The Spiritual Malady and Personality Disorders

By Kelly Palmer 09/28/17
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When I first entered the rooms of 12-step recovery, rattling and on the verge of an emotional breakdown, my future sponsor (one of) showed me a paragraph of a book that was passed around reverently like, well, a Bible...
'Do you ever feel like this?' she asked me. I read the paragraph on p52 that sums up the symptoms of the infamous AA 'spiritual malady' said to be at the root of all alcoholism/addiction; the reason why we need to drink/drug/have sex with strangers/eat our weight in sugar/work 'til we drop just to cope with daily life;
'We were having trouble with personal relationships, we couldn't control our emotional natures, we were prey to misery and depression, we couldn't make a living, we had a feeling of uselessness, we were full of fear, we were unhappy...' it goes on.
Yes, I felt like that. And not just on a comedown but nearly all of the time, even before I 'picked up'. I identified.
I was also struck by how similar this malady was to the symptoms of the Borderline Personality Disorder I had been diagnosed with.
Of course, another symptom of borderline (and many other personality disorders) is substance misuse and/or addictive behaviours. The others include inability to regulate emotions, feelings of emptiness and unworthiness, unstable self-image, self-destructive behaviours and self-harm, anxiety/depression/anger...sounds a lot like p52 to me.
Not every addict has or qualifies for a diagnosis of PD (though it is undoubtedly common) yet I have never spoken to anyone in recovery who doesn't identify with at least some of the above symptoms. A therapist friend of mine believes both PD and the emotional misery that drives many to addiction is simply the human condition writ large. Some of us are simply more sensitive than others.
Labels change over time. The original alcoholics who manifested the symptoms described on p52 of Alcoholics Anonymous may be highly likely today to get a PD diagnosis.
There are those who will say there's no correlation - PD is a 'mental' disease, the malady a 'spiritual' one. Yet advances in medicine show us that mind, body and spirit are undeniably connected and indeed, the very first AAers described alcoholism as a disease that manifested as a physical allergy, a mental obsession and a spiritual malady. Labels change, but the thing itself stays the same.
The clincher, for me, that suggests a strong link between the two is the ways in which PD have been found to be best treated. The parallels with addiction are immediately obvious. AA tells us 'a chemical solution can't solve a spiritual problem'. PD is notoriously difficult to treat and although certain symptoms may at times need medication, there is no medication that can truly treat the underlying disorder. Psychodynamic therapy is rarely successful in the long-term. What has been found to be helpful for many however is Dialectical Behaviour Therapy, pioneered by Marsha Linehan, a psychiatrist who was also a BPD sufferer and chronic, addictive self-harmer. Based on acceptance and mindfulness strategies, DBT focuses on coping skills, emotional regulation, improving relationships and mindfulness. As well as therapeutic tools, DBT strategies include prayer and meditation, and logging ones moods and behaviours.
That sounds a lot like Steps 10 and 11 to me.
Now I'm not a doctor, or a psychiatrist, so this is an opinion formed mainly by my own experiences and observations as an addict in recovery and someone on both sides of the counsellors couch. But it seems to be a possible link worth exploring. I'd love to know what others think?