What St. Thérèse of Lisieux Can Teach Us About Mental Health: Psychologist Offers Catholic Perspective
Greg Kolodziejczak seeks the integration of psychology and the spiritual life.
To the casual observer, everything is just fine with Margaret. She’s intelligent, energetic and charming. Colleagues notice that she has an edge at times, but who doesn’t? Yet those people very close to Margaret experience far more than an edge. They experience sudden rage, hostility, accusations and demands that make it very difficult to stay nearby. Quite ironically, however, people remaining close to her is exactly what Margaret wants.
What is going on in Margaret’s mind, and how can she be helped?
That is what Greg Kolodziejczak specializes in. The Cambridge, Massachusetts, psychologist has treated clients with borderline personality disorder (BPD) for more than a decade. The disorder was named “borderline” because psychiatrists thought it was on the border between neurosis (difficulty in adapting well to one’s environment) and psychosis (loss of touch with reality), though that is no longer considered an accurate description. Now, the term “emotional dysregulation disorder” is sometimes used, due to the central role of emotional flooding and intense inner pain.
Regardless of the terminology, Kolodziejczak helps people who have an underdeveloped, fragmented sense of self to become more integrated and better able to navigate the inevitable challenges of life. Although he treats patients of any religion, he does have a Catholic understanding of psychology — one that he thinks holds the deepest possible meaning of self and humanity.
Before earning a master’s degree in theology from The Catholic University of America and a doctorate from the Institute for Psychological Sciences (now Divine Mercy University), Kolodziejczak had already earned a B.S. in physics from the U.S. Naval Academy and a doctorate in ocean engineering from the Massachusetts Institute of Technology (MIT).
In this interview, Kolodziejczak explains his journey from regulating the oceans through engineering to regulating the emotions through the healing of past wounds, improved insight and awareness, clear thinking, effective life skills and decision-making, healthy relationships, and the development of a solid and cohesive sense of self.
The Church celebrates the memorial of St. Dymphna, the patroness of those suffering from mental illness, on May 15. The U.S. House of Representatives designated May as Borderline Personality Awareness Month in 2008.
Did you change from oceanography to psychology because, despite enjoying ocean life, you decided there were “bigger fish to fry” in the realm of the mind?
Oceanography (the study of oceans and life within them) is fascinating, though it is different from ocean engineering (the design, construction, and operation of structures in the ocean or related to the ocean). The latter is what I did.
After finishing MIT in 1987, I spent one year at a naval ship design laboratory and then two years in the Naval Sea Systems Command as director of long-range requirements for the Office of Advanced Submarine Research and Development.
It was a terrific and intellectually fascinating job, but my heart wasn’t in it. I had wrestled for a number of years with a sense that my vocation was elsewhere; I was more drawn to human issues than to engineering problems.
What had appealed to me about physics was probing the deepest mysteries of the material universe. Theology seemed like a natural extension of that, into the spiritual domain. That led me to receive a master of arts in theology from The Catholic University of America (CUA) in 1998, then to work for the Archdiocese of Washington, D.C., for several years in the field of religious education.
In 1999, a new Catholic graduate program in psychology opened up, called The Institute for Psychological Sciences (IPS), in Arlington, Virginia. I had been away on a retreat for Labor Day weekend that fall, then returned home Monday evening and talked with a new roommate who had moved to D.C. to attend IPS.
The program sounded interesting, and I thought I’d try taking one or two evening courses. I applied on Tuesday and started class on Wednesday. For the first two months of that initial semester, those courses took place in a hotel meeting room. I enjoyed it immensely and quickly decided to take the plunge and get the master’s degree and then eventually the doctorate.
What was it about psychology specifically that drew you?
My interest in psychology came from two directions. First, on a practical level, I had done considerable ministerial work over the years: hospital ministry, youth ministry, prison ministry, parish ministry, at one of Mother Teresa’s homes for the dying, working with children on the streets in poor areas of D.C., and so on. All of this work made me realize that an understanding of psychology would be enormously helpful.
Second, on an academic level, I had studied Christian anthropology at CUA; I enjoyed it and found it quite valuable and insightful, but it seemed to me that it was underdeveloped. It was skeletal and needed more meat on the bones. Psychology, I believed, could help to provide that because it explores the deep workings of the human mind and heart.
How did you get involved with treating borderline personality disorder specifically?
After returning to the Boston area for my clinical internship at The Danielsen Institute at Boston University in 2005-2006, I did my postdoctoral fellowship at Two Brattle Center, a clinic in Cambridge that specialized in treating patients with borderline personality disorder. I wanted to understand this painful condition better, and I wanted to learn how to work with patients who experience it. That was a challenging but excellent year, and I’ve maintained BPD as one of my specialties ever since.
What exactly is BPD?
BPD is one of 10 “personality disorders” that are listed in the official compendium of psychological disorders, knows as the Diagnostic and Statistical Manual of Mental Disorders, generally referred to as the DSM. Personality disorders are broadly defined as long-term patterns of behavior, thinking and “inner experience” (emotions, memories, worries, regrets, suspicions, urges, sensations, etc.) that are maladaptive and impair functioning. Personality disorders are sometimes called “disorders of the self,” since they’re rooted in the basic structure of the self.
“Self” is one of those words that’s very important but hard to define, as is the word “intelligence.” When we observe that a person is very good at solving problems, we say that he or she is intelligent. “Intelligence” is a concept that we utilize to explain phenomena that we can observe, in this case, solving problems, figuring things out, and so on.
“Self” is analogously a concept that we use to explain phenomena that we can observe: the ability to reflect on and regulate one’s own thoughts, emotions and actions, to relate to others, to give and receive love, to maintain a positive and realistic sense of self-worth, and to exercise self-agency (that is, to think clearly, make decisions and take action).
The best definition of the “self” that I’ve come across is “the psychological structure that organizes and gives meaning to human experience.” When we say that the self is a structure, we mean that it endures in time. An emotion is not a structure. The self is, though it’s not a unitary structure.
The self has different facets which are ideally well-integrated, but in BPD these facets are not well-integrated, leaving the self-structure fragmented and easily susceptible to fracture. The majority of persons with BPD can tell stories of trauma, especially emotional abuse, neglect and sometimes sexual or physical abuse; trauma inevitably leads to fragmentation in the developing self-structure. Other factors can lead to fragmentation, though trauma often plays a significant role.
What are the most distinguishing characteristics of BPD?
Some authors distinguish three key features of BPD: severe emotional dysregulation, impulsivity (often with an aggressive tone) and intense, unstable interpersonal relationships. Underlying all of these is the fragmented sense of self.
Fear of abandonment is generally considered to be a key feature of someone experiencing BPD; the first diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) is “Frantic efforts to avoid real or imagined abandonment.” Those frantic efforts, ironically and sadly, often cause the very abandonment the person fears.
Years ago I read a story online about a person who felt deeply distressed that her boyfriend’s plans for her birthday were rather superficial. Because of a painful history of emotional abandonment in her early life, this struck a raw nerve, leading to an intense emotional reaction, in some ways analogous to a flashback. In a short period of time, she sent several hundred texts and emails, most of which were quite accusatory and hostile. Needless to say, this did not draw him closer.
People understandably withdraw in the face of such actions, which the patient then interprets as proof that the fear of abandonment was warranted, and so they double down on their efforts to prevent further abandonment, becoming even more hypervigilant and reactive, which in turn heightens the risk of more extensive abandonment. A vicious cycle quickly takes over.
Mary Zanarini and Frances Frankenburg, two researchers at McLean Hospital in Belmont, Massachusetts, wrote an insightful article entitled “The Essential Nature of Borderline Psychopathology.” In it, they identify two key features of BPD: first, intense emotional pain characterized by statements such as “I feel completely panicked” or “I’m being tortured” or “I’m damaged beyond repair”; and, second, the counterproductive nature of the efforts to deal with the pain and express it to others, including angry outbursts and sometimes self-mutilation or suicide threats or attempts. Zanarini and Frankenburg emphasize that although these behaviors are often irritating or frightening to others, they are best understood as “outmoded survival strategies.”
Are books such as Achieving Peace of Heart by Father Narciso Irala, Uniformity With God’s Will by St. Alphonsus Liguori, or Introduction to the Devout Life by St. Francis de Sales or The Healthy Brain Book, co-written by Dr. Vince Fortanasce, enough to help someone with BPD?
For someone with only mild symptoms, books can be very helpful. We psychologists call this “bibliotherapy.” Books can also help someone with more intense symptoms, but the person-to-person help offered by a psychologist is even more important.
Another limitation of books is that the meaning is always open to interpretation, and it is possible that the intended meaning of the book will be misunderstood by the person. According to St. Thomas, “a message is received according to the mode of the receiver” (Quidquid recipitur ad modum recipientis recipitur). For example, someone who experiences life in starkly black-and-white terms will interpret the book through that lens.
A very well-written book will be able to address that and other tendencies, but those tendencies run deep and are etched into the structure of the personality, so changing them generally requires much more than merely reading about them.
Bibliotherapy can inform the mind, but it’s much harder to heal the heart. In almost every form of therapy, the most important factor is the quality of the relationship with the therapist.
In addition to the relationship with the therapist, what are some ways that therapy heals?
In both Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT), we help the patient to identity maladaptive thought patterns that contribute to emotional dysregulation. We often call these cognitive distortions or negative automatic thoughts.
In CBT, we try to help the patient challenge and change these thinking patterns. In DBT, we balance change with acceptance, since these patients often have had very little validation and acceptance in life, and they therefore tend to have an allergic reaction to any approach based exclusively on change. The fundamental dialectic in DBT is that of acceptance and change, and it parallels the approach that God has towards us: He loves us just as we are, and yet he loves us too much to leave us that way.
In DBT we also try to help the patient become more accepting of their own thoughts and emotions. Some thinking patterns are so deep and automatic that it will take a long time for them to change, so we help the patient to change the way he or she relates to those thoughts and the accompanying feelings.
We help the patient step back from their own experiences — including their own thoughts and feelings — and develop an observer stance. This helps the patient to tolerate a painful experience and to reflect more deeply on it, rather than becoming fused with it and swept away by it.
Oblate Father Tim Gallagher points out that, in the spiritual life, I make an important step forward if I move from me in desolation to me reflecting on me in desolation. So too in the psychological life: If I can observe and reflect on my own experience rather than just be caught in it, that is helpful. In DBT, that is part of the mindfulness skill, which teaches patients to relate to their own experience in a more effective manner.
To get thoughts and feelings to change in a deep and lasting manner generally requires repeated life experience. Some of that happens through the relationship with the therapist, and much of it happens as the patient learns the skills for engaging life more effectively, thereby accumulating positive experiences that help to heal and change some of their most basic ways of relating to themselves, to others, and to life in general.
Our ways of relating to ourselves and others depend strongly on the internal mental representations, or mental models, that we have developed from prior experience. In BPD, those mental models developed in maladaptive ways.
So DBT is an extensive version of what Harvard psychiatrist Dr. Kevin Majeres calls “reframing”?
You could think of mental models as the lenses through which we view reality. They’re formed from prior experiences, and they enable us to anticipate and interpret future experiences. The mental models that matter most in our psychological and spiritual lives are those of self, of other persons, of relationships and of God. These all have very strong emotional dimensions, and they generally exist at an unconscious level.
When most people think about memory, they have in mind what is called “declarative memory” or “explicit memory.” That is the memory system for facts and events: memories that we can verbally express or declare.
Facts of science, states and their capitals, who won the Super Bowl last year, what you did yesterday or on your 16th birthday are all part of explicit memory. This function doesn’t come about until around age 2 because that’s when the child’s hippocampus, a part of the brain that enables explicit memory consolidation, is well-formed.
There are other things that we remember but that don’t lend themselves to explicit expression. All of us remember how to walk, ride a bike, tie a shoe, but we can’t express those in the same way we could express that “yesterday I did such and such.” These types of memories are part of what’s called “implicit memory.” More specifically, they’re part of “procedural memory,” one of the main forms of implicit memory. Explicit memory is “a memory that”: that two plus two equals four, that Abraham Lincoln was the 16th president, that the capital of Idaho is Boise. On the other hand, implicit procedural memory is “a memory how”: how to ride a bike, how to tie a shoe, how to tell a joke, how to relate to others, how to feel about ourselves in relation to others or to God.
Unlike explicit memory, implicit memory is present from birth, or even before. Implicit memory includes the mental models that really matter for our social-emotional well-being because they provide us with the framework in which to interact with others — a framework that we probably aren’t even consciously aware of but simply see as reality. For example, if an infant was mistreated during its first year of life, he or she would have no explicit memory of that, but that experience would be stored in implicit memory; it would shape the person’s sense of self and of relationships, and it would have a strong emotional effect on the person. We sometimes call these implicit mental models “emotional convictions.” Maladaptive mental models include emotional convictions that “I’m unlovable,” “I don’t matter,” “I’m fundamentally defective,” “I’m worthless,” “Others will always abandon me,” and so on. These types of mental models tend to characterize BPD.
By contrast, for a positive example, take that of the universally loved St. Thérèse of Lisieux. Ida Friedericke Görres wrote an exceptional biography of this “greatest saint of modern times” entitled The Hidden Face, republished by Ignatius Press in 2003. On page 48 she writes: “The experiences of the dawn of life create the premises for all later experience, or at least the key by which we interpret that later experience.”
That interpretation occurs via the mental models that have been formed in the relationship between the child and his or her parents. The author continues:
“A happy childhood means above all a loved child. Because Thérèse was a happy child, her beginnings could contain perfection. Because she was a loved child, she received from the beginning the knowledge that others must struggle towards so consciously, with such difficulty, by painfully strenuous detours: the simple truth that to so many of us seems the most incredible and amazing lesson of religion: that we can be loved without having deserved it: that grace comes first. ‘Love resides, not in our showing any love for God, but in His showing love for us first’ (1 John 4:10). The core of the Christian revelation is prefigured, secretly and compellingly, in this experience which precedes all anticipation, all expectation, all questioning; the knowledge that childhood is bliss. It is bliss simply to be someone’s child, child of a father, of a mother, living, moving and having its being in a love which is unmerited, unmeritable, anticipatory, unconditional and immutable. On this basic mystery and reality Thérèse’s childhood was built. This was the source of her subsequent doctrine of the ‘way of spiritual childhood.’”
Thérèse’s childhood was significantly complicated by the death of her mother when she was 4, and yet she had a firm psychological foundation on which to work through that traumatic loss. That is because her implicit mental models had been strongly formed.
Do you think the regularity of the Church’s liturgical calendar, emphasis on humility, forgiveness, prayer, good works, etc., are all helps toward a BDP person becoming more integrated and peaceful?
Surely anyone who experiences the love and truth of God in a deep and profound way will undergo considerable healing, though BPD by its very nature makes the love of God much harder to experience. Furthermore, any serious mental-health disorder (or personal idiosyncrasy, for that matter) can take the faith hostage and distort the way it’s understood and lived. Therefore, the healing process is seldom as straightforward as becoming an active Catholic and pursuing a robust spiritual life, though everything you mention is good in itself and potentially helpful if pursued in an appropriate way.
As mentioned before, one of the principles of scholastic philosophy is that “a message is received according to the mode of the receiver.” Hence, the Gospel message is heard, interpreted, appropriated and lived out in accordance with the mode of that person — their psychological configuration, which is predominantly the mental models discussed earlier.
Unfortunately, when the mental models are maladaptive, the person might interpret and apply the Gospel accordingly, and might then defend their maladaptive thinking patterns and actions with the conviction of their religious faith, thereby potentially misusing the Gospel as a defense mechanism, or even as a hammer with which to bludgeon others (or themselves). Some psychologists refer to a “spiritual bypass”: the tendency to put a spiritual Band-Aid on a psychological broken arm. In The Four Loves C.S. Lewis warned against “mistaking the decays of nature for the increase of grace,” and it’s a warning we should take seriously.
My doctoral dissertation adviser was Paul Vitz, and he was fond of saying that John the Baptist should be the patron saint of psychologists because he prepared the way of the Lord. Psychologists seek to foster healing on the natural level so that people’s minds and hearts can be fertile ground for grace.
What are some of the specific things this grace can bring?
Most importantly, grace can give a person a sense that they are loved and lovable, even with their shortcomings. It can be a long and arduous road to arrive to this heartfelt awareness, the difficult struggle with painful detours that Ida Friedericke Görres referred to in The Hidden Face. For example, I worked with one patient who was a wonderful person, a devout Catholic with a solid theological understanding, and yet, because of her long history of emotional, physical and sexual abuse, she felt like “life unworthy of life.” She needed healing on the natural level before grace could adequately take root and blossom, which it eventually did, and she’s now doing very well both personally and professionally.
Religion also provides a framework for life that overflows with meaning. It provides guidance and a moral compass, and, correspondingly, a source of ultimate justice. Religion also provides a way to make sense out of suffering and an awareness that ultimately life is not about doing it all on our own, but rather, surrendering to a benevolent power much greater than ourselves.
Finally, religion provides a deeper understanding of the self. Mark Leary, professor of psychology at Wake Forest University, wrote in The Curse of the Self (Oxford University Press, 2004), “Most spiritual traditions suggest that people are much more than the small, earthbound, psychological self that they imagine themselves to be and should heed the True Self rather than the personal ego.”
I believe that Catholicism has the deepest and most accurate understanding of the true self. Mystics, saints and spiritual writers often describe this in compelling terms. All the spiritual practices mentioned earlier — prayer, the sacramental life, liturgical life, acts of charity, and so on — these are designed to awaken, develop and help the person live from the true self, where God is present in the core of one’s being, so that one can be transformed in the love of God and share that love with others. Perhaps this is what psychoanalyst Carl Jung had in mind when he wrote:
“Among all my patients in the second half of life — that is to say, over thirty-five — there has not been one whose problem in the last resort was not that of finding a religious outlook on life. It is safe to say that every one of them fell ill because he had lost that which the living religions of every age have given their followers, and none of them has really been healed who did not regain his religious outlook” (Modern Man in Search of a Soul, 1933, p. 264).
Register correspondent Trent Beattie writes from Seattle.
His book Fit for Heaven (Dynamic Catholic, 2015)
contains numerous Catholic sports interviews,
most of which have appeared in the Register.
His latest book is Apostolic Athletes.