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Blaise Aguirre M.D.
Blaise Aguirre M.D.

How Do You Do What You Do?

Working with suicidal people who have borderline personality disorder

When people ask me what I do for a living, I tell them that I work with highly suicidal adolescents. I typically get a surprised, at times skeptical look back and then the questions flow: “Are they locked up?” . “No,” I answer. “They live on an open residential unit, without locked doors and without padded rooms. Without injections or restraints.” “Well then how suicidal could they be?” the questioning continues. “Often many of the kids who come to us have made many attempts at killing themselves. Many have been hospitalized multiple times and when they are admitted to our unit they are on average on about 6 psychiatric medications.”

The listener shakes their head in awe or suspicion or admiration or disbelief and then asks: “How do you keep sane? How can you live with such suffering and what about their parents? Doesn’t it get to you? ” “It does get to me. I feel tremendous compassion for the kids and their parents and the staff that I work with. But I know that most of the young people feel lost and misunderstood, struggling with a condition known as Borderline Personality Disorder or BPD; a disorder with great prognosis if they can get through the suicidal and self-destructive phase," I answer.

And so in order to do that I have to stay focused, present and calm so that I can be attentive to the fluctuations in mood that can set a young person and their family spiraling into a maelstrom of emotional chaos, a chaos that can lead to self-injury and suicidality. And the best way to stay focused is through the practice of mindfulness. Mindfulness has made a profound difference in my personal and professional life and this blog post, my first entry on Psychology Today, will be dedicated to mindfulness, borderline personality disorder, and the interface between the two. I fundamentally believe that the most essential healing from BPD takes place through the practice of mindfulness. It is also the practice that best helps clinicians be effective, compassionate and enduring in the clinical care of people with BPD.

In subsequent posts I will look at specific mindfulness practices for BPD but for today I want to underscore the utility and universality of mindfulness by telling you about a documentary I recently participated in. I was filmed with a group of non-mental health professionals from disparate walks of life who all come to the conclusion that mindfulness is the practice that keeps us at our best while making us happier, and more capable of handling life's adversities.

A few years ago I was approached by producer and director Larry Kasanoff who asked me if I would agree to be in his documentary: "Mindfulness: Be Happy Now" together with the famed Buddhist monk Thich Nhat Hanh, author and mindfulness advocate Deepak Chopra, actress Sharon Stone,and the "Dog Whisperer" Cesar Millan.

From his IMDB profile Larry seemed like an unlikely mindfulness documentary producer. His resume was full of high action movies like "Mortal Kombat" and "Terminator 2", not the stuff of mindful reflection, but Larry told me that he has been a mindfulness practitioner for years and I welcomed the opportunity to help spread awareness on the practice of mindfulness. The documentary is finally out and well worth watching. I realize that I am not impartial in saying this because I am in it, but I would say so even if I had not made the final cut.

As a society we are slowly losing our ability to pay attention. More and more we have devices, apps and sensors that tell us what to do, where to go and what to be aware of. Mindfulness is a way to reclaim awareness. It teaches us to pay attention to what is and what isn’t in this present moment. All too often we are stuck in the past or worried about a future that has not come.

In my line of business when people are full of dread and anxiety, they come to psychiatrists looking for medication to deal with the problems in their life. And then we have to deal with insurance companies to get approval for many of the medications. Patients have to deal with side effects and have to wait many weeks to see if the medications are going to work.

For many mental and physical conditions, mindfulness is a cleaner, proven, side-effect-free way to lasting mental and physical health stability--one that does not require prior authorization and with no restrictions on the amount used.

My hope with this blog is threefold. The first is that as it evolves we will all -- yes me included -- learn more about the magic of being present through the ongoing practice of mindfulness. The second is that we can continue to understand the nature of BPD and find enduring compassion for people who suffer with the condition. And finally that we explore the ways that mindfulness can be central to reducing the suffering that people with BPD experience.

About the Author
Blaise Aguirre M.D.

Blaise Aguirre, M.D., is an assistant professor of psychiatry at Harvard Medical School.

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