A Matter of Personality

From borderline to narcissism

Mindfulness or Mindlessness?

The latest fad in both psychotherapy and self help is “mindfulness.” Derived from Zen Buddhism, it is a skill one can use to better tolerate emotional distress. When faced with distress, having ways to keep oneself calm is a good thing—much like taking a tranquilizer. But changing the social environment creating the stress in the first place is far more important. Read More

Mindfulness or Mindlessness?

Not a professional in this field at all, I am a Master Plumber, but have been trying to use Mindfulness as a way of dealing with anxiety and focus. I find that I tend to wander off course and into a, more or less, Selfhypnoiss as I seem to get the relaxation and a better feel for direction from hypnosis. I have read many books and even taken a one day seminar on the practice, and still it's benefits seem to evade me. I think I have a tendency to over think things, and I am looking for an "answer" or what is called, thanks to Oprah, an Ah Ha moment. I must say that I have not given it a consistent run as I tend to start and stop, but the relaxation aspect seems to be real. I guess my question to you is, are you saying that Mindfulness has no place in our or is it useful in selected situations? Thanks for the thought provoking article and I await your follow up.

minfulness

Hi Frank,

Thanks for writing.

No, I am saying that mindfulness techniques, as well as relaxation exercises, self-hypnosis, and other ways of coping with stress, can be very helpful while a stressful situation is in play (or just for generally decreasing everyday anxiety, for that matter).

If an environmental issue is soon going to play out itself out or fix itself and won't be an ongoing concern, it may be all that is necessary for a person to get through a rough patch. (That usually is not the situation of someone coming to a therapist).

What it does not do is actually change a stressful environment, which in the long run may often be far more important. That requires active engagement of the mind with the problem at hand.

Dr. Allen I have been

Dr. Allen I have been benefiting greatly from reading your blog the last several weeks. The 3-part series of posts about how NOT to interact with a BPD in crisis have been giving me some semblance of hope in my relationship with my significant other, who likely is undiagnosed Borderline, and I look forward to the part IV (to-dos). Several years ago I read Mindfulness in Plain English and gleaned some great insights about the nature of the mind's ability to filter our experiences in ways that increase our sense of suffering, but you build on excellent points that the family or social environment has a tremendous impact on the efficacy of mindfulness practice. Thanks for sharing your reflections and expertise!

Eagerly awaiting for 'counter moves' post…

ghost walker wrote:
Dr. Allen I have been benefiting greatly from reading your blog the last several weeks. The 3-part series of posts about how NOT to interact with a BPD in crisis have been giving me some semblance of hope in my relationship with my significant other, who likely is undiagnosed Borderline, and I look forward to the part IV (to-dos). …. Thanks for sharing your reflections and expertise!

Two things.....

Firstly a little criticism with regard to the serenity prayer you have used - it's the 'new age' version as opposed to the original - so the original actually reads:
God grant me the serenity
to accept the things that cannot be changed;
courage to change the things that can;
and wisdom to know the difference.
This version puts quite a different slant on the prayer.
And secondly - excellent article in pointing out that the environment can be a big problem for people, and that this problem is, in the main, ignored by psychologists.
I recognised with the aid of a psychoanalyst and counsellor that my 'family of origin' had had a massive impact on my life and were the initial (but not only) cause of many of my issues. Although my parents would be considered 'successful/healthy/wealthy/normal/good parents' etc etc it's quite shocking how very dysfunctional they are.
I would actually go beyond the family when considering the environment - many of my current issues are now due to the fact that I can see this dysfunction playing out very clearly all around me - however my problem is that I am unable to remove myself from the environment. It appears to me, and others that can 'see' it, that this dysfunction is actually a global epidemic which is commonly referred to as 'normal/functional'.
Lucky for me that I've stumbled across serenity, courage and a touch of wisdom to keep me plodding onwards and upwards. :)

Inner & Outer

David

Thanks for this opinion piece. I was particularly pleased to discover that you were a psychiatrist who emphasised the self in context. \

As a social worker with an active interest in psychology, who has experienced over ten years of psychodynamic therapy, I believe it is important to take a balanced view in the sense that early experiences are a significant factor in shaping the self, however mental health intervention must do more than explore the past and its relation to present functioning. Accordingly, clients need support and interventions designed to help them identify and make changes now.

People need to feel empowered, and as the informed know, it is the unconditional positive regard of the practitioner that affects the outcome of the treatment more than any other identified factor. The strength and resilience of the client must be acknowledged and we need to validate the reality of their difficult present and, when applicable, problematic past. Change requires an inner shift as well as action in the external world.

Missing the point

Hi,

I've been practicing mindfulness for close to a year through and after some very stressful times and I must say, your article, while thoughtful and all... does not explain mindfulness in full at all. And that's doing a disservice to anyone contemplating it.

The potential effects of mindfulness goes far beyond just being calm in the moment or anything else just superficial that you seem to think. It teaches focus and it provides clarity of mind that otherwise doesn't exist often for those of us who have "suffered" from anxiety or depression or personality disorders.

Mindfulness allows one to see thoughts first without reacting. One can then think and reflect on the situation, the thought and the appropriate reaction rather than going with the automatic, learned and most likely maladaptive response/reaction.

And it teaches us not to judge our thoughts/feelings as good or bad but just as what exists in the moment... and that the moment will pass.

Therapy should absolutely be used to explore the potential origins of whatever affliction exists and to coach the patient in new behaviors but, as far as for present and future healing and understanding, it's all about the acceptance of what's come before but dis-identifying with that, which mindfulness makes much, much easier through focus and clarity and calming the "monkey-brain."

missing the point

Hi Anonymous,

Thanks for your comment, which is certainly fair. Mindfulness certainly helps people, as you rightfully point out, to become less reactive, think more clearly, and avoid being unduly defensive.

All of these things are in fact prerequisites to learning how to deal with a dysfunctional social system. (There are other ways, of course, to achieve these things besides or in addition to mindfulness. For example, reviewing and interpreting family genogram data to better understand why parents may be acting in horrible ways certainly helps).

What I am critical of in this post are those who think that mindfulness strategies are some sort of cure all, and who minimize the importance, the seriousness, and the intractibility of the social environment in which many of people exist, and do nothing further to address it (and those therapists who don't help their patients to do that).

Heroin addicts in Vietnam

Anyone who doubts that changing the situation can change the psychology need only read up on the experiences of tens of thousands of American GIs who became heroin addicts while fighting the war in Vietnam. When they came home, the vast majority of these men, who were addicts by any objective measure, kicked their habit for good without rehab, 12-step, or anything, including psychotherapy. What changed? Their situation.

http://www.rkp.wustl.edu/VESlit/RobinsAddiction1993.pdf

Situation AND Mindset

I am familiar with this example, but have never been able to determine if the soldiers were smoking it or using the drug intravenously. I imagine that, for a number of reasons, addiction involving syringe use typically complicates recovery.

You also find that it is not just the situation that changed but the soldier's mental orientation. Heroin use in Vietnam was not framed as a troubling behaviour but rather as a temporary response to an unusual set of circumstances. Thus, heroin provided a solution to such things as boredom, stress and homesickness which no longer existed once they returned home.

Also, I seem to recall the study showed a co-relation between a problematic background and ongoing difficulties with substance abuse. Thus, it was more likely that men who had demonstrated troubling behaviours prior to serving overseas found it more difficult to discontinue use upon returning.

I've been practicing zen

I've been practicing zen meditation for years, and one of the side-effects of mindfulness is that you see your family's maladaptive coping strategies much more clearly. However, this does create its own problems, in that seeing them more clearly, you are also much more likely to reject them, and in doing so, risk suffering the consequences listed in the post: threats of suicide, etc. My family, which has spawned both BPD sufferers and narcissists, has a psychological coping system that resembles a Rube Goldberg machine, and when I upset the system even a little, family members go into overdrive to set me "right." This should in no way dissuade anyone from pursuing mindfulness or extricating oneself from a problematic family system because, at the end of the day, there is no other way to deal with the system than to call a spade a spade, and leave people to their own coping mechanisms. Growth isn't easy.

Thank you

Dr. Allen -

Thank you for your article.

I agree with what you say about mindfulness, which requires one to already be in a good emotional place to make use of it. Your idea about directing addressing the source of stress, which is usually in the environment, makes total sense.

Your points refuting biological determinism are also well taken. It's frustrating when people use poor research and faulty reasoning to cast BPD as a biologically "caused" disorder. As you noted, the environment is extremely important, and there is a complex interplay between genes and the environment that yields psychological problems. Jay Josephs writing on mental health disorders, in particular The Gene Illusion, covers this issue of environment vs. genes very well. Another good one is Evelyn Fox Keller's book, The Mirage of a Space Between Nature and Nurture.

You might be interested to know that there are many former BPDers (people who once had Borderline Personality Disorder) who write about how they recovered to become non-borderline. I am one of them.

I was diagnosed with BPD 10 years ago, and at that time, had all 9 symptoms of the condition. I had had a severely abusive childhood with a father who beat me and a mother who neglected my need for support. Things seemed hopeless and I felt that I would never be able to attend school consistently, get a job, or have satisfactory relationships.

Today, I am 28 years old. I work full-time as manager of a successful business, have many good, intimate friendships, a serious long-term girlfriend, and I am enjoying life! I worked in intensive therapy for eight years, gradually developing a healthy personality. I learned to tolerate ambivalence, to work through difficult emotions, to control my projections and acting out behavior, to trust and depend on someone else without fearing abandonment, and more. Today, I have great self-esteem and feel well most (not all) of the time.

I am trying to spread the word that BPD can be fully recovered from. In case you or others are interested, I keep a blog about how I recovered here - http://bpdtransformation.wordpress.com

You might be interested in this article about BPD and Genes - http://bpdtransformation.wordpress.com/2013/12/09/is-borderline-personal...

And this discussion of a four-phase approach to BPD treatment - http://bpdtransformation.wordpress.com/2014/02/08/four-phases-of-bpd-tre...

I look forward to reading your future articles, since you are one of a minority of positive and fair voices I have read about BPD.

good point ! but family members won't own up..

Dr Allen you have raised a really good point here!

I have BPD and it definitely is increased/worsened by how my family members treat me and interact with me. I try to step out of the equation (with help from my therapist) but they work hard to keep me in their dysfunction... they will never ever own up to their causing part of the problems.

Just read the comments here on PT how negative towards the loved one with BPD all/most of these people are. In their mind they are just fine but "ruined" by the BPD in their life. In their minds it is all the BPD's fault. How on earth do you get a family member to see this????

family members won't own up

Hi anonymous,

Thanks for your comment.

The question of how to get family members to let another member "slip out of the equation," as you so nicely put it, and to discuss their own role, is unfortunately very different for every family and each member in it. So I can't give you any specific advice. Generic assertiveness skills often fail miserably,and doing it badly is often worse than not doing it at all.

With my patients in therapy, we have to trace the entire history of the repetitive relationsip patterns. Then we have to figure out why the older family members react the way they do by constructing what is called a genogram, which is a sort of emotional family tree that charts the family's experiences in their social and historical context over at least three generations.

I then come up with a theory about why everyone is stuck in the patterns they are in.

We then use role playing to figure out strategies for approaching each family member in order to get past their formidable defenses and help them to react non-defensively and to problem solve. The patient first plays the targeted family member so I can see what they are up against, and I play the patient. I try out various strategies I have learned over 30 years of doing this sort of work and seeing what sorts of negative reactions are likely to result, and how they might be headed off.

Once we agree on a strategy, we switch places and the patient practices the strategies. I play the relative, usually a parent, and throw worst case scenarios at them, consistent with the parent's prior behavior.

I do hope you and your therapist can work to extricate you from any family craziness without cutting them out of your life.

Mindfulness and Acceptance

Anxiety is exhausting. Constantly grasping the good and pushing away the bad feelings. Mindfulness lessens the hills and valleys by helping me accept and appreciate the present moment. That's what I get out of it. It's not a strange concept at all. It's merely living life rather than worrying about living.

Very well done! An

Very well done!
An interesting dimension on the same matter is the notion of Benjamin LS's; the dysfuctional family does not need at all to be present here and now, since it has been deeply engraved in BPD's minds during childhood, as a "family in the head".

well done

Hi Mr. Spigos

Lorna Benjamin is right to an extent, but occasional contact with attachment figures both triggers and reinforces previously learned behavior. (The amygdala, in a part of the brain called the limbic system, has specific cells that respond ONLY to one's mother, and others which respond ONLY to a father or other attachment figures). Contact can have this effect even if it is exceedingly rare or even communicated through third parties.

After the primary attachment figures die, some people are indeed freed up considerably, but others seem to get worse than ever. I don't know exactly why this is. One patient told me she had conversations in her head with her parents every single day that always turned out exactly the same, so come degree of obsessiveness may possibly be one important factor. I also wonder about belief in the afterlife. My one research project did not have a large enough number of subjects whose parents had died to see if this is possibly true, although I did include items about beliefs in the afterlife on my Family Interaction Scale.

Interesting

Funny I have used mindfulness with mixed results... but the biggest "cure" for my BPD has been since my biological family moved away. (and fortunately they are far to busy in their own lives to think about or talk to me very much including holidays ...other than a phone call)

I now have my own family, and while I am not perfectly normal probably by any means... I no longer qualify for BPD diagnosis! Just having that dysfunction gone that was around me so much allows me to breathe and be mindful… whew! I can see where a trigger would have come in but now doesn't because I am mindful to it… but had they still been around I probably wouldn't be mindful and they thought I was the problem because I had the diagnosis...

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David M. Allen, M.D., is a Professor of Psychiatry at the University of Tennessee and author of the book How Dysfunctional Families Spur Mental Disorders.

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