|This article is published in the book:
"Psych 101 -
What you didn't learn in nursing school."
by Kathi Stringer
Paperback: 320 pages
Borderline Personality Disorder
Written by Kathi Stringer
July 4, 2003
Individuals with borderline personality disorder usually cannot tolerate ambivalence. Webster’s defines ambivalence in this way, “simultaneous and contradictory attitudes or feelings (as attraction and repulsion) toward an object, person, or action” and or “continual fluctuation (as between one thing and its opposite).”
Since the borderline pathology is fragmented, problems are routed into black and white thinking. The fragmented individual for the most part does not view people in shades of gray, but as all good or all bad. The fragmented mind routes ‘good’ into good clusters, and ‘bad’ into bad clusters. These clusters are not integrated because to do so would cause frustration, impulsivity or even rage.
Let’s take a closer look. An individual with borderline organization clings, loves and shadows her spouse. Then out of some provocation, the spouse triggers anger. This anger is directly connected to an event that just took place. We call this layer 1-anger (Vaknin), and this anger is routed and connected into the bad cluster (splitting), layer-2 anger. What we have now is the appropriate anger (layer 1) fused with the unresolved anger within the fragmented bad clusters (layer 2) that creates an amplified and inappropriate anger (splitting). Thus layer 2 amplifies the original anger (transference - projection). In other words, the target of the anger has been split-bad with amplified anger.
The target was split-bad since the individual with borderline organization cannot tolerate ambivalence – “feelings attraction and repulsion toward a person.” The defense mechanism – “splitting” is kicked in to prevent a further breakdown toward psychosis.
Let’s look at few examples concerning ambivalence.
The fragmented individual is asked to make ‘goals.’ There is an instant disturbance, a conflict within the mind. One fragment says, “I want to die” and another fragment says, “I want to live” and still another fragment says, “I want to flirt with self-dangerous behavior.” As each of these fragments pull, tension and anxiety begin to mount. The 3 fragments in our example create ambivalence within. As the ambivalence rises, so does the anxiety. If the individual decompensates, we have an individual that cannot tolerate ambivalence. In this case, the thought of ‘goals’ created a conflict.
It is easier to live in a black-and-white world, a solid yes, or no, without inviting details to muck up the decision making process. Decisions are easier to make when they are a ‘slam-dunk.” However, the lower level individual with borderline organization will become overwhelmed if too many conflicting issues are thrown into the mix. It is as if the frustrated individual would scream, “I CANNOT TOLERATE AMBIVALENCE!” Leave me alone! Stop doing this to me!
It would be helpful to practice Ambivalence toleration to hatch out of the splitting defense. If an individual’s anxiety begins to rise out of a decision-making process…it would help to step back and observe that what is taking place is due to ambivalence. Keyword – Focus. When there is a ‘twang’ in the pit of the stomach and time feels pressured, then bring the key phrase “ambivalence toleration” to the forefront of the mind. Awareness is the first step to tolerate ambivalence anxiety.
Once the individual has identified ambivalence, she must be mindful of the conflicting sources. Encourage her to identify them. Once identified, there will be an essence of regaining control. Encourage her to hold the conflicted sources at length without acting on them. This will be like working out with weights. Each time ambivalence is identified, hold it, do reps with it like a weightlifter to gain strength. It is like working out. Begin with “ambivalent weights” that are “lighter”, then, after holding them for longer periods of time the individual will advance to levels of ‘heavier’ ambivalent weight.
One can always run from ambivalence, the trick is to hold it,
tolerate it, for maximum ambivalent toleration. With practice, one can
be a champion that is able to tolerate ambivalence. Practice!
Cognitive Restructuring & Modification
"…I can now see from the outside, how/why the non-borderline think it should 'make sense' when explained this way. It would, if our brains could think clear. They can't and don't because of neurochemical bombastment. And that seems to be the least thing taken under consideration. In my opinion."
After over 30 hospitalizations from poor ambivalence toleration, I really do understand this, there is just one more thing...I didn't address it because the topic was on ambivalence, but this is the rest of it.
Not just cognitive restructuring by NO means. That is 'only half of it." The other half is modification of the closed core structures by a skilled treater. Medications act as stability until some of that restructuring can be accomplished.
There is evidence that early crisis can cause biological problems in the brain. I am suggesting that by altering the closed core structures, meds are needed less. Through modification and cognitive practice...it can be accomplished. In other words, the treater is just as responsible as the client here, the treater even more so. Winnicott said that the patient does not fail, only the treatment fails.
- The Iron Mask -- Sam Vaknin Ph.D.