Day: March 18, 2021

Do No Harm

I’ve written about this relatively new path of stability Handsome and I are on. It’s great, but I feel like I – we, really- walked through fire to get here. It’s important to me that other partners who may be newer to this journey know that progress, if it comes at all, does so in a dance that often seems like two steps forward for every three steps back. Healing isn’t linear. Not individually, and not as a couple. In this post and the next few I’ll address some of the steps backwards, and then forwards, we took to get here.

Handsome’s therapist, Doc #2, basically fired him as a patient in mid- September. It completely blindsided Handsome. And me. (It apparently wasn’t a complete firing. His parting words were “Call me when you have something to talk about.”)

You run through a checklist in your mind about whether insurance was an issue (nope, great coverage), or cancellations (also no, only one in over 50+ visits a year), or anything else that might have prompted the move. Handsome was left wondering why someone else in his life decided he wasn’t worth the time or effort. He felt abandoned. He was hurt.

I’ve had months to ponder that decision and I have to say that I still don’t fully understand it. Perhaps I never will until I get to speak to the Doc again at some point. Our CSAT and Doc#2 are professionally acquainted and have multiple clients in common. I’ve heard through her that the Doc grew frustrated with Handsome’s lack of progress, particularly after the disclosure process imploded last summer.

Fair enough. I can understand that to a degree, but what therapist doesn’t expect any regression in their patients? This is a practitioner who specializes in process additions. Handsome has been sober for over 3 years, but what if he had relapsed? Would Doc#2 have booted him out of therapy? That’s a frightening thought to me as a partner. I’m sure it’s a horrifying fear for Handsome.

Doc#2 is the one who diagnosed Handsome with borderline personality disorder. That all good/ all bad thinking that alternately led Handsome to work crazy hard on the disclosure or totally give up on it is a hallmark trait of BPD. Maybe Handsome was more than he wanted to handle? I don’t know.

Doc#2 added insult to injury in early January. To prepare for his disclosure, and at the urging of our CSAT, Handsome swallowed his pride and reached out to Doc#2 to ask for help and to get back on his schedule. Doc#2 said “great” and scheduled an appointment for about 10 days later. Handsome waited patiently and worked on the disclosure. The morning of the appointment Doc#2 called Handsome and cancelled, telling him that he was overbooked and likely couldn’t fit him in for 2-3 months. All over again, Handsome was hurt, his fear of abandonment was triggered, and he really had to fight to stay centered and focused.

What therapist does that to a patient with mental health issues? And take Handsome out of the equation for a moment… how are you “partner sensitive” if you don’t see how these actions might negatively impact the partner too?

It’s easy for me to write here to vent about all the things Handsome does “wrong” but the fact is that there are many things he has done right. He is lightyears ahead of where he was in December of 2017. Can he still be a self-centered dolt? Absolutely, but it happens far, far less than it used to. His rage is mostly gone. He strives to show empathy. (It still doesn’t come naturally to him, but he tries to be intentional about it… when it occurs to him to do so. It’s still a big improvement and he does work on it.) I’m not a mental health professional but even I can recognize that his reluctance on the disclosure stemmed from his fear of abandonment. (“If I tell her everything she couldn’t possibly love me and she’ll leave.”) I was incredibly frustrated by his reluctance, but I was never surprised by it. Certainly his therapist shouldn’t have been surprised by it either.

Our CSAT advised Handsome to try to schedule at least one final session with Doc#2, basically for the purpose of confronting him about how he felt abandoned. I’m pretty sure that Handsome would have preferred chewing glass during a colonoscopy to making that phone call to Doc#2, but he made it. They actually met twice. Handsome reported that their first session was wildly uncomfortable, but the second session was incredibly helpful on an issue of importance. It likely saved their relationship. Handsome will no longer be seeing Doc#2 weekly but they have mutually agreed to work together intermittently as issues arise.

If you’re keeping score at home, as of early last Fall Handsome had stopped 12-step, refused to do the disclosure, and gotten himself fired from his therapist. There was one more big shoe to drop though before 2020 would come to a close…

The Elephant in the Room

My husband has had a lot of therapy the last three years. We occasionally joke that he has ALL the therapists. He did an intensive with Dr. Minwalla. He did OnSite’s Living Centered Program. He did a 6+ week inpatient stint at Sierra Tucson. Since 2018 he has often had two or three therapy sessions a week of some mix between his Psychiatrist, a Somatic Experiencing therapist, and/or our CSAT.

I could never put a finger on it but I always felt as though all the professionals were missing something. He had received multiple diagnoses from different professionals – no doubt some of them were right – but I felt like we were playing wack-a-mole with pharmaceuticals (“He’s depressed? Here’s a pill. He’s got ADHD? Here’s a pill. Anxiety? Take 3 of these, etc. etc.”) Yes, between the drugs and all the therapy, he improved. Nonetheless, something was still… off. He was either happy or miserable with no in-between. His responses to daily events often seemed grossly out of proportion to whatever had occurred. He was better, but he still wasn’t “well.”

Apparently I wasn’t the only one seeing this. His psychiatrist ran him through a variety of structured and semi structured interviews, the Mood Disorder Questionnaire, and other assessment tools. His conclusion: Borderline Personality Disorder.

Cue the violins and rending of garments here. I knew that “BPD” is a highly stigmatized diagnosis. I knew that it was deemed untreatable till a few decades ago. I knew it was a serious enough diagnosis that it can trigger eligibility for SSDI benefits. I knew it presents in a very, very small proportion of the general population (<1%). In short, I knew enough to be scared. I really didn’t know much else. At the time, I didn’t realize how the diagnosis was truly the missing piece of the puzzle.

So what is BPD? Per the DSM-IV, BPD is a pervasive pattern of instability in interpersonal relationships, self-image, and affects [emotion], marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  • Chronic feelings of emptiness
  • Emotional instability in reaction to day-to-day events (e.g., intense episodic sadness, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
  • Frantic efforts to avoid real or imagined abandonment
  • Identity disturbance with markedly or persistently unstable self-image or sense of self
  • Impulsive behavior in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
  • Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
  • Pattern of unstable and intense interpersonal relationships characterized by extremes between idealization and devaluation (also known as “splitting”)
  • Recurrent suicidal behavior, gestures, or threats, or self- harming behavior
  • Transient, stress-related paranoid ideation or severe dissociative symptoms.

Of those 9 criteria, Handsome ticks 7 of the 9 boxes. He is not and has never been suicidal, nor has he had paranoid ideation or severe dissociative symptoms. Everything else is squarely him. It’s so on point that I can’t believe no one saw it earlier.

What, if anything, does this change? For me the diagnosis legitimizes my experience. It gives me an explanation for some of what I’ve been dealing with. I’m not crazy or overly sensitive or any other negative description of a partner. For Handsome, once you are armed with a diagnosis you can pursue treatment. If we thought options for sex addiction treatment in our area were bad, the options might actually be worse here for BPD. (And we live in a city with multiple highly regarded teaching hospitals, including a psychiatric hospital. It’s sad.) Yes, his psychiatrist can help but dialectical behavioral therapy (DBT) seems to be the preferred method of treatment. While many therapists claim that expertise, few do it in the type of intensive outpatient program thought to be most impactful on BPD patients. The one lone program that seemed to operate locally had been shuttered due to COVID. Handsome was game to try though, even if the therapy had to look different than usual.

Slowly the various professionals started working elements of DBT into their sessions with him. Equally slowly – very slowly – it has started to help. It is an ongoing and likely long term effort. He still misreads the temperature of my emotions and those of our kids and occasionally responds … unhelpfully. At least I know where it’s coming from.

“Stop Walking on Eggshells” is a well known book for people who have someone with BPD in their life. The title is really on the nose. Living with someone with untreated BPD is like walking on eggshells or making your way through an unmarked minefield. Every day. It’s exhausting. (Probably true for the BPD sufferer as well.) I am glad to be getting off the eggshells. Glad that my footing is more secure and that my days are uneventful. I do not miss the drama and I’ll be delighted if it never returns. I realized today that it has been months (maybe 4??) since I heard my husband yell. If your spouse isn’t a screamer that might sound like no big deal, but in our house Handsome’s angry outbursts were a daily thing during his acting out. Sometimes more than once a day. I certainly don’t miss them. If naming the elephant in the room has enabled Handsome to laser focus on important issues and get some really targeted help, I’m all for it.

It hasn’t been a smooth path to this point (more to follow on that), but we are at a great place now. I love a day that is simply uneventful. Nothing remarkable happens. There is no drama. No eggshells were crushed resulting in a tirade or tears. Again, it sounds small or like it should be a given, but for a period of years that wasn’t the case in our house. I’m delighted that this is our new normal.