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Borderline Personality Disorder and Buddhism (IV)

Borderline Personality Disorder and Buddhism (IV) September 27, 2008

– Meditating on the aggregates of the disorder.

It is a gorgeous day in Missoula today – blue skies, 70 degrees, and the forecast is for four more days of the same. Sorry, but on such days I find it hard to ‘hole-up’ and devote myself to sustained thought on much of anything. I’m too much of a sun-lover and combining sunshine and laptops, while nice in theory, isn’t too great in practice.

So – a smathering of thoughts/links for the day.

In Buddhism there is no such notion of “original sin.” Instead there is “original ignorance” (Pali: moha). Ignorance is the deepest root of our suffering. From it arises both greed/craving (lobha) on the one side and hatred/aversion (dosa) on the other. To see things clearly, “as they truly are” is the final goal of Buddhist practice.

There is also no notion of the ‘normal’ person in society as there seems to be in contemporary psychology. In Buddhism we are all mentally ill / dis-eased. For this reason, Buddhism and contemporary psychology may not always match up so well. For the Buddhist psychologist, it may not make sense to create the hundreds (thousands?) of categories of mental illness found in the DSM. Everyone is ill; some are just more hateful, some more greedy, some more delusional. For all the prescription is the same 8-fold path, with a skillful teacher who can prescribe various meditations appropriate to one’s type.

This goes back at least as far as Buddhaghosa, author the Visuddhimagga (Path of Purification) in the 5th century. Greedy types were taught to meditate on death and the impermanence of all things, hateful types focused on loving-kindness and delusional types were given brightly colored objects to look at – at least that’s roughly how it went. So what would be done with a borderline person? Well the simple answer is that it would depend on the person – that is to say that, as I am learning, “Borderline” is a pretty broad category, so the particular meditations would need to be prescribed for each individual.

That said, there are some general suggestions that can be made, based on the 9 symptoms given by the DSM-IV.

  1. To combat the fear of abandonment, one might meditate on the impermanence of all things, including oneself and other people. Everyone that comes into your life will leave, some sooner than others. Thus we seek to overcome this fear by accepting the truth at the heart of it. Accepting that all people will leave us (and that the feeling of abandonment only means we are clinging), we learn to live more freely in the moment and more lovingly with everyone.
  2. The problem of splitting, or seeing others in the extremes of idealization and devaluation (as “all-good” or “all bad”), is a matter of delusion, failing to see the enormous gray area that we all inhabit. Perhaps a meditation on the qualities of a candle can help. Begin by seeing the positive qualities: light, warmth, dance. But acknowledge also that it may burn us, that it will not last forever (see #1), and that it is certainly limited in its power to please us. Through this we learn a gentle acceptance, even appreciation, of the candle. People are the same. They may be the light of our life, or they may badly burn us – or both at different times.
  3. The lack of a persistent sense of self or identity is probably closely related to #2, only directed at oneself. To accept others for all their gray areas of good and bad, we must accept ourselves. A borderline is sometimes described as a chameleon, quickly adapting to the standards of his/her surroundings. This may seem beneficial, but it is not the kind of ‘adaptability’ that we commonly praise. Adaptability in this sense is a cognitive function, the ability to re-think one’s ideas and change them if needed. For the borderline it is not cognitive, but much more primal, and thus not satisfying or growth-producing. To overcome this, one should meditate on loving-kindness (metta), emphasizing loving the various aspects of one’s self, bringing them into union.
  4. Potentially self-damaging impulsivity is, I believe, an attempt to self-sooth; to activate adrenaline (and other chemicals) in the brain to override the painful discomfort of whatever other emotions are present. Here a faith or confidence meditation may be best, such as calling to mind the positive qualities of the Buddha or Jesus or another exemplary figure. Invoking the imaginative energies of your mind to ‘remove’ yourself from the unpleasant sensations will enable you to withstand them without harmful impulsive actions. It is said that a borderline often doesn’t recognize his/her impulsive actions as harmful, so here it is especially important to have a trusted teacher/therapist to whom you can say “I did x when I felt y, was that okay?” or “whenever z happens, I want to x.” We all overreact sometimes, and nobody else can guide us through all of life’s ups and downs, but having a trusting sounding-board and advisor may prevent us from unknowingly harming ourselves and others.
  5. Suicidal behavior/self harm seems to be simply an extreme aspect of #4. Ihave heard self-harming (cutting) described by borderlines as a way to feel physically in order to drown out the emotional pain of the moment. It has also been described as an attemt to simply feel – which brings us to #7 below.
  6. Affective instability, marked reactivity of mood – basically “extreme mood swings” may be combated with another wisdom meditation on impermanence and nonself-identification with the moods of the moment. No matter what we are feeling, good, bad, in between, it will pass. In meditation we can watch feelings and even whole moods rise and fall quickly and without a trace. Second, we learn to see that we are not our mood. Learning to ‘see’ strong emotions as they arise and before they get a hold on us, we realize – through experience – that we are bigger than even our worst thoughts and feelings.
  7. Chronic feelings of emptiness arise only when we are desperately seeking substantiality. We all feel sad and alone sometimes. Chronic feelings of emptiness arise when our response to this is to want something out there to overcome those feelings. The want is just the feeling pushing us around. We are bigger, but we submit and become that want. Submitting to it, we feed it (by trying to fill it up – seeking a person or object to make our emptiness/aloneness go away) and it grows. So the same meditations as in #6 may be prescribed here.
  8. Inappropriate, intense, out of control anger is again an aspect of #6. Perhaps it is true of all of us, but I think for a borderline person this intense anger is a sort of “channeling.” You are not reacting to the present situation, but instead the situation opens you to a past pain and anger that is then expressed. Opening just a tiny gap of awareness for this realization will hopefully prevent you from acting out this anger. Use your awareness as a weapon against it – slay the angry feeling by watching it, tracing its roots, and again growing larger than it.
  9. Transient, stress-related paranoid ideation; basically hallucinations. The most common, it seems, is the belief that the borderline’s partner is cheating, but delusions of grandeur and occult powers seem to come up a lot. Of course the cheating fear is closely tied to #1. The hallucinations my seem like ‘out-of-body’ experiences and feel 100% real. This may just be a strange evolutionary mis-adaptation of the brain to protect the person from the situation – similar to fainting in times of danger. Because these states seem to be tied to extreems of real-life stress, it seems an analytical meditation may be best. In this meditation one should identify the ‘players’ of the situation: people, events, causes of stress, and so on, and break them down into manageable parts. In this way we see that what looked like a big solid ‘mess’ of a situation is actually composed of various parts, some helpful, some not helpful or simply in the wrong place. Often it involves dealing most with one’s own thoughts.For example, imagine that your partner goes for a week-long business trip. This raises fears of cheating/abandonment and can spiral into a very real ‘sense’ that the partner is cheating, despite there being no proof or reason for your partner to cheat. To combat this – again using another (objective) person as a sounding-board will be useful – try to identify feelings (loss, emptiness, yearning) and see how they give rise to thoughts (cheating), and these can even give rise to perceptions (he is being distant, he is acting strange). Notice, and this is quite common among borderlines -but can happen to any of us-, that the feelings drive the thoughts that then drive perceptions, not the other way around. If you can use above techniques to look at your feelings as they arise, the painful perceptions here will never get to you.Other times of great stress are likely to occur too. So long as you are in the throws of BPD and know it, perhaps the best thing to do is to simply tell others – tell them that you are under unbelievable stress, don’t wait for them to see it (they’re probably under stress too). Hopefully you can understand BPD a bit and give you needed space and reassurance. But aside from reaching out like this at tough times, it may be necessary to simply tell yourself “this is a crazy time” and not to believe any of the ideas that arise out of it. Again this is a case of being bigger than one’s thoughts and feelings.

Well, for a sunny afternoon that seems to have actually been a remarkably focused post. 🙂 I guess I’ll save my scattered thoughts for another day. Some scattered resources though:

Books for borderlines via an amazon list. Some psychology, some Buddhism, all good.

Biological Unhappiness (on BPD): Dr. Leland Heller’s work and ideas on BPD, focused highly on the etiology/physical causes of BPD. Very promising as a new perspective for treatment.

DBT Self-Help: a site developed by people who have gone through Dialectical Behavior Therapy. As stated on the site, it is a valuable source of information, not a replacement for DBT.

BPD Relationship Recovery: perhaps not helpful for borderlines to read, this is the account of a man who ended his relationship with a borderline person. It is, however, important for everyone to see that BPD has a powerful effect on loved ones of the borderline person.

Buddhist Channel article on John Kabbat-Zinn and his mindfulness based cognitive therapy, which has been used to treat a wide variety of ailments and is very close to DBT.

An even better article is this one by K. Salters-Pedneault, Ph.D. – discussing how Mindfulness Meditation may be applied in living with BPD.
Dialectical behaviour therapy for borderline personality disorder
Advances in Psychiatric Treatment (2002) 8: 10-16 — © 2002 The Royal College of Psychiatrists: a useful academic discussion of DBT and its potential usefulness in Britain.

This is part 4 of a series. Click here for part 1part 2part 3, and part 5.

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