It’s Not All Your Fault

1132x1600_12879_Bat_your_eyes_girl_2d_illustration_girl_sad_woman_portrait_picture_image_digital_artRecently I was talking to a 27-year-old female who had been arrested for the first time on various drug charges. Emotionally she was a wreck. I could tell she was really a good person on the inside, but emotionally she obviously wasn’t as stable as she could be and I immediately sensed that her childhood was filled with some type of neglect or abuse.

Why was I able to sense that? Because from my years of working with people, especially teenagers and women who have been abused and/or neglected as children, I’ve noticed that a large majority of them present very similar including being angry, shy, depressed, manic or lacking boundaries coupled with other cues such as body language.

This young lady was at some points crying, then angry, then laughing, and then crying again. Her life was “a mess” as she put it. She had two children, was in an unstable relationship (like all the other relationships she had been in), couldn’t seem to get her life together or in her words, “do anything right” and she had started smoking crack cocaine, a secret she kept from her family until she got arrested.

She couldn’t understand why she couldn’t get her life together. Why every time things would be going good, she would do something to mess it up. She was living almost in constant chaos and was using drugs to escape it. She had never been diagnosed with anything before and blamed herself for not being able to stop herself from making bad choices over and over again.

And then I asked her if she was ever abused before. I already knew the answer, I would have been shocked if I was wrong, I was hoping I was wrong, but I was right. She started crying and told me she had been molested repeatedly from the age of 8. Her childhood from that point on was filled with abuse, neglect and abandonment. No wonder now as an adult her life was “a mess”.

One of the things that happens to children and even adults when we experience abuse, neglect, trauma, abandonment or anything that is so mentally and emotionally painful that we can’t make sense of it, is that it doesn’t get fully processed and it becomes clutter in our minds, thoughts and emotions.

Our emotions and thoughts become fragmented with a lot of unprocessed feelings and those unprocessed feelings are what eventually will cause us to express ourselves in unhealthy ways, especially if we aren’t naturally resilient or have great social-emotional supports. However, even if we are naturally resilient and have great supports, chances are that fragmentation will still affect the way we think, feel and interact with other people.

That is what was going on with this young lady and until I explained to her how the trauma and pain from her past was affecting her future, she had no idea that at least some of what she was going through wasn’t totally her fault. Deep inside she is holding on to feelings of rage, insecurity and hurt from all the abuse, trauma and abandonment. All that unprocessed, raw emotion has to come out somewhere consciously or unconsciously. In a lot of people it comes out  in the form of rage towards themselves or others.

They may cut themselves, or do other things that demonstrate a lack of love for themselves such as being promiscuous, abusing drugs or alcohol and getting into abusive or neglectful relationships over and over again just to name a few. Some may even attempt suicide. Drugs, sex, self-mutilation and even suicide may be used as ways to try to control the rage they have inside.

They may turn their rage outwards and inflict hurt on others by being abusive, bitter, and pushing people away sometimes to the point where they wake up one day and realize they are totally alone and will blame other people for abandoning them even when they were the one pushing them away.

On top of that, they become so used to hiding their real feelings and emotions that they have difficulty communicating and expressing themselves in a healthy way. In return, they often end up feeling misunderstood and often blaming others for everything that doesn’t go right. Their psychological defenses will leave them blind to their own role in their interpersonal difficulties.

When someone has all this stuff going on in their conscious and subconscious mind, there’s no wonder their lives are continuously in chaos. Almost nothing they do will fix it if they remain unaware and blind to how their past is influencing their present. If they aren’t willing to try to change and get help, then it’s very unlikely that their lives will ever be all that it could have been.

Change Starts With Insight

Sometimes the toughest part of therapy is insight building, which means getting the person to see things as they really are and how they are truly affecting their lives. Many people like to place blame on others and take absolutely no responsibility for their circumstances. Even this young lady at one point was trying to blame her boyfriend for calling the police when he couldn’t find her. When the police found her and search her, they discovered the drugs so this was all the boyfriends fault according to her.

Once I got this young lady to see that she had to take responsibility for her current incarceration, I pointed out to her that it wasn’t all her fault.  Much of her current issues, the relationship instability, the drug use, the emotional instability, all had roots in her past. Once she got this she had an “aha” moment. She had never even put the two together. Even in that moment I could see the light bulb go off as some insight started pouring in.

That was amazing, but now it was time for the real hard work to begin. Now that she had insight, she had even more responsibility to start taking charge of her life and to stop letting the garbage from the past stink up her present and future.

Where To Start Healing

Immediately she said she wasn’t strong enough to do that, that she was too weak and that might be true which is why I told her the first thing she needs to do is to get into rehab. She needs to get clean and then to also find a good psychotherapist. She is going to have to be determined, patient and emotionally open because she will have to face a lot of emotional pain she’s been avoiding and she’ll have to resist the urge and the fear to do what she’s always done which is to get angry,  runaway from getting help or to sabotage herself again.

This is not something that is going to be resolved in one session, one month or even one year. This will likely be a life long battle for her, but one that is worth fighting.

She has a long road ahead of her, but if she is willing to do the work, she will have a much better life. Until she does the work and gets the help she needs, nothing in her life will make sense the way it should and she will always be left feeling like a victim. It’s not all her fault, but she now has the responsibility to take control of her life and to at least minimize the hurt from the past.

This one young lady’s experience echos that of hundred of young women I have dealt with over the last several years. Many of them due to their experiences, stressors, and predispositions to certain illness will go on to become drug addicts, alcoholics, diagnosed with bipolar disorder, borderline personality disorder, depression, anxiety, etc. Some of them will be resilient and despite their past live incredible lives as relatively emotionally healthy people.

It may not be all your fault, but it is your job to take responsibility and control over your life.

Mental Health Awareness Week: Borderline Personality Disorder

istock_000008463493xsmall-243x300Perhaps out of all of the different types of personality disorders, borderline personality disorder is the most studied and most known as it seems like more and more people today are being diagnosed with borderline personality disorder (BPD) and it was definitely one of the most common personality disorders I run into when working with teenage girls.

People with borderline personality disorder are said to stand on the threshold between neurosis and psychosis. They are characterized by their incredibly unstable affect, behavior, mood, self-image and object relations (how they relate to others).

Borderline personality disorder is thought to represent about 1 to 2 percent of the population and is twice as common in women compared to men.

People who have borderline personality disorder seem to be in a constant state of crisis. They experience almost every emotion to the extreme and typically have mood swings. They can go from being very angry and confrontational one moment, to crying the next moment to feeling nothing at all the very next. They may even have very brief periods of psychosis known as micropsychotic episodes that are generally not as bizarre as those who have full-blown psychotic breaks and may even go largely unnoticed or written off as “strange”.

The behavior of people with BPD is highly unpredictable and they generally do not achieve everything they can to their full potential. Their lives are usually marred by repetitive, self-destructive actions.

These individuals are very often associated with cutting and other self-injurious behaviors as they may harm themselves as a way of crying out for help, to express anger or to feel pain or numb themselves from intense and overwhelming emotions and affect. As a matter of fact, most of the young women I ended up counseling who had BPD were referred to me for their self-injurious behaviors and/or their intense mood swings.

They may feel both dependent and hostile which creates an environment for stormy interpersonal relationships. They can be dependent on the people they are closest to, yet lash out with intense anger at the smallest perceived slight or frustration. They basically pull and push people away all the time, yet they can not tolerate being alone and will prefer chasing and trying to have relationships with people who are not good for them, even if they themselves are not satisfied in the relationship. They tend to prefer that roller coaster over their own company.

They will complain about being treated like crap in their relationships, discuss leaving their partner, yet if their partner doesn’t respond to their text or phone call they will panic and do whatever it takes to track them down.

When they are forced to be alone, even briefly, they will take a stranger as a friend or become promiscuous to fill the loneliness they feel. They are often trying to fill the void of chronic feelings of emptiness, boredom and lack of a sense of identity. They may even complain about how depressed they feel despite all the other emotions that they usually display.

People with borderline personality disorder tend to distort their relationships by characterizing people to be all good or all bad. They will see people as either nurturing or as evil, hateful figures that threaten their security needs and are always threatening to abandon them whenever they feel dependent. The good person, even if they really are not a good person, then gets idealized while the bad person, even if they really are good, gets devalued. More often than not, the same person can be seen as good one moment and bad the next, meaning that a woman can see her husband as perfect and caring today and tomorrow he is the most evil man in the world and she hates his guts, even if nothing really changed between them over the last twenty-four hours.

This aspect of BPD I found extremely frustrating at times because one moment a client would see me as the only person in the world who could understand and help her and the next session she would treat me like she hated me and like I hadn’t ever helped her. One client in particular for instance was chatting with me like I was her best friend one week, the next week when I was redirecting a negative statement she made about herself she said “F*ck you” out of the blue and walked out of the room, only to come back the next week and apologize, but this cycle repeated itself over and  over again. It wasn’t uncommon for her to tell me in one session that she “couldn’t stand me” and the next session tell me that I was the only one who understood her.

Another reason people with BPD are trying even for therapists is that they are very good at subconsciously projecting a role unto someone and getting that person to unconsciously play that role. It can be very draining and even scary trying to deal with someone who has BPD as their impulsiveness and instability as well as their dependency needs can make them overwhelming for many people.

For the most part, this particular client and all other clients I’ve dealt with who had BPD were overall pleasant people with great personalities whenever they were in a good mood and I generally enjoyed our sessions, but there were times when they made therapy so difficult that although I enjoyed working with them, I was relieved when I was able to discharge them, not that I was happy to get rid of them so to say, but it was draining and by then I felt like I had given them everything they could have learned from me and now needed to practice the skills they built up with others.

 DSM-IV-TR Diagnostic Criteria for Borderline Personality Disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is what we use in the mental health field to diagnose mental disorders and personality disorders and it list the criteria for BPD as:

A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1)   Frantic efforts to avoid real or imagined abandonment.

Note:  Do not include suicidal or self-mutilating behavior covered in Criterion 5.

2)   A pattern of unstable and intense interpersonal relationships characterized by alternating between  extremes of idealization and devaluation.

3)  Identity disturbance:  markedly and persistently unstable self-image or sense of self.

4)   Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).

Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

5)   Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

6)   Affective [mood] instability.

7)   Chronic feelings of emptiness.

8)   Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

9)   Transient, stress-related paranoid ideation or severe dissociative symptoms.

 Treatment

Psychotherapy has had the best results for treating individuals with borderline personality disorder, especially when combined with pharmacotherapy. Reality-oriented and social skills training are ideal in order to help people with BPD see how their actions affect others. Intense psychotherapy on an individual and group level is often recommended to help clients work on their interpersonal skills and to deal with their self-destructive and self-injurious behaviors.

Dialectical behavior therapy (DBT) is a specific type of psychotherapy that works great with people who have borderline personality disorder, especially those who do self-harm behaviors like cutting. It has perhaps gotten the best recognition for being high effective with people who have BPD.

I mostly used psychotherapy in the form of cognitive behavioral therapy, but later started utilizing much of DBT and it proved to work faster if not better than traditional cognitive behavioral therapy.

More Information

There are some great books on borderline personality disorder, but I recommend the classic, I Hate You- Don’t Leave Me: Understanding Borderline Personality Disorder by Kreisman MD, Jerold J. and Hal Straus as a great place to start.

www.borderlinepersonalitydisorder.com  is another great resource and they even have a list of movies with characters who have BPD and they include:

Fatal Attraction (1987)

In “Fatal Attraction,” the infamous femme fatale character played by Glenn Close displays the emotional instability and fear of abandonment that are symptomatic of someone with Borderline Personality Disorder. Her character also exhibits the BPD symptoms of self-harm, intense anger, and manipulation as she stalks her former lover and his family.

Single White Female (1992)

Jennifer Jason Leigh’s character in “Single White Female” exhibits the Borderline Personality Disorder symptoms of fear of abandonment, impulsivity, and mirroring as she attempts to take over the persona and life of her roommate (Bridget Fonda).

Girl, Interrupted (1999)

“Girl, Interrupted” is based on the memoir of Susanna Kaysen, who struggled with mental illness and Borderline Personality Disorder as a teenager and young adult. The film, which stars Winona Ryder and Angelina Jolie, centers around Kaysen’s 18-month stay at a mental hospital.

Hours (2002)

The three main characters in “The Hours,” which include author Virginia Woolf, all struggle with Borderline Personality Disorder, depression, and suicide. The movie, which links women from different generations to Woolf’s book “Mrs. Dalloway,” stars Nicole Kidman, Meryl Streep, and Julianne Moore.

Monster (2003)

Charlize Theron transformed into the role of female serial killer Aileen Wuornos in “Monster.” Wuornos was diagnosed with Borderline Personality Disorder, which may have contributed to the unstable and angry behaviors that led to her killing at least six men.

My Super Ex-Girlfriend (2006)

One of the few comedy movies that features a character with Borderline Personality Disorder is “My Super Ex-Girlfriend.” In this movie, Uma Thurman portrays a woman with superpowers and a secret identity who also displays the BPD symptoms of impulsivity, unstable interpersonal relationships, and poor self-image.

Blinded By Beauty: Ignorance Towards The Mentally Ill

Alexander_AyannaYesterday while watching the local news, I saw a story about an officer who was called to an apartment complex after residents called bout a naked woman outside of her apartment.

Upon arriving, officer Ryan McIntosh found 20-year-old Ayanna Alexander outside of her apartment, but she had put on clothing by then.

Ayanna, who is an exotic dancer, told the officer that she was upset because she didn’t have a ride to work at Rachels, a local strip club.

The officer didn’t think Ayanna was impaired or had any other medical conditions, so he called his supervisor and got permission to drive Ayanna to work. He dropped her off and left, only to be called back shortly afterwards to a nearby restaurant after receiving a call about a naked woman thrashing the restaurant and disturbing patrons.

The officers arrived at the restaurant to find Ayanns with no pants or underwear on and during questioning by the police, she removed her shirt and bra and said she wanted to go to jail.

Ayanna was charged with disturbing the peace, indecent exposure and trespassing.

The problem I have with this is, not many people in their right minds, especially an “attractive” 20-year-old woman would just strip naked and cause havoc. To me, this just screams mental illness from the start, rather it is bipolar disorder or something else, but from the start of this story i felt like this woman should have been taken to the hospital for a mental evaluation, not taken to work and just dropped off.

Even after the second incident, instead of taking her to jail, I still feel like she should have been taken for a mental evaluation. Something clearly isn’t right. Maybe it is drugs, who knows? The officer said she didn’t seem impaired, but her behavior was abnormal and he didn’t do a urinary drug screen to rule out she was on anything.

Also, he was obviously not a Crisis Intervention Team officer or had much training, experience or exposure to mental illnesses or he would have recognized that this woman was in need of help, not a ride to her place of employment.

I’m not necessarily blaming the officer for not being trained properly, but I am blaming him for being ignorant and perhaps even blinded by an attractive female and wanting to do the “nice” thing by giving her a ride to work instead of truly investigating the incident.

At the hospital I work at it’s not uncommon for officers to bring us young, attractive, 20 something year old women they find naked running or walking through the streets or just sitting in the middle of the road. Nine times out of ten these women are not under the influence of any drugs or alcohol, but are suffering some type of mental break.

Often times it’s their first psychotic episode and they go on to be diagnosed and treated for bipolar disorder (most commonly), and other times they are people with long histories of mental illness.

The late teens and early twenties are the prime ages for the development of bipolar disorder and it’s not uncommon for people to present with symptoms of erratic, impulsive and irrational behavior for the first time around 20.

If this woman is simply arrested, charged and then released, she will get no help and eventually spiral out of control again, but maybe next time she won’t run into a naive officer who is trying to be nice, but maybe a predator or someone else who instead of helping this lady may victimize her or she may do something much more reckless and dangerous than taking off her clothing and throwing food in a restaurant.

Sometimes it’s hard to recognize and start treating the first symptoms of a mental illness, but to me it’s common sense that if you come across a naked, exotic dancer who gets paid to take her clothes off, doing it for free outside in the daytime, something isn’t right and the two most likely culprits are drugs and mental illness.

If the officer quickly decided she wasn’t impaired or had a medical conditions, why didn’t he take her to rule out a mental health condition other than ignorance? This is a problem on many occasions, but especially when you consider that the jails and prisons in our country today house many more mentally ill people than all of the mental hospitals, clinics and institutions combined.

Untrained officers come in contact with mentally ill people on nearly a daily basis and often times the result is tragic (numerous officer related shootings involving mentally ill people is what sparked crisis intervention team training for law enforcement officers), or they are arrested or simply ignored.

In this case, two out of three happened. Her mental condition was ignored and then she was arrested.

The Face of Mental Illness

girl-in-shadows-istockI love working in a psychiatric hospital because it’s rarely boring. The type of people who come through the door are everyday people, no different from you or me, it’s just that what they are dealing with at the time is more than they or most likely any of us can handle.

I remember when I first started working here, a senior co-worker said that the only thing separating us from the patients is that we have the keys that let us in and out.

That’s one reason customer service, even in a mental hospital is so important. We strive on treating everyone, no matter what their circumstances or mental state, fairly and therapeutically because you never know when we or one of our family members or friends will end up in a place like this and it’s fairly easy.

Say the “magic words” to the right person and you may find yourself involuntarily hospitalized. Have an over exaggerated emotional or behavioral reaction and you may end up placed in a mental hospital to help you calm down.

Since I’ve been here I’ve seen correction officers, police officers, teachers, college students, professional athletes, lawyers, daughters of politicians, doctors, nurses and business owners come through our doors under involuntary hospitalization statuses.

People are placed here everyday who feel like they shouldn’t be and some may very well not be, but the majority at least need a cool down period.

For example, last week a college student got into a fight with his girlfriend and someone reported he threatened to kill himself. He denied does accusations, but he was emotionally upset enough that law enforcement thought it was best that he was brought here for his safety and the safety of those around him.

Now that he was here he didn’t want to be here and wanted to leave. He kept trying to convince me and everyone that he didn’t need to be here, but in doing so, he was getting more and more upset and therefore appearing more and more like he needed to be here for his safety and those around him.

I kept trying to talk to him and tell him that if he truly didn’t think he should be hospitalized then he needed to be calm and relaxed, otherwise he was risking looking like every other patient in the hospital who truly needed to be there.

However, he was so agitated and insistent on leaving that we had to place him on an elopement risk which lessened the chance of him being released sooner than he would have been otherwise.

When people think of the patients in a mental hospital, they almost automatically get an image in their head as if mental illness has a face. Those of us who work in the field or know someone or are ourselves suffering from a mental illness know that this couldn’t be further from the truth.

This morning I spoke with the mother of one of our patients who just graduated with an advanced degree and has an extremely high IQ, but has a long history of bipolar disorder and hasn’t been on her medication in over a year.

This is a beautiful young lady who was found sitting outside naked, stating that her old self had died and given birth to her new self with a new name she was calling herself by and a new age. She also believed she had God like powers.

Here at the hospital, for the most part, this young lady was selectively mute and at times appeared catatonic. We even had to carry and pose her limp body at one point when we had to transport her to another part of our facility.

She was definitely in need of some medication to help her start getting back to her “normal” self.

I was really hoping to speak with her, I throughly enjoy talking to people who both have a long history of mental illness and the ability and awareness to really talk about it and analyze their experiences, but she wasn’t speaking to anyone, so I spoke with her mother for a while about her history of treatment and tried to help calm her mother’s fears about her daughter’s recent deterioration.

This young lady reminds me that mental illness is all around us and it’s nothing to be ashamed of or to run from. Sometimes it’s in your face like the guy talking to himself while begging for change or it’s wrapped in the package of a pretty grad school graduate who on most days could hold the most intellectual conversations, but today she’s just staring into out of space unresponsive to the world around her.

 

Bipolar Disorder: A Snap Shot Through A Clients’ Eyes

The other day I was privileged to work with a client who had been battling bipolar disorder for over 30 years. This remarkable woman, we’ll call her Jane, first started experiencing symptoms of bipolar disorder at the age of 17.

In high school Jane was popular and on her way to be the school valedictorian, and then suddenly she was struck with a deep, deep depression. She describes that depression as feeling like someone had taken a dark veil and wrapped it all around her. It was suffocating.

During this depression Jane slept and ate as much as possible, gaining a large amount of weight. Her father, whom she lived with and was very close to, had no idea how to handle this situation. Instead of getting her help, he let her wade through this depression which she eventually came out of and went on to graduate from high school despite having a very rough year.

Then she started college, and the other side of bipolar disorder showed up, mania. She was extremely hyper, unfocused, partying all the time, exhausting her friends and boyfriend who eventually broke up with her and she quickly failed out of college.

Her father, still confused about what was going on with his daughter and maybe in denial or frustration, sent her to live with relatives on the other side of the country, telling her to get herself together.

By the time Jane was relocated with other family members, the depression was back and so was the binging and the weight gain. Jane reported that she slept as much as possible to try to avoid the intensely deep depression.

The mania and depressive episodes continued and eventually Jane left her family, ended up living on the street abusing drugs and alcohol like so many people who have a mental illness, but feel misunderstood do.

Eventually she was arrested and later hospitalized where she was diagnosed with bipolar disorder and put on Lithium, which she still takes to this day.

After she got treatment for her disorder, Jane was able to be her true self again. As she describes it, “Lithium allows me to be me”. She became fully functioning, got married, had children and obtained a job making six figures.

However, eventually her husband and her started having marital problems and she felt as if she had lost the bark she used to have when she wasn’t on lithium and was in one of her manic states. She felt as if the lithium was dulling her ability to stand up for herself so she stopped taking it.

In a short matter of time she fell back into a manic state which caused her to drive halfway across the country where she was eventually hospitalized after she was found wandering the streets telling people she was Jesus and they should follow her.

She was hospitalized and put back on Lithium, but by then she had lost her husband. Now however, she knows that bipolar disorder is something that she is going to have to live with, deal with and respect her whole life.

Now she doesn’t have a six figure job, or a husband, but she has her life back and she goes around speaking to groups about bipolar disorder in hopes to help get rid of the stigma of mental illness through recognition and education about mental illness.

There is a lot of stigma that goes with mental illness which causes those who are affected with it to refuse to talk about it and get help, and family members and friends to live in denial, refusal or misunderstanding about it.

Jane is helping people talk about mental illness so that someone doesn’t have to go through the things she went through before finally getting help.

She is a remarkable and strong person like most people who battle a mental disorder are once given the tools and support they need.