Could we have saved her?
January 25, 2021 12:00 PM Subscribe
The one year anniversary of my mother’s suicide is approaching, and I’m grappling with what we could have done differently.
My mother struggled with her mental health for her whole life. Her father was an alcoholic and her own mother had postpartum depression and a thyroid condition that made it hard for her to get out of bed a lot of the time, or to parent in an attuned or attentive way.
My mother’s family made several international moves before she was ten. Now as someone whose job is largely suicide risk assessment, I know that that that’s a major chronic risk factor for suicide later in life. She actually checked pretty much every box for every chronic risk factor, except for being male, street involved, or indigenous- although at one time they lived on an isolated First Nations reservation with a lot of violence, alcoholism, and inter generational trauma, and she mentioned to me feeling that white therapists could never know what it was like to be a child in that setting.
I had a middle class childhood with music lessons, summer camp, a trip to Europe when I graduated. It was punctuated here and there with being sent to my grandmother’s house in another city for a month or three at a time, during which time I wouldn’t attend school. It didn’t bother me- I liked my grandma’s house and I did well in school anyway. This would usually happen if my mother had a stomach flu or something. She’d throw up for a few days, maybe faint, and I’d go away for a bit. I didn’t think it was weird. She couldn’t really maintain friendships, so we didn’t have people over or go to many social things. We didn’t have “family friends” per se.
When I was fourteen my mother had her first suicide attempt that I was aware of. I stayed home from school to care for her and eventually got offered the choice of a call to CPS or a truancy officer.
As a teenager, particularly as I spent more time around other people’s families, I became aware that my mother’s communication could be cruel. Once she told me she was done being a parent to me because I ate the chocolates for a few days ahead in my Advent calendar. She tended towards black and white thinking. In college I lost my debit card and she tried to make me sign a contract saying she could make my life decisions for the next five years. She sent long, cruel emails saying she never wanted to talk to me again, or long emails professing her love and devotion and apologizing for how she damaged me and ruined my life.
When I left for college, she made a more serious suicide attempt. She started experiencing chronic pain that doctors said was just stress, and no one would treat. She started drinking to cope. Suicide attempts increased in frequency. My stepfather didn’t even tell me about all of them.
Throughout my twenties, she was in and out of treatment for alcoholism. It was all subsidized faith based treatment centers, and she was never able to access real, evidence based therapy for her mental health, her substance use, her trauma, or her pain.
One of the suicide attempts caused her to seizure and hit her head. She had brain damage, and after that was barely recognizable as my bright, quick, quirky mom.
Occasionally she would be hospitalized, but it always focused on behaviorally containing her for a bit after a suicide attempt, tweaking her meds, and never actually reducing her distress.
In December of 2019, she was diagnosed with BPD. She discovered forums for family members of people with BPD and NPD and read about herself in terrible terms: that she was manipulative, that her pain wasn’t real, that family members should cut themselves off from her, that she had no capacity for empathy, reciprocal relationships, or recovery. She sent an email identifying all of this to us, and self diagnosing as a narcissist we should stay away from.
Then she intentionally ODed in a hotel room at 56.
I know I personally couldn’t have saved her, but I wonder what we, collectively, as a society could have done better. I see so much rhetoric online vilifying people with BPD, and I get really triggered and kind of depressed seeing the lack of compassion for people who struggle to fit with their environments in this way. All the advice is cut them off, excommunicate them, focus on your own boundaries. I work in healthcare and people with BPD are treated as low suicide risk because they’re understood to be manipulative and just trying to get attention. The research says BPD is a much better predictor of suicide than any mood disorder, but we turn people with BPD away and dismiss their pain. There is no publicly funded access to DBT where I live or where she lived. And I think more glaringly, there’s just no sympathy for this constellation of difficulties.
I look back on her life, and I wonder, how could I/we have been more gentle with her, and helped her know that her life was precious and meant something? I work in a field where I have some influence, and I’ve designed a training on compassionate and evidence based suicide risk assessment of people with personality disorders, in her memory. I would like to use my position to do more.
My mother struggled with her mental health for her whole life. Her father was an alcoholic and her own mother had postpartum depression and a thyroid condition that made it hard for her to get out of bed a lot of the time, or to parent in an attuned or attentive way.
My mother’s family made several international moves before she was ten. Now as someone whose job is largely suicide risk assessment, I know that that that’s a major chronic risk factor for suicide later in life. She actually checked pretty much every box for every chronic risk factor, except for being male, street involved, or indigenous- although at one time they lived on an isolated First Nations reservation with a lot of violence, alcoholism, and inter generational trauma, and she mentioned to me feeling that white therapists could never know what it was like to be a child in that setting.
I had a middle class childhood with music lessons, summer camp, a trip to Europe when I graduated. It was punctuated here and there with being sent to my grandmother’s house in another city for a month or three at a time, during which time I wouldn’t attend school. It didn’t bother me- I liked my grandma’s house and I did well in school anyway. This would usually happen if my mother had a stomach flu or something. She’d throw up for a few days, maybe faint, and I’d go away for a bit. I didn’t think it was weird. She couldn’t really maintain friendships, so we didn’t have people over or go to many social things. We didn’t have “family friends” per se.
When I was fourteen my mother had her first suicide attempt that I was aware of. I stayed home from school to care for her and eventually got offered the choice of a call to CPS or a truancy officer.
As a teenager, particularly as I spent more time around other people’s families, I became aware that my mother’s communication could be cruel. Once she told me she was done being a parent to me because I ate the chocolates for a few days ahead in my Advent calendar. She tended towards black and white thinking. In college I lost my debit card and she tried to make me sign a contract saying she could make my life decisions for the next five years. She sent long, cruel emails saying she never wanted to talk to me again, or long emails professing her love and devotion and apologizing for how she damaged me and ruined my life.
When I left for college, she made a more serious suicide attempt. She started experiencing chronic pain that doctors said was just stress, and no one would treat. She started drinking to cope. Suicide attempts increased in frequency. My stepfather didn’t even tell me about all of them.
Throughout my twenties, she was in and out of treatment for alcoholism. It was all subsidized faith based treatment centers, and she was never able to access real, evidence based therapy for her mental health, her substance use, her trauma, or her pain.
One of the suicide attempts caused her to seizure and hit her head. She had brain damage, and after that was barely recognizable as my bright, quick, quirky mom.
Occasionally she would be hospitalized, but it always focused on behaviorally containing her for a bit after a suicide attempt, tweaking her meds, and never actually reducing her distress.
In December of 2019, she was diagnosed with BPD. She discovered forums for family members of people with BPD and NPD and read about herself in terrible terms: that she was manipulative, that her pain wasn’t real, that family members should cut themselves off from her, that she had no capacity for empathy, reciprocal relationships, or recovery. She sent an email identifying all of this to us, and self diagnosing as a narcissist we should stay away from.
Then she intentionally ODed in a hotel room at 56.
I know I personally couldn’t have saved her, but I wonder what we, collectively, as a society could have done better. I see so much rhetoric online vilifying people with BPD, and I get really triggered and kind of depressed seeing the lack of compassion for people who struggle to fit with their environments in this way. All the advice is cut them off, excommunicate them, focus on your own boundaries. I work in healthcare and people with BPD are treated as low suicide risk because they’re understood to be manipulative and just trying to get attention. The research says BPD is a much better predictor of suicide than any mood disorder, but we turn people with BPD away and dismiss their pain. There is no publicly funded access to DBT where I live or where she lived. And I think more glaringly, there’s just no sympathy for this constellation of difficulties.
I look back on her life, and I wonder, how could I/we have been more gentle with her, and helped her know that her life was precious and meant something? I work in a field where I have some influence, and I’ve designed a training on compassionate and evidence based suicide risk assessment of people with personality disorders, in her memory. I would like to use my position to do more.
Response by poster: I think this is the thing. People assume she didn’t know she was hurting us, but all she could see was the pain she caused. Eventually she couldn’t live with the shame. There was nothing good or meaningful left in her life, there was only pain she had no support in coping with. She was brain damaged and in constant physical and emotional pain. No better future was really on the table.
posted by unstrungharp at 12:27 PM on January 25, 2021
posted by unstrungharp at 12:27 PM on January 25, 2021
My heart goes out to you, unstrungharp. I'm sorry for your loss, I'm sorry your mother had such a hard life, and I'm so sorry you had such a difficult childhood.
I don't feel equipped to address your actual question of whether you could have prevented her suicide - it seems like something for you to discuss with a therapist, maybe? or perhaps even with your mother's therapist, if that's possible? - but as someone who was raised by a similar mother (BPD, harshness, volatility, suicidality, etc) what resonated with me most in your post was how strongly you believe that your role was to protect your mother from the world, protect her from herself, her guilt, her shame. It's a feeling that I can recognize as intimately and familiarly as my own face.
I'm not sure if this is the case for you, too, but from being in therapy for almost three years, I came to recognize how I have been playing this role in my mother's life since I was very young. Consciously recognizing this gut instinct, and mindfully resisting its pull, has allowed me to not only heal from my harsh childhood and hold space for myself in my life, but also, paradoxically, to become the more stable person with a clearly defined sense of self that my mom once craved, which I was unable to provide for her for as long as I was caught up in the struggle of trying to selflessly rescue her. In order to be the calm anchor for her stormy self, I had to stop identifying totally with her and become solidly, heavily, thuddingly, my own person instead.
This sounds muddled upon re-read, I apologize that I can't express it better. What I think I'm trying to say is, perhaps the best way you can honor your mother is to become the person that your mother needed her parents to be for her, back when she was very young. That person is someone who has a strong sense of self from which their kindness and generosity springs. Someone whose works to make the world better for those who are in pain, but only up to a certain point: never letting kindness turn into rescue fantasies, never letting generosity turn into taking over other people's struggles for them. The best way to honor your mother, I think, is by learning to let go of feeling responsible for saving her. You are her daughter. Just her daughter. If your mother express her love most truly for you right now, she would ask you to honor your loss, your grief, your bereavement. She would want you to mother yourself gently through this. I'm sure of it.
posted by MiraK at 12:39 PM on January 25, 2021 [42 favorites]
I don't feel equipped to address your actual question of whether you could have prevented her suicide - it seems like something for you to discuss with a therapist, maybe? or perhaps even with your mother's therapist, if that's possible? - but as someone who was raised by a similar mother (BPD, harshness, volatility, suicidality, etc) what resonated with me most in your post was how strongly you believe that your role was to protect your mother from the world, protect her from herself, her guilt, her shame. It's a feeling that I can recognize as intimately and familiarly as my own face.
I'm not sure if this is the case for you, too, but from being in therapy for almost three years, I came to recognize how I have been playing this role in my mother's life since I was very young. Consciously recognizing this gut instinct, and mindfully resisting its pull, has allowed me to not only heal from my harsh childhood and hold space for myself in my life, but also, paradoxically, to become the more stable person with a clearly defined sense of self that my mom once craved, which I was unable to provide for her for as long as I was caught up in the struggle of trying to selflessly rescue her. In order to be the calm anchor for her stormy self, I had to stop identifying totally with her and become solidly, heavily, thuddingly, my own person instead.
This sounds muddled upon re-read, I apologize that I can't express it better. What I think I'm trying to say is, perhaps the best way you can honor your mother is to become the person that your mother needed her parents to be for her, back when she was very young. That person is someone who has a strong sense of self from which their kindness and generosity springs. Someone whose works to make the world better for those who are in pain, but only up to a certain point: never letting kindness turn into rescue fantasies, never letting generosity turn into taking over other people's struggles for them. The best way to honor your mother, I think, is by learning to let go of feeling responsible for saving her. You are her daughter. Just her daughter. If your mother express her love most truly for you right now, she would ask you to honor your loss, your grief, your bereavement. She would want you to mother yourself gently through this. I'm sure of it.
posted by MiraK at 12:39 PM on January 25, 2021 [42 favorites]
I think your/your mom's story illustrates the critical thing: we need healthcare for all, cradle to grave, and all healthcare for all: mental health, vision and hearing and dental, learning and processing support, parenting resources and childcare, food security, trauma management (and a model of trauma that includes "life events" particularly for children like moves, school changes, parental health issues), neurological care, et cetera et cetera so that a comprehensive support system is poised and ready when needed.
The system (that should exist and doesn't) let your mom down her whole life (and then let you down along with her). If you can identify some particular thing you can do that might advance that cause, whether that's in your personal time or as a professional advocate in some way, that moves that ball forward, it is likely that you will save some lives a long time from now.
Aside from getting involved the general organizations already working towards this, you might also look local - run for school board, find out if local support orgs need bodies or voices to help more people, get trained to volunteer with at-risk kids, watch for your opportunity to tell people with power and money that they should be doing/saying/helping more.
posted by Lyn Never at 12:44 PM on January 25, 2021 [12 favorites]
The system (that should exist and doesn't) let your mom down her whole life (and then let you down along with her). If you can identify some particular thing you can do that might advance that cause, whether that's in your personal time or as a professional advocate in some way, that moves that ball forward, it is likely that you will save some lives a long time from now.
Aside from getting involved the general organizations already working towards this, you might also look local - run for school board, find out if local support orgs need bodies or voices to help more people, get trained to volunteer with at-risk kids, watch for your opportunity to tell people with power and money that they should be doing/saying/helping more.
posted by Lyn Never at 12:44 PM on January 25, 2021 [12 favorites]
There was nothing good or meaningful left in her life, there was only pain she had no support in coping with.
I just want to add: while your mother may have frequently said these words, this was - I guarantee you - not the truth. If it's something you heard her say repeatedly from when you were a child, then of course you would take her words literally and never question it. But I promise you that her life did have meaning and beauty and joy in it. She felt it, lots of times. Her BPD may have made it very difficult for her to remember the good times while she was in the throes of a downward spiral, but the good times did exist. Her life was not a totally barren, torturous waste. Her brain was lying to her during the times that she believed this to be true.
posted by MiraK at 12:53 PM on January 25, 2021 [8 favorites]
I just want to add: while your mother may have frequently said these words, this was - I guarantee you - not the truth. If it's something you heard her say repeatedly from when you were a child, then of course you would take her words literally and never question it. But I promise you that her life did have meaning and beauty and joy in it. She felt it, lots of times. Her BPD may have made it very difficult for her to remember the good times while she was in the throes of a downward spiral, but the good times did exist. Her life was not a totally barren, torturous waste. Her brain was lying to her during the times that she believed this to be true.
posted by MiraK at 12:53 PM on January 25, 2021 [8 favorites]
My first thought was programs aimed at preventing those adverse childhood events that set up children for failure and similarly programs that try to strengthen the factors that give children resiliency. There are so many factors and this is so complicated, you could start with whichever piece spoke to you and make a (small) difference. Lyn Never's comment about universal healthcare might be one.
Specifically for BPD, there are two things that come to mind. One is that Marsha Linehan's work in Dialectic Behavioral Therapy was game changing. BPD is treatable!! So, you may find a way to get involved in promoting awareness and training among mental health providers. Another small thing is the effort get the DSM to recognize cPTSD (complex PTSD) which is often a better diagnosis than BPD for the sufferers.
posted by metahawk at 12:59 PM on January 25, 2021 [5 favorites]
Specifically for BPD, there are two things that come to mind. One is that Marsha Linehan's work in Dialectic Behavioral Therapy was game changing. BPD is treatable!! So, you may find a way to get involved in promoting awareness and training among mental health providers. Another small thing is the effort get the DSM to recognize cPTSD (complex PTSD) which is often a better diagnosis than BPD for the sufferers.
posted by metahawk at 12:59 PM on January 25, 2021 [5 favorites]
One thousand times what Lyn Never says. As it turns out, it’s way too fucking hard to get mental healthcare at all and/or good mental health care here in Sweden. I don’t know what it will take to make mental healthcare understood as healthcare, but then many people can’t get any type of healthcare. As someone with mental illness who loves other people with mental illness, I find this super frustrating both for myself and for everyone else.
We also need better research. I feel like we know very little about mental illness and don’t even know how to diagnose it accurately. It also enrages me that we lose so many to suicide. Apologies, that’s probably not helpful but anyway, condolences on your loss. I admire your efforts to change the situation. I genuinely believe that giving as many people as possible access to quality mental health care as well as regular mental health care would improve lives in significant and unimaginably impressive ways.
posted by Bella Donna at 1:00 PM on January 25, 2021 [3 favorites]
We also need better research. I feel like we know very little about mental illness and don’t even know how to diagnose it accurately. It also enrages me that we lose so many to suicide. Apologies, that’s probably not helpful but anyway, condolences on your loss. I admire your efforts to change the situation. I genuinely believe that giving as many people as possible access to quality mental health care as well as regular mental health care would improve lives in significant and unimaginably impressive ways.
posted by Bella Donna at 1:00 PM on January 25, 2021 [3 favorites]
I have quite a bit of experience with BPD, as a suicide hotline volunteer, as a residential assistant for the mentally ill, as well as with family members.
I totally agree with you that the common take on BPD, not just among lay people but unfortunately among mental health workers as well, is disrespectful and dismissive. Too often, I have heard people with BPD labeled as "manipulative" rather than "in pain and desperately flailing about to get their needs met, which sometimes results in other people feeling manipulated". I also often hear people talk about "borderlines" rather than "people with Borderline Personality Disorder." I see this much more commonly than with other mental illnesses. I have heard people referred to as "depressives" etc. but much less often. It's dehumanizing.
Where we disagree is that I am strongly against CBT. I suppose it "works" for some people in a manner of speaking, in the same way it "works" to spank a child to correct behavior. The child may stop displaying the unwanted behavior because she or he has been terrorized into submission. People may start parroting the "right" words when they are argued out of their "maladaptive" thoughts.
But what really works, in the sense of healing someone deeply, is almost the exact opposite: Truly listening to the person's experience and validating it rather than arguing with it and trying to impose your own sense of how someone should feel, or how it would be more adaptive for them to think. The research shows that an invalidating parenting style is one major factor in the development of BPD. It doesn't then make sense that helping an adult with BPD--someone who was terribly wounded as a child and who needs help to heal those wounds--should consist of repeatedly invalidating them.
Statements like this: "while your mother may have frequently said these words, this was - I guarantee you - not the truth" make me cringe. We learn in training for working with the suicidal that what helps people is to listen to them, not try to talk them out of their pain, or tell them it isn't that bad. This is universal, but especially true for people with BPD. Your mother was the authority on how she felt, and some stranger on metafilter does not know better than she did how she felt. Any therapy style that invalidates a client's stated feelings is toxic and to be avoided.
CBT, especially when done in a rote way, is often dismissive, demeaning, and disrespectful. It does not allow room for the patient's pain to fully be expressed without being invalidated. I know it's all the rage right now, but all kinds of questionable or downright harmful treatments have been popular throughout the years, including things like lobotomy and shock treatment. I'd ask that you leave room for the possibility that CBT is really not the solution you think it is.
I think efforts in combating BPD would be best spent in advocating for alternatives to CBT including person-centered / Jungian / humanistic psychology, done well. It's an uphill battle in this society both because it will tend to be more expensive and because it relies on the relationship between therapist and client first and foremost, not a formula or set of workbook exercises that can be reused for each patient. It's the relationship between the therapist and client that is healing. All good therapists ultimately come to understand this.
I also think your efforts would be well-spent on attempting to prevent BPD in the first place, by interventions that teach parents respectful, validating ways of treating their children. If I wanted to devote my professional life to eradicating BPD, and I could only do one thing, I would focus on providing or advocating for respectful, validating family therapy when the child is as young as possible.
posted by Flock of Cynthiabirds at 1:24 PM on January 25, 2021 [25 favorites]
I totally agree with you that the common take on BPD, not just among lay people but unfortunately among mental health workers as well, is disrespectful and dismissive. Too often, I have heard people with BPD labeled as "manipulative" rather than "in pain and desperately flailing about to get their needs met, which sometimes results in other people feeling manipulated". I also often hear people talk about "borderlines" rather than "people with Borderline Personality Disorder." I see this much more commonly than with other mental illnesses. I have heard people referred to as "depressives" etc. but much less often. It's dehumanizing.
Where we disagree is that I am strongly against CBT. I suppose it "works" for some people in a manner of speaking, in the same way it "works" to spank a child to correct behavior. The child may stop displaying the unwanted behavior because she or he has been terrorized into submission. People may start parroting the "right" words when they are argued out of their "maladaptive" thoughts.
But what really works, in the sense of healing someone deeply, is almost the exact opposite: Truly listening to the person's experience and validating it rather than arguing with it and trying to impose your own sense of how someone should feel, or how it would be more adaptive for them to think. The research shows that an invalidating parenting style is one major factor in the development of BPD. It doesn't then make sense that helping an adult with BPD--someone who was terribly wounded as a child and who needs help to heal those wounds--should consist of repeatedly invalidating them.
Statements like this: "while your mother may have frequently said these words, this was - I guarantee you - not the truth" make me cringe. We learn in training for working with the suicidal that what helps people is to listen to them, not try to talk them out of their pain, or tell them it isn't that bad. This is universal, but especially true for people with BPD. Your mother was the authority on how she felt, and some stranger on metafilter does not know better than she did how she felt. Any therapy style that invalidates a client's stated feelings is toxic and to be avoided.
CBT, especially when done in a rote way, is often dismissive, demeaning, and disrespectful. It does not allow room for the patient's pain to fully be expressed without being invalidated. I know it's all the rage right now, but all kinds of questionable or downright harmful treatments have been popular throughout the years, including things like lobotomy and shock treatment. I'd ask that you leave room for the possibility that CBT is really not the solution you think it is.
I think efforts in combating BPD would be best spent in advocating for alternatives to CBT including person-centered / Jungian / humanistic psychology, done well. It's an uphill battle in this society both because it will tend to be more expensive and because it relies on the relationship between therapist and client first and foremost, not a formula or set of workbook exercises that can be reused for each patient. It's the relationship between the therapist and client that is healing. All good therapists ultimately come to understand this.
I also think your efforts would be well-spent on attempting to prevent BPD in the first place, by interventions that teach parents respectful, validating ways of treating their children. If I wanted to devote my professional life to eradicating BPD, and I could only do one thing, I would focus on providing or advocating for respectful, validating family therapy when the child is as young as possible.
posted by Flock of Cynthiabirds at 1:24 PM on January 25, 2021 [25 favorites]
Statements like this: "while your mother may have frequently said these words, this was - I guarantee you - not the truth" make me cringe. We learn in training for working with the suicidal that what helps people is to listen to them
You will notice that I did not say these words to OP's mother while she was feeling suicidal. I said it to OP, who is struggling with feeling responsible for their mother's suffering, which they (falsely) believe was unremitting and constant.
Here, again, I was speaking from personal lessons learned. I've spent most of my life believing that my mother, too, had nothing to live for, that her life held only pain, that she never knew true joy or love, that nobody supported her, that she suffered constantly. This belief increased my own suffering tremendously... and needlessly... because, as I said before (and like OP confesses in their post), I believed I had some/all the responsibility for alleviating my mother's suffering. Recognizing that my mother's BPD made her sometimes (not always!) falsely believe this distorted idea, and recognizing that in reality she did have friends and she was loved by many people at various points in her life, that she did experience many moments of joy and meaning and love, lessened my own emotional burden immensely. During my mother's downward spirals she wasn't healthy enough to hold a balanced view of her life. But that is no reason for me to believe the same thing about her when I am neither sick not in a downward spiral.
posted by MiraK at 1:38 PM on January 25, 2021 [18 favorites]
You will notice that I did not say these words to OP's mother while she was feeling suicidal. I said it to OP, who is struggling with feeling responsible for their mother's suffering, which they (falsely) believe was unremitting and constant.
Here, again, I was speaking from personal lessons learned. I've spent most of my life believing that my mother, too, had nothing to live for, that her life held only pain, that she never knew true joy or love, that nobody supported her, that she suffered constantly. This belief increased my own suffering tremendously... and needlessly... because, as I said before (and like OP confesses in their post), I believed I had some/all the responsibility for alleviating my mother's suffering. Recognizing that my mother's BPD made her sometimes (not always!) falsely believe this distorted idea, and recognizing that in reality she did have friends and she was loved by many people at various points in her life, that she did experience many moments of joy and meaning and love, lessened my own emotional burden immensely. During my mother's downward spirals she wasn't healthy enough to hold a balanced view of her life. But that is no reason for me to believe the same thing about her when I am neither sick not in a downward spiral.
posted by MiraK at 1:38 PM on January 25, 2021 [18 favorites]
I can't speak from any personal experience, but I just wanted to share that usually these days on the internet when I see a negative comment about people with BPD, the top reply is usually pushing back and encouraging empathy for people with BPD, and reassuring people with BPD that they can learn to manage their disorder well. So awareness and empathy is reaching some corners of the internet.
posted by mekily at 2:02 PM on January 25, 2021 [3 favorites]
posted by mekily at 2:02 PM on January 25, 2021 [3 favorites]
Response by poster: Not to threadsit, but maybe to clarify because I was kind of emotional when I was typing, and I know my question didn’t clearly come through: I’m a mental health provider trained in DBT but skeptical about the limitations of behaviorism generally. I’m wondering how I can best ally or align myself, personally or professionally, with people trying to offer both a gentler view of people with BPD and better care for those people. Or strategies on coping when I encounter cruelty towards people with BPD, especially on the internet.
posted by unstrungharp at 2:15 PM on January 25, 2021 [2 favorites]
posted by unstrungharp at 2:15 PM on January 25, 2021 [2 favorites]
I'm skeptical of psychiatric diagnosis in general; people get diagnosed differently by different practitioners. Borderline, especially, is a pretty unkind label that may not address the feelings of the individual or give them any guidance on coping. It sounds like the label caused her to devalue herself really deeply. She sounds like a person with perhaps more compassion than she knew what to do with. My Mom had bipolar disorder and alcoholism; it's a lot of baggage for her children to carry.
Suicide is always a significant cause of death, usually in the top 10 causes of death. I'd love to see more and better research into ways to help.
I'm so sorry your Mom was ill and sad so much, and that you now have the pain of parental suicide. Remember that you will go through the stages including anger, that grief is legitimate and can't be avoided. Sending hugs and support.
posted by theora55 at 3:03 PM on January 25, 2021 [1 favorite]
Suicide is always a significant cause of death, usually in the top 10 causes of death. I'd love to see more and better research into ways to help.
I'm so sorry your Mom was ill and sad so much, and that you now have the pain of parental suicide. Remember that you will go through the stages including anger, that grief is legitimate and can't be avoided. Sending hugs and support.
posted by theora55 at 3:03 PM on January 25, 2021 [1 favorite]
Response by poster: That’s exactly the attitude and perspective that this question asks for alternatives to.
posted by unstrungharp at 4:51 PM on January 25, 2021
posted by unstrungharp at 4:51 PM on January 25, 2021
Would it help to treat this (online anger against people with BPD) as a personal trigger? Maybe you can avoid going on these communities or threads until you have found a way to cope with the fact that yes, there are people who have been victimized by personality disordered parents, and they do express their anger on the internet in ways that trigger you. There will always be people on the internet that you disagree with deeply. They are not you, so you cannot control their speech. And in this case, it would be inappropriate for you to argue against them or discourage their process of coming to terms with the way they have been victimized. They are allowed to be very angry towards people with BPD on those forums... and you are allowed you avoid these forums.
What there is no excuse for is *professional* mistreatment and dehumanization of people with BPD. You are likely in a much better position to know of people and organizations in the mental health community who are working on destigmatizing BPD and championing the cause that's close to your heart. Off the top of my head, if DBT and Marsha Linehan's affiliated org doesn't appeal to you, there is also Nancy McWilliams who is a vocal advocate for patients with BPD accessing psychodynamic therapy or psychoanalysis. Judith Herman is of course a pioneer of cPTSD becoming a DSM diagnosis, and an advocate for trauma informed therapies. Many trauma focused orgs within the mental health community are doing work that you might want to join with.
posted by MiraK at 5:14 PM on January 25, 2021 [2 favorites]
What there is no excuse for is *professional* mistreatment and dehumanization of people with BPD. You are likely in a much better position to know of people and organizations in the mental health community who are working on destigmatizing BPD and championing the cause that's close to your heart. Off the top of my head, if DBT and Marsha Linehan's affiliated org doesn't appeal to you, there is also Nancy McWilliams who is a vocal advocate for patients with BPD accessing psychodynamic therapy or psychoanalysis. Judith Herman is of course a pioneer of cPTSD becoming a DSM diagnosis, and an advocate for trauma informed therapies. Many trauma focused orgs within the mental health community are doing work that you might want to join with.
posted by MiraK at 5:14 PM on January 25, 2021 [2 favorites]
Response by poster: I like Linehan and DBT, and just also don’t know if they’re the panacea we want them to be, particularly when people with DBT are rejected socially, by family, and by professionals (but constantly told to “get help” that doesn’t exist, particularly in the public system.
A personal trigger is pretty much correct. I encounter this attitude on metafilter, Instagram, Reddit, and at work, even when avoiding those terrible forums. I really believe this attitude killed my mother, and I can’t get away from people espousing it. It reads to me as socially permissible hate speech because everyone has agreed in this moment that it’s okay to hate and mistreat group of people.
posted by unstrungharp at 5:21 PM on January 25, 2021 [7 favorites]
A personal trigger is pretty much correct. I encounter this attitude on metafilter, Instagram, Reddit, and at work, even when avoiding those terrible forums. I really believe this attitude killed my mother, and I can’t get away from people espousing it. It reads to me as socially permissible hate speech because everyone has agreed in this moment that it’s okay to hate and mistreat group of people.
posted by unstrungharp at 5:21 PM on January 25, 2021 [7 favorites]
DMing you, Unstrung, since back and forth conversations are discouraged here.
posted by MiraK at 5:26 PM on January 25, 2021
posted by MiraK at 5:26 PM on January 25, 2021
here are two resources that I think are a bit different, apologies if you already know of them. I include them because they are very oriented toward STAYING in relationship with people struggling with this illness:
https://www.tara4bpd.org/ - they host seminars and family support events, all sorts of things, all based on Valerie Porr's work, she wrote a book
and
a book called "When Hope Is Not Enough" authored by a spouse of someone with BPD who also felt the mainstream treatments weren't adequate. The website is called "Anything to Stop the Pain" and there's a google group as well.. I don't know how active it is now, but a few years ago the google group was *very* active and illuminating in terms of ..well.. just how much people are struggling to desperate to help their loved ones with this disorder.
I really think these two resources might fit the bill - for example, the "Anything to Stop the Pain" book *really* emphasizes validation, and the discussion email list is all about how to put that validation into *practice*
posted by elgee at 8:56 PM on January 25, 2021 [2 favorites]
https://www.tara4bpd.org/ - they host seminars and family support events, all sorts of things, all based on Valerie Porr's work, she wrote a book
and
a book called "When Hope Is Not Enough" authored by a spouse of someone with BPD who also felt the mainstream treatments weren't adequate. The website is called "Anything to Stop the Pain" and there's a google group as well.. I don't know how active it is now, but a few years ago the google group was *very* active and illuminating in terms of ..well.. just how much people are struggling to desperate to help their loved ones with this disorder.
I really think these two resources might fit the bill - for example, the "Anything to Stop the Pain" book *really* emphasizes validation, and the discussion email list is all about how to put that validation into *practice*
posted by elgee at 8:56 PM on January 25, 2021 [2 favorites]
I like Linehan and DBT, and just also don’t know if they’re the panacea we want them to be
They're not. And if you go on YouTube, you can search for some videos made by folks who've been diagnosed with BPD (some of whom identify with it, and some who don't) and speak on their experiences with DBT and it is not all positive. In fact, some have had pretty terrible experiences with it, to the point of being retraumatizing, and they are very open and vocal about how it did not work for them (unfortunately specific videos don't come to mind right now). For whatever you or I might think about the specifics of their experience, I do think it's nice that YouTube and other social media platforms can function as a space where their voices can be heard, rather than simply those of family/friends/therapist who have been negatively impacted. It might be helpful for you in your situation to hear that side of it.
From the psychoanalytic tradition, Otto Kernberg is well known for working with personality disorders (more along the narcissistic spectrum, but there's a fair bit of overlap between that and the borderline diagnostic category), and may provide a helpful viewpoint outside mainstream psychotherapy. I also find Donald Winnicott to be very lovely to read, even though he never really talks about personality disorders per se; he writes almost entirely on developmental child psychoanalysis, but it ends up being germane. If you think about what characterizes BPD, and then imagine that in a child, you'd probably be understanding and patient with that child. And if trauma were then inflicted repeatedly upon that child, you could imagine a stunting of their psychic development, such that they grow into an adult body with adult responsibilities and expectations, but something much closer to a child's capacity for emoting and relating. In that sense, Winnicott has a lot to say on personality disorders without ever talking about personality disorders. It's an especially important and poignant point that he makes about how a child learns to survive their own rage and terror and hatred only by experiencing their attachment figure as capable of withstanding, of not being destroyed by, that rage/terror/hatred. Unfortunately, not all of us are lucky enough to have had such a figure in our early lives who could survive being destroyed.
posted by obliterati at 10:11 AM on January 26, 2021 [6 favorites]
They're not. And if you go on YouTube, you can search for some videos made by folks who've been diagnosed with BPD (some of whom identify with it, and some who don't) and speak on their experiences with DBT and it is not all positive. In fact, some have had pretty terrible experiences with it, to the point of being retraumatizing, and they are very open and vocal about how it did not work for them (unfortunately specific videos don't come to mind right now). For whatever you or I might think about the specifics of their experience, I do think it's nice that YouTube and other social media platforms can function as a space where their voices can be heard, rather than simply those of family/friends/therapist who have been negatively impacted. It might be helpful for you in your situation to hear that side of it.
From the psychoanalytic tradition, Otto Kernberg is well known for working with personality disorders (more along the narcissistic spectrum, but there's a fair bit of overlap between that and the borderline diagnostic category), and may provide a helpful viewpoint outside mainstream psychotherapy. I also find Donald Winnicott to be very lovely to read, even though he never really talks about personality disorders per se; he writes almost entirely on developmental child psychoanalysis, but it ends up being germane. If you think about what characterizes BPD, and then imagine that in a child, you'd probably be understanding and patient with that child. And if trauma were then inflicted repeatedly upon that child, you could imagine a stunting of their psychic development, such that they grow into an adult body with adult responsibilities and expectations, but something much closer to a child's capacity for emoting and relating. In that sense, Winnicott has a lot to say on personality disorders without ever talking about personality disorders. It's an especially important and poignant point that he makes about how a child learns to survive their own rage and terror and hatred only by experiencing their attachment figure as capable of withstanding, of not being destroyed by, that rage/terror/hatred. Unfortunately, not all of us are lucky enough to have had such a figure in our early lives who could survive being destroyed.
posted by obliterati at 10:11 AM on January 26, 2021 [6 favorites]
While it's fine to pondering "what if", I, in my purely amateur-ish understanding of psychology, wonders if you have completed your grieving process for your loss. As this has the appearance of the bargaining process in the five stages of grief.
posted by kschang at 2:31 PM on January 26, 2021
posted by kschang at 2:31 PM on January 26, 2021
I have struggled with suicidal ideation up until very recently. I don't have BPD, but I am autistic, and our survival rates into middle age aren't great, for various reasons. You could simply call it burnout. There's no quick or easy answer or solution for this, nor is there a easy solution for much of life's suffering.
After a decades-long wrangle with SI and various ineffective treatments and therapies for it, I consider it my prerogative and my absolute right to decide when and how my life will end. I believe the same for everyone else.
And I am not saying this at all to negate your own sorrow over your mother's decision or the concerns you've put forth here. What I'm trying to get across is that... people just wear out under the burden of "sickness, aging, and death" as Buddhism puts it. How they choose to deal with those universal truths is ultimately their call.
I believe you did everything you humanly could to help your mother and to preserve your own mental and emotional health. She's not in pain anymore.
You are left with time to live and doing what you consider important and worthwhile is the best way to honor her legacy.
posted by Sheydem-tants at 2:36 PM on January 26, 2021 [6 favorites]
After a decades-long wrangle with SI and various ineffective treatments and therapies for it, I consider it my prerogative and my absolute right to decide when and how my life will end. I believe the same for everyone else.
And I am not saying this at all to negate your own sorrow over your mother's decision or the concerns you've put forth here. What I'm trying to get across is that... people just wear out under the burden of "sickness, aging, and death" as Buddhism puts it. How they choose to deal with those universal truths is ultimately their call.
I believe you did everything you humanly could to help your mother and to preserve your own mental and emotional health. She's not in pain anymore.
You are left with time to live and doing what you consider important and worthwhile is the best way to honor her legacy.
posted by Sheydem-tants at 2:36 PM on January 26, 2021 [6 favorites]
This thread is closed to new comments.
It's difficult because there ARE people with familial trauma and subsequent maladaptive disorders (whether that is depressive orders, BPD, the whole constellation as you mentioned) that do go on to develop coping mechanisms and live as happy a life as is possible for them. Some don't. I think the difference is being able to cross that barrier of how a diagnosis will help them toward a brighter future and happiness for everyone involved rather than paint them as the REAL villain they never wanted to be but couldn't help being (i.e. oh, I'm BPD and I ruined people's/my family's/my child's life, therefore I will never be forgiven or understood and should die). It's TOUGH, often people have no desire to forgive or understand them even if they need it to cope, and I have no idea how it works for some and not others. Your mother obviously was trying to understand herself, the damage she's done, and do the research (via forums), but she fell short into self-loathing and didn't have the resolve to do the work. Again, I don't know why, but maybe because she felt it was too late with you? I think one aspect of therapy that is missing is to make these individuals understand the cycle of pain, in that yes it hurts to admit you did damage to people you love, but that is the first step toward them being in your life again and continuing the work toward that better future.
That being said, it wasn't your job to be your mother's support through all of this, certainly if you never received an apology or an invitation to work together to heal as a family. I think with suicide we always wonder how we could have done better or something different, no matter who it is.
posted by Young Kullervo at 12:19 PM on January 25, 2021 [2 favorites]