BPD - how to help...?

[Vicky_17051]

It seems we have lots of BPD veterans on here, which is great and not so great at the same time, if that makes sense.

My close friend and next door neighbor has BPD as well as many co-morbid issues. There are a group of us that do all we can to support her, but it is not enough. She is under the local mental health team but they only offer very minimal support. Efforts by all friends to get hospital admission have been unsuccessful. If she phones crisis line they will actually say "can't you go and be with so-and-so"? They have her support system noted down, and while we are all happy to help and support we cannot keep her safe 24/7. She is currently living on her own, but even if she was staying with any one of us we could not ensure her safety unless we kept vigil.

Efforts to find a private hospital and funding to go with it have been unsuccessful, as have efforts to find a therapeutic community.

Does anyone have any advice or experience to share that may shed some light on our situation, and help us to better help our friend?

[bowlingbun]

It's a really difficult situation. Sadly, it may be the case that she is just one of those people who want more and more and more until there is nothing left of you. So decide on clear boundaries, what you can do, what you can give whilst still living a life that is happy and satisfying for you. Ultimately, we are all responsible for our own happiness.

[jenny lucas]

Vicky, hi - I wrote a bit about the difficulties of caring for someone with MH in my post to you on the Newbies section!

What would happen to your friend if none of you paid any attention to her? Just trying to see the 'worst' possible outcome, and then work back from there.

Sadly, you may find the only way to 'force' the MH NHS services to do anything is to tell them that ALL of you are withdrawing support, and are ceasing to be 'on hand' for your friend. This is 'brinkmanship' I know, but as you are finding out, the poor old NHS will ruthlessly exploit anyone it can to do what it is underfunded to do itself.....

[jenny lucas]

PS - Google 'secondary gain'. Someone on this forum referred to it a while back and I found it VERY enlightening. I'd never heard of it before. It rings horribly true in cases known to me alas....sigh.

[MrsAverage]

Hi Vicky
This is circulating widely today
http://www.bbc.co.uk/news/av/uk-england-39822507/six-months-for-help-after-suicide-bids
and shows how difficult it is to help help and treatment.
With any mental illness, a supporters best role to to be that, a supporter. You cannot treat or cure your friend. That has to come from her and you just support her efforts. Do not start to do things for her, help her to do them for herself.
There's limited advice for carers on Mind and Rethink sites. The fullest advice I found was in this Australina site 're bipolar. Have a look they may have something on BPD, which is often called EUPD too these days
http://www.bipolarcaregivers.org

It is easy for caring person to get swept up into another's mental illness so do remember to look after your own physical and mental well being and set limits and get breaks

Kr
MrsA

[Vicky_17051]

Thank you all for your input, and for yours in the newbies section Jenny, which I will address here. I am reticent to go into to many details on the off chance that this post gets read by the wrong people, but at the same time I will do my best not to be so vague things do not make sense.

Secondary gain is something I was aware of in theory but did not know it had a name. Oh my word, is it appropriate here! She likes having people around to talk to, and has obviously made the connection that the more acute her crisis, the more people are likely to be around. I have put this to her before in so many words before, when she asked why everyone had 'backed off'. I said that when she was in her acute period of crisis (using other words, I'm not a robot...or am I? ) people rallied round to get her through that bump in the road, but when she came through it, it was back to business as usual - which is still a very high level of support to give to a friend. I know (read: hope) that it wouldn't be consciously thought out, but I have no doubt that she enjoys and revels in the attention she gets from people and professionals, particularly when she is made to feel 'special'. Learned helplessness has been a term on the tip of my tongue for some time too, as she is very used to people doing everything for her and does not feel the need to learn or adapt or try.

Efforts to get her help have largely been a bust. She will not consider the help that is on offer, but when something else is proposed she makes short work of finding a reason that wouldn't work either. In short, she does need to try, but none of us are brave enough to make her. I have reached the point before where I have told her she needs to actually engage in her own recovery, only to be ghosted. Far from being a holiday from worry, I worried all the more about where she was and what she was doing. I know I need to detach with love, after my pre-set 'healthy boundaries' were breached, more by myself than anything, as I responded to threats of suicide and brief disappearances with flurries of texts and apologies about asking so much from her. Having a parent with severe and ongoing mental health difficulties, and knowing all the 'rules' about positive reinforcement and I still crumbled when I thought her life may be in danger, though this is a dance she has been doing with other friends for many years, and is something I was cautioned against.

Living just next door, and my own physical disabilities making going out something that needs a lot of pre-planning and can still be easily scuppered when it comes to it, I appear very 'available', despite this not being the case. I have many responsibilities, passions, and other people in my life that I need to prioritise. Just because I might spend the day in my pyjamas does not mean I am not busy. During friends 'tests' she also makes plans with friends or with her father (who is extremely enabling), and when she is not there when these people knock on her door, they come and knock on mine, which leads me to worry about where she may be and what she is doing.

I have circled back to enabling, which I feel sure we are all doing to an extent. I would prefer to give her just enough rope and actually let her try, even if she fails. I think she is yet to reach her rock bottom. The problem is that with this person, rock bottom may very well mean six feet under. I am not being glib, and I know that this is always a possibility with anyone, even more when dealing with MH issues, and even more so when dealing with BPD. She is neglecting herself terribly and engaging in MANY dangerous and self destructive behaviours. That time I did try to talk to her I was very measured and calm (I rarely lose my temper in the moment and often have to extend near infinite patience to get through to and live with some of the people I love) and told her though she couldn't help being ill, it was up to her what she did about it. She is stuck in a delusion that nothing she does is 'her fault', it is because she is ill, and while some friends with a little less knowledge might buy that, I don't.

I know I am a dialectic all of my own, knowing her game and unwittingly enabling her (and thus NOT helping her) because I care. Thank you all for your input. I constantly waver between thinking I'm being a cold hearted cow and thinking I do to much and should leave her to try and cope on her own. Now matter how she decries you when she's unhappy with anything/everything your are/are not doing or saying, she comes back as soon as shes stuck for an audience/friend...sigh. Yes, I do think far too much about her when I have soooo much going on, but the carer in me constantly snaps back to wanting to 'help'...encore sigh

[bowlingbun]

I suspect you have been manipulated by her into thinking that she is your responsibility - this is simply not true. You need to work on yourself to not worry, because it seems that she is making YOUR life hardly worth living because of her behaviour. So don't think about her so much, think about you and yours more. I know this won't be easy, or happen quickly, but bit by bit it should be possible. You can't always change someone else's behaviour, but you CAN change your own. Just keep telling yourself this regularly until it works.
Ask yourself "If she didn't live next door, would I still be involved and visit her?"

[jenny lucas]

Hmm, the term 'emotional vampire' also now springs to mind! I don't means she's being one 'deliberately' but it's definitely providing her with a LOT of secondary gain!! ( I think the 'learned helplessness' is spot on - I hadn't heard that term before, but it ties RIGHT in with secondary gain, doesn't it??)

OK, I think you are saying all the right things to us, and clearly see what is going on, BUT you have been 'programmed' to keep behaving in a certain way with her. She is most DEFINITELY manipulating you - again, not necessarily consciously, but certainly quite, quite obviously (Reread your post as if one of us had written it, and I think you'll see it glaring in technicolour from your description of her behaviour!)

In practical terms I would say, despite your living next door, despite you being apparently 'available' to her, the time has come when you msut simply be NOT available to her. So, how about the following:

- working from home (doesn't matter what, something you can do despite your own health problems - whether it's, for example, making clothes for orphans, or painting pictures to sell, or baking cakes or whatever whatever)

- taking an Open University degree (or equivalent).

- researching family history online

Basically ANYTHING that means 'Sorry, I can't come over, I'm finishing a dress/got an essay to write' etc etc.


You do, as you yourself say, have to set boundaries and KEEP THEM.

Now, as you 'withdraw' from her she will inevitably react in the way all 'manipulators' do, she'll try and 'get you back in line' .She'll probably do this by 'getting worse' - having another crisis, etc etc, this is SIMPLY to make you 'comply' again, to get you back to the 'attention-paying minion' that she has cast you in, and which she revels in, as you yourself see.

You MUST resist this.

You do need to 'call her bluff'. At the moment the ultimate threat she holds over you is the threat of suicide. Well, I'm going to be blunt here, but unless she has children, I'm going to say (hold your breath now) - 'so what'. As in 'so what' if she chooses to end her life? It's her life. She is ENTIRELY ENTITLED to end it if she wants to. That is true of ALL of us - except those of us who are parents, when our lives become our children's. We choose to have children, therefore our first and abiding responsibility is to them, and depriving them of us is an act of extreme and unforgiveably selfishness (though of course in most cases the suicidal parents is so desperately tragically delusional they genuinely believe their child would be 'better off without them'......)

Why not call her bluff by having the conversation along those lines? eg

'While all of your friends would be horrified if you decided your life was not worth living, we DO respect your right to choose for yourself. We will always argue against taking your own life, and deplore it totally, BUT if that is truly your decision, your will, then we must respect it, however much it upsets us. So please know that we will back you entirely in that decision, if that is ever one you decide is the only option for you. Of course we hope it won't be, but we will respect it.'

That should spike her guns!!!!!!

If I put all this another way - if you TRULY want your friend to 'get better' (and she obviously 'doesn't want to' or she would not be turning down all the medical help etc etc!) then you MUST change what is currently your 'enabling' behaviour towards her to truly 'supporting' her. Which means that you insist that any attention she gets from you is ONLY if she is 'in treatment'.

The choice for her has to become not 'refuse treatment and get attention' (because she is having a crisis!), or 'accept tratment and get no attention' but the other way round 'refuse treatment and get NO attention' (because that attention is simply enabling her to stay in crisis) or 'ACCEPT treatment and get attention'!

You have to 'reward' her 'improving' behaviour, not her 'crisis' behaviour. The 'crisis' behaviour gets 'punished' by you witholdhing your attention (and yes, risking her pushing herself into the 'I'LL MAKE YOU SORRY FOR IGNORING ME!' arch-manipulator stuff of threatening suicide.)

YOU are NOT responsible for her mental wellbeing - SHE is. And that is the bottom line.

If you truly want to help her, this is the time for Firm Love - and it's hard to do, because of your natural compassion and concern, but it is for her own good (even though she won't see it that way)

All the best, and hope this is the start of you changing your behaviour towards her from enablement to support.

[jenny lucas]

Just another thought -

Why not invite all her other friends over to you for a 'pow-wow' to discuss and hopefully agree on a joint 'new strategy' to shift your behaviour towards your BPD friend from 'enabling' to 'supporting'.

That would be more effective in finally getting her to 'move on' rather than 'stay stuck' (where she currently finds it' comfortable' to be)(and yes, 'getting better' can be a scary prospect for her!)

That said, I personally would say that if the others don't agree with you, or lapse (too much), that you yourself still adopt the 'new strategy' (ie, supporting with firm love rather than enabling with 'weak' love), not just because it is better for her, but also for you - as I replied in your Newbie post, you have too many carees for a single person to cope with!!!!!

Would it help, I wonder, if you could all speak to a psychotherapist on this issue of support vs enablement, to get some 'validation' for the new strategy that might help convince the other friends that you can't just keep going the way you are, as it's not really doing her any good.

Whilst a psychotherapist can't discuss an individual case, they could, surely , speak to you in general about the most effective relationship for friends to have with someone who has BPD, and what to look out for by way of 'pushback' (where they try and get you 'back in line'). And especially on the issue of her being a danger to herself - my 'spike her guns' suggestion might be NOT a good idea (though how else to stop her constantly getting you all 'back in line' by threatening to self-harm/dsestruct I don't know)

[Vicky_17051]

****TRIGGER WARNING***

Thank you all. Your advice is spot on. I was one day in to 'detaching with love' when the proverbial hit the fan. You might want to grab a cuppa if you're going to read this in one go.

So, taking a rest day and comfortably Z shaped in my adjustable bed watching television. I am physically disabled so the support I offer to my husband and others in my life is almost entirely cerebral. My brain still works...mostly. Friend buzzed at my door (I have an intercom system so I can buzz people in from where I am, if it's bed or my chair) and said, "hi, it's friend". Unusual not to text first, but I had not text her as part of 'detaching with love'. Buzzed her in, then went downstairs. "I've stuffed up", or similar, she says. She had overdosed. Another friend was already aware of this and had called mental health services who had called the police. The police were looking for her so she ducked in here. She does overdose regularly as a form of self harm but this had become quite serious quite quickly, more than anything because of the amount of people involved and the police on their way. I phoned her GP who phoned the police and told them where she was. I was advised to phone ambulance and did so.

Police came pretty quick, but ambulance took over an hour to get here. I'd listed the pills I believed she had taken as she did not know what she had taken or how much. I'd taken blades, and vodka from her, and the majority of the pills, so that they would not be given back to her (which has happened previously). She went and I thought I'd done my due diligence. This was not my first rodeo, having supported friends and family with mental health issues all my life.

I went to lay down but soon the texts started. She had not been seen and was unhappy. I replied to her till she got belligerent, and then she tried someone else when I did not reply. (Yes, this does very much represent the unhealthy group dynamic and further supports the need for us to all be on the same page about our approach with her). A friend turned up a couple of hours later, and I sent husband down to give her the keys. When he did not appear to be coming back up, I went down to investigate. Said friend had set up a work station in my front room and was using our phone to 'organise' things. There was in truth nothing that needed organising and I soon got to the root of what she was trying to do and made sure it was done. Someone was already with friend in hospital, there was really nothing that needed to be done. I gave her a taking too and said that such flapping was helping no one, least of all herself.

I got away from 'helper friend' about 10pm and got a call from BPD friend around 11.30pm. I would not usually take a call at that time but I did, and she cried a lot. She was obviously not admitted to hospital and the drama was all for nowt.

Yes, we need consistency. I am going to suggest a meeting of her support system and make sure we are all on the same page and no one goes off book and negates efforts of everyone else to get her to stand on own two feet. Jenny, you are right in saying that she is comfortable where she is. It is all she knows. The complication is that there ARE children, two beautiful girls of 10 and 12 who were taken into care several months ago. This has fueled the current crisis and there is no way the girls are coming back when she's as unwell as she is. It is very unfortunate.

I am making sure I stick to my boundaries - no dropping everything for her, other than when I have a front room full of police and really have no choice. I even had to cancel my own care call while we were waiting for the ambulance.

Thank you all for all your advice. Will update as situation progresses. xXx