I Hate You, But Don't Leave Me

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Langle Lecture Notes on Borderline Personality Disorder

Borderline personality disorder from an existential-phenomenological perspective

If we focus Borderline Personality Disorder (BPD) to one point, then we can say that this is a person who suffers from the instability of his inner impulses and feelings. People with BPD can experience vivid feelings, from love to hate, but the peculiarity is that these feelings arise only in the process of interacting with other people. And these impulses are the way they make contact with the world.

If you look at the symptoms of BPD, the first one is constant desperate attempts to avoid rejection, both real and imagined. And this is the central symptom. They cannot stand being alone. Even more precisely - not loneliness, but abandonment. They can be alone with themselves, but do not tolerate being left behind.

The second symptom grows out of the first - very high intensity and instability of personal relationships. A person with BPD alternates between idealizing and devaluing their partner, and this can happen almost simultaneously.

The third symptom is that these people do not know who they are. Their self-image is also very unstable. They do not understand what is happening to them, what is really important to them. Today may be one thing, and tomorrow another. This is the same instability in relationships with ourselves, as well as with other people.

The fourth symptom is impulsivity. Instability pushes them towards it. And the peculiarity of this impulsiveness is that it harms them themselves. Let's say they can arrange sexual excesses, or spend a lot of money. Or they may abuse surfactants. They can have powerful impulses, a desire to get drunk, and then - for many months no alcohol. And the dependence that can arise is often a consequence of their RL. Bulimia is more common in women. Dangerous driving at high speed. Many of these impulses put them in danger.

Fifth symptom. People with BPD live so close to the brink of being that they can often commit suicide attempts. They have this impulse directed at themselves and it is not so difficult for them to make this attempt, and it is not so rare for them to die of suicide.

The sixth symptom is emotional instability. Their mood can change very quickly and dramatically. Then they have depression, after an hour irritation, after a couple of hours - anxiety.

The seventh symptom is a chronic feeling of inner emptiness that haunts them. Inside they do not feel anything, experiencing emptiness, they are constantly looking for some kind of external stimuli, impulses in the form of sex, substances or something else that would push them in order to feel something.

The eighth symptom is inadequately strong anger that is difficult to control. They often show their anger. For them there is no problem to hit someone, beat someone on the street, who sticks to them or touches them.

The ninth symptom is paranoid manifestations of imagination or symptoms of dissociation. They feel that other people want to hurt them, to control them. Or they may have internal dissociation, they may experience feelings and impulses without being aware of them at the same time.

If you look at these symptoms, you can distinguish three main groups

1. Pulse intensity.

2. Instability.

3. Impulsivity of behavior that is subject to dynamic impulses.

All this gives their personality a lot of energy. And we see that this is real suffering. And when these people act under the influence of impulses, this means that they do not make decisions about their behavior, but something happens to them. They may not want to behave this way, but they cannot suppress or contain themselves. This impulse is so strong that they must obey or explode.

And now, from the surface, we will go deeper to understand the essence of their suffering

What are they missing, what are they looking for? They are looking for themselves. They are constantly looking for themselves in themselves and cannot find, they do not understand what they are feeling. Their feelings tell them they don't exist. I can work, think, communicate, but do I really exist? Who am i?

And, of course, it is very difficult to live in such a state. You can relate to yourself rationally, but it is difficult to live out of this inner feeling. A person wants to get out of this state of inner dullness and emptiness.

How does he try to resolve this situation? He strives to experience some kind of experience that will save him from this emptiness. And first of all, this is an experience in a relationship. When they are in a relationship, they have a life, they feel that now I exist. They need someone next to them, so that thanks to this person, they have a sense of themselves.

But if there is no other nearby, and they are in a false situation, they need to feel themselves, their body. They can cut themselves with knives or blades. Or they can extinguish cigarettes on their skin, or prick with a needle. Or drink very strong alcohol, which burns from the inside. Completely different ways. But the feeling of pain is pleasure. Because when I am in pain, I have the feeling that I exist. I have some kind of relationship with life. And then I understand - here I am.

So a person with BPD suffers because they have no idea of themselves, because they don't feel themselves. He does not have an internal structure of self, he constantly needs an affective impulse. Without an impulse, he cannot build the structure of the self. And there is a feeling that if I don’t feel, then I don’t live. And if I do not feel, then I am not me, I am not myself. And this is true, if we do not feel, we cannot understand who we are, this very reaction to the absence of feelings is normal.

But the method they choose gives relief in the here and now, but does not give access to their feelings. And a person with BPD may have fireworks of feelings, and then again dark nights. Because they use the wrong ways to experience feelings, such as satisfying their emotional hunger, they can abuse the relationship.

One can imagine that borderline patients are close to depressive, but there is a difference. A depressed person has a feeling that life itself is not good. He also lacks life. But life itself is not good. Whereas a person with BPD may have a sense that life is good, life can be very beautiful, but how is it to be achieved?

Let's go a little deeper. Where does the instability come from, the transition from opposite to opposite, from black to white?

People with BPD have a positive experience of meeting, and experience it as something very valuable. When they feel love, they feel a great life within themselves, just like all of us. For example, when they are praised in front of a group of people, they can have very good feelings and begin to sense themselves. We all react to these situations in this way - they bring us closer to ourselves.

But we are normal and so are in a fairly close relationship with ourselves. Whereas a person with BPD starts from scratch. Either he has an emptiness inside him, complete nothingness, then he experiences love, praise and suddenly approaches himself. Then he had nothing, no sensation, and suddenly it was so bright. And this his approach to himself arises only due to the fact that there is someone else. This is not his own process rooted in him, but a process that depends on something external. And this person is approximately like a hologram: you look at it and it seems that it is something real, but this is just the effect of external intersecting rays.

And then people who love him, praise him, are perceived as absolutely good, ideal, because they make them feel so good. But what happens if these people suddenly say something critical? And a person from this height suddenly falls not just to where he was, but somewhere deeper. He begins to feel that the other person is destroying him, destroying. It destroys his sense of self, hurts.

And, of course, it is reasonable to imagine that a person who does such nasty things is just a bad person. The very person who seemed to be an angel suddenly seems to be the devil. And this experience can be called hellish, because the person again does not understand who he is. When he falls out of this symbiosis with people who give him good feelings, and falling out of this symbiosis is so painful that this experience needs to be separated. Divide, break something that is connected with this feeling.

He can divide another person in time, for example, a father or mother - before he was so beautiful, and now the devil, because internally these experiences are very difficult to combine with one person. At one point, the father praises, says something good. But how then can you imagine that the same father might say at another moment, and now you have such nonsense, rubbish, redo it please.

And if we normally understand that criticism and praise, positive and negative, are all partly a common reality, then it is impossible for a borderline person to connect them together. Because one fine moment they have a great relationship with themselves, and the next - emptiness and only pain inside. And the person he just loved, he suddenly begins to hate. And this hatred causes a lot of anger and he can show aggression or impulses arise to hurt himself. And this separating dissociative reaction is characteristic of borderline individuals.

This separation is due to the fact that they do not want to experience the feelings they have when they are criticized. The criticism is so painful that they feel like they are dissolving. And they defend themselves by trying to maintain this symbiosis. To return to the state when they were loved, praised, because this is the state in which they can live. But this inner positive feeling of oneself is artificial, in the sense that it depends entirely on the other person. They have no inner idea of themselves, so they project everything outside, and try to understand something outside.

You can compare this with the behavior of a five-year-old child: he can close his eyes and think that this is no more. The borderline person does the same on the psychological level: he separates something and it seems to be no more.

What does the phenomenological approach and existential analysis tell us? What causes a person to lose himself?

This loss of self is related to two things.

On the one hand, they constantly experience violence and some kind of impermanence of others in whose power they are. Their past may have traumatic experiences of emotional or sexual abuse. When a person simply cannot understand when their good relative behaved this way. These opposite experiences of experiences associated with people who are important to them, as it were, tear them apart in different directions. Often these are people who grew up in families where there was a lot of tension, scandals, and ambivalence.

The experience gained from childhood can be phenomenologically formulated as follows.

An adult, or someone from the external environment, tells them: be here, do something. You can be here, but you have no right to live. Those. borderline children feel that they have the right to be, but to be only as an object, a means for solving some other people's problems. They are not needed as a person who has his own feelings, who wants to react to life in his own way, to enter into a relationship with it. They are only needed as tools.

And this is the very first form of this inner division, when a person grows up with such a message, with such an experience, and this is the basis of his future division.

But in response to this reality, he has an inner impulse: but I want to live, I want to be myself! But he is not allowed to be himself. And this inner voice is suppressed, drowned out. And it remains just an impulse.

And these impulses of the borderline person are perfectly healthy impulses against external aggression. Against the external reality that makes him torn apart, separate, not be himself. Those. outside they are separated from themselves, separated, and from within there is a kind of rebellion against this situation.

And from here comes a constant tension.

There is a very powerful internal tension associated with borderline disorder. And this tension gives intensity to their lives. They need this tension, it is important for them. Because when they experience this tension, they feel a little bit of life.

And they do not even sit relaxed, calmly, they are all the time, as it were, a little suspended, their muscles are tense. He sits in his space, on his support.

And thanks to this inner tension, he protects himself from inner pain. When he has no tension, when he is in a state of complete relaxation, he begins to experience pain associated with being himself. How painful it is to be yourself! If there was no inner tension, he would have sat down in a chair with nails. And this inner tension, on the one hand, gives him life, on the other, protects him from inner pain.

We thought about how a person comes to this state of separation, separation and saw that his life experience leads him to such a situation. Life itself was contradictory for him.

Another feature is the development of some images. Instead of seeing reality as it is, a person with BPD creates an ideal image of reality for themselves. His emotional vacuum fills with thoughts, imagination. And these imaginary images give the borderline person some stability.

And if someone begins to destroy this inner image or if reality does not correspond to him, then he reacts to it impulsively. Because this is a loss of stability. Any change in the way a father or mother behaves leads to a feeling of loss of support.

What happens when this image is destroyed or changed? Then the image of the ideal person is replaced by another. And in order to make sure that such a loss of the ideal will no longer occur, they turn the image of a person who was ideal into the complete opposite. And thanks to this change, the image of the devil will no longer have to be changed, you can be calm.

Those. images replace those feelings, thoughts and reactions to reality that help to live and deal with this reality. Ideal images become more real than reality. Those. they cannot accept what they have been given, what they really are. And this emptiness, due to the fact that they do not accept reality, they fill with images.

The borderline patient's deepest experience is pain. Pain, from the fact that if you leave, then I lose myself. Therefore, it pushes them to drag other people into relationships, not to let them out. NS Do you understand what the pain of the borderline patient is?

The main idea is that if the other leaves me or I stop feeling pain, then I lose touch with myself, it's like a kind of amputation of feelings. Feelings fade away, everything inside becomes dark and the person loses contact with himself. He feels that he is not accepted, not seen, not loved for who he is, and this experience in the past leads to the fact that he does not accept and does not love himself.

Their behavior in relationships can be described as "I am not with you, but also not without you." They can be in a relationship only when they dominate in these relationships and when these relationships correspond to their ideal inner image. Because they have a lot of anxiety, and when the other person walks away from them or does something else, it causes even more anxiety.

For them, life is a constant battle. But life should be simple and good. They have to fight constantly and this is not fair. They find it difficult to deal with their own needs. On the one hand, they have the feeling that they have a right to their needs. They are impatient and greedy about their needs. But at the same time, they are not able to do something good for themselves, they can only do it impulsively. They do not understand who they are and therefore provoke other people.

So borderline patients are very often aggressive when they feel abandoned or disliked by someone, but when they feel loved, when they are treated well, they are very warm, kind and sweet.

And if, for example, after a couple of years of marriage, the partner says that I want to divorce, then the borderline can change his behavior in such a way that life in marriage becomes wonderful. Or he may react impulsively and be the first to file for divorce or break up himself. And to predict exactly how he will behave is very difficult, but it will obviously be extreme.

They live extreme lives, they can work to their fullest, drive at full speed, or play sports to the point of exhaustion. For example, one of my patients rode a mountain bike and descended the mountain at such a speed that he knew if something got in his way, he would break his neck. And I drove my BMW in the same way, and felt that if there were leaves on the road, it would be blown off the road. Those. it is a constant game with death.

How can we help the borderline person with therapy?

First of all, they need confrontation. Those. you need to meet them face to face and show yourself to them. Stay in touch with them, but don't let them react impulsively. Do not give in to their impulses and say, for example, "I want to discuss this, but I want to discuss it calmly." Or, "if you really need to be that aggressive, we can discuss it quite calmly."

Those. on the one hand, stay in a relationship with them, keep reaching out to them, but don't let them treat you the way their impulses dictate. And this is the best way for borderline patients to learn how to switch their impulses and make contact.

The worst thing you can do is reject them and push them away when confronting them. And this stimulates their psychopathology. Only if you combine this confrontation with maintaining contact, continue to talk to them, then they can withstand this confrontation.

Show them your respect. For example, "I see that you are now very annoyed, angry, perhaps this is something important for you, let's talk about it. But first you calm down and after that we will talk about it."

And this helps the borderline patient to understand how he can be, who he can be in a situation when another person approaches him and allows him to make contact. And this is a very important resource that can be used in relations with border people, who are colleagues and partners for us. It cannot cure them, it is not enough, but this is the kind of behavior that does not stimulate their disorder even more. This gives them the opportunity to calm down a little, and enter into a dialogue with him.

It is possible to work with a borderline person on the same team for decades if you know how to deal with that person. And if you yourself are strong enough as a person. And this is the second important thing. If you are weak, or you have traumatic experiences with aggression, you feel traumatized, then it will be very difficult for you to be in a relationship with a borderline patient.

Because when dealing with him, you need to constantly be rooted in yourself. And it's not easy, it needs to be learned.

And the second thing borderline patients need to learn is to endure themselves and endure their pain.

And if you look very briefly at the psychotherapeutic process, it always begins with counseling work. To help at the first stage to find some relief of internal tension, relief in a life situation. We work as consultants with their specific relationship problems in their lives, at work. We help them in making decisions, in gaining a life perspective, and in a sense, this is educational work. We help them learn to notice their aggression.

This work continues for the first couple of months, six months, sometimes more. This work at the advisory level is necessary to gain access to a deeper level. For the borderline patient, pharmacological agents and medications are not very helpful.

And after the first stage of facilitating work related to counseling on life problems, we move on to a deeper level. We teach them to take a position. Position in relation to ourselves. Better to see yourself. For example, we can ask "what do you think about yourself, about your behavior?" And usually they say something like, "I didn't think too much, I'm not valuable enough to think about." And in the process of work, you try to understand how it happened and how they come to respect themselves.

And the first part of this work is working with yourself. And the second part is working on relationships with other people and biographical experiences. And in the course of therapy, they may experience increased pain and suicidal impulses. They experience loss of feeling amputated. And we can give them information that the pain you are experiencing cannot kill you, just try to endure it. It is very important to help them enter the process of internal dialogue with themselves. Because the therapeutic relationship is a mirror that reflects how they feel inside, how they deal with themselves.

Psychotherapy of the borderline patient is a complex art, it is one of the most difficult diagnoses in terms of working with them. Over the years, they can have suicidal impulses, they can aggressively deal with the therapist, fall back into their disorder. Such therapy lasts 5 - 7 years, at first with weekly meetings, then every 2 - 3 weeks.

But they need time to grow up, because when they come to therapy, they are like little children 4-5 years old. And how long does it take for a child to grow up and become an adult? We grow up in 20-30 years, and they should in 4-5 years. And in most cases they also have to deal with difficult life situations, which are very violent over them. Those. they have to make a very great effort to deal with their suffering and stay in therapy.

And the therapist himself can also learn a lot, together with them we also grow up. Therefore, working with borderline patients is worth doing.