Hospitalization Boundary

[VIDEO: "What is parental alienation?"]

Hello.  I need some support in terms of my most recent boundary about my wife w/BPD's hospitalizations.  This is a hard boundary to make, but these hospitalizations have an impact on my health, anxiety, blood pressure, family finances, cause lots of instability, and I fear the impact they are having on my 4 year old daughter.  It's also hard because for some people hospitalizations are beneficial, but I don't think that has been the case for my wife.  Below are the circumstances around my wife's hospitalizations:

#1:  She had an emotional affair with a coworker & I was getting hot on her trail.  She had a minor psychotic episode.
#2: I confronted her about her emotional affair.  She responded by refusing to eat and making a suicidal threat to her therapist.
#3:  I was let go from my job, and was in the process of interviewing for a new one.  She said she couldn't handle the pressure and instability of possibly having to move and made a suicidal threat to her therapist.
#4:  Based on my boundaries I got a financial separation due to attention seeking ER visits with co-workers.  She dysregulated and called a crisis line and claimed she was afraid she would overdose on pills.
#5: She was not taking her antidepressant, antipsychotic, and thyroid medicine regularly and had a psychotic break.
#6  She was hearing voices after meeting with an SSDI/Social Security Disability Attorney and making the decision for applying for Disability benefits.  Again, she said something to the therapist to get hospitalized, but because of privacy and releases I don't have access to what exactly was said.

I can tolerate all of her other behaviors, but the hospitalizations are too much for me.  Apparently, she was hospitalized several times before we dated, but I did not know that when we got married.  Before the first hospitalization she had 5 years of stability in our marriage.  I really think it is once we had a daughter it was too much for her to handle or she thinks she can get away with her behavior with no consequences.

Anyway, here is the boundary.  If she breaks it I may also be looking at a separation or divorce.  I wanted to make it so I would have some leeway in terms of my actions.

I can not be reasonably expected to take care of myself, wife, and daughter.  Wife must be able to take care of herself.   Her next hospitalization will require her to live with her parents for a period from 30 days to up to six months to allow her to take care of herself and stabilize.  If she becomes stable she may return to live with me and daughter at my discretion.

[Michael43]

Hello.  I need some support in terms of my most recent boundary about my wife w/BPD's hospitalizations.  This is a hard boundary to make, but these hospitalizations have an impact on my health, anxiety, blood pressure, family finances, cause lots of instability, and I fear the impact they are having on my 4 year old daughter.  It's also hard because for some people hospitalizations are beneficial, but I don't think that has been the case for my wife.  Below are the circumstances around my wife's hospitalizations:

#1:  She had an emotional affair with a coworker & I was getting hot on her trail.  She had a minor psychotic episode.
#2: I confronted her about her emotional affair.  She responded by refusing to eat and making a suicidal threat to her therapist.
#3:  I was let go from my job, and was in the process of interviewing for a new one.  She said she couldn't handle the pressure and instability of possibly having to move and made a suicidal threat to her therapist.
#4:  Based on my boundaries I got a financial separation due to attention seeking ER visits with co-workers.  She dysregulated and called a crisis line and claimed she was afraid she would overdose on pills.
#5: She was not taking her antidepressant, antipsychotic, and thyroid medicine regularly and had a psychotic break.
#6  She was hearing voices after meeting with an SSDI/Social Security Disability Attorney and making the decision for applying for Disability benefits.  Again, she said something to the therapist to get hospitalized, but because of privacy and releases I don't have access to what exactly was said.

I can tolerate all of her other behaviors, but the hospitalizations are too much for me.  Apparently, she was hospitalized several times before we dated, but I did not know that when we got married.  Before the first hospitalization she had 5 years of stability in our marriage.  I really think it is once we had a daughter it was too much for her to handle or she thinks she can get away with her behavior with no consequences.

Anyway, here is the boundary.  If she breaks it I may also be looking at a separation or divorce.  I wanted to make it so I would have some leeway in terms of my actions.

I can not be reasonably expected to take care of myself, wife, and daughter.  Wife must be able to take care of herself.   Her next hospitalization will require her to live with her parents for a period from 30 days to up to six months to allow her to take care of herself and stabilize.  If she becomes stable she may return to live with me and daughter at my discretion.

[formflier]

Hey... has something recently happened that has brought up this discussion?    I see "recent" boundary, yet I'm not making a connection to something that happened recently.  I can certainly see how this behavior is distressing, even if it has been a while.

When was most recent hospitalization?


Ummm... I see where you head is and there are some boundary things here, but this looks much more like a "rule" and a "consequence" for her behavior, rather than a boundary.

One of my personal tests is can you enforce the boundary without her compliance.  Sometimes take it up a notch, can I enforce the boundary with her "actively trying to cross it".

For me  "I don't have financial dealings (make deals) with people that don't keep their word."  Here is the thing, my wife "usually" keeps her word about money... .it's the 5 percent that she doesn't that's the killer for me. 

So... I control who I "make deals with" and I no longer share joint accounts with my wife.  This used to be very distressing to her and she now seems to have accepted it... .because really... .she has no choice or control in the matter.

For you  "I will not live with someone that is not following doctors treatment plan."  (just a starting suggestion)

Make it about you... .vice specifically about your wife. 

Thoughts?

FF

[formflier]

Big picture question:  I choose to be in a relationship with a person whose behaviors I "tolerate" because... .?

FF

[babyducks]

Hi Michael43

There are some very good workshops on this site about boundaries.   Here is what I remember from them.

Boundaries are for and about ourselves and our behavior.   They should come from our values and beliefs and say what we will do and not do.    

If they are about us and reflect what we stand for, they are easier to enforce.    If they are about someone else and what they should/will/can't do they tend to devolve into an argument.

One of my boundaries was about peace and quiet... .I valued having an hour of peace and quiet before bedtime, I would not engage in deep conversations about the status of the relationship as I was trying to go to sleep.

So with that in mind I would tweak your boundary this way:

I can not be reasonably expected to take care of myself, wife, and daughter.  Wife must be able to take care of herself.   The next hospitalization will require me to focus on the stabilty of the family home and care of my daughter by placing our needs as primary.   Including seperating households to allow each of us to care for ourselves and stabilize.  If the situation becomes stable we may return to living together as a family.  with me and daughter at my discretion.

That's basically your same boundary but with the focus on what you will and will not do.    

'ducks

[Michael43]

Formflier,

There was a hospitalization in the last month.  She did spend some time at her parents' house to stabilize.  I do acknowledge this is much more like a rule/consequence than a boundary.  Like you I have already separated finances.  I don't have an answer for your Big Picture Question at this time.  It gives me something to think about.

BabyDucks,
Thank you very much for helping me revise the wording.  This makes it more about me and what I will do and less about her.  Awesome!  That is the help I wanted by posting this.

[Skip]

Here is the best material we have regarding boundaries. I'd encourage you to read it when you can:
https://bpdfamily.com/content/setting-boundaries

I can not be reasonably expected to take care of myself, wife, and daughter.  Wife must be able to take care of herself.   Her next hospitalization will require her to live with her parents for a period from 30 days to up to six months to allow her to take care of herself and stabilize.  If she becomes stable she may return to live with me and daughter at my discretion.

This could easily be the end of any hope to recover this relationship. Few outsiders (including professionals, judges, school principals, child advocate, her parents, your child, etc) will comprehend this in the context of "in sickness and health". Denying her access to her child is also a problem. You probably won't have much support.

Besides, boundaries/values are things we live by. They go both ways. If you're in a car accident, should you stay with your parents until you are deemed suitable to return home, at her discretion?

The question I would ask, is this a constructive move? I would contend that it is a destructive one. It contains a lot of messages such as "you are faking it", get sick/get out, I will punish you will limited access to your child, etc. It's a declaration you may not want to have show up in a divorce / custody case.

So what can you do?

Blaise Aguirre talks about the hospitalization and the role of family support in his video. It is really good. He is the best of the best.


Date: Nov-2011Minutes: 41:56  
BPD in Adolescence  | Blaise Aguirre, MD | NEA-BPD 2011 Meeting

He does not allow his patients to be visited by parents during hospitalization. Listen to this explanation as it is really what you are facing/wanting to do (10:44 into the video).

I am very concerned about your recent breakdowns and hospitalizations. In speaking with an expert in the field and with your parents, I am understanding that it is important for you to have time and space to recover after these episodes - that jumping back into the strain of routine life is not giving you a fair shot at recovery.  After your next hospitalization it would be best for you to live with her parents for a period from 30 or more and to slowly integrate back into your day to day life. I will do everything I can to support you and visit with _______ (child)

[Michael43]

The question I would ask, is this a constructive move? I would contend that it is a destructive one. It contains a lot of messages such as "you are faking it", get sick/get out, I will punish you will limited access to your child, etc. It's a declaration you may not want to have show up in a divorce / custody case.

Skip,

Thank you for your advice and the video.  It is very thought provoking.

I have been reading the book "Stop Caretaking the Borderline or Narcissist: How to End the Drama and Get On with Life."  I am being careful not to become a caretaker, but my wife's dysfunction has been making it difficult.

My wife is responsible for her thoughts, actions, and behaviors, and those behaviors have been having a negative impact on our relationship, finances, and my health.  I have decided that I would like our relationship to improve or I want out.  That may mean I will file for true separation or divorce in the future.  I have done many things to take care of myself and deal with my own issues of anxiety and depression.

I also want this to be an automatic action that she will go to her parents for 30+ days.  I just wonder when or if these hospitalizations will ever end.  I am almost to the point where I will accept that they will keep happening every month or two.  I feel that I am not living up to my values in allowing myself to accept this behavior in my marriage.

[formflier]

I also want this to be an automatic action that she will go to her parents for 30+ days. 

Can you help me understand this more.  What specifically is good about her parents residence that is going to help her recover?  Has her medical team recommended this?

For sure, hospitalizations are draining events.  I would hope her medical team is looking at her AND at her family system to prepare a plan to best reintegrate  her into the family system... .post hospitalization.

If you are worn out by all of this, feel incapable, need something different than before. I would press for your voice to be heard by the professional planning this. 

Let them take the lead, with all the information you can get them.

FF

[Skip]

Margalis is a member here and we have given her book a top 10 recommendation.

In your case, you are a caretaker... .as caretaker of the children and a caretaker of a ill wife. It might help to look at Margalis' title more in terms of don't be an enabler and don't be sacrifice yourself for another... .but there is a lot of bandwidth in that range to support your child and support your wife is part of that.

The number one predictor of recovery in mental health is family support... .the people who are rejected by their support system, generally struggle much more.

None of this is to say that you should go with the flow... .it is just to suggest that take the actions in a way that there is a path to thing getting better.

You sound, in many ways, like you're done. If she jumps through hoops, you might reconsider, but short of that, your goodwill toward her is depleted. It's ok, if that is where you are.  We all have a breaking point.

I'm just stating it so that you don't convince yourself that laying down such a tough love condition is going to rehabilitate your marriage.

[Lady Itone]

I was with my exgf for not even 2 years, and she was in psyche wards long-term twice while we were together, and recently a 3rd time, just after our breakup.

I've driven her to a detox center, I've held "Baker Act" paperwork in my hand (I didn't do it.) I've visited her in two psych wards, sat in with her in therapy sessions that were all about her. A couple of weeks after our last break up, I called the ambulance myself and had her taken away in convulsions. It's exhausting.

Visiting psyche wards is stressful and depressing The "mental healthcare" system is broken, through no fault of our hardworking drs, nurses, orderlies, etc., but these are not good places for healing.

It took a lot out of me to see my love in those places. Plus, I took on the role of her advocate and caretaker, which I resented. She usually left some kind of mess I needed to clean up. 
 
After the second hospitalization, where I had to make my way to a different city and bring her clothes (they found her naked.) I vowed never to visit her in a psych ward again so long as she was the one who put herself there through non-compliance with medications or by taking street drugs.

Believe me, I get you.

[Skip]

After the second hospitalization, where I had to make my way to a different city and bring her clothes (they found her naked.) I vowed never to visit her in a psych ward again so long as she was the one who put herself there through non-compliance with medications or by taking street drugs.

Believe me, I get you.

We all do. 

This discussion is about what to say... .what did you tell your partner?

[Michael43]

Can you help me understand this more.  What specifically is good about her parents residence that is going to help her recover?  Has her medical team recommended this?

Formflier,

Her mother works by cleaning houses and would be able to check on her which would not trigger her fears of being left alone.  When she spends time alone she can sometimes be overcome by her fears.  She is able to help her mother work part time.  My daughter is the age that my wife was when her sexual abuse started.  Her therapist stated that is a trigger for her.  Combined with the constant invalidation that is given by a child, you can see how she can be emotionally triggered.  My wife has devalued me/painted me black for quite a long time.

Because of privacy laws I have limited contact with her medical team.  She has only signed a release to her therapist and no other professionals.

I also understand that having her go to her parents for a while is unlikely to change or help anything, but it is about the only option that is left that allows me to continue to take care of myself after a hospitalization.

[formflier]

The number one predictor of recovery in mental health is family support... .the people who are rejected by their support system, generally struggle much more.


I'm just stating it so that you don't convince yourself that laying down such a tough love condition is going to rehabilitate your marriage.

I saw in another place that you have limited access to her team and records due to privacy and what she has signed off on or made a decision to keep you out of.

Is there a family therapist for you and the child? 

I see a couple options.  Best option is a family T that focuses on you and the child and how to best integrate your pwBPD back into the family unit and to keep the entire thing "stable".

Here is the thing.  If you are asking for access to her team and her medical records and you are being shut out, then I'm moving much more towards seeing your point of view on having her go somewhere else to see "if she is better" before she comes home.

I would present your request to be a voice on the team/part of the team as you are looking for solutions... .for a better outcome.  It's probably not a "one time" conversation either. 

As far as having her go to her mom's.  I would not suggest it (you pushing it).  I would let her come to that as a solution. 

So, since there is history of hospital, home... .not a good outcome... .you can identify that pattern and kind of "shrug your shoulders" about "what can we do differently".  Especially if they are "shutting you out" or she is "shutting you out".

In your tone of voice and body language... .be focused on the shoulder shrug vice a "finger point".

"Hey babe... .what can we change here for a better outcome?"

Last:  think about what Skip said about your "purpose".  If you want to "rehabilitate" your marriage I see one pathway... .if you are looking in the mirror and you are out of energy and need space (then that's another pathway).

And... .no failure if you are out of energy... .it is what it is.  Step 1... .get on pathway to get more energy, then deal with life.

FF

[Michael43]

I would present your request to be a voice on the team/part of the team as you are looking for solutions... .for a better outcome.  It's probably not a "one time" conversation either. 

Well here's how the conversation went with my wife w/BPD.

I have come around to thinking that most of her behavior is caused by a lack of skills involving positive coping mechanisms as opposed to direct manipulation.  She has a skills deficit and should be given more time to acquire and apply her skills.  She went to her parents for 7 days after the last hospitalization, but that was not enough time for both her to readjust to functioning and for me to take care of myself and calm down my emotions.

We had a relatively civil conversation compared to how she has reacted in the past.  When I asked for her input on what we could do differently she just shrugged her shoulders and said, "I dunno."  We were both able to agree that the hospitalizations are concerning, and she agreed the goal is to make the hospitalizations less frequent, and make them a rare occurrence.  If she becomes fully functional she may be able to have them not occur.  Remember, she did have a period of 5+ years without a hospitalization.  She did understand that she will go to her parents for 30+ days after the next hospitalization to give her a chance to re-adjust and for me to take care of myself.  She did say she does believe in herself "somewhere deep inside" that she can stay out of the hospital.

She did agree to have me attend her next treatment plan meeting for my input.  When I asked what is in her treatment plan she said "I don't know."  The treatment plan I have is over 1 year old.  I would like something put in her treatment plan about "She will acquire, practice, and apply positive coping skills to stay out of the hospital" and that she will work to deal with uncertainty/anxiety.  She also has agreed to try and join the DBT skills group offered at our treatment center.  This is her third time trying DBT... .she has never finished the entire program.

She did bring up many ridiculous claims during our conversation, saying "It is YOUR fault that I went to the hospital.  They didn't believe that you could take care of me.  They knew you would not be supportive.  My support system is worthless.  My therapist will not want to talk to you.  It's bull___ that you get to take care of yourself.  If I took care of myself you would be mad at me.  I have a chemical imbalance and was born this way so there is nothing I or you can do about it.  You just need to accept that I have crippling depression and it is NEVER going away."  She was also upset that I said I felt her behavior was a lack of positive coping skills instead of manipulation because it meant I didn't accept her behavior outright.

I just responded to her using the SET approach and trying to validate her feelings the best I could.  I handled the conversation like a calm adult, and I feel that getting her to agree on the goal to gradually decrease or even eliminate the hospitalizations and to rejoin DBT is realistic outcome.  I am glad she will allow me to attend her next treatment plan meeting.