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8

Mindfulness and Feelings

of Emptiness

Fabrizio Didonna and Yolanda Rosillo Gonzalez

“Nothing is as unbearable for man as to be completely at rest, without

passion, without business, without distraction, without application to

something.”

In such a state of rest man becomes aware of “his nothingness, his

foresakenness, his insufficiency, his dependence, his impotence, his

emptiness.”

Incontinently there springs from the depth of his soul “the ennui, the

blackness, the tristesse, the chagrin, the spite, the despair.”

Blaise Pascal

Introduction

The feeling of emptiness is a common symptom or phenomenological

experience found in clinical practice with several kinds of disorders. What is,

however, more difficult is finding two patients who describe this experience

in the same way. Patients report different experiences: “I feel an emptiness

inside,” “everything seems empty,” “I feel like I’m falling into a great empti-

ness,” “nothing makes sense because of the emptiness,” and many others.

Though at first sight they may appear to be very similar, some specific and

distinctive characteristics surface on closer observation. The diagnoses that

comprise these manifestations can be multiple and are recurrent in relation

to a series of disorders: from common depressive episodes to personality

disorders, even in comorbidity with other pathologies.

This phenomenon seems to be a universal human experience and might

not always seem directly linked to a pathology. All of us, at some moment in

our lives, can experience a “feeling of emptiness,” without suffering from

a mental disorder. Like many other nonspecific symptoms, the feeling of

emptiness is neither a necessary nor a sufficient reason for a frank diagnosis

although it has become one of the inclusion/exclusion nosological criteria of

borderline personality disorder (BPD) in the Diagnostic and Statistical Man-

ual of Mental Disorders (DSM-IV, American Psychiatric Association, 2000).

The experience of emptiness has aroused the interest of well-known schol-

ars and has become the main subject of their writings. Unfortunately, few

thorough or rigorous studies have focused specifically on emptiness. This

may be because of the many methodological problems involved in this type

of study. For example, what do we mean by experience of emptiness? Does

this feeling of emptiness always present itself in the same way? Does it vary

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Fabrizio Didonna and Yolanda Rosillo Gonzalez

according to the disorder diagnosed? Although we will try to answer these

questions, at least in part, in this chapter, the main aim is to take the reader

through a theoretical reflection on the possible clinical use of mindfulness,

to alleviate, reduce, or eliminate the suffering caused by the experience of

emptiness as a pathological symptom.

Psychology and Emptiness

He who has a why to live, can bear almost any how

Nietzsche

The experience of emptiness has not been studied only by psychologists.

Various categories of scholars, including philosophers and theologists, have

been and still are interested in this phenomenon of human experience.

However, if we focus specifically on psychology, we can highlight some

epistemological approaches that, more than others, have tried to explain

this psychological experience. Cognitive-behavioral theory
(Linehan, 1993;

Young, 1987),
existential psychology
(Frankl, 1975, 1963;
May, 1950, 1953),

and psychoanalysis
(Kernberg, 1975; Kohut, 1971, 1977)
are some of the

theoretical perspectives that have provided important contributions to the

understanding of the experience of emptiness. These contributions will be

discussed in detail below.

Cognitive-Behavioral Theory and Feelings of Emptiness

Several cognitive-behavioral authors have suggested that the experience of

emptiness can be a sort of dysfunctional avoidance strategy in a situation of

deep subjective suffering
(Beck, Freeman et al., 1990;
Linehan, 1993;
Young,

1987).
Linehan (1993)
bases her therapeutic model on the idea that the inability to regulate and modulate painful emotions is an essential element

in explaining the behavioral difficulties of patients with BPD. These patients

present a sort of intolerance to negative emotions: “Many borderline patients

try to control their emotions simply by forcing themselves
not to feel
what

they are experiencing”
(Linehan, 1993).
Other researchers, such as Fiore and Semerari
(2003),
speak of a state of
emotional anesthesia
to avoid any suffering by which patients detach themselves from everything and everyone.

Young, Klosko, and Weishaar
(2003)
have identified various
modes
, meaning the specific emotions, cognitions, and behavior active in a person in the

here and now. Among these, the
detached protector mode
aims at isolating

the person from his needs and feelings, creating a sort of detachment with

a protection purpose. The main symptoms of this mode include depersonal-

ization, self-harm, boredom, and feelings of emptiness. These theories can be

associated with Hayes, Wilson, Gifford, Follette, and Strosahl’s (1996) asser-

tions on
experiential avoidance
.

Experiential avoidance is a putative pathological process recognized by a

wide number of theoretical orientations. Experiential avoidance is the phe-

nomenon that occurs when a person is unwilling to remain in contact with

particular private experiences (e.g., bodily sensations, emotions, thoughts,

memories, and behavioral predispositions) and takes steps to alter the form

or frequency of these events and the contexts that occasion them. We occa-

sionally use terms such as
emotional avoidance
or
cognitive avoidance

Chapter 8 Mindfulness and Feelings of Emptiness

127

rather than the more generic
experiential avoidance
when it is clear that

these are the relevant aspects of experience that the person seeks to escape,

avoid, or modify. We recognize that thoughts, memories, and emotions are

richly intermingled and do not mean to imply any necessary rigid distinc-

tion among them (although distinctions might be drawn by some theoretical

perspectives without threat to the underlying principle of experiential avoid-

ance)
(Hayes et al., 1996).

The question, then, is what can a patient do if, as has been hypothesized by

the aforementioned authors, the feared stimulus is one’s own emotions? How

can a person avoid something that is not outside, but part of his or her natural

and theoretically adaptive response to the outside world? Certainly, a possi-

bility is to try
not to feel
, as was said above. Experiencing this “emptiness”

creates a detachment leading to actions aimed at distancing the subject from

the stimulus situation, that is, the negative emotions, replacing them with

physical pain (self-harm), numbness (alcohol or substance abuse), euphoria

(acting out dangerous behaviors), or physical gratification (sexual promiscu-

ity, bulimic crises), all manageable situations from the subject’s point of view.

Referring to the BPD,
Linehan (1993)
claims that exposure to an invalidating environment, where inadequate and unforeseeable answers follow the

manifestation of a person’s inner experiences, leads to the
non-recognition

or
inhibition
of negative emotions. This continuous inhibition of negative

emotions leads to emotional avoidance. The paradigm, the author claims,

is similar to learning flight behavior to avoid painful stimuli. In this case,

the emotions, meaning the complex response of the body (activation of the

central nervous system accompanied on a neurovegetative, behavioral, and

cognitive level by specific modifications), seem to be conditioned. This con-

ditioning may have been caused by a repeated process of adversive asso-

ciation stimuli such as those previously described by Linehan regarding an

invalidating environment. If we add this to specific circumstances, increases

in fear not caused by events experienced by the subject but rather by the

simple repeated presentation of discriminative and conditioned stimuli, con-

nected to such events
(Sanavio, 1991),
we find that even simple physical sensations, previously associated with a negative emotion, can produce a

phenomenon known as
incubation of fear
. The sense of emptiness could

be triggered by the simple arising of one of these discriminative stimuli, pre-

ceding the activation of the negative emotions, which the subject avoids and

sometimes fails to recognize.

Existential Psychology

Viktor Frankl coined the term “existential vacuum” (1963; 1973), and aspects

of the meaning of this term come close in meaning to the term “emptiness”

as described in this chapter. Frankl posits that humans have a “will to mean-

ing,” which is as basic to them as the will to power or the will to pleasure.

The frustration of the will to meaning results, in Frankl’s estimation, in a

“noogenic neurosis” – an abyss experience
(Hazell, 2003).
If meaning is what you desire, then meaninglessness is a hole, an emptiness, in our lives. Whenever you have a vacuum, of course, things rush in to fill it.
Frankl (1963)

suggests that one of the most conspicuous signs of existential vacuum in

our society is boredom. He points out how often people, when they finally

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Fabrizio Didonna and Yolanda Rosillo Gonzalez

have the time to do what they want, don’t seem to want to do anything,

for example, people go into a tailspin when they retire, students get drunk

every weekend, and people submerge themselves in passive entertainment

every evening. He calls this the “Sunday neurosis” and defines it as “that

kind of depression which afflicts those who become aware of the lack of

content in their lives when the rush of the busy week is over and the void

within themselves becomes manifest”
(Frankl, 1963,
p. 169). The result of this is an attempt to fill our existential vacuums with “stuff” that, because

it provides some satisfaction, we hope will provide ultimate satisfaction as

well; for example, we might try to fill our lives with pleasure, eating beyond

all necessity, having promiscuous sex, living “the high life;” we might seek

power, especially the power represented by monetary success; we might fill

our lives with “busyness,” conformity, and conventionality; or we might fill