Post-anesthesia rage, hopelessness, and drug-seeking behavior

[LoveFaithHope]

My girlfriend and I have been together off and on for four years. She has brain injuries, BPD, PTSD, cancer, rheumatoid arthritis, and fibromyalgia at 40. I love her unconditionally, and I'm very afraid. The second year we were together, her medications were all wrong, and she was waking up in gabapentin withdrawal every morning. I thought it was just her brain injuries at the time. Every morning before her meds kicked in, she was Mr. Hyde, and as they took effect, turned back into Dr. Jekyl. I don't know if I'm speaking about this in the right terms exactly, please bear with me.

Her BPD and PTSD symptoms have been manageable for a while now, and she has shown progress at behaving appropriately. However, whenever she has to have surgery and goes under anesthesia, when she wakes up she isn't herself, she's back to Mr. Hyde and seeks escape, I'm afraid through stimulants again. I can almost understand, she probably just wants to wake back up all the way as if she never fully did, like part of her brain is still asleep. She just hopped in a car with Lord-knows-who and is off doing God-knows-what. This has become a pattern. It's always post-anesthesia. Of course they tell everyone not to sign legal documents for 24-hours, but with her, the effect lasts days. Her ex from before me just died of an overdose, so she's already been grieving. Horrible time to have to have kidney stone surgery. So she wakes up from anesthesia, and the grief is completely uncorked, and she's completely unhinged, out of her mind, raging at me for not being him, and there's nothing I can do.

If we make it through this episode, I just have one concern. She's a cancer patient. She has countless more surgeries to come. We don't even know where the cancer is now. If every time she goes under anesthesia it chemically exacerbates her BPD and PTSD symptoms and behaviors to this extreme, I literally don't know how we will be able to cope. It pushes her to this cusp of psychosis where it seems like a really grey area... How can I explain... When she has the opportunity to have a clear head for months at a time, she behaves more like a higher functioning borderline, she can regulate her emotions better, and calm herself down, and hold her tongue, and withhold threats of leaving me, etc. But whenever something chemically shuts down her inhibitions, she loses all rational control, and the BPD and PTSD just come out full force, she has no self control, and can't be trusted to make any appropriate decisions. But she has to have the surgeries. She has to go under anesthesia. But literally, when she's like this, she's functioning at the level of someone who should legally have power of attorney taken away from them. But this is where it's a grey area. It's only temporary, chemically induced, post-anesthesia. As soon as she's back to herself, she has enough self control and presence of mind to have power of attorney over herself.

Just now while writing this she called, super happy and excited (she was raging at me a couple hours ago, ready to leave me), because she has someone on the phone who "can repair her credit" and she's looking for her disability card, her social security disability debit card, to get the numbers off it to give the lady. It could be a scam. It could be anything. But there is nothing I can do. Nothing I can say. This is like her signing a legal document within 24 hours of anesthesia like they tell you not to do, only it's almost a week after surgery, and she's still out of her mind. I am at a loss as to what to do or how to handle this. I have been with her for 4 years and have never posted in one of these forums. I guess I once heard someone say, "When you go asking for advice, you've usually already made up your mind what you're going to do, and you're just looking for confirmation." Well, in this case, I haven't made up my mind about anything. I haven't a clue how to improve this situation.

I'm afraid at some point during this episode, worst case scenario, she'll wind up at a stranger's house across town smoking meth, and then pick a fight with me, and then leave me. She could wind up in jail or hurt herself. If she wake's up in 2 weeks able to come back to me, I'm afraid of what will have happened to her in the meantime. If she winds up using a hardcore drug, she's liable to really completely go out of her mind. And get this, here's the thing. She's not a drug addict. She used drugs off and on recreationally when she was younger. When she wakes up from anesthesia, it's like she reverts back to that behavior.

I wish this were a simple question of free will and self control. I wish humans could retain will power and self control under all circumstances. But when you watch chemicals strip someone of their self control, free will, and rationality, and induce the behavior to go seek out even more chemicals that compound the problem, what are you to do? If more surgeries, and anesthesia, have the potential to push her to drugs in the future, things could get dangerous again. I haven't even told you about the shards of glass and knives and death and suicide threats. The trips to the mental institution and jail. Decisions that I made, to make the phone calls, that I regret to this day. Things she still hates me for, when the pendulum swings to rage. And the fact that this all has pushed me to mental illness myself. I was so hopeless one day, I wanted to die, and wound up at the mental institution myself.

If I ever have to leave her again because things literally get too dangerous, I'll never forgive myself. I left her twice before, and sunk into the worst depression of my life both times. She is the love of my life. I always see the real her beneath the layers of mental illness and personality disorder and brain injury and post-anesthesia behavior. She doesn't choose to be this way. She doesn't choose any of it. If it weren't for her brain injuries, she would be able to do CBT and DBT therapy and go into remission as far as BPD is concerned, I'm sure of it, I know it. She used to be that smart before the car wreck. She had a photographic memory. She was smart. But all that got ripped away and changed in an instant. Even if she learned great DBT techniques, the sad thing is, she would forget them. But like I said, somehow, remarkably she's made progress. Especially the past 5 months. And then, surgery, and bam, it's like the reset button gets pressed and it's back to square one. All that progress, all that self control, all that will power, all that appropriate behavior, all that emotional regulation, gone, wiped out, in an instant. And it's been that way all week.

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[Harri]

Hi and welcome.

That is a lot to be dealing with and must be scary and frustrating I imagine.  Devastating too. 

And the fact that this all has pushed me to mental illness myself. I was so hopeless one day, I wanted to die, and wound up at the mental institution myself.

You are not alone in having reached this point though I know that is of little comfort.     These relationships are extremely taxing and we can reach our limits.  Are you safe now?   Other than here, what sort of support do you have?

I am not sure how to advise you regarding the post anesthesia aspect of her episodes other than to ask if her surgeons and the anesthesiologist are aware of what happens and of her mental illnesses?  Even if those diagnoses are in her chart, they need to be told each and every time.  You'd be surprised at how many either do not read the whole chart (and it sounds like hers is big) or forget important details that may not be their primary concern in terms of surgery.  Would she be receptive to you reminding her to remind her doctors?  When she returns to baseline is she aware of what she has done and how anesthesia affects her?

I am glad you are reaching out for help.  We can at least support you as you figure out ways to cope and maybe manage this at your end.

Again,

[LoveFaithHope]

Thank you for your response, Harri. It feels surreal to see someone's first response to me be positive and affirmative with the words cope and manage. I've grown so accustomed to people just telling me to get out while I'm still alive. I am safe right now, and I have a support system. My parents for one have turned over a new leaf and are now finally being understanding and supportive. For a long time, off and on, they joined those saying get out while you're still alive. Our relationship and her personality and behavior have been very difficult for people around us to understand, let alone support on an ongoing basis.

I believe she will be open to dialogue more about the anesthesia with me and her doctors. A friend reminded her today that it does make some people depressed. I feel somewhat relieved that she is open to talking about it more.

Okay, you know what... Now that I've finally made the plunge after 4 years and joined a forum where I can open up about this stuff and ask some questions, I've got a question that has been bugging me for a long time...

How much is someone with BPD a victim of the disorder? With people going into remission once committing to the right therapy, what does that mean exactly -- that they really had the self-control all along but just weren't choosing to exercise it?

This is the kind of question I see in people all around us all the time. I observe it more in their nonverbal communication than verbal, but there have been those who have been outspoken about it, too, insisting to me she has more self-control than meets the eye. And I've thought a lot about it, too. I usually insist that with her brain injuries and other conditions like PTSD, the issues are all compounded to the point where she is utterly the victim and not in control. Or at least not when she's having an episode. Am I wrong? Maybe it's impossible to know for sure, given limited information, but is it within the realm of possibility that I'm right? I don't know how much I'm looking for a real answer to this one. I suppose the level of genuine victim-hood varies from case to case, and probably varies over time, too. If anyone can speak into this, though, I would appreciate it.

[Harri]

Hi! 

Sorry, things got crazy busy at my end so I am catching up and checked in this thread asap.

Is she back and safe with you now?  How are you coping?

How much is someone with BPD a victim of the disorder? With people going into remission once committing to the right therapy, what does that mean exactly -- that they really had the self-control all along but just weren't choosing to exercise it?

Do you mean in terms of a pwBPD not being responsible for their behaviors?  I would say they are responsible always, though they have limitations, that does not excuse behaviors.  A therapist once told m there is not psychological disorder that causes abusive behavior.  I haven't unraveled all of what that means and am not sure I agree 100%, it is something I think about often.

Recovery from BPD means being able to live life where the behaviors are no longer pervasive and where the person no longer meets the requirements for diagnosis.

And I've thought a lot about it, too. I usually insist that with her brain injuries and other conditions like PTSD, the issues are all compounded to the point where she is utterly the victim and not in control. Or at least not when she's having an episode. Am I wrong? Maybe it's impossible to know for sure, given limited information, but is it within the realm of possibility that I'm right? I don't know how much I'm looking for a real answer to this one. I suppose the level of genuine victim-hood varies from case to case, and probably varies over time, too. If anyone can speak into this, though, I would appreciate it.

The issues are compounded though I am not sure seeing her as a helpless victim is helpful for you or her.   If she is indeed a victim, does that mean she gets a free pass?  We often look at the consequences of a pwBPD's/disordered persons behaviors based on how they affect us.  What about what they do to them?  Do we just give them a free pass?  I don't know the answers here BTW and I am not judging you I am just thinking out loud.  I know for me I like to simplify things into binary choices:  blame/no blame, victim/not a victim and so on but I don't think it is that simple.

What would change if you do decide she is a victim with no means of control?