Sometimes, in other words, there are no satisfying choices to be had.
CAROLYN
So many years chasing Carolyn. I understand better now how my sister's life was spent tracing the skewed patterns of her neurons. Did she have a deep-seated genetic predisposition for her sinister behavior? Quite possibly. Did the polio exacerbate her instability? Almost certainly. Did she drink to fill the emptiness of her ephemeral, underperforming neurotransmitters, and did that contribute to her behavioral problems and her anorexia? Absolutely.
Fig. 12.2. Carolyn's final photo album is packed with photographs of feline knickknacks and her cat. But this haunting picture—different from all the others—somehow meant enough for her to keep.
Carolyn's ultimate psychiatric diagnosis? Perhaps it doesn't matter. After all, borderline, psychopath, and any number of other diagnoses are all just words we clumsily apply to the complex processes that can be associated with both nature and nurture as a dysfunctional brain develops.
Do I forgive Carolyn?
Certainly writing this book has given me a compassion I never felt before. I can understand now some of the neurological and genetic quirks that spun Carolyn in directions she had little control over, whatever her conscious feelings to the contrary. But I also know that if, through some cosmic trick, Carolyn were to suddenly be alive again, smiling in my living room as she played with one of my children, something visceral would still rise in me, as if I'd just found my children toying with a snake. Perhaps surprisingly, I think this means I'm “at a good place” now. Reason has given me an understanding and peace that might be called forgiveness. But emotions remain, serving as a shield that helps protect both my loved ones and myself from Carolyn and people like Carolyn. Researching this book hasn't saddened me, or at least not too much, about the things that can't be changed in people like Carolyn. It has just given me a gentle reminder that in the end, we should perhaps not worry so much about changing others. Rather, we might think instead about changing ourselves.
Still, when all is said and done, I can't but wonder—did Carolyn have the capacity for love? Not cheaply expressed “love” for an easily manipulated paramour or for an obedient and at least temporarily useful caretaker, but real love that included the idea of sacrifice and sorrow and joy for another? Did she love, for example, our father—the person who, through all the years, loved her most unwaveringly, most loyally, most honestly?
A journal entry tells me:
May 6th: Penny watered the artichokes and fed the birds; also, cleaned up the dried parsley I accidentally spilled. Barb called—Dad died. My request for help with periodontal care seemed self-serving; but apparently this will be handled through a trust fund.
I page onward through the entries. The diary continues on routinely through May, June, and July: she changed sheets, read cookbooks, pulled a muscle while inebriated, went shopping, watched television. One Thursday she presciently notes: “There is absolutely no reason to keep a journal. Actually self-indulgent! My hubris will catch up with me.”
Actually, it wasn't hubris. It was her boyfriend, Jack.
Jack himself had apparently called 911 to report Carolyn's death, but when the police arrived at the apartment, Jack had proved curiously evasive. When asked if Carolyn drank, after much prodding, Jack confessed she drank a third of a bottle of alcohol a day. As Officer Crispin related in his subsequent phone call to me, this amount of booze was unimpressive: “Most alcoholics drink about a half gallon a day,” he told me. “A third of a bottle shouldn't have killed her.” Crispin had ordered toxicology tests; he suspected by Jack's jittery demeanor that he had somehow drugged her.
And we did our own investigating. According to her caretaker, Carolyn had apparently been edgy over the previous month about pains in her chest. Jack had moved in to ease her fears and be around in the case of emergency. Instead, the visit had somehow turned into a two-week mutual bender.
Three days after Carolyn's death, Jack himself called, voice slurred though it was only mid-afternoon, and admitted that Carolyn was in no pain when she died. “She was just setting there and she got kind of quiet.” By then we'd talked with the forensic pathologist, who'd penciled in coronary artery atherosclerosis as the cause of death. (Actually, the pathologist added offhandedly, the cirrhosis of the liver was so bad that it could really have been a toss-up.)
Fig. 12.3. Carolyn circa 1948.
“What time of day did Carolyn die?” my husband asked Jack inanely. It's a little hard to know what to say to someone who's just intimated he was too drunk to call for help when Carolyn had had, right in front of him, the heart attack she'd been fearing.
“By the time I was available again,” Jack answered elliptically, “it was history.”
Carolyn's last written words reverberate: “Back to the real world after panic attack. Must ease Jack out. Can't tolerate the smoke or the late night ‘sloppies.’ He is still a good friend to have.”
I rifle through her diaries. Nothing more. Nothing of interest.
Except one day. August 9th—three months after my father died. Two years before her own death.
Nancy did nice lady visitation to thank me for goodies. I fell very much in like with her. I was too talky—I had lost last night's supper and had swollen eyes from tears shed over that actor Charlton Heston's announcement of Alzheimer's diagnosis in lieu of Dad's recent demise. Great buy on ripe brie at Sunny Farms Grocery with sour grapes and mediocre plum and nectarine.
* * *
a.Stephen Morse, the Ferdinand Wakeman Hubbell Professor of Law & Professor of Psychology and Law in Psychiatry at the University of Pennsylvania Law School, notes that “free will or lack of it is not a criterion for criminal responsibility or non-responsibility.” He also adroitly points out the corollary that free will is also not used as a basis for any psychological diagnosis. Fundamentally, if a psychiatric “syndrome does not sufficiently impair the defendant's capacity for rationality, it will have no excusing force [from a legal perspective] whatsoever, no matter how much of a causal role it played…. To say that a syndrome caused a crime tells us nothing about whether the defendant deserves excuse or mitigation (except in New Hampshire…).”
b.This behavior can't help but evoke shades of psychologist Stanley Milgram's work. In a classic set of experiments, Milgram revealed that many ordinary people will go to absurd lengths—even giving electric shocks to shocking screaming victims—in their blind tendency to obey authority. Perhaps this relates to Posner's research involving people's varying ability to resolve conflicting information and Wilson's studies related to decision making and synchronized neural rhythms.
c.When I served as a communications officer in the army in the late 1970s, I still remember the enlisted men complaining to me about one of my sergeants. “He's a completely different person around us than around you,” warned one of the cable apes, as they called themselves. One day I happened to overhear my creepily servile sergeant abusing the company clerk, and I suddenly understood what the men were talking about. Becoming aware of this type of brown-nosing was good preparation for becoming a professor. It's amazing how often I'll hear a professor proudly describe how his firm chewing out set a cheating student back on the right path. Yet I hear through the grapevine how that same student continues to brag about his cheating prowess.
Professor Barbara Oakley's Evil Genes provides a terrific “big picture” overview of those who carry traits similar to borderline personality disorder. What Barb didn't tell you, however, was that when she first began to look for information related to her sister, she stumbled across my Stop Walking on Eggshells. “That's what started the boulder rolling,” she told me.
Many who have read Evil Genes have asked Dr. Oakley what they should do if they are dealing with a troubled person in their life who they suspect has some—or many—of the symptoms of borderline personality disorder. As it turns out, my most recent book, The Essential Family Guide to BPD: New Tools and Techniques to Stop Walking on Egg
shells, deals with precisely that topic. That's why Barb asked me to write this afterword.
As you know, many of those who have symptoms of borderline personality disorder remain undiagnosed. Some of these people can function at prominent levels—as doctors, ministers, business leaders, or other highly respected individuals. If you suspect someone you care about or work with has some or many of the traits of borderline personality disorder, you may be left feeling helpless and hopeless. However, you do have the power to improve your situation whether or not the borderline-like person (“BP”) you know chooses to change.
Your feelings are normal, and you are not alone.
The following are common emotions among those who affiliate with BPs (called non-BPs here for short):
Self-doubt: People question their own sanity because BPs forcefully and consistently maintain that the non-BP's perceptions are completely wrong.
Guilt/shame: Over time, the accusations have a brainwashing effect. The non-BP comes to believe that he or she is, indeed, the source of all the problems.
Depression/grief/exhaustion: Non-BPs being devalued by a BP in once loving relationships cherish powerful memories of the times when the BP loved them unconditionally and thought they could do no wrong. Non-BPs can ultimately feel as if the person who loved them has died and been replaced by someone unknown. The “love/hate” cycle is completely unpredictable—it can take minutes, hours, days, months, or years.
Isolation: If you are in a relationship with a BP, you may find that the BP's unpredictable behavior and moodiness can make friendships difficult. Some non-BPs find that friends and family do not believe them when they describe the BP's behavior. Other non-BPs say friends suggest solutions they consider simplistic or unacceptable. The non-BP's self-esteem suffers, and making friends eventually seems impossible. In addition, the BP may insist that the non-BP cut off ties with friends or family. The non-BP often feels there is little choice but to comply.
Feeling trapped and helpless: Staying in a relationship with a BP may seem hopeless, but leaving may not seem like a realistic option either. Getting angry does not work—neither does reasoning or anything else. Who wouldn't feel helpless under these circumstances?
If “your” BP is a family member, don't tell him you think he has BPD or try to force therapy upon him.
If you do, as Dr. Oakley pointed out earlier in Evil Genes, you can be sure your family member will become furious and say that you're the one who has borderline personality disorder—especially if you and your BP have been playing the “blame game.” Even if the diagnosis was coming from a doctor, it would be meaningless unless your BP wanted help. Making major changes is tough even when people want to make them.
The question people ask most often is, “How do I make my family member go to a therapist?” The answer is, “you can't.” You may be able to threaten the person into going, but all you get is a warm body, not an engaged or open mind. Rather than focus on what your family member thinks, which you can't control, focus on his behavior toward you, and think about what you will and will not accept.
Recognize the common triggers of shame and fear of abandonment.
Whether your BP is in your family, or simply someone you must work with, you can create more predictability in your life by identifying triggers (sensitive areas) that lead to borderline defense mechanisms. The most common ones are shame and fear of abandonment.
Everyone fears abandonment to some extent. However, BPs react to real or imagined threats. And they have a good imagination. In a family situation, normal things such as spending time with your own friends or working long hours can trigger an over-the-top expression of fear that cannot be easily assuaged because it originates from within the BP.
People with borderline personality disorder feel innately bad, worthless, defective, or toxic at the very core of their being—not for something they have done, but simply for being. This makes them sensitive to rejection. They anxiously await it, see it when it isn't there, and overreact to it whether it's there or not. This is why small slights—or perceived small slights—can cause major messes.
Leave if your family member rages or becomes violent.
Don't listen to family members berate and call you names. At that point in time, they can't see your point of view or think through the effects of their interactions with others. It's not that they won't—it's that they can't, not without having had the proper treatment. Remember—their emotional toolkit is missing some key components.
Verbal abuse harms you: ongoing, repeated verbal assaults can be every bit as emotionally devastating as physical battering—especially when it is meted out by an intimate or by someone in a position of authority.
If your family member loses control, you can:
Retreat to a room that is off-limits to everyone else
Call a friend and go over to her house
Call a friend and have the friend come to your house
Go to a movie
Put on some headphones and listen to music
Take a taxi home
Turn off your answering machine
Think through your options and make concrete plans ahead of time. Then discuss your plan with the BP before these situations occur so that you have a shared understanding of what will happen. Assure your family member that if you leave, you will be back. Let your BP make her own choices, and give the gift of allowing her to take responsibility for the outcome of her decisions.
Use phrases like:
“I want to hear about your feelings, but it's hard for me when things get too emotional” (instead of “you get too emotional”).
“We'll talk later, when things calm down. I want to give you my full attention, and that's too hard for me to do right now.”
“I can't listen right now. Not until things are calmer.”
“Let me have a little while to calm down and then we can talk.”
Become an advocate for your borderline child.
If you believe your minor child has BPD, run to your nearest bookstore and purchase a copy of Borderline Personality Disorder in Adolescents (Fair Winds Press, 2007) by Blaise Aguirre, MD.
You will hear over and over again that a person can only receive a diagnosis of BPD after the age of eighteen. This is an old and entrenched way of thinking. Today, experienced clinicians believe it's crucial to address borderline-like behavior as soon as possible. The longer the disorder goes untreated, the more entrenched it can become.
Learn and practice the five core skills that will empower you to improve your own life.
Borderline personality disorder is multifaceted and borderline-like behaviors can be wildly unpredictable. Those with BP family members, or who are dealing with a BP in their work life, need more than information: they need skills training, emotional support, and often their own therapist to help them determine what is and isn't “normal.”
My book The Essential Family Guide to Borderline Personality Disorder (Hazelden, 2008) identifies five major tools family members need to organize their thinking, learn specific skills, and focus on what they need to do instead of becoming overwhelmed. If you are dealing with a BP in your work life, you will also find these tools to be useful.
Here, I'll briefly go over the first three: take care of yourself, uncover what keeps you feeling stuck, and communicate to be heard. (The fourth and fifth have to do with setting limits and reinforcing the right behavior. These are too complicated to discuss given the amount of space available.)
TOOL 1: TAKE CARE OF YOURSELF
Non-BPs tend to become isolated. Don't let this happen to you. Reach out to others. Don't let yourself be embarrassed into isolation or pushed into it by threats, implied or outright.
Depend on friends to give you reality checks. Non-BPs almost always lose sight of what is normal. Join a support group, whether online or in real life (see links at BPDCentral.com). Get enough sleep and live a healthy lifestyle.
TOOL 2: UNCOVER WHAT KEEPS YOU FEELING STUCK
Feelings of fear—for example, fear of conflict, fear of being alone, fear of financial problems, and fear of losing the relationship—make some people feel trapped. Susan Jeffers, the author of Feel the Fear and Do It Anyway, says that all we need to do to diminish fear is to develop more trust in our ability to handle whatever comes our way.
Sometimes survival is dependent upon giving up the myths of the ideal parent, sister, or other family member, and accepting reality, no matter how much we wish it were otherwise. We may cherish our feelings of loyalty and carry a strong sense of obligation, but sometimes those feelings can mislead us into doing things that are ultimately harmful for both ourselves and our loved one.
Take a close look at your beliefs and decide which ones are based on myths and which ones are based on reality. This consists of asking questions such as: What do I do because of a sense of obligation? What feelings rise up when I ask myself that question? Which of my obligations feel good to me? Which ones do not?
Guilt drives parents to lose their sense of judgment and go to ridiculous lengths to assuage their guilt. Society says that parents who have a child who isn't functioning well are not up-to-snuff. Acknowledge your guilt, but formulate a plan to overcome it so it doesn't act as a barrier.
Rescuers love their family member and want to help. So they “help,” often by doing things they don't want to do or by giving up things they don't want to give up. When things don't improve (or get even worse), they “help” some more—even though they resent it and think it's unfair. Rescuers do things for people that the people could do for themselves, which encourages their dependence.
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