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meditation and personality disorders
anger suffering
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8/6/10 10:25 AM
Hello everyone. I follow this topic since quite a while now but there are just scattered hints available but nothing like a solid overview. I'd be really grateful if anyone could add more information on this topic which is..

as Dan Ingram points out (Mastering the Core Teaching of the Buddha, chapter on re-observation), advanced mindfulness practices can successfully be done by people with borderline (DSM-IV 301.83) or antisocial personality disorder (DSM-IV 301.70), making the trip probably rather wild.

Personally I seem closer to the first but more interesting to me is the latter in conjunction with meditation, including diagnostic criteria not really guaranteeing big scores in morality, mindfulness or concentration:

Apparent lack of remorse or empathy; inability to care about hurting others
No personal experience of suffering (as explicated in "The Sociopath Next Door" by Martha Stout, Phd except inability to tolerate boredom
Poor behavioral controls, impulsivity and/or recklessness
Persistent lying or stealing
Disregard for the safety of self or others

Mindfulness techniques also seem to be some of the few approaches which have any effect in the treatment of borderline (which seems to resist anything else) and are a core element of Dialectic Behavioural Therapy by Marsha Linehan. They're also applied in genuinely buddhist flavoured treatment approaches like the one of Edward Podvoll.

So my questions are:

  1. Does this mean that somewhere in the future there will be an epidemy of hight risk, weird symptom meditators in the re-observation stage? The ajahns, rinpoches and roshis might be puzzled, won't they?
  2. Are there any people out there having personal experience about the effect of meditation or know about such cases?
  3. How do affected people, especially those falling in the antisocial category, experience meditation and how do meditation triggered changes in experience interact with the disorder? I'm thinking especially about the possible dissolution of the self-other distinction like described e.g. in the "spiritual rollercoaster"-chapter in Jack Kornfields "A Path With Heart" and as I know it from my own experience. Should't this be the maximum possible impulse towards empathy or a non-aversive habit at least?
  4. How do people of the antisocial category come to meditation at all?
  5. What are the possible special difficulties that anybody affected or his environment has to face in the dark night according to empirical evidence?
  6. Does Dan Ingram think about specializing in psychiatry (for which he seems unusually qualified) or does he prefer his emergency doctor job (ambulances, helicopters, adrenaline...?)?


The only personal encouter with this topic is a friend of mine who was labeled as suffering from schizoaffective disorder, with frequent stays in mental hospitals ranging from days to half a year. After introducing her to anapanasati she immediately could handle it quite well and seemingly profited a lot by increased perception of her own agressive and destructive impulses which before she tended to project etirely at her environment. In a course of about five years her hospital stays reduced to one to two per year, usually only for one day.

Personally I gained tremendously from 10 years of mindfulness practice (which was very much on the "stuff"-side as I have to admit, but the stuff just presented itself predominantly before I crept up the insight stages for the first time a while a go) in terms of abilities to perceive and handle emotions and impulses with a definitive increase in my empathy-score. But my practice also started from a comparably moderate level of madness.

More on that can be found in a lot of publications (e.g. see the summary of clinical research by Klaus Engel, "Meditation", vol. 2, "Theory and Empirical Research"), but seemingly no specific info can be found related to antisocial disorder.


Greetings, Stefan

RE: meditation and personality disorders
Answer
11/25/09 3:17 AM as a reply to chamaeleon yogi.
Seems there's not much resonance available. Nevertheless, spending my time in the Nilambe meditation center in Sri Lanka more reading than meditating I found this:

In "Transformations of Consciousness" (Wilber/Engler/Brown, Shambhala, 1986) the authors explore the interaction of personality organisation and mindfulness meditation along the progress of insight as laid out e.g. by Mahasi Sayadaw (same title, 'The Progress of Insight'). Case studies are mentioned anecdotically, but the euvre is not about case studies in particular but about psychological/psychiatric theory.

(Engler, p. 30 ff) Mindfulness meditation is an "uncovering technique" which individuals with a mental borderline organisation can not bear, as it is the same with psychoanalysis for example, if used as an uncovering technique only.

Mindfulness meditation requires technical neutrality ("bare attention"), removal of censorship, abstinence (observation rather than gratification of wishes, impulses, desire and striving) and an "therapeutic observer/observed-split" in the ego of the practitioner. All of them presuppose certain ego capacities which define a normal or neurotic level of functioning and personality organisation ("one that is differentiated from others and has an degree of autonomy", p. 39). These may be seen as quite usual capacities, but in case of borderline organization they are weak or absent. The borderline ego is not capable of consistently maintaining this attitudes or integrating their outcome.

People with weak ego structure who nevertheless practice mindfulness meditation may oscillate between great rage, feelings of emptiness and depression and great euphoria, bliss and mystical feelings, disintegrating their egos even further.

All this may not be overcome by overcoming the ego in the buddhist sense, rather it seems that it is an ultimate blocker for progress in insight meditation. "Paradoxically, it is precisely their self-pathology [...] their consequent lack of a cohesive, integrated sense of self, that makes meditation based on self-detachment difficult, if not impossible" (p. 33), to such an extent as that the author supposes an built in self-selective and self-protective mechanism (p. 38). A view that is also supported by Wilber (p. 143) in saying that these individuals with significant borderline symptoms hardly may develop to the stage of equanimity. Put in short: "one has to be somebody before becoming nobody".

Despite that buddhism seems to have a special attraction for people with borderline organization because of its non-self doctrine, which they relate to their fragmentally sense of self, as well as they tend to confuse the emptyness-doctrine with a personal feeling of being empty.

As opposed to mindfulness meditation the authors think that prelaminary practices and concentrative meditation may be beneficial also in these cases.

Considering all this it is still not clear how many borderline yogis (not to speak of antisocial yogis whose deficiencies seem to be even more severe) are out there evoking unresolvable nightmares of a kind that they did not encounter since their early childhood ("pseudo-dukkha" in the terms of the authors, pointing at non-insight-problems arising in insight practice), being encouraged by their teachers to go on practicing (since usually they have no idea of the psychological factors involved) just to be messed up even more (which also was my experience in a retreat in the Mahasi-tradition). The authors suggest to stop practice entirely in these cases for at least a few months and to try to reestablish some firm ground to stand on, probably using "structure building" therapy, as opposed to mere "uncovering" techniques. I agree.

Using this occasion I also want to advertise the discussion about bipolar disorder and the cycles of insight sharing some flavour with the one here but it seems somehow stale by now, so nobody reads the last posts (veeery substantial) added by me. I mean, it seems really to add to the discussion and topics are really overlapping.

RE: meditation and personality disorders
Answer
10/28/09 5:15 PM as a reply to chamaeleon yogi.
Your posts are so complete and thorough that I can't really respond to both at the same time. So I'll try to respond to the questions you mentioned in the first one, and then hopefully I'll remember to come back and talk about your second one. If not, then bumping the thread will work if you want me to respond to the second post.

1. Does this mean that somewhere in the future there will be an epidemy of hight risk, weird symptom meditators in the re-observation stage? The ajahns, rinpoches and roshis might be puzzled, won't they?

I don't know how many people with full blown personality disorders will actually do full insight meditation. I think that as more and more mindfulness-based practices like the Dialectical Behavior Therapy so successful for things like Borderline Personality Disorder become a part of Western psychotherapy, an attitude will develop that you don't need to do Buddhist meditation to get the mindfulness benefits for psychiatric/psychological problems. Whether or not that attitude will be correct will depend upon how effective future mindfulness-based psychotherapies are.

That said, every personality disorder has a corresponding non-pathological personality type. For example, someone with histrionic personality disorder has a huge need for attention and uses emotional displays, charm, sexuality, and position to make other people pay attention. Their speech is vague, but very animated and even captivating. However, someone who has a histrionic personality type demonstrates the adaptive (rather than maladaptive) sides of these traits. They are charming while still genuine, emotionally expressive but not manipulative, and they enjoy attention but do not demand it "or else." However, the underlying factors of emotionality, charisma, and desire for attention are still there, even if manifested in vastly different ways. Maybe a meditator with a healthy personality type that resembles one of the personality disorders will experience some similar inner territory.

2. Are there any people out there having personal experience about the effect of meditation or know about such cases?

I don't know any people with personality disorders that meditate, though I know some people with personality disorders that I sure wish would meditate.

3. How do affected people, especially those falling in the antisocial category, experience meditation and how do meditation triggered changes in experience interact with the disorder? I'm thinking especially about the possible dissolution of the self-other distinction like described e.g. in the "spiritual rollercoaster"-chapter in Jack Kornfields "A Path With Heart" and as I know it from my own experience. Should't this be the maximum possible impulse towards empathy or a non-aversive habit at least?

People with antisocial PD are notoriously resistant to any attempt to change them. I would guess that if someone with APD started to somehow develop empathy and caring, they would probably stop meditating and let the effects die out. Maybe I'm wrong though -- I've never seen any studies. But it seems more likely that in meditation, as in psychotherapy which also deals with the sense of self, the APD individual would simply never develop caring and empathy regardless of how much a "normal" person would develop those qualities in the same circumstances
.
4. How do people of the antisocial category come to meditation at all?

If they do meditate, their only motivation would be personal gain. Perhaps they are after the siddhis in an attempt to be able to control other people, or they want the status associated with being a spiritual teacher. A great book to read is Saints and Psychopaths. If that link doesn't work for you, let me know. I have the document on my computer and I can upload it somewhere else if you can't use Scribd.

5. What are the possible special difficulties that anybody affected or his environment has to face in the dark night according to empirical evidence?

I've never heard of any empirical evidence about this, and I'll refrain from guesswork and anecdotes since you specifically asked for empirical evidence.

6. Does Dan Ingram think about specializing in psychiatry (for which he seems unusually qualified) or does he prefer his emergency doctor job (ambulances, helicopters, adrenaline...?)?

I'll leave that question for him to answer if he wants to.

RE: meditation and personality disorders
Answer
11/1/09 1:41 AM as a reply to chamaeleon yogi.
Dear CY,

Your analyses are insightful, interesting and relevant.

Thanks for taking on this not-so-easy topic.

For some explorations of people with Cluster B personality disorders and meditation, the classic case series is Bill Hamilton's Saints and Psychopaths, whose link has been nicely included above.

Beyond that, definitely like the action-oriented Emergency Department: no other branch of medicine really fit my energy level and get-it-done now attitude.

As to lots of psychopath meditators out there, I haven't found any great wave of them, but have run into about the standard number, a few in a hundred with Cluster B traits of significance, which is more than enough to cause trouble and drama.

As to your references and quotes, they are very interesting and I am grateful for them.

RE: meditation and personality disorders
Answer
11/25/09 3:13 AM as a reply to J Adam G.
Ha! There's response indeed!

After recherche about histrionic personality disorder (DSM-IV-TR 301.50) it seems to me that it previousely has been known as hysteria, maybe the classical type of neurosis. Wilber e.a. point out that a neurotic level of functioning is pretty good and can't compare at all to, what they call, deficiencies in personality organisation like appearing in borderline pd. Whatever this means. I'm not really an expert in these issues, just someone who has read a bit (but maybe you are, having had the histrionic thing at hand quickly, which I've hardly ever heard of before). So although the the borderline and histrionic criteria list may be significantly overlapping, the related inner territories should be totally different.

As far as I've grasped there's criticism about these schemata anyway: the DSM and ICD pigeonhole lists should lack the conceptual background that give these differences much significance according to our question. They entirely target on behavioral aspects and about which number to choose from the list in order to profit the associated refund for that number from the social insurance, given that there is a system of social insurance in the country of question. We'd probably have to find some semantically more rich models of our favorite diseases, but this may approximate some sort of exegesis for texts that approximate religious dogma, at least as far as Sigmund Freud and descendants are concerned, and I'm not so much into intellectual shadowboxing.

But as we're about to guess anyway, some guesses about the motivation and meditational development for APDs came to my mind, quite opposed to yours, as it seems to me, perhaps just the reversed intellectual echo of your arguments:

  • Concentration states are nice and even infamous for being potentially addictive, so they should be for APDs, who are quite into comorbid substance abuse anyway
  • The progress of insight has some entertainment value, especially the special effects section like mentioned in the "spiritual rollercoaster" chapter of Jack Kornfields "A Path with Heart". This may counteract boredom, which is the only mental state APDs seem to disgust (acc. to the reference given above)
  • Meditation can be a tool to handle boredom. But what seems questionable to me at this point is the prominent position of boredom in this question, since it hardly ever is a mental state in its own right but rather some camouflage for potentially anything else, as long as that is a pain in the ass
  • APDs may resist any attempt change them, but this implies that someone tries to do that. Change triggered by meditation on the other hand does not come from anybody, it just happens. I also can't see the reason why APDs should disgust empathy, which seems quite unlikely to arise anyway, since empathy would raise the overall emotional entertainment value, reduce boredom and may map somehow to the range of primary emotions of which is said that APDs are capable of. That are desire/lust, aversion/aggression/fear. Given that range of possibilities there's a probability of 50% that empathy will be perceived positively.


What also seems questionable at this point is this oversized motivation of mine about the issue of transforming, what on other places, and I really don't like this notion, was called "reptiles in human bodies" into meditators. Maybe it has just the best entertainment value of all the icd issues.

RE: meditation and personality disorders
Answer
11/18/09 1:17 PM as a reply to chamaeleon yogi.
chamaeleon yogi:

As far as I've grasped there's criticism about these schemata anyway: the DSM and ICD pigeonhole lists should lack the conceptual background that give these differences much significance according to our question. They entirely target on behavioral aspects and about which number to choose from the list in order to profit the associated refund for that number from the social insurance, given that there is a system of social insurance in the country of question. We'd probably have to find some semantically more rich models of our favorite diseases, but this may approximate some sort of exegesis for texts that approximate religious dogma, at least as far as Sigmund Freud and descendants are concerned, and I'm not so much into intellectual shadowboxing.


The DSM and ICD criteria certainly have their problems. However, as you mention, part of the problem is that those classifications are not really designed to fully communicate the specific nature of one individual's mental health problems. There's still disagreement within psychiatry and psychology as to exactly what the DSM should be, but few have ever called for it to involve rich descriptions of a person's inner territory. It isn't used just to get diagnosis codes for insurance companies, but also for categorizing people in studies of mental illness. If lots of studies on ADHD are done, it helps the general body of research for all of these studies to use the same, primarily behavior-based description of what ADHD is.


There is a diagnostic manual that attempts to provide a more thorough description of the inferred inner territory of an individual psychotherapy client, called the PDM or Psychodynamic Diagnostic Manual. As the name implies, it's based on psychodynamic theories of mental illness which generally involve the far descendents of Freud's work, but much more modern with a cognitive psychology flair. I don't know too much about it, but perhaps what it has to say about APD could reveal something interesting.

chamaeleon yogi:

  • Concentration states are nice and even infamous for being potentially addictive, so they should be for APDs, who are quite into comorbid substance abuse anyway
  • The progress of insight has some entertainment value, especially the special effects section like mentioned in the "spiritual rollercoaster" chapter of Jack Kornfields "A Path with Heart". This may counteract boredom, which is the only mental state APDs seem to disgust (acc. to the reference given above)
  • Meditation can be a tool to handle boredom. But what seems questionable to me at this point is the prominent position of boredom in this question, since it hardly ever is a mental state in its own right but rather some camouflage for potentially anything else, as long as that is a pain in the ass
  • APDs may resist any attempt change them, but this implies that someone tries to do that. Change triggered by meditation on the other hand does not come from anybody, it just happens. I also can't see the reason why APDs should disgust empathy, which seems quite unlikely to arise anyway, since empathy would raise the overall emotional entertainment value, reduce boredom and may map somehow to the range of primary emotions of which is said that APDs are capable of. That are desire/lust, aversion/aggression/fear. Given that range of possibilities there's a probability of 50% that empathy will be perceived positively.


These seem like very good points to me. I suppose my own statement that APD individuals would only meditate for personal gain was not articulated very well. I would consider concentration states and the avoidance of boredom as personal gain for the APD individual. I especially would agree with your statement about the concentration states -- the more calculating APD individuals would absolutely love jhana! I would think that the more rash individuals would find traditional drugs easier, however.

One nitpick -- the probability that someone with APD would perceive empathy as positive is not a random 50/50 coin-flip event. A value of 50% needs to be substantiated by evidence because we can't infer how likely any choice is based on an assumed equal distribution of probablity amongst those choices.

chamaeleon yogi:

What also seems questionable at this point is this oversized motivation of mine about the issue of transforming reptiles in human bodies into meditators. Maybe it has just the best entertainment value of all the icd issues.

It's certainly interesting enough though, isn't it? While I think DhO is intended for practice-focused discussion, I think it's good that there are parts of the forum where these kinds of theoretical discussions can happen too. As long as theory doesn't overtake practice, this kind of discussion doesn't need any justification.

RE: meditation and personality disorders
Answer
1/17/10 6:47 AM as a reply to J Adam G.
Hi. 50% ... sure, just wild guess emoticon

Btw it seems that with a solid dose of some SSRI (selective serotonine reuptake inhibitor) procedures can be reasonably shortcut given somebody suffers from APD effects, see here.