The Bus by Frida Kahlo, 1929
This past week, I've been talking with a friend who has a friend who has been talking to a friend that no one can hear but herself. My friend hadn't noticed the decline in Tammy’s mental health until finding her on her bed---unconscious from a drug overdose. Did Tammy take a bottle of pills to end her back pain…or herself?
Over the past decade, Tammy managed to alienate nearly everyone in her community while increasing her dependence on a select few who could handle her occasional whacky-doo. Ordinary people with extraordinary compassion became tangled in a web of obligation and guilt over their inability to save a friend from self-destructing. As some of us learned after reaching the end of our proverbial ropes: empathy & compassion cannot cure mental illness, even if we'd like to believe love is all-powerful.
NOTE: Befriending troubled people is not a task for the faint of heart, nor is it advisable for those who might be tripping the light fantastic themselves.
At the hospital, the psyche nurse said Tammy had a personality disorder along with her mood disorder. When she heard that, my friend’s jaw nearly hit the floor. How she could have known Tammy for years and never have seen a personality disorder? I asked her, "How could you see a personality disorder if you didn’t know what to look for?"
“Well, I’ve heard you talk about Narcissistic Personality Disorder,” she said, “but it seemed so complicated to me. Besides, I thought I’d always be able to tell if someone wasn’t, well, you know---normal. Now I don’t know what to think about my ability to define normal from not normal. Tell me, what exactly is a personality disorder?”
I repeated from memory, "A personality disorder is an enduring pattern of inner experience and behavior that differs markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment. Personality disorders are a long-standing and maladaptive pattern of perceiving and responding…”
She interrrupted, “Ya lost me. How about talking in English?”
Is it any wonder people are overwhelmed by psychological definitions? If I hadn’t cared so much, I’d never have devoted myself to learning about mental illness. My interest in NPD, albeit questionable to some, has been a labor of love. Not only for the narcissistic, but also for people wondering-and-wandering in the dark, blaming them selves for not being able to ‘create’ a healthy relationship---or not being able to spot unhealthy friendships.
She said, “I felt terrible about what happened in your life but people with personality disorders didn’t impact my life. It wasn't as if I was living with someone who had a mental illness, so it wasn’t any of my business. Like, who are we to judge? That’s how I thought---before now. Now I’m not so sure it’s none of my business.”
I replied, “Did you know that personality disorders may also be the root cause of addictions and depression? Medical doctors treat a patient’s immediate problems but they generally don’t treat the underlying personality disorder. That means tender-hearted people like yourself will suffer, if you’re ignorant about a disorder that is not being treated! Let me ask you a few questions just to see if we can make sense of psychological parameters defining a personality disorder, not a personality trait.”
Question One: emotions
“Did your friend rage? Maybe she wasn’t angry all the time, but when she was, her reactions were out of proportion to the situation?”
She answered, "You know that poem we learned as kids? When she was good, she was very, very good, but when she was bad she was horrid? That’s how people described her. She took a couple of days to cool off and then she acted as if nothing had happened. Some people refused to reconcile with her. I was cautious after the first rage attack but as long as I didn’t say anything to set her off, we got along pretty well. It did mean I was a little nervous around her though. I couldn't predict what I might say that she would interpret as being wrong.”
Question Two: impulses
“Did she rage again? I mean, after you had made up? Maybe you could call it a cycle because she couldn’t stop herself from acting out?”
She replied, “Well, she never could stop herself! That really confused me and it made me angry, too! Why couldn’t she stop herself when the last time she got mad at people, she said she was going to kill herself because she felt so bad about it. And then of course, there’s her prescription drug addiction. No matter how many times she promised to control herself, she couldn’t! I felt miserable about that too, but what could I do? Live with her? I even thought about turning my home into a pharmacy and handing out her pills once a day. Then I realized she’d just get her pills somewhere else. She’s done that before, too. ”
Question Three: relationships
“How about her family? Does anyone stay in contact with her?”
“No. No one. Her son shows up once in a blue moon. He’s also an addict so all he wants from her is money. Come to think of it, she doesn’t have a close relationship with anyone, so I see what you’re getting at. The least little thing someone might say would send her skyrocketing to the moon and she’d dump a friend overnight. Absolutely throw her friend away on a whim. I felt sorry for her, so very sorry that she was alienating people because they couldn’t trust her anymore!”
I interjected, “Did she idealize people after deciding her former friends were worthless rubbish? Like yourself, maybe. Did she see you as an angel of mercy because YOU understood and no one else did?”
She thought about my comment without saying anything.
Question Four: empathy
“Is she oblivious to other people’s feelings? In other words, does she connect her relationship problems with her behavior, or is it always their fault?”
She said, “It was always about her, what she felt, wanted, needed and never about the other person’s feelings. I guess my answer is that she couldn't understand people’s reactions to her at all. That’s really weird now that you bring it up. I never could figure that out. She seemed to be a sympathetic person but if she were able to put herself in other people’s shoes, she’d never treat them the way she did!”
Question Five: thoughts
“Would you say her thinking was ‘off’, maybe even disordered, especially when she was stressed?”
“I remember when she got all into this book called The Secret," she said. "Tammy believed she could move mountains with her thoughts and when I’d reason with her, she’d get mad at me for having negative energy. She said everything in her life was under her control, even stuff she could never have caused or prevented, like her mood disorder. She decided she could control her depression by changing her thinking, so she quit taking her meds. That’s when things got really bad. I almost swore off our friendship at that point. But instead, I called her doctor who made her get back on her medication.”
I said, “So we can say there are four areas in which your friend had exaggerated behaviors, beyond what most of us recognize as personality traits everyone shares. In other words: her thoughts were noticeably distorted; her emotions were erratic and unpredictable; her relationships basically sucked eggs; and she had zero control over her impulses. If she had a thought, she acted on it regardless of the consequences, including the pain she inflicted on her friends. Would you say that’s a fair way to describe Tammy?”
“Yes. The basic things people didn’t like about her, never changed no matter how much we talked. She wanted me to do everything for her, she couldn’t stand being alone, she expected me to put her life in the center of mine and it was hard sometimes. Like when I drove her to work twice a day for weeks because she wouldn’t drive her car. Even after the doctor had given his permission after her back surgery. I scheduled my whole day around taking care of her and she never thought about the impact she had on my family.”
I told her, “Well, you’re a lot like myself. You’re a good-hearted person who wants to help people if you can. Have you heard of a group called Al-anon? That’s where I started learning how to be responsible to myself and how to grant someone the freedom to be responsible for their life, too.”
I ended our conversation by reminding her she owed it to herself to learn about mental illness, i.e.: mental and personality disorders. “You can’t change your friend,” I told her, “but you can change yourself by getting smart about who you need to be compassionate to first: YOU. How about we meet for lunch and talk about prioritizing healthy self-care when someone we care for has a personality disorder?”
Personality Disorders. AllPsyche Online: the Virtual Psychology Classroom