From Both Sides of the Couch

A therapist reflects on her time with patients, and her time as a patient.

Untangling the Bonds of Enmeshment

A therapist speaks about the knots created by enmeshed families

I tried to make myself as comfortable as I could in the hard-backed chair turning this way and that, but I soon gave up and sat straight up resting my feet gently on the edge of my mother's hospital bed. In March, 2002 she was in the end stage of pancreatic cancer and earlier that evening my brother and I had been at her home where she was resting comfortably in her bed. Without warning her demeanor shifted; she began having visual hallucinations and when I questioned her, a guttural "Nooo" escaped through her lips and she took a swing at me. My brother and I called 911 and she was admitted to the hospital. In the early hours of the next morning, my mother, sedated, slept as I sat silently watching her.

An old photograph came into my mind of my mother and I dressed up in matching summer dresses of the same fabric, stripes of corals, yellows and white. She must have sewn them; she was a skilled seamstress when I was a child. I was about five years old and we were standing in the foyer of our apartment which also doubled as our dining room. She had a flip hairdo which was popular in the mid-sixties and she was wearing a lot of makeup. She was smiling and looked quite beautiful. I was holding her hand. I can't recall if I was smiling. 

The doctor came in to check on her and put a stethoscope to her chest. He left it there for a quick minute and removed it. He looked at me and shook his head.

"I'm sorry." he said. "She's gone. Her heart has stopped."

 I didn't comprehend what he had said at first. She was just sleeping. She had been combative just hours ago; perhaps she had been swinging at death. I didn't cry. My facial muscles froze. 

"Mommy," the little girl in the photograph wailed. "Don't go. I still need you." But the adult in me was afraid to break down for fear that I would never be able to stop. In all my years of going in and out of the hospital, I had never known such a feeling of defeat. I couldn't fathom living without her. I was afraid that there would be nobody to take care of me and that I wouldn't be able to take care of myself.

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Prior to developing anorexia at the age of 27, I had been out in the world working in advertising and marketing, trying hard to make a life for myself. I was playing softball in my city's advertising league and partying hard afterwards at a popular bar. I had become addicted to cocaine, having been introduced to the drug by my friends and teammates. Perhaps it wasn't the smartest decision I ever made, but it was mine, and no one in my family ever knew about it.

My mother had poked her head into my life every so often; she found me my first apartment and she urged me to undergo breast reduction surgery as my natural size was a DD. Mom knew from experience (she was also a DD) how uncomfortable living with large breasts could be, especially since I was an athlete. 

Once I was diagnosed with anorexia and discharged from the hospital for the first time, our relationship changed. Determined to feed me and keep my weight at an acceptable level, she took me out for dinner, or ordered in (Mom didn't believe in cooking) every night. 

 Following my most deliberate suicide attempt, I was hospitalized for nine-and-a-half months on a long term unit specializing in treating borderline personality disorder. My insurance ran out and the staff made arrangements for me to enter a state hospital. Swearing that would never be the fate for her daughter, my mother fought hard and a compromise was reached for a 24/7 supervised residence and a day program. I spent 3 ½ years living in the residence until the administrators thought I was capable of keeping myself safe outside.

As soon as I left the residence and moved into my own apartment, my mother, determined to do her best to keep me alive, suggested that I spend weekends at her home which was about a 30 minute drive from my apartment. We did everything that two best friends did together; shopped, had manicures, went to the movies, and went out for meals.

What I didn't realize at the time, and neither did she was that this pattern of behavior was preventing me from re-engaging in the separation process. Spending each weekend with her was impeding me from meeting people my own age and making friends that I could socialize with.

The ensuing enmeshment that occurred handicapped my sense of individuality. I didn't know where I stopped and she began. Needing her approval for every decision, I felt paralyzed with fear when I couldn't reach her, when I couldn't talk to her about every decision, major or minor, that I was required to make. We were fused, joined at the hip for fourteen years until she passed away.

In my practice at the clinic I see many forms of enmeshed families. The forty-year old, fifty-year old child who continues to live with and be supported by his or her mother. The parent who pays her adult child's rent and pays the rest of his or her bills while they claim to be looking for a job. The adult child and parent who come for a joint therapy session and the parent answers the questions which are directed towards the child.

Because enmeshment has often been going on for a long time and because the pattern is hard to see if one is in the midst of it, the topic is difficult to broach whether my patient is the child or the parent. My patient might have learned not to look within himself for awareness, but to look to his mother. If my patient is not separate from his mother, how can he come to make a decision about his place in the family, and subsequently, in the world?

 I start by introducing the concept of boundaries and how they can become blurred. I give the example of a family where the members borrow another's possessions from each other without permission, because there is an ongoing assumption that what belongs to Mom belongs to her daughter and no one needs to ask if it is okay

 Identities aren't clear, limits aren't set; it is a slow process to enlighten the patient, help him or her become aware of the pattern that is causing the problem. Only after the patient has acknowledged that there is a problem, admitting that there is something that is not working, can we start to work on change.

Following my mother's death, I remained numb for a long time. During the week, I went to work, but on the weekends, I was a robot, going through the motions. Lost without her, I visited our favorite haunts alone in the town where she had lived; our nail salon, our favorite clothing boutique, our hairdressers. I couldn't bring myself to find closer places in my neighborhood which I could establish as my own.

I remained faithful to my mother in my mind and in my behavior. I couldn't let go of the memories of all the time we had spent together. I wasn't socializing, I wasn't making new friends; I was merely existing. At that time, I had stopped all my medications and also quit individual therapy, another poor decision, but one that was also all mine. As a result, I felt the ghost of depression begin to inhabit my mind, pushing the memories of my mother away.

Around that time, my group therapist (I was still hanging on in a group) referred me to a psychiatrist who specialized in treating patients with borderline personality disorder. After several years of working together, it was only then I was ready to look at my relationship with my mother and just how intertwined and dependent on each other we were.

The most difficult concept for me to have come to terms with was that I probably would not have made all the progress that I have if my mother hadn't passed away when she did. I fight with myself because I want her here to see me thriving, but I have to question myself; would I be who I am today if she were still here?

I think of that photo often, with my mother and myself in the matching outfits. Sometimes I long to tear it down the middle, but I know I won't be able to restore it, so I stop myself. The last photograph I have of her was taken in a frenzy of picture taking, during the last months of her life. She has a vase of pink tulips beside her, but her face is drawn, and there are grey circles under her eyes. That photo sits on my coffee table in a pink frame and is the one I talk to when I feel the need to speak with her.

I feel the need to apologize for moving ahead without her, for saying that I flourished once she was gone. Sometimes I question myself, I ask myself if I have betrayed her in some way; some irreversible way. And I have come to the conclusion that there is nothing else she would have wanted more for me.


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Gerri Luce is a licensed clinical social worker who publishes under a pseudonym.

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