Can I give my dBPDh an ultimatum?

[How to communicate after a contentious divorce...]

Hi all,

My dBPDh has a P and a social worker here in the UK. He has had good solid contact over the years until his long term P retired last summer. He was already starting to come apart at the seams triggered by a house move and FOO crazy-making stuff ( for him not me ) when she retired and it is as though he has fallen to pieces.

Here in the UK in my opinion and experience there is a huge reluctance to deal head on with BPD even when a person has a long standing diagnosis. My dBPDh has a dx of Paranoid Schizophrenia as well and mental health services seem much more comfortable working within this frame of reference.

He is always in crisis so never receptive to any additional treatments on offer. He has absolutely no insight into any aspect of his illness, almost as though he has suffered some kind of brain injury that makes insight and awareness impossible.

Anyway what I want to know is will I make everything a hundred times worse if I ask him to accept the DBT therapy that he was offered in his last care-planning meeting. I have made references to it since the offer. ( I was present at the meeting as well ), and if he doesn't at least try DBT  by a certain date then our marriage can't continue.

Even as I am typing this it sounds rubbish, because therapy is about accepting there is a problem and wanting to do something about it.

I still want to know what you all think... .

Any other thoughts gratefully received also ... .

[sweetheart]

Hi all,

My dBPDh has a P and a social worker here in the UK. He has had good solid contact over the years until his long term P retired last summer. He was already starting to come apart at the seams triggered by a house move and FOO crazy-making stuff ( for him not me ) when she retired and it is as though he has fallen to pieces.

Here in the UK in my opinion and experience there is a huge reluctance to deal head on with BPD even when a person has a long standing diagnosis. My dBPDh has a dx of Paranoid Schizophrenia as well and mental health services seem much more comfortable working within this frame of reference.

He is always in crisis so never receptive to any additional treatments on offer. He has absolutely no insight into any aspect of his illness, almost as though he has suffered some kind of brain injury that makes insight and awareness impossible.

Anyway what I want to know is will I make everything a hundred times worse if I ask him to accept the DBT therapy that he was offered in his last care-planning meeting. I have made references to it since the offer. ( I was present at the meeting as well ), and if he doesn't at least try DBT  by a certain date then our marriage can't continue.

Even as I am typing this it sounds rubbish, because therapy is about accepting there is a problem and wanting to do something about it.

I still want to know what you all think... .

Any other thoughts gratefully received also ... .

[OutOfEgypt]

In my opinion and experience... . ultimatums don't work.  They don't work for BPD people and I don't think they work in general.  Consequences work, sometimes.  Ultimatums... not so much.  You don't want someone to be forced into seeing there is a problem -they won't be doing it for the right reasons.  It's like trying to force someone to believe something.  You can't.  You can only put them in a position where they will act like they believe it to avoid unwanted consequences.  Aside from that, you are just handing them an opporunity to keep control of and manipulate you and the situation.

I gave my ex wife an ultimatum.  She laughed.  She angrily ruminated about it and interrogated me about it.  And then she filed for divorce behind my back to "protect" herself.  After our divorce, she did do therapy as we attempted a reconciliation... . but she did it for "me" and eventually said she had no idea why she was there -didn't see that she needed it.  It fell apart again.

I understand why you would want to do an ultimatum.  You want things to work out.  You love him.  And you want to give him the chance to say "No, wait... . "  And after all his emotional outbursts and pleading, he will probably say that... . but likely not for the same reasons you want him to.

Sorry... . that's my experience and 2-cents.  In my opinion, the best course is to suggest... . suggest WITHOUT stating a consequence if they don't agree.  And then if they don't take responsibility, act for yourself and your own sanity.  Grant them the opportunity to take a look in the mirror for themselves by acting for yourself.  Maybe they will, too, in response.  Maybe they will not.  Either way, *someone* has to make the first step out of the crazy cycle and into reality.  But you can't push or pull him along.  You can invite, but he will have to come willingly.

[seeking balance]

Perhaps you should rethink the question in terms of boundaries.  Ultimatums don't work in nonBPD marriages, they certainly won't produce desired outcomes in BPD relationships.

What are your boundaries?  What behaviors do you want to see changed and why?  If this is clear, you can explain to your H that DBT is his best shot at changing these behaviors and that you would really like to continue with the marriage. 

DBT has to be his choice to work.

Using DEARMAN - how do you think you could communicate this to him so he could have the best chance at "hearing" it?

[sweetheart]

Thanks OutofEygypt, as I was typing I was thinking this won't work. He can barely cope with a suggestion at the moment.

It is also me who is desperate for a therapist, really desperate. Therapy helped me immensely in the past.

I am also angry at the mental health services because they are not doing anything. My dBPDh keeps asking for a planned hospital admission, which I believe is a great idea, but there are no beds anymore so unless he ends up detained they won't admit him.

Personally I think that he will end up going back to hospital via prison, his acting out is gathering attention from the general public. He is a very unwell man and has been for a while now, it breaks my heart to see him like this. He has been suffering a long time now, in and out of crises this last year. I suppose if I do leave then this will definitely see him admitted to hospital, but it feels wrong at the moment... . Always so much to think about. I love him very much and so want our lives to improve.

Seeking balance that's a really good way of putting it - thinking about the behaviour that way.

I tend to just completely disengage now, but that's all. There seems to be so much dysregulation all the time and it scares me and I kind of freeze

I'm going to think about it and post it on here for feedback first. Thank you.

[sweetheart]

The replies made me think I have been approaching things wrong.

I have been saying kind of " look you're ill, so why don't you consider the therapy on offer it might make things better between us" I have also been applying pressure with this during a dysregulation thinking this would help him. WRONG WRONG WRONG I have only succeeded in invalidating him over and over again 

Why can't I realise that I am still adding to his problems, oh it's so hard to see sometimes 

[seeking balance]

Why can't I realise that I am still adding to his problems, oh it's so hard to see sometimes 

Hon, if you were perfect at this, you wouldn't be here 

It takes PRACTICE to relearn our own communication styles.  Honestly, our MC told me, "SB you have just as much work to do"... . I didn't really believe her... . but, I was wrong.  My own core stuff kept me tangled up in making it worse and not making it better.

You might want to pick up High Conflict Couple and Loving Someone with BPD - both books really helped me gain perspective... . with perspective, I was able to change too.

Practice here - the people who turn it around, practice the tools... . staying board really is the best place to get the good feedback.

Be gentle on yourself.

[sweetheart]

I suppose at its most basic all I want are things to be better between us, not perfect, just a bit better. I have felt so exhausted and angry this last year ( anger is a truly scary emotion for me it doesn't usually get through, I do everything I can to keep it down) I realise now that some of that anger is still finding its way toward my husband.

I became aware just recently that I had taken to complaining about everything, I started fighting every cause I felt that was wronging us, I got seriously caught up in righting every injustice in the world

I am currently reading, I Don't Have to Make Everything all Better, it is a lovely, easy kind read. I shall read your suggestion next. I have just bookmarked DEARMAN to work through once s6 has gone to bed. DBPDh currently sleeping off an afternoon of dysregulation, triggered by me, I knew the comment I was making as it was coming out of my mouth would cause him to feel guilty, but it was too late. He was off and raging, and I engaged because I felt guilty and tried to make everything better = train wreck of an afternoon

[seeking balance]

He was off and raging, and I engaged because I felt guilty and tried to make everything better = train wreck of an afternoon

Well, tomorrow is a new day - it is ok to make mistakes, we wake up and do our best each day... . be kind to you. 

You are sticking with him and you are here trying - don't dismiss this stuff as little, this takes  a lot of energy and love.

[Haye]

Sweetheart, I am so sorry to hear how the healthcare are treating your husband.  :'( It feels so uneccasary to add your pain and burden by witholding your husband proper treatment/help. Is there any possibility you could apply for another doctor's evaluation or to move entirely to another care area, or otherwise get some change to how he is (not)being treated? In my country it helps if patients closest person (spouse or such) has the stamina to be "patienly demanding" right kind of help (well that's pretty much the _only_ way to get decent help). With patient demanding i mean telling the workers peacefully my concerns and stating kindly bit firmly that this patients case needs to be re-evaluated, as soon as possible. I've found out it works much better if i'm being symphatetic to the health care people's busy schedules and lack of resources etc and pointing out their (in my opinion shockingly stupid mistakes) also kindly, gently stating things like "of course, these are difficult matters, the doctor has to work under so little time like minutes only and i've known the patient for this and this long etc". It is possible mentalcare specialist will not hear you no matter how many times you repeat to them you believe the diagnose is all wrong, but I believe there are more chances for success if you can remain calm and nice, stating the facts backing your thoughts for the dx and at the same time also remain superduper hard and not letting them talk you out of getting your husband some help. (If you can understand what i mean? It's a bit difficult for me to translate into english, I don't know the correct terms... .  I live in europe too, but outside UK, I learnt english at school and for some reason they didn't teach us these things)).

Anyhow, I'm worried about your husband being dysregulated and waking a lot of negative attention around him. I doubt it's good for him, you or the people in your neighbourhood. I'm also worried about how you are coping with all there pressure. Those two alone should should be enough to wake mentalcare people to help you.

Otherwise same thoughts as seeking balance. Instead of an ultimatum one can and is even recommended to state their boundaries. But it sounds like your husband is not doing well enough to be able to control his behaviour much? I don't think stating and maintaining boundaries work at all if person is really badly not ok?

[sweetheart]

seeking balance I have lots of love, but so little energy, I feel a 100 years old right now. Thank you for your kind insightful responses.

Hello Haye, I am really worried about him too, and our family for that matter. It has  been just luck that he has not died this last year and still they did not detain him.

With the focus on his schizophrenia, they are missing what he is actually presenting with. I do not feel that he has schizophrenia, but that his BPD is causing his paranoia and psychotic symptoms. I cannot know this in any professional way and do not pretend to, but the disorder is full blown at present and as I have said he is truly suffering. It is almost unbearable to witness as his wife.

Thinking about what you are saying, he is due to be allocated a new P, they are concerned enough about him to control his medication tightly so that he cannot continue to overdose, and they want him to establish some kind of relationship with a P like he had done in the past.

I can put together a letter for his medical team outlining a timeline of events and behaviours that have occurred over the last year. I know that they will already have access to this information, but I suppose when it is in print in front of you sometimes things may be seen differently.

Also I am really tired of fighting the system and them not hearing it has become a full-time job. There is no reference to his BPD diagnosis at all and believe me I have asked. They said it causes too much stigma and may cause problems for him with other agencies. Ha ha it is causing no end of problems with everyone anyway. He is shouting at people in the street if they look at him wrong, he is shoplifting. I don't know why. For about three months he went out wearing a bandana over his face because he felt so exposed to other peoples judgements and perceptions of him. I remember once I was driving along the road and I saw him walking on the footpath, and i couldn't believe that he was my husband, he is almost unrecognisable from before we moved, mind you so am I.

Sometimes it is hard to be proactive when I just what to lie down in a dark room for at least a year.

[KateCat]

sweetheart,

What a wonderful partner you have been to this man! I'm sorry your efforts have met with so little success.

My husband is diagnosed as paranoid schizophrenic and much of what you describe is all too familiar to me. Can you explain a bit more why you don't believe he is schizophrenic?

[sweetheart]

Hello Katecat,

I suppose I wasn't sure the two could coexist, and I know that BPD presents with many of the same symptoms as PS and it is a chronic disorder. However thinking about it as I am typing my husband does believe 100% that he is telepathic and this is the reason he takes his antipsychotic medication. He has had thoughts about mind control since he was age 11. Telepathy is also one of his primary delusions, and I don't recall this being a feature of BPD, I could be wrong though.

I suppose I am searching for answers rather than just accepting things as they are. I was caught up in believing I could fix things for years, it's hard to disentangle myself from that mindset. It is the absence of recognition for his BPD diagnosis that I struggle with because the services then treat aspects of his behaviour as just bad behaviour or say "why is he doing that then?" And at times over the last year his behaviours have been seriously high risk. He has been at risk of harm and most definitely other people have too.

I'm not sure I have been such a great wife, our marriage this last year has been very messy and chaotic and I have definitely added to his distress.

Does your husband have a diagnosis of BPD as well? Is he receiving any treatment?

[KateCat]

sweetheart,

Forgive me for not directly answering your question. . . . In order to answer, I went back and read a number of your previous posts. My strong opinion is that your first order of business right here and right now is to get help for yourself and for your son. What I learned from your previous posts is that your husband has a long, long history of serious mental illness characterized by chaotic behavior and violence toward multiple individuals. And in the moment, he is not safe to be around.

Are you getting therapy for yourself? Does your son have access to a child psychologist?

And, most importantly, is there somewhere your husband can live at this time other than with you?

(You don't have to give up on helping your husband, but right now it seems that you need decisive, concrete help for yourself and your son.)

[sweetheart]

Thank you for such a direct response KateCat. It has helped me to think about your suggestions as a way of realising what is in place for myself and our son.

Therapy is very difficult to access here in the UK, there is currently a two year waiting list for long term therapy here in our area. I cannot afford a private therapist so I am waiting to be allocated a low cost therapy slot from a local clinic. I also have very good support from our local carers support team who are directly linked with the Community Mental Health Team where my husband is treated. There is also a monthly support group which I attend from time to time that is for partners of people with chronic and enduring mental health needs.

Our son has not been exposed in anyway to any extreme bouts of chaos and dysregulation. He is however fully aware of his fathers mental health issues, but thus far he is a happy, well adjusted little boy. He has a loving relationship with his father despite the limitations of his condition. The school are fully aware of our circumstances, and there is emotional support available for our son when and if he needs it. There has been no involvement from a child psychologist/therapist because he doesn't need one. If however at any point the school or myself were to identify any difficulties he would be referred immediately. My sons well being is my line in the sand.

My husband does have a long history of violent and dangerous behaviour, and he has threatened me once in the past. I did not press charges because he was mentally unwell at the time, as a result of this incident our family were assessed and evaluated by mental health and social services. When my husband was more stable I also said that were anything like this to happen again I would leave him, it has never happened again.

That said I am not willing to continue my life in this much chaos, and as I posted somewhere else today, if when a Crisis Management a Plan is put in place nothing changes in the next couple of weeks I am going to ask my husband to leave.

I would have moved out long ago to help the situation if I had somewhere to go, I don't. My husband has also asked over and over again for a voluntary admission to hospital for respite, this has not happened.

I do not feel in danger and neither is my son, but what I do feel is sad. I am also at a loss as to why the mental health services refuse to be proactive in their approach to my husbands mental health. It is the absence of this support that will end my marriage, not because it is something I want.

[KateCat]

I am so glad your son has such a perceptive and determined mother.

One thing I heard a psychologist say that struck me deeply (though it is a bit depressing) is each time a child is present for (even "overhears" extreme emotional dysregulation by a parent, it changes who that child is. And that results will not be fully known for many years.

Children of the mentally ill are already at greater "biological risk" for problems like addiction, anxiety, and anger in adolescence and adulthood, so any learning you can do about best practices for guiding these children will be a great benefit for your son.

On another section of this forum, advisor livednlearned writes that the first thing a child psychologist may tell a child like your son is that it is ok for him to have fun and to be happy (even if daddy isn't). She and other parents who post here have books to recommend as well as other good advice. . . . Have you been able to take a look at these?

I know you have the wisdom and intelligence to do all these things for your son. I worry, though, that you are so distracted and exhausted by your husband's unending struggles, that many other things must be slipping by.

[sweetheart]

Thank you for calling into question my priorities KateCat, that is what posting here is about. My sons well- being is paramount to me, he is our world. Yes I am aware of the outcomes for children of parents with mental health problems. My own childhood had lots of shouting in it so it is something I cannot have my son exposed to. What a psychologist said to me once is that as long as children are not lied to,that issues are not hidden and they are encouraged to talk about how they feel from the word go then mental health issues do not have to mean damage later on. Our son has also just been referred to a Young Carers Charity that offers support through fun and play to children who are involved in caring for a parent including emotional carering. I am under no illusion that our son has to make allowances for his father in ways that other children don't, but to our beautiful son his daddy is the one who will watch Spongebob with him, take him skateboarding, and teach him guitar. Our son is a gifted dancer, yes I know he is six, but he seems to have been born to be a Principal Boy, his choice 

It's cool to talk about our son, the good things about our lives are sometimes absent on these boards.

Thanks to support and advice from here recently I took my son away for a long weekend, it was brilliant and I plan to do it again. Without this place I would never have had the confidence to this. We had fun, he won the dancing competition two nights in a row, we swam together, it was a truly special time.

I am not perfect, I have made many mistakes, but I am doing the vest I can. It is good to type this out and see it in print, it reminds me that I'm ok

[KateCat]

That's wonderful that your son is getting so much community support.

Here's an interesting discussion from this forum about young sons and their mentally ill dads. I now wonder if this particular perspective is more reflective of U.S. culture, though, than it would be of U.K. beliefs and practices:

https://bpdfamily.com/message_board/index.php?topic=226750.0

[sweetheart]

That's a great link KateCat thank you very much.