I Hate You—Don't Leave Me (16 page)

This kind of problem is especially common within families of borderlines who display prominent self-destructive behaviors. Delinquent or suicidal adolescents, alcoholics, and anorexics may present similar no-win dilemmas to their families. They actively resist help, while behaving in obviously self-destructive ways. Usually, direct confrontation that precipitates a crisis is the only way to help. Some groups, such as Alcoholics Anonymous, recommend standardized confrontational situations in which family, friends, or coworkers, often together with a counselor, confront the patient with his addictive behavior and demand treatment.

“Tough Love” groups believe that true caring forces the individual to face the consequences of his behaviors rather than protect him from them. “Tough Love” groups for parents of teenagers, for example, may insist that an adolescent drug abuser either be hospitalized or barred from the home. This type of approach emphasizes the
Truth
element of the SET-UP triangle but may ignore the
Support
and
Empathy
segments. Therefore, these systems may be only partially successful for the borderline, who may go through the motions of change that
Truth
confrontations force on him; underneath, however, the lack of nurturing and trust provided by
Support
and
Empathy
hinder his motivation for dedicated and lasting change.

Borderlines typically respond to depression, anxiety, frustration, or anger with more layers of these same feelings. Because of the borderline's perfectionism and tendency to perceive things in black-and-white extremes, he attempts to obliterate unpleasant feelings rather than understand or cope with them. When he finds that he cannot simply erase these bad feelings, he becomes even more frustrated or guilty. Since feeling bad is unacceptable, he feels bad about feeling bad. When this makes him feel worse, he becomes caught in a seemingly bottomless downward spiral.

One of the goals for the borderline's therapists and other close relations is to crack through these successive layers to locate the original feeling and help the borderline accept it as part of himself. The borderline must learn to allow himself the luxury of “bad” feelings without rebuke, guilt, or denial.

CASE 2: NEIL AND FRIENDS.
Neil, a fifty-three-year-old bank officer, has had episodes of depression for more than half his life. Neil's parents died when he was young, and he was reared mostly by his much older, unmarried sister, who was cold and hypercritical. She was a religious zealot who insisted he attend church services daily, and frequently accused him of sinful transgressions.

Neil grew up to become a passive man, dominated by his wife. He was reared to believe that anger was unacceptable and denied ever feeling angry at others. He was hardworking and respected at his job, but received little affection from his wife. She rejected his sexual advances, which frustrated and depressed him. Neil would initially get angry at his wife for her rejections, then feel guilty and get angry at himself for being angry, and then lapse into depression. This process permeated other areas of Neil's life. Whenever he experienced negative feelings, he would pressure himself to end them. Since he could not control his inner feelings, he became increasingly disappointed and frustrated with himself. His depression worsened.

Neil's friends tried to comfort him. They told him they were behind him and were available whenever he wanted to talk. They empathized with his discomfort at work and his problems in dealing with his wife. They pointed out that “he was feeling bad over feeling bad,” and that he should straighten up. This advice, however, didn't help; in fact, Neil felt worse because he now felt he was letting his friends down on top of everything else. The harder he tried to stop his negative feelings, the more he felt like a failure, and the more depressed he became.

SET-UP statements could help Neil confront this dilemma. Neil received much
Support
and
Empathy
from his friends, but their
Truth
messages were not helpful. Rather than trying to erase his unpleasant emotions (an all-or-none proposition), Neil must understand the necessity of accepting them as real and appropriate, within a nonjudgmental context. Instead of adding layers of more self-condemnation, which allows him to continue to wallow in the muck of “woe is me,” he must instead confront the criticism and work to change.

Further
Truth
statements would acknowledge the reasons for Neil's passive behavior and the behaviors of his wife and others in his life. He must recognize that, to some degree, he places himself in a position of being abused by others. Although he can work to change this situation in the future, he must now deal with the way things are currently. This means recognizing his anger, that he has reasons to be angry, and that he has no choice but to accept his anger, for he cannot make it disappear, at least not right away. Though he may regret the presence of unacceptable feelings, he is powerless to change them (a dictum similar to those used in Alcoholics Anonymous). Accepting these uncomfortable feelings means accepting himself as an imperfect human being and relinquishing the illusion that he can control uncontrollable factors. If Neil can accept his anger, or his sadness, or any unpleasant feeling, the “feeling bad about feeling bad” phenomenon will be shortcircuited. He can move on to change other aspects of his life.

Much of the success in Neil's life has resulted from trying harder: Studying harder usually results in better grades. Practicing harder usually results in a better performance. But some situations in life require the opposite. The more you grit your teeth and clench your fists and try to go to sleep, the more likely you will be awake all night. The harder you try to make yourself relax, the more tense you may become.

The borderline trapped in this dilemma will often break free when he least expects it—when he relaxes, becomes less obsessive and self-demanding, and learns to accept himself. It is no coincidence that the borderline who seeks a healthy love relationship more often finds it when he is least desperate for one and more engaged in self-fulfilling activities. For it is at this point that he is more attractive to others and less pressured to grasp at immediate and unrealistic solutions to loneliness.

The borderline frequently involves himself in predicaments in which he becomes a victim. Neil, for example, perceives himself as a helpless character upon whom others act. The borderline frequently is unaware that his behavior is provocative or dangerous, or that it may in some way invite persecution. The woman who continually chooses men who abuse her is typically unaware of the patterns she is repeating. The borderline's split view of himself includes a special, entitled part and an angry, unworthy part that masochistically deserves punishment, although he may not be consciously aware of one side or the other. In fact, a pattern of this type of “invited” victimization is often a solid indication of BPD pathology.

Although being a victim is most unpleasant, it can also be a very appealing role. A helpless waif, buffeted by the turbulent seas of an unfair world, is very attractive to some people. A match between the helpless waif and one who feels a strong need to rescue and take care of others satisfies needs for both parties. The borderline finds a “kind stranger” who promises complete and total protection. And the partner fulfills his own desire to feel strong, protective, important, and needed—to be the one to “take her away from all this.”

CASE 3: ANNETTE.
Born to a poor black family, Annette lost her father at a very young age when he abandoned the household. A succession of other men briefly occupied the “father” chair in the home. Eventually her mother remarried, but her second husband was also a drinker and carouser. When Annette was about eight, her stepfather began sexually abusing her and her sister. Annette was afraid to tell her mother, who gloried in the family's finally achieving some financial security. So Annette allowed it to continue
—“for her mother's sake.”

At seventeen, Annette became pregnant and married the baby's father. She managed to graduate from high school, where her grades were generally good, but other aspects of her life were in turmoil: her husband drank and ran with other women. After a while, he began beating her. She continued to bear more of his children, complaining and enduring
—“for the children's sake.”

After six years and three children, Annette's husband left her. His departure prompted a kind of anxious relief—the wild ride was finally over, but concerns over what to do next loomed ominously.

Annette and the kids tried to make things work, but she felt constantly overwhelmed. Then she met John, who was about twenty-five years older (he refused to tell her his exact age) and seemed to have a genuine desire to take care of her. He became the good father Annette never had. He encouraged and protected her. He advised her on how to dress and how to talk. After a while, Annette became more self-confident, got a good job, and began enjoying her life. A few months later, John moved in—sort of. He lived with her on weekends but slept away during the week because of work assignments that made it “more convenient to sleep at the office.”

Deep inside, Annette knew John was married, but she never asked. When John became less dependable, stayed away more, and generally became more detached, she held in her anger. On the job, however, this anger surfaced, and she was passed over for many promotions. Her supervisors said that she lacked the academic qualifications of others and that she was abrasive, but Annette wouldn't accept those explanations.

Incensed, she attributed the rejections to racial discrimination. She became more and more depressed and eventually entered the hospital.

In the hospital, Annette's racial sensitivities exploded. Most of the doctors were white, as were most of the nurses and most of the other patients. The hospital decor was “white” and the meals were “white.” All of the anger built up over the years was now focused on society's discrimination against blacks. By concentrating exclusively on this global issue, Annette avoided her own personal demons.

Her most challenging target was Harry, a music therapist on staff at the hospital. Annette felt that Harry (who was white) insisted on playing only “white” music, and that his looks and whole demeanor embodied “whiteness.” Annette vented her fury on this therapist, and she would stalk away angrily from the music therapy sessions.

Although Harry was frightened by the outbursts, he sought out Annette. His
Support
statement reflected his personal concern about Annette's progress in the hospital program. Harry expressed his
Empathy
for Annette by voicing his recognition of how frustrating it feels to be discriminated against, and cited his own experiences as one of the only Jews in his educational program. Then Harry attempted to confront the
Truth
, or reality, issues in Annette's life, pointing out that railing against racial discrimination was useless without a commitment to work toward changing it. Annette's need to remain a victim, Harry said, shielded her from assuming any responsibility for what happened in her life. She could feel justified in cursing the fates rather than bravely investigating her own role in continuing to be used by others. By wrapping herself in a veil of righteous anger, Annette was avoiding any kind of frightening self-examination or confrontation that might induce change, and thereby was perpetuating her impotency and helplessness. This left her incapable of making changes
“for her sake.”

At the next music therapy session, Annette did not stalk out of the room. Instead, she confronted Harry and the other patients. She suggested different songs to play. At the following meeting the group agreed to play some civil-rights protest songs of Annette's choosing.

Harry's response exemplified SET-UP principles and would have been useful for Annette's boss, her friends—anyone who faced her angry outbursts on a regular basis.

SET-UP communication can free a borderline or anyone who is locked into a victim role by pointing out the advantages of being a victim (being cared for, appearing blameless for bad results, disavowing responsibility) and the disadvantages (abdicating autonomy, maintaining obsequious dependency, remaining fixated and immobile amid life's dilemmas). The borderline “victim” must, however, hear all three parts of the message, otherwise the impact of the message will be lost. If “The Truth will set you free,” then
Support
and
Empathy
must accompany it to ensure it will be heard.

Much of the borderline's dramatic behavior is related to his interminable search for something to fill the emptiness that continually haunts him. Relationships and drugs are two of the mechanisms the borderline uses to combat the loneliness and to capture a sense of existing in a world that feels real.

CASE 4:RICH.
“I guess I just love too much!” said Rich in describing his problems with his girlfriend. He was a thirty-year-old divorced man who had a succession of disastrous affairs with women. He would cling obsessively to these women, showering them with gifts and attention. Through them he felt whole, alive, and fulfilled. But he demanded from them—and from other friends—total obedience. In this way he felt in control, not only of them but more important of his own existence.

He became distraught when these women acted independently. He cajoled, insisted, and threatened. To stave off the omnipresent sense of emptiness, he attempted to control others; if they refused to comply with his wishes, Rich became seriously depressed and out of control. He would turn to alcohol or drugs to recapture his sense of being or authenticity. Sometimes he would pick fights or cut himself when he feared he was losing touch with his sensory or emotional feelings. When the anger and pain no longer brought changes, he would take up with another woman who perceived him as “misunderstood” and merely needing “the love of a good woman.” Then the process would start all over again.