Tuesday, November 21, 2017

Why is Intimacy so Difficult for Us?

A correspondent asked the question. What I have learned over the course of 14 years in recovery from complex post-traumatic stress disorder may answer it... or, maybe not. You can decide for yourself.
I just went through a get-close-then-run-away, push-pull, seduce-and-distance relationship like this a year to three years ago. I come from a relentlessly abusive family of origin. So did my SO. Parts of my psyche are "therapized" and out of the box that experience built; others are not. Parts of my SO's psyche are therapized and out of the box; others are not. We trust (as per Erik Erikson; see below) when we do; we don't when we don't. We both know that, but merely knowing it is insufficient to overcome it (right now, anyway).
Depending upon whatever ever parts (or, as trauma specialist Bessel van der Kolk calls them, "states") we were in at any given time, we were variously (as Pia Mellody calls it) "love addicted" or "love avoidant," and (as Barry & Janae Weinhold call it) "co- vs. counter-dependent.".
Coming to an understanding of all this in at least some of our other, more edified compartments, we came to see that we were (as John Bowlby called it) "ambivalently attached", flipping back and forth in the polarity described above, and unlikely to be able to be all that comfortable committing to some "scary" long-term arrangement and/or living together. We'd already bought rings. She took hers off first. Smart girl.
If the concepts linked above are not enough to explain what going on, one may be able to get the complete picture looking into the links below.
Is Intimacy Hopeless in the Age of the Self-Obsessed Trance?

© 2017 by Rodger Garrett; all rights reserved. Links are permitted. Please contact not.moses@outlook.com with comments or questions. Thank you.

Thursday, November 16, 2017

Is Intimacy Hopeless in the Age of the Self-Obsessed Trance?

Someone wrote, "All but one of the men I can confirm that I have attracted ever since college have all been fucking brilliant... and have been hopelessly full of issues of some kind." And "...no relationship is better than a bad one." So I wrote back...

May I suggest -- without trying to be totalistic or absolutistic about it -- that the sociologists and social psychologists (including Gustav LeBon, Trignant Burrow, Charles Cooley, Max Weber, S. E. Asch, Jules Henry, Eric Hoffer, Peter Berger, Thomas Luckman, Jackson Lears, Stuart Ewen, Christopher Lasch and even S. Freud) may be right in asserting in various ways that something like 90 to 95 percent of the population is conditioned to what Charles Tart calls the consensus trance

If that is the case, won't the compromised ability to trust others (as per Erik Erickson) in those who were serial abused as children run head-on into a culture of half-conscious robots? And while they may acquire considerable technical grasp and skills in certain areas (and even be able to "understand" bits and pieces of Jagged Little Pill), won't those robots remain as clueless to things like the Karpman Drama Triangle... and as interpersonally inept as I was for several decades? 

Is there a way out of the fuzzy frame, the boarded up box, the futile paradigm, the Plato's crappy cave of our sleepy cult-ure? I think there is, but it's a long way, and one most people will never take because it doesn't fit in the frame / box / paradigm / cave of their conditioning. That being the case, I have as much fun as I can allow in "interpersonal recreation" without any expectation or requirement (as per Stan & Carolyn Block) that others recapture what they have no interest in until it's usually too late to do anything about it.

Astonishingly to me (after a career in sex, romance and relationship addiction), I'm more content now than I've ever been in my entire life. 

Related article: Why is Intimacy so Difficult for Us?

Resources & References

S. E. Asch: Effects of Group Pressure upon the Modification and Distortion of Judgments; in H. Guetzkow (ed.): Groups, Leadership and Men; Pittsburgh: Carnegie Press, 1951. 

Stanley & Carolyn Block: Come to Your Senses: Demystifying the Mind-Body Connection, 2nd. Ed.; New York: Aria, 2007.

Peter L. Berger & Thomas Luckman: The Social Construction of Reality: A Treatise in the Sociology of Knowledge; New York: Doubleday, 1966

Trigant Burrow: The Social Basis of Consciousness; New York: Harcourt, Brace, 1927.

Charles Cooley: Human Nature and the Social Order; Piscataway, NJ: Transaction, 1902, 1986.

Stuart Ewen: Captains of Consciousness: Advertising and the Social Roots of the Consumer Culture; orig. pub. 1976, New York: Basic Books, 2001.

Stuart Ewen: All Consuming Images: The Politics of Style in Contemporary Culture; orig. pub. 1988, New York: Basic Books, 1990.

Stuart Ewen: PR!: A Social History of Spin; New York: Basic Books, 1996.

Sigmund Freud: Group Psychology and the Analysis of the Ego; orig. pub. 1921, New York: W. W. Norton & Company, 2002.

Jules Henry: Culture Against Man; New York: Random House, 1963.

Jules Henry: On Sham, Vulnerability and other forms of Self-Destruction; London: Allan Lane Penguin Press, 1973.

Eric Hoffer: The True Believer: Thoughts on the Nature of Mass Movements; New York: Harper and Row, 1951, 1966. 

Jiddu Krishnamurti: Education and the Significance of Life; San Francisco: HarperSanFrancisco (1953) 1975.

Jiddu Krishnamurti: The First & Last Freedom; New York: HarperCollins, 1954.

Jiddu Krishnamurti: Freedom from the Known; New York: HarperCollins, 1969.

Christopher Lasch: The Culture of Narcissism: American Life in an Age of Diminishing Expectations; New York: W. W. Norton, 1979, 1991.

T. J. Jackson Lears: No Place of Grace: Antimodernism and the Transformation of American Culture, 1880-1920; Univ. of Chicago Press, 1994.

Jackson Lears: Rebirth of a Nation: The Making of Modern America, 1877-1920; New York: HarperCollins, 2009. 

Gustav LeBon: The Crowd: A Study of the Popular Mind; orig. pub. 1895, Minneola, NY: Dover Publications, 2002. 

William McDougall: The Group Mind: A Sketch of the Principles of Collective Psychology; orig. pub. 1920, North Stratford: Ayer Company, NH, 1973.

Stanley Milgram: Obedience to Authority; New York: Harper, 1974.

Vance Packard: The Hidden Persuaders; orig. pub. 1957; New York: Ig, 2007.

Talcott Parsons: Social Systems and The Evolution of Action Theory; New York: The Free Press, 1975.

Paul Roberts: The Impulse Society: America in the Age of Instant Gratification; New York: Bloomsbury, 2014. 

Milton Rokeach: The Open and Closed Mind: Investigations into the Nature of Belief Systems and Personality Systems; New York: Basic Books, 1960, 1973.

Anne Wilson Schaef: When Society Becomes an Addict; New York: Harper & Row, 1987. 

Maurice Stein et al (editors): Identity and Anxiety: Survival of the Person in Mass Society; Glencoe, IL: The Free Press, 1960.

Charles T. Tart: Waking Up: Overcoming the Obstacles to Human Potential; New York: New Science Library, 1987.

Wilfred Trotter: Instincts of the Herd in Peace and War; orig. pub. 1916, New York: Cosimo Classics, 2005.

Max Weber, Talcott Parsons (translator): The Protestant Ethic and the Spirit of Capitalism; Oxford: Oxford Univ. Press, 1930.

Gary Woodward & Robert Denton: Persuasion & Influence in American Life, 4th Ed.; Prospect Heights, IL: Waveland Press, 2000.


© 2017 by Rodger Garrett; all rights reserved. Links are permitted. Please contact not.moses@outlook.com with comments or questions. Thank you.

How & Why... and the Long Road Out of Complex PTSD

Let's start with a clarification of How It *Was* (so that you have a frame of reference): 

Bipolar hypomanic natal ma & pa > 
borderline & codependently depressed adoptive ma & pa > 
severe and relentless (physical & verbal) child abuse 
. . . (probably owing to not meeting my adoptive parents' "requirements" > 
complex post traumatic stress disorder > 
autonomic nervous system stress & dysfunction > 
bipolar rapid *and* long-term cycling > 
borderline personality disorder > 
drug & alcohol abuse > 
becoming clean & sober > 
switching addictions (because the cause was not treated) > 
increasing sex, work, exercise, noise & other excitement addictions > 
bipolar crashes into extreme autonomic imbalance in '94, '97, '99, '02 & '03 
. . . (rapid cycling, mixed-state, running through the "terror tunnel" manic panic 
. . . from wake-up to passing out every day for 8, 11, 2, 8 and 1 months) > 
2 wake-up-in-the-ICU suicide ODs >  
11 hospitalizations total, including two in terrifying long-term lockups > 
15 different meds I can recall > 
a blown career plus several *hundred* thousand dollars down the drain > 
bankruptcy & incarceration for repeated, misdemeanor violent behavior > 
finally beaten into a state of healthy desperation > 
*extensive* education & treatment.

Then what I had to come to recognize, acknowledge, accept, own and appreciate had happened to cause all the above:

"If one was regularly neglected, ignored, abandoned, discounted, disclaimed, and rejected -- as well as invalidated, confused, betrayed, insulted, criticized, judged, blamed, embarrassed, humiliated, ridiculed, denigrated, derogated, victimized, demonized, persecuted, picked on, dumped on, bullied, scapegoated, and/or otherwise abused -- by others upon whom they depended for survival in early life... 

and/or they are highly stressed by school, work, relationships or other chronic life challenges... 

they may have been programmed, conditioned, socialized and/or normalized to conflicting beliefs, values, ideals, principles, convictions, rules, codes, regulations and requirements about how we or they (or the world) should / must / ought / have to be, and then beat themselves up for not being able to meet their conflicting expectations and requirements."

Then what I've had to do to climb out of being *normalized* to being in The Hole:

From Bipolar to Borderline to Complex PTSD: The Long Way Around the Recovery Barn

The Feeling is Always Temporary


"I Don't Know" & the "Beginner's Mind" 

Resources & References

© 2017 by Rodger Garrett; all rights reserved. Links are permitted. Please contact not.moses@outlook.com with comments or questions. Thank you.

Tuesday, November 14, 2017

The Mandate to Control... & the Upshots Thereof

The Development of Reciprocal Reactivity from an Eriksonian Perspective

If the mother was herself a victim of abuse (e.g.: having been neglected, ignored, abandoned, discounted, disclaimed, rejected, invalidated, confused, betrayed, insulted, criticized, judged, blamed, embarrassed, humiliated, ridiculed, denigrated, derogated, victimized, demonized, persecuted, picked on, dumped on, bullied, scapegoated, and/or otherwise abused by others upon whom she depended for survival in early life... perhaps even her own mother), it is often the case that the child of such a mother (or mother surrogate) will attempt to compensate by attempting to control everything she can in the world around her.

The children of such mothers may attempt to progress through Erik Erikson's early first five stages of psychosocial development, but they will often be thwarted, impeded, distorted and compromised right from the git. 

1) **Trust** will become split into excessive and insufficient as the child experiences repeated instances of having the mother's love suddenly disappear and be replaced by an imperative and obsessive urge to restrict the baby's normal, genetically programmed desire to explore the environment, as well as express its needs (e.g.: to be fed or changed) in ways that do not suit the mother's requirements and control mandates. The baby will press its own requirements excessively at times. At others, it will simple give up. And trust will appear to be "too great" here... and almost non-existent there.

2) **Autonomy** will become split into too much and too little, as well, if the mother's erratic behavior continues into the child's own initial struggle for independence and the freedom to explore an ever-wider territory. The anxious, over-protective, over-restrictive, over-controlling mother who is "sweet and loving" one minute, but under the influence some unconsidered stress at another becomes passively indifferent or actively hostile, further confuses the already abuse-expectant infant who is now an abuse-expectant toddler. Further reciprocal reactivity (as described by Scheflen in Berger, and later by Titelman) can be expected from both mother and child unless the mother somehow grasps the child's own imperatives as non-threatening to her requirements.

3) **Initiative** in such children often splits into excessive and restless exploration and stimulus-seeking on one end of an increasingly obvious polarity... to disinterested listlessness on the other at about age four or five. If the mother continues to over-limit the child during the exploration phases, the child can be expected to react with frustration and hostility, setting up further reciprocal reactivity in the mother. In time a cybernetic "feedback loop" is established, and the reciprocal reactivity becomes habituated, normalized and institutionalized for and within both members of the parent-child dyad.  

4) **Competence** in these children is often bifurcated into too much here and too little there as the child converts the institutionalization of his or her conditioning into distorted beliefs about self in the world in the face of challenges from an increasingly challenging surrounding environment full of "friends" and "enemies" in the schoolyard and playground. Even if the mother is no longer being as controlling, limiting and/or restrictive as she was when junior was younger, many children who were over-controlled in the earlier developmental stages are now so habituated, normalized and institutionalized to their earlier interpretations of and reactions to the world around them that they see (unconsciously) only two courses of action: One is to try to assert that they are as "right" about what they do as their mothers did, regardless of it being interpersonally effective and functional... or not. The other is to cave in to gross, "learned helpless" complaining, incompetence and sloth. 

5) **Identity** in such children is so often a disjointed mish-mosh of over-reaching for autonomy, initiative and (pseudo-) competence by the time they are adolescents that neurotic, borderline or even psychotic levels of conflict are evident to any adequately trained clinician... and they are seen as "difficult," "obstreperous," and/or "impossible" according to the controlling mother (or father)... and "childish," "over-sensitive" and "unpredictably intolerable" by their peers and romantic partners. Attempts at intimacy will almost always result in failure as these adolescents carom back and forth from desperate attachment seeking... to hostile frustration and rejection of those they come to see as unsupportive or even "abusive" after repeated experiences of cyclical, reciprocal reactivity with such intimates. 

Resources & References

Beck, A.: Prisoners Of Hate: The Cognitive Basis of Anger, Hostility, and Violence, New York: Harper-Collins, 1999.
Briere, J.: Therapy for Adults Molested as Children: Beyond Survival (Revised and Expanded Edition), New York: Springer, 1996.
Brown, N.: Children of the Self-Absorbed: A Grown-Up's Guide to Getting Over Narcissistic Parents, 2nd. Ed., Oakland, CA: New Harbinger, 2008.
Carnes, P.: The Betrayal Bond: Breaking Free of Exploitive Relationships, Deerfield Beach, FL: Health Communications, Inc., 1997.
Forward, S.: Emotional Blackmail: When the People in Your Life Use Fear, Obligation and Guilt to Manipulate You, New York: HarperCollins, 1997.
Gibson, L.: Adult Children of Emotionally Immature Parents: How to Heal from Distant, Rejecting, or Self-Involved Parents, Oakland, CA: New Harbinger, 2015.
Golomb, E.: Trapped in the Mirror: Adult Children of Narcissists in Their Struggle for Self, New York: William Morrow, 1992.
Greene, R.: The Explosive Child: A New Approach to Understanding and Parenting Easily Frustrated, Chronically Inflexible Children, New York: Harper Collins, 1998.
Heller, L.; LaPierre, A.: Healing Developmental Trauma: How Early Trauma Effects Self-Regulation, Self-Image, and the Capacity for Relationship (The NeuroAffective Relational Model for restoring connection), Berkeley, CA: North Atlantic Books, 2012.
Herman, J. L.: Trauma and Recovery, New York: Basic Books, 1992.
Kaufman, G.: The Psychology of Shame: Theory and Treatment of Shame-Based Syndromes, 2nd. Ed., New York: Springer, 1996.
Kurtz, R.: Body-Centered Psychotherapy: The Hakomi Method, Mendocino, CA: LifeRhythm, 1990.
Levine, P.: In An Unspoken Voice: How the Body Releases Trauma and Restores Goodness, Berkeley, CA: North Atlantic Books, 2010.
Miller, A.: For Your Own Good: Hidden Cruelty in Child Rearing and the Roots of Violence, London: Farrar, Straus & Giroux, 1979, 1983.
Miller, A.: Prisoners of Childhood / The Drama of the Gifted Child, New York: Basic Books, 1979, 1996.
Miller, A.: Thou Shalt Not Be Aware: Society’s Betrayal of the Child, London: Farrar, Straus & Giroux, 1981, 1984, 1998.
Miller, A.: Breaking Down the Walls of Silence, New York: Dutton/Penguin, 1991.
Ogden, P.; Minton, K.: Trauma and the Body: A Sensorimotor Approach to Psychotherapy, New York: W. W. Norton, 2006.
Ogden, P.; Fisher, J.: Sensorimotor Psychotherapy: Interventions for Trauma and Attachment, New York: W. W. Norton, 2015.
Payson, E.: The Wizard of Oz and other Narcissists: Coping with One-Way Relationships in Work, Love and Family, Royal Oak, MI: Julian Day, 2002.
Roth, K.; Friedman, F.: Surviving a Borderline Parent: How to Heal Your Childhood Wounds & Build Trust, Boundaries & Self-Esteem, Oakland, CA: New Harbinger, 2003.
Russell, D.: The Secret Trauma: Incest in the Lives of Girls and Women, New York: Basic Books, 1986.
Shapiro, F.: Eye Movement Desensitization and Reprocessing (EMDR): Basic Principles, Protocols, and Procedures, 2nd Ed., New York: Guilford Press, 2001.
Titelman, P.: Differentiation of Self: Bowen Family Systems Theory Perspectives, New York: Routledge, 2014.
Tangney, J. P.; Dearing, R.: Shame and Guilt, New York: Guilford Press, 2002.
Van der Kolk, B: Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society, New York: Guilford Press, 1996 / 2007.
Van der Kolk, B: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, New York: Viking Press, 2014.
Bockian, N.; Porr, V; Villagran, N.: New Hope for People with Borderline Personality Disorder, New York: Three Rivers Press, 2002.
Clarkin, J.; Yeomans, F.; Kernberg, O.: Transference-Focused Psychotherapy for Borderline Personality Disorder: A Clinical Guide, 1st Ed., Arlington, VA: American Psychiatric Publishing, 2015.
Frankenberg, F.; Kymalainen, J.: The clinical significance of co-morbid post-traumatic stress disorder and borderline personality disorder: Case study and literature review, in Journal of Personality & Mental Health, Vol. 3, No. 3, July 2009.
Friedel, R.: Borderline Personality Disorder Demystified: An Essential Guide for Understanding and Living with BPD, Cambridge, MA: De Capo Press, 2004.
Grinker, R.; Werble, B.; et al: The Borderline Syndrome: A Behavioral Study of Ego Functions, New York: Basic Books, 1968.
Gunderson, J.: Borderline Personality Disorder, New York: American Psychiatric Publishing, 1984.
Liotti, G.: The inner schema of borderline states and its correction during psychotherapy: A cognitive-evolutionary approach, in Gilbert, P. (ed.) Evolutionary Theory and Cognitive Psychotherapy, New York: Springer, 2004.
Mason, P.; Kreger, R.: Stop Walking on Eggshells, Oakland, CA: New Harbinger, 1998.
Masterson, J.: The Narcissistic and Borderline Disorders, New York: Bruner/Mazel, 1981.
Masterson, J. (editor/author): The Personality Disorders Through the Lens of Attachment Theory and the Neurobiologic Development of the Self, Phoenix, AZ: Zeig, Tucker & Theisen, 2004.
McCormack, C.: Treating Borderline States in Marriage: Dealing with Oppositionalism, Ruthless Aggression, and Severe Resistance, Northvale, New Jersey: Jason Aaronson, 2000.
Meissner, W.: The Borderline Spectrum: Differential Diagnosis and Developmental Issues, New York: Jason Aronson, 1984.
Meissner, W.: Treatment of Patients in the Borderline Spectrum, New York: Jason Aronson, 1988.
Millon, T.: Personality Disorders in Modern Life, New York: John Wiley & Sons, 2004.
Paris, J.: Treatment of Borderline Personality Disorder, New York: Guilford Press, 2008.
Preston, J.: Integrative Treatment for the Borderline Personality Disorder, Oakland: New Harbinger, 2006.
Roth, K.; Friedman, F.: Surviving a Borderline Parent: How to Heal Your Childhood Wounds & Build Trust, Boundaries & Self-Esteem, Oakland, CA: New Harbinger, 2003.
Searles, H.: My Work with Borderline Patients, New York: Jason Aronson, 1986.
Simonsen, S.: You can’t always get what you want: A commentary on ‘The clinical significance of co-morbid post-traumatic stress disorder and borderline personality disorder: Case study and literature review,’ in Journal of Personality & Mental Health, Vol. 3, No. 3, July 2009.
Vignarajah, B.; Links, P.: The clinical significance of co-morbid post-traumatic stress disorder and borderline personality disorder: Case study and literature review; in Journal of Personality & Mental Health, Vol. 3, No. 3, July 2009.

© 2017 by Rodger Garrett; all rights reserved. Links are permitted. Please contact not.moses@outlook.com with comments or questions. Thank you.




Wednesday, October 25, 2017

Teasing Out the BSDs from BPD

I have just read the article in Current Psychiatry online about screening for Borderline Personality Disorder (BPD). In it, there's a graph that shows the very high co-occurrence of BPD with the Bipolar Spectrum Disorders (BSDs). (25-35 % which seems about right to my observational experience.) 

But what it doesn't get into is that it's easiest to tease them out from each other by seeing the BSDs as "ups and downs," and BPD as "side to side." In the BSDs, we're either waaaaaaaaaaaaay up (as in "manic") or waaaaaaaay down (as in "depressed"). In BPD -- which is now quite commonly seen as a set of expressions of coping strategies for complex post-traumatic stress disorder (see, for example, Alex Chapman et al, Robert Friedel, Marsha Linehan, Patricia Ogden, and Bessel van der Kolk, and even Pierre Janet, though the term "PTSD" was a long way from being devised when he was writing) -- one is fundamentally coming from fear of abuse or invasion... OR fear of abandonment & isolation. Either one of those <---polarities---> can look like BSD mania or depression. 

BUT, if one knows how to look for the four *baseline* types of BPD, one can pretty easily see...

1) which end of the fear polarity is presenting at any given time, and 

2) where the person may have gone in a co-occurring BSD in emotional reaction thereto (especially in the "ultradian" or "very rapid cycling" version of the BSDs).

Here are some examples: 

1) If a "petulant" &/or "impulsive" type (rarely are borderlines any single one in my experience) is triggered by fear of abuse or invasion, and he or she is co-morbidly bipolar, they are likely to move into at least mild mania. 

2) If a "self-destructive" &/or "discouraged" type is triggered by fear of being abandoned (which is more typical of those two types), and he or she is co-morbidly bipolar, they are likely to move into at least mild depression.

All that said, us borderlines are notorious for suddenly flipping polarities in both "up & down" *and* "side-to-side" directions. Which makes dealing with them (myself included when I am stressed and/or hypomanic) a Real Challenge. This is because our minds are "split off" into compartments (really, more like "vaults") of consciousness that are not all that conscious of each other most -- not all -- of the time. "Inter-vault" consciousness tends to be fleeting (if it happens at all), and rarely occurs other than under conditions of sudden, "exaggerated startle" that tend to fragment even that degree of inter-compartmental awareness. 

Borderlines in therapy come to be able to see all these compartments as their "executive personalities" are developed in the course of therapies like Dialectical Behavior Therapy. DBT has become the "gold standard" for BPD symptom management and pre-requisite for ensuing treatment of the CPTSD that is almost *always* the energy or force driving one to develop the BPD coping mechanisms.

Related articles:

Understand the Drama Triangle. Understand BPD.

Treat Autonomic AND Cognitive Conditions in Psychopathology?


Resources & References


Chapman, A.; Gratz, K.: The Borderline Personality Disorder Survival Guide: Everything You Need to Know About Living with BPD, Oakland CA: New Harbinger, 2007.

Clarkin, J.; Lenzenweger, M.: Major Theories of Personality Disorder, New York: The Guilford Press, 1996.

Clarkin, J.; Yeomans, F.; Kernberg, O.: Transference-Focused Psychotherapy for Borderline Personality Disorder: A Clinical Guide, 1st Ed., Arlington, VA: American Psychiatric Publishing, 2015.

Friedel, R.: Borderline Personality Disorder Demystified: An Essential Guide for Understanding and Living with BPD, Cambridge, MA: De Capo Press, 2004.

Gabbard, G.; Wilkinson, S.: Management of Countertransference with Borderline Patients, Washington, DC: American Psychiatric Press, 1994.

Gabbard, G.; Bossert, S.: Psychotherapies for Borderline Personality Disorder Work… Slowly, in Clinical Psychiatry News Digital Network, April 2011.

Grinker, R.; Werble, B.; et al: The Borderline Syndrome: A Behavioral Study of Ego Functions, New York: Basic Books, 1968.

Gunderson, J.: Borderline Personality Disorder, New York: American Psychiatric Publishing, 1984. 

Herman, J. L.: Trauma and Recovery, New York: Basic Books, 1992.

Kernberg, O.: Severe Personality Disorders: Psychotherapeutic Strategies, New Haven, CT: Yale University Press, 1977.

Levine, P.: In An Unspoken Voice: How the Body Releases Trauma and Restores Goodness, Berkeley, CA: North Atlantic Books, 2010.

Linehan, M.: Cognitive–Behavioral Treatment of Borderline Personality Disorder, New York: Guilford Press, 1993.

Livesley, W. J.: Practical Management of Personality Disorder, New York: Guilford Press, 2003.

Masterson, J.: The Narcissistic and Borderline Disorders, New York: Bruner/Mazel, 1981.

Masterson, J. (editor/author): The Personality Disorders Through the Lens of Attachment Theory and the Neurobiologic Development of the Self, Phoenix, AZ: Zeig, Tucker & Theisen, 2004.

McCormack, C.: Treating Borderline States in Marriage: Dealing with Oppositionalism, Ruthless Aggression, and Severe Resistance, Northvale, New Jersey: Jason Aaronson, 2000.

Meissner, W.: The Borderline Spectrum: Differential Diagnosis and Developmental Issues, New York: Jason Aronson, 1984.

Meissner, W.: Treatment of Patients in the Borderline Spectrum, New York: Jason Aronson, 1988.

Miller, A.: For Your Own Good: Hidden Cruelty in Child Rearing and the Roots of Violence, London: Farrar, Straus & Giroux, 1979, 1983.

Miller, A.: Prisoners of Childhood / The Drama of the Gifted Child, New York: Basic Books, 1979, 1996.

Miller, A.: Thou Shalt Not Be Aware: Society’s Betrayal of the Child, London: Farrar, Straus & Giroux, 1981, 1984, 1998. 

Miller, A.: Breaking Down the Walls of Silence, New York: Dutton/Penguin, 1991.

Millon, T.; Grossman, S.; Meagher, S., Millon, C., Everly, G.: Personality Guided Therapy, New York: John Wiley & Sons, 1999.  

Millon, T.; Grossman, S.: Moderating Severe Personality Disorders: A Personalized Psychotherapy Approach, New York: John Wiley & Sons, 2007.    

Negrao, C.; Bonanno, G.; et al: Shame, Humiliation and Childhood Sexual Abuse: Distinct Contributions and Emotional Coherence, in Child Maltreatment, Vol. 10, No. 4, November 2005.

Ogden, P.; Minton, K.: Trauma and the Body: A Sensorimotor Approach to Psychotherapy, New York: W. W. Norton, 2006.

Ogden, P.; Fisher, J.: Sensorimotor Psychotherapy: Interventions for Trauma and Attachment, New York: W. W. Norton, 2015.

Paris, J.: Treatment of Borderline Personality Disorder, New York: Guilford Press, 2008.

Perry, B.: Incubated in Terror: Neurodevelopmental Factors in the Cycle of Violence, in Osovsky, J. (ed.): Children, Youth and Violence: The Search for Solutions, New York: Guilford Press, 1997.

Perry, B.; Szalavitz, M.: The Boy Who was Raised as a Dog…, New York: Basic Books, 2007.

Preston, J.: Integrative Treatment for the Borderline Personality Disorder, Oakland: New Harbinger, 2006.

Roth, K.; Friedman, F.: Surviving a Borderline Parent: How to Heal Your Childhood Wounds & Build Trust, Boundaries & Self-Esteem, Oakland, CA: New Harbinger, 2003.

Russell, D.: The Secret Trauma: Incest in the Lives of Girls and Women, New York: Basic Books, 1986.

Schore, A.: Affect Dysregulation and Disorders of the Self, New York: W. W. Norton & Company, 2003.

Searles, H.: The Effort to Drive the Other Person Crazy -- An Element in the Aetiology and Psychotherapy of Schizophrenia, in British Journal of Medical Psychology, Vol. 32, No. 1, March 1959.

Searles, H.: Countertransference and Related Subjects: Selected Papers, Madison, CT: International University Press, 1979, 1999.

Searles, H.: My Work with Borderline Patients, New York: Jason Aronson, 1986.

Stone, M.: Abnormalities of Personality Within and Beyond the Realm of Treatment, New York: W. W. Norton, 1993.

US Dept. of Health and Human Services: In Focus: Understanding the Effects of Maltreatment on Early Brain Development, Washington, DC: US Government Printing Office, 2001.

Vachon, D.; Krueger, R.; et al: Assessment of the harmful psychiatric and behavioral effects of different forms of child maltreatment, in JAMA Psychiatry, Vol. 72, No. 11, November 2015.

Vaillant, G.: Ego Mechanisms of Defense: A Guide for Clinicians and Researchers, 1st Ed., Arlington, VA: American Psychiatric Publishing, 1992.

Van der Hart, O.; Brown, P.; and Van der Kolk, B.: Pierre Janet’s Treatment of Traumatic Stress, in Journal of Traumatic Stress, Vol. 2, No. 4, 1989. 

Van der Hart, O.; Friedman, B.: A Reader's Guide To Pierre Janet: A Neglected Intellectual Heritage, in Dissociation, Vol. 2, No. 1, 1989.

Van der Hart, O.; Horst, R.: The Dissociation Theory of Pierre Janet, in Journal of Traumatic Stress, Vol. 2, No. 4, 1989.

Van der Kolk, B.: The Compulsion to Repeat the Trauma: Re-enactment, Re-victimization, and Masochism, in Psychiatric Clinics of North America, Vol. 12, No. 2, 1989.

Van der Kolk, B.; Hopper, J.; Osterman, J.: Exploring the Nature of Traumatic Memory:  Combining Clinical Knowledge with Laboratory Methods; in Journal of Aggression, Maltreatment & Trauma, Vol. 4, No. 2, 2001.

Van der Kolk, B: Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society, New York: Guilford Press, 1996 / 2007.

Van der Kolk, B: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, New York: Viking Press, 2014.

Van der Kolk, B.: Commentary: The devastating effects of ignoring child maltreatment in psychiatry – a commentary on Teicher and Samson 2016, in Journal of Child Psychology and Psychiatry, Vol. 57, No. 3, March 2016.

Vedel, E.; Emmelkamp, P.: Psychological treatments for borderline personality disorder: Are all treatments equal or are some treatments more equal than others?, in Journal of Personality and Mental Health, Vol. 4, 2010.

Vignarajah, B.; Links, P.: The clinical significance of co-morbid post-traumatic stress disorder and borderline personality disorder: Case study and literature review; in Journal of Personality & Mental Health, Vol. 3, No. 3, July 2009.

Walsh, K.: National prevalence of posttraumatic stress disorder among sexually revictimized adolescent, college and household-residing women, in Archives of General Psychiatry, Vol. 69, No.9. September 2012.

Watts-English, T.; Fortson, B.; DeBellis, M.; et al: The Psychobiology of Maltreatment in Childhood, in Journal of Social Issues, Vol. 62, No. 4, 2006.

Widom, C.: Posttraumatic stress disorder in abused and neglected children grown up, in American Journal of Psychiatry, Vol. 156, 1999.

Woititz, J. G.: Adult Children of Alcoholics, Pompano Beach. FL: Health Communications, 1983.

Woititz, J. G.; Garner, A.: Life Skills for Adult Children of Alcoholics, Pompano Beach, FL: Health Communications, 1990.

Wood, M.; Balduf, J.; Howard, K.; Huang, H.; Marino, P.; McConky, K.: Reactive Attachment Disorder: A Disorder of Attachment or of Temperament? Unpublished but peer-reviewed manuscript at http://www.personalityresearch.org/papers/wood.html, Rochester, NY: Rochester Institute of Technology, 2003-2005.

Zimbardo, P.: The Lucifer Effect: Understanding How Good People Turn Evil, New York: Random House, 2007.


© 2017 by Rodger Garrett; all rights reserved. Links are permitted. Please contact not.moses@outlook.com with comments or questions. Thank you.

Tuesday, March 7, 2017

Understand the Drama Triangle. Understand BPD.

Having very often been neglected, ignored, abandoned, discounted, disclaimed, and rejected -- as well as invalidated, confused, betrayed, insulted, criticized, judged, blamed, embarrassed, humiliated, ridiculed, victimized, demonized, persecuted, picked on, dumped on, bullied, scapegoated, assaulted, (and sometimes even) molested, incested and/or otherwise violently abused -- by others upon whom they depended for survival in early life, the Grinker-Meissner Level Four, adult borderline is sometimes (not always) one of author Aaron Beck's Prisoners of Hate in the hunt for blood. (This is not true of all people with BPD, but it is very often the case in the "hair trigger" Petulant and Impulsive types of BPD.)

Many people with BPD were raised by mothers who did know how to regulate their *own* emotions, and could not show their children how to self-soothe, or worse, were the actual sources of their children's relentless fear. These borderlines cannot shake their belief that they are still going to be victimized by those to whom they must attach because it is equally terrifying to them to be alone. They are trapped by a classic double-bind in Erik Erikson's "trust" and "autonomy" stages of psychosocial development in emotional infancy or toddlerhood, and It Doesn't Feel Good

It is utterly imperative to them that they not find themselves at the bottom of the Karpman Drama Triangle. Which, of course, means that someone else will have to occupy that corner so that the borderline can experience themselves as competent, powerful and secure. Righteous anger sometimes ensues. 

I have thus far encountered over 200 people with BPD. All of them display the traits of complex post-traumatic stress disorder. For them, some components of their BPD (not all of them, by any means) represent the best coping and defense mechanisms they can come up with to defend them against threat in a hostile and/or uncaring world. For the BPD who went severely "petulant" and "impulsive" at their home base, as opposed to "self-destructive" or "discouraged," others who are codependent make perfect victims upon whom to vomit their understandable frustration and rage. 

Millon's research-based, four types of BPD is a spectrum that runs from the most extraverted and externalizing to the more introverted and internalizing. One who understands Martin Seligman's concept of "learned helplessness" and George Vaillant's list of "defense mechanisms" can also see that the same spectrum demonstrates more energized and potent defenses among Petulants and Impulsives (who prefer to occupy the two positions across the top line of the Drama Triangle because they fear abuse), and more learned helplessness among Self-destructives and Discourageds (who usually settle for the bottom corner of the Drama Triangle because they fear isolation). 


I'll try to illustrate this graphically for everyone:

Petulant . . . . . Impulsive . . . . . Self-Destructive . . . . . Discouraged
Most extraverted . . . . . . . . . . . . . . . . . . . . . . . . . . . Most intraverted
Most externalizing . . . . . . . . . . . . . . . . . . . . . . . . .Most internalizing

In addition to those categorizations, Roy Grinker originated and William Meissner developed a sort of "intensity scale" of symptoms that ran from something like "occasional" and/or "mild" through "regularly observed" and/or "moderate" to "pretty much constant" and/or "severe," though they called the two ends of their spectrum "more neurotic" and "more psychotic."

What I have observed over the past 15 years is that Petulants and Impulsives tend to congregate but get in fights with each other... while Self-Destructives (especially in the digital age of social media; one need only look at the posts on reddit's SelfHarm to see that) and Discourageds tend to hang with each other, but not with non-SDs or non-Discourageds. The problem, of course, is that -- under stress -- a SD or (more occasionally) Discouraged may "flip" to Petulant and wreck the relationship.

All that said, please do not think that the borderline is anything like conscious or mindfully aware of, or anything like at "detached choice" about, his or her character or temporary position-taking on the Drama Triangle. The Petulant-Impulsive borderline is not essentially an anti-social or a sociopath, thought they may have such traits when aroused into a defensive posture. To him or her, the whole paradigm of their lives was in-struct-ed, in-doctrine-ated, programmed, conditioned, socialized and normalized long before they were old enough to have any real grasp of what was happening. In some respects, they are automatons programmed to deal with the world through a filter of mostly unconscious paranoid projection and dire need to strike a balance between their terror of being abandoned, isolated and alone... and their relentless expectations of being used and abused yet again, just as they were as infants, toddlers, pre-schoolers and possibly well into adolescence. As fearful as they are of being alone, they are equally fearful of being abused, and that is one very powerful and frightening double-bind.

Aside from personal observation, the experts I learned a lot of this from are listed at the end of this article.

It seems to me that the best thing one can do to "manage" a relationship with a borderline is to understand what is described above, as well as in Bockian's, Chapman & Gratz's and Friedel's books for people with BPD and their intimates, as well as look into...

1) The Patterns & Characteristics of Codependence on the Codependents Anonymous website;

2) "The Five Stages of Recovery" at pairadocks.blogspot.com to see where one is in them;

3) The "Karpman Drama Triangle" schematic of avoidance and control strategies in interpersonal relationships;

4) Codependents Anonymous and Emotions Anonymous meetings (you can find meeting locators on their websites);

5) "Jiddu Krishnamurti on Loneliness vs. Being Alone" at pairadocks.blogspot.com, further quoting Krishnamurti at his best on being alone vs. being lonely;

6) Practicing some thought questioner & mindfulness inducer like the "10 StEPs of Emotion Processing" at pairadocks.blogspot.com, so that one is able to continue to sense what is going on and know what to do about it;

7) Pia Mellody's book, Facing Codependence;

8) Anne Wilson Schaef's book, Co-Dependence: Misunderstood, Mistreated;

9) Barry & Jane Weinhold's book, Breaking Free of the Codependency Trap;

10) "The StEPs to Freedom from Emotional Blackmail" at pairadocks.blogspot.com, and Susan Forward's book, Emotional Blackmail on manipulative relationships;

11) Patricia Evans's book, Controlling People on the same topic;

12) Pia Mellody's book, Facing Love Addiction, especially with respect to the flip flop from addiction to avoidance;

13) Anne Wilson Schaef's book, Escape from Intimacy on the same topic;

14) Barry & Jane Weinhold's book, Flight from Intimacy on the same topic;

15) DBT's "FAST" boundary-setting skills set (on DBTSelfHelp.com).

Related Articles:

Teasing out the BSDs from BPD.

Resources

Berger, M. D., ed.: Beyond the double bind: Communication and family systems, theories, and techniques with schizophrenics, New York: Bruner/Mazel, 1978. 

Briere, J.: Therapy for Adults Molested as Children: Beyond Survival (2nd Ed.), New York: Springer, 1996.

Chapman, A.; Gratz, K.: The Borderline Personality Disorder Survival Guide: Everything You Need to Know About Living with BPD, Oakland CA: New Harbinger, 2007.

Clarkin, J.; Lenzenweger, M.: Major Theories of Personality Disorder, New York: The Guilford Press, 1996.

Clarkin, J.; Yeomans, F.; Kernberg, O.: Transference-Focused Psychotherapy for Borderline Personality Disorder: A Clinical Guide, 1st Ed., Arlington, VA: American Psychiatric Publishing, 2015.

Friedel, R.: Borderline Personality Disorder Demystified: An Essential Guide for Understanding and Living with BPD, Cambridge, MA: De Capo Press, 2004.

Gabbard, G.; Wilkinson, S.: Management of Countertransference with Borderline Patients, Washington, DC: American Psychiatric Press, 1994.

Gabbard, G.; Bossert, S.: Psychotherapies for Borderline Personality Disorder Work… Slowly, in Clinical Psychiatry News Digital Network, April 2011.

Grinker, R.; Werble, B.; et al: The Borderline Syndrome: A Behavioral Study of Ego Functions, New York: Basic Books, 1968.

Gunderson, J.: Borderline Personality Disorder, New York: American Psychiatric Publishing, 1984. 

Herman, J. L.: Trauma and Recovery, New York: Basic Books, 1992.

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Levine, P.: In An Unspoken Voice: How the Body Releases Trauma and Restores Goodness, Berkeley, CA: North Atlantic Books, 2010.

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Masterson, J. (editor/author): The Personality Disorders Through the Lens of Attachment Theory and the Neurobiologic Development of the Self, Phoenix, AZ: Zeig, Tucker & Theisen, 2004.

McCormack, C.: Treating Borderline States in Marriage: Dealing with Oppositionalism, Ruthless Aggression, and Severe Resistance, Northvale, New Jersey: Jason Aaronson, 2000.

Meissner, W.: The Borderline Spectrum: Differential Diagnosis and Developmental Issues, New York: Jason Aronson, 1984.

Meissner, W.: Treatment of Patients in the Borderline Spectrum, New York: Jason Aronson, 1988.

Miller, A.: For Your Own Good: Hidden Cruelty in Child Rearing and the Roots of Violence, London: Farrar, Straus & Giroux, 1979, 1983.

Miller, A.: Prisoners of Childhood / The Drama of the Gifted Child, New York: Basic Books, 1979, 1996.

Miller, A.: Thou Shalt Not Be Aware: Society’s Betrayal of the Child, London: Farrar, Straus & Giroux, 1981, 1984, 1998. 

Miller, A.: Breaking Down the Walls of Silence, New York: Dutton/Penguin, 1991.

Millon, T.; Grossman, S.; Meagher, S., Millon, C., Everly, G.: Personality Guided Therapy, New York: John Wiley & Sons, 1999.  

Millon, T.; Grossman, S.: Moderating Severe Personality Disorders: A Personalized Psychotherapy Approach, New York: John Wiley & Sons, 2007.    

Negrao, C.; Bonanno, G.; et al: Shame, Humiliation and Childhood Sexual Abuse: Distinct Contributions and Emotional Coherence, in Child Maltreatment, Vol. 10, No. 4, November 2005.

Ogden, P.; Minton, K.: Trauma and the Body: A Sensorimotor Approach to Psychotherapy, New York: W. W. Norton, 2006.

Ogden, P.; Fisher, J.: Sensorimotor Psychotherapy: Interventions for Trauma and Attachment, New York: W. W. Norton, 2015.

Paris, J.: Treatment of Borderline Personality Disorder, New York: Guilford Press, 2008.

Perry, B.: Incubated in Terror: Neurodevelopmental Factors in the Cycle of Violence, in Osovsky, J. (ed.): Children, Youth and Violence: The Search for Solutions, New York: Guilford Press, 1997.

Perry, B.; Szalavitz, M.: The Boy Who was Raised as a Dog…, New York: Basic Books, 2007.

Preston, J.: Integrative Treatment for the Borderline Personality Disorder, Oakland: New Harbinger, 2006.

Roth, K.; Friedman, F.: Surviving a Borderline Parent: How to Heal Your Childhood Wounds & Build Trust, Boundaries & Self-Esteem, Oakland, CA: New Harbinger, 2003.

Russell, D.: The Secret Trauma: Incest in the Lives of Girls and Women, New York: Basic Books, 1986.

Schore, A.: Affect Dysregulation and Disorders of the Self, New York: W. W. Norton & Company, 2003.

Searles, H.: The Effort to Drive the Other Person Crazy -- An Element in the Aetiology and Psychotherapy of Schizophrenia, in British Journal of Medical Psychology, Vol. 32, No. 1, March 1959.

Searles, H.: Countertransference and Related Subjects: Selected Papers, Madison, CT: International University Press, 1979, 1999.

Searles, H.: My Work with Borderline Patients, New York: Jason Aronson, 1986.

Stone, M.: Abnormalities of Personality Within and Beyond the Realm of Treatment, New York: W. W. Norton, 1993.

US Dept. of Health and Human Services: In Focus: Understanding the Effects of Maltreatment on Early Brain Development, Washington, DC: US Government Printing Office, 2001.

Vachon, D.; Krueger, R.; et al: Assessment of the harmful psychiatric and behavioral effects of different forms of child maltreatment, in JAMA Psychiatry, Vol. 72, No. 11, November 2015.

Vaillant, G.: Ego Mechanisms of Defense: A Guide for Clinicians and Researchers, 1st Ed., Arlington, VA: American Psychiatric Publishing, 1992.

Van der Hart, O.; Brown, P.; and Van der Kolk, B.: Pierre Janet’s Treatment of Traumatic Stress, in Journal of Traumatic Stress, Vol. 2, No. 4, 1989. 

Van der Hart, O.; Friedman, B.: A Reader's Guide To Pierre Janet: A Neglected Intellectual Heritage, in Dissociation, Vol. 2, No. 1, 1989.

Van der Hart, O.; Horst, R.: The Dissociation Theory of Pierre Janet, in Journal of Traumatic Stress, Vol. 2, No. 4, 1989.

Van der Kolk, B.: The Compulsion to Repeat the Trauma: Re-enactment, Re-victimization, and Masochism, in Psychiatric Clinics of North America, Vol. 12, No. 2, 1989.

Van der Kolk, B.; Hopper, J.; Osterman, J.: Exploring the Nature of Traumatic Memory:  Combining Clinical Knowledge with Laboratory Methods; in Journal of Aggression, Maltreatment & Trauma, Vol. 4, No. 2, 2001.

Van der Kolk, B: Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society, New York: Guilford Press, 1996 / 2007.

Van der Kolk, B: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, New York: Viking Press, 2014.

Van der Kolk, B.: Commentary: The devastating effects of ignoring child maltreatment in psychiatry – a commentary on Teicher and Samson 2016, in Journal of Child Psychology and Psychiatry, Vol. 57, No. 3, March 2016.

Vedel, E.; Emmelkamp, P.: Psychological treatments for borderline personality disorder: Are all treatments equal or are some treatments more equal than others?, in Journal of Personality and Mental Health, Vol. 4, 2010.

Vignarajah, B.; Links, P.: The clinical significance of co-morbid post-traumatic stress disorder and borderline personality disorder: Case study and literature review; in Journal of Personality & Mental Health, Vol. 3, No. 3, July 2009.

Walsh, K.: National prevalence of posttraumatic stress disorder among sexually revictimized adolescent, college and household-residing women, in Archives of General Psychiatry, Vol. 69, No.9. September 2012.

Watts-English, T.; Fortson, B.; DeBellis, M.; et al: The Psychobiology of Maltreatment in Childhood, in Journal of Social Issues, Vol. 62, No. 4, 2006.

Widom, C.: Posttraumatic stress disorder in abused and neglected children grown up, in American Journal of Psychiatry, Vol. 156, 1999.

Woititz, J. G.: Adult Children of Alcoholics, Pompano Beach. FL: Health Communications, 1983.

Woititz, J. G.; Garner, A.: Life Skills for Adult Children of Alcoholics, Pompano Beach, FL: Health Communications, 1990.

Wood, M.; Balduf, J.; Howard, K.; Huang, H.; Marino, P.; McConky, K.: Reactive Attachment Disorder: A Disorder of Attachment or of Temperament? Unpublished but peer-reviewed manuscript at http://www.personalityresearch.org/papers/wood.html, Rochester, NY: Rochester Institute of Technology, 2003-2005.

Zimbardo, P.: The Lucifer Effect: Understanding How Good People Turn Evil, New York: Random House, 2007.

© 2017 by Rodger Garrett; all rights reserved. Links are permitted. Please contact not.moses@outlook.com with comments or questions. Thank you.