The Practice of Loving Compassion and Happiness in Overcoming the Debilitating Misery Associated with Borderline Personality Disorder
Overcoming the misery associated with Borderline Personality Disorder (BPD)Blaise Aguirre MD is an expert in child, adolescent and adult psychotherapy, including dialectical behavior therapy (DBT), and psychopharmacology. He is the founding medical director of 3East at Harvard - affiliated McLean Hospital, a unique, residential DBT program for young women exhibiting self-endangering behaviors and borderline personality traits. Dr. Aguirre has been a staff psychiatrist at McLean since 2000 and is widely recognized for his extensive work in the treatment of mood and personality disorders in adolescents.The misery associated with living with Borderline Personality Disorder is an intolerable concoction of pain, sadness, emptiness, loneliness and self-loathing. For many who live with this disorder it is this misery, frequently unresponsive to any medication, which leads the person to say "enough." Death is a better option. I have never experienced such misery, but I can imagine that if believed that I was destined to a life of such suffering, that I too would consider the option of death.
Overcoming this apparently insurmountable obstacle to joy, is a question of practice. Practicing joy and loving kindness on a regular basis is the key.
As a general rule, the more we practice any behavior or action, the better we get at that behavior or action. It stands to reason therefore that the more we practice doing something incorrectly, the better we get at doing that thing incorrectly. Even more, the longer we practice a behavior the more it "hard-wires" or embed into our brain circuits. If we think about the acts of walking, eating with a fork or brushing our teeth, these are behaviors practiced over so many years that we hardly consider the hundreds of factors that go into each behavior, and just how habitual the behaviors have become. The brain simply knows. But if you were to change these behaviors by, for instance, brushing your teeth with your opposite hand, or walking sideways, we would become very aware, and in fact it would take tremendous practice to feel comfortable doing a very familiar thing in a new way. The tendency would generally be to go back to old ways of doing things.
Although we do not normally consider it, thoughts are simply behaviors. In as much as we can change an errant golf-swing with the regular practice of an effective swing, so we can change destructive thinking, by the regular practice of constructive (positive) thinking. Some trivial change of mind might be that I have decided that I prefer red wine to white, that although I used to like cats I now like dogs, or any other number of seemingly insignificant changes of mind. Usually it is easy to change one’s mind when there isn't some big emotion or feeling associated with it. Fewer people change their mind about their feeling on abortion or gay marriage, than about their favorite ice-cream flavor, because the former evoke tremendous emotions and passions. Such intense feelings are an indicator of the important significance that the brain places on a subject.
For many people with BPD, the idea that they are unlovable, evil, toxic people, leads to intolerable self-loathing and desire to die. For years they have practiced such thinking. The repetitive practice of such thinking slowly hardwires the thought (behavior) into the brain circuits of people who suffer from BPD and ultimately is reflected in their sense of self. The conclusion of such thinking is that death is the best option and hence the very high suicide rates for people who suffer with BPD.
Because the practice of any thought or behavior makes us at that behavior, the repeated attention to self-loathing and the misery that accompanies it entrenches this thought all the more. Changing such thinking means practicing something different. In this case practicing joy and what the Buddhists call "loving compassion." There is important scientific evidence that such practice makes a difference in the way the brain works. I will first give the evidence and then some exercises for daily practice.
SOME OF THE EVIDENCEIn 2001 Richard Davidson, the director of the Laboratory for Affective Neuroscience in Wisconsin scanned the brain a western Buddhist monk in a Tibetan tradition. The monk was attached first to a functional MRI scanner, a scanner that measures blood flow in a person's brain, and then to an EEG which measures electrical activity in a person's brain. The monk then went through a series of meditation practices, including the practice of meditating on loving compassion.
The MRI showed changes in blood flow in the monk's brain as he switched meditations. The EEG further showed that while the monk was practicing loving compassion, that the activity in his brain shifter dramatically to the left side of his brain and in particular an area known as the left pre-frontal cortex, which is that part of the brain behind your left eye. This added to data that show that, in people who are stressed or depressed, the right frontal cortex of the brain is overactive and the left frontal cortex underactive.
That's all very well for highly trained compassionate monks, but what about the rest of us, or people who suffer from BPD?
Davidson then hooked up with Jon Kabat-Zinn, a psychologist well-known and well-regarded for his teaching of and research into mindfulness. Their team recruited 41 ordinary folk, who happened to be stressed-out volunteers at a local biotechnology firm. They all underwent EEG tests at the beginning of the research and the 41 were then divided into two groups - 25 who practiced meditation group and 16 who did not.
The meditation group took an eight-week course in mindfulness meditation and then both the meditators and the non-meditators were tested again by EEG. To make matters even more interesting, all 41 were also given an influenza vaccine and then had blood tests to check for antibodies. Four months later they all had EEG tests again. The 25 meditators' brains showed a marked shift in activity toward the left frontal lobe, while the non-meditators' brains did not. The meditators also had a more robust immunologic response to the influenza shots.
So ordinary people like stressed-out lab techs can shift brain patterns to the left. So what?
The two halves of the prefrontal cortex that is the left and the right appear to have specialized functions. The left half is involved in generating positive feelings and the right half in establishing negative ones. Research shows that in depressed people, the left prefrontal cortex that shows lower activity, and the right prefrontal cortex greater activity. Simply speaking, the emotion of joy and the experience of well-being appear to be located in the left pre-frontal cortex.
What about the practice of loving compassion?A 2008 study by Antoine Lutz and Richard Davidson compared 16 Buddhist meditators to 16 "normal people", to look at what happened in the brain during the practice of contemplating loving compassion or loving-kindness, that is, the wish of happiness for others, and the wish to relieve others' suffering. The state of loving-kindness and compassion was defined as an “unconditional readiness and availability to help living beings”. What the researchers found was that the mental expertise to cultivate positive emotion powerfully stimulates the activation of brain pathways linked to empathy and the capacity to understand that other people have desires, emotions, beliefs and intentions different from ours. This is known as the theory of mind, or the capacity to mentalize, a skill that has been shown to be lacking in people with BPD.
The data thus show that regular practice of loving compassion activates the area of the brain that experiences joy and that allows us to consider that others might experience things differently from the way that we do. Both of these ideas are of profound importance to developing well-being in people with BPD.
People who know me know that I run marathons. I am not a prototypical marathon runner. I am much heavier than the regular runner and so the training is more difficult. Nevertheless I have run more than 40 marathons and ultramarathons. Training is not easy, but it is necessary if I want to complete the distance. Certainly it is much easier for many to train, yet they too have to train even if it does come easier. And so the practice of loving compassion and joy may be easier for Buddhist monks, who train for many hours a day than the rest of us, and especially those burdened with BPD, but the practice WILL reduce misery and enhance joy.
OK finally, what to do?
PRACTICE:On a daily basis, think of someone, anyone you truly care about; a parent, a sibling, a best friend or a romantic partner. Let your mind be invaded by a feeling of love, of wishing well-being to that person. Allow compassion, the act of wishing freedom from suffering, to dominate your thoughts about the other person. Practice this on a regular basis. After some practice, extend this feeling to others and continue the practice until all living beings are incorporated, including those you might not like as much AND most importantly include yourself in such compassionate thinking.
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