Borderline Personality Disorder

 

I specialize in treating individuals who have been diagnosed with Borderline Personality Disorder (BPD). My familiarity with BPD has come not only from formal training in this area but also from many years of careful listening to BPD sufferers, believing what they say and patiently studying the course of their symptoms and their unique personal experiences.

Mindfulness, and Buddhist psychotherapy?

We hear a lot about mindfulness meditation. Psychotherapists, doctors, authors and people who are interested in health, healing and well-being have something to say or show us about “mindfulness” practices. Some of them mention something about Buddhism. Most don’t, unless they are monks or master teachers of some kind from the east. And so, we read the mindfulness books and acquire our relationship with “Buddhism” through the writings of teachers, experiences of authors who have received teachings, were once monks, and we feel a bit inspired and consider applying what we read, maybe some of their experiences, to our lives before going back to work on Monday, or before coming home and seeing the family and dealing with our relationships, our worries, our addictions. Sometimes we go hear a lama or master teacher in person when they are in town, or we attend a retreat and feel a bit taken out of our routine and “enlightened”. But then we’re right back in traffic, at the bank, eating breakfast with our spouse or going on another date with someone from the Internet. And those Buddhist teachings seem far away.  So, what is all this about? What do we do with mindfulness this and that, and what about this Buddhism thing?

First of all, there are good reasons you hear very little, if anything at all, about Buddhism when you attend mindfulness trainings and seminars provided by psychiatric and psychological institutions and academicians. The not-good reasons are fear and confusion. Among the good reasons you do not hear much about Buddhism are: mindfulness practice does not require any attention to faith, religion, philosophy. The benefits of mindfulness are real and measurable and scientifically supported. So, why complicate a beneficial thing with abstract philosophy and unnecessary systems or “isms”? No reason! Also, professional psychology, psychotherapy, psychiatry are “hands off” in the area of patients’ spiritual beliefs because a lot of people have very deep, strong feelings when they hear mentioned “Buddhist” or “Catholic” or “Christian” or “Jew”, and it’s just not necessary, and not always helpful, to start examining a person’s faith or religion when they are coming to therapy for depression, anxiety, a relationship concern, and so on. Indeed, conventionally, It is the focus of psychotherapists to help people function as well as possible, to have meaningful lives, to reduce disabling symptoms, behaviors. If delving into the deeper questions about faith, meaning, purpose and birth death come into the therapy room, so be it. Otherwise, these issues, even if always in the fabric and seams of human existence, do not stand out as the immediate concerns that most people bring to therapy.

Seldom is it the focus of therapy to enhance and define a client’s spiritual and philosophic relationship with him-/herself. Or, is it?

I would like to share some of my observations about psychotherapy when it includes mindfulness practices and also “Buddhist” philosophy that can be very helpful and does not require a belief in or practice of Buddhism or devotion to a religion or cult. The reason: some of the substance of Buddhism, Buddhist philosophy, is logical, has a methodology that can be learned and applied to living one’s life and can aid mental/emotional health and address anxiety, mood difficulties and relationship challenges. Using Buddhist philosophy to help you learn how to regard the activity of your mind and how to view yourself and the events in your life does not require you to have faith or obedience to any system of beliefs or religion. And when you go there, a bit deeper, and you indeed examine purpose, meaning, why you are here and what you want to make of your life, you might find that your seemingly simpler reasons for coming to therapy are illuminated and that you can really benefit from taking a closer look at the details and the “big picture”.

Currently, in Los Angeles, you will find a number of meditation centers associated with some form of Buddhism. Usually these are Zen centers or Tibetan Buddhist places. All Buddhism comes from ancient teachings written by monks and devotees at least several centuries after the death of the historic Buddha Shakyamuni (350 B.C.) and the oral transmission of his teachings. The Buddha was not a god, not a deity, not a miracle, but a man who achieved a rare state of consciousness through devotion to many trials—wanderings, asceticism, self-denial, and finally, through deep contemplation, sitting and “mindfulness” practice, integrating experience, wisdom and observations over many years, while sitting for quite some time under the Bodhi tree. Buddhists revere his teachings and practice precepts in order to cultivate their consciousness. It is an individual pursuit. It is not magic. It is not miraculous. It is about effort and method. It is very simple and profound. And it’s all up to the individual.

One of the historic figures that emerged after the historic Buddha’s time was a brilliant south Indian philosopher from a Brahmin family named Arya Nagarjuna. He lived in the 2nd century CE. His teachings are now called Madhyamika or the “Middle Way School” of Buddhism. Nagarjuna’s work, a kind of logical exposition of the historic Buddha’s teachings, is foundational for Tibetan Buddhism. Nagarjuna’s writings, as I understand them from reading translated texts and learning about Nagarjuna as taught by The Dalai Lama XIV, are quite complementary to cognitive-behavioral psychology/psychotherapy, except that Nagarjuna goes further than psychology and inquires into the true nature of things, including the existence and quality of existence of the self. His inquiry was not just a rigorous philosophic exercise, however. He was supporting the historic Buddha’s quest to address the human experiences of suffering—birth, sickness and death, and not as a morbid preoccupation and resignation; rather, his was a method and philosophy to help people deliver themselves from suffering by using the unexplored depth of their mental resources. Psychotherapy is much the same.

I have provided a summary of a few points from Nagarjuna’s teachings. They are very potentially very beneficial in psychotherapy, and an excellent complement to mindfulness practice.

Supporting and elaborating on the historic Buddha’s teachings, Nagarjuna offers that:

  • Our fundamental disposition is to seek happiness and overcome suffering.
  • We have a “thirst for the real”, but we grasp at details and miss the big picture.
  • Reasoning, not faith alone, is necessary in the effort to cultivate happiness.
  • No views are ultimate; ideas and language are helpful but different than reality.
  • The mind is originally neutral. Experiences, thoughts, emotions arise later on.
  • Fundamental ignorance of the way things really are is at the root of our suffering.
  • Our thoughts, feelings create a distorted, misapprehension of ourselves and the world.
  • Insight, the cultivation of wisdom, and investigation into our perceptions, helps us.
  • It’s a mistake to go to extremes—making things absolute, denying things outright.
  • Things come into existence in dependence on causes and conditions, not alone.
  • Things are not what they appear. “Underneath” everything are causes and conditions.
  • We can find causes and conditions of our suffering, the origins, and remove them.

Nagarjuna sums up and pithily expresses a few of his central teaching points in the following quotations I have listed below:

“The thirst for the real is the basic fact about man. What we are and what we do depend on the way we respond to and interpret to ourselves this deepest urge”.

–Nagarjuna

“The world around us is a reflection of the condition of our mind: we do deeds that build the world for us exactly in the way we interpret to ourselves the reality of things”.

–Nagarjuna

 

Anxiety–it’s something, but not always what you think!

Anxiety is a real physiological and mental/emotional phenomenon. We know when we are anxious when we feel apprehensive, keyed-up, worried, restless, suffer from distressing mental images, memories, and sometimes when we perspire or have insomnia or a rapid heart rate and shortness of breath. When we have these experiences, we do what we can to reduce our distress. Sometimes we avoid certain places, people and tasks because we are anxious.

Indeed there are many ways we notice anxiety. What is less obvious, however, and what we tend not to notice, especially when we are in the midst of anxiety, is that anxiety really is an internal experience and not exactly the events and people and places and things about which we feel uneasy. Anxiety is arousal that is triggered by external cues and sometimes internal cues such as thought, feelings, interpretations. Anxiety happens inside us even if triggered by events, places, people and circumstances in the environment. The good news is that we can work with our internal experiences and we really do not need to suffer even if we are anxious. Further, when we pay attention to our thoughts and feelings when we are anxious, for example when we focus on breathing and counting or saying  mantra when we are anxious, we can begin to observe that anxiety as a state of arousal is not the stories—beliefs, interpretations— we tell ourselves, and not the pictures we imagine or the events and circumstances we fear while we are anxious. Indeed, anxiety is not the same thing as thoughts and emotions, and it can be experienced more clearly as just a signal, albeit a distressing one, but a more harmless and less daunting state of sensation and attention, and not the things, events and circumstances that we used to take ourselves away from, guard up against and around which we engage in rituals, magical thinking, avoidance and sometimes compulsive behaviors. Mindfulness practice serves us well to know the difference between anxiety and fear, anxiety as a signal versus anxiety as a state of suffering. .