In my post of 2/6/11, Dysfunctional Family Roles, Part I: The Spoiler, I opined that the basic problem in the "borderline" family (one that produces offspring with borderline personality disorder [BPD]) is this: the parents in such families see the role of being parents as the end all and be all of human existence, but all the while, deep down, they either frequently hate being a parent or see their parental role as being an impediment to their personal fulfillment. This conflict leads parents to give off, subtly or not-so-subtly, the double message “I need you – I hate you” to their child. In response, the child often develops borderline traits.
In Part I of this post (5/28/12), I pointed out the following:
In order to fully understand BPD, we have to ask, "What on earth makes these parents so damn neurotic that they compulsively have children and then covertly resent them?" … If the parents are not patients themselves, the only way for a therapist to get to the bottom of this is by helping the patient with BPD to construct a family genogram. A genogram is sort of an emotional family tree.
I then described the one most common major issue in families that produce offspring with BPD, and its historical development as revealed by genograms - gender role conflicts.
In Part II, I will describe some other common ones.
Before doing that, I will repeat an important caveat mentioned in Part I: All of these issues may seem very common everywhere, and indeed they are. Most families that face them do not produce emotional conflicts significant enough to create BPD pathology in offspring. Rather, the issues in families that do have been magnified significantly by an interacting tableau of historical events impacting the family and the individual proclivities of each and every family member and descendant.
So here goes:
Common issue #2 causing parental ambivalence over being parents: Untimely deaths. The loss of children, in particular, may easily make someone fearful over losing the others while, at the same time, resentful over the worries and insecurities created by the presence of the remaining ones.
For example, one grandparent of a patient in our clinic had lost 10 out of 11 children to disease; the 11th one was the parent of the therapist's patient with BPD. The grandmother was overprotective of the mother but at the same time avoided closeness for fear of the pain of losing yet another child. When the mother grew up and left home, the grandmother became depressed. The patient was then given up as a child to the care of the grandmother to help feel the void, and became the new focus of the grandmother's hyper-concern and insecurity. This is also an example of a parent giving up a child as a gift to a grandparent.
Issues #3 and #4: Financial reverses and chronic illnesses - including severe mental illnesses. Because of the financial strains and general chaos caused by these considerations, the joy of raising children may be suddenly turned into a frightful burden, both emotionally and financially, and thereby generate parental ambivalence.
Interestingly, the presence of bipolar disorder in a parent - with which BPD is often confused these days by both incompetent psychiatrists and the public alike (despite the fact that they do not look anything alike) - may lead to the very chaos in families that generates BPD behavior in children. Children in such a family are at risk genetically for bipolar disorder and environmentally for BPD.
Issue #5: Ambivalence over religious or cultural values concerning childbearing, child rearing and filial responsibilities may lead to parental ambivalence. Examples include:
1. The Roman Catholic emphasis on large families in a day and age when children cost a small fortune to raise. This may lead parents to follow the church rules but be extremely unhappy about the results.
2. Children, often the eldest female in a traditional family, may be called upon to take care of younger siblings in large families. In doing so they are often forced to give up exciting adolescent activities in which their peers and younger siblings at school freely indulge. The result may be that they become identified with the caretaker role yet resentful of it. When they leave home and have families of their own, this history may lead them to envy their own children.
I used to practice in Los Angeles where I saw many Chicano (Mexican American) patients. I saw several females who had functioned as "mother's assistants" when they were growing up. They were the eldest sister in large families. They had to stay home and take care of their younger siblings, and frequently had to miss important social events in school such as their senior Proms. Their younger sisters, however, got to go to and do everything the olders sisters had missed. When these older sisters grew up and had their own children, this recreated the family of origin issues for them and induced ambivalence in them about their brood.
3. The eldest male in a traditional family, such as seen in some Asian cultures, may be called upon to take over the family business in a career that he may just happen to hate. The costs incurred in raising children may lead to continuing family pressure to keep the business going when he wants out. The anger of Son #1 in such a situation may be displaced onto his children.
Issue #6: Parent-child role reversals. If adults in a family become incapacitated for whatever reason, and their children are therefore called upon to take over heavy adult responsibilities prematurely, the children may become resentful in a manner analogous to the situation of the eldest female in a traditional family described above.
They spend their whole childhood as caretakers of their parents at an age when they are ill-equipped to do so, and often feel helpless and frustrated as well as resentful of all of the responsibilities. When they themselves grow up and have children, covert resentment of their parents may be "projected" onto their dependent children.
In some cases, they may start to employ a defense mechanisms that psychoanalysts call "reaction formation." They try to cover up what they feel to be unacceptible anger by compulsively doing the opposite of what they would covertly like to do - literally throwing themselves into the caretaker role. In a sense, their children are not allowed to grow up. Unfortunately, their resentment still shows through, and the children get the double message that leads to the spoiler role.
Such individuals often describe this state of affairs with statements such as “I never got to be a kid.” [As an aside, this is not the reason that Michael Jackson said that]. A similar situation occurs when parents who were themselves enfantalized by their parents appear to be unable to take care of themselves. Their children then try to fill the power vacuum and take care of them - once again, before they are really equipped to do so.
Issue #7: A couple has a child to “save the marriage.” The child then becomes the reason that the parents must continue in their miserable relationship. The resentment within the marital dyad becomes symbolized by the child whose presence was supposed to make the relationship better, but instead has led to the continuation of the same old marital misery.
The child then begins to believe that the family problems are all his or her fault, and the parents do not seem to try very hard to dispel this belief. Children in such a bind usually come to the conclusion that their very existence is the reason their parents seem to hate each other. They may also feel that it is their responsibility to provide an outlet for their parents' anger at each another by drawing the anger on to themselves. Otherwise, their parents might destroy one another emotionally or physically. This is one of the functions of the spoiler role.
Two or even several of these issues can present themselves simultaneously to a given family, thus increasing parental ambivalence over the presence of children exponentially. The whole family becomes embroiled in quite a stew, and the abuse and neglect of children that sometimes results from these conflicts becomes more understandable, although still not excusable.
Expressing empathic understanding for the family's behavior, without condoning it, is far more productive in helping a family to stop troublesome behavior patterns than raking them over the coals for their misbehavior. But that is just the first step for a therapist.