He's Not Crazy, He's My Brother
Yesterday I had my monthly appointment with Dr. Turkeypants. Usually these appointments are a quick check-in and update of my life, then the prescription pad comes out. Occasionally, when I actually have some sort of appropriate material to discuss with a shrink, he gets a half hour current drama update. Yesterday was one of those appointments.
I filled him in about the work bullshit and then moved into the saga of my sister and I. What's cool about Dr. Turkeypants is he has treated both of us for the past year. He knows all the details of her and her personality without me having to go into it. He was the first person to tell me to throw her ass out when she kept giving us the bullshit line that she was "looking for work", while actually sleeping, smoking and eating for months on our dime.
In a complete breach of professional behavior, he said, "Your sister is a very selfish person. Between you and me, she is a Borderline Personality. There is no Borderline-specific treatment. She is already on all the medications. But I didn't tell her that because she uses her physical and mental diagnosis to to further her illness." Whoa! I wasn't expecting that one. She had asked him after she got out of the booby hatch for a round of ECT last year if he thought she was Borderline. He had assured her no. Other doctors had suggested that diagnosis to her before, which seemed to completely freak her out.
Not even knowing what the hell Borderline Personality is, I looked it up on Google. This is from the DSM-IV, the book of criteria doctors use to diagnose mental illness:
DSM-IV criteria
The DSM-IV gives these nine criteria; a diagnosis requires that the subject present with at least five of these. I left in every one that applies here, and deleted what didn't.
Traits involving emotions:
Quite frequently people with BPD have a very hard time controlling their emotions. They may feel ruled by them.
1. Shifts in mood lasting only a few hours.
2. Anger that is inappropriate, intense or uncontrollable.
Traits involving behavior:
3. Self-destructive acts, such as self-mutilation or suicidal threats and gestures that happen more than once
4. Two potentially self-damaging impulsive behaviors. These could include other drug abuse, eating disorders, compulsive sexual behavior (add in self-mutilation).
Traits involving identity
5. Marked, persistent identity disturbance shown by uncertainty in at least two areas. These areas can include self-image, career choice or other long-term goals, friendships, values. People with BPD may not feel like they know who they are, or what they think, or what religion they should be. Instead, they may try to be what they think other people want them to be.
6. Chronic feelings of emptiness or boredom.
Traits involving relationships
7. Unstable, chaotic intense relationships characterized by splitting (see below).
8. Frantic efforts to avoid real or imagined abandonment
Splitting: the self and others are viewed as "all good" or "all bad." Someone with BPD said, "One day I would think my doctor was the best and I loved her, but if she challenged me in any way I hated her."
Alternating clinging and distancing behaviors. Sometimes you want to be close to someone. But when you get close it feels TOO close and you feel like you have to get some space. This happens often.
Great difficulty trusting people and themselves. Early trust may have been shattered by people who were close to you.
Sensitivity to criticism or rejection.
High degree of interpersonal sensitivity, insight and empathy
9. Transient, stress-related paranoid ideation or severe dissociative symptoms
This means feeling "out of it," or not being able to remember what you said.
Miscellaneous attributes of people with BPD:
People with BPD are often bright, witty, funny.
Their lives may be a chaotic landscape of job losses, interrupted educational pursuits, broken engagements, hospitalizations.
Many have a background of childhood physical, sexual, or emotional abuse or physical/emotional neglect.
What does she win if she gets all 9?
Do I believe this? I don't even know. She's just been that way all her life and I just thought that was just her. But it IS a big coincidence if it is all bullshit. In a way, it's a big relief. Now I can stop expecting rational or adult behavior from my sister. I felt guilty for finally getting tired of supporting her for the past 5 years and shoving her off onto my dad. But if this is a real disorder, she got the economy-size helping of it. And I'm free to have a life outside of bailing her out and helping her.
Even though I'm married to Monkey, it was really difficult to admit he is my best friend and the most important person in my life. I felt as though by having a great life, with a great guy, and a decent job, I was betraying her. Somehow I should not be happy. We were raised in the same crazy house. Why was I able to get over it? Why wasn't I a perpetual victim as she was? Why did I get over things that seemed to disable her daily? She had always said I was just more callous than she was and didn't care as much for people as she did. I think my mom subscribed to that theory as well.
What does this all mean? Who knows. Maybe I am using her diagnosis to justify my own behavior of distancing myself from her. As cool as my sister can be, I always feel like I'm her mother, not her sister. Monkey and I always referred to her as "our kid" when she lived here.
I filled him in about the work bullshit and then moved into the saga of my sister and I. What's cool about Dr. Turkeypants is he has treated both of us for the past year. He knows all the details of her and her personality without me having to go into it. He was the first person to tell me to throw her ass out when she kept giving us the bullshit line that she was "looking for work", while actually sleeping, smoking and eating for months on our dime.
In a complete breach of professional behavior, he said, "Your sister is a very selfish person. Between you and me, she is a Borderline Personality. There is no Borderline-specific treatment. She is already on all the medications. But I didn't tell her that because she uses her physical and mental diagnosis to to further her illness." Whoa! I wasn't expecting that one. She had asked him after she got out of the booby hatch for a round of ECT last year if he thought she was Borderline. He had assured her no. Other doctors had suggested that diagnosis to her before, which seemed to completely freak her out.
Not even knowing what the hell Borderline Personality is, I looked it up on Google. This is from the DSM-IV, the book of criteria doctors use to diagnose mental illness:
DSM-IV criteria
The DSM-IV gives these nine criteria; a diagnosis requires that the subject present with at least five of these. I left in every one that applies here, and deleted what didn't.
Traits involving emotions:
Quite frequently people with BPD have a very hard time controlling their emotions. They may feel ruled by them.
1. Shifts in mood lasting only a few hours.
2. Anger that is inappropriate, intense or uncontrollable.
Traits involving behavior:
3. Self-destructive acts, such as self-mutilation or suicidal threats and gestures that happen more than once
4. Two potentially self-damaging impulsive behaviors. These could include other drug abuse, eating disorders, compulsive sexual behavior (add in self-mutilation).
Traits involving identity
5. Marked, persistent identity disturbance shown by uncertainty in at least two areas. These areas can include self-image, career choice or other long-term goals, friendships, values. People with BPD may not feel like they know who they are, or what they think, or what religion they should be. Instead, they may try to be what they think other people want them to be.
6. Chronic feelings of emptiness or boredom.
Traits involving relationships
7. Unstable, chaotic intense relationships characterized by splitting (see below).
8. Frantic efforts to avoid real or imagined abandonment
Splitting: the self and others are viewed as "all good" or "all bad." Someone with BPD said, "One day I would think my doctor was the best and I loved her, but if she challenged me in any way I hated her."
Alternating clinging and distancing behaviors. Sometimes you want to be close to someone. But when you get close it feels TOO close and you feel like you have to get some space. This happens often.
Great difficulty trusting people and themselves. Early trust may have been shattered by people who were close to you.
Sensitivity to criticism or rejection.
High degree of interpersonal sensitivity, insight and empathy
9. Transient, stress-related paranoid ideation or severe dissociative symptoms
This means feeling "out of it," or not being able to remember what you said.
Miscellaneous attributes of people with BPD:
People with BPD are often bright, witty, funny.
Their lives may be a chaotic landscape of job losses, interrupted educational pursuits, broken engagements, hospitalizations.
Many have a background of childhood physical, sexual, or emotional abuse or physical/emotional neglect.
What does she win if she gets all 9?
Do I believe this? I don't even know. She's just been that way all her life and I just thought that was just her. But it IS a big coincidence if it is all bullshit. In a way, it's a big relief. Now I can stop expecting rational or adult behavior from my sister. I felt guilty for finally getting tired of supporting her for the past 5 years and shoving her off onto my dad. But if this is a real disorder, she got the economy-size helping of it. And I'm free to have a life outside of bailing her out and helping her.
Even though I'm married to Monkey, it was really difficult to admit he is my best friend and the most important person in my life. I felt as though by having a great life, with a great guy, and a decent job, I was betraying her. Somehow I should not be happy. We were raised in the same crazy house. Why was I able to get over it? Why wasn't I a perpetual victim as she was? Why did I get over things that seemed to disable her daily? She had always said I was just more callous than she was and didn't care as much for people as she did. I think my mom subscribed to that theory as well.
What does this all mean? Who knows. Maybe I am using her diagnosis to justify my own behavior of distancing myself from her. As cool as my sister can be, I always feel like I'm her mother, not her sister. Monkey and I always referred to her as "our kid" when she lived here.