Friday, September 4, 2015

Pt. Two - And Then We Were Three: Understanding Borderline Personality Disorder

Note ~ There are ten personality disorders listed in the Diagnostic Statistical Manual for Mental Disorders. Their etiology is extremely complex as is management of them. The purpose of today's blog is to shed some light on Borderline Personality Disorder. Names have been changed for confidentiality.    First, I invite you to read -
Pt. One - And Then We Were Three: A Troubled Relationship with a Borderline Sister

Part Two - And Then We Were Three:
Understanding Borderline Personality Disorder

It was towards the later part of the lengthy eighteen year span of upheaval when I entered graduate school to pursue a career as a Marriage and Family Therapist. In one of my first psychology classes, we began studying the Axis II Disorders (often referred to as personality disorders) cataloged in the Diagnostic Statistical Manual of Mental Disorders (DSM 1V).  One evening in class as the professor moved through the ‘Personality Disorders’, my attention was immediately drawn to Borderline Personality Disorder (BPD). As I scanned the diagnostic criteria, my mind grabbed hold of key words or phrases such as frantic efforts to avoid real or imagined abandonment…a pattern of unstable and intense interpersonal relationships… identity disturbance…and chronic feelings of emptiness.  I couldn’t believe what I was reading!  Of the nine criteria listed that described the manifestations of Borderline Personality Disorder, I could see my sister Kelly clearly in at least seven of them.  Here it was – the explanation as to what was wrong with Kelly!  Finally, the puzzle made sense!!  Perhaps there was hope for her! She could get help; she could get better!  Things could change.  We could be sisters.
As my weeks of study continued and as the professor knowledgeably guided us through the challenges of all the Personality Disorders, a sobering and sad realization set in.  Paraphrasing our diagnostic manual, the professor acknowledged that with ‘personality disorders’, there is a pervasive pattern of some measure of unhealthy behavior, affect, etc., beginning in early adulthood and present in a variety of contexts.  In simpler terms, these personality characteristics are not an explanation of stages the individual is going through – these traits describe who the person is. This is the individual’s personality. This is their state of being. In my naivete as well as with my deep desire to know more, one night in class I raised my hand and asked the dreaded question, “With Borderline Personality Disorder, can an individual who seeks out professional counseling or therapy heal from the issues of abandonment or intense rejection and lead a more healthy stable life?”  For the next hour, the professor led us in an intense discussion on this topic.  There were no concrete answers. I was reminded that the practice of psychology is a study of human behavior and when working with injured individuals, there are always many variables to consider.

Although there were no absolutes, the professor lifted my hopes a bit with a few concluding words. “Personality disorders are very hard to treat. Borderlines are especially challenging because they often do not stay in therapy long enough to create any kind of healthy change.  But, there is always hope. This is why we, you and I, have chosen this field – to bring healing to others and to give them hope for a healthier way of being.” With his encouraging words, I was determined to gain a deeper understanding of the disorder.  After class that evening, I asked the professor for any additional readings that he could recommend on BPD.  Without hesitation, he replied, “Get a copy of ‘I Hate You- Don’t Leave Me’.  It’s really the best little book on Borderline Personality Disorder I’ve ever read!”

As soon as I purchased the book, I devoured it. I read it again and again.  I shared my new insights and understanding with my two other sisters and encouraged them to read it as well. Although about half of the book describes in detail what life is like for the Borderline and how the individual came to that place of being, the remainder of the book gives specific strategies for those in relationship with the Borderline.  Several of the most important tools I learned were how to communicate with the Borderline, how to set realistic expectations for the relationship, and how to honor my own place of being in the process.  However, the most unsettling truth that I confronted and came to terms with was  no matter what I did or didn’t do in my desire to achieve a healthier relationship with my sister, it would not change her.
About twenty years have passed since I first read "I Hate You, Don’t Leave Me”.   Although there has been more of stability in Kelly’s life during these years, the relationship between Kelly and me as well as my two other sisters has not changed.  There have been periods where the four of us came together in celebration of a family event and we were able to sustain a calm reunion for a while.  And then, the peace was once again shattered by an insensitive comment or an indication of exclusion on some unfounded basis.  In 2006, our mother became quite ill.  While we all rallied around our mom to give support and help, there was a glimmer of hope that it might draw the four of us a bit closer given there was a deep shared concern.  But even amidst the recovering  process, words of care about our mother were mis-perceived and again, phone  conversations ended abruptly and the familiar slam of the receiver pierced our ear drums.  

For almost two years, I once again was one of three sisters.  Then, my daughter’s wedding in 2008 opened a window for the possibility of being one of four, at least for a short period of time.  To my surprise, Kelly and her husband did attend the wedding, and it actually was the beginning of a healthier time for all of us.  For me, much of what I had learned in my readings and studies of BPD helped me immensely. In addition, I had worked with several clients who were Borderlines, and those experiences taught me how to navigate through the challenges of the personality. Maintaining strong boundaries, shoring up realistic expectations, and keeping communications around safe territory were paramount to sustaining any kind of relationship.  Also, shortening periods of contact aided in the stability of the time spent together.

In the summer of 2008, my husband and I moved closer to family.  My sister Kelly and I spent more time together than we had in over thirty years.  We went to a few movies together, had dinner as couples with our husbands, and joined together as one large family for special celebrations.  For the first time in my life, I felt I was indeed one of four sisters. As strange as it was, it felt good. And then, in the Fall of 2009, the inevitable happened.  A comment shared by one of my sisters to Kelly was perceived as a deliberate attack on her family. Kelly exclaimed her feelings of unforgivable hurt and ultimate rejection.  There was no rational reason for Kelly’s response or discussion of it. In a moment, the relationship with Kelly was over.  My sisters and I were disowned.   I was, once again, one of three.

It has been almost exactly six years since the last exile from sisterhood.  During my own personal journey through this experience with Kelly as well as coming to terms with my own healing truths, I have come to understand two important tenets which have freed me from the troubled relationship with Kelly.  First of all, all relationships take work, even healthy ones.  But, when any relationship consistently injures, harms, or erodes the integrity of my being, it is my responsibility to take care of myself and step away from it.  Because this unhealthy dynamic involved a family member, I had let it go on far too long, and I had disrespected my well-being in the process.  It was time to release it and free myself from it. Secondly, the more I learned about BPD, the more I came to grasp fully how Kelly’s issues of chronic abandonment and rejection stemmed from other sources and other deeply embedded traumas in her life. It was never about what my sisters and I did or didn’t do or what we said or didn’t’ say. With one simple yet profound insight, I  realized my sisters and I were the triggers or the reminders of such injustices, and thus, we became the recipients of the brokenness which flowed from her fractured self.  We were never to blame for Kelly’s pain; it was merely projected onto us. 
It is freeing to acknowledge that Kelly, to some degree, feels less threatened without my two sisters and me in her life. Distanced from us, Kelly can be an only child who can create her own sense of safety. Perhaps, she too, in her solitary world, is more free.   

Recommended Readings:
I Hate You, Don't Leave Me by Jerold J. Kreisman, M.D., and Hal Strauss

Wednesday, September 2, 2015

And Then We Were Three: A Troubled Relationship with a Borderline Sister

Note ~ There are ten personality disorders listed in the Diagnostic Statistical Manual for Mental Disorders. Their etiology is extremely complex as is management of them. The purpose of today's blog is to shed some light on Borderline Personality Disorder. Names have been changed for confidentiality.    
Part One - And Then We Were Three:
A Troubled Relationship with a Borderline Sister

  I was overly excited as I slid out of the driver’s seat and walked briskly to the entrance of “Carats” – a specialty boutique filled will all sorts of bling.  Although there were shelves lined with shiny sliver -stoned purses and glass cases protecting rows of sparkling chains and bobbles, I had my eye out for a delicate but extraordinarily elaborate picture frame.  I had been into the shimmering little shop a few weeks previously; it was then I spotted the perfect 60th birthday gift for my older sister.
     As I approached the nearly six-foot tall glass enclosed locked case, I breathed a sigh of relief.  The smooth forest green unique circular frame dotted with multi-colored tiny jewels and gems awaited my purchase.  A striking petite woman with a thick silky grey page-boy style hair poised herself next to the display case and asked if she could help me.  Within just a couple of minutes, I was at the counter paying for the special gift and we began to talk.  

     “Is this a gift and would you like me to wrap it for you?” the soft-spoken woman asked.
     “Yes, it is,” I smiled.  “It is for my sister’s 60th birthday. And I would like it gift-wrapped.  Thank you.”
     “How lovely,” she responded.  “She must be very special to you.”
     “Oh yes,” I confirmed.  “She gave me a surprise 40th birthday celebration many years ago, and I have always wanted to give one for her.  My younger sister and I have spent weeks planning a surprise luncheon at one of her favorite places with a group of her very close friends.  We are so excited!  It’s hard to put one over on my older sister, but we think she will be completely shocked!”
     As the sweet woman carefully wrapped several pieces of tissue paper around the frame before placing it into a frosty pink and black bag, she quietly asked, “So, you have two sisters – one older and one younger?”
     Immediately, a lump lodged its way into my throat and I found it hard to swallow. Although seconds seemed like minutes, and I had been in this same conversation many times before, I always found myself caught off guard. While I searched for the right words, a stream of responses replayed themselves through my mind:
No, I have a third sister.   But she has disowned us.   No…that is not a good answer. 
Well, I have a third sister but she doesn’t talk to my other sisters and me – at least not right now.
Or, should I just lie?  Yes, I have just two other sisters.  No, that doesn’t feel right either.
      I took in a deep breath, sighed, and responded to her question.  
     “I do have three sisters – another one who is younger – the youngest of the four of us.  Unfortunately, she is angry with the three of us right now and is not speaking to us.  This happens a lot.  It’s just the way it is.” 
     I was waiting for an uncomfortable look or perhaps an “I am sorry” response from the gentle lady.  I paused not knowing if I had said too much.  She looked up at me with sorrow in her eyes. She placed her hand on mine as it rested on top of the cold glass.
     “I know what you mean.   I have ten brothers and sisters.  Of the seven of us that are still living, two of them still do not talk to the rest of us.  I let go it a long time ago.  Nothing I can do about it.“ A soft smile crossed her face.  “Life is just too short and too hard.  It is easier this way.”
     “I know,” I said, “I agree.”  I picked up my pretty gift-wrapped bag and started to leave.  “Thank you so much.  It looks lovely!”
     “Have a wonderful time at the surprise party for your sister,” she added. 
     “We will,” I responded as I made my way to the door.  Turning one last time before I exited the shop, I smiled and said, “It will be a beautiful and memorable day!”
     Walking to my car, I couldn’t help but think of my youngest sister – Kelly.  She would not be a part of an incredible joy-filled day.  Once again, she would be missing at an important family event – a sister’s birthday.  Once again, I felt sad.  And then, I recalled the little lady’s words, “It is easier this way.”
    I had known that for a long time.

     As far back as I can remember, life was a struggle for Kelly.  I was six and entering first grade when she was born.  I remember a fussy baby, lots of crying, and no one really being able to comfort her.  Throughout my elementary and junior high years, I remember Kelly’s presence and yet, I cannot recall vivid memories of her.  I was a senior in high school when she was just twelve.  That was when she first started getting sick a lot –even hospitalized.  Her allergies to medications intensified her illnesses.  While away at college, I really did not know her well.  Coming home for mandatory school breaks, I remember how Kelly argued with my other sisters and with me. I can still hear the yelling, the screaming, and bedroom doors slamming with never any hope of resolution or apology.  She was difficult.  I don’t remember her being happy or settled. 
     One of the few times I felt I got a glimpse into Kelly’s being more closely was when I was in my late twenties.  Three days prior to the school year starting, I had unexpectedly and thankfully been offered a teaching job in my home town. I moved in with my parents and would stay with them until I could get my feet on the ground and secure my own apartment.  My youngest sister, in her early twenties was still living at home.  Although I would certainly not consider myself a tower of stability at the time, I did have a good job and was determined to get my life on track.  During the ensuing year, my sister and I enjoyed one another’s company.  I remember that we even double-dated a couple of times, and we shared our newly-found true romances with one another.   I recall Kelly laughing, and at times, I thought she bottled up a free spirit within her that was bursting to get out!  And then there were so many other occasions when her fragility and sensitivity to the outside world seemed to come crashing down on her.  Her trust in others was paper thin, and the slightest inference of rejection tore at her being and she recoiled instantly. 
     By the end of the school year, I had saved enough money to get my own apartment and to start living independently again.  Although I remember that Kelly was sad to see me move out, I was ready to go. However, I remember how much I worried about her. Kelly’s life was like riding a rough roller-coaster of sorts with lots of bumpy ups and downs and sharp twists and turns.  I knew I needed to distance myself from the drama that surrounded her, some self-inflicted, and some that appeared to always find her.
     Over the next eighteen years, my other two sisters and I remained close.  Although we all married, had children, and lived quite a distance from one another, we still managed to see each other especially on holidays and for family events.  Although each of us certainly faced our own challenges, for the most part the three of us grew from those experiences and we turned to one another often for comfort, compassion, and companionship.  It was during the same eighteen year period that Kelly’s life was filled with turmoil and tragedy.  There were numerous failed relationships.  She endured a violent marriage for many years and struggled to raise children in a myriad of environments that often proved ill-suited for her and for them.  To add to the instability, Kelly’s health was also fragile.  With life-threatening diseases that always had a diagnosis but rarely had effective treatments, Kelly managed to cope with life, but not much more.
     During this tumultuous period of time, my other two sisters and I would help her in ways that we could given the demands on our own lives and the lack of proximity from her.  Whether it was phone calls with offers for assistance, or keeping her children for a period of time, or listening to and encouraging her during a time of challenge, or just being available to help with some aspect of her life, the three of us gave to our youngest sister because we loved her. However, a pattern of behavior started to develop that soon began to erode at the relationship between Kelly and each of us.
     Regardless of what the situation was in Kelly’s life and in spite of what one of my other two sisters or I did in response to it or did not do, there was always a price to pay.  A phone call to Kelly would turn into an argument over what one of us did or said.  A monologue of self-pity would often turn into blame-filled accusations and then full-on rage.  Screams of how the three of us always abandoned her, excluded her, and neglected her flowed from her lungs quickly followed by a slamming down of the phone.  Other times, when we met in person, the exchanges would start off with a level of calm and civility. But one mis-perceived comment would lend itself to a flood of ‘poor me’ scenarios with angry bursts of ‘you don’t care and you’ve never been there for me’ heating up the room. And as time wore on, it also became a pattern that at the conclusion of one of these dramatic episodes, Kelly would inform the three of us that she wanted nothing to do with us...we were disowned.

     And so it would be, that for a period of time – perhaps a few weeks or a few months or even a year or so - I would be one of three sisters. Then, because we felt sorry for Kelly, or the holidays were approaching, or the dynamics of the family pulled on our guilt strings, one of my other two sisters or I would give Kelly a call – to apologize.  It never went really well.  It was like walking a tight-rope, trying to stay balanced and focused while someone is shaking the wire. But, typically, the mission was accomplished and our rejoining as four sisters stood for a time, although neither of my sisters nor I expected the connection to last.  As this unhealthy dynamic continued throughout the years, my two sisters and I felt its burden upon on.  The constant expenditure of energy that it took to navigate through the relationship with Kelly was exhausting and exasperating. Never being able to do enough or be enough for her was irritating and defeating.  And always being judged by the last deed that was done for her and being told that it fell short in some way was crazy making. Never knowing if we were in her favor or out and so often not having a clue as to why, caused my sisters and I to withdraw and to protect ourselves.  It was just too hard.

Next time: Part Two: And Then We Were Three: Understanding Borderline Personality Disorder

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