Elderly uBPD mom, driver's medical, and subsequent dysregulation

[Depression = 72% of members]

I think it is too short on after the driving test disappointment for her to absorb a conversation about dementia.

[GaGrl]

I think it is too short on after the driving test disappointment for her to absorb a conversation about dementia.

[Turkish]

I think that would be best shared by a medical professional. They have the experience. I would think, maybe not even then. It would be a brutal diagnosis. I was also told by professionals that dementia is a terminal diagnosis.

[Notwendy]

I would leave that decision and conversation in the hands of her medical providers. This is not something that needs to be heard from you.

Although my mother doesn't have that diagnosis, the medical information I get from her providers is different from what she tells me. This is probably because she's concerned about what other people know. Although it's clear you know what is going on, your mother may not wish to have that out in the open between the two of you. It may also be how she copes with it. I'd leave that alone and let her medical providers handle the medical information.

[zachira]

I don't know a lot about dementia. I just know in some kinds of dementia, the person is completely unaware and in other cases, they know. Do you think your mother knows she is declining mentally or not aware at all?

[Methuen]

I don't know a lot about dementia. I just know in some kinds of dementia, the person is completely unaware and in other cases, they know. Do you think your mother knows she is declining mentally or not aware at all?

At this point I think either is possible.  It has been bothering her a lot for quite a few years that she is so tired all the time.  She knows there is something wrong with that because she complains to me about it all the time (and she used to have so much energy).  I use the broken record technique to remind her and redirect her to tell her doctor that, not me.  She never does.  The last Dr appointment I was at with her was for her prolia shot (osteoporosis treatment), and at the end of the appointment the doctor asked her to write out the same sentence 10 times.  She wrote out "I am happy" 10 times.  An unbelievable lie.  But she wanted to project how well she was doing to her doctor. She was so proud of herself.

My mom, like all our mom's is a master deceiver.  She has been in denial about her mental health her entire life, and always refused to see a counsellor.  So I think she could be in denial about this too, to the point of being completely unaware.  She has never voiced any concern to me about any declining mental abilities.  Only about her physical ailments.

Oh I would never take that on to tell her - not my job.  I’m not looking  to put a target on myself.

My question is more of a moral or ethical  question.  Considering her personality, would it be more humane for the doctor to tell her, or not tell her, yet?  I realize none of us are doctors or professionals, but I’m curious about perspectives.

Like I have said, I have no intention (and never have had) to inform her about her dementia.  I could have done that anytime in the last 6 years.  I am not a fool, or a cruel person.  My question is more about an autonomous person's right to their own personal information.  At what point, if ever, is there a "duty of care" by the medical profession to inform?

The consensus from the forum seems to be that it is better she doesn't know.  Trust me, I get this, because I have to live with her everyday of my life, and I know what she's like.  Again, trust me, I get this.  But it is  very ironic, that a person with BPD, who needs to control every aspect of their life will not be given the chance to learn this diagnosis about herself.  No "right to information" about herself.  Just my observation. 

For example, I remember when my father found out he had Lewy Bodies (a nasty form of dementia).  He was told by the doctors.  I saw him just aferwards.  He handled it with such grace.  He did everything possible to make it easy for the loved ones around him (my mother was a mess and made it all about her).  My FIL had vascular dementia, and was informed about it at the time the diagnosis was made.  My MIL was informed about her ALS when it was diagnosed.  But I agree it probably wouldn't be helpful for the doctor to inform my mom.  However, I would want to know if it was me.  But I am not my mom.

I am already exhausted by her needs.  She doesn't want assisted living.  She doesn't want home care.  But her needs (physical, cognitive, and emotional) just continue to grow.   She's completely overwhelming.

[missing NC]

Randi Kreger, author of Walking on Eggshells makes the distinction between conventional and unconventional individuals with BPD. The former knows something is wrong and may seek help on her own. The latter simply cannot conceive of anything other than those closest to her being solely responsible for her woes. Trying to inform the latter of the true origin of her malady is like trying to feed a person who is actively vomiting.  The information simply will not/cannot get into their brain.  I assume even doctors without a full understanding of BPD develop some intuition over time regarding patients who are so lacking in self awareness that nothing good would come of discussing their condition with them. 

My heart really goes out to you Methuen. I cannot imagine what a hellion my sister will be for medical professionals and her children when she develops dementia (which runs in the family) on top of her BPD/NPD.  I'm assuming your mom would not be open to something like an antipsychotic or mood stabilizer ostensibly to help her sleep. 

[Methuen]

Randi Kreger, author of Walking on Eggshells makes the distinction between conventional and unconventional individuals with BPD. The former knows something is wrong and may seek help on her own. The latter simply cannot conceive of anything other than those closest to her being solely responsible for her woes. Trying to inform the latter of the true origin of her malady is like trying to feed a person who is actively vomiting.  The information simply will not/cannot get into their brain.  I assume even doctors without a full understanding of BPD develop some intuition over time regarding patients who are so lacking in self awareness that nothing good would come of discussing their condition with them.  

 Thank you for this.  Very very helpful.  My mom would be the latter (unconventional).

No mom would explode and implode simultaneously if anyone ever suggested antipsychotic.  I can't even imagine it in my worst nightmare.  She currently takes antidepressant (mood stabilizer?) but in the past has taken herself off of that a number of times, only to relapse, predictably.

Thank you so much for the support.

[GaGrl]

My mom was prescribed Seroquel to help with sleep, long before her call and hospitalization. Her internist said sleep disturbances are frequent as people age. If something like Seroquel (a common antipsychotic) could be prescribed for sleep, that could help.

[Methuen]

My mom was prescribed Seroquel to help with sleep, long before her call and hospitalization. Her internist said sleep disturbances are frequent as people age. If something like Seroquel (a common antipsychotic) could be prescribed for sleep, that could help.

Thank you GaGrl.  I’ll store that info

[Notwendy]

The "trying to feed a person who is actively vomiting"- what a perfect analogy.

I have used the "emotional vomiting" analogy to describe that they feel better after they rage or unload their emotions. Like a small child who ate too much candy - they throw up- and then run off to play because they feel better.

Once my mother has "emotionally vomited"- she feels fine, and to her nothing has happened. Because she feels fine, she assumes we do too.

Because of this pattern, my mother does not learn from her behavior. There's no point in discussing it with her. It all comes right back at you and then it appears to be gone from her thinking. Then when she retells something, it's a different story. History is re-written.

[zachira]

They feel better for a time after the emotional vomiting and then the cycle starts again. Healthy people know how to process their emotions and move through the pain. We can heal. Our mothers with BPD can't.

[Methuen]

I met with a person from our local health unit, who works with the home care team as an elderly services consultant.  I shared with her the highlights and events since mom's last Rai Assessment (about 9 months ago).  The consultant has met mom several times in the past, and I have also met or spoken with her privately probably half a dozen times (usually in crisis) over the past two years.  My H was with me today, as we work as a team when it comes to managing my mom.

I thought I would share several takeaways:

1) When mom says toxic things like "you don't love me" or "I would rather die than live in long term care" what she's really saying is I'm scared, or terrified.  She doesn't have the words to articulate what is really going on because her brain isn't wired up to do that.  So what we (children of BPD's) have to do is look for the hidden message (she's fearful and terrified), and not the literal message (because it's really not personal).

2) When mom says things that FOG me such as "less and less I feel like eating", or "I only weigh 125 lb" (designed to get attention and obligate me to cook more for her, or come over to eat with her), I can use a script such as "what does the nurse in you think you should do about that?"

3) If mom falls and can't call for help and isn't found for a long time because she refuses to wear her Lifeline, "oh well that's unfortunate but that was her choice"

4) When she tells me she would rather die than go into assisted living, don't share what H and I have planned for that period of our life, because she will just find it invalidating.  Just validate and say something like "it's good to know what you want".

5) The next time my mom falls and I end up in emergency with her, and the doctor is talking like s/he will release her to me as the hospital's "after care" plan, I need to speak privately to the Dr and explain that I am not up to that task, and that she has received home care in the past, and has not gone home from hospital until the home care has been arranged.

6) If mom falls before we go on a trip, the consultant said to "go on the trip, of course!"  Home care would look after her.  She reminded us that a healthy parent would tell their kids to "go" and remind them that she would be well taken care of while we were away.  My mom would expect us to cancel, which we have done in the past.

7) When she's telling me another one of her problems, use a script such as "what would your friends say?" (since she values her friends opinions as biblical, but if I ever suggested the same thing first she would either dismiss it or get angry)

8) The elderly services consultant was shocked that mom didn't know about the vascular dementia diagnosis.  She said that within the medical profession, she has the right to know that information about herself, even if she doesn't like hearing it at the time.  As I have written about on this thread, this has been something that has been troubling me.  I discussed with her my concerns that mom could emotionally unravel with this news, and she was firm in saying that it was her right to know.

9) Seek and accept help when it is offered.  I'm so thankful I did not turn down the opportunity to meet with this person when mom's case worker offered to set up an initial meeting with an elderly services consultant.  Seeking and accepting help is hard to do, but worth it.

There were so many takeaways, but these are the ones I can think of to share right now.  

She gave us (H and I) a full 2 hours today.  It was an 11am appointment.  She didn't cut us off for a lunch break.  She didn't rush us.  She listened.  She heard.  At the end of it, she volunteered to do the next Rai Assessment in January 2022 (she's qualified).  She said it made sense for her to do it, especially after hearing our stories about the advancing Parkinson's, and the vascular dementia (which was not followed up, but lost in an emergency room report from 2015).  She actually volunteered to do the Rai after I mentioned that mom was unaware about her own vascular dementia.  This person is a mental health professional, and demonstrated understanding and empathy throughout the entire appointment.  She totally gets the "borderline" and "demand avoidance" personality profiles.  I told her that mom had a traumatic childhood, and suffered acute anxiety.

She said that ultimately, to get into assisted living, the person must give consent and want it.  She also said that the longer mom waits, the more likely that her "window to get into assisted living" closes, and eventually something will happen that results in her going directly into long term care.

It did feel like I was betraying my mom a bit.  I struggled with that.  But if I didn't get help for myself, I wouldn't be able to support my mom.  The consultant could see that, and said so in as many words.  I also told her if the next Rai said mom didn't need "assisted living", I would be totally OK with that.  I'm not trying to stick her in a home.  I have mom's best interests at heart, but get burned out, and I can see her Parksinson's advancing (at some point she won't be able to feed herself, and she's already struggling with the toilet which always has poop on it) and her cognitive abilities deteriorating.  She point blank came out and assured me she knew that, and gave me concrete examples to make me believe it.  

My mom was my matron of honour at our wedding.

It was really good for H and I to meet with this person.  

Just thought I would share, as I found the meeting helpful, and know many other people on this board are also struggling with elderly parents or in-law parents.  Hopefully something of this story can help one other person.

[Notwendy]

Methuen,
I am glad you had this consultation. Yes, I agree that our elderly parents are likely very afraid of being in an assisted living situation, and I can understand that. I know that the emotional projections are not personal, even though they are difficult for us to hear.

It seems as if you had a better relationship with your mother growing up than I did. I think I could handle my mother being difficult in her elder years better if this was something new for her, but it's not. She's in sound mind and knows what she's doing, and is also deliberately and calculatingly manipulative and mean.

For instance, my sibling has some medical issues and rather than being sympathetic, she makes a mockery of them. One reason we don't reveal any kind of emotional vulnerability to her is that she then becomes mean and critical of them.

As to the interpersonal dysfunction- she does this with her helpers as well. She's verbally abusive- calls people names and criticizes them. One of my concerns is if she did go to assisted living, she'd be asked to leave due to these behaviors. However, she doesn't want to go to one and so it's her choice.

She can be sweet as candy and perfectly lucid when she wants to be. It's during these times that we can actually question our own reality "is she really that hard to deal with or is it me?" and then turn in an instant to being verbally abusive or pitifully waify. She's in control of this, it's manipulation.

When she's with me, it seems she can't resist getting into some kind of manipulation. She just can't leave it be. She'll ask me to go through some papers with her, then get angry when I asked her about them. Doing something for her means she gives exact orders and you don't say a word or ask a question, you just do what she says. Or she will pry me for information, rather than just have a conversation.

I don't recall her being genuinely affectionate with me. She'll fake it sometimes ( and I know she's faking) and most of the time she's cold as ice. Having a relationship with her means being useful to her.

I really like the advice the counselor gave you about how an emotionally healthy parent would want you to go on the trip and not cancel for them and also to seek support for yourself. It's clear that you do care very much about your mother and there's something there between the two of you that is connected. I am not sure my mother feels any connection to me other than I am useful to her. Maybe this is something she just can't do. I care enough about her welfare to want to know she's well cared for and has what she needs but realize there's probably no possibility of any true relationship with her.

[zachira]

I am so glad you have found an elderly services consultant who took the time to show you she understands your challenges with your mother and how to handle them. I hope you feel you are no longer alone in your community and you now have someone who is really there for you that will do whatever is possible to help you and your mother. I like how she is encouraging you to take your planned vacation and assuring you that you have adequate back up. Thank you for sharing, as there is a lot of wisdom in what you learned in this meeting that so many people with an elderly parent with BPD would find very useful.

[Methuen]

It seems as if you had a better relationship with your mother growing up than I did. I think I could handle my mother being difficult in her elder years better if this was something new for her, but it's not. She's in sound mind and knows what she's doing, and is also deliberately and calculatingly manipulative and mean. For instance, my sibling has some medical issues and rather than being sympathetic, she makes a mockery of them. One reason we don't reveal any kind of emotional vulnerability to her is that she then becomes mean and critical of them.

I am so sorry for the pain you have suffered and what you are describing.  I am speculating here (always dangerous), but your mom sounds like perhaps she leans to the witch personality type (as per Christine Lawson), whereas in my relationship with my mom, she was predominantly waif (although the witch surfaced on occasion).  As a waif, my mom "groomed" me (probably from infancy) to be her rescuer. I can remember from the age of 5, having to "take care of her" when she had her migraines.  These were 3 day episodes like clockwork.  I was also groomed to take care of her feelings.  After a lifetime, and with recent learnings and reflection, I have come to accept that I was probably heavily enmeshed.   I can see that now.  The relationship between PJ's husband and his mom comes to mind here, but every relationship still has differences along with the commonalities.  The enmeshment played a role in my mom being my matron of honour at our wedding.  The process of differentiating from a parent you have been groomed to be enmeshed with (in your late 50's) is complicated.  The process has been slow, and the push back has been crazy making, especially as her health problems grew, and her ability to cope with them declined (an inverse curve). The fork in the enmeshment path really happened when my father became ill about 20 years ago, and she abused him so terribly.  That was when I finally had my eyes opened.  After that, it's a glacially slow dawning of realization that my relationship with her wasn't a normal mother-daughter relationship after all.  With that comes slow recognition of the emotional abuse.  Then becomes the process of differentiation.  With that comes the push back behaviors.  While our mothers have many similar behaviors and characteristics as BPD moms, the witch (I really don't like using that word by Lawson) is very different than the waif.  Although I can't speak from experience, I would hypothesize that the witch is worse than the waif.  While it can be demoralizing to hear everybody's stories on this forum ((when considering the problems of humanity in the bigger picture) as they are so painful to hear and imagine (since we have the ability to empathize),  there is also immense comfort to know we are not alone, and this forum gives us such a great opportunity to both learn and support and heal. Not sure if I articulated that well enough.

The part about your mother mocking your sibling with significant health issues is really disturbing.  I can't help but wonder if she was so terrified of your sister's illness that she minimized it and mocked it in an attempt to just make it go away.  Denial.  I also can't help but think of the cycle where the childhood victim, later becomes the bully. All our pwBPD seem to be bullies when they are FOGing.  That's just my take.  Whatever the underlying psychology behind the behavior, it is horrible that a mother treated her daughter that way, and it must have been traumatizing for you to be a witness.

As to the interpersonal dysfunction- she does this with her helpers as well. She's verbally abusive- calls people names and criticizes them. One of my concerns is if she did go to assisted living, she'd be asked to leave due to these behaviors.

I have never heard of anyone being asked to leave assisted living, but maybe it is different depending on where one lives.  The elderly are at a particular stage of human development in the life cycle, and aging has it's own set of complex issues, both physical and cognitive.  The body and brain both change, hence "geriatrics".  I would expect the staff at assisted living and complex care facilities are educated and trained to deal with complex behaviors that come with aging.  It is hard to conceive that they could "ask someone to leave", when that is the age group and the corresponding behaviors they are trained to deal with.  I would think they should have many tools in their toolbox and resources and experience to deal with the full spectrum of aging adults in their facility.  Asking someone to leave, just seems off, like maybe they aren't informed or trained enough.  

She can be sweet as candy and perfectly lucid when she wants to be. It's during these times that we can actually question our own reality "is she really that hard to deal with or is it me?" and then turn in an instant to being verbally abusive or pitifully waify. She's in control of this, it's manipulation.

Ah yes. "The turn".  I know these moments too.  They are truly terrifying.  So many stories.  I think from our point of view its manipulation.  From where they are coming from, I think it's a learned unhealthy coping strategy from their early life before our time.  Deep psychiatric stuff going on there.

I don't recall her being genuinely affectionate with me. She'll fake it sometimes ( and I know she's faking) and most of the time she's cold as ice. Having a relationship with her means being useful to her.

The cold as ice is probably a defense mechanism.  Mother's aren't supposed to be cold as ice.  The witch comes to mind again.  My mom was never affectionate either.  She couldn't hug.  Hugs came from my father and friends.  She was icy during silent treatment periods, but not on a daily basis.  She was generally thawed, until something triggered her and she dysregulated.  Then all
H_ _ _ broke lose and I would say or do anything to calm her.  I tried hard to be the "perfect child", but in my 50's I finally accepted that I was never going to be good enough. I'm sorry that your mother has always been so unavailable to you and your sister.  

It's clear that you do care very much about your mother and there's something there between the two of you that is connected. I am not sure my mother feels any connection to me other than I am useful to her. Maybe this is something she just can't do. I care enough about her welfare to want to know she's well cared for and has what she needs but realize there's probably no possibility of any true relationship with her.

Like you I care about my mom, but the "connection" you refer to between us is not a healthy one.  It was one of enmeshment (like emotional incest).  The connection only works if I am meeting her needs.  Since I can never meet all of her needs (think plums falling under the tree onto the ground and me not picking them) especially now that she is aging and geriatric, the "connection" is actually quite toxic.  As the elderly services consultant put it, our relationship has changed since my dad died, since I became the next in line to dump all her toxic feelings on, and since the aging process took her over.  I have responded with boundaries, asking validating questions and other tools.  She has pushed back hard with tremendous FOG.  It has been tormenting.  The only connection I have to my mom now, is my usefulness to her, so she says things like "if it weren't for you I would want euthanasia".  On another day she will cry "I just want to die" in the most painful voice possible.  These don't feel like healthy connections.  Everything she says comes with obligation.  There is no escape.  It has worn me down.  I do have some happy memories from the past, it wasn't always bad 100% of the time.  She did have better moments or spells.  But the chaos was unpredictable, and guaranteed, and omnipresent.

I truly hope that your mother does not move closer to you as she is telling you she wants to do.

[Notwendy]

Methuen, our stories are similar in many ways. My mother takes on all 3 roles at different times. She enjoys Queen mode- she's happiest in when we are completely subservient to her and she can act superior. She likes to have people do things for her, like do something for her around the house, or go get her some water not because she wants these things ( she could get them herself if she wanted to) but that she likes being waited on and having people "serve' her. Some of her requests are irritating because she manipulates me to do things for her- for the sake of having me "wait on her" and she likes me to "obey her". My father would do these things for her too and she'd say things like "your father was such a good boy today" or "I told everyone you were a good girl for me today". As if my father were a dog, or a little boy.

If you dare disobey the Queen, you get the witch. And it doesn't have to be much. Like if she asks you to do something and you say "in a minute" the Witch will come out to say "No, I mean no, do it now"

After she's been so abusive and we tend to draw away, she becomes waify and so pitiful, but it's manipulation.

The result of this though, is an enmeshment similar to yours, because we were also groomed to wait on her and meet her needs, out of fear. Fear of the Witch. To avoid the Witch, one needs to be a very good servant to the Queen. I also tried to be the perfect child and be a good servant to the Queen. I did this in part because she blamed me for our issues and I thought it was mostly with me. However, when my father got sick, I saw her abuse him and like you, this changed how I saw the situation.

I did bring up the idea of them moving near me so I could help my dad and yet they both refused at the time. I am grateful that happened. I brought up the idea when I didn't know better. But I see things more clearly now.

My mother wasn't the maid of honor at my wedding, but it was her party. Although my dad didn't have much money to help me for college, there was plenty for the wedding because, basically it was her party and my father would pay for what she wanted. I had little say in it and at the time, I was so enmeshed, I didn't even know I could have a say. Likely it wouldn't have mattered. It would have been her party as it was. Almost all the guests were her friends and family. One person from my father's family was there, my H's immediate family and a few of our friends, but it was her party.  The funny part is that it was my father and maid of honor helping me get ready. She was off getting her hair and makeup on. I was fine with that- quality time with Dad without her. But I don't have a lot of emotional attachment to my wedding day as it didn't really have much to do with me. It was lovely, in every way. She knows how to entertain well- and did a great job, but I didn't have much input- and didn't even know how to speak up if I did.

I hope she doesn't move either and if she brings it up, I plan to tell her I don't want her to. She knows this but if she pushes the idea, I need to firmly tell her that I don't wish for that.

[Methuen]

NotWendy, I agree our BPD mom’s are similar  in many ways. 

I have so much gratitude for this forum and meeting many people including yourself. 

I can’t even begin to imagine where I would be if I hadn’t  found this forum, and this site with all its information and resources.  I was so alone, and angry and terrified when I arrived here. It’s just so important to be heard and understood by people with similar experiences.  This forum has perhaps become to me, what AA meetings  must be to an alcoholic. 

I guess I’m saying thank you to everyone for the support.  It means more than words can say.

I hope she doesn't move either and if she brings it up, I plan to tell her I don't want her to. She knows this but if she pushes the idea, I need to firmly tell her that I don't wish for that.

yes, this is wise. I am putting myself in your place, and I can empathize how hard it would be to say this to your mother. Oh my.  If it was me I might practice in front of a mirror so that when the time comes, you are able to see  it through.  It will be very important to do it if she is serious about the move so that she knows in advance that is your boundary.  Then if she moves, and you are not available, the choice  was hers alone and she had advance  notice you would not be available. 

Brutal, but necessary.

[Methuen]

Zachira, thank you for being you. You often know just what to say. 

[Notwendy]

I made an appointment with a therapist to work on this- I'll see how it goes. I asked her for help stating my boundary in the most respectful but firm way.  Not for how my mother is going to react, but for me to know I said it as well as I possibly could.

It's hard to do because it goes against my own conditioning and also my own feelings for what I wish could be, but she's shown over and over again that a relationship between us consists mainly of me in servitude to her. Not that I expect anything from her except one thing- to respect boundaries and she doesn't do that. This is why distance is necessary for me to maintain a relationship with her.

Ironically, she may not bring it up, as sometimes the "moving near me" is an empty statement. But if she does bring it up again, I want to be as prepared as possible.

[zachira]

Methuen,
Thank you for your kindness. I do hit the nail on the head sometimes and other times I am not helpful at all. I don't even attempt to try to address most of what members say because I am only good at picking out something I believe I have empathy for and can be helpful with. You are talented in going line by line, and really empathizing with nearly everything the member has said.