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

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