Shaping the Future of BPD Care: Dr. Lois Choi-Kain, Director of the Gunderson Personality Disorders Institute, Shares Her Story
“Working with people with BPD and their families has taught me the greatest lessons of what it means to be human.” Today’s woman dreamer is Dr. Lois Choi-Kain. She is currently the Director of the Gunderson Personality Disorders Institute (GPDI), an internationally recognized center for training in empirically supported treatments for borderline personality disorder (BPD), and conducting research on outcomes and the social cognitive mechanisms targeted in these interventions. She is also an Associate Professor of Psychiatry at Harvard Medical School. We are honored to share her inspiring journey on Women Who Win!
1. Tell us your story. You are currently the Director of the Gunderson Personality Disorders Institute (GPDI) at MGB. How did you decide to specialize/focus on borderline personality disorder (BPD) and the development of effective treatments?
I grew up in a very sheltered and organized world. However, I was born in South Korea and my family were immigrants as of 1975 here in America. What that meant is a double dose of conformity, both to the Korean communal way of getting along, and also as an immigrant with the demand to mainstream to succeed simply to have opportunities available here. I did succeed by these standards and went to Harvard-Radcliffe College, where I concentrated in Social Studies, which is a progressive interdisciplinary department concentrating on the integration of theory and social science. There I became fascinated with theories of the human dark side, outside the margins of conformity, the flaws and untamable parts of us. I was most drawn to psychoanalytic, postmodern and feminist ideas, questioning the status quo and prevailing norms.
In a way, I followed a similar path as a psychiatrist. While I aimed to become a psychiatrist in order to practice psychoanalysis, by the time I entered MGH-McLean as a resident, research became the prevailing force leading treatment development and innovation. I met John Gunderson early on, actually as a medical student rotating at McLean, and he saw my combined interest in intellectual controversy, psychotherapy, and greater social context as a perfect fit to inherit his legacy as the "grandfather" of borderline personality disoder (BPD). He, with other colleagues, forged this new category of diagnosis in order to put an objective and humane handle on a strain of human variation that was observed in the psychiatric ward, but poorly understood and therefore stigmatized. In four decades, he was on a relentless pursuit to legitimize the disorder and prove this is a treatable condition for which most professionals can provide good enough care. I developed and lead the Gunderson Personality Disorders Institute (GPDI) which is basically a think tank about personality, personality disorders, and interventions aimed to reduce the health burden of these conditions on individuals and society at large. This involves both a research lab as well as a training and consultation service where we teach, supervise, and consult with clinical teams around the world.
2. How has your work with BPD patients and research influenced your perspective on mental health?
Working with people with BPD and their families has taught me the greatest lessons of what it means to be human. The emotional storms, relational turbulence, and self-confusion are things we all experience on our dark sides. We need to incorporate an affirmative way of working with these experiences and find useful ways of managing them to help people be clearer and more optimistic about themselves and their place in the world. We all are on a long unique journey in life, and all we do now has been a culmination of influences as they interact with our biology, and our job in the current moment is to sort out how we can continue that journey in a way that defines and actualizes who we want to be. Some people need clinical support for that, and some use the resources in their environment to navigate the human journey. At the end of the day, life requires some mixture of both.
3. What advice would you give to families dealing with cases of personality disorders? What steps can the broader mental health community take to better support individuals with BPD?
We need to understand BPD, other PDs, and other conditions such as neurodivergent disorders represent a broad range of personalities and endowments that we can all learn to live and thrive with, but not everyone will or not all the time. Life is difficult and sometimes symptoms are signals that help us orient to what is wrong in the bigger picture. People need treatment to help them invest in living and life outside treatment to build a sense of self and connection to humanity.
4. What are your future goals for the Gunderson Personality Disorders Institute and your research in BPD?
My goal is to harness technological and social change to make treatment and management of BPD and other personality disorders more accessible, for both patients and clinical professionals, and even society at large. The more we can understand these phenomena, the better handle we will have on them both individually and communally. We need to spread the wealth of what specialists do with intensive manualized psychotherapy by translating them into common human wisdom and care in the community that diminishes alienation and loneliness for people to find a niche to survive and grow.
5. You are certainly in a busy and challenging line of work. How do you relax and unwind? How do you find your work life balance?
I gave up on the elusive "work-life balance" recently, as it seems one of those standards built to support women but also set up impossible demands that make it hard to hit the gas pedal on making an impact on the world like men have free range to do. It is not possible to have it all but it is possible to be satisfied that is what I strive for usually. Sheryl Sandberg's book Lean In: Women, Work, and the Will to Lead captured a significant message for me as a professional woman. We need to lean in and make things work at the level of the demands males sustain to represent and change the narrative on what roles women can occupy. This takes a lot of hard work, emotional strain, and high levels of unremitting demands. Nonetheless, understanding personality, I learned that becoming very psychologically skilled, self-aware, and seeking the right support is crucial. The best thing I have as a support is my life with my two daughters who bring so much joy and pleasure to my life. I try to spend as much time with them- they are 11 and 15. I want to be around as they blossom, especially during the dark times, to process those feelings and make more clear sense of themselves as they navigate a difficult time in life. I would hate to go to high school again. My professional work has taught me in so many important ways what teens need to become steady adults. I also love to exercise and get fresh air, so I go to the gym as much as I can. I used to be a fitness instructor when I was in my college and grad school phase, and nothing helps me be in a different mental space than a good exercise class. When I am lucky I play golf. Hitting a small ball with a long stick to a little cup far away is oddly relaxing, but occasionally frustrating in a way that gets you hooked. The best part of golf is playing women's events and meeting and bonding with other women both professional and not, living other walks of life.