Angels at OWLAG

ANGELS AT OWLAG

My mother had a deep, unwavering faith. She reminded me just before she died that once she got to heaven she would ensure that my guardian angels would not slack off in accompanying me along my journey.  This is the story of an encounter with my celestial companions. It occurred at the end of a week of teaching wellness at the Oprah Winfrey Leadership Academy for Girls in South Africa. Oprah founded the school in 2007 to give academically gifted girls from impoverished backgrounds an education that they would not otherwise have been able to afford. Her goal is to tap these girls’ leadership qualities and intrinsic motivation to make their communities, society, and as a consequence, the world, a better place. To have been given the opportunity to spend a week teaching wellness to these young scholars was a gift unto itself. And it is within this backdrop that the story unfolds. Some may quibble as to the specific details of what happened that night and the next morning, but here it is as I remember it.

THE CONTEXT

Whether by total chance or by design, the perimeter track of the OWLAG Academy happens to be exactly a mile. I know this because many of the staff told me so, but also, being the skeptic that I am, I know because I measured it.  I used my Garmin watch and, starting at the gatehouse at the entrance of the school, ran once around the dirt track that surrounds the grounds. My watch read one mile precisely. “Love is in the details,” Oprah had told me as we toured the school grounds, lovingly garnished with artwork, gardens and architecture. So perhaps the one mile was by specific design—I still don’t know.

Anyway, when I heard that it was a mile around, and after verifying the distance, I had the thought of running 26 times around the school—almost the exact distance of a marathon, which is 26.2 miles. I have run 56 marathons and ultra-marathons in my life and as recently as 2012 I was running about three marathons a year. In more recent times the increasing demands of work have reduced my exercising to an hour in the gym every morning with a bit of running on the weekends. So on the one hand, I had some stamina and the memory of fifty-six marathons in my legs but on the other hand I was definitely not in shape to run the distance.

The Wellness Week at OWLAG started on Monday and ended on Friday.  The week was dedicated to the complete wellness of the students, or learners, at the school. The Wellness Team included the irrepressible Dr. Bruce Perry, MD and the even more irrepressible Ms. Iyanla Vanzant. The focus of the week was centered on the spiritual, physical, mental and intellectual well-being of the entire OWLAG community, both teachers and non-teaching staff.

With the irrepressible Dr. Bruce Perry, MD

THE BEGINNING

On Thursday, I had mentioned to Becky Sykes, the Head of the OWLAG Foundation, that I was considering running 26 times around the school on Saturday morning. I will digress for a sentence or two to say that I know why Oprah chose Becky to lead the foundation. Becky gets things done. Becky asked me what I would need to do the marathon and I said perhaps a small table with some water, bananas and energy bars and not much more than that. The next day, Friday, was the last day of the Wellness Week.  After the morning teaching and a celebratory whole school lunch attended by everyone , the day was punctuated by a stunning hour-long theatrical dance performance by the girls.

With Oprah and the inspirational Iyalna Vanzant 

Afterwards, the Wellness Team together with Dr. Perry and Ms. Vanzant was invited to Oprah’s house for dinner and drinks.  It will come as little surprise to the reader that dinner was delicious. However, and I tell you solemnly that as someone who has enjoyed fine wines throughout my life, Oprah’s cellar offering was exceptional. So much so that my dear friend Dr. Perry eschewed his abstinent ways and agreed to share a few glasses of wine with me. The night flowed like the wine and 10 o’clock became 11 then 12 and 1. At some point during the night, and my memory fails as to precisely when, Oprah approached and said that she had heard that I was going to run a marathon around her school. She looked bemused, maybe even skeptical. Or perhaps it was the look she would give the guests on her show just before asking them a most serious question. She held my elbow gently while waiting for an answer.

“A marathon? Who told you? Yes! Of course I am going to run 26 miles tomorrow!” She took my glass of wine and ensured that no more headed my way. I am not sure how she did that but I imagine a nod to the keepers of the wine did the trick. Next she handed me a bottle of water, and then another and another. “You need to hydrate.” Oprah refused to accept my insistence that the wine was carbo-loading, so Bruce and I decided to call it a night. Becky had long ago headed off to bed and reminded me before she left that she would be picking me up at 5:30 in the morning.  We left the house at 1:30 and I was asleep by 1:45 for what seemed like 15 minutes. I cursed at the clock by the bed blasting its alarm, insisting that it was 5:15. The exhaustion after a week of teaching and the added lingering effects of the remarkable wine made me certain that only 15 minutes had passed [repetitive] and that the clock was wrong. ‘Great, I still had a few hours to rest,’ I thought to myself,  but my watch was having none of it and agreed with the clock by simultaneously beeping with an unpleasant, repetitive threefold of beep beep beep, beep beep beep, beep beep beep.   

More than anything I wanted to climb into bed but the thought of having Becky wake up to come pick me up induced a level of guilt that allowed me to fight the urge to crawl under the sheets. I jumped into the shower and blasted the cold water, standing there for as long as I could before getting out and putting on my running gear.

5:30 A.M

Not surprisingly, Becky appeared on time, and had the bemused look that Oprah had displayed the previous evening. She too brought some water, and I drank a bottle, and then another, which helped me steady the spinning in my head. We drove to the school and entered through the main gate. Just on the other side and in front of the administration building, the staff had set up a large table with bottles of water, energy drink, bananas, and energy bars. The guards at the gate offered an encouraging smile and thumbs-up as I stretched and downed more liquid. A few minutes before 6, Becky took a pre-marathon photo.  She told me to call her when I was done or to let her know if I needed to head back for whatever reason.

Pre-Marathon

6 A.M

I will share a thought with you now that I had only shared with myself at the time and that was that I was going to do three miles and then call it a day. I was too tired and the headache too strong to do more than that. Surely I would have a story to tell after three miles, one of teaching and wining and dining—on Oprah’s wines no less—and getting up early to run some miles. Who could fail to be impressed by that?

 Thankfully, the combination of a lot of fluids and the cold Highveld air took my headache away. I imagined doing a few more miles and continued to jog at a modest 9:30 pace, stopping at the table each lap to have a long drink. After my fifth mile, some early morning teachers appeared on the track and greeted me warmly as I jogged by, adding energy to a tired soul. Soon I got to six miles, nearly 10 kilometers in just about an hour. ‘I think I have one more in me,’ I told myself. After all, if three miles was a story to tell, then seven miles was even more impressive. I imagined my mother telling me that it would be OK and certainly for that next mile it was. I sped up during the last half of that mile with the intention of stopping then, but the angels were not done with me, at least not yet.

As I completed the seventh mile, I felt looser and better hydrated and it was then that one particular and memorable angel made her appearance. She met me at the gate; “Nonkululeko,” she introduced herself, it means “freedom in Zulu. I’m a senior.” An appropriate name for an angel, I thought to myself, as we started my eight mile together. She told me of her time at OWLAG and her big dreams for the future. Soon we had completed the mile together. I asked her if she ran regularly, because she kept a decent pace and she said that she tried to do three times around the track a few times per week, and that her longest run ever had been five miles. We completed the ninth and 10^th mile. “Do you want to get to your record? Five miles?” I asked. She smiled and said, “Let’s go!” Soon we had reached 12 miles and she said excitedly, “if we complete one more mile, you will reach a half marathon and I will have done six miles!”

We picked up the pace a little and I reached the half marathon distance in just under two hours and 20 minutes. More girls showed up and together we ran a couple more miles. I told Nonkululeko that I was likely done after the next lap, as I was closing in on 15 miles and she was at eight. During an internal reality check, I admitted to myself that 15 miles was more than I had expected to complete. Just before we were about to complete the lap a hubbub of staff activity heralded the unexpected arrival of Oprah herself. She showed up kitted out in workout gear and running shoes and said “I didn’t think you’d do it! Should we do a few laps together? I have a board meeting in half an hour.” By then Nonkululeko and I had a merry band of fellow runners and the idea of a few laps with our benefactor thrilled all of us. Fortunately Oprah wanted to walk. I needed the break and thanked the angels for the opportunity. This was no ordinary walk though, and Oprah shared the story of her finishing the Chicago Marathon when she was 40 while power walking through the two miles and jogging as we approached the end of each lap. She said: “You are at 17. I expect you to finish.”

With Oprah and the Angels. Nonkululeko is on the right with green shorts and white sneakers

I told her that there was no way that I was going to be able to do it but that I could likely do a few more.” Nonkululeko pointed out that she was now at 10 miles and that if we could do three more she would reach a half-marathon.  Oprah smiled before heading back to her house and her board meeting.

Nonkululeko is still smiling!

Yes. Three more miles. Nonkululeko’s companionship had gotten me to this point. I could do three more to get her to a half-marathon.  In past marathons, I have almost always hit the dreaded WALL, which means different things to different people, but for me means that I am completely out of energy, each steps hurts and the final few miles feel like an entire full marathon onto themselves. In the past this typically happened between miles 20 to 22 for me.  It was OK. I would reach 20 miles and call it a day then. I was at peace with the distance and ready for a shower. After I completed 20, Nonkululeko and I hugged and she left to go wherever angels go when they have done their earthly work. I thanked her for her companionship on our journey and encouraged her to take a warm shower and drink some chocolate milk as a recovery drink.

Nonkululeko, Karolien and other kind supporters- nearing the end!

But it was not to be. Waiting at mile 20 was Karolien, a senior who during the Wellness Week had shared with me the many obstacles she had overcome to get to OWLAG and now was just a few months from graduation. She wanted to join me for a few laps. I told her that I could no longer think and tried to explain THE WALL to her, but angels are kind and she said: “We can go slowly. You don’t have to talk.” We jogged slowly and I listened to more of her story as we completed the 21^st, 22^nd and 23^rd miles. That was it. I hugged her in gratitude and was going to head in to get my bag of dry clothes. I needed to go back to my room, wash up and meet a driver who was going to take me to my sister’s house in Johannesburg.

As I completed mile 23 a group of three students came up to me: “Hi Uncle Blaise—that was the name I had been given during the week—Mum O is in her board meeting and it is running late. She said that she will be done in 40 minutes. When you finish, she will come and pick you up to take you back to the Guest House.”

I tried to do the math, but the brain did not work.  ’13-minute miles? Something like that,’ I thought to myself.  If that was right, it was on the edge of what I felt I could do. I jogged once around clocking 12:20 for the mile. “Ok I have an extra 40 seconds,” I told myself.  12:14 for the 25^th mile. I had more than 14 minutes to complete the final mile. I jogged and walked and breathed in the rarified air of OWLAG. I reflected on the endurance of the girls whose resilience had overcome the burden of lack of resources and sometimes traumatic experiences. I considered the many staff who had committed themselves to transform these improbable lives. I felt gratitude that Oprah had opened up her heart in a way to make this all possible. And then it was over. 26 miles completed. I walked to stretch for another 300 meters or so to get to the official 26.2. I looked down at my watch. 5 hours 27 minutes.  I went to the front of the administration building where I passed out on the cold tiles that adorned the entrance.

THE AFTERMATH

I felt even worse than this!

Soon after passing out I discovered the meaning of “there is no rest for the weary.” It means: Oprah is going to do an interview with you right after a marathon and at the precise moment that the cold OWLAG Administration Building tiles are the only thing that will provide any relief. “You did it,” she said holding her phone while filming, “and after all that wine! This is your Oprah interview.”  We chatted for a few minutes before we all drove back to the guest house. We knocked on Dr. Perry’s door and he came out in a white robe, stretched his just-woken but clearly rested arms and said, smiling “So what’s going on?”

HEAVENLY LESSONS

So what have I learned? First is that all too often, each one of our successes depends on the right person showing up at the right time. Second, sometimes angels appear as high school students. Third, never doubt your mother when she is invoking her heavenly connections. Fourth, Oprah is one motivating lady!

HEALING- A POEM

You do not have to take pills
Nor lie anxiously on the couch wading through hours of mindless exploration

To heal

You need only know that you're asleep
And awaken to the freedom of awareness

The glimpse of a fleeting reflection that whispers: "Wait! That is me!"

So talk to me, and I will listen

Even while outside the leaves fall from autumn’s weary trees and children chase each other in the park,
And the afternoon shadows creep toward the street then cross it with the determination of a youngster refusing his mother’s hand.

The haunt of distant memories is the nightmare of your sleep.
The world goes on nonetheless, waiting patiently for your participation, waiting for you to wake up, waiting to share its whimsical secret with you:

Our separateness is a delusion.

Written at AACAP in San Diego October 2014

Whose Therapy is it Anyway? DBT, Psychoanalysis or Both

“My dear if you could give me a cup of tea to clear my muddle of a head I should better understand your affairs.” ~Charles Dickens, “Mrs. Lirriper's Legacy”

Today at our weekly conference on Borderline Personality Disorder a question arose about whether a therapist would make a cup of tea for their patient. The well attended conference provided a smorgasbord of responses with the strict analysts saying no, the more dynamic types saying yes, but with an exploration of the meaning for the patient, the supportive psychotherapists saying yes and the DBT therapists saying yes and making a cup for themselves!

I made myself a cup of tea after today’s conference which got me reflecting on my experience attending the gathering over the years. In certain ways, the conflicts that arose years ago between our clans, the “behaviorists” and the “analysts,” are the ones that continue to arise, although today the effects of theoretical interbreeding and cross-pollination has led to a more nuanced analyses and treatment of our complicated patients. Nevertheless, in the face of what appears to be enduring skepticism, it is a perplexing juxtaposition that I would comfortably (and have done) refer a difficult to treat patient with BPD to any other seasoned clinician in the room, whether or not I agreed with their theoretical stance. There is something about inherently knowing that despite differences in style and orientation, there is particular wisdom and compassion in the room that any patient would find holding and useful.

Even if it were not within my nature to be curious, as a DBT therapist my training requires me to not be certain that I know it all. It compels me to recognize that the “truth” often has opposing points of view, and that there is wisdom in mulling the tension of any disagreement, listening without judgment, while working towards a clearer synthesis, a newer way of thinking. It seems to me that at times we get too stuck in the certainty about how we see things. This stuckness that has less to do with imagining each other as incapable and more to do not listening with open curiosity. Why not make the cup of tea? Or why make it? How is what we do helping the patient and what evidence do we have that it is helping? Do we get so rigid in our approach that any nod to a dissenting perspective automatically casts us from our clan? On the other hand, having a free-for-all approach and doing whatever pleases each one of us makes little sense.

Each patient is unique, just like all the others. The same goes for each one of us. We do the treatment that works for us and the patient, and in most cases things work out. It is when therapy does not work as we intended in the cases that we present that ego appears to arise within our group of dedicated and expert clinicians and the sense that “I” could have done better permeates, sending those of us who have failed, feeling judged and scurrying back to our dens to get support from our clan. And it is here that the conflict arises. That initial judgment imprints, particularly in young minds leading to an enduring mistrust that is hard to shake.

What about integration?

Another manifestation of dialectical tension in our work with patients is that a psychodynamic approach works with the “truth” that the past determines present behavior and that it will inform future behavior. In theory, understanding the past empowers the patient to do things differently going forward. Through a thorough exploration of how a person comes to be stuck in their way of thinking, the ensuing insight offers liberation from the repetition of maladaptive interactional styles. On the other hand, DBT recognizes the “truth” that simply focusing on the past can be an unproductive exercise, one that drains time, energy (and money) from more immediately changing problematic behaviors and cognitions. Because living in regret about the past or worry about the future is a major source of suffering in people with BPD, DBTs emphasis on staying in the present moment while developing the skills to deal with painful emotions makes sense. If we cannot see the wisdom in these two approaches then what is it like for our patients, caught in the confusion of therapies that each promise a way out. We become bickering parents, inflexible in a rigid stance. This rigidity indignifies the undertaking of our collective purpose.

What about science?

A fair argument could be made about using the scientific method to test competing approaches to a specific problematic behavior. The research data strongly indicates that DBT is very effective in dealing with suicidality and self-injury, particularly in adolescents. If my child were severely self-injuring I would want them to be in a DBT therapy. But it is not the impulsive, dysregulated behavior and emotions that keep a person in therapy. It is self-constructs like self-loathing, unworthiness and insignificance that perpetuate misery and these don’t yield their grasp all that easily, and certainly not to standard DBT. In DBT parlance effectiveness is doing what is required. The evidence is the health of our patient. A therapist integrating an exploration of the past as a means of understanding entrenched, potentially unconscious patterns of thinking and behavior together with the teaching of new, present focused behavioral skills including mindfulness combines the best of what all of us have to offer. Let us all be open to that.

So back to the tea!  Eliot’s (The Love-Song of J. Alfred Prufrock) distant musing captures the spirit of our endeavor at our weekly conference:

Time for you and time for me,

And time yet for a hundred indecisions

And for a hundred visions and revisions

Before the taking of a toast and tea.

And surely we can all agree to that!

If you are interested: Our Mindfulness Book for BPD

Or the new edition of BPD in Adolescents

Disconnecting what you think is real from what is real

The happiness of your life depends upon the quality of your thoughts: therefore, guard accordingly, and take care that you entertain no notions unsuitable to virtue and reasonable nature.

Marcus Aurelius 

Nearly two thousand years ago the Roman Emperor Aurelius noted this wisdom, and it is as relevant today as it was then. This perspective has important implications in the treatment of borderline personality disorder (BPD) and that is because it is typical of brain function to look for evidence that supports an idea you believe to be true and to not pay attention to data that says the idea is inaccurate. Generally speaking this can be of trivial consequence, so you might wear your lucky cap to the ballgame in the belief that doing so will help your team win, and then you are likely to focus on the times when your team won when you were wearing your cap. At the same time you discount the times when they won and you weren't wearing the cap, or when they lost and you were wearing the cap. In order to change this perception you have to be aware that you have a perception that a belief you have is true, want to examine it and then decide if you want to change it. 

One simple way to do so would be to examine the evidence, by being a careful observer of the data at hand. You might take a note-book to future games and wear your lucky hat and plot the correlation between your hat-wearing and game outcome. It would be a fun thought experiment to have a friend loyal to the other team, and who has an equal belief in lucky-cap-wearing, to similarly track results.

In people who have BPD, the consequence of this particular function of brain activity can be decidedly destructive for two reasons that are characteristic of people with the condition: The first is that the thoughts and beliefs tend to be painful. "No one loves me", "people hate me", "I am toxic", "I deserve to die", and the second is that people with BPD tend to magnify these particular thoughts, and so the thought that "no one loves me" becomes universal, and without exception. Unfortunately the opposite is not true. If you have BPD, you don't tend to have self-compassionate thoughts and then if a compassionate self-thought pops into your mind, you don't tend to dwell on it and don't tend magnify it, instead rejecting it as false.

But the brain is constantly distorting information. It does so in order to make sense of the world. There are multiple examples of how the brain changes perception even when you are not aware that it is doing so. In many circumstances, if the trick or the perceptual distortion is not pointed out you continue to believe that what you imagine to be true is true. Here is a great little article on this very point. The examples in the article are of visual misperceptions, and as the article shows, in many circumstances there can be a simple solution to rectify the misperception. Thought mispreceptions tend to be far more complicated, and in people with BPD can be the ones that lead to the conclusion that suicide is the only way out.

Another characteristic of brain function is that continued practice and repetition of any thought or behavior, makes the thought or behavior increasingly hard-wired. And so if you repeatedly imagine an event occurring, and continue to ruminate on the thought that it will occur, your view of the likelihood of it occurring increases. If you have BPD and you worry and ruminate about an awful event, such as that your therapist hates you and wants to get rid of you, you are also increasing your perception that the awful event will occur. Whether it happens or not, the fact that you are thinking about it will add to your misery. And it all started because your brain created the thought and then repeated it over and over again. 

Sadly, it is possible that because you believe your perception to be true and factual, you might then act in ways that not only confuses the other person, in this case your therapist (for example you might attack your therapist for being uncaring because you thought she was being uncaring), and then because of the attack, the therapist decides that they no longer want to work with you and then the perception that they don't care and will leave you becomes a reality..

Stopping this kind of thinking is difficult. Again, this is because rumination is practice and the more you practice a painful thought, the more neuronal connections become dedicated to practicing the thought, the more hard-wired it becomes and the more you suffer.

When you feel something powerfully, the tendency is to act decisively and you behave in a certain way. However you can never have all the information about a particular situation so you tend to make decisions with the data that you have at hand. You tend not to realize that there is often information to which you are not paying attention. Here is a famous video by Daniel Simons proving the point. When certainty sets in, the task is to consider what information is being left out, to slow down consider that it is possible that you may have missed some critical facts. Going back to the imaginary situation with your therapist, if you are angry with her because she did not show up on time to your session, consider that it is possible that rather than the certainty that she doesn't care about you, that it is possible that you don't have all the information. Was she stuck in traffic? Was her child ill at home? Was she running late from a meeting with her boss?  In BPD in particular it is typical that the closer that you are to another, the more likely that strong emotions will distort interactions with that person. And with that the more powerful the certainty that resulting thoughts become "truths." Being curious about what happened and getting more of the facts will lead to more effective behavior. This does not invalidate the fact that you are angry, but it does allow for more adaptive interactions.

The problem is that when strong emotions, particularly anger and shame engulf your experience, there can be a misery-inducing loop where you make interpretations and assumptions about the behaviors of others. When you then behave in ways that are based on these interpretations, perceptions and assumptions, rather than relying on what you can actually observe to be true, the ensuing behaviors can lead to destroyed relationships and enduring shame and anger. Remember that you can never observe another's intentions. Intentions are in the mind of the other. The task here is to use the "observe" and "describe" skills of mindfulness (as taught by dialectical behavioral therapy (DBT)) to describe what you can actually see rather than making assumptions and interpretations of what you see.

So when thinking is causing you to suffer because you imagine your thoughts to be facts, the sooner you catch the thought spiral, the sooner you can deal with it and the quicker you can prevent your brain neurons from establishing long-lasting connections, which over time will become more difficult to undo. The skillful practice of noticing rumination through mindful awareness is the way out of enduring suffering. The fact that you have a thought does not make that thought a fact.

And so we go back to the wisdom of Aurelius who noted:

Very little is needed to make a happy life; it is all within yourself, in your way of thinking.

For more on targeting the struggles of dealing with BPD our book Mindfulness for Borderline Personality Disorder has been well received.