#740 Dialectical Behavior Therapy - Dr. Blaise Aguirre

Summary

Episode Overview

Podcast: Mental Illness Happy Hour
Host: Paul Gilmartin
Episode: #740 - Dialectical Behavior Therapy - Dr. Blaise Aguirre
Date: March 21, 2025
Guest: Dr. Blaise Aguirre
Main Theme:
This episode centers on borderline personality disorder (BPD), dialectical behavior therapy (DBT), and the pervasive issue of self-hatred. Dr. Aguirre, a leading psychiatrist specializing in BPD and DBT, discusses misconceptions, treatment strategies, personal narratives from listeners, and the nuanced realities of living with and treating BPD. The latter half delves deep into the origins and unlearning of self-hatred.

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Key Discussion Points and Insights

1. Introduction & Listener Connections

• Listener Surveys: Paul reads a range of anonymous listener submissions, illustrating real struggles with relationships, fear, attachment, and emotional pain.
• Main takeaway: “Walking through that fear is... about more than just that instance or that relationship... we get to develop a self-care muscle that is then stronger for us to utilize in future situations.” (Paul, 05:00)

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2. Borderline Personality Disorder—Characteristics and Myths (18:13–29:40)

Core Features of BPD

• Emotional Dysregulation: Persistent difficulty managing emotions, reacting intensely to triggers most would find minor.
• Fear of Abandonment: “They fear that [abandonment] is going to happen... and then because they’re so terrified, they start to behave in ways that can sometimes be somewhat off putting to the other person.” (Dr. Aguirre, 19:38)
• Intense Relationships: Relationships swing between idealization and devaluation; rapid shifts in how others are perceived.
• Sense of Self: Unstable self-image, chronic feelings of emptiness.
• Suicidality: High rates—up to 10% of hospitalized individuals ultimately die by suicide.
• Pain as Survival: “The emotional pain that people with borderline personality disorder feel is so intense that the thought of suicide comes to their mind as a way of ending emotional pain.” (Dr. Aguirre, 22:24)

Common Myths and Stigma

• Manipulation & Attention Seeking: Misunderstood as intentional, when behaviors are actually desperate survival attempts.

  “If they’re manipulative, they’re very bad manipulators because they’re not ending up getting what they want… Burning a bridge, getting psychiatric treatment.” (Dr. Aguirre, 23:16)

• Prognosis: Myth that people with BPD can’t get better; evidence-based therapies like DBT refute this.
• Relationship Potential: “...when they've learned how to regulate and how to manage relationships and how to manage strong emotions, they're just ordinary people with very strong emotional system.” (Dr. Aguirre, 29:44)

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3. Dialectical Behavior Therapy (DBT) for BPD (29:40–52:38)

What is DBT?

• Origins & Philosophy: Developed by Marsha Linehan—DBT bridges cognitive-behavioral intervention with radical acceptance and mindfulness.
• Balance of Validation and Change: “You can only get to change through accepting who they are in the present moment.” (Dr. Aguirre, 39:00)
• Evidence Base: The only therapy for BPD with extensive research backing; “No other psychotherapy up until then, and actually I would say up until now, has stood the test of so much rigor.” (Dr. Aguirre, 40:42)

How DBT Works

• Triage Approach: Prioritize urgent behaviors (suicidality, self-injury) before addressing deeper issues.

  “If I don’t target the suicidality, then all the rest of the stuff isn’t going to matter. I can’t deal with childhood trauma... if you’re dead.” (Dr. Aguirre, 30:34)

• Skill Building: Focus on teaching emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness.
• Validation of Coping Methods: Even maladaptive behaviors like self-harm serve a purpose—short-term relief at a long-term cost.

  “Can a problem and a solution, can the same thing be a problem and the solution at the same time?... For people with BPD, self-injury actually is calming for the brain.” (Dr. Aguirre, 43:34)

• Function Over Form: It’s about why people do things, not just what they do. Even ‘positive’ behaviors (like excessive homework) can be avoidance tools.

On Humor in Recovery

• Humor and irreverence can help break through the darkness and build therapeutic connection.

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4. Unlearning Self-Hatred (52:22–87:15)

Self-Hatred as a Widespread, Neglected Issue

• No Books on Self-Hatred: Dr. Aguirre notes, to his surprise, there is almost no literature or books specifically on self-hatred—even though it's a core driver in many forms of suffering.

  “If you look up DBT books, there's thousands...If you look at mindfulness books, there's thousands...If you look up self-hatred, nothing.” (Dr. Aguirre, 61:18)

Origins and Maintenance

• Self-hatred is learned: “A child is not born hating itself...if you learn how to hate yourself, you can learn how to not hate yourself.” (Dr. Aguirre, 69:17)
• Teachers of self-hatred: Abusive/invalidating parents, bullying, trauma, and a lack of validation or protection. Also, absence or trivializing of emotional sensitivity.
• Emotionally Sensitive Children: More prone to absorbing negative labels and internalizing them.

How to Undo Self-Hatred

• Identifying Teachers: “…Who were your teachers? Tell me who your teachers were. Was it the bullies? Was it a parent who didn’t protect you…?” (Dr. Aguirre, 72:34)
• Challenging Toxic Messages: Break down the negative internal messages and see if they carry any valid weight.
• Live an Antidepressant Life: Instead of just relying on medication, encourage activities and connections that create positive feelings and meaning.

  “If I know that not calling my friends, staying in bed, not eating, not showering, perpetuate depression, calling my friends, going for a walk, having a healthy meal, shaving and showering makes me feel better...” (Dr. Aguirre, 81:16)

• Esteemable Acts: “If you want to improve your self-esteem, do esteemable acts.” (Paul, 82:33)

Contextualizing Shame & Self-Acceptance

• Moving from judgment to curiosity and compassion; reframing behaviors as attempts to self-soothe rather than moral failures.

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5. Notable Quotes & Memorable Moments

• On Emotional Pain:

  “If your house...were to catch fire...imagine the emotional brain on fire, it's very, very hard to think for any of us, independent of whether we have borderline personality disorder or not.” (Dr. Aguirre, 24:39)

• On learned self-hatred:

  “You weren't born fundamentally bad. No matter what you think, that is the greatest fake news that there is.” (Dr. Aguirre, 86:10)

• On the function of maladaptive behaviors:

  "Even though those were very powerful tools for you...there's no judgment about it. It's just the thing that people do to feel better." (Dr. Aguirre, 47:07)

• Connection vs Comparison:

  "People in connection with somebody that matters hate themselves less. But rather than connect, we compare, and contemporary industry markets to self-hatred." (Dr. Aguirre, 84:44)

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Timestamps for Important Segments

| Timestamp | Segment | |--------------|-----------------------------------------------------| | 00:00–17:14 | Listener Surveys, Fear, and Self-Exploration | | 18:13–29:40 | Introduction to BPD & Myths | | 29:40–52:38 | DBT Explained: History, Mechanisms, and Use Cases | | 52:38–60:53 | Self-Hatred – Literature Gap & Emergence | | 60:53–69:13 | Origins and Deep Nature of Self-Hatred | | 69:13–87:15 | Unlearning Self-Hatred and Practical Interventions | | 87:15+ | Closing, Listener Stories, Reflections |

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Additional Insights

Humor and Humanity

• The episode is shot through with dark humor and gentle irreverence, serving both as a balm and as a reality check for those in deep emotional distress.

Practical Takeaways

• You can learn to undo toxic self-beliefs.
• Effective therapy involves triage and prioritizing survival.
• Behaviors—even ones we dislike—always have a function; challenge the shame, not the behavior.
• Recovery is a communal and deeply personal journey.

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Resources Mentioned

• Dr. Blaise Aguirre’s book: I Hate Myself: Overcome Self-Loathing and Realize Why You’re Wrong About You (with forward by Jewel).
• DBT centers (reference to the Harvard-based DBT program).
• Jewel’s Inspiring Children Foundation (mindfulness and resilience training).

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Overall Tone

Empathetic, candid, and often wryly humorous. Both Paul and Dr. Aguirre maintain a compassionate stance toward suffering—never minimizing pain but also refusing to stigmatize the messy reality of mental illness.

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For Listeners Seeking Support

• DBT is an effective, research-backed intervention for BPD and other emotional regulation struggles.
• Self-hatred is not a permanent truth—it is a learned belief that can be unlearned.
• Connection (not comparison) is antidotal to shame and self-loathing.
• Community, professional support, and cultivating new coping skills are key to moving forward.

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Summary prepared for those who want a complete grasp of episode #740, independent of direct listening.

Transcript

[Paul Gilmartin]

Welcome to episode 740 with my guest, Dr. Blaise Aguirre. Welcome. If you're new, this is a place for honesty about all the battles in our heads, all the bullshit ping ponging around. The website for this show is mentalpod.com that's a social media handle in general. You can follow us at and we also have a Patreon page where you can support it and through our webpage mentalpod.com that's where you can take the surveys that you will occasionally here read on the podcast and sometimes they are also read on our Patreon only. What would you call it? Reward tier. We're not off to a good start. This is slow and messy and.

[Dr. Blaise Aguirre]

If.

[Paul Gilmartin]

You'Re listening and you have ocd, God bless you. This is from the Struggling Ascendance survey and this is filled out by Katie. And she doesn't say what she struggles with, she just gives a snapshot from her life and she says, on Wednesday, I'm breaking up with my boyfriend that I've been with for nearly 15 years, two months before we're supposed to get married. It's a big step for me, standing up for myself and believing I deserve something better. But holy fuck am I so sad and afraid of losing my best friend and partner and roommate all at once. I'm so scared no one will ever love me again and I'm making a huge mistake not settling for what I have, even if it feels empty. I just want to give you a high five on listening to, to that part of yourself that. I don't know, it sounds corny to say your inner truth, but walking through the fear and doing something that you know is practicing self care, even if it's terrifying. And I think many of us, whether it's leaving a marriage or cutting somebody out of our life, walking through that fear is often about more in the scope of our lives, is often winds up being about way more than just that instance or that relationship that we walked away from because we get to develop a muscle, a self care muscle that is then stronger for us to utilize in future situations. You know, those of you who have gone through divorce after being in a long term marriage know how painful and scary it is to walk away from that. And getting on the other side of that, you, you realize wow, there so much of the world, so many of the fears seem so gigantic and insurmountable and if you just take it one baby step at a time, one day at a time. As one of my friends said one time, fear is a mile High, a mile wide and paper thin. This is from the Fear survey. And this is filled out by a woman who. She filled out a couple of surveys and this is one of the ones she filled out. She calls herself Pendulous Dog Tits. And I mean, is there any other kind of dog tits? She writes, I fear that I will die, suffocated. I have asthma and a while ago I got infected with whooping cough. I thought for sure that was going to be it and I was going to die. Now every time I need to cough, even a normal cough, I get a little panic attack. I scan everybody I am with and if they would be able to save me, which one would be able to punch my throat with the straw to make me breathe? And if there is a straw at all, available, even at spinning class, I look around to see possible straw throat punchers. I don't even know if that would help at all. It's just something I saw once on tv that is so fantastic. That is. You are a custom made guest for this podcast, my friend. This is from the Struggle in a Sentence survey. And this is filled out by Calamity Jane, which got me thinking of that fantastic old HBO show Deadwood. The character, the Calamity Jane character and the actress who portrayed her in that was so good. One of the best characters in the whole series. If you've never seen Deadwood, it is dark and funny and I don't even know. And then David Milch, who was the creator and executive producer on that, did another show after that, which I think was called John of Cincinnati or something like that. One of the worst shows I've ever seen. And I stuck with it for six episodes, thinking, this is David Milch, it's got to get better. Nope, nope. Calamity Jane is in her 30s. What best describes your sexual orientation? Women are hot, but I've never dated one. Does that mean I'm bi? That's a really good question. And so I, I ran that past a minister who mops his forehead. And first I asked him why is he so stingy with his air conditioning? And he told me he was on the fritz. And then he said, but back to the heathen. And he said that you're going to hell for even thinking of that. And I said, look, I'm. I identify as straight, but I got to be honest, some pictures of Jesus, he looks pretty fucking good. And mopped his forehead a couple of times. And he said, do you think about our Lord when you're in the shower? And I said, I don't because I have a clawfoot tub. And he said, you will keep the devil away if you just light some candles and have a nice dry Chardonnay. And then he mopped his forehead. Was that the longest pointless riff in the history of podcasting? Might have been. But back to our friend Calamity Jane. About her depression. Like I'm dying, but without the added benefit of actually dying. That might be one of my favorite depression struggle in a sentences in the decade plus we've been reading these about her. Add all the information all the time. Every experience, every memory flipping through my mind like old school channel surfing. Completely overwhelming, paralyzing. Interesting. Lots of interest. Impatient with people's explanations. Get to the point. Oh wait, I've already made the connection go away. Hey, look at that thing over there. So good. Oh, I love me a good struggle in a sentence Survey just feels it just feels like a a hug across the Internet. This is from the Shouldn't Feel this Way survey. And this is filled out by a guy who calls himself Ouroboros O U R O B O R O S and he's in his 20s and identifies as gay. How would you like people to think of you? I would like to be thought of as a caring, thoughtful person that shows support to those around him. Also as someone that has clear boundaries and has no qualms about enforcing them. How does it feel writing that? I feel what my therapist refers to as cognitive dissonance because I want to be caring and express my love for my friends and whatever family I have left. But in my day to day I display textbook avoidant attachment. I can never say I love you back to my family and friends. It feels like an elephant sitting on my chest every time I think about expressing something basic, something basic loving emotion like that, I think there's a typo in there. For this and other reasons, I don't have any friends that know me deeply. That's so interesting that even after them saying it, it's hard for you to say that because for a lot of people the fear is to be the first one to say it. Anyway, continuing. I don't have any friends that know me deeply. I will be that person for someone else but cannot bring myself to open up to them. Which I know closes off or caps the friendship, intimacy and romantic relationships as well. How would you use a time machine? I don't think I would use it if I had the chance. What? What? Even if you went back for five minutes to when the first sip of your coffee was good? Well Actually, yeah. It would be your first sip of coffee again, so of course it's going to be exactly the same. Sorry, I'm working the kinks out here. Everything that has happened to me and that I have done in response to what it is and has brought me to this moment, which is alive and mostly healthy, with goals and limitless possibilities in my future, good or bad. I don't know if any other decisions would have taken a much darker turn, like it has for so many people I have known. I'm supposed to feel excited about quitting my job to chance my dreams, but I don't. I feel this is all a slight manic high and that there is an irreversible low depression around the corner which will paralyze me for the rest of my life. Yeah, I've got a persistent voice in my head that won't go away no matter how well I can feel physically. I'm supposed to feel sad about having to find a home for my pet because I know I cannot take good care of them, but I don't. I feel relieved and anxious to have one less stressor in my life. I also feel this kind of thinking is what drove me to end my last relationship and will probably lead to me dying friendless. And then parentheses. There it is again. Fuck. How does it make you feel writing your real feelings out? I journal somewhat frequently and look and occasionally look back on the entries. I get the same feeling as I do here, like I'll never get better and the same negative cycles will repeat themselves endlessly. Well, you know, there's a saying in recovery that if nothing changes, nothing changes. And yeah, man, we gotta try something different. Do you think you're abnormal for feeling what you do? For the average person, yes. For someone with the current major depressive disorder, no. Would knowing other people feel the same way make you feel better about yourself? Yes. I've actually tried to find a local support group in parentheses. Your soapbox works, Paul, but find it impossible to have not even the local mental health clinics host them. Just paid group therapy. Not actual independent support groups. I've signed up for some online, but time zone differences suck. I would love to find one. I hope you do find one. And I just hope you keep searching and trying different things. Yeah. And thank you for filling your survey out, brother. This is from the Ask Paul Anything survey. And this is filled out by a guy who calls himself Tristan Fake. And he writes this is about episode 729, the ripples of Childhood Abuse with Nathan Spiteri. After listening to the episode, I spoke with my therapist about how it left me feeling very uncomfortable, more so than I'd have expected. With the number of traumatic stories you've heard, have you ever questioned your own reaction? Is it the, quote, normal, unquote response to a graphic and upsetting narrative or possibly something repressed? That's a good question. And yeah, I am always doubting my integrity, my instinct. I think any of us who were raised in, any of us maybe who are alive, are constantly questioning ourselves. Am I normal? Am I doing this right? Am I doing life right? Did I say the right thing back there 15 minutes ago? So, yeah, all of that to say big, big yes. We are going to take a quick break and see if we have any sponsors. This episode is sponsored by Alma. We've run a couple of their ads so far and the feedback we're getting from listeners is very positive. They have A directory of 20,000 therapists with different specialties, life experiences, identities, and 99% of them take insurance. You know, every client therapist relationship is unique and it's a chemistry. And so being able to find one easily and efficiently is huge. I shudder to think what my life would look like without having done therapy. We spend money to keep our cars tuned up. Why wouldn't we do it for our brain and our soul? You deserve to feel like a future version of yourself. A year from today is not that far away. Get started [e-mail] happy hour. And Alma is spelled a l, m a. That's helloalma.com h a p P Y H O U R. And we'll put the link in the show notes. This episode is sponsored by Quince. What do you want from Quince? You want. You want home, you want bath, you want kitchen, you want travel? They got it all. If somebody were to ask me, hey, Paul, what is the place where I can get the best quality stuff for the least amount of money? I would say Quince. This past summer I got three pairs of underwear, an undershirt and a dress shirt for $100. And you would think, well, then it can't be very good quality. And you would be wrong. The quality is excellent. They're stylish. And now that winter is upon us, why don't you go to Quince and get a nice coat? Maybe. Maybe a cashmere sweater. Mongolian cashmere sweater. You need to look sassy. It's winter. Refresh your winter wardrobe with quince. Go to quince.common for free shipping on your order and 365 day returns now available in Canada too. That's Q U I n c e.com mental free shipping and 365 day returns. Quince.com mental and finally, this is a happy moment from tired and hungry and they write. I began teaching at the upper elementary level a year and a half ago after years working in an office job. It's an incredibly challenging job that was already stressful enough before the current presidential administration was voted in. However, it is all worth it when you can see the moment. The material really clicks with the students when they are able to express that aha moment, either in class or on a graded assignment. I know that I am in the right place and doing the right work. For three days I've been on the verge of a fucking panic attack. You know, I remember being young and just like hitting my head against the wall. And I hate that, you know? That feels better.

[Dr. Blaise Aguirre]

I was suicidally depressed.

[Paul Gilmartin]

This is everything I've always wanted. Times a million. Total despair. And I've never been less happy wandering around London. I don't really like not having control. Hoping I could step in front of.

[Dr. Blaise Aguirre]

A car crying uncontrollably while eating.

[Paul Gilmartin]

Predators think that men will never talk about it.

[Dr. Blaise Aguirre]

There's just no stopping it.

[Paul Gilmartin]

Everyone's dealing with something.

[Dr. Blaise Aguirre]

Anger where I feel my jaw tightening.

[Paul Gilmartin]

Oh, maybe tonight I won't have 20 drinks. You're being disrespected. Oh, I have a pretty deep and overwhelming. You're not being appreciated. Fear of abandonment. You're gonna die alone. I'm trying to get to a place where I'm valuable.

[Dr. Blaise Aguirre]

Sometimes you just need to hang on one more day.

[Paul Gilmartin]

Just because I exist. I had crippling social anxiety and severe depression. My mom's response was to get me into modeling. I'm here with Dr. Blaise Aguirre and we're gonna talk about self hatred. We're gonna talk about borderline personality disorder. That's your specialty.

[Dr. Blaise Aguirre]

Yeah, no, that's exactly right. In 2007, I opened up a treatment center at Harvard dedicated to the treatment of people with borderline personality disorder. And it was from there that the topic of self hatred came in.

[Paul Gilmartin]

Such an important.

[Dr. Blaise Aguirre]

Service.

[Paul Gilmartin]

Talk about the marginalization and the myths. First of all, before. Before we get into that, talk about what are some of the characteristics of people with borderline personality disorder and then talk about what some of the myths are.

[Dr. Blaise Aguirre]

Sure. So is that a good place to start? I think that's a very fine place to start. And maybe I'll blend those two questions because I think that as with any mental illness, no one wakes up any morning and says, I want to struggle, I want to hear voices, I want to be manic, I want to be anxious, I want to be depressed. No one does. And unfortunately, because a lot of the symptoms of all of these mental illnesses are behavioral, often people get judged, stigmatized, told to behave in different kinds of ways, behave better ways, as if they have a choice. So when we think about borderline personality disorder, different from other major mental illnesses, the problem is that people have a very hard time regulating their emotional responses, their relationships, their sense of self. So, for instance, one of the criteria is terrible fear of abandonment. Now, no one wants to be abandoned. None of us would. But for people with borderline personality disorder, they fear that it's going to happen. Whether that fear is justified or unjustified, it's always in their mind. And then because they're so terrified, they start to behave in ways that can sometimes be somewhat off putting to the other person, like constant texting, constant calling, constant reassurance. The other characteristic is that they tend to be involved in relationships that are very intense. And the intensity can be thrilling to the person on the receiving end who feels idealized, but then that can rapidly switch, and then the person can be devalued so that these relationships are intense. They're characterized by these extremes of idealization and devaluation. The people struggle with a sense of self. They struggle with regulating their emotions. So that people with borderline personality disorder, when something that might seem trivial to another person, when something like that happens, they have very big reactions, very big emotional reactions. And those can happen throughout the course of the day. It can be every few hours, every few minutes. And it could be something as seemingly.

[Paul Gilmartin]

Trivial, I forgot to pick up bananas at the grocery store.

[Dr. Blaise Aguirre]

It could be something like that. And it's, you know, you know how important bananas are to me. And like, you're always doing this and those sorts of things to the person on the receiving end. It's like, wait a second, these are bananas. I can just go and buy the banana somewhere else, you know, and. But to the person with BPD in that moment, it feels pretty intense. And then one of the other problems is that, that whereas we can imagine physical pain, a toothache, a broken limb, cancer, the emotional pain that people with borderline personality disorder feel is so intense that the thought of suicide comes to their mind as a way of ending emotional pain. And tragically, many people have suicidal thinking, 10% or many will attempt. And in certain populations, the ones who end up in psychiatric hospitals, 10% will succeed in taking their lives. So it's a condition that comes with a tremendous amount of pain, a tremendous amount of stigma and a high morbidity, I mean, and a high mortality, meaning, like, a lot of people, unfortunately, will die to the condition if it's severe enough. And so some of the myths, you know, that you were asking about is that they're attention seeking, that they're manipulative. You know, people say, well, they're manipulative. And I think these people are in hospital as a manipulative person. I wouldn't want to manipulate my way into hospital. Like, how's that manipulative? You know, and if they're manipulative, they're very bad manipulators because they're not ending up getting what they want. They're ending up again burning a bridge. Burning a bridge, getting psychiatric treatment. And at the end of the day, we're all manipulative. You know, we all use relationships in such ways that there's some benefit to ourselves. The only thing is that we don't feel taken advantage of, and there's a kind of a mutual benefit to that kind of interaction. So one of the things that we do at my work is we get rid of some of this stigmatizing and judgmental language. Sometimes people say, well, manipulative isn't a judgmental language. But if you put the word manipulative into kind of a search engine, you never get like, manipulative. Mother Teresa gives money to the poor. It's manipulative politician cheats the voters. So there is this idea of being manipulative, being attention seeking, when they're often people who are suffering tremendously and who just don't know what else to do. They don't have the skill set to be able to manage their very, very painful lives.

[Paul Gilmartin]

Would it be fair to say that they're often in state of emotional and mental survival? It's driven by a desperation.

[Dr. Blaise Aguirre]

I love that. I love that idea. I love that idea. And if you think about this is, you know, we're having this discussion now. If your house, God forbid, LA's met with a lot of fires, but God forbid it were to catch fire. And I said, well, wait a second, Paul. You said that we were going to have this interview and you're running around like, what's going on? I said, what are you talking about? Is on fire, and I've got things I have to deal with. But if you can imagine the emotional brain on fire, it's very, very hard to Think for any of us, independent of whether we have borderline personality disorder or not. So it's that constant state of crisis. But you're asking the person to be logical to think. And it's very hard to think when you're not regulated.

[Paul Gilmartin]

And I have heard we do anonymous surveys on the podcast, and there's one survey called Struggle in a Sentence. And one of the things that people can try to sum up in a sentence or two is borderline personality disorder. And I have more, on more than one occasion, read somebody describing it as their insides being on fire.

[Dr. Blaise Aguirre]

Yeah. Oh, and I think that that's. That's accurate. But again, I mean, you don't actually have to have borderline personality disorder in order to experience the torment that people go through, because any of us who is human, anybody who feels emotions, if we think about the worst emotional time of our life, maybe the loss of someone we loved, maybe the loss of a job, something that caused endearing emotional pain, and then we're sitting around saying, well, what do you think of Plato's discourse on the shadow self or something? Or is it Socrates? I forget. But he's like, what are you talking about? I just lost my job. I'm in so much pain. And you don't have to have a disorder for those strong emotions to impact you. But for people with borderline personality disorder, that is their life all the time, they're in this constant state of crisis, emotional and relational crisis, and it's very, very painful for them and to the point that at times they don't want to live.

[Paul Gilmartin]

This sounds fucked up, but I'm never surprised when somebody kills themselves and people will say that was a selfish decision. And I. The analogy I always think of is the people that jumped from the. The towers on 9, 11. It's when you feel trapped and on fire.

[Dr. Blaise Aguirre]

Exactly.

[Paul Gilmartin]

And somebody else said something that I so relate to. They said, I'm not afraid of death. I'm afraid of life. And that's how I feel.

[Dr. Blaise Aguirre]

Yeah, yeah, yeah. And, you know, I mean, and I think if you get to that point, if you think about, you know, I was meeting with these physicists, and they had a child with borderline personality disorder. And, you know, they kept saying that their kids report of pain and of trauma and of suffering was inaccurate. And they say, you know, if you see her, you know, she has a lot of fun a lot of the time. Now, if you think about pain, so say you have the worst toothache of your life or the worst headache you've ever had. And I say, okay, I'm going to give you that pain for 10 minutes, but it has to be the worst ever. I once had kidney stones and I just thought, you know, shoot me right now. But. And I say, okay, 10 minutes. Start the stopwatch. You do 10 minutes of that, and then I say, okay, you're going to have 10 minutes of the most loving, endearing, wonderful time you've ever had. And so we'll measure those 10 minutes. Well, the 10 minutes of suffering feels like an eternity because strong emotions are a magnifying glass to pain. And so when you have a strong emotion, when you recount it, I was in the most emotional pain, you say, well, it only lasted 10 minutes, but it doesn't matter. In that moment of suffering, it feels eternal and people want to escape from emotional suffering.

[Paul Gilmartin]

Any other myths around it?

[Dr. Blaise Aguirre]

I mean, I think that there's a lot of myth around the intentionality. I think that another myth is that people with borderline personality disorder can get better, when in fact, all of our research shows that it appears to be a good prognosis diagnosis. Of course you've got to get treatment, but the other thing is it's a myth because historically, when we used unhelpful treatments, people didn't get better. So. Yes, but that's true of any disorder. If you've got diabetes and I use Tylenol, it might help for your headaches, it's not going to get rid of your diabetes. So when you use an inaccurate treatment for someone with borderline personality disorder, they're not going to get better. And then you could say, yes, people aren't getting better. But then when you use the right kinds of treatment, you see a huge reduction in the symptomatology that people with BPD cannot be in relationship. And again, when they've learned how to regulate and how to manage relationships and how to manage strong emotions, they're just ordinary people with very strong emotional system so that they can be in relationship. Go ahead. Yeah.

[Paul Gilmartin]

Our dialectical behavior therapy, clearly the, the hands, hands down, best modality for helping people with bpd. Or am I wrong?

[Dr. Blaise Aguirre]

Well, so first of all, I so agree with you that I need to. I can see other colleagues sort of challenging this, this assertion. So what dialectical behavior therapy says is that many people with bpd, as with many people who are receiving mental health treatment, have a lot of things that they need help with. But when suicidal thinking and suicidal behavior dominate your presentation of mental illness, that if I don't target the suicidality, then all the rest of the Stuff isn't going to matter. I can't deal with childhood trauma. I can't deal with self dissatisfaction if you're dead. And I often tell people, look, I'm one of the world's leading experts in dbt, but even I am not that good to treat a dead person, you know, because.

[Paul Gilmartin]

Have you really tried though?

[Dr. Blaise Aguirre]

Well, you know, I did tell one that I would yell at her through the ground into her grave and tell her to stop acting that way. But, and you have to have a little bit of, you know, you have to have, and especially working with adolescents, you have to have a bit of irreverence and if not sarcasm.

[Paul Gilmartin]

Yeah.

[Dr. Blaise Aguirre]

I had a patient who, she was very funny with bpd and she's done fantastically well now in law school, but she also had comorbidity. So I gave her medication which caused her a near lethal reaction. And after we had done a year of treatment, she said we were ending treatment. And she gave me a book that she'd collected of all the anecdotes that had happened between us. And she specifically highlighted that I'd given her this medication that nearly killed her. And, and the title of her little pamphlet was I Couldn't Kill Myself. So my psychiatrist tried and I just thought it was really, really funny, you know, and, but, but it's, you know, that, that, that people can get better and those sorts of things. You know, be like you told me you were learning Spanish and if I keep sending you to a Greek language school, you'd say, boy, I've been going to this Greek language school, but I still can't speak Spanish. I said, well, right, because you're learning the wrong treatment. So when we think about dbt, DBT really focuses on a lot of the behaviors that are manifest in terms of externalizing behaviors, self injury, drinking, drugging, eating behaviors.

[Paul Gilmartin]

So the present moment.

[Dr. Blaise Aguirre]

Exactly. A lot of sexual behaviors that are, that could be dangerous, impulse driven impulse. So a lot of the stuff that you and I could see, wow, that person is doing those things. What DBT is less good at is the way in which a person sees themselves and conceptualizes themselves. And then there's, you know, that's when my colleagues in the psychodynamic world, in the mentalizing world, in some of the, in the schema therapy type world would say that their treatments are pressed better at those internal constructs. So, you know, I'm hardly a one size fits all person, but for the types of presentations that I see, especially in young people, DBT has been by far the Very, very best approach that, that I've ever seen.

[Paul Gilmartin]

Would it be fair to say it's a, almost a form of a triage? Like let's prioritize what, what we're dealing with.

[Dr. Blaise Aguirre]

I really like that. And actually I have a colleague who works with older people with borderline personality disorder and maybe they're less self destructive. And he's actually tried to figure this out to sort of say if they present with these sets of symptoms, DBT makes the most sense if they present with this set of symptoms. So I like this concept of triage. And he's actually used the term like triaging people with borderline personality disorder. Go ahead.

[Paul Gilmartin]

I feel the same way about addiction. You know, somebody will occasionally email me or they'll fill a survey out where they say, you know, my relationship with my spouse is going to shit. I hate my job, I can't quit smoking and I drink a 12 pack every night. And the thing that I always say, because I'm recovering and been sober 20 plus years, and the one thing I know is if I don't stay sober.

[Dr. Blaise Aguirre]

Right.

[Paul Gilmartin]

I cannot get any of that other shit under, under control.

[Dr. Blaise Aguirre]

Exactly, exactly. Did you see the movie Louder Milk about. So he's a, he's a, he's in recovery himself and he runs a self help group. But he's got a wonderful sense of humor in a very dark sense of humor. And you kind of remind me of Louder Milk. But.

[Paul Gilmartin]

And humor, it's so important whether it's recovery or you know what, whatever it is, we need that when we're in that darkness, man, we need that light so much. And especially I think when it's fucked up and it's dark, you know, that's the right, right.

[Dr. Blaise Aguirre]

And I think that we delude ourselves, every single one of us, especially if you haven't struggled manifestly with mental illness, that that darkness does not exist in all of us. And I think that there's a coming to terms with yourself when you recognize that, but for the grace of whoever is out there go I, you know, and that includes a lot of the darkness, whether it's in thought or action, but it's, it lies within all of us.

[Paul Gilmartin]

So let's talk about what exactly DBT is and if you have any, whether they're an amalgamation of actual people or not. You know, give me some kind of stories if you can.

[Dr. Blaise Aguirre]

Sure. So, you know, the traditional psychotherapy was psychodynamic, psychoanalytic psychotherapy, the Freudian stuff. And so there was the idea that there was this Unconscious self that would. That the brain was sort of trying to manage all the time, or that the unconscious self was trying to manage the brain. And that whenever there was a kind of behavior that somebody would do that that was a representation of something, perhaps in childhood. And then the therapist and the patient would try to over time figure out what that was and develop insight around that. And then, you know, with that development of insight, then start to maybe change the behaviors. I wasn't a very, very big fan of insight oriented psychotherapy because people who smoke have the insight that it's not good for them, doesn't stop them from smoking. People who are maybe actively alcoholic will know, like, hey, this is not good for you. But there's insight. So we have insight. You know, you don't exercise insight. It's not good for you. Well, exercise, it's not going to change behavior. Simply having there's a cherry on the top, maybe it's nice if it's there, but it, but insight in and of itself, you know, so. So just simply striving for insight isn't, you know, isn't enough. But because. So therapists were very, very attentive to people as they told their narrative. Often that felt very comforting, that kind of narrative. You know, I like this person. They're listening to me and I feel understood. But people with borderline personality disorder didn't necessarily get better simply with listening. Then came cognitive behavioral therapy, which is much more about a behavioral therapy that changing behavior changes the brain more than talking about changing behavior changes the brain. And cognitive behavioral therapy had been found to be ultra helpful for depression and anxiety. Obsessive compulsive disorder. But what happened with people with borderline personality disorder who are very, very suicidal? A therapist might say something like, look, when you stay in bed, you're very depressed, and then you're going to feel suicidal. So what you have to do is get out of bed. Now, if you've got, let's say, ordinary depression, that might say, wow, that actually makes sense, I should get out of bed. But for somebody who's suffering with deep emotional pain, it feels pretty invalidating, actually, to tell them, you know, you're making it sound as if that's just getting out of bed.

[Paul Gilmartin]

Like, I didn't know that was an option. Boom.

[Dr. Blaise Aguirre]

You know, like, wait a second, I'm with a genius here. You know, like, I didn't realize this. And so what Marsha Linehan, the developer of dialectical behavior therapy, said is that people have to change in order not to suffer. But you can't tell them to change. You can only get to change through accepting who they are in the present moment. And so she merged these two traditions into one that I help you to change through acceptance of who you are in the present moment. It was very, very beautiful. And then you started to see huge reductions in this kind of, you know, in these kinds of borderline and other pathologies.

[Paul Gilmartin]

And she herself has borderline personality disorder.

[Dr. Blaise Aguirre]

Exactly. And I was very, very close with Marcia and did a lot of training with her. And she spent two years at the Institute for Living in Hartford, Connecticut. And it was there where she felt that there was through initially divine inspiration, but then through a lot of scientific trial and error showing that the meditative contemplative state of acceptance. And you know, we think about, you know, there's a lot of overlap with a lot of AA based points, etc. The Serenity Prayer, a lot of accepting of what you can change, accepting of what you cannot change and this concept of acceptance and, and then working on those things that you can change. And so, but because it sounded very kind of woo woo, you know, what are you talking about? Mindfulness? What are you talking about? Acceptance and all that. Different from all the other psychotherapy. She says, I'm going to put this to a test. I'm going to see if we're getting reductions in suicidal behavior, reductions in self injury and self destructive behaviors. And she did no other psychotherapy up until then. And actually I would say up until now has stood the test of so much rigor, you know, rigorous testing. So you know, we've had 5,000 people come through our program and this is.

[Paul Gilmartin]

The one at Harvard.

[Dr. Blaise Aguirre]

The one at Harvard. Okay. So I started it with some colleagues in 2007 and we've had, you know, sort of 5,000 people come through and we said we're not going to lock the doors, we're not going to inject people with medication, we're not going to strap them down, we're not going to have quiet rooms. We're going to treat them with a compassionate therapy that targets their symptoms. So a lot of the young people who come in sometimes come in because they've had some sort of failed relationship, feeling that it's the end of the world, that they're they, that someone essential for their well being and for their existence in a way has gone and that they're in too much emotional pain, they don't know what to do. And so they start doing, you know, self destructive behavior such as cutting themselves.

[Paul Gilmartin]

Is that a common one?

[Dr. Blaise Aguirre]

Very Very common. Yeah, a lot of self harm and a lot, a lot of cutting. And by the way, so this is where the concept of dialectics, so dialectics and dialectical behavior therapy say two things are true at the same time, even if they seem opposing. Okay, so if I were to say to you, is cutting a problem? What would you think? Cutting yourself? You would think, yes, I would think, yes, right now. So you say, okay, so here we have a problem. Can a problem and a solution, can the same thing be a problem and the solution at the same time? So I say, is cutting a solution. Now to the people with borderline personality disorder who are emotionally suffering, yes, it is a solution.

[Paul Gilmartin]

Yes, it's a tool, a blunt tool.

[Dr. Blaise Aguirre]

But a tool and a very effective tool. And we actually, if you think about like what happens when a mosquito bites you, you scratch yourself, it sends a message, a soothing message to your brain. For people with borderline personality disorder, self injury actually is calming for the brain. So what one person sees as a problem, oh my God, you're cutting yourself. The other person saying, no, you're saying, this is a problem for me, it's a solution. Now when I ask a lot of the young people this, do you want to stop cutting? They'll say, no. And that makes sense to me. Why am I going to take away the solution to their emotional suffering? But then I say to them this, have you had your appendix removed? Many of them say, no, because they're young. So I say, well, what about your wisdom teeth? And they'll say, yeah. I say, well, how many times have they removed your wisdom teeth? And they look at me like, what? And they say, once. And I said, why haven't they taken them out more? They say, well, because when they remove them, they're gone. And I say, exactly. They only have to take them out once. If cutting was a solution to your problems, you don't have to do it once and then you wouldn't have to do it again. The problem is that it's a very, very short term solution. Like any other target behavior, whether it's like drugs, alcohol, alcohol, promiscuity, all of that, all of that, these are just temporary ways to change how you're feeling in the moment. And they're so powerfully reinforcing that of course you want to do them over and over again. And if I say with dialectical behavior, I'm going to teach you a new set of skills that maybe won't work as well in the moment, but they're going to have long term benefit it's painful originally, but then as people begin to delve into the treatment and learning the new skills, they see how powerful they are in terms of reducing some of that emotional suffering. And again, it's not going to be as quick as a hit of a drug. It's not going to be as quick as a drink, it's not going to be as quick, as quick as self injury. But the long term benefit, not only in emotion regulation, but self respect and self esteem is remarkable.

[Paul Gilmartin]

And I would imagine you then begin to get some momentum in the positive direction because there's a return of hope. There's a tiny little pin light of, oh, that worked. It wasn't as, like you said, as immediate as cutting. And for me, so much of life is just upgrading your tools.

[Dr. Blaise Aguirre]

Absolutely.

[Paul Gilmartin]

And trying anything.

[Dr. Blaise Aguirre]

Right, right, right. And here's the thing is if you were to so, and I sometimes do this with my staff, I say, okay, fill in this gap if I, or when I, I feel better. Okay, so put in something there. Dance, cook, spend time with my friends. Binge watch Netflix.

[Paul Gilmartin]

Three Body Problem.

[Dr. Blaise Aguirre]

Three Body Problem. That was good. Very, very good.

[Paul Gilmartin]

I'm on episode two. Go ahead.

[Dr. Blaise Aguirre]

I love it. Do drugs, you know, you know, have promiscuous sex, whatever it is. It's just the thing that the person is doing to feel better. And then we tend to judge, oh, well, that one's good, that one's bad, that one's good, that one's bad. Those are just judgments about the thing that that person's doing. I say, okay, let me ask you the question again. Would you think that cutting is bad?

[Paul Gilmartin]

Yes, to the average person.

[Dr. Blaise Aguirre]

Right, okay, yes. You will never be a surgeon because surgeons need to cut. So what we're saying is like, it's context dependent. You know, you sort of say, oh, cutting is bad. Well, unless you're a surgeon, then you love cutting. So what is the context in which the behavior is happening? And is that behavior short term beneficial, long term beneficial, enduringly beneficial? And by the way, once these kids start getting feeling better, I often say, well, do you want to have a family one day? And they say, well, I never thought of it, but maybe I'm thinking about that. And I say, so what are you going to tell your teenage daughter when she's really struggling? Go out and have multiple sexual partners, Go out drinking, go out self injuring? Of course not. Even though those were very powerful tools for you. And I get it, you've got to validate it. There's no judgment about it. It's Just the thing that people do to feel better. I actually had you asked for another case. I had a case of a kid who I ran a parent group and parents were talking about the behaviors that their kids were doing. And this parent was saying, my kid, they were all saying, oh, my kid's self injured, my kid took drugs, my kid was doing all this. And this parent was saying, I came to visit my kid and she had been doing her homework all weekend. And these other parents were like, oh my God, why can't our kids be doing their homework all the weekend? So I went and I spoke to that kid because something seemed not right about this. And it turned out that she used doing her homework as a way to avoid feeling what she felt. So to the outside observer, it looks pretty adaptive. Wow, she's doing her homework, but she would just bury herself in her books in the same way that those other kids were doing their behaviors as a way of avoiding feeling emotions. So what I'm saying is that just because, you know, you could see two people having a drink, one of them is an alcoholic, one is not, because you have to think about what the function of it is and what the impact is. But maybe the other person is just like somebody's having a glass of wine socially with dinner, and there's not a problem for that person. So just simply looking at behavior doesn't tell you why that person is doing it. What function? So intent, sussing out, sussing out what we call function. What's the purpose of doing that behavior? And typically speaking, any behavior that is helpful gets reinforced. And you might say, but how can that self injury be helpful? Well, because it's reducing the level of emotional intense pain. And think about emotional pain so powerful that self injury is better than that emotional pain.

[Paul Gilmartin]

It must be pretty. A real motherfucker.

[Dr. Blaise Aguirre]

Exactly.

[Paul Gilmartin]

Yeah. One of the things, you know, we talked a little bit about self compassion. And one of the things that for me, and for a lot of people that I know is changing the words that we use. Especially when it comes to like sexually acting out, looking at pornography, things like that, there's so much shame attached to it. And one of the things that was a breakthrough for me was to, instead of saying, oh, I looked at pornography for, for five hours, that was bad. I began to say that wasn't the ideal tool to deal with what it is that I, that I'm feeling. And I began to feel less shame and to be reminded that it's just about solution. What's the solution?

[Dr. Blaise Aguirre]

Exactly right. Exactly right. And I Think. I mean, that when you've been, and I'm going to use this word, intentionally indoctrinated into believing that certain things are shameful and some are not, that they're good or they're bad, if you can, then, I mean, and there are some things that are just clearly so detrimental to society that maybe you're punching people, you know, those sorts of things that we need to protect you from society, from you and those sorts of things. But if we can sort of think about it's whatever the human being is doing in order to change how they're feeling. So rather than judging that behavior, because we tend to pontificate, you know, saying, you know, well, I don't do that, you know, but maybe you're restricting food. Maybe you're. You're doing some other behavior. Maybe the behavior that you're doing to make yourself feel better is to judge somebody else. Right. Which. Which, you know, you sort of say, you know, like, I sit on my moral high horse and I go around judging other people, you know, and that makes me feel better about myself. That is just as toxic to you. It's still a tool. It's still a tool. That's just the tool that you're using, you know, so. Yeah.

[Paul Gilmartin]

So let's. Anything more about DBT that you'd like to share before we talk about self hatred, which you have a. A book about that I have right here called I hate myself Overcome self loathing and realize why you're wrong about you.

[Dr. Blaise Aguirre]

Right.

[Paul Gilmartin]

And we didn't. Oh, and it's got a forward by. By Jewel.

[Dr. Blaise Aguirre]

Yeah, she's a.

[Paul Gilmartin]

How did you meet her?

[Dr. Blaise Aguirre]

Well, it was interesting. I did a documentary on mindfulness that had the great meditator Thich Nhat Hanh. And in this documentary, people like Oliver Stone and Sharon Stone and Thich Nhat Hanh and just some other meditators were on this, and they invited me to talk about meditation in the context of dialectical behavior therapy. I grew up very Catholic. I mean, my three of my aunts were nuns. My grandfather was a Spanish ambassador to the Vatican. My dad is a deacon, and my mother was a very evangelical Catholic. I mean, she truly just embodied love. And what I found was that when I was in contemplative states, that I just felt better about, you know, who. Who I. Who I was. And so, so when we did this documentary, you know, they. They asked me about mindfulness and I said, look, I also work with a lot of extremely suicidal people. I have to be fully present. I cannot be Scared in the moment. I have to be as fully present as I can be. And so what happened is the Jewel has a mental health foundation in Vegas and the president of her foundation, who's a very big meditator, saw the documentary and it's the first time that he'd heard a psychiatrist talk about the fundamental role of being fully present in terms of helping people with mental illness. So he invited me to a show that they were having and I met her and we rapidly became very, very close friends because given her history of trauma in Homo Alaska and saying my destiny was one of sex, drugs and rock and roll. She got the rock and roll part probably right, but that she said, I'm not going to go down the path of what happens to young women who are abused and traumatized. And she started to pay attention to actions that allowed her to feel better about who she was and ones that made her feel worse about who she was. So she kind of, as a 16 year old, independently discovers this way of paying attention. Amazing. Amazing. We'll have to. 16? Wow. 16. Yeah. You know, and so she has been a meditator. I think she's, you know, turning 15 now, but you know, for the last 34 years. And, and she has this foundation where they treat children skills to, to manage. And I said, wow, this looks a lot like dbt. And so we became close. So when I was thinking about who I wanted to get the forward to this book, and I know lots of illustrious people at Harvard and other places, I thought no, because she, she's not a mental health expert per se, but she has incredible. Not only lived experience, but she's an empiricist. I mean, she examines her own life, she's her own scientist. To say this work and this doesn't.

[Paul Gilmartin]

Work.

[Dr. Blaise Aguirre]

Which is ultimately the goal for all of us, that we have dominion over our lives, that we don't have other people telling us what to do or not to do, that we discover this works for me and this doesn't work for other people. Doesn't matter. It's working for me and it's working for me. In wisdom, not alcohol works for me. It's like in the long run, this works for me.

[Paul Gilmartin]

What are the most common places that you have directed somebody with DBT to help themselves in addition to the treatment you're doing with them? For instance, a support group or, you know, clearly meditation is one that helps. Have you ever. Because impulse control can be an issue. What are some outside supports or places that you have recommended, if any?

[Dr. Blaise Aguirre]

You mean a Non clinical context. Correct, for example? Well, I think, I mean, I had a friend who was really, really worried about her son and she kept telling me about, you know, about just how worried she was. And you know, I have four of my own kids and. I just have very open discussions. And of course as a parent I'm going to worry at times and everything like that, but because through mindfulness and through meditation, I tend to be much calmer, you know. And she was telling me about this worry and everything, and then she looked at me one day and she said, you know, I see how calm you are. And she said, like, don't you ever worry? And I say, would it help? You know, and so this idea of like, you know, yes, thinking is for planning, it's not for worrying. What happens is if. People tend to ruminate with thinking, which leads to just tremendous worry. And then it's what if, what if, what if. But if you think about how many what ifs there are in the world at any given point, how many are there?

[Paul Gilmartin]

Gazillion.

[Dr. Blaise Aguirre]

And how many what is. So if you change that F to an S, what is in this present moment, it's just this. So rather than spending all your time, what if this, what if this, what if this? You know, we have a DBT skill called the COPE ahead plan. So what you do is you take the worst case scenario and you plan for if that were to happen. Because then anything that's less than that, you've already got a plan. And this often happens to me as getting to the airport, what if I miss my flight? Okay, I plan for then a missed flight, I'll catch the next flight, I'll call the conference organizers. This is what I'm going to do. But I'm not going to sit in the cab in the Uber saying what if, what if, what if, what if doesn't help you. What if causes more anxiety, causes more distress. So I think just in ordinary life it's, you know, don't suffer twice. If I'm suffering, then I'm going to miss the flight. I'm suffering, I miss the flight, I've suffered again. Suffering will happen when suffering is required to happen. If I miss the flight, that's the time to suffer, not ahead of time. Because if I suffer ahead of time, I'm suffering once, miss the flight, suffer twice. If I don't miss the flight, I've suffered needlessly. And the problem is that when I'm suffering with that worry, it will often prevent me from thinking. So it's sort of like saying, okay, this is my worry. What am I going to do if this thing comes to pass? So even just in ordinary life and people who don't have like, you know, any kind of formal mental illness, it's just like saying, okay, like this is a way in which you can use a DBT skill to plan for situations that you're struggling with.

[Paul Gilmartin]

Yeah, if it's with you, it's with you. It doesn't matter what the name of it is. What's the tool?

[Dr. Blaise Aguirre]

Exactly.

[Paul Gilmartin]

What's the tool?

[Dr. Blaise Aguirre]

So.

[Paul Gilmartin]

So let's talk about self hatred. Yeah, it seems to be a barnacle that just sticks to our soul. It's like we can get sober, we can, you know, learn how to be better in relationships, even let people love us, and to, to be vulnerable. But it seems like just one of the things that is, is the hardest. Maybe it's just me.

[Dr. Blaise Aguirre]

It's not just you. This is, this is, this is what's so key. So, so this is my 20th book. And, and one of the things that happens when you publish a book is that the publisher wants to know, can you give us other examples of books in this genre that have done well? Because if we're going to invest in a book, we want to know that this is of interest. If you look up DBT books, there's thousands of them, hundreds of them. If you look up borderline personality disorder books, there's lots of them. If you look at mindfulness books, there's thousands of of them, Lots and lots of these books. So you can say these are these books on these topics and here's how they sell. And then, you know, depending on how you're ranked in terms of an author, maybe they'll say, okay, you know, we'll give you a contract to write this book. When I proposed this idea of self hatred and I went to them, they said, okay, they did the standard thing, give us a comparison group. Nothing. There was no book on self hatred. Now if you think about this, you use the word barnacle like this self hatred barnacle sort of sticks to you and it's unshakable. Why is it that a barnacle that causes so much damage has no literature out there for. We haven't talked about it. And if you think about your recovering from alcohol, when you were initially evaluated, did they ask you about how much you drank? Did they ask you what your name was, how old you were? How are you sleeping at night? Do you have energy? Are you eating okay? Are you using other drugs? Do you hear voices? Other people don't think, you don't hear. And do you have suicide thoughts? Are you depressed? Are you anxious? All those questions, what do you think about yourself? Do you like yourself? Never gets asked in psychiatric evaluations. And yet it's a thing that's leading to part of this destruction. Why weren't we asking about this? And then why wasn't there any literature on this? But for me, when I started to write this book, I hadn't considered any other disorder because I mostly work with people with borderline personality disorder. And what happened is that the very few people who've tragically taken their lives on my unit have felt so unbelievably hurt and had such core self hatred that the idea of continuing to live was unimaginable. The idea that they weren't a burden to those around them was inconceivable. So tragically. And I'm very, very close to some of the families of the kids who didn't make it tragically. They made that determination that it was more than they could bear. So. So I thought, okay, well, wait a second, so if self hatred is such a huge issue, let's just start treating self hatred. But where was I going to go for There was no book on it. There was no DBT book on self hatred. There was no cognitive behavioral psychoanalytic book on self hatred. It just did not exist. And it's sort of interesting. I really find it interesting what you say, and I love that metaphor of barnacle, like this barnacle that sticks to you. Because as I started writing this book with BPD mostly in mind, and then I was helping out a colleague on an eating disorders unit and a lot of people with anorexia had self hatred. And then I was speaking to people in the substance use world and they had self hatred. And I was just like, wait a second, maybe it's its own entity. Maybe there's. But no amount of telling someone that they didn't deserve it, that they should love themselves or anything removed that barnacle.

[Paul Gilmartin]

Not at all. Not at all. You just think you don't really know me exactly. Or your standards are different.

[Dr. Blaise Aguirre]

Exactly right. Exactly right. Exactly right. And I can be sitting here and thinking, wow, what an insightful question that is. And I appreciate that and I admire you for having asked me that question. Thank you. And then you say, yeah, but I hate myself. And I'm just thinking like, wow, somebody who's potentially contributing something so important to the rest of the world doesn't like themselves very much. Why is that? And so the problem is. Well, don't be silly. You got to like yourself. Come on. You know, it doesn't matter. It doesn't matter how much I tell you I like you.

[Paul Gilmartin]

Smile your way out of diabetes.

[Dr. Blaise Aguirre]

Exactly, exactly, exactly. That would be sweet. So getting telling people that they had to love themselves, you know, or, you know, it'd be, you know, I mean, you identify as male. Yeah. You know, I took a swath of your, you know, drink earlier on. I took some DNA testing. You're XX now. I tell you that and I even show you the result. How much could I convince you that you're female, do you think? In your current state, like, could I convince you that you're a woman? No. What if I insisted you have to think that you're a woman.

[Paul Gilmartin]

I would think you just don't know what you're talking about.

[Dr. Blaise Aguirre]

And what would that do to our relationship?

[Paul Gilmartin]

Fuck it up.

[Dr. Blaise Aguirre]

Totally. So it's the same kind of thing. It's not like I leave here and then you say, oh, I should have asked this question. That was silly. Next time I'm going to write it down. It's not like this transient, temporary state of dissatisfaction. It's a permanent state of business. It's even worse than the barnacle because that barnacle has become integrated with a sense of who you are. It's now no longer a barnacle that can be removed. It's a permanent part of you, who you are, so that you don't see it as a separate entity. And yet the manifestation of it in terms of relationships, in terms of substance use, in terms of like career choices and all of those things is always done, whether with your awareness or without, through that filter, that you're not worthy.

[Paul Gilmartin]

Yeah, it's like an embedded Google Maps and it's like these well worn paths where, oh, I'm not going to put myself out for that thing because that's not going to work out. I've done that before. I face the rejection. It was a waste of time. I would rather, you know, not try it and not feel the pain.

[Dr. Blaise Aguirre]

Yeah, but what's even worse about. I love your analogies by the way, you know, but I'm just thinking about the Google Maps analogy. What's even worse is this, is that there's been so much development in the neighborhood that the streets have all changed and so. But you are still believing that that's the map, you're saying. No, but there's a house there now. Like there is no road there anymore. But you still believe that that is True. So that if from very, very early on you were led to believe that those narratives were true about who you are and who you are, and you carry those narratives because of constant programming, you're not enough. And you then start to take on, you don't even have to have whatever generated that thought in the first place because then you're carrying that baggage on your own on an ongoing basis, like, yep, they were right. I'm a fuck up. I can't do anything right. And that's just what I deserve.

[Paul Gilmartin]

So how do you deal with self hate?

[Dr. Blaise Aguirre]

So, okay, the breakthrough came when, because I couldn't figure out a way to tackle this. How do you separate such a core construct, self construct, from the person when manifestly it's not true? You know, even though the person believes it to be true? No amount of telling them, no amount of cognitive behavioral therapy, no amount of that. So it had to start off with the idea that a child is not born hating itself. I mean, English is your native language. You don't speak Italian because you weren't born born learning how to speak Italian. But if you learn how to speak Italian, if you learn how to speak English, you can also say, well, okay, if I'm going to live in Italy, I'm going to go to take Italian classes and I'm going to learn another language. And eventually, if you were to spend enough time in Italy, you would just start speaking Italian. So you're not born hating yourself. You have to learn how to hate yourself. But you see, this is the breakthrough that if you learn how to hate yourself, you can learn how to not hate yourself. Because a child cannot be born hating itself. And if it's learned to hate, it can learn to love. Love comes much more naturally to the human heart than hatred does. You also cannot overcome hating yourself by hating somebody else. Sometimes people say, that person was so cruel to me, I hate them. You're not going to overcome self hatred through hating this other person. So if you think about the conditions and the contexts in which you learned how to hate yourself, and you can see that as a young child, that indoctrination from people who and conditions that didn't allow you to feel safe told you this untruth about yourself. That's part one. The second thing is this. There's not a single person to date that I've met with self hatred who's not an emotionally sensitive person. If I say, you're running around the schoolyard and I say, well, you're stupid or you're not fast enough and you don't have a lot of emotional sensitivity. So what? Like you're going to move on if you're an emotionally sensitive child? And that's biology. Emotional sensitivity is biology. Strong emotions are super glued to labels so that you're an emotionally sensitive child. And I. And maybe you've got dyslexia and I call you stupid, maybe you were heavyset as a child and I call you fat or something like that. And that label sticks, and it sticks so strongly that it's hard to dislodge. And you know, time after time there's a repetition of those kinds of insults and they all stick to you. And you start to believe of yourself as flawed, that there's something broken within.

[Paul Gilmartin]

You.

[Dr. Blaise Aguirre]

That you weren't hating yourself. The environment teaches you that you're not worthy, and you learn that that is true. But how often? I mean, we're seeing this in America today, like lots and lots of saying, we repeat so much. This is true, this is true. This is true about immigrants, about all sorts of different people. And we just believe that that's true. And we don't learn to challenge that. But when you're 4 or 5 or 6 years old, how are you going to challenge that? Because your world is a tiny world. You're surrounded by a couple of caregivers and the kids in your school. So the first thing I say is like, okay, when did you start hating yourself? So first of all, I asked the question. I then say, you learned this. Who were your teachers? Tell me who your teachers were. Well, what are you talking about? Was it the bullies? Was it a parent who didn't protect you against a step parent? Was it, you know, and sometimes it doesn't always have to be like cruelty, like, you know, Paul, if you were only just like your older brother, you know, he's really good because he's a great sports person. He always does his homework on time. Even if.

[Paul Gilmartin]

Even if they never said that out loud. But you could see more attention was.

[Dr. Blaise Aguirre]

Being paid, more attention was being paid. There was more admiration for the person who was more successful. You're saying it's not that they admire them so much, it's that they devalue me so much.

[Paul Gilmartin]

The absence of things.

[Dr. Blaise Aguirre]

Exactly. And so it could be physical, sexual, emotional trauma. It could be a lot of bullying in school, but it could also be the absence of something or the trivializing of your emotional sensitivity and which makes you feel bad about yourself. And you see, this is where this idea of sticks and stones will break my bones. But names will never hurt me. If you're an emotionally sensitive person, names are going to hurt you. That's much more.

[Paul Gilmartin]

Yeah, much more.

[Dr. Blaise Aguirre]

And if you're not an emotionally sensitive person, it might not. And, you know, like, a lot of people can go through very bad episodes in their life and nothing bad happens to them. But if you're an emotionally sensitive person, now people say, well, you know, get over yourself. But, okay, you've got a peanut allergy. Get over yourself. Because every single time I give you a peanut, you have this big reaction to the point that you might even die. So these kinds of insults are emotional peanuts to somebody with an emotional peanut allergy. So it's like they have these very big reactions, and the problem is that internalization of a sense of who they are as flawed. And I say, okay, now here's the thing is never take lessons from a person that you don't want to be like, they're just bad teachers for you. I often see parents who are doing the best that they can, and the grandparents are berating them. The parents like, oh, you're doing this all wrong. You're doing this all wrong. They don't seem that happy. I'm saying, why are you taking advice from an unhappy person? You know, what they're teaching you is how to be unhappy. They're not teaching you how to be happy. How is it that you feel when you're in the context of hurtful people? Do you feel shut down? Do you feel constricted? Or do you feel alive? Do you feel positivity?

[Paul Gilmartin]

Do you feel seen?

[Dr. Blaise Aguirre]

Do you feel, you know, Those are the people to circulate around, the ones who are telling you that you're doing everything wrong. Those are the toxic teachers. And if you as a parent are constantly telling your children how wrong they are, all you're doing is you're reinforcing an idea that they're somehow broken. And by the way, that's often a manifestation of something within you that you haven't resolved. So it may not be with intention. It may be with the best of love. And that you're telling your child that they have to do their homework and do all these sorts of things. But I don't know. I mean, maybe the child isn't all that interested. Mathematics, maybe they like art or music. Maybe the child has a learning disability and no amount of yelling at them is going to cure their dyslexia. But the child doesn't wake up in the morning saying, how am I going to piss my parents off? It does the best that it can. The parent is often doing the best that they can because they don't know better, neither of them do better. But because of that transaction that doesn't match, then the parent often ends up thinking it's a terrible parent and that they have a terrible child. The child then internalizes that they're a terrible child. And when the message is loud enough and there's no one there that can validate that child's experience, they internalize badness to the point in extreme conditions of self hatred. So yes, I do talk about I hate myself in the book I hate myself, but I also talk about all the related concepts, self criticism, people pleasing behavior, perfectionism, self judgment, and all of those kinds of things.

[Paul Gilmartin]

And so how do you begin to peel those layers off that have been just put on year after year? Is it talking about that, exploring that with a therapist or somebody who's doing talk therapy? What, what do you.

[Dr. Blaise Aguirre]

Yeah, how do you get out of that? Okay, so. So first of all, you've learned this, you've learned so. So you recognize that you've learned this and that you had toxic people in your life, whether they intended to be toxic or not, that have hurt, that have hurt you and that you've learned that you were this. Now. But if I tell you you've got to practice loving self compassion, you're going to say, what are you talking about? So given that you've learned this, how can you begin to unlearn it? Okay, the message was I was stupid. Okay, now let's even just break down that statement. Could I do math? No. Could I do geometry? No. What about English? Yeah, I was pretty good at English. What about art? Yeah, I was good at. What about music? I was pretty good at music. Okay, so what does this idea you're stupid actually mean? So when you start to break down the messages of that was incoming. And then when you can see that because you were a sensitive human being, you gave much more weight to those kinds of messages. And then you take every one of those messages and break them down to their core elements. What did they actually mean? Now this was a very hurtful person who told me I was stupid, and yet I believed it to be. Do I want that person, that terrible teaching, that was incorrect teaching to continue to survive in my experience. So now what I'm going to do is I'm going to challenge that idea. So it takes that active awareness of saying there was that message. I started to believe the message to the point that I hated myself. The messenger was toxic. I don't want them in my life. And the message was toxic. And I'm going to break that down. And it might be true, by the way, that I'm not good at math. That doesn't make me stupid. It might be true that I was really good at art and maybe that other person didn't care about art. So what? And then I'm also going to say, who are the people in my life who make me feel seen? Because when you feel seen, you don't hate yourself as much as. And then I get people to also pay attention to their body, internal body experience when they're self hating. And often it's a very constricted, very.

[Paul Gilmartin]

Sort of shut down, shoulders hunched over.

[Dr. Blaise Aguirre]

Not feeling good about yourself. And then you think, okay, you know what? When I'm volunteering, when I'm with these friends, when I'm playing my music, I actually feel a little bit better, say, okay, well do those things, you know, somebody comes in for depression, what do we do? We give them an antidepressant, live an antidepressant life, don't take antidepressants. You have.

[Paul Gilmartin]

You don't mean that literally.

[Dr. Blaise Aguirre]

I say, okay, it's a good point. I'm just saying that all too often we rely simply on antidepressants when somebody has depression, when there's also an antidepressant life that you can live.

[Paul Gilmartin]

Gotcha.

[Dr. Blaise Aguirre]

So if. And by the way, I'm a psychiatrist, so I prescribe medication. I just want to be very, very clear about that. But there's a difference between a biological depression and kind of an existential angst. So that if I know that not calling my friends, staying in bed, not eating, not showering, perpetuate depression, calling my friends, going out for a walk, having a healthy meal, shaving and showering makes me feel better, those are behaviors that you can do that make you feel better about yourself. The other ones are behaviors that you can do that keep you stuck in a cycle of depression. So I'm saying that you can also live an antidepressant life. I mean, we know that 30 minutes of exercise every day in mild to moderate depression is equivalent to 10 milligrams of certain antidepressants. And that you can, in someone with mild to moderate depression, I'm not talking about severe depression with suicidality, they can actually stop taking their antidepressants under the supervision of a psychiatrist. Do more of those behaviors and they're going to feel better about themselves.

[Paul Gilmartin]

There's a saying in recovery that if you Want to improve your self esteem? Do esteemable acts.

[Dr. Blaise Aguirre]

Of course. Yeah, exactly.

[Paul Gilmartin]

Which sounds so simple and it's so true.

[Dr. Blaise Aguirre]

But I actually get people to say, write down the things that make you feel better about yourself when you're depressed. Why is it. Okay, you write down the things that make you feel worse about yourself and the things that make you feel better about yourself. Why is it that when you're depressed, you give up the things that make you feel better about yourself and you continue to do the things that make you feel worse about yourself?

[Paul Gilmartin]

Now, what about a up one? And I know I'm not the only one.

[Dr. Blaise Aguirre]

Sure.

[Paul Gilmartin]

That this brings me comfort.

[Dr. Blaise Aguirre]

Yeah.

[Paul Gilmartin]

But watching documentaries about Hitler.

[Dr. Blaise Aguirre]

Yeah.

[Paul Gilmartin]

I'm always like, I'm not a bad guy. Yeah, yeah, it's, it's so terrible that I have to watch this suffering.

[Dr. Blaise Aguirre]

Yeah.

[Paul Gilmartin]

Of people by a monster to be able to go, hey, I'm, I'm a pretty good dude.

[Dr. Blaise Aguirre]

Well, I actually, I had this, this patient who insisted that she was the worst person that had ever lived on the planet. And I said, how many millions of people have you killed? And she said, what? I said, well, I mean, you're the worst person ever. You must have killed millions and millions of people. And she said, you mean like Hitler? And I said, well, I'm just wondering, I mean, you know, is that, are you equating yourself to that level of badness? And she says, no, of course not. Okay, what about, what about, you know, politicians who enrich themselves at the expense of their constituents? Are you that level of badness? Where in the category of badness are you? Because you're saying you're the worst person ever. The problem I have with it is that one of the most powerful ways to reduce self hatred is through connection. People in connection with somebody that matters hate themselves less. But rather than connect, we compare and contemporary industry markets to self hatred.

[Paul Gilmartin]

Oh fuck yeah. Not enoughness.

[Dr. Blaise Aguirre]

You're not enoughness. You're not tall enough, you're not handsome enough. You don't have a six pack enough. But if, by the way, if you buy my product, if you buy my book, you'll feel better about yourself. And so, but when we're in connection rather than we're comparison, I mean we're sort of sitting there in comparison, there's going to be much more dangerous than if we're in connection. And so. This idea of comparisons can be like temporarily helpful, but it's the same sort of thing. It's like, okay, at least I'm not that bad, but I Don't want your healing to come from something outside of yourself. I want you to see that the learning that you had was incorrect and that, like, you were told this about who you were and it just wasn't true. And perhaps you weren't capable at some things. Okay, fine. But a lot of that toxic messaging was very, very judgmental and was very belittling of you as a human being. And why are you still carrying those messages from people who you don't respect, who you'd never want to be? Like, why aren't you carrying the messages of love from the people that cared about you?

[Paul Gilmartin]

But it is hard. It is a long road.

[Dr. Blaise Aguirre]

It is hard. It is hard. But what I'm saying is it has to start off with the idea that you weren't born fundamentally bad. No matter what you think that that is the greatest fake news that there is because a child cannot be there. They're born into the world, trying to survive, trying to charm their parents, and maybe they don't succeed, so they try even harder, but then they start to believe this about themselves and it's just tragic. You know, you don't have to believe this about yourself anymore. And I know that what I'm saying is, like, don't believe this about yourself, but take the belief and challenge where it came from, and then you can see, wait a second. I don't want to be like those teachers. I just had incorrect learning. Yeah. Yeah.

[Paul Gilmartin]

Your book is called I hate myself Overcome self loathing and realize why you're wrong about you.

[Dr. Blaise Aguirre]

Dude.

[Paul Gilmartin]

Thank you so much for coming on such great topics.

[Dr. Blaise Aguirre]

Thank you. Thank you so much. Thank you for the message that you're getting out to your listeners who have the voice of wisdom helping them, perhaps asking the questions that they wish that they'd asked for challenging. I love that you said you don't. You don't mean that literally. Which is. Which is true. I don't mean it literally. Literally. I just, you know, I just want it not. Not to think about it, but just that ability to catch something like that. I appreciate that you. That you did that. So thank you very much for having.

[Paul Gilmartin]

Me and thank you for being of such service to the DBT community. I know a lot of the listeners deal with dbt, whether it's a loved one or they themselves deal with it. It's. They can feel so marginalized. And the bcd, the people with bpd, it's. It's so nice to. To know that you're doing what you do.

[Dr. Blaise Aguirre]

Thank you very much.

[Paul Gilmartin]

I forgot to ask him on mic, but at least I think I did. But he is originally from Spain. If you were if you were wondering El este Espana. Look at me, huh? I'm international. We're going to take a quick break, see if we have any sponsors. Wix it's where website creation meets AI and where your boldest ideas become real. It just takes one platform to build a site that looks great and does everything you need it to. And it just takes one person you to start taking care of business. Like a 10 person team with AI tools for creating an entire website from scratch or testing new ways to make money. WIX is there with you from day one. Try it out [e-mail] this is from the Body Shame Survey and this is filled out by a guy who calls himself Endless Pit of Despair. I believe I use your cologne, he writes. I like my face from time to time, as long as it's not riddled with pimples. I know I have an average handsome face structure, but every time I look in the mirror I can't help but focus on everything that's wrong or needs fixing. I obsess over these things and start picking at scabs or popping pimples when I know it only makes it worse and they'll last longer. I sincerely love my thighs, though they're fairly meaty and just toned enough, they're exactly as the type I'm attracted to. Excuse me, I hate my belly. It sticks out in any position I sit or stand, even though it's not that big. I oscillate between the same eight pound range and can never seem to get below that line unless I'm sick or physically starving myself when I stick to my exercise routines. I love my biceps since they get more toned and it makes me feel sexy. Otherwise they look like limp sausages that should be hidden from the weight world. I want to love my body as it is, although it makes me feel hypocritical since I don't feel physically attracted to anyone that doesn't meet my criteria. It's it's not even having perfect body, just proportional. Of course these are the same standards that lead me to hating the way I look in most clothes and why I have been sexually starving myself for two years. I don't feel I can be loved as I am and so I don't want to put myself out there to quote judge others. The gay community is so hypocritical, hyper critical of bodies that I don't even know how. I used to have the courage to put myself out there before. Thank you for sharing that, my friend. And I was just talking with somebody the other day and I believe we were on mic when we were talking about it, but we were talking about the relationship, how things often go hand in hand where we are denying ourselves usually more than just one thing in our lives. You know, we very rarely just starve ourselves in one way, whether it's literally starving ourselves from food. It's almost always accompanied by starving ourselves of affection or intimacy or self care. But yeah, that just made me think of that. This is from the Light Bulb Moments survey. And this is filled out by tiredinhungry. And she writes, I used to get really freaked out by the sounds of the house settling at night. In my head, the sounds would make me imagine someone was sneaking up the stairs into the bedroom. I would always know this didn't make sense because I hadn't heard any other signs of breaking into the house, but it would keep me up for hours some nights. One night I realized it was because my father used to sneak into my bedroom growing up. And sometimes my only hint that he was about to come into my room was the slight creek of a floorboard in the hallway. I also had no bedroom door until I moved out of my house at 18, which is another thing entirely. Once I made this connection, the sounds of the house settling at night no longer bother me, which has been such a wonderful change for me. That snapshot that you just shared with us of the floorboards creaking as your father would sneak into your bedroom at night is so fucking chilling. Oh my God. I don't know what it is about why I find that detail so much more spine tingling than some of the other details that get shared in this. Or maybe because I don't. That's maybe the first time I've ever heard that one. So it's new, but that one just like went right to. I don't know what that.

[Dr. Blaise Aguirre]

Oh.

[Paul Gilmartin]

Fuck. And I'm glad you made that. That connection. And shout out to anybody else. I'm not including myself in this. But. But kids who weren't allowed to have when they were growing up, you know, who weren't allowed to have a door or a locked door. Yeah, that's its own kind of head. Fuck. This is from they Shouldn't Feel this Way survey. And this is. This is filled out by our friend Danish Delight. We did a riff last week, I believe, on Danish Delight. Or maybe it was. Maybe it was the week before, but I think we did that one make it into the. Into the podcast. Oh, maybe that survey didn't make it in and it's coming up. Oh, it just got foreshadowed. She is in her 30s. She identifies as straight. How would you like people to think of you as a person who cares and feels deeply for other people? As someone who can trust in. You can trust in, but also a funny, charming, smart and lovable person. And if I'm truly being honest, and I am, as a very hot and someone you would very much like to person as well, my toxic trait is that I think more about my appearance, appearance and how others see me than any other thing in this world. I'm glad you're honest about it. How's it feel writing that? Fucking depressing and pitiful. How would you use a time machine? Regarding myself, I would go back and hug the shit out of little me all the times where I felt so alone and needed it the most. Standing all alone in the world, being abused by a preschool teacher and living with my mom and her abusive boyfriend. Also, I would be much nicer to my little sister who I love so much and is my best friend today. It was not her fault that she got all the attention and was treated like a wish child and I was treated like Cinderella. I am supposed to feel fulfilled with motherhood as the only thing I've ever truly wanted was to be a mother. But I don't. I feel suffocated and always worried that I'm not enough for them. I'm supposed to feel happy about my life, but I don't. I feel inadequate spending my time comparing myself to others in all aspects. How's it make you feel to write your real feelings out? Like, I want to lay down for a nap. Do you think you're abnormal for feeling what you do? Maybe a little. Everybody seems so goddamn happy all the time in my country and there's a lot to be happy about here. I guess I just can't keep up with my fellow dissatisfied Scandi people, which makes me feel even more abnormal. Well, you ought to import some miserable Americans over there because we will. Oh, we will keep you company. We will. We will bring the over. The overall median attitude plummeting in Scandinavia, that is one of my bucket list is to get over there and just see all the. Oh, the beautiful nature and the nice Scandinavian people and the furniture. Would knowing other people feel the same way make you feel better about yourself? Yes. Thank you for filling that out. And I can tell you, you know, I think for a lot of people, our External circumstances can seem like it's 100% of what the thing is about what the panic or the rage or the fear. But I don't know if you've done enough therapy. The thought begins to occur to you that it's not always about the thing that it seems like it's about. A lot of times it's about something else. Even if it's just the negative self belief that things aren't going to work work out. This is from the Shame and Secret survey. And this is filled out by a gender fluid person who refers to them self as bmas and they identify as pansexual. They're in their 20s, say that they were raised in a slightly dysfunctional environment, never been sexually abused, been physically and emotionally abused. I'm coming to the realization that the discipline I experienced as a child was abuse. Both of my parents would hit me via spankings with a ruler with a belt. They would always say it hurts them more than it hurts me. I would always like to hear a kid say, well, good, then let's switch positions. Growing up, I also experienced my parents lashing out at me, screaming. And one time I remember my dad almost punching me in the face. But he stopped himself before he did it. In my first relationship, I projected a lot of this abuse and it was very toxic. Where we would emotionally abuse each other through verbal arguments and different forms of control. Any positive experiences with abusers? My parents were very caring and the punishment would always be wrapped up in this care, making me associate love with pain and normalize the abuse, thinking that it would only happen if I were bad or acted imperfectly. Hmm. I wonder what their most powerful sexual fantasy is going to revolve around. I could be wrong. I could be wrong because the abuse was, quote, controlled. It was very confusing because I wouldn't understand what things would or would not cause my parents to be upset with with me. Darkest thoughts I sometimes have intrusive thoughts about incest with my sister, but it's always in an abstract way where I can't actually visualize it, but it's more of an icon that represents my sister rather than actually looking like her. It's very disturbing though, especially in dreams since it feels like it's out of my control. I have a wonderful, wonderful relationship with her real life and would absolutely never do something like that, so it really disturbs me. But ever since I learned about intrusive thoughts and how they manifest in ocd, I don't identify with them as much. Darkest secrets in the years after My first partner and I had broken up. There had been a few times where we shared a bed. After a night out drinking. I groped her without her consent, knowing she was asleep, unconscious, and pleasured myself. I feel so ashamed at myself because I did it more than once and knew it was wrong. Looking back on it, I can't believe I betrayed myself in those moments and let that wickedness take over. It was driven by control, impulse, addiction. As far as I know, she never found out. I would also say it was you betrayed her as well. That was over five years ago, and we have since resolved a lot of our trauma from our toxic, abusive relationship and even shared a bed platonically, completely safely. But I haven't ever told anyone. This is the first time I'm writing it down and really acknowledging it. I feel so, so sorry for it. It and would never do something like that again. But sometimes I feel like I am unforgivable and evil for, you know, unforgivable and an evil. You know, if you're going to use the word evil, I don't like to use the word evil. I know evil exists, but people who fret about their morality generally don't fall into the evil category. People who have, you know, anyway. For some reason, it feels worse than the direct emotional abuse I inflicted on her because she was at least aware of that abuse and we were able to work through it. Eventually. I know it would just be more harmful for me to reveal this to her, to apologize for it, and ultimately it would just be for me to feel like I'm absolving myself. So I've kept it a secret. I've decided that I want to finally share this with my therapist and try to identify where this impulse came from so I can make sure I never do something like that again. And that's what's most important is you've. Your consciousness is awake and you're working to do better and you're willing to talk about it.

[Dr. Blaise Aguirre]

It.

[Paul Gilmartin]

That's what matters. Sexual fantasies most powerful to you? Dominating slash forced sex with someone who would never consider me in real life, who I consider, quote, out of my league, unquote, and generally white slash, conventionally attractive. It makes me feel really uncomfortable and disgusted writing this because it reinforces a lot of the gender violence, racism and privilege, objectification, masculinity, et cetera, that I actively aim to dismantle in my life and regular listeners of the show. You know what I'm going to say, which is that is often the very nature of the powerful sexual Fantasy is that it goes against our moral code or it's something that is steeped in emotional or mental anguish or anxiety. What, if anything, would you like to say to someone that you haven't been able to and why? I'm so, so sorry for hurting you. I wish I could take back all the pain I caused you. You didn't deserve it. I wish we weren't in such a toxic environment then. I wish I could tell the younger version of me that it was okay, that they were loved and they didn't need to keep hurting you and everyone around them. I want to tell you that I sexually assaulted you and you didn't know about it, and that I feel terrible about it. In those moments, I truly questioned my nature and how I could be such a monster. I'm sorry for projecting all my trauma onto you. I'm sorry for any ways I've hindered your healing or held you back or kept you in the past. I truly just want you to be happy and experience true love and that you can live life fully on your own terms. I'm sorry for making things more complicated, and I'm so grateful for your forgiveness, your grace, and your patience. I hope we can heal, too. You sound like such a sweet soul. You really do. You know what, if anything, do you wish for? I wish for unconditional love from my new partner. Have you shared these things with others?

[Dr. Blaise Aguirre]

Years?

[Paul Gilmartin]

I've gotten to the point where I've shared pretty much everything except the sexual assault. I know that if I share it, it will just cause more harm, even if it's as an apology. So I've kept it in the past as a reminder of my capability to cause harm and know that I never want to reach those depths again. Sharing everything else has led to more healing, more trust, and more compassion, which is why I think finally talking about the sexual assault in therapy would be helpful. How do you feel after writing these things down? I feel a lot more grounded. I know I'm not defined by the worst things I've done in life, and I want to make sure that they remain the worst thing I've done in life. It's hard to find resources on restorative justice healing as someone who has been abusive, and just having a place to express the remorse and regret and get these things down sometimes somewhere helps a lot. I hope it could help both victims to know that there is the possibility of change from someone who's done harm and for abusers, others who've done something similarly awful, to feel less alone and Know that they have the capability to change too. Anything you'd like to share with someone who shares your thoughts or experiences? No matter how horribly you up, just know that I feel love and forgiveness towards you. And the only path towards healing is for you to express that to yourself too. You did something terrible, but as long as you're growing from it and doing everything you can to alleviate harm and help heal, moving forward, that's all you can do. You are just a person who has done harmful things, but those things don't define you. You also have the capability to heal and that is the best, perhaps the only way to atone. Love yourself. Love the person you hurt. Love the people who hurt you. Accept the love from anyone else who shows you love moving forward. Thank you for that. That was deep. That was deep. Very personal. And then finally, this is a happy moment filled out by a trans man, calls himself Jules, and he writes. The other day I was out for my regular walk. I'm in recovery from a severe eating disorder. So my walks are my exercise in the parentheses. Compulsive exercise used to consume at least half of the of each day. So I'm not letting myself try anymore. Right now I take the same route so as not to overdo things. I wasn't even halfway done when suddenly I saw a couple drop their cat off by the side of the road in the middle of the city. I was in shock. And then I had a choice. I could continue my beloved walk or I could stop here. Without a second thought, I stopped and rescued the cat. As soon as I picked him up, he buried his head in the crook of my arm and cuddled as closely as possible. His name is Hugo now, and he is the sweetest boy with the loudest purr. That's what recovery looks like because I'm no longer so obsessed about exercise. I saved the most beautiful cat. I saved a life because my recovery team helped save mine. I don't have to tell you how much I love that. That's how I got Gracie. That's why I called her Gracie. Why I called her Gracie is I invited a kid that I was mentoring in my support groups to come stay with me because he was going through a bad breakup. And he said, I found this stray yesterday. Can I bring her? And she walked in the door and I just knew. I was like, that is my next dog. Because I thought I was never going to get another dog again because the Herbert and Ivy dying was just so painful. Even though they died of old age, pretty much. But I was just like. So I don't have to tell you how much I love that one man. So, as always, if you want to hear more surveys on patreon at the $5 and above level, every other week, we've cut them back to every other week. Now every other week you will see bonus surveys there at the $5 and above level. And if you're out there and you're feeling stuck, just never forget that you're not alone. And Gracie says hi and thanks for listening.

[Dr. Blaise Aguirre]

Everybody I know is bizarrely, beautifully Everybody I know weird way Bizarrely beautifully fucked up in some weird way.

[Paul Gilmartin]

Hi, I'm Casey Clapp. And I'm Alex Croson, and we are.

[Dr. Blaise Aguirre]

The hosts of Completely Arbitrary, the podcast about trees and other related topics.

[Paul Gilmartin]

Each episode we feature a tree species from around the world and have a discussion about its unique position in culture, ecology, and history.

[Dr. Blaise Aguirre]

Topics range from urban forestry to folk.

[Paul Gilmartin]

Mythology, from evolutionary biology to popular culture, and much, much more.

[Dr. Blaise Aguirre]

Don't have a PhD in biology?

[Paul Gilmartin]

Don't worry, neither do we.

[Dr. Blaise Aguirre]

This podcast's mission is to provide approachable science to audiences of all experience levels.

[Paul Gilmartin]

And reconnect people with the nature around us with plenty of silly games, parody songs, and awful puns to help the medicine go down.

[Dr. Blaise Aguirre]

New episodes drop every Thursday, so subscribe.

[Paul Gilmartin]

To Completely Arbitrary on Spotify, Apple Podcasts.

[Dr. Blaise Aguirre]

Or wherever you get your podcasts.

[Paul Gilmartin]

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