How to Disarm a Borderline Part VIII Splitsville

Before reading this post, particularly if you are going to try this at home with a real adult family member with borderline personality disorder (BPD) (which is not recommended without the help of a therapist), please read my previous posts Part I (October 6), Part II (October 29), Part III (November 24), Part IV (December 8), and Part V (January 12), Part VI (March 2), and Part VII (April 30). The countermeasures described in this post do not work in isolation but must be part of a complex, consistent, and ongoing strategy.

In today's post, I will discuss how patients with BPD get two or more other people to fight with one another, and how to avoid getting sucked into such fights.

The psychoanalytic concept of splitting has been used by analysts in a few different senses.  The different meanings of the term are clearly connected with each other, but the analysts are somewhat vague in describing in detail what this relationship actually is.  The most common use of the term, as I described in my post A Splitting Headache of 4/24/10, applies to something going on entirely inside the heads of patients with BPD. 

As I described in the earlier post, BPD patients are thought by analysts to be either unable to see both the good and the bad in anything or anyone at the same time, or do not do so because they are using splitting as a defense mechanism.

As is their wont, the analysts seem loathe to look at a mental phenomenon in terms of its interpersonal meanings withing the context of the patient's real relationships.  However, one well-known interpersonal phenomena seen with patients with BPD is often spoken about when analytic therapists converse.  This phenomenon is also called splitting.

When individuals with BPD are hospitalized in psychiatric facility, it is frequently noted that professionals will start arguing among themselves about the patient.  Two doctors, or a doctor and a nurse or social worker, will get into what are at times very heated discussions about the patient's treatment.

Sometimes the entire ward staff becomes divided into two warring camps, with one side thinking that the patient is being treated unfairly with the other side wanting to come down on the troublesome patient with the proverbial hammer.  This situation became known as the infamous staff split.

My first clue as to what was happening in these situations came with the realization that a lot of the aggravating behavior of patients with BPD is a big act that can be turned off and on at will, like a faucet, depending on who they were performing for.  The act can also be greatly altered so that they act one way with one group of people and completely differently with another group.

I was consulted on a hospital patient on a medical (not a psychiatric) floor whose medical condition was clearly being affected adversely by her stress level.  When I first met the woman, she was the sweetest, friendliest, and most pleasant of patients.  We were having a nice chat about her stress level when her phone rang. It was the patient's husband. 

Suddenly I witnessed the most amazing transformation short of a caterpillar turning into a butterfly.  She without warning turned into the nastiest, most shrill harridan one could imagine.  Her comments towards her husband were so unrepentently vicious and venomous that I began to feel sorry for him.  After a short conversation, she practically hung up on him.  As soon as she put down the receiver, however, she turned right back into all sweetness and light in a heartbeat.

Amazing.  Patients who have real mental illnesses cannot do that.  They act pretty much the same way with everyone - and even when they do not realize they are being observed.

The staff split is set up by the patient.  To one group, he or she acts like a damaged, pitiable abuse victim in need of kind understanding. To the other group, like hell on wheels.

Eric Berne, founder of the school of psychotherapy known as Transactional Analysis and author of the best selling book Games People Play, had a name for this whole pattern. He called it the game of Lets You and Him Fight. In other words, the patient acts in ways that essentially picks a fight between other people.  If this game had a professional league, individuals with BPD would be the superstars.



Eric Berne

The solution to the staff split is actually simple and straightforward.  First, staff members have to be aware of the fact that their arguments are being set up by the patient, not by the unreasonableness or stubborness of the other side.  They can then ask each other on what patient behavior they are basing their opinion, and compare notes.  They can then decide on a mutually acceptable course of action and present a united front to the patient, and voila, the patient stops trying to split them.

The relationship between the senses of the term splitting is that the patient acts all good with one group, and all bad with another group.  If pressed, the analysts would probably say that the staff split is just an incidental byproduct of the patient's tendency to see some of the staff as all good and others as all bad. 

I, in contrast, see is at a well planned, although sometimes automatically and subconsciously played, interpersonal strategy designed to create staff wars.  Once again, however, I believe such patients are ambivalent about this and down deep hope that their efforts to provoke fights will fail.  The power to play mommy off against daddy is actually very frightening for them.

When seen in individual therapy, patients with BPD will often make a damaging or incendiary accusation about an important referral source, about a colleague who is well respected or who is even a friend of the therapist, or about a nurse with whom the therapist will have to work. If therapists defend the other person without having an impartial account of what actually transpired, they are invalidating the patient.
 
However, the patient may be exaggerating what happened, making undue inferences about the motives of the accused, or discounting the role of his or her own provocative behavior in the dispute. Also, the therapist should never forget that there really are a few Nurse Ratcheds on psych wards.
 

Nurse Ratched, "One Flew Over the Cuckoo's Nest"

 
My solution: I state, "I was not there, and I have a different impression of him from my other contacts, so I am not in a position to make a judgment on this." I just refuse to take sides in the dispute, and the patient will often then drop the subject completely.

One major exception I make to this is when a patient alleges that a former therapist had sexual intercourse with the patient. (This caveat does not apply when the patient just had the opinion that the former therapist had inappropriate thoughts).  I take this allegation very seriously because, in my experience, patients rarely make unfounded allegations about this subject, and unscrupulous therapists need to be taken out of the profession.  The willingness of the patient to allow the therapist to take advantage of her in this manner is irrelevant.

The next time your friend with BPD tendencies tells a story about someone else that starts to make your blood boil - at the person being described in the story - keep these suggestions in mind and do not take sides.

Guest Post The Good Enough Parent How Children from Abusive Families Sometimes Do Not Seem To See Their Own Abusiveness

Today's guest post is by Sara Dawkins. This is the second post in which a writer recounts his or her own experience in a family with a problematic history. She addresses the confusion a child can feel when parents who have themselves been abused by their own parents do unto others what had been done to them. ~ D.A.

This is a topic that is very close to my heart so it is difficult for me to write about. Let me start with something that is a little easier. First of all, I will talk about my partner. His father, to be precise. My partner’s father was abused as a child. As was his father. I am sure the cycle continued for many generations. However what got me to really recognize this idea in my own life was something my partner said to me the other day:

“My father is proud of the fact that he is a better father than his father was, but that’s not very hard to do.”

Wow. He was so right. Just because the father came from an abusive home, that did not mean that his own abusive behavior was better in some way. As a matter of fact, my partner’s father can’t even see how abusive he is, as a father and as a spouse.

That brought me around to thinking about my own family. Both my mother and grandmother were from abusive homes, as was my father.

My father was practically abandoned for most of his life and when his parents were around they were verbally and physically fighting with one another. Although he was not hurting in material things, he did not get any instruction about how to behave, and was left to his own devices. He turned into a very selfish individual. Instead of trying to avoid repeating his history of abuse with his children he simply gave up. He stayed home for much of my young life, yes, but withdrew to his bedroom as soon as he got home and only left it to go to work. He did not interact much with my brother and I;  when he did it was only the minimum required so that he could feel as if he had “done his duty.” 

Eventually the stress of even that much involvement got to be too much for him and he left. He never did seem to see that he was falling into the same cycle of abuse that he had suffered through. After all, he could tell himself, he didn’t leave… for a while.

Likewise, my grandmother came from a difficult home. Her father was an alcoholic and the family lived in basements and with relatives because he would drink away his paycheck or simply not go to work at all. From this lifestyle my grandmother learned to work hard and try to keep everything as perfect as possible so that she, hopefully, would not have him get angry at him when he got home. 

She later married a man who was much like her father, and as her children grew up under his verbally and physically abusive hand, she cleaned and kept everyone looking good. To this day she defends her father and is in denial about the abuse she lived through. By keeping everything whitewashed in her mind, she was simply repeating the process of enabling abusers and was keeping the process going.

Needless to say my mother grew up feeling abandoned by her mother and abused by her father. Shockingly, she chose to fight the trend. Although she could not fight off the effects completely, she did not give into the same habits that had plagued the generations before her. Don’t get me wrong. She still had many issues. She was prone to rage and verbal abuse. However, she decided that her children were not going to suffer like she had. 

She was determined to break the cycle. I have to admit, she works really hard to do so. She is not perfect by any means, but when she does fall into those bad habits she always makes sure to apologize for them and tell us what she should have done instead. By thusly changing the pattern, she has been successful at breaking most of the bad habits that plagued our family. Although we are not completely unaffected, my brother and I are moderately well adjusted. I believe that the most important thing she taught us is to be mindful of our actions.

Sometimes people that have been abused do not seem to see the abuse that carries on in their lives. They have many of those same habits and ways of thinking. Sometimes they just assume that they are better parents because they do not do exactlythe same thing or do not do everythingtheir parents did. Being a ‘better’ parent does not make you a good parent or even a non-abusive one.

It really hurts me to see that my uncles are not as cognizant of this as my mother is. They have many of the same abusive behaviors in their homes and yet they act as if they can’t understand why their children are acting out, being rebellious, running away, or just giving up. They don’t see that they are just continuing a cycle of abuse.

I know how difficult it is to break habits that you have grown up with and I am thankful that my mother was able to give me some understanding and insight into her mind. This has helped me to break the cycle within my own relationships and live a healthier, more balanced life.

Author Bio

Sara is an active nanny as well as an active freelance writer. She is a frequent contributor of http://www.nannypro.com/.  Learn more about her at http://www.nannypro.com/blog/sara-dawkins/.

How to Disarm a Borderline Part IX Listen to the Lyrics Not the Tune

Before reading this post, particularly if you are going to try this at home with a real adult family member with borderline personality disorder (BPD) (which is not recommended without the help of a therapist), please read my previous posts Part I (October 6), Part II (October 29), Part III (November 24), Part IV (December 8), and Part V (January 12), Part VI (March 2), Part VII (April 30) and Part VIII (June 5). The countermeasures described in this post do not work in isolation but must be part of a complex, consistent, and ongoing strategy.

This post will continue describing specific countermeasures to the usual strategies in the BPD bag of tricks used by them to distance and/or invalidate you, as well as to induce you to feel anxiously helpless, anxiously guilty, or hostile.

Today I discuss statements made by individuals which sound hostile or critical but which may or may not actually be as critical or hostile as they sound.  A lot of psychotherapists recommend responding to an individual's tone of voice and body language over responding to the content of what that person actually says. 

We all have a tendency to do that anyway - most likely because tone and body language preceded verbal language in the evolutionary development of the brains of primates like ourselves.  Chimps, for example, know whether another chimp is coming to fight with them or mate with them throught the approaching chimp's posturing and the noises it makes. (And if you injure a certain part of their brains called the amygdala, they completely lose the ability to make this call).

Nonetheless, I recommend precisely the opposite: listen to the words (the lexical content) and ignore the tone and posturing, as well as any seeming insinuations implied by what is said that are not stated clearly and overtly.

If you respond only to the words, the individual with BPD will usually change to a friendlier tone.

For example, a client with panic disorder responded to my recommendation for anti-depressant medication for her panic attacks with the sarcastic-sounding remark, "Oh, so you want to mess with my brain chemistry?" It sounded as though she was accusing me of being a devious, malicious mad scientist. Some anti-psychiatry types might agree with that interpretation of my recommendation, but I digress.

I nonchalantly responded, "Yes, anti-depressants do alter brain chemistry, although we don't know exactly how they work," and went on to describe their possible mechanism of action just as one might do with any other patient. She agreed to the drug trial.  (Of course she went off the meds the very next day, but that's another issue altogether).

The structure of all human language is such that ambiguity is extremely easy to generate. Any sentence in any language can refer to a multiple of unclear attributes or objects, or can be interpreted in exactly opposite (antithetical) ways. Negative judgments can come out sounding positive and vice versa through changes in body language, tone of voice, or even choice of synonym.

For example, almost any adjective with a positive or a negative connotation has a synonym with precisely the opposite valence. An optimist, for instance, can be called a Pollyanna. People can be described as stubborn or tenacious, loyal or as being lap dogs, and so forth. A complete discussion of the antithetical nature of language is beyond the scope of this post, but can be found in my book, Deciphering Motivation in Psychotherapy.

Another trick that people with BPD are especially adept at employing is to create ambiguity through the use of unvoiced implications, as I alluded to earlier. Individuals imply something without stating it explicitly, thusly creating opportunities for plausible deniability of having made those implications at a later date.

For example, a mother may admire her daughter in some way, but make it sound as if she were critical about the very behavior that she really admires.

A good illustration of this process occurred in a conversation between a nurse and her mother. The mother was discussing the daughter’s rather assertive (some might say even aggressive) stance towards the mostly male physicians with whom the daughter worked. The mother said, “I can’t believe you talk to doctors that way!”

The patient took this to mean that the mother believed that she should not engage in this behavior. In one sense this was an accurate assessment of the mother’s view, but it was only part of the whole truth. The mother indeed was worried that the daughter might get fired. Such would have been the case during earlier times, when the mother was younger.

As it turned out, however, the mother was also expressing covert admiration for the nurse’s bravery, assertiveness, and feminist leanings. What Mom had difficulty "believing" was that the patient had the audacious nerve that the mother lacked.

Her critical tone of voice obscured the admiration. The actual lexical content of the comment has no positive or negative valence at all.  She was merely expressing surprise. The nurse perhaps should have responded, "Well, is that a good thing or a bad thing?"

Parenting How Criticisms and Nagging Backfire

Children give their parents what the parents seem to need

Mell Lazarus, the cartoonist who created Miss Peach, writes a very creative comic called Momma. I wish it were in a lot more newspapers. He understands something paramount about family dynamics that it seems a lot of so-called parenting experts do not address or even seem to notice. 

Psychiatrists and pediatricians who prescribe medications for children who supposedly have "ADHD" or "Pediatric Bipolar Disorder" never even ask their teenage patients about it - or inquire in any detail about much of anything that goes on at home between them and their parents.

I've included in this post several of his strips that demonstrate how tuned into this process Mr. Lazarus is. The dynamics can be described quite simply in three sentences:

1. If a parent repeatedly criticizes a child or a teenager about the very same behaviors, the child will not only not stop them, but will continue or even dramatically increase them.

2. If a parent continually nags a child or teenager to do the same things, the child will not only refrain from doing what the parent is ostensibly asking for, but will studiously avoid doing so - or even do the exact opposite.

3. If a parent continually tells children or teenagers they have some trait, or lack some trait, the children will compulsively act out the trait they have been told they have, and/or will compulsively avoid doing anything that suggests they actually have any trait they have been told they lack.

So why is this? Well, if parents obsessively do something, children will conclude that they parents either need to do it and/or enjoy doing it, even if the parents repeatedly deny it. Actions speak louder than words. Far be it for any child to deprive a parent of a cherished role.

So, if the parents seem to like or need to nag or criticize, their children will continue to misbehave. If the parents compulsively state or predict that the child has or will develop a negative trait, their children will continue to prove them right. They do these things so that the parents will feel good about themselves, not because they enjoy have negative traits.

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How the Citadel directors agoraphobia inspired a horror film

Ciaran Foy is the director of a new horror film, Citadel, in which an agoraphobic man tries to protect his daughter from a roaming band of warped, feral kids. In an interview with io9, he discusses his real life agoraphobia and how it informed his film:

How similar was your experience with agoraphobia and what the character went through in this film?

Well it's kind of in many ways the first half of the film is very personal...I was 18 still living at home with my parents, the front door became the biggest challenge for me. I guess it symbolized the one threshold I couldn't pass...

So from that standpoint, feeling that sense of complete weakness. I can't even open the front door. I should be able to face the world, what is wrong with me. It's complete irrational fear.

I'm not a huge horror fan, but I'm interested in this.

And, hey, reader. If you've seen it, was it good?

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