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Monograph Psychospiritual Foundation Of Personality Disorders 2009


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This monograph, originally presented as three papers to the Association for Transpersonal Psychology titled The Abandoned Heart, describes an alternative model for understanding the borderline personality disorder.

Included in the monograph is a paper describing the theoretical foundations for this "energy-shift" model, and the energetic relationship between BPD and co-dependency.

Finally, a theory is offered that describes and explains the developmental functions of the soul in space and time and how these processes relate to normal and abnormal human development.

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Monograph Psychospiritual Foundation Of Personality Disorders 2009

  1. 1. 1
  2. 2. Lewis, Robert M. The Abandoned Heart. San Diego: Behavioral Science Applications, Revised and Abridged Edition, 2000 Copyright © by Robert M. Lewis, 1982, 1983, 1984, 1985, 1988, 1990, 1996, 2000. Printing 9 8 7 6 5 4 3 2 Cover photo-art and graphics by Robert M. Lewis Illustrations by Vincenzo G. Adragna and Robert M. Lewis 2
  3. 3. Preface To the The Abandoned Heart A Dynamic Energy-Shift Model of the Borderline Personality Syndrome Robert M. Lewis, Ph.D Behavioral Science Applications San Diego, California 3
  4. 4. Preface Revised and Abridged Edition Version 2000 In its original form, The Abandoned Heart monograph is a collection of three papers presented to the Association for Transpersonal Psychology at annual conferences during the summers of 1982, 1983 and 1984 held at Asilomar near Pacific Grove, California. These papers have gained a degree of recognition that could not have been anticipated. Inquiries for reprints have been requested throughout the 50 states as well as Canada and Europe. These continue to be received as of this writing, nearly twenty years since the first paper was presented. In several instances, one or more of the papers have been placed on required reading lists in graduate psychology departments that introduce their students to transpersonal issues. Although the original monograph included several additional papers that address peripheral issues, the majority of requests have been for the first two papers, which specifically discuss issues of onset and recovery of the borderline personality phenomenon. In order to meet this need, the revised edition is being made available in this abridged format. Nevertheless, since the first papers were presented, there has been a natural progression of research and understanding, which has led me to the following conclusions: 1) The original premise is correct, 2) there are many who suffer from an abandoned heart who do not display the full extent of the syndrome, and 3) the personal, interpersonal and transactional processes of human nature are imbedded far more deeply in man’s spiritual nature than I had originally assumed. These conclusions support the original assumptions, but extend them far beyond what is presented here. It is my hope that those who suffer from an abandoned heart, or who know and love them on a personal level as well as those who work professionally with these issues, will continue to explore their own spiritual nature ever more deeply. The rewards are worth the journey. Although I am presently retired from my private practice, I remain open, as I have in the past, to receiving inquires and calls from those who wish to discuss these important issues. I can be reached at the address and numbers listed below. If you wish to order additional copies of this abridged version, the cost is USD $29.95, which includes shipping and handing. San Diego, California January 20, 2000 Robert M. Lewis, Ph.D. Founding Director Behavioral Science Applications 4869 70th Street, Suite 8 San Diego, California 92115-3061 Phone 619-463-5350 / 619-750-7290 4
  5. 5. The Abandoned Heart A Dynamic Energy-Shift Model of the Borderline Personality Syndrome Robert M. Lewis, Ph.D. Edited and Abridged Version 2000 Table of Contents Preface to Version 2000…………………………………………………. 4 Introduction……………………………………………………………… 6 -13 The Model………………………………………………………………... 14 - 21 Borderline Pathogenic Development…………………………………… 21 - 32 Energy Dynamics and Symptom Formation…………………………... 33 - 36 Recovery: Initial Considerations.………………………………………. 37 - 42 Initial Summary and Conclusions……………………………………… 42 - 49 Onset and Breakdown: Setting the Stage for Recovery………………. 49 - 55 The Recovery Process…………………………………………………… 49 - 55 Psychotherapy and the Recovery Process……………………………... 56 - 59 Technological Advances: Hemispheric Synchronization……………... 59 - 62 Altered States of Consciousness and Recovery………………………... 62 - 65 5
  6. 6. The Abandoned Heart A Dynamic Energy-Shift Model of the Borderline Personality Syndrome Robert M. Lewis, Ph.D. Founding Director Behavioral Science Applications San Diego, California Introduction Historical Perspective The borderline personality syndrome is one of the more puzzling, complex, and difficult to differentially diagnose of the major personality disorders. It is also not without its special challenges in treatment. Historically, the borderline syndrome has been surrounded with controversy and a certain skepticism. Although the clinical picture had been formally described in 1911 by Bleuler, who used latent schizophrenia as the diagnosis, and while the terms borderland and borderline were utilized in 1918 by Englishman L. Pierce Clark, it was not until 1938 that the term borderline was introduced formally in American journals by Stern. Following a paper by Hoch and Polatin on pseudoneurotic schizophrenia in 1949, and two papers in 1953 by Knight, who used borderline as the descriptive term, the diagnosis of a discrete clinical entity became more common. The diagnosis has only recently been given permanent clinical status by the American Psychiatric Association, which has for the first time included the borderline personality as a diagnostic classification in the DSM-III. 6
  7. 7. Clinical Picture of the Borderline Personality 1 Much has been written concerning the clinical picture presented by the borderline personality. Although a comprehensive review is beyond this paper’s scope, a brief description will be useful. The text of the disorder, as presented in the DSM-III manual, is reproduced below: The essential feature is a Personality Disorder in which there is instability in a variety of areas, including interpersonal behavior, mood and self-image. No single feature is invariably present. Interpersonal relations are often intense and unstable, with marked shifts of attitude over time. Frequently there is impulsive and unpredictable behavior that is potentially physically self-damaging. Mood is often unstable, with marked shifts from a normal mood to a dysphoric mood or with inappropriate, intense anger or lack of control of anger. A profound identity disturbance may be manifested by uncertainty about several issues relating to identity, such as self-image, gender identity, or long-term goals or values. There may be problems tolerating being alone, and chronic feelings of emptiness or boredom. Some conceptualize this condition as a level of personality organization, rather than as a specific Personality Disorder. Quite often social contrariness and a generally pessimistic outlook are seen. Alternation between dependency and self-assertion is common. During periods of extreme stress transient psychotic symptoms of insufficient severity or duration to warrant an additional diagnosis may occur (pp. 321-322). 2 The symptoms presented by the borderline are varied, and overlap with other disorders. The most important of these are: (1) Absence of a centered sense of self-identity; (2) Strong approach-avoidance, or vacillation, in relationships; (3) Depression of significant duration; cyclothymic mood swings; (4) Anger as a primary affect, often explosively or inappropriately expressed; (5) Somatic complaints and/or hypochondrias; 1 The contributions of Vincenzo G. Adragna to the development of this model are gratefully acknowledged. 2 It is now interesting to note that the current DSM-IV includes abandonment issues as an essential feature of the borderline personality diagnosis. 7
  8. 8. (6) Anxiety, phobias, and panic anxiety states; (7) Dependency and fear of dependency; (8) Feeling of being empty, unfulfilled, bored, with difficulty being alone; (9) Inconsistent work habits, and faltering long-term career patterns; (10) Difficulty being in touch with true affect, or lack of congruence between thoughts or feelings and their expression; (11) Fear of separation from or abandonment by others; (12) Self-condemnatory thoughts, with high risk of self-mutilation or suicide; (13) Possibility of psychotic-like states of limited duration; (14) Obsessive-compulsive tendencies. Disagreement among clinicians and therapists regarding the borderline personality as a discrete syndrome stems from the fleeting and cyclical nature of the symptoms, and the not uncommon shift from neurotic patterns, to the loss of ego boundaries associated with psychotic-like episodes of relatively short duration, and back again. In addition, many borderline patients function within normal ranges a good portion of the time, and may be quite successful in their careers. It is the complexity of these processes, which shift and recycle between neurotic, normal, and psychotic-like episodes, and the observation that many symptoms of the borderline are shared with other diagnostic categories, which have contributed to the clinical controversy, and have delayed its acceptance as a diagnostic category. Even now there is disagreement concerning “borderline” as an appropriate term for this syndrome. Questions such as the following continue to be asked: What is the person afflicted with this disorder borderline to? Is it primarily a thought disorder, associated with the psychotic states of schizophrenic processes? Or is it more closely aligned with the rigidity and internal constraints of the neuroses? Is it primarily an affective disorder, 8
  9. 9. manifesting as depression, countered by explosive episodes of anger? Is its onset triggered by abnormal developmental patterns, and is it therefore a learned behavior? Or is it more closely tied to genetic and constitutional factors? This paper is the initial attempt to present an alternative, yet integrative, approach to understanding the development, symptoms, and recovery of the borderline personality. The approach may be considered unorthodox by some, perhaps radical by others. However, it is not an attempt to dispute or to replace the current ideas of others. It is, rather, an attempt to further explain the puzzling dynamics of the borderline, using a frame of reference uncommon to Western psychology and psychiatry, and to suggest some alternate means for therapeutic recovery. The concepts herein are presented in terms of a model, rather than to prematurely elevate them to the level of theory. In addition, the idea of a model more adequately encompasses the dynamics of energy flow central to this presentation, although many of the concepts lend themselves readily to the generation of testable hypotheses required of theory construction. The rigors of hypothetico-deductive thinking and empirical procedures must await the prerequisite of more intensive clinical observation, from which the ideas contained herein were initially obtained. The model to be presented has had its own historical development. Although covering a relatively brief time span, it has evolved through certain stages, each one having a bearing on understanding the model. The author made the initial observations and tentative hypotheses in the clinical setting of his private practice in individual and family psychotherapy. As the clinical model crystallized, and there began to be evidence of its application in psychotherapy, these observations were shared and explored with research associate Vincenzo Adragna during weekly discussions. It was during these discussions that many of the spiritual implications began to unfold. 9
  10. 10. Stage I was a period of exploring the dynamics of reactive (functional, uni-polar) depression with clients responding to some form of situational loss, great or small, and its relationship to anger. Stage II, a closely related and natural extension of the first, involved the complex reactions, dynamics and symptom development of clients working through the grieving process of separation, death, or their own terminal illness. It was during this period that a most interesting observation was made. Each of these clients was able to describe a certain set of somatic complaints, primarily involving deep visceral pain, in the region of the lower thorax, heart, and upper abdomen. Also experienced was a great emptiness, or void in the same region, accompanied by a sense of personal powerlessness. This symptom was more commonly expressed during periods of depression, and was often accompanied by intense separation or death anxiety. As this observation was pursued, it was noticed, consistent with object relations theory, that the symptoms disappeared when a strong emotional connection was made. This fact in itself is not surprising. It has always been a part of the human condition. However, we began to ask the question “why?” Why did the symptoms disappear? Were they related to an inner process, perhaps an energy dynamic, which could, if understood, be helpful in the recovery phase of loss and grieving? Was the feeling of emptiness or void a literal subjective interpretation, rather than a psychological metaphor? If so, what “disappeared” to produce the void and pain, and what “returned” to provide the feeling of fullness? Sometimes the fullness was associated with love, and a yearning to give of oneself. In these moments, the pain disappeared, replaced by a sense of warmth and contentment, as well as increased excitation and body tone, accompanied by a lessening of depression. At other times, the emotional response was fully experienced anger, in 10
  11. 11. which the pain temporarily disappeared, and a sense of personal power returned, but which was often accompanied by increased anxiety, sometimes reaching panic proportions following awareness of the anger. Stage III was a period of working with clients experiencing phobias, a large proportion of whom were diagnosed as agoraphobic. It was during this period that an understanding developed of the complex dynamics between intense separation anxiety, dependency, deep visceral pain, emptiness, depression, anger, panic responses and the fugue states of ego boundary dissolution, which were key to recycling and perpetuating the process. Later, similar processes were to be seen again and again in the borderline personality. Stage IV was a period of contemplation and integration. What did these observations mean? The most important observation seemed focused on clients who were experiencing intense loss of an important emotional relationship. For these clients, there seemed to be genuinely something we could describe as a “broken heart.” But what was it that was “broken?” Certainly it was not the physical heart. Besides, the symptoms were not necessarily located in the left lower thorax, but were in a broader, although still circumscribed, region. And rather than broken, it was more as if something vitally important was temporarily missing. It was, as some clients would describe, as if there were a deep hole in their very center, a hole which, when present, produced such a deep ache or pain that it seemed at times unbearable, and which prompted many of them to first seek medical attention, before being referred for psychotherapy when all diagnostic tests proved negative. An assumption about human nature, which had gradually been evolving into acceptance over the years, was the eastern religious philosophy of an energy matrix or system contiguous to and interactive with the structural system of the physical body. Was it possible that the broken heart and the symptoms, which corresponded to it, were 11
  12. 12. actually the predictable outcome of a vital energy depletion of the Heart Center, or Fourth Chakra? It was recalled that Shafica Karagula had reported observations by certain sensitives concerning swirling energy vortexes, or “holes”, receding into the body structure, which seemed to be correlated with physical or psychological pathology. Was the pain of a broken heart associated with a “negative” energy vortex, and the fullness of being in love associated with a “positive” energy vortex which extended outward beyond the boundary of the physical body to make a literal energy connection with the loved one? Tentatively at first, this idea was advanced to clients experiencing these symptoms. With very few exceptions, there was a subjective response in which the idea made intuitive sense to them. In some instances, simply the idea itself seemed helpful. If nothing else, it “explained” to them something that had been so puzzling. Some clients also began to consciously attempt to “move” the energy outward, resulting in the alleviation of symptoms. Was there an important therapeutic principle hidden here? It remained for a concentrated period of work with borderline patients for the answer to become clearer. The movement of energy outward from the Heart Center to make a connection with a loved one was later to be viewed as an ultimate act of giving, but presented a basic paradox. Energy extending outward from the Heart Center produced more fullness, whereas attempts to “take in” energy from someone else from a state of neediness eventually produced a greater emptiness. Teaching the nature of this paradox, the flip side of our normal world view, became a basic task in psychotherapy with patients experiencing the pain of a broken heart. Stage V extended further the processes of observation, contemplation, integration, and application, with some surprising results. An increasing number of borderline patients were being seen in therapy during this phase. Gradually, some basic 12
  13. 13. patterns began to emerge, which drew quite naturally upon the experiences and understandings of the previous four stages. In fact, the symptoms and dynamics of the borderline seemed a composite of these stages, with the addition of certain unique characteristics that presented a picture of greater complexity, variability, and difficulty. First, there emerged a consistent pattern of characteristics or traits, which suggested a predisposition or constitutional factor. Second, there seemed to be a typical set of developmental variables, which interacted with the predisposition-constitutional factors. Third, from this genesis arose a reasonably predictable set of dynamics which, when set into motion, could be viewed as accounting for the fleeting, cyclical, and unstable patterns of the borderline personality. Finally, as a cognitive model of the borderline syndrome emerged, opportunities arose to apply some unique therapeutic interventions derived directly from the model. The results were far beyond expectations. Indeed, for some patients recovery came so swiftly and so completely that one had to wonder if these patients were in fact borderline, even though they fit well the clinical picture. We were reminded of the medical “problem” of spontaneous remission, and were tempted to dismiss the event as misdiagnosis. However, since instances of spontaneous remission were being observed in case after case, it was felt that there might be value in sharing the model. The validity of these observations must of necessity await further corroboration by others. 13
  14. 14. 1.0 The Model Borderline Predisposition, Basic Assumptions, and Healthy Development The progressive stages of observation described above became the building blocks from which this model evolved. The most significant observation, which will be detailed as we progress, was this: The dynamics of the borderline personality appeared to be a derivative of the broken heart pattern, but with some fundamental differences. The basic symptoms of deep visceral pain, emptiness, and depression were the same. However, the symptoms of the broken heart were temporary, being the acute stage of response to intense loss. In the borderline personality, the symptoms of loss had become chronic. There had, for whatever reasons, developed a certain permanency to the depletion of energy in the Heart Center. Although it could, and often did, return temporarily, resulting in illusive feelings of euphoria, there eventually came to be an expectancy of the emptiness, void, and pain, which contributed to an ongoing dread and hopelessness. Although the depletion and void was the result of inner dynamics and processes, the emptiness and pain so often felt was not experienced as such, but was instead attached to the presence or absence of a loved one, or nurturer, which contributed to the feeling of helplessness and dependency: It was others who were perceived as ultimately in control of the borderline’s sense of well-being on the one hand, or vast emptiness and pain on the other, resulting in the constant dread of separation or abandonment. Thus the defense of projection developed and was maintained, and prevented the borderline from seeing the singular truth that would ultimately set them free. At a critical point in their development, the borderline had made a most crucial decision. Out of an agonizing sense of survival and self-protection, the decision was made to prevent the 14
  15. 15. possibility of any further pain from abandonment. This was accomplished, in one intuitive leap, by removing awareness from the locus of pain, from their own Heart. With the removal of awareness, the energy of the Heart Center became increasingly depleted, numbing the pain through denial, but with ever so costly results. The borderline had made the decision that began the process of their own pathology. They had made the decision -- to abandon their own Heart. From this point onward, the constellation of personal beliefs, feelings, and behaviors symptomatic of the borderline personality progressed in a fairly predictable manner. However, the predictability that was observed was not simply the end result of mutually interactive dynamic processes. Further, developmental variables were not enough to account for the disorder. Gradually it became more and more evident that persons with the disorder had certain general characteristics in common, characteristics which, if isolated within normal development, were certainly not pathological. As these characteristics were identified, we came to view them as borderline-predisposed individuals. 1.1 The Borderline-Predisposed Individual Certain individuals seem more prone to the borderline syndrome than others. We believe there are three primary predisposing characteristics. These are: (1) A highly sensate body, (2) a capacity for high emotional intensity, and (3) a naturally creative intelligence. A fourth, involving the possibility of a constitutional factor, will be discussed in a following section. 1.1.1 Sensate body. Borderlines have a highly sensate body, with lower than usual sensory input thresholds of pain and touch. Their bodies are very responsive to external stimuli, and 15
  16. 16. therefore the environment, especially other people. They are also unusually aware of inner body states. As a result, they tend to be sensual and pleasure seeking, as well as pain sensitive and pain avoiding. The borderline’s low thresholds involve the peripheral nervous system. This is not the same as the inadequate CNS filtering of information input hypothesized to account for some schizophrenic processes. They, therefore, have the capacity for accurately “mapping” the external world, sometimes in great detail, which seems not to be true of the schizophrenic. 1.1.2 Emotional intensity. Borderline’s have a higher than usual capacity for emotional intensity. The intensity of their emotional energy makes them inherently responsive to relationships. In its natural, undistorted state, we might view this as a love-giving, love-receiving trait, that is, having a “full heart.” When distorted, it will shift to a deficiency state of neediness, and may become a preoccupation with sexuality, perversions, or gender identity, often expressed only in fantasies, which act as substitutes for the fulfilling emotional connection and expression in love-giving, love-receiving relationships. Under the strain of repeated separation, loss of important emotional relationships, or physical abandonment, this emotional intensity will eventually provide the fuel for the pain-generated anger and later, when insulated from awareness, will account for much of the depression experienced by the borderline. 1.1.3 Creative intelligence. Borderline’s have a naturally creative intelligence. Although not necessarily associated with a high measured IQ., the borderline-prone individual is intellectually- cognitively responsive. Paradoxically, this quality, as we will see later, is necessary for the development of the disorder. Their minds are often constantly active, and they frequently report difficulty shutting off their thoughts. An obsessive-compulsive quality 16
  17. 17. develops from attempting to avoid pain and find fulfillment. To use the colloquial, their minds are “sharp,” with a quick wit, and “fluid,” being able to make cognitive associations easily. These quick and fluid qualities also make their cognitive processes slippery,’’ being unable to maintain certain cognitive sets required for a consistent self-identity, and making long-range goal-setting and attainment difficult. These qualities may also make them prone to using dry humor, often to a degree that becomes annoying to others. Although eventually counter-productive, humor is an attempt to spontaneously bring relief to the pain or emptiness they are experiencing. Although they are able to put cognitive constructs together in unusual ways, this creativity may be for better or for worse. While it allows them to problem solve productively, it also provides the mechanisms for developing intricate defensive patterns, the cornerstones of which are projection and denial, which eventually become their undoing. These three predisposing factors, each of which in their positive forms are potentially enhancing of the self, have a negative side if distorted. In Abraham Maslow’s terms, they can become Deficiency-needs rather than Being-needs, with predictable adverse consequences. In combination, these three factors can account for the tripartite essence of the borderline personality: (1) A thought disorder, giving it pseudo-psychotic characteristics, combined with (2) an affective disorder, involving both a preoccupation with sensation and a denial of true affect, resulting in (3) relationship difficulties, which not only provide the primary genesis, but serve to perpetuate the disorder as well. These factors intertwine to form the relatively predictable dynamics, which are the predominant subjective experience of the borderline. 17
  18. 18. 1.2 Constitutional Factors: A Tentative Hypothesis Individuals with a borderline disorder often report somatic complaints in the general region of the throat, thorax and upper abdomen. These generally include vague aches, pain, and neuromuscular tensions of varying intensities. We believe it may be of heuristic value to note that this is the region served by the Tenth Cranial (Vagus) Nerve, an autonomic efferent and afferent system, with motor fibers to the larynx, pharynx, lungs, esophagus, heart and stomach. It has lesser branches to several abdominal organs, and sensory fibers to the larynx and lungs (see Figure 2). We have noted, for example, that upper thoracic and laryngeal tension increases as primary emotional energy moves upward, away from the Heart Center, and decreases as the energy returns to the Heart Center. Voice register, an indication of laryngeal tension, also seems to rise and fall in correlation to the upward and downward energy movement. Other tentative observations include peritonitis, gall bladder disorders, nausea, upper respiratory ailments, heart and chest pain associated with the chronic nature of an abandoned Heart. Is it possible there is some causal or mutually causal relationship between Tenth Cranial Nerve activity (e.g., inhibition; dis-inhibition) and the instability of primary emotional energy of the Heart Center in borderline prone individuals? The question seems worth pursuing further. 1.3 Basic Assumptions of the Model Several assumptions are basic to the model. These are treated “as if” true for purposes of hypothesizing certain processes and dynamics. Consequently, there is no attempt to support the validity of these assumptions with empirical evidence for, in fact, there is none. It is a theoretical procedure familiar to the physical sciences in which an unknown 18
  19. 19. energy state, process or dynamic is advanced to account for an observable event. This has been particularly valuable to theoreticians concerned with developing a more unified theory. Assumption 1: The Heart Center, or Fourth Chakra, consists of out-flowing energy, which remains immeasurable and therefore unobservable to contemporary Western science. Only its effects are objectively observable. Assumption 2: This energy we shall call Primary Emotional Energy, and is the basis for the emotional connection between persons in a relationship. It is, therefore, the “energy of relationships.” Assumption 3: In its natural state, primary emotional energy ‘fills” the region of the lower thorax or chest area, producing the subjective experience of contentment, warmth, openness to others, trust, and giving of self (love). Assumption 4: Under certain conditions, primary emotional energy can shift away from the Heart Center, resulting in the subjective experience of a “hole” in the center of one’s self, producing either undifferentiated or specific somatic complaints of vague or unknown origin. Assumption 5: Primary emotional energy follows the “Law of Awareness” which states : (a) Awareness activates the energy; (b) The energy follows awareness; therefore, by shifting awareness, the energy will shift to the new locus of awareness; (c) Withdrawal of awareness de-activates the energy; it is potentially available, but latent; and (d) Reactivation of awareness reactivates the energy. Assumption 6: The natural state of the energy is without limit or constraint, and establishes connection (i.e., relationships) in an undifferentiated manner. That is, it “gives to all.” Assumption 7: Thoughts give form to (produce constraints upon) the natural state of the energy. Thinking (i.e., information processing) results in the formless energy being in-form-ation. Assumption 8: Thinking directs the locus of awareness. That is, one’s thoughts are responsible for shifting the locus of primary emotional energy. Assumption 9: Specific emotions are the result of thoughts (i.e., constraints) applied to the formless primary emotional energy. 9.1: Every thought (i.e., a constraint, producing a form) applied to primary emotional energy will to some degree shift energy away from the Heart Center, which is it natural “home”. Assumption 10: Primary emotional energy can be returned to its natural state (i.e., its “home”), and to formlessness, by redirecting an emotion, through the vehicle of awareness, to the region of the Heart Center. Assumption 11: Having redirected an emotion (e.g., guilt, anger, love, hate) back 19
  20. 20. to the Heart Center, it will undergo a natural transformation analogous to biological metabolism, making the energy more readily available to the self and others. 11.1: This natural transformation will change the emotion from a state of constraint (form) to a state of undifferentiation. This is analogous to the change that occurs when H20 is transformed from ice, to water, to vapor. The process allows the new thought-energy to re-fill the void once created by its shift away from the Heart Center. Assumption 12: The steady state of the return of all primary emotional energy to the Heart Center will produce a state of internal integration, and the subjective experience of fullness and wholeness, resulting in a natural, spontaneous giving of self: A parable’s parable of the Prodigal Son. 1.4. Normal (Ideal) Childhood Development Normal childhood development is discussed briefly to provide a backdrop for understanding the pathogenic processes that contribute to the borderline disorder. Ideal development for the borderline-prone infant and child (i.e., childhood interactions that will prevent development of the disorder) focus primarily on qualities of the nurturing parent. Although we will often use the term “mother,” this denotes function rather than gender, and could just as easily be provided by an appropriate male or significant non-biological surrogate parent. Proposition 1.1: The ideal mother (of a borderline-predisposed infant) has a full Heart. That is, her own primary emotional energy is strong and stabilized in her Heart Center. She is therefore centered within herself. Proposition 1.2: Because she is centered in the Heart, the mother experiences herself as full and whole, and is therefore able to give freely. Proposition 1.3: Being centered in the fullness and wholeness of her own Heart, the mother is free from projection. There is no need to attribute her internal state to those around her, including her infant. Proposition 1.4: Being integrated and whole, the mother is free from denial. There is no pain of unfulfillment, and therefore no need to withdraw awareness from any portion of herself, including thoughts, feelings, or actions. Proposition 1.5: Being free from projection and denial, the mother can maintain full awareness of her child’s essence and needs, including the infant’s needs for fusion and oneness, and later the child’s needs for separation and individuation. Neither oneness nor separation are cause for anxiety, either for the mother or her 20
  21. 21. child. Proposition 1.6: The strong, stable primary emotional energy of the mother establishes and maintains connection with the infant’s Heart Center. 1.6.1: The stability and consistency of this connection gradually serve to anchor the child’s primary emotional energy. 1.6.2: The child’s subjective experience is warmth, contentment, trust, openness, and freedom to explore fully their own nature. The experience of fullness allows for the development of their own capacity for giving to others. Proposition 1.7: The stability and consistency of the primary emotional energy connection between mother and child continues through both the separation- individuation (going away from mother), and the rapprochement (coming home to mother) sub-phases of development. This further reinforces the strength and stability of the child’s primary emotional energy, thus setting the stage for normal and fully adaptive adolescent and adult development. 2.0 Borderline Pathogenic Development The idea that developmental factors contribute to the borderline disorder is not new. Masterson (1981), for example, argues well for this viewpoint. This model does not differ greatly from others regarding what is objectively observed about the borderline disorder. Where the model departs is the level of explanation, by hypothesizing an energy dynamic rather than a psychodynamic as the primary moving force. This may account for the difficulty traditional clinicians have experienced in circumscribing the phenomena. Even so, psychoanalytic writings are not discounted, having proven quite useful in understanding the borderline personality. Developmentally, we believe there are four primary stages in the pathogenesis of the borderline. The first is the infant stage, from birth to 18 months. The second is the toddler stage, from 18 to 36 months. The third stage occurs around age seven, plus or minus one year (6 to 8 years), and is the critical turning point of the disorder. The fourth stage occurs during puberty at approximately age 12, plus or minus two years (10 to 14 years), and signals the onset of a prolonged period of formalizing and rigidifying the 21
  22. 22. personality infrastructure. This is the period, from adolescence through adulthood, in which the social consequences of endogenous factors reinforce and perpetuate the syndrome. 2.1. Infant Stage (birth to 18 months): “The Empty Heart.” The borderline-prone infant, paradoxically, has the potential (perhaps even more so than other infants), for a strong, intense Heart Center. However, as described above, the infant requires a nurturing parent with a strong, stable Heart Center to ensure the anchoring and stabilization of their own primary emotional energy. Proposition 2.1.1: Developmentally, the disorder begins when the borderline- prone infant is nurtured by a parent with “an Empty Heart” who, through predisposition, physical or emotional illness, has weak or unstable primary emotional energy, and is therefore unable to establish a consistent connection with the infants Heart Center. Proposition 2.1.2: During periods in which the infant does not experience the stable primary emotional energy connection with the parent, there will begin to occur a dissipation, shift or “drift” of energy away from the infant’s Heart Center. Proposition 2.1.3: In the infant this will be recognized to be a generalized irritability and/or crying, as if in discomfort or pain, but with no identifiable physical source. Proposition 2.1.4: Over prolonged periods, this drift of primary emotional energy away from the infant’s Heart Center will eventually produce a deeper ache of emptiness and unfilled “hunger.” The infant may begin to show symptoms of eating difficulties or digestive problems. Behaviorally, there may begin to be signs of either passivity or hyperactive movement, and may be difficult to hold, console, or put to sleep. Proposition 2.1.5: Because (1) the natural tendency of the infant is for a strong Heart Center, (2) and because the infant has not yet developed a cognitive understanding of the source of its vague, internal discomfort (i.e., a parent with an Empty Heart), and (3) because there may be other children, family members or part-time surrogate parents who nurture the infant’s Heart Center, the drift of energy may occur slowly, and may in fact return to fullness for periods of time, only to drift again if not anchored by the mother’s primary emotional energy. It is during the toddler stage, without a “change of Heart” occurring within the 22
  23. 23. mother, that the developmental process and symptom formation will become more ominous. 2.2. Toddler Stage (18 to 36 months): “The Broken Heart.” A critical period of the child’s development is the “toddler stage.” It is between 18 and 36 months that the child begins the important process of moving away from its mother, establishing separation and mdividuation, and then returning to re-experience her presence. Both the sub-phases of separation-individuation, and the complimentary sub-phase of rapprochement, are necessary for healthy development. The borderline-prone child experiences difficulty, even a sense of trauma, with one or both of these sub-phases. It is during the toddler stage that projection becomes established as a cornerstone of the eventual pathology. Proposition 2.2.1: It is during the active process of moving away from mother that the child establishes the ability to separate self from the parent, and develops a sense of self, or individuation. At first, this may cause little difficulty or anxiety for the child. Since the mother has an Empty Heart, it may even provide a sense of relief from the discomfort, or energy drain, it experiences in her presence. Proposition 2.2.2: The critical event for the child is its return “home,” for its need is to reestablish the connection with mother’s primary emotional energy. In the early stages, the child is ever hopeful that, upon return, he will experience the warmth, the fulfillment, the contentment and the oneness associated with being-in-connection with her Heart Center. Proposition 2.2.3: When the borderline-prone child returns, he finds “no one home,” for he returns to a parent with an Empty Heart. Again and again, the child experiences the emptiness, the hunger, the ache of having hopeful expectations broken. Although separation is being accomplished successfully, there is a gradual erosion of a sense of self, as the pattern of emptiness, hunger, and unfulfillment is re-experienced upon each return, for the true self-identity 23
  24. 24. of the borderline-prone child is in its awareness of its own Heart Center. Proposition 2.2.4: Gradually, as the pattern of returning home to an Empty Heart continues, the child will experience a deeper and more persistent pain in the region of the Heart Center. He will be experiencing the initial stages of a Broken Heart. Crying may be more frequent. Sleeping patterns may be disrupted with nightmares, and anxiety about death, couched in the symbolism of a child’s mind, may be noticeable. Normal eating patterns may be altered by “tummy aches” or overeating. Enuresis may be a signal that anger and depression are present. Communication difficulties, involving articulation or dysfluency may appear. As the child grows older, the tension, somatic discomfort, and visceral pain associated with a Broken Heart may reach intolerable limits, prompting irritability, angry outbursts, and acting out behaviors, or withdrawal. Separation anxiety and fears of abandonment may increase. Proposition 2.2.5: It is during this period that the child is earning a significant lesson: Other people seem to be directly responsible for either the fleeting feeling of fulfillment, or the increasingly familiar awareness of somatic discomfort and visceral pain. Thus is born the defense of projection. Proposition 2.2.6: Projection as a primary defense. The borderline-prone child is highly sensitive to two major loci of awareness simultaneously, a combination that leads directly to projection as a primary mechanism, and which eventually serves to perpetuate the borderline disorder. First, the highly sensate nature of the child makes them acutely aware of their own body states. They are natural bedfellows to both pleasure and discomfort, and may be unusually sensual as well as pain avoiding. These two qualities may predispose them later to hypochondrias, and to avoidance patterns. Second, their capacity for high emotional intensity and responsiveness to primary emotional energy connections with others which, when present, provide them with fulfillment or, when absent, are associated with emptiness and pain, make them acutely aware of human relationships, and to the movement of people in and out of their life. 24
  25. 25. In combination, these two qualities create projection, which is the process of attributing the cause of their own internal states to the thoughts, feelings, or actions of others. 2.3. The Critical Age Seven--Plus or Minus One: “The Abandoned Heart.” Up to the age of seven, plus or minus a year, the constitutional, pre-dispositional, and developmental factors associated with the borderline condition have not yet solidified to produce the borderline personality. Proposition 2.3.1: At the approximate age of seven, if the nurturing parent is still not capable of “being home” in the Heart Center (thus providing connection and stabilization of the child’s primary emotional energy) a situational crisis may occur, which will precipitate a decision by the child that will take them a critical step closer to becoming borderline. The crisis may be either major (e.g., a death), or minor (one more rejection, or emotional abandonment) in objective terms. However, it will be perceived as irrevocably traumatic by the child, thus by definition producing the crisis. Proposition 2.3.2.: Because of the now intolerable pain associated with a sudden shift of energy away from the Heart Center, the child makes the self-protective decision to withdraw awareness from the locus of pain, creating a chronic state of void or emptiness. Not realizing that to withdraw awareness from the pain in their Heart Center is to unavoidably create more emptiness, the child unwittingly makes the decision to abandon their own Heart. Thus, motivated by a sense of self-preservation, the child initiates a process which eventually leads to their down-fall. Proposition 2.3.3: The child has now firmly established the defense of denial, which is temporarily helpful, for through it the pain is dampened. It results in the denial of awareness, but also the denial of self. Self-identity thus becomes an on- going issue as the disorder progresses. Proposition 2.3.4: Although the child has made the decision to abandon their own Heart, this is protected from awareness and therefore self-responsibility through the defense of projection, already firmly established from the preceding stage. In the eyes of the child, others still remain the cause of their emptiness and pain. 25
  26. 26. Proposition 2.3.5: This stage is critical in the development of the borderline dynamics because the child is now actively directing the energy shift. This is made possible by the maturation of the child’s creative intelligence. He is now in control of logical processes, which, inevitably, given his nature, dictate an upward shift of energy to the region of his “mind” (i.e., his head). At the moment of decision, his mind has been given the role of savior, rather than his heart. Self-protection has taken the place of love. This shift could (and eventually will) also be made downward to the sex center. But at age seven, the child is entering into the latency period, reducing awareness of genitals and sexual energy. Further, school is serving to give heightened attention to the mind, adding to the logical choice of shifting energy upward to the head region. Proposition 2.3.6: As the energy is shifted upward, it may accumulate inappropriately and excessively in various body parts along the midline, including upper thorax, neck, larynx, pharynx, tongue and lips, creating tension and awareness of discomfort, resulting in various possibilities for communicative disorders. 2.4. The Critical Age Twelve--Plus or Minus Two: “The Split Heart.” It is a paradox of the disorder that the borderline-prone child has a higher than average capacity for love-giving, while those in advanced stages are often viewed as excessively selfish, needing to take from others and, in fact, seeming to have little to give in return. They can be a continual drain on those around them, and may receive more than their share of social rejection as a result. When in a state of excessive need, the borderline may actually draw primary emotional energy from others, quickly raising the discomfort level of those around them, without others consciously knowing why they are uncomfortable. When this occurs, there can be the feeling of simply wanting to escape the presence of the borderline. As people consistently withdraw from them they may react in socially inappropriate ways, which serves only to create more distance and fewer opportunities for social contact. They may have few true friends. They may not only feel lonely, they may in fact be socially isolated for extended 26
  27. 27. periods. As a result, they often have a delayed social and sexual development. It is not uncommon for the borderline disorder to be complicated by sexual issues and concerns, sometimes of a pathological nature, which may have an obsessive- compulsive quality. These may include unusual sexual practices, excessive masturbation, questions of gender identity, and masochism, to suggest the more common. These may exist primarily or solely at the fantasy level for long periods, or may break forth into episodes of acting out during the reduction of impulse control following periods of excessive stress. Many of these dynamics have their genesis during and following the onset of puberty, and occur as a function of their predispositional qualities in combination with a second major energy shift, this time downward to the genitals. Proposition 2.4. 1: The borderline-prone adolescent, following the essence of their predispositional nature, are innately sensate and sensual, emotionally intense and responsive to relationships, and creatively intelligent. When found in conjunction with a full Heart, these qualities will manifest as unusual capacities for nurturing, empathy, love-giving, and problem-solving, and they may prove to be unusually strong candidates for the healing professions. However, when present in conjunction with an abandoned Heart, an unfortunate distortion of these qualities is likely to result. Proposition 2.4.2: During the pre-adolescent years, the borderline-prone child has made a uni-polar vertical shift of energy to the head region. As sexual awareness increases during puberty, a portion of the primary emotional energy may be shifted downward to the genitals, creating a bi-polar shift, or “Split Heart,” with excessive energy accumulating both above and below the Heart Center. Proposition 2.4.3: The essence of the Heart Center is the natural, spontaneous love-giving that comes from awareness of one’s wholeness. It is a feeling of “fullness to overflowing.” It has no need to take; only to give. The shift to the head region is essentially the shift from love- giving to self-protection. Indeed, the shift was precipitated by the vast feeling of emptiness and pain. Proposition 2.4.4: As energy and awareness become split between the head and genitals, a distortion occurs. Without the mediating awareness of the Heart 27
  28. 28. Center, sexuality becomes a means of “getting” fulfillment, rather than giving it. Sexuality becomes a substitute for love, rather than love’s expression. Proposition 2.4.5: Sexual perversions, in the true sense, are acts of taking rather than giving. It is therefore not the act itself, but its motivation, coming as it does from the deepest form of confusion about the nature of one’s self, which is the perversion. The sexual pathologies of the borderline are precipitated by the bi-polar energy shifts of the Split Heart. This dynamic results inevitably in confusion about self-identity, and the identity of self-in-relation-to others as sexual beings. It is compounded by the obsessive-compulsive tendencies that result from the never-ending cycle of attempting to substitute sexuality for self-fulfillment, love-taking for love-giving. 3.0 Energy Dynamics and Symptom Formation The symptoms manifested by the borderline personality tend to group naturally into symptom constellations. However, they will change and fluctuate cyclically, appearing to give a fluid, unpredictable quality to the borderline disorder. In this section, we have organized the symptoms into groupings, which correlate with directional energy shifts. Here we suggest tentative hypotheses of energy-symptom relationships in order to provide some coherence and predictability to changing patterns of the borderline. Six major energy shift patterns are hypothesized. They tend to occur in time- sequential phases, suggesting a relationship to developmental events. Each energy pattern is presented in two parts: First, a description of the energy dynamics, followed by the symptoms which correlate with the shift. 28
  29. 29. 3. 1 Phase I: The Upward Vertical Shift Description As a pain avoidance response, awareness is withdrawn from the Heart Center. Awareness is focused on thinking processes, which are then defined as the essence of self. Primary emotional energy follows awareness in an upward vertical shift. Primary emotional energy changes from its original undifferentiated state, to the constraint of specific emotions, from formlessness to form. Initially vitalizing the natural creative intelligence, it later serves to distort reality as it is used for self-protection through the mechanisms of projection and denial. Symptom formation 3.1.1: Pain, emptiness, void, boredom As primary emotional energy shifts away from the Heart Center, it produces deep visceral ache or acute pain. The more quickly the shift occurs, the sharper the pain. The chronic state results in the subjective experience of emptiness and void in the center of one’s self. Boredom is experienced when emptiness is projected onto the current life situation. 3.1.2 Anxiety, panic states, phobias Anxiety occurs when the shift of primary emotional energy away from the Heart Center is anticipated. Panic anxiety states, often associated with depression, occur when a sudden, unexpected shift occurs. This is usually associated with a belief in the lack of support for self by others. It is correlated with depression when slowed motor, cognitive, and affective responses are subliminally recognized as being inadequate to respond adaptively to a life situation. Phobias (e.g., agoraphobia) are a learned pattern of response to a belief in the absence of support for self, combining anxiety, panic states, and depression. 3. 1.3 Obsessive-compulsive tendencies Awareness of one’s thinking process increases as the energy moves upward to the head region. Awareness, in turn, draws more energy. Excessive reliance on thought processes to protect self and avoid pain, in conjunction with anxiety, produces obsessive, repetitive, and circular thinking. Compulsive behaviors can result from the impossible dilemma of attempting to experience fulfillment through activities, rather than a return of awareness to the Heart Center. 29
  30. 30. 3.1.5 Avoidance patterns The essential formula is: “A void produces avoid.” The void in the Heart Center produces pain. A consistent motivation of the borderline is pain- avoidance. Social avoidance is the response to anticipated pain of eventual abandonment in relationships. 3.2 Phase II: The Upward-Downward Cyclical Shift Description In the borderline, primary emotional energy can return to the Heart Center if certain, usually situational, conditions are met. However, this is temporary and the upward vertical shift will again occur, usually in response to a life stress. Symptom formation 3.2.1 Euphoria, cyclothymic mood swings Many borderlines retain hope, sometimes against seemingly great odds, of eventually finding a “perfect” love relationship in which they will never be abandoned. Consequently, they may “fall in love” many times in their lifetime. Each time a potential love relationship exists, their primary emotional energy may temporarily return to their Heart Center, producing euphoria. However, since they still rely on projection, which is the belief that one’s fulfillment or pain is caused by someone else, they eventually lose trust or faith. They then re-experience the pain and depression, and fall out of love, only to keep searching and repeat the pattern, thus vacillating between hope and hopelessness, euphoria and depressive mood swings. Some, however, may give up and withdraw from meaningful social contact for long periods. 3.2.2 Approach-avoidance and vacillation in relationships The above patterns will eventually result in an approach-avoidance in relationships. Because they retain their underlying belief that others are responsible for their inner states, they seek dependence, yet fear it at the same time, producing pronounced vacillation. 3.3 Phase Ill: The Inward-Outward Shift. Description Usually in response to a love relationship, in which primary emotional energy has temporarily returned to the Heart Center, a quick shift of energy may occur in either an outward, or inward, direction, rather than upward or downward. 30
  31. 31. Symptom Formation 3.3.1 Sadness crying, joy crying The quick shift of energy outward from the Heart Center, which makes a connection with a loved one, will often produce a crying response of sheer joy. The opposite, a quick shift inward, signaling a disconnection from loss or pain in a relationship, may also produce the crying response, this time as sadness. This dynamic may also be similar to a “flutter,” in which the shift occurs in and out quickly, producing a crying response, in which the person is not sure whether they are happy or sad. 3.4 Phase IV: The Split Shift. Description This dynamic involves the bi-polar vertical shift of energy upward to the head region, and downward to the genitals, leaving a void in the Heart Center. It has been discussed at some length in a preceding section. 3. 5 Phase V: The Pendulum Shift. Description This energy dynamic results from a cyclical vacillation between projection and denial, anger and depression, as self-protective mechanisms. Although purely symbolic, the imagery of a pendulum swinging from one apex of its arc to another, with depression (denial) at one end, and anger (projection) at the other, has proven useful in therapy. These two affective responses are connected psycho-dynamically, being mutually interactive in the borderline, which swings from one end of the pendulum to the other and back again, in a cyclical pattern. Recovery requires stopping this cyclical pattern. This is accomplished by stopping the pendulum swing. The technique is to bring awareness of the energy in anger, and the energy in depression, back to the midline of the body, and “dropping” the energy, through the mediating process of awareness, to the Heart Center. Once awareness returns, it undergoes the natural transformation from emotion to primary emotional energy. 31
  32. 32. Symptom formation 3. 5. 1 Explosive anger Intense anger is generated in response to the pain, emptiness and personal powerlessness experienced from the Abandoned Heart. Projection maintains the delusion that the cause of the anger lies outside of oneself. Anger is withheld for long periods, since the anger is usually felt toward those whom the borderline feels most dependent upon. Therefore, to express anger directly might lead to driving away the very person upon whom the borderline relies for love, support and caring. Anger is experienced as threatening to oneself, since adverse social consequences may follow. When anger is expressed, a duality is experienced. First, there is a temporary shift of energy to the Heart Center, helping to create a feeling of strength and the return of personal power. However, guilt will often follow as awareness is gained of the social consequences, along with a renewed feeling of threat to self. 3.5.2 Depression In response to the guilt and threat, the energy of anger is encapsulated through denial and the withdrawal of awareness, which temporarily deactivates the energy, eventually producing, through the mechanism of depression, the slowing of motor, affective and cognitive responses. The borderline then becomes less effective, adversely influencing social, self-expressive, and career patterns. Gradually, as the energy of anger is added to the dynamics of the depression, tension builds beyond the capacity of the protective encasement of depression to contain it. The energy of anger, fed by projection, is finally forced into awareness by the disequilibrium, and the cycle repeats. Helpless to stop the pattern, hopelessness seeps in, undermining self-worth. 3.5.3 Suicide risk Awareness of depression, dependency, helplessness, sense of loss, emptiness, lack of self-worth and hopelessness combine with the energy of anger, guilt, and awareness of social threat to produce high suicide risk. 32
  33. 33. 3.6 Phase VI: The Up and Out Shift Description In response to a severe life stress, often involving separation, primary emotional energy is depleted almost completely from the Heart Center as it is directed upward and “compressed” into the head region during a panic anxiety state. Symptom formation 3.6.1 Pseudo-psychotic episodes Activated by the energy, an information processing over load stress occurs, which creates intolerable subjective experiences of tension, obsessive, circular and redundant thinking. Since the borderline does not have the healing strategy of returning energy to the Heart Center, there may be one further last-ditch attempt to push the energy upward, as a response to the intense stress. With no other directional options, the energy is expelled upward and “outward,” away from the “self,” producing an energy under load stress which creates the additional feeling of void in the head region, resulting in the feeling of non-being and unreality. Temporary fugue states may occur, in there are short- term memory lapses, and short-term hospitalization may be required. 4.0 Recovery Initial Considerations The borderline personality syndrome is the clinical manifestation of an abandoned Heart. An abandoned Heart is the chronic phase of a broken Heart. A broken Heart is the disintegration of the energy matrix or subsystem known as the Fourth Chakra, or Heart Center. Puzzling in its complexity, the borderline syndrome is often viewed as presenting special challenges to both the individual and the therapist. Because of the inherent change and flux of the symptoms which may produce a sense of hopelessness and fear of abandonment, the recovery process has been viewed as a therapeutic mine-field for patient and therapist, both of whom can experience frustration and despair. The model of the borderline personality as an abandoned Heart, derived from clinical experience, suggests hope. In this section we will outline the basic principles of 33
  34. 34. recovery. Derivations of the model, they are straightforward, and essentially simple to understand and implement. The emphasis, in therapeutic terms, is always on the basic principles underlying the development of this disorder, rather than on the symptoms. The symptoms, however, are useful therapeutically, for they signpost the underlying energy dynamics, and their disappearance in the course of therapy will be viewed as great cause for hope, something the borderline desperately needs. Further, knowing the symptom constellations, and how they interact, can be used sensitively and caringly by the therapist to communicate empathic understanding of the client’s disorder, and thereby engender the trust so necessary for successful recovery. The client is hopelessly confused by the internal disorder they subjectively experience. The therapist need not be. 4.1 The Basic Principles The basic principle, for both understanding the disorder, and implementing therapeutic processes and techniques, is the “Law of Awareness,” discussed earlier under the section on Basic Assumptions. Principle 4.1.1 A cognitive map of the disorder, including predisposition, development, and energy-symptom dynamics, has proven useful to clients. This should follow an intense period of exploring the unique subjective experience of the client. Because of the natural creative intelligence of the borderline, they often can take this information and make it work for them at a conscious level, reversing the unconscious decision they earlier made to abandon their own Heart. Principle 4.1.2 In therapeutic use of the model, the therapist should feel free to continue using all the therapeutic skills acquired through training and experience. Nothing about this model implies discarding the old for the new. Principle 4.1.3 The overriding purpose of therapy is to return primary emotional energy to its home, the Heart Center or Fourth Chakra. 34
  35. 35. Principle 4.1.4 The only guideline for the implementation of any therapeutic skill, process or technique should be the question: Does this action help return primary emotional energy to the individual’s Heart Center? Principle 4.1.5 Primary emotional energy follows awareness. To return this energy to its home, one first returns awareness to the Heart Center. Concentrated, focused awareness on the Heart Center will transform an emotion, or emotional state (e.g., anger, guilt, sadness, anxiety, depression, and sexuality) into the subjective experience of warmth, peace, contentment, fullness, and desire for love-giving. 4.2 Techniques The techniques for recovery described below involve a reversal of the original decisions and energy dynamics that led up to and perpetuated the borderline disorder. Once this principle is understood, the therapist to suit the individual needs and circumstances of the client can invent new techniques. Technique 4.2.1: Resolving Anger Anger is a product of projection. It is an attempt to place responsibility for an unwanted state or condition in one’s life onto someone else. It is an attempt to reduce the internal tension of misdirected primary emotional energy by expelling it, and projecting it outward onto someone else, rather than to return the energy to its original home, the locus of the Heart Center, which resides within oneself. Alone, or with someone you trust, lie or sit down in a comfortable position. Become aware of the anger, in all its intensity, with all the accompanying thoughts. Become aware, but do not express your awareness verbally. Next, “move” your awareness to the region of your Heart Center. This may involve a spatial reorientation, bringing thoughts and imagery from outside of yourself, back to your body’s centerline, and then downward to the Heart Center. At first, there may be experienced a burning sensation in the throat or lungs, and a strong desire to run, mentally, emotionally, or physically, from this experience by shifting awareness. However, by maintaining awareness of the anger at the location of the Heart 35
  36. 36. Center, within a short period (20-40 minutes) the burning will change to warmth, and the Heart Center will be experienced as calm, strong, and full. This indicates that the natural transformation of the emotion into primary emotional energy has occurred. This can be repeated during each occurrence of anger, but each successful attempt will reduce the total amount of anger, acquired during your life time, until it is eventually eliminated, and replaced by compassion and a desire for love-giving. Technique 4.2.2: Dealing with depression Depression results from denial of awareness of an unacceptable feeling. The denial encapsulates the energy of the emotion by removing awareness from it. The energy in therefore deactivated, and is temporarily unavailable for use, either for self-expression or work. Therapeutic paradox can be useful here. For example, “We accept your depression. It is useful to you now, and you do not need to change. Therefore, we would encourage you to be as depressed as you need to be. However, as you allow the depression, become aware of it. Become aware of all the body states that accompany your depression. Then, express to the fullest possible extent your awareness of the many body states as they arise.” At the point the client becomes aware of the unacceptable emotion (e.g., anger, guilt) hidden within the depression, follow Technique 1 (Resolving Anger). Technique 4.2.3: Pain, Emptiness and Void Pain in the Heart Center is a signal that primary emotional energy has been withdrawn. However, the borderline is unusually sensate, pleasure seeking, and pain avoiding. Their natural tendency is to avoid pain. This is attempted by the strategy of removing awareness. However, the result is the perpetuation of the pain. Pain is seen as the natural “enemy” of the borderline. This view can be reversed. Pain now can become the “friend,” since pain can now tell the individual exactly where primary emotional energy is needed for recovery. 36
  37. 37. Therefore, when the pain of emptiness occurs, it can be used as the locus for awareness. As awareness is maintained, the natural transformation will occur. The pain will become warmth, strength, peace, contentment, the experience of fullness as the primary emotional energy returns. 5.0 Initial Summary and Conclusions 5.1 Summary The borderline personality disorder, recognized only recently by the American Psychiatric Association as a discrete and diagnosable syndrome, is gaining clinical and public attention. Increasing numbers of cases are being seen in both private and publicly funded mental health clinics, suggesting we may be on the verge of a psycho-social phenomenon approaching epidemic proportions. It has been hypothesized, for example, that Vietnam veterans who have experienced extreme difficulty adapting upon their return may include relatively large numbers of borderline personalities. This is suggested by their susceptibility to abandonment depression, low frustration tolerance, explosive anger and high suicide risk, among other features. John Hinkley, the man who attempted to assassinate President Reagan, fits many of the borderline criteria. However, there are many others in our society, with less extreme public visibility, who suffer the constantly shifting emotional anguish, relationship difficulties, and interrupted or delayed career patterns also associated with the disorder. Historically considered difficult to differentially diagnose due to its cyclical and elusive characteristics, having both neurotic and pseudo-psychotic qualities with 37
  38. 38. pathological affective, cognitive, and behavioral-social components, it is confusing and difficult for the patient to subjectively understand. It breeds hopelessness, despair, and suicidal tendencies, among other symptoms. It has therefore been a most perplexing and difficult phenomenon for psychotherapists as well, with treatment times averaging three years. However, with increasing numbers being seen for therapy, length of treatment has become a critical issue. Traditionally, the borderline personality has been considered the primary clinical domain of psychoanalytically oriented psychiatry. However, borderlines are now being diagnosed and seen for treatment by psychologists, marriage and family therapists, and clinical social workers who, although confronted with a patient in crisis and in need of skilled professional assistance, may not have the orientation, resources or time to provide a long-term psychoanalytic treatment program. Further, a three year time span in pursuit of recovery has enormous costs to the patient, both economically and socially. Confronted with these variables in my own clinical, consulting and supervisory practice, I began a process, brought into focus through necessity, of reconceptualizing the borderline disorder. This activity culminated in a paper (attached) which was presented to the Association for Transpersonal Psychology (1982) and the California Association of Marriage and Family Therapists (1983), with additional presentations and workshops scheduled for professional organizations in 1983. Although still in the early stages of development and refinement, clinical observations have proven encouraging far beyond expectations. In some cases, recovery time has been reduced to under three months, thus giving hope for addressing a present need within both the mental health community and society-at-large. 38
  39. 39. 5.2 Chronic Loss, Energy-Shift Patterns, and the Borderline Syndrome The original model was based on the observation that the borderline patient displayed symptoms strikingly similar to people experiencing the intense pain, grief, anger, and depression of a “broken heart.” However, rather than reflecting an acute, one- time loss, the borderline had patterns suggesting their experience of loss had become chronic. Furthermore, their experience was compounded by an almost constant feeling of emptiness or void, which they invariably identified as being located in their lower chest and closely surrounding area. We began our clinical research with the assumption that, in addition to a bio- psycho-social being, man is an energy-matrix system, the form of which responds sensitively to awareness, thought, and choice. Following this assumption, we explored with patients their subjective perceptions of being “in love” and “in loss.” Invariably, with these patients, being in a love relationship stimulated a feeling we called a “fullness of heart,” in which there was a sense of connection with another, a feeling of expanding beyond the body’s physical boundary, and a desire to fill or give completely to the loved one. On the other hand, the experience of loss produced a profound and often excruciatingly painful disconnection, with a feeling of contracting and becoming empty, and a compulsive desire therefore to take into their own bodies something, anything, which would reproduce a feeling of fullness, alleviate the pain and boredom of emptiness, and recreate the experience of oneness sought for in their love relationships. Drug, alcohol and eating dependencies are therefore not uncommon secondary features of the disorder. In sum, our observations suggested that something (e.g., energy) was “present” in the Heart Center during the love experience, and “absent” in loss. Formulating these observations into a working hypothesis, we began searching for 39
  40. 40. means with borderline patients to assist this energy to “return to its natural home,” i.e., the Fourth Chakra or Heart Center, even (and particularly) in the absence of a love relationship which, if viewed as necessary for recovery, would unavoidably perpetuate the defense of projection, well recognized as a cornerstone, along with denial, of the borderline pathology. Initially utilizing techniques which emphasized focusing awareness on the locus of emptiness or pain in the Heart Center, we observed indications of symptom relief and recovery. Although clinically hypothesized from the model, the speed with which the patient began to experience recovery was surprising. Clinically we proceeded on the following assumptions: (1) the pain and emptiness resulted from a void or breakdown in the underlying energy-matrix system, (2) the energy-matrix system responds sensitively to awareness, thought and choice, (3) returning awareness to the locus of pain produces a return of primary emotional energy to that location, and (4) it is possible to eventually anchor this energy by maintaining the new locus of awareness for a sufficient period of time so that it no longer shifts erratically, thereby eliminating the cyclical, fluctuating pain-avoidant patterns of the borderline. Although the exact process remains unknown, permanence seems to require only that the energy be “anchored,” and the length of therapy is determined largely by successes (or failures) in this energy stabilization. A subjective result of this internal process, reported by clients, is the sensation of warmth and fullness in the Heart Center usually associated with emotional connection in a love relationship, but now occurring in the absence of such a relationship. Nevertheless, we also observed that some patients were resistant to the elusive nature of techniques which depended upon refocusing awareness, making it imperative that other treatment modalities also be found. In general, we found that those who experienced the most difficulty with awareness techniques (1) experienced more emptiness than pain, (2) had not yet broken through major areas of denial, (3) had little 40
  41. 41. experience differentiating between thought and awareness (e.g., had not previously engaged in meditation) and (5) had a greater tendency to view the therapist as an expert to whom they could look for solving their emotional and behavioral dilemmas. 5.3 Conclusions The borderline personality syndrome is a composite disorder initiated by constitutional, predispositional and developmental factors involving a dynamic cyclical shift of primary emotional energy away from the Heart Center or Fourth Chakra. As the energy moves away from the Heart Center, it accumulates in other energy centers and/or body parts of the individual, producing several discrete sets of symptoms, which correspond to the following processes: 5.1 Energy underload symptoms Energy underload symptoms, which result from energy shifting away from the Heart Center (e.g., emptiness, pain, anxiety, boredom, depression); 5.2 Energy overload symptoms Energy overload symptoms, which result from the energy shift accumulating inappropriately and excessively in other energy centers and/or body parts (e.g., tension along vertical midline, communicative disorders, sexual pathologies, panic states, and explosive anger); 5.3 Information underload symptoms Information underload symptoms, which result from withdrawal of awareness from self and/or one’s life situation, including social contact (e.g., interrupted career patterns, lack of reality testing, delayed emotional development 41
  42. 42. and unrealistic appraisal of self); 5.4 Combined information overload/energy underload symptoms Combined information overload/energy underload symptoms, which result from panic response to intense life stress, such as separation (e.g., obsessive, repetitive and circular thinking, with an attempt to forcefully expel excess energy from the head region, producing a thought disorder and psuedo-psychotic episodes); and 5.5 Behavioral changes 5.5.1 Behavioral changes producing relationship difficulties and occasional social pathology, which serve to both trigger and perpetuate the disorder. 5.5.2 Puzzling and confusing to both the borderline and therapist due to the intensity, complexity, and cyclical nature of the disorder, the individual nevertheless is not without hope. 5.5.3 Recovery can come swiftly once the basic principle of therapy is understood and implemented. The abandoned Heart of the borderline can be returned to the wholeness and fullness of its natural state by following the Law of Awareness: Reawaken awareness of the Heart Center, thereby allowing one’s primary emotional energy to return to its natural home, producing peace, strength, contentment, and a desire for giving of self. The successful outcome of the recovery process is a spiritual transformation, in which one can finally say: I Am Being Within love With you. 42
  43. 43. 6.0 Onset and Breakdown: Setting the Stage for Recovery From onset to complete recovery, the borderline syndrome may be viewed as occurring in seven stages, the progression of which moves through several overriding phases, including onset, breakdown, crisis, recovery, and a psycho-spiritual transformation. These seven stages are: Onset and 1. The Broken Heart Breakdown 2. The Abandoned Heart Crisis and 3. The Awakening Heart Recovery 4. The Heavy Heart 5. The Strong Heart Interpersonal and 6. The Full Heart Spiritual 7. The Light Heart Transformation 43
  44. 44. The Seven Stages of Onset and Recovery 6.1 Onset and Breakdown The constitutional, developmental and psychological factors, which, when occurring together and in sequence, comprise the borderline personality syndrome, have been described in detail above. However, we shall again summarize the essential elements here, hoping it will contribute to a perspective of the disorder, from its onset to full recovery in its entirety. Although the description of onset and breakdown is bleak, and the borderline’s subjective experience filled with pain, turmoil and emotional anguish, the essential message here is hope. Based on clinical observation to date, full recovery is not only possible but can occur swiftly, changing a person’s life not only in ways unforeseen, but (and I admit to editorial license here) awe-inspiring. The transformations I have been privileged to observe have touched me, as deeply as if they were my own. 6.1.1 Stage I: The Broken Heart The essence of the borderline pathology is a broken heart. Most of us have experienced an intense emotional loss, and with it the pain that we are often able to locate in a particular area of our body, usually our chest or upper abdomen. The pain may be so intense that we feel genuine concern for our physical and emotional wellbeing. Physical symptoms may ensue, motivating us to seek medical attention. What we may not yet recognize is that a broken heart, far from being simply another metaphor, is a valid subjective phenomenon. The pain and emptiness are real, because something has been torn from us. Whereas before something was present that provided a feeling of fullness and well being, that “something” is 44
  45. 45. now absent. There is, in a literal sense, a hole in our middle. It is, if we are to judge from our reaction to it, an invisible gaping ugly wound. Although first occurring during infancy, and continuing periodically throughout their lives until the final crisis which brings them to therapy, the broken heart of the borderline patient is the same experienced by all who have known catastrophic emotional loss. There is only one major difference. The borderline has known this loss not once, but literally hundreds of times. During the initial phases of treatment, it can be especially meaningful to the patient if they sense the therapist has an intuitive and sympathetic understanding of the subjective emotional significance of a broken heart. It is helpful for the therapist to know their own emotional pain in this way. And it is useful to be sympathetic to that special insanity that can follow loss: The grieving process, profound depression, frustration and futility leading to rage, to helplessness in the face of overwhelming emotional adversity, the undermining of self-worth from nameless guilt, and hopelessness leading to suicidal ideation or action. It is helpful for the therapist to intuitively know this, and more, for these comprise the foundation of the borderline’s subjective experience and existential dilemma. Often, however, the borderline’s walk through life is not met with empathy, much less sympathy. They are in actuality quite disabled for lengthy periods in their life, but appear to others to be very much the master of their own fate. Expectations from others are often high, yet their own competencies, particularly interpersonal ones, may be severely underdeveloped. Later in life, career patterns may falter for these underlying, unseen reasons, thus leading to greater frustration and eventual explosive rage. 45
  46. 46. The pain of a broken heart leads to symptoms interpreted as physical. These may range from appetite loss to nausea, from irregular heartbeat to symptoms mimicking angina. Physical pain in other body parts is not uncommon. Although medical attention is often sought, there usually is no basis for diagnosis. Disenchanted and unconvinced, the borderline may drift from physician to physician until a mental health referral is finally made. The psychotherapist who can assess within the first session or so the presence of a borderline syndrome, and then work immediately toward uncovering the multiple experiences of loss by encouraging them to tell their life’s story, will often be rewarded by the statement, “This is the first time I have ever felt understood.” Although payment for therapy is always appreciated, it will never replace the feeling one receives from a borderline’s gratitude. For most of us, our first broken heart does not occur until adolescence, or later, when we have a strong, usually sexually energized connection with another person. Not so with the borderline patient, who through predisposition, constitutional factors and family history, has lived through that experience multiple times, usually hundreds if not literally thousands, since infancy. 6.1.2 Stage II: The Abandoned Heart The child who is constitutionally prone to the pain of a broken heart is in greater than usual need of consistent, stable emotional nurturing from a parent well-grounded and secure in their own sense of self, and whose primary fulfillment comes from resources not directly tied to the child. The nurturing principle of empathic non-possessive, emotionally warm caring, provided by a mother capable of emotional and non-erotic intimacy while encouraging independence applies to this situation. 46
  47. 47. So, imagine the child in vital need of this nurturing. Yet also imagine that each time the child comes to the parent to fulfill this need, the parent is unable to respond. The parent has an “empty heart,” unable to connect emotionally with the child. For the child, the parent may be physically there. But emotionally, no one is home. For the child, seeking merely to have their own Heart Center affirmed, each time they approach the parent without the fulfillment of connection, their primary emotional energy drifts. It moves away from its center. And each time it drifts, each time it is not allowed to connect and to stabilize, there is an empty ache. At first the ache may be but a gnawing hunger. But each time it becomes stronger, more and more a dominant part of awareness, until finally it becomes pain, the pain we know as a broken heart. This process, for the borderline-prone child, occurs not once, but again and again, a thousand times, uncountable times, until the pain reaches intolerable limits. Drastic measures for self-survival are necessary now, and the child responds. The acute pain of a broken heart has multiplied once too often: It has become chronic. And the child responds, attempting to forever remove awareness from the pain’s locus. However, without recognition of the enormous implications, the child has abandoned not their pain, but their own Heart. They have abandoned awareness of their own essence. And thus doing, they have begun a process of breakdown, which will lead them, step by anguished step, toward the syndrome we now know as the borderline personality. 47