Clinical Handbook of Mindfulness (39 page)

from the outside never work – it only creates deeper frustration. What does

work is beginning to understand our holes – what they are, where they come

from, and how we can fill them. To do this, it could be helpful to have a look

at what the author calls “the essential needs”.

As a child, we each have essential needs (see also
Bowlby, 1980).
When

these needs are not met, we could live in a constant state of deprivation.

That deprivation is the hole inside, longing to be filled. While the degree

and types of deprivation vary, we all share a common experience of depri-

vation in some form. From our deprivation, we unconsciously project our

unmet needs onto our lovers, children, close friends, and those we work

with – in fact, on anyone with whom we relate. The closer the connection,

the deeper the projection. The experience of being deprived is universal,

and it is an important rite of passage. People usually start out in a state of

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Fabrizio Didonna and Yolanda Rosillo Gonzalez

denial, in which they are not even aware that they were deprived of cer-

tain essential needs or how.
Trobe-Krishnananda (1999)
highlighted some of individuals’
essential needs
: the need to feel wanted and to feel special and

respected; the need to have our emotions, thoughts, and perceptions vali-

dated (see also Chapter 11 in this volume); the need to be encouraged to

discover and explore our unique aptitudes and turns, sexuality, resourceful-

ness, creativity, joy, silence, and solitude; the need to feel secure, protected,

and supported; the need to be physically touched with loving presence; the

need to be inspired and motivated to learn; the need to know that it is right

to make mistakes and to learn from them; the need to witness love and inti-

macy; the need to be encouraged and supported to separate; and the need to

be given firm and loving limits and boundaries. This list is where an individ-

ual’s deprivation comes from, and it is ever present. It is interesting to notice

that when one starts a relationship with another person, very often he or she

is unconsciously experiencing these unmet needs. When there is no aware-

ness, the individual automatically moves into one of five behavioral patterns

of the emotional child: reaction and control, expectation and entitlement,

compromise, addictiveness, or magical thinking
(Trobe-Krishnananda, 1999).

For this author, the starting point for overcoming these holes, and feelings of

emptiness, is recognizing how automatically people try to fill them from the

outside. This process of watching and understanding releases energy to break

the automatic behavior and just be with the experience of emptiness when

it is provoked. This means feeling it and letting it be there without trying to

fix or change anything. Mindfulness, as we will see in the last part of this

chapter, can be the core strategy to developing this non-reactive attitude.

Mindfulness and Emptiness: The “Paradox” of Meditation

If you say you are somebody, you are attached to name and form,

so I will hit you thirty times.

If you say you are nobody, you are attached to emptiness,

so I will hit you thirty times.

What can you do?

Soen Sa Nim (Citated in J. Kabat-Zinn,
Coming to Our Senses
)

As we mentioned in the introductory paragraph, the aim of this chapter is

to theorize a possible clinical use of mindfulness to treat the pathological feel-

ing of emptiness. To be able to speak about the relationship between mind-

fulness and emptiness, it is essential to know how it is conceived within the

psychological and philosophical approaches and traditions that have given

origin to meditative practice.

The concept of emptiness in Eastern psychology and culture is totally unre-

lated to that of the West, especially considering the negative value that is

commonly ascribed to it in the West. An analysis of the classical texts of Tao-

ism or Chinese Buddhism is enough to conclude that the Christian-Western

concepts are basically opposite of those illustrated in Eastern thought.

The majority of Buddhist schools share a series of basic common prin-

ciples. What interests us is called
Sunyata
(Sanskrit), generally translated

into English as “emptiness” or “voidness.” This is a concept of central impor-

tance in the teaching of Buddha since a direct realization of Sunyata is a

Chapter 8 Mindfulness and Feelings of Emptiness

133

requirement for achieving liberation from the cycle of existence (
samsara
)

and full enlightenment. Widely misconceived as a doctrine of nihilism, the

teaching on the emptiness of people and phenomena is unique to Buddhism,

constituting an important metaphysical critique of theism with profound

implications for epistemology and phenomenology.

Sunyata
means that everything one encounters in life is empty of abso-

lute identity, permanence, or “self.” This is because everything is interrelated

and mutually dependent – never wholly self-sufficient or independent. All

things are in a state of constant flux where energy and information are for-

ever flowing throughout the natural world giving rise to themselves under-

going major transformations with the passage of time. This teaching never

connotes nihilism – nihilism is, in fact, a belief or point of view that Buddha

explicitly taught was incorrect – a delusion, just as the view of materialism, is

a delusion. In the English language, the word emptiness suggests the absence

of spiritual meaning or a personal feeling of alienation, but in Buddhism the

emptiness of phenomena enables liberation from the limitations of form in

the cycle of uncontrolled rebirth.
Kabat-Zinn (2005,
p. 180) explains the concept:

People can get scared even hearing such a thing, and may think that it is

nihilistic. But it is not nihilistic at all; emptiness means empty of inherent self-

existence, in other words that nothing, no person, no business, no nation or

atom exists in and of itself as an enduring entity, isolated, absolute, indepen-

dent of everything else. Nothing! Everything emerges out of the complex play

of particular causes and conditions that are themselves always changing. This

is a tremendous insight into the nature of reality.”

Further he posits that “Emptiness is intimately related to fullness. Empti-

ness doesn’t mean a meaningless void [
. . .
] emptiness is fullness, [
. . .
] is the

invisible, intangible “space” within which discrete events can emerge and

unfold. No emptiness, no fullness.”

Rawson
(1991)
states that “One potent metaphor for the Void, often used

in Tibetan art, is the sky. As the sky is the emptiness that offers clouds to

our perception, so the Void is the ‘space’ in which objects appear to us in

response to our attachments and longings.” The Japanese use of the Chinese

character signifying Sunyata is also used to connote sky or air.

Sunyata is a key theme of the
heart sutra
(one of the Mahayana Perfec-

tion of Wisdom Sutras), which is commonly chanted by Mahayana Buddhists

worldwide. The
heart sutra
declares that the skandhas, which constitute

our mental and physical existence, are empty of any such nature or essence.

However, it also states that this emptiness is the same as form (which con-

notes fullness), that this is an emptiness which is at the same time not differ-

ent from the kind of reality which we normally ascribe to events, and that

it is not a nihilistic emptiness that undermines our world, but a “positive”

emptiness that defines it.

The inability to experience emptiness (Sunyata), considered as the true

nature of reality, would represent a sort of primordial ignorance of the human

being (avidya). When this happens, it is called
nirvana
(the awakening) in

Buddhism. This concept is a central part of all the Buddhist psychology, so

much so that the teachings of Buddhism on the nature of reality develop

in order to help understand this vacuity. Mark
Medweth (2007)
explains

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Fabrizio Didonna and Yolanda Rosillo Gonzalez

this notion of emptiness in Buddhism: “Emptiness has been a term used

to describe many psychological states in the West, including the confusing

numbness of the psychotic, incomplete feelings of the personality disorders,

identity diffusion and existential meaninglessness
(Epstein, 1989).
Buddhists, however, refer to emptiness as the ultimate reality. Emptiness assumes a

defining role in the notion of ‘self’; it is the experience of emptiness that

destroys the idea of a continuous, independent individual nature. Unlike

many Western misconceptions, emptiness is not an end in itself nor is empti-

ness considered real in a concrete sense but merely a specific negative of

inherent existence
(Epstein, 1988).
While the ordinary consciousness perceives things as permanent and independent, Buddhists would counter that

perceived phenomena are interdependent and thus empty of permanence

and without an identity based on their own assumed nature
(Komito, 1984).

In relation to the sense-of-self, in Buddhism, emptiness does not imply (as

Westerners have often interpreted) the abandonment or annihilation of the

ego, ‘self,’ or ‘I’ but simply a recognition that this ‘self’ actually never existed

at all
(Epstein, 1989).
Buddhism is not an escape from the world but simply a refusal to extend or exaggerate the importance of conventional reality.

In so doing, the mind becomes empty of struggle, allowing us to see things

as they are in an ultimate sense. Thus, in Buddhist psychology, the empty

quality of the mind is regarded as the true nature of a person.” Therefore, a

translation of this mental and experiential state in Western terms is what we

called “
mindemptiness
”.

The Feeling of Emptiness as an Indicator

of Psychopathology

There are many psychological disorders in which the feeling of emptiness

generally presents itself as a transitory symptom (e.g., eating disorders,

obsessive compulsive disorders, PTSD, schizophrenia) or as a rather stable

phenomenological condition (personality disorders). Describing all these dis-

orders is beyond the scope of this chapter, so we will limit the following

discussion to pathologies where the feeling of emptiness often appears to be

a central and recurrent experience of the pathology.

Personality Disorders and Emptiness

All clinicians who have worked with personality disorders are familiar with

the relationship between this type of disorder and the experience, often

reported by patients during sessions, of the feeling of emptiness. The descrip-

tions, the hypothesized causes, and the consequences of experiencing these

sensations vary greatly even within the different disorders in Axis II (DSM-IV,

1994). We will now try to discuss what “emptiness” means when we come

across a patient with a specific personality disorder.

Borderline Personality Disorder

The main characteristics of BPD, as reported in the DSM-IV (APA, 2000), are

a pervasive instability condition of interpersonal relations, self-esteem, and

mood and a marked impulsiveness, with onset in early adult age and occur-

ring in several contexts. Among all the diagnostic criteria of the disorder,

Chapter 8 Mindfulness and Feelings of Emptiness

135

criterion 7 specifies, “These individuals can be affected by chronic feelings

of emptiness. They are easily bored, they are continuously searching for

something to do.” This state, as well as anger, has been a specific charac-

teristic of this disorder since its first formalized empirical descriptions (Fiore

& Semerari,
2003).
Kernberg (1975),
in his descriptive analysis, considers it a minor criterion. Other important authors like
Gunderson and Singer (1975)

or
Spitzer (1975)
consider this diagnostic criterion a discriminating feature of this disorder.

As previously pointed out, several authors in the field of cognitive-

behavioral therapy think that the experience of emptiness in BPD can be

a sort of dysfunctional avoidance strategy in situations of clear subjective suf-

fering and associated with a major risk of abuse or injuries to self and others

(Beck, Freeman et al., 1990;
Linehan, 1993;
Young, 1987).
According to Fiore and Semerari
(2003),
the perception, in this type of patient, of the “unworthy self” and the “vulnerable self” can expose them to intolerable pressure.

At times, patients succeed in escaping this pressure, detaching themselves

from everybody and everything and entering into a state of numbness. This

is the condition where frequent suicide attempts and self-injuries occur more

frequently, representing a state of complete detachment from the world or a

way to evoke such detachment. Other times, according to these authors, the

emptiness can be perceived as “a painful sense of lack of purpose.” In these