Blaise Aguirre (I Hate Myself: Overcome Self-Loathing and Realize Why You’re Wrong About You) is a child and adolescent psychiatrist specializing in dialectical behavior therapy. Blaise joins the Armchair Expert to discuss becoming an expert on Borderline Personality Disorder and DBT, the correlation between BPD and suicidal ideation, and that it’s not a choice to live with the disregulation of BPD. Blaise and Dax talk about the analogy of a person with a BPD brain being saddled with a very fast car but not the skill to drive it, the fact that when we are disregulated we can’t think properly, and why being too protective of one’s feelings can actually rob them of the ability to confront necessary emotions. Blaise explains the glory he has when a patient leaves therapy, the saying in DBT that you have to go where angels fear to tread to truly help patients, and how liberating it is to realize that our common destiny is stardust.Follow Armchair Expert on the Wondery App or wherever you get your podcasts. Watch new content on YouTube or listen to Armchair Expert early and ad-free by joining Wondery+ in the Wondery App, Apple Podcasts, or Spotify. Start your free trial by visiting wondery.com/links/armchair-expert-with-dax-shepard/ now.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
Chapter 1: Who is Dr. Blaise Aguirre and what is his expertise?
Blaise Aguirre. Yeah.
Aguirre.
You say it. I'm just, I'm going to own it. I'm having a very hard time pronouncing Blaze's last name because it's A-G-U-I-R-R-E. And Wabiwab was nice enough to write it out phonetically for me.
Yes.
Which is A-E-H-G-E-R-R-E.
Aguirre.
Aguirre.
Yeah. That's a hard one.
It's a hardie.
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Chapter 2: What is Borderline Personality Disorder (BPD)?
Hopefully will help a lot of people.
Yeah, I think so. And yet another big, crazy endorsement for CBD and dialectical behavioral therapy. Yep.
Which we've had a Jenny Tates we had on was also a DBT specialist.
Yeah, it's pretty amazing stuff. Please enjoy Dr. Blaise Aguera.
Aguirre.
Aguirre. Dr. Blaise Aguirre. Perfect. Can I start with a question I'm so embarrassed to ask you? Yeah. I've never seen your first name.
Blaise, patron saint of throats. So I grew up Catholic. Are you Irish? Half Irish, half Iberian. Aguirre is actually Basque from northern Spain. My mother is actually Spanish. So Blaise is the patron saint of throats. And it's interesting, her name is Isabel. And Blaise and Isabel are anagrams.
Oh, wow. Oh, sure.
And I was like this with my mom. Oh, that's so sweet. And where did you grow up? I grew up in South Africa. Oh, you did. Okay, that's why I came out. You've got a lot going on. Yeah, you're high in 57, my friend.
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Chapter 3: How does BPD relate to suicidal ideation?
Okay, but throughout this whole time, you have held a position for 25 years at McLean Hospital? Yeah, I have. So we've had a great interest in borderline personality disorder. It comes up occasionally and we've yet to have an expert on. And you've written three or four books about borderline.
We sometimes talk out of school on it.
We have the thinnest understanding of what the predictable pattern of someone suffering from that is. And we could be completely wrong because we've fucked up OCD a couple of times. We've stepped in it, our colloquial understanding.
Yeah, we try to fix those things by having someone who really knows in the room.
I think we've had about 5,000 patients come through our programs since we opened them in 2007. And I'd say about 70% have had borderline personality disorders.
So is there an enormous correlation between suicidal ideation or suicide and BPD?
Yeah, very, very high. For the people who come to my unit, I don't remember one that hasn't had suicidal ideation. So I say of all those 5,000, they've all had suicidal ideation. A very large percentage have made attempts. Now, it's possible that the people who come to my unit are people with very severe forms of BPD. You know, it's like not everybody with asthma ends up in an intensive care unit.
So it's a spectrum disorder.
Exactly. And I think that there's mild to very severe forms. But I think that when you get to the severe forms, almost everybody has suicidal ideation and self-destructive behaviors.
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Chapter 4: What are the differences between mood disorders and personality disorders?
understand it correctly from the expert we had on. It's like, you don't suffer from narcissism the way you suffer from some other.
It's the scariest one because they're in it in such a way that they don't want to feel better.
Maybe I could teach you a thing or two.
Okay.
What I'm saying is that's what the narcissist will say. But the most common comorbidity with a personality disorder is another personality disorder. So you can have borderline personality disorder with some narcissistic traits.
And one of the ways in which I have been able to work with a few cases of people with a narcissistic personality disorder is to say, here's the thing, no one actually likes you. And you also have to just call it out as the truth. Like I know that you feel that people adore you and you're surrounded by people who you believe love. are supportive. They don't actually.
And the thing about it is you can't even see it. So I'm going to teach you how to see the world differently, even if you don't feel that what I'm telling you is true, because what's happening is that you're kind of lonely for a narcissist, like what's going on. Is it actually about everybody else or maybe it's about you?
So mostly it's hard for me to answer that question only because I see so few people with NPD.
Yeah, so what are the symptoms of borderline personality disorder?
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Chapter 5: How is self-hatred addressed in therapy?
Then the responsibilities for the other person to say, do I need to exposure therapy? Basil and I often talk about psychodrama sort of stuff, body keeps the score, that kind of work. that it doesn't actually serve you to not have dealt with that. Because in this context, you could say, well, we know each other very well, and I'm not going to say things that are going to be activating.
But, you know, you walk onto the street and somebody is going to say something. And I would rather know that there's something wrong and that I make a choice about I'm going to deal with it or I'm not going to deal with it. You don't intentionally want to be upsetting someone. At the same time, you're not the world. The world is going to do upsetting things.
You could be soft kids gloving at, but you're one person. So what do you really? Yeah. I think we could further articulate devaluing.
It came from an old psychoanalytic concept. So more like Freudian kind of ideas. And I was trained in Freudian psychoanalysis. I then moved to behavioral therapy, dialectical behavioral therapy. So. The idea is that I, as an individual, feel very flawed. But that's unbearable for me to experience.
So I project my lack of value onto you, and then I devalue you when you're doing behaviors that I don't like. Devaluing is like you're the worst person ever.
Could we say, if you notice who you hate... It generally will fall into two categories. They either exhibit a side of yourself you hate about yourself or they've achieved some success in this deficit you think you have.
Yeah, I think that we see both of those sorts of things. But I think there's often an emotion that shows up before that. And that is sadness, maybe jealousy. But staying in that emotional state is very, very painful. It moves from that primary emotion, which is generally 10 to 30 seconds, to a secondary emotion, which includes a lot of cognitions and thoughts about what the other person is.
Kind of creating the story to explain the feeling you initially had. Exactly right.
Stay tuned for more Armchair Expert, if you dare.
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Chapter 6: What role does self-perception play in mental health?
You learned how to hate yourself.
Yeah, that's a big admission.
That was the only way in which I was able to break through.
They could hear that.
They could hear that they learned. And so I would say, who were your teachers? So the other part of it is I wanted them to start writing. You weren't born hating yourself. When do you have a recollection of you starting to hate yourself? I want you to write that down. I want to know who your teachers of self-hatred were.
the bully in school, the parent who expected perfectionism, the comparison with a more achieving sibling, the teacher who abused you. All of these teachers said that you were not enough.
There's even incidents where your conclusion could be that, right? Because this woman eventually writes you this letter, which is really inspiring. She's the reason that her parents got divorced. Neither of them needed to tell her that. That could have just been a conclusion she made.
Exactly. So there's all this faulty conclusion. And the more you're exposed... to you being the fault of something, the more every single time something goes wrong.
It's like muscle memory.
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Chapter 7: How does society influence self-hatred?
really interesting which is she had taken time to write you this kind of long letter and it was full of lots of kind things about you and she clearly took a lot of time on it you read it and she is not to a place yet where she has transcended self-hatred and you said this is lovely and i can see you've taken a lot of time on it but i'm afraid i have to reject this
You cannot give that which is not within you to give. You cannot experience that which is not with you to experience. If we go back to this idea.
I like the stolen money analogy you gave her. You can't give someone $100 you stole.
Exactly. It has to be within you. What's it like to have your menstrual period every month, Dax?
That's rough. I'm so mean to my husband.
How dare you?
Exactly.
It doesn't matter. There's no way that you can experience that because you don't have that experience. When you experience love, when you experience kindness, it's happening inside of you. You are the source of it. There might be things in the environment that allow it to manifest more. But if it's not within you already, it doesn't matter who shows up or what shows up.
And if it's within you and if it's within you to give, it's within you to give to yourself as well.
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Chapter 8: What are effective treatments for overcoming self-loathing?
I can't eliminate all the triggers in the world to satisfy the most triggered among us. It's very defeatist too, right?
A hundred percent. Isn't it better that either you've learned how to deal with it or that you've decided, yeah, I hate seeing my friends at parties all the time where I'm not invited. Okay, well then you don't have to continue to consume that media if it's making you sick, if you're allergic to it. Yeah.
Okay, this is petty for me to bring up, but you would be the person that I could ask this to. I have said committed suicide on here several times. I've heard in the comments people say I'm not allowed to say that anymore. And you who specializes in suicide. I feel like it's a little bit of... pandering and pageantry.
And I actually think it's just for the people who are advocates and not the people who have done it. I think it's like when people say, I can't say drunks and junkies, which is what we call ourselves. Do you have a take on this? What's this move to not say committed suicide?
Okay, so there's a couple of things. First of all, let me just say that I used to say that all the time. When people died, they died by cancer, by pneumonia, by whatever it is. The problem was that it assigned a certain degree of blame when you used that rather than saying they died by suicide. They died by cancer. They died by pneumonia. They died by whatever it is.
Rather than committed, like I committed a crime. I walked into your house and I stole your money.
Because you could say my dad committed cancer. He smoked like three packs a day.
I suppose you could in a certain way. But you wouldn't say that. But you wouldn't. And the other thing is, I have this concept of, do I want to be right or do I want to be effective? And there's some times when maybe I know what I'm saying, but I don't want that to be the disagreement. And what's it cause our relationships?
If what anybody's going to remember about this show was that you said committed suicide, then people are going to say, what a jerk, like he didn't understand. And then you may have had 99% really great points. That's not what they're going to remember.
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