When a BPD person has a serious physical illness
July 2, 2018 6:44 AM   Subscribe

My mom, who has unofficially diagnosed but very obvious borderline personality disorder, very likely has breast cancer. How can I stay appropriately detached but empathetic?

I've written about my BPD mom before. I love her very much, but she is mentally ill, and I've spent most of my adult life trying to detach emotionally from her as much as possible. Her BPD makes her paranoid, anxious, narcissistic, and she has completely overtaken my life multiple times - showing up at my door in the middle of the night demanding money, texting me for hours on end calling me a bitch/terrible daughter, etc.

My mom hasn't been to a doctor in years, and my sister & I knew that her health was not great. She had not had a mammogram in 20+ years. A few weeks ago, she noticed a large lump in her breast. She had a mammogram and ultrasound on Saturday that showed that it is very likely cancer. She has a biopsy scheduled for a few weeks from now to confirm.

I love my mom. I hope she does not have cancer, but I'm also a realist who knows that this does not look good. And because of my history with her and her illness, I know that I need to prepare to take care of myself if this is cancer. Her mental illness makes her crave and demand attention, so this whole thing is feeding that desire and could very easily make her spin out of control.

She has already started to tell family members. Today, she asked for my sister and I to get on a conference call with her and talked to us for 30 minutes about an ache that she was having and if it was going to make her have a heart attack and if it was more cancer and if she should go to the doctor ASAP, despite the fact that they've already told her the next steps for diagnosis. My sister is getting married next week. My mom is giving the blessing at dinner, and I know this is going to turn into an epic cryfest where she talks about how she's dying.

I know that this probably sounds cynical and terrible to people who don't have a parent or relative with BPD. I'm hoping there are others out there who have dealt with a person with BPD who has a serious physical illness, and can help me with some tips and tricks on how to make sure that my sister & I can get through this in a way that is empathetic but also takes care of us, too.
posted by anotheraccount to Human Relations (10 answers total) 9 users marked this as a favorite
I know that this probably sounds cynical and terrible to people who don't have a parent or relative with BPD.

Oh man I am sorry. I had an N-Mom with cancer and I won't lie, it's a tough road. The good news was that my mom wasn't sick that much while she had it (she passed last year), the good/bad news was that she had cancer for over a decade before it finally got bad, so it gave my sister and me a long time to sort of figure out how to put up boundaries while still trying to be as compassionate as we could considering. So yeah, I feel you.

Things that helped with my mom:

- getting her into a support group that she could basically dominate so that she had an outlet for some of her nervous energy
- helping her do some planning w/r/t wills/health care proxy/power of attorney because this was an appropriate role to be in with her
- finding ways to stay in touch that were NOT long awful phone calls (I emailed her every morning in the last six months of her life, sometimes this was reciprocated, sometimes it resulted in a dump of her latest concerns, sometimes it was ignored, sometimes, rarely, it turned into a fight)
- creating a strong relationship with my sister and not letting her pit us against each other. She and my sister were much closer than she and I were, so my role became, in large part, supporting my sister helping my mom
- being honest and open with other family members and not let her anxiety and urgency set the tone for how we interacted with them

Prepare to get a lot of "I am dying!!!" news from her. I know it sounds terrible but I felt like having cancer was my mother's trump card with us so that she finally felt she could get the attention she "deserved" from us (which worked for a lot of other people) and, yeah, it made her resentful when we'd sometimes gently push back or not drop everything and respond. A lot of times, especially lately, cancer is a marathon, not a sprint and so it's worth basically making longer term plans (for your own mental health, for communicating with family, for how to determine what is truly an emergency) so you can be responsive and not reactive.

Same general BPD advice applies: cut off communication if she's being abusive, don't argue with her, don't let her set the agenda. Good luck as you move through this and congrats to your sister.
posted by jessamyn at 7:08 AM on July 2, 2018 [30 favorites]

This is a terrible thing to have to say, but are you sure that the mammogram/ultrasound actually happened, and actually showed the results she says they did? I'm not saying it's impossible, but you do not generally get a mammogram interpreted in one weekend day and I'm not even sure they'd tell someone a lump was "very likely cancer" prior to biopsy. (There probably are exceptions, though, so don't lean on that too hard.) Even if the story of the clinical experience is not inherently implausible, there's always the lying about what was actually found. I would make sure to get some confirmation from someone who does not have a serious mental illness that causes her to disregard truth in the compulsive search for All The Attention before I even geared up for this ride. (I have a relative who we say has Schroedinger's Cancer; he's lied so often and so compulsively that no one's going to know whether he's actually ill pretty much til he actually dies.)

Good luck to you.
posted by praemunire at 7:50 AM on July 2, 2018 [12 favorites]

I have BPD and chronic illness.

Do tell her that no matter what you won’t abandon her. If she starts to be abusive then taking a break until she cools down is wise. (Thats not the same as abandoning her so don’t get it twisted— although she most certainly will! ). Same rules around boundaries applies. Don’t get sucked in to petty arguments. Let a lot of stuff go.

Unfortunately your suspicions are right, she WILL be getting worse BPD symptoms because of her scary new diagnosis.
BPD is a trauma response and something like a cancer diagnosis will re-trigger her traumatic memories.
It might be wise for you and other caregivers to seek out a support group. Jessamyn’s suggestion of your mom participating in a support group is wonderful. Honestly the very best treatment for me has been in groups. If she won’t go in person there are phone groups and also loads of groups on Facebook.

Who is your mom’s “person?” It sounds like either you or your sister is her closest confidante? Her person should now be her primary caregiver (with appropriate boundaries at all times, of course). Everyone else’s job, in addition to whatever support they give your mom, is to support the caregiver. Comfort in, dump out (google ring theory).

Things that seem obvious to you such as remembering doctors appointments or making phone calls to doctors, might be much too overwhelming to your mom. Anxiety fogs the brain and normal tasks literally become impossible. Even asking mom “have you eaten anything today?” can be helpful.

Good luck and I’m so sorry you are going through this!
posted by shalom at 8:05 AM on July 2, 2018 [10 favorites]

I hate to go there also (like praemunire said) -- but these clinical details sound a little off to me.

I was diagnosed with breast cancer in the US in 2015. After a suspicious mammogram and ultrasound, I was scheduled for a biopsy within a couple days - not weeks.

If it is cancer, like jessamyn said upthread, it is a marathon, not a sprint. There will be multiple rounds of diagnoses, deciding on treatments, choosing specialists, etc. The more you can have a game plan in place to manage these decisions with support for yourself (so it's not just your mom and her drama) the better it will be.

So sorry you have to manage this.
posted by pantarei70 at 11:15 AM on July 2, 2018 [2 favorites]

Borderline Personality Disorder is not a precise diagnosis. I think it's more effective to address the components: anxiety, panic, emotional intensity, narcissism, impulsiveness, recurring/ intrusive thoughts, self-esteem issues that can easily be poor self esteem and grandiosity at the same time. You obviously understand that you can't fix your Mom, and that you need very strong boundaries. My Mom likely had bipolar as well as alcoholism. She used the threat of her impending death routinely and when she had some illnesses, they were used manipulatively, though she frequently tried to manipulate me with threats that had no basis in reality. It takes a ton of energy to deal with such stuff.

Read the Shamu article; it helps a little. Reward the positive stuff, detach and disengage from the rest. I have hung up the phone, left the room, left the house, and, on occasion, left town to disengage from unkind manipulative behavior. Illness does not give anybody a free pass. Read Stop Walking on Eggshells.

When my Mom had throat cancer, the fear and trauma of cancer made her so much more so. I drove her to the 1st radiation session, and the whole way she kept saying she wasn't going to have it, etc. while ranting about my driving, choice of route, hair, clothing, and she wasn't having radiation and that's that. We get to the appt., and she was silent and submissive, so I asked the doctor what would happen if she didn't have the treatment. He looked at me like I was a crazy and bad daughter, but reviewed. Her internist knew her well, so when I called, he upped her anti-depressant and the script for anti-anxiety meds.

Decide what you can do for her. How much time you can provide, how much energy, what type of help. As you know, she will be only too ready to suck you dry. Scheduling will help. Call her when you're making coffee or take a specific break. I have to return to work now, Mom. Talk to you tomorrow. Bye. Identify the things you can do, like helping her remember appts., organize meds, make foods that she can eat. My Mom didn't have much appetite, and radiation made that worse, so when I was staying with her, I made tiny portions frequently. A slice of cinnamon toast, some fresh fruit, cut up, small dish of scrambled eggs, etc. If you visit, tell her This is a short visit; I brought groceries and I can make some food for you. or I got this movie at the library; let's watch it together.

It took years, but my Mom eventually recognized my boundaries and realized I wasn't susceptible to manipulation. We had an okay relationship, about the best outcome possible. It's awesome that you are loving and kind to her, good luck.
posted by theora55 at 11:19 AM on July 2, 2018

My spidey sense is tingling, based on my own n-mother. To elaborate on the notion that this situation might be, err, embellished if not fanciful, I think it's no coincidence that your sister's wedding is coming hard on the heels of this diagnosis but before the biopsy. That timing coincides with peak worry--Something is Wrong!-- but before proof is available that might start people down the practical path of being helpful and hence receiving independent verification. It's peak worry because there's no known path forthward, so to avoid feeling ineffectual, people noodle around with all the possibilities. Hand-wringing by others provides narcissistic supply which may be amped up by Noble Suffering, another likely behavior; both take attention off of your sister and add to your burden as well, why you run around trying to be supportive of each.
posted by carmicha at 12:15 PM on July 2, 2018 [5 favorites]

She had a mammogram and ultrasound on Saturday that showed that it is very likely cancer. She has a biopsy scheduled for a few weeks from now to confirm.

nthing the other comments who are suggesting that this isn't really how it works. First, no mammogram or ultrasound tech would tell her that the tests show that she "very likely" has cancer; second, if her test results were really that concerning, she would almost certainly have been scheduled for a biopsy within days (possibly even that same day); third, being referred for a biopsy in and of itself does not indicate that something is "very likely" cancer (according to the American Cancer Society, most results from breast biopsies are benign, not malignant).

This is not to suggest that your mom didn't actually get a mammogram, or hasn't actually been referred for a biopsy. But it is to suggest that you pull back from accepting the entire framework of her narrative about her medical situation as it stands. This would be true even if your mom wasn't BPD, but it's doubly so in this case.
posted by the return of the thin white sock at 4:40 PM on July 2, 2018 [2 favorites]

As a breast cancer patient, I'm going to gently push back on the idea that the sequence of medical events is implausible. When I was diagnosed in 2015, a radiologist (physician) did an ultrasound the same day as the mammogram, and she told me what was wrong with me (although she said we needed a biopsy to be absolutely sure). She also reassured me I didn't have a large solid tumor. It's certainly seems possible to me that if I had presented with a large tumor, she might have tried to prepare me for the possibility that it would be cancerous.

OP, good luck to you.
posted by purpleclover at 5:14 PM on July 2, 2018 [1 favorite]

My severely BPD mom managed to coincidentally time her ovarian cancer discovery (not full diagnosis, which took months) two weeks before I delivered my child. I wouldn't have believed it without independent verification, because she had a different crippling diagnosis that made it impossible for her to help me just the month before (which magically disappeared), but it does sometimes happen that way - I swear that some people draw this kind of happening though. It was always believed to be an edge case and her prognosis is great, no chemo, but you'd never know that. I think the hardest part is completely giving up on any chance that your parent will ever be able to be there for you, because even if they were terribly abusive all your life, there is a tendency to hold out hope that you will have a real mom at those important moments. You will never have a mom who gives more than she takes. I don't know if it's possible for your sister to intervene in her speechmaking so as to not endure this at her wedding - maybe say you want a specific reading rather than a speech so she doesn't feel shut out? - but in the future she should not be assigned the duties of an actual mom. I don't have further advice, but I am sorry that you are carrying this.
posted by decathexis at 8:37 PM on July 2, 2018 [2 favorites]

I don't have a lot to add other than I'm really sorry for what you're going through. I also have a difficult relative with a few related diagnosis/behaviors, who recently went through a major medical event and .. Well.. It's a journey. If you ever feel you need/want someone to listen or commiserate witth, feel free to memail me.
posted by elgee at 9:34 PM on July 4, 2018 [1 favorite]

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