Trying to support hospitalized Sister with BPD without enabling

[spacedisco70]

I have an older sister (she is 37 and I am 28) with whom I have had an extremely confusing relationship, which until recently seemed to make no sense. After several sessions with my own therapist, she recently suggested that it sounded like my sister had BPD, although she obviously didn't want to diagnose her in her absence. However she suggested I read "stop walking on eggshells", and it felt like I was reading mine and my sisters' biography.

I had managed to step away from the relationship last August. Following a very hurtful outburst from her I had decided to have a lot less contact with her. I was unaware of the existence of BPD at the time so it just felt like the last straw in a string of cruel and self-centered behavior. I'm ashamed to say, but it was the happiest I had been in a long time. But in late October she was hospitalized following a suicide attempt and I resumed contact as I wanted to be there for her and support her.

After being released from the hospital she contacted me several times each day, pressuring me into getting her a job at my workplace (for a job she doesn't have qualifications or experience for). When I was unable to do so, she stopped contacting me and I didn't contact her back, so we had very sporadic contact for a few months.

Two weeks ago, she was hospitalised again after a very serious suicide attempt. She had to stay on life support for 24 hours and it was by sheer luck that she survived. Since her hospitalisation we have been in contact again. Luckily, just 3 days before her suicide attempt I had learned about BPD so things are making a lot more sense now than they used to.

She has never really had me and our relationship on the "black" side of things, probably due to the fact that I have very rarely set her any boundaries. When I have tried, the backlash has been so severe that I never tried again, and just went along with all her delusions about how nothing was ever her fault, commiserating about the cruelty of everyone in her life, sharing her opinion of those people. When I started to get a clearer picture of how it might not all be everyone else's fault and how she might need to learn to take responsibility, and started to (very cautiously) share those thoughts with her, she distanced herself from me. She tends to always seek out the company of those who are willing to agree with her victimhood, only there are fewer and fewer people in her life willing to take that stance.

I am struggling these days, because my sister, who I love very much, and who I am starting to understand a lot better, is locked inside a hospital in a lot of pain, and I can't trust that she will survive. Despite all this, she is still unwilling to take the help that is given to her, she refuses to attend any kind of therapy or be subjected to any form of treatment that will require her to look at her own choices and take responsibility for her own mental health.

I am struggling because I want to be there for her but being there for her seems to mean going along with her delusions. She calls me and complains about others in our family, especially those who suggest that she needs to take responsibility in some areas of her life.

I have a hard time figuring out a way to be honest with her in her fragile state, or even deciding whether I should be honest with her at all. And I feel disgustingly selfish because part of me just wants to move to another country so that I can have a life beyond all this confusion.

Does anyone have a similar experience or even any solutions that worked for them?

[Naughty Nibbler]

Welcome spacedisco70:     

I am struggling these days, because my sister, who I love very much, and who I am starting to understand a lot better, is locked inside a hospital in a lot of pain, and I can't trust that she will survive. Despite all this, she is still unwilling to take the help that is given to her, she refuses to attend any kind of therapy or be subjected to any form of treatment that will require her to look at her own choices and take responsibility for her own mental health.

I am struggling because I want to be there for her but being there for her seems to mean going along with her delusions. She calls me and complains about others in our family, especially those who suggest that she needs to take responsibility in some areas of her life.

I have a hard time figuring out a way to be honest with her in her fragile state, or even deciding whether I should be honest with her at all. And I feel disgustingly selfish because part of me just wants to move to another country so that I can have a life beyond all this confusion.

I''m so sorry about what's going on with your sister. Your sister has to be responsible for her own emotions and behavior.  You can't fix her and you can't be responsible for her choices, or be made to feel responsible for her outcome due to  FOG (Fear, Obligation and Guilt)

The quote below has some information that might be adapted to your situation.  The "What to do" and "What not to do" could be helpful. Although some of the examples relate to a romantic relationship, they can give you some idea of dialog you might adapt to your situation.

In their 1996 book Choosing to Live, Thomas Ellis and Cory Newman write:  The sense of collaboration and togetherness you once had with the suicidal person diminishes, while the uncomfortable power struggle increases. Comments like, "If you really cared whether I lived or died you would come back to me," and "You make me want to die" have something in common: they make someone else's decision whether to live or die conditional on your response. This is unfair to both parties.

Sometimes your family member will try to make you believe that you are responsible for their misery, and that you will be to blame if he kills himself. Remind yourself that you are not threatening the other person with homicide-the other person is threatening suicide. You're dealing with someone who needs immediate professional attention much more than he needs your capitulation.
What Not To Do
Newman and Ellis suggest avoiding the following actions with someone threatening suicide:

Don't fight. Don't get into an argument with your BP about whether he or she is serious about wanting to die-even if you're angry and feel like venting. He may attempt suicide simply to prove you wrong.

Don't confront your family member and accuse her of manipulating you. Again, this may turn into a power struggle. If she is asking you to do something that is against your better judgment, follow your instincts. However, if the two of you are in a session with a mental health professional, it can be helpful to talk about how this behavior is making you feel.
Don't give in to threats. Be extremely cautious about relenting just to prove that you really care. You and your partner will not be happy in a relationship in which one of you stays because of emotional blackmail. In the long term, your loved one won't be happy in a relationship with someone who doesn't want to be with them. They need to get better before they're ready for a healthy relationship.

Remember, contrary to what your angry, distraught family member may be telling you, you don't have to prove anything. Say Newman and Ellis, "When you give in to the threats, you will still be angry, the other person will still be at risk for self-harm at any time, and the underlying issues will not have been addressed. Plus, it is likely that the same scenario will repeat itself again and again."

Seek help for yourself. If you have a history of complying with demands because you believed that suicide was imminent, get professional help for one or the both of you before the next crisis occurs.

What To Do
Suicide threats that feel manipulative are the ultimate in no-win situations. Whether you comply with the other person's wishes or not, the risks are unacceptable.
So, Newman and Ellis say, the best thing to do is to simply refuse to be put in this position, despite your family member's attempts to make you feel responsible for her life and death. Just say no, following the guidelines that follow.

Express your support and concern for your family member while firmly maintaining your personal limits. You can do both, even if your BP thinks otherwise. You can accomplish this with mirroring responses that put the choice of life or death back where it belongs-with him-while stating as strongly as possible that you care about him and you want him to choose life and seek help.

Newman and Ellis give these sample responses, which I have paraphrased:

In response to, "I'll kill myself if you leave me":

I'm not breaking up with you to be cruel. I'm very, very sorry that this hurts you. I want what's best for you in the future, but I just can't be part of it. And even if I were to stay with you, that wouldn't solve our problems.

For one thing, your life's worth should be based on much more than just being in a relationship with me. Secondly, I know that you know deep inside that our relationship shouldn't be based on me staying because I'm afraid of you dying and you staying because you think you can't live without me. That's not healthy. I care about you. And because I care about you, I want you to live. And I want you to find your own happiness, and your own life's worth, without me.

In response to, "If you really cared whether I lived or died, you would come home every weekend":

The fact that I love you and am concerned about you is already beyond doubt. I feel like I have proven my love time and time again, and I suspect that even if I did come home every weekend, that wouldn't be enough for you. I want to see you, and I do plan on coming up once a month or so.

The fact is that I can't visit every weekend because I have my own family now and my own life to attend to. Perhaps the answer is that you need more things to do on your own, or more friends you can get together with on Saturday and Sunday. You used to talk about a lady you played cards with from your church; have you seen her lately?

These statements should be accompanied by statements that show that you are taking the threats of suicide very seriously. Show warmth and concern in your voice and actions. For example, you might say, "We have to get you to the hospital. This is a matter of life and death." Show that a serious threat warrants a serious response.

In this way, you give appropriate attention to your family member's cry for help while making it clear that you aren't qualified to give the professional help that is necessary in such extreme situations.

I understand that your sister is in a facility at the moment, but I thought I'd share the resources below, as they could be helpful in the future.  The first one is a discussion about suicide ideation.  The second link contains information about Safety in relation to suicide prevention.  The third is a link to a suicide prevention website that has information for families of survivors.

SUICIDE IDEATION IN OTHERS

SAFETY FIRST

SUICIDE PREVENTION

Sorry if I overwhelmed you with information.  You just might want to bookmark the three links above for future reference, and check them out one at a time.    After reading the suggestions in the quote above, do you think you can adapt some statement for conversations with your sister?

[schwing]

Hi Spacedisco70 and

I had managed to step away from the relationship last August. Following a very hurtful outburst from her I had decided to have a lot less contact with her. I was unaware of the existence of BPD at the time so it just felt like the last straw in a string of cruel and self-centered behavior. I'm ashamed to say, but it was the happiest I had been in a long time. But in late October she was hospitalized following a suicide attempt and I resumed contact as I wanted to be there for her and support her.

Please don't underestimate the toll it takes on someone to live with a family member with this disorder.  You only had a brief taste of what your life can be like without the stress and drama that you have had to deal with nearly all of your life.  It has had (and may continue to have) a profound effect on you in ways that you are only beginning to understand. And perhaps through the work you will do with your therapist you can deconstruct these effect and your future life will be more of the life you choose for yourself rather than a life of reacting to, and accommodating people like your sister. Consider not offering any more help and support to your sister than she is willing to accept without condition.

After being released from the hospital she contacted me several times each day, pressuring me into getting her a job at my workplace (for a job she doesn't have qualifications or experience for). When I was unable to do so, she stopped contacting me and I didn't contact her back, so we had very sporadic contact for a few months.

Please don't mistake need for love: when your sister needed/wanted something from you, she offered attention. But once she determined that you could not give her what she needed, then her behavior altered.

Listen to her actions above her words. What do her actions tell you?

I understand that your sister is in pain.  And I understand that you wish to help her. But consider that she may refuse the kind of help and support that you offer.  She may only want things the way she wants them, or not at all.

She has never really had me and our relationship on the "black" side of things, probably due to the fact that I have very rarely set her any boundaries. When I have tried, the backlash has been so severe that I never tried again, and just went along with all her delusions about how nothing was ever her fault, commiserating about the cruelty of everyone in her life, sharing her opinion of those people. When I started to get a clearer picture of how it might not all be everyone else's fault and how she might need to learn to take responsibility, and started to (very cautiously) share those thoughts with her, she distanced herself from me. She tends to always seek out the company of those who are willing to agree with her victimhood, only there are fewer and fewer people in her life willing to take that stance.

And this may be how she wants her "support."  As I see it, she lives in a kind of denial and seeks to have her denial validated. This defense mechanism has served her probably most of her life. Don't try to be her therapist. She has probably seen therapists before and have refused their support as well.

I think the best way you can support her is to be around and listen but only as much as does not injure you.  You see, she might just as easily decide that you better serve her as a scapegoat than as a someone will accept her delusions.

I am struggling these days, because my sister, who I love very much, and who I am starting to understand a lot better, is locked inside a hospital in a lot of pain, and I can't trust that she will survive. Despite all this, she is still unwilling to take the help that is given to her, she refuses to attend any kind of therapy or be subjected to any form of treatment that will require her to look at her own choices and take responsibility for her own mental health.

If you are struggling, please I urge that you gather support for yourself as well.  One of the most difficult things in life is to watch someone you love suffer, and suffer from mistakes of their choosing. But you must accept that their life belongs to them.  Their choices are theirs to make, good or bad.

I am struggling because I want to be there for her but being there for her seems to mean going along with her delusions. She calls me and complains about others in our family, especially those who suggest that she needs to take responsibility in some areas of her life.

You can validate your sisters feelings without subscribing to her delusions. Take a look at the lessons offered here.  Naughty Nibbler has brought up a lot of good ones as well.  Again, do not support her to your own detriment. But do support her if that is your inclination.

I have a hard time figuring out a way to be honest with her in her fragile state, or even deciding whether I should be honest with her at all. And I feel disgustingly selfish because part of me just wants to move to another country so that I can have a life beyond all this confusion.

Does anyone have a similar experience or even any solutions that worked for them?

You should *not* feel selfish for wanting to have a life without this kind of stress and turmoil.  I give you the license to limit how much support you think you are obligated to give your sister -- you are not obligated to give any more than your choose to give.  Do not feel like you must life your life in a manner that must accommodate the needs of your sister. Just like her life belongs to her, your life belongs to you.

My situation is a bit different from your situation. My mother is the uBPD family member.  Although my brother has some traits I do not believe he has BPD.  But I'm there are others here who have been in a situation similar to your situation.

You are in the right place.

Best wishes, Schwing

[junebug1929]

Dear spacedisco70 (great user ID!),

I'm sorry to hear about what you are going through with your sister. I can completely relate to this - I also have an older sister struggling with BPD who engages in pretty similar behavior. When she contacts me, it's always to share a story about someone who did her wrong, usually family members. The stories are frequently outlandish, involving family members (including children) who said outrageously cruel things to her. It took a long time for me to understand that 1) our family members weren't saying these things to her but 2) she was instead "hearing" people's words through the filter of her inner voice. Feelings are facts to people with BPD; they shape the facts (such as what a person said or did to her) to fit the overwhelming feelings inside them.

When she contacts me now to tell me her troubles, I listen and validate ONLY her feelings. I say things like "I'm sorry you're feeling so lousy today" or "I would be upset too if someone said that to me" or "Yes, I can appreciate that would be terribly hurtful." If she asks directly about an incident (do I think she was right to respond with x or should she stop talking to so and so), I either refer her back to her therapist to work things out or, more recently, I tell her I wasn't present for the conversation and thus I'm not qualified to have an opinion on what went down. I don't drop what I'm doing to respond and I stay as cool as possible during the interaction (not always easy, believe me, and sometimes I get sucked in).

The result is that my sister contacts me much less, turning instead to people who believe her every word, encourage the drama and take sides in conflicts. I feel guilty sometimes but for the most part, I enjoy the calm. I'm a better, healthier person for engaging less in the made up drama - and I'll be stronger and healthier in the event that a real crisis comes where I might actually be able to do some good.

It's a small strategy that can go a long way. I hope it works for you. Please know you're not alone in this journey and that better times are ahead for you.