Saturday, July 3, 2010

Emotional Sensitivity

Some of the writing about Borderline Personality Disorder by therapists and health care professionals seems to almost disparage the emotional sensitivity of sufferers who are characterized as experiencing widely varying emotional responses that can swing from anger to delight in a moment. Some portray BPD sufferers a having multiple personalities. This is not strictly true.

We do not imagine ourselves to be multiple personalities in the way schizophrenics were once perceived in the popular imagination. I believe BPD sufferers have multiple emotional responses, at the same time, to the same stimulus. We only appear to be shifting rapidly from one emotion to another. A wide range of conflicting emotions are probably present to a greater or lesser degree all at once. One is either paralysed by the opposing forces and appears emotionally blocked or one bounces rapidly between the expression of each of them.

In fear of the resulting confusion and rejection, some people mask this turmoil by behaving with a false air of equanimity. Such people are anxious to be liked, but may appear distant or insincere. They may appear calm but they are exerting great strength of will to manage their internal tensions. Feelings come to be associated with pain. Perhaps you don't know what to feel because you feel different things at once. I don't so much feel ambivalence, I feel like a pinball, rebounding from one thought to another, bouncing through the flashing, vibrating pinball machine in my head until I slip past the bumpers and, my run spent, roll down into the hole at the bottom of the machine.

I don't know anyone with whom I can share this disordered emotional chaos, except my therapist, so I have dissociated from it. I have created splits. These are not so much fully formed split personalities, but containers for the split-off emotions; it is my way to manage the chaos. By linking these splits to certain people and places, I can appear consistent and emotionally concordant (literally: being of one mind), to outside observers, so long as I maintain the role continuously in their presence. This is difficult to maintain over long periods or in painful or emotionally demanding situations. That is why people like me, despite our hunger for intimacy, feel more comfortable with either superficial attachments to others, or short-term intimacies with virtual strangers.

It seems too simplistic to characterize these symptoms as emotional sensitivity, but it is clear that such a syndrome would impact upon one's ability to form significant attachments with others. This is ironic, because I believe the emotional chaos is a result of pain experienced in infancy, the pain of an insecure, unstable or disorganized attachment to the mother or primary carer.

John Bowlby was the first researcher to develop a major study of human attachment and loss in his work "Attachment and Loss", a trilogy, the first volume of which, "Attachment" was published in 1969, and revized in 1982 incorporating newer research. The Trilogy was re-printed in a new edition in 1997 by which time his attachment theory had attained much wider acceptance.

 

Infants become attached to adults who are sensitive and responsive in social interactions with the infant, and who remain as consistent caregivers for some months during the period from about 6 months to two years of age. Parental responses lead to the development of patterns of attachment which in turn lead to 'internal working models' which will guide the individual's feelings, thoughts, and expectations in later relationships. In Bowlby's approach, the human infant is considered to have a need for a secure relationship with adult caregivers, without which normal social and emotional development will not occur.

 

Quoting from the entry for John Bowlby in Wikipedia.

I propose that in some people the particular emotional sensitivity we are discussing is a result of an insecure or "disorganized" attachment to the mother or primary carer as an infant, privation or the loss of the mother at this time or the experience of trauma or abuse whereby the mother or carer failed in her protective duty toward the child.

Some years ago BPD was not accepted as a diagnosis since some in the mental health profession described it as a manifestation of Post Traumatic Stress Disorder. I've been given this diagnosis myself, but I don't think it is accurate. A young person or adult with BPD is experiencing a transaction or interaction between an abusive or invalidating environment and his or her own emotional sensitivity. The symptoms such as splitting and other primitive defenses, lack of identity (identity diffusion), fears of abandonment, and a sense of unreality (lapses in reality testing) are adaptations to a toxic environment and/or a toxic history.

Many BPD sufferers exhibit impulsivity (spending, promiscuity), anger, suicidal tendencies, intense, discomforting feelings and close relationships in which the other person is either idealized or despised, though it hardly seems fair to characterize these as faults. Rather they are expressions of alarm, though probably much delayed, that have evolved to protect human offspring. Evolutionary psychology has influenced attachment theory so that it is commonly believed that the formation of attachments between infant and carer has the evolutionary benefit of protecting the immature young. This alarm system is built in to us to alert the carer and to protect the child.

Unfortunately, as grown children or adults, not enough has been done to help us in response to these alarm bells. The individual consequences and social costs are serious and they manifest in unacceptable rates of crime, suicide, depression, drug abuse, addiction, relationship breakdown and violence; all the social costs of a poorly functioning mental health system.

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