which drove everybody crazy,” he recalled in an interview that is posted on YouTube.
“For the most part, they were given psychotherapies from which they got worse,” he added in the interview with Sigmund Karterud. It was a time when the term “atypical schizophrenia” was “on the margins, Dr. Gunderson said.
A few years later, while at the National Institute of Mental Health, “I had this opportunity, being a schizophrenia fellow, to try to identify who the people with atypical schizophrenia were,” he said. “And that involved a literature review, called ‘Defining Borderline Patients,’ published in 1975.”
Beginning with that work, Dr. Gunderson’s studies of people with suicidal urges, fears of abandonment, and squalls of emotion helped establish borderline personality disorder as a stand-alone diagnosis, which provided a foundation for research and the first effective treatments. He was 76 when he died Jan. 11 in his Weston home of prostate cancer.
Trained in Freudian analysis, he was evaluating the effects of psychotherapy on people identified as schizophrenic in the early 1970s when he discovered that many participants in his study had received the wrong diagnosis. They did not have recurring psychoses, the signature symptom of schizophrenia, but rather a poorly understood syndrome described by the German-American psychoanalyst Adolph Stern in 1938: Their mental state was on the “border” between garden-variety neurosis and full-blown psychosis.
Studying the literature on borderline patients, Dr. Gunderson distilled defining features such as intense fears of being alone, floods of emotional turmoil, and impulsive self-harming, like cutting. While working at McLean Hospital in Belmont, He collaborated with Margaret T. Singer on the influential 1975 paper, “Defining Borderline Patients: An Overview,” which turned a collection of descriptive accounts into a firm diagnosis. He also developed a diagnostic interview that set the standard for identifying the disorder, bringing focus to what had been a baffling condition.
“The way these patients were described before was as treatment failures, as if it was somehow their fault,” Dr. Lois Choi-Kain, director of the Adult Borderline Center and Training Institute at McLean, told The New York Times. “John came along and said no, these are symptoms of the disorder, not failures.”
The 1975 paper and others provided a foundation for research into borderline disorder that had not previously existed, clearing the way for its inclusion as a full stand-alone diagnosis in the landmark third edition of the Diagnostic and Statistical Manual, psychiatry’s encyclopedia of mental disorders, published in 1980.
Dr. Gunderson was recruited in 1973 to work at McLean and spent much of his career at the Belmont hospital. In 1996, he published another analysis, “The Borderline Patient’s Intolerance of Aloneness: Insecure Attachments and Therapist Availability,” which provided doctors and patients with an X-ray of the condition’s internal emotional terrain.
“Being alone is often intolerable to them because it is associated with a profound sense of being bad or evil,” he wrote, “a self-image distortion accompanied by such intense feelings of guilt or shame that the question of worthiness to live often follows.”
Over the years, Dr. Gunderson was adamant that psychiatric drugs did not help resolve borderline symptoms. He favored talk therapies, including what is known as dialectical behavior therapy, an approach developed by the University of Washington psychologist Marsha Linehan.
He also published, with Dr. Paul Links, a handbook describing what he called good psychiatric management, intended for nonspecialists, patients, and families dealing with the storms of rage and self-loathing of borderline personality. This guide became widely used by doctors.
Dr. Gunderson’s long commitment to people with borderline personality disorder had a hopeful payoff. He collaborated on a long-term study, led by Mary C. Zanarini, a Harvard Medical School psychology professor who is director of McLean’s Laboratory for the Study of Adult Development. Their research found that most people given a diagnosis of borderline personality eventually recover: some 15 percent in the first year, a third by two years, fully 85 percent after a decade.
“He was the first person to look systematically at the data and figure out what the heck this diagnosis really meant,” Dr. Glen Gabbard, a professor of psychiatry at Baylor College of Medicine in Texas, told the Times. “Before John, there were observations, case studies, confusion; after John, we had clarity.”
In a long essay reflecting on his career, Dr. Gunderson returned repeatedly to the intensely personal, often uncertain craft that drew him to psychiatry in the first place.
“My life in psychiatry has provided me with access to people’s deepest feelings, their most private secrets, and to the responsibilities of being entrusted by such access,” he concluded. “At these times you are like a priest, parent, or best friend as much as a doctor.”
John Gunder Gunderson was born in Two Rivers, Wis., the youngest of three children. His father, Sherman, was a professor of economics, and his mother, Alma Walter, was a high school English teacher. He grew up in Oshkosh and graduated from high school in 1960.
Determined to become a doctor, he entered Johns Hopkins University in Baltimore, where he found that everyone else seemed to be pre-med, too, and appeared better prepared. He stuck it out, earning his way into a two-year Dartmouth Medical School program that fed Harvard’s medical school, where he finished his degree in 1967.
In 1963, while at Dartmouth, he met Susan Riley, a Skidmore College student, on a blind date. They married in 1965. In addition to his wife, Dr. Gunderson leaves two children, Craig and Kelly, and five grandchildren.
After completing an internship in Minneapolis, Dr. Gunderson did his residency at the Massachusetts Mental Health Center in Boston and received training as an analyst at the Boston Psychoanalytic Institute. He joined Harvard Medical School in 1973 and retired last year as professor emeritus, seeing patients throughout his tenure there.
In the interview with Karterud, Dr. Gunderson said treating borderline patients “required that I listen to things which I would not have heard or would not have wanted to hear. And like the Grinch, my heart grew a bit larger because of this.”
His interest in and understanding of such challenging patients “changed as a result of my work,” he said, adding: “I can’t say for sure, but I think that it’s made me a more benevolent person.”
Material from The New York Times was used in this report.