If you’ve worked with clients who have borderline personality disorder (BPD), you’ve probably had a conversation like this:
Therapist: How did that make you feel?
Client: I dunno.
Therapist: How do you think that might have made someone else feel?
Client: I dunno.
Therapist: Take a look at that list of feeling words and see if there’s anything that fits.
Client: Oh God. I can’t face that list today.
Therapist: Well… hm.
Client: You’re getting worried. You’re thinking about referring me, aren’t you?
Carina Frick, Simone Lang, et al answer at least half of that question in their new study. They asked clients with BPD to receive an MRI while guessing the emotions others displayed in photographs. The BPD clients out-guessed the control group of healthy subjects. The fMRIs showed they actually used different parts of the brain. They were so skilled at identifying what others feel that the mentalization term ‘mind-reading’ seems eerily appropriate.
The researchers suggest this serves as empirical evidence for Alan Krohn’s 1974 paradoxical theory. Krohn noted people with these issues usually grew up with unpredictable parents and inconsistent rules; what Marsha Linehan would later dub the invalidating environment. The clients he studied had to hide their feelings and read their guardian’s mood quickly to avoid punishment. Clients with BPD are often alert to your emotions and blind to their own, because that kept them safe through childhood.
Neurologists will be titillated by the differences in the brain activity. The fMRIs showed BPD clients’ amygdala, medial frontal gyrus, left temporal pole and the middle temporal gyrus were more active when guessing others’ emotions. The members of the control group lit up in the insula and the superior temporal gyri. Therapists will be excited that even very low-functioning clients with these issues have a common strength to build on. Two possibilities:
- Clients with BPD often feel hopeless about their abilities. We can validate and encourage them by reminding them of this skill, and how useful it is in the work world.
- When clients talk about times where it was obvious what someone else felt, I’m going to ask just what they saw. What posture did that person take? How did their face look? What tone was in their voice? What happens in the client’s throat and mouth when they reproduce that tone?
Here’s to the hope these ‘mind-reading’ abilities can be reverse-engineered towards greater self-awareness.
Frick C, Lang S, Kotchoubey B, Sieswerda S, Dinu-Biringer R, et al. (2012) Hypersensitivity in Borderline Personality Disorder during Mindreading. PLoS ONE 7(8) e41650. doi:10.1371/journal.pone.0041650
@ 2012 Jonathan Miller All Rights Reserved