Themes of This Blog Seen In Newspaper Advice Columns: The Principal of Opposite Behaviors

In Amy Dickinson’s advice column of 4/5/17, she published a letter which serves as a good, simple and straightforward illustration of something I call the principle of opposite behaviors, described in several previous posts, as well as illustrating how seemingly opposite behaviors are actually just two sides of the same ambivalent coin.

The principle states that completely opposite behavior patterns can lead to the exact same result. If you’re afraid of being dependent on others, you can refuse to let anyone help you with anything. Or you can ask for way too much, annoying and eventually driving off people who might want to help you. In either case, you will end up with no help!

This principle comes into play when someone is ambivalent about certain rules of behavior in specific social situations. If this ambivalence is pervasive and frequently seen as a problem, said people who exhibited it were once called neurotics. The psychoanalysts who were the first to describe intrapsychic conflicts as a phenomenon missed the fact that these conflicts were usually shared by all the members of their patients’ entire family. 

In some cases, the conflict is expressed by compulsive or polarized behavior at one end of the spectrum - or at the exact opposite end. Some highly ambivalent people go back and forth between the two extremes, while in other cases, one generation goes to one extreme, the next to the other, and the third back to the first one.

In the letter, the father in the family was ambivalent how involved he should be with his son, and his conflictual behavior became apparent at his son’s little league games. His behavior was polarized and seemingly the exact opposite of that of his father. Amy’s answer points out that trying not to be like your own parents in some way that you didn’t like can lead to a situation in which you try to do the exact opposite – and get the exact same result. Here, in abbreviated form, is the letter and the relevant response.

Dear Amy:  ...when we go to our son’s Little League games…my husband is the loud one on the sidelines — pacing, swearing and turning red; he micromanages our son, and shouts belittling comments at him and other kids on our team. He argues with the umpires, and complains about the coaches… he has been ejected from games during those seasons. I’ve tried asking him to be calmer...He says that he’s a lot better than his own dad, who never showed up for anything…

Dear Exhausted: Your husband claims that he is “better” than his own father was, but how is getting ejected from a game better than not showing up for the game? Either way, Dad is not at the game!

Book Review: Prescriptions Without Pills by Susan Heitler

When I first started to develop my integrative psychotherapy paradigm, unified therapy, a central problem I focused on was how patients could fruitfully discuss sensitive family dynamics with their parents without the conversation turning into just another variation on the same exact dysfunctional theme. How could someone confront highly invalidating and/or abusive parents about their interactions, with a goal to stopping them, without the conversation devolving into mutual rage, defensiveness, attacks, and/or emotional cutoffs?

I was amazed at how family members could be such experts at re-framing something meant to be constructive back into something highly destructive. Readers of the comments to my blog posts on Psychology Today know that even today many people think I am the insane one for even thinking it is possible to interrupt this admittedly highly malignant process.

After I first developed and wrote about some good strategies for keeping things constructive, I came across a helpful book by Susan Heitler, Ph.D., called From Conflict to Resolution (W.W. Norton, 1990), which described several strategies for detoxifying toxic interchanges between intimates as well as between patients and therapists. The book helped me to refine and expand upon my repertoire of strategies. Since every family and family member responds differently, the more strategies I have in my bag of tricks, the more different patients I can help.

I later briefly met Dr. Heitler at a meeting of the Society for the Exploration of Psychotherapy Integration, an organization to which we both belong. Its purpose is to look into ways to integrate various ideas from the different "schools" in psychotherapy— primarily the psychoanalytic/psychodynamic therapies and cognitive behavior schools.

(As an aside, I have since become less involved with the organization for two reasons. First, the leaders of the group were afraid that if they succeeded in devising an overarching theory, then they would just become yet another therapy school. I, on the other hand, was tired of exploring and was interested in actually doing. Second, family systems and social psychology were woefully underrepresented in the group. Since humans are among the most social of organisms, that just seemed crazy).

Dr. Heitler has now written a self-help book for lay readers which goes over a lot of the same territory as the Conflict book, Prescriptions Without Pills: For Relief of depression, anger, anxiety and more. The title stems from an opinion we both share: today there has been an explosion of excessive prescribing of anti-depressant and anti-anxiety medication to clients who just have problems in living. While she is not against the use of medication, it is often just plain ineffective for many problems with which people come to mental health professionals. Antidepressants for example, as I have written about many times, are completely useless for chronic unhappiness as opposed to Major Depressive Disorder.

The book is chock filled with very useful suggestions for people who are locked into what were once termed neurotic styles. (See the book of the same title by David Shapiro from way back in 1965). The term neurosis has unfortunately now been practically banned from psychological discourse and psychiatric diagnosis because its role as a "cause" for any psychological problem has not been "proven." 

It refers to problems created for people because of internal conflicts between what they would like to do based on their own preferences and what they think they are supposed to do based on the "rules" they have learned from their ethnic group, religion, and most importantly their families of origin. "Style" refers to such things as ways of thinking and perceiving, modes of subjectively experiencing other people, and repetitive, unthinking types of stereotypical behavioral transactions in various circumstances within one's interpersonal relationships.

People who will benefit most from this book are those who learned these styles growing up and who have gotten into some bad habits which create sadness (the author uses the word depression but seems, at least in this book, to have conflated major depression and dysthymia, the differences between which are elucidated in this post), anxiety, anger, and/or addictive behavior—but who are generally functioning fairly well in some areas of their lives, have minimally cordial relationships with their parents and siblings, and are highly motivated to change. They will find the suggestions in the book quite helpful in getting problematic behaviors and feelings under control. This in turn will help them with their love life and their work life as they interact with others.

I do not believe that people with more severe personality pathology and highly dysfunctional families will be able to successfully avail themselves of these strategies for reasons I will also mention in a bit. So this book will not be as helpful for folks like that.

Dr. Heitler describes the typical habitual ways neurotic people respond to problems, particularly interpersonal ones. The one healthy one is to define and boldly face the problems and to work on solutions to them. The unhealthy ones include folding (leading to discouragement and low moods; fighting (leading to anger and aggression); freezing (leading to chronic anxiety); and fleeing (obsessively burying oneself in a substance or behavior and becoming addicted to it).

A big part of the techniques for changing the bad behavior when it starts to occur is stopping and thinking about what the real nature of the problem is, as well as the reasons behind one's own seemingly overly-strong, over-the-top emotional reactions. The reasons for those are often past experiences with important attachment figures (emphasis on the word past. If those experiences are ongoing, that's a 'hole 'nother level) which bring up strong feelings.

For instance, if when you were growing up your divorced father frequently did not show up for his visitation days when he was supposed to, and in response you started to think that you are basically unlovable, then any time another person disappoints you, you might over-react even if the other person had a very valid reason for not doing what you had expected. 

This is actually a way of conceptualizing what the psychoanalysts call transference. Many cognitive behaviorists claim they don't believe in it, even though they actually do but just call it by another name: mental schemas.

Dr. Heitler recommends visualization techniques one can use to let one's mind recall the important precipitating events from one's past. The techniques can be thought of as another way of employing what the analysts call free association.

She also suggests many useful questions to ask oneself and ways of thinking that one can use to explore one's own psyche, to change perceptions about what other people might really be doing and thinking, and clarifying dilemmas in life. She describes how one can use their own strong feelings as a vehicle for constructive engagement with other people in order to solve mutual problems.

When discussing mutual problems that occur in intimate relationships, certain words and phrases often lead to more conflict than light. The author provides a useful list of words to use and words to avoid in what she calls the Word Patrol.

The reasons these otherwise wise and productive suggestions are likely to fail in people from more disturbed families with ongoing repetitive dysfunction relationship patterns is because they are quickly and easily overcome by powerful family reactions to the patient's new behavior. If your new behavior causes your mother to suddenly stick her head in an oven, metaphorically or literally speaking, or if everybody you know and care about comes down on you like a pack of hungry wolves with the strong message, "You're wrong, change back," most people will wilt and go back to the way they were. This process is particularly vicious in families that produce people with borderline personality disorders, as described in this post.

Instead of responding with less defensiveness and anger, dysfunctional family members can twist around what anyone says no matter what words are used or avoided. They can employ ambiguity and double messages to such a degree that the person who is trying to engage them in problem solving does not know what was actually meant or whether or not any issue was really resolved.

This does not mean that family members in families like these cannot be reached. They most definitely can be. But the process is way more difficult and intricate than the solutions described in this book might seem to imply.

Antipsychotic Medication Used to Dope Up Unhappy Children.

There were two interesting editorials in the September 2015 issue of JAMA Psychiatry, a journal that used to be called the Archives of General Psychiatry and which is published by the American Medical Association. On the surface, the articles seem to address completely unrelated subjects, but on closer inspection, they both involve a common theme.

The first one is entitled "Antipsychotic Use in Youth Without Psychosis: a Double Edged Sword." I have of course railed in many of my blog posts about the use of antipsychotic medication for patients who do not have psychosis, because these agents can have serious drawbacks, and because better alternatives exist. In many cases, the better alternative is psychotherapy that can help the anxiety and mood symptoms that used to considered to be part and parcel of, and caused by, neurosis - behavioral disorders based both on internal ambivalence about one's life choices as well as interpersonal conflicts.

I have been particularly critical of the use of antipsychotic drugs in children who are almost never actually psychotic, and who are being diagnosed with bipolar disorder when they are in fact just misbehaving because of stress and family discord. As the JAMA Psychiatry editorial points out, the long term effects on the brains of developing children of antipsychotic drugs are unknown, although changes in the density of neurons have been observed.

The editorial mentions recent statistics that really do prove that the medications are being used in children primarily to shut them up. I quote: "All signs suggest that [antipsychotic medication use] among children is chiefly in those with aggression and behavioral dyscontrol, ADHD, and disruptive behavior disorders, but not for those with psychosis, bipolar mania, Tourette's Syndrome, or autism spectrum disorders." They are also being combined more and more with stimulants. 

Repeat after me, "Uppers and downers, and bears, oh my!"

Fewer than 25% of the young people in this study had any recorded psychotherapy of any kind. 

These drugs are effective for aggressive behavior - but not because they are specific for that problem, but because they are sedating and at times mind-numbing - as a side effect. Heroin would probably work just as well! After longer term use, however, the sedation side effect diminishes, so the drugs don't seem to work as well any more, which is when second and even third drugs are added.

The second editorial is titled, "Why Are Children Who Exhibit Psychopathology at High Risk for Psychopathology and Dysfunction in Adulthood?" Somebody actually did a study about this question, which should be high on my all time list of studies appropriate for the journals Duh! and No Shit, Sherlock. The study wasted time and money actually investigating the question of whether or not the proposition in question was even true. Turns out it was. Surprise!

Gee, childhood conduct disorder predicted antisocial tendencies. Who'd'a thunk? However, behavior problems in childhood predicted a wide range of different mental disorders, and was therefore a non-specific risk factor for a whole host of problems. 

Even less surprising, "a subthreshold or threshold mental disorder at some time from late childhood through adolescence predicts lower levels of adaptive functioning." So poorly functioning children become poorly functioning adults. I wonder why?

Actually, the question of why childhood behavior problems are non specific in being risk factors for various other psychiatric disorders is addressed in the editorial, and this part is where this editorial touches on the issues addressed by the other editorial discussed above. Three possible "causes" of why disturbed children become dysfunctional adults are listed. 

While there is some truth to the possibilities, which are not mutually exclusive by any means, it is simply amazing to me how the editorial author studiously avoids any clear-cut mention of ongoing family dysfunction as the culprit.

Family dysfunction is often chronic and ongoing and is rather widespread in our culture. To name just a few: parental drug abuse, divorces with multiple lovers coming and going and/or with children being passed around to different relatives, child abuse (physical, sexual, psychological), domestic violence, parenting issues (parents leaving children unattended or neglected for long periods, putting childcare entirely on the backs of older siblings, catering to children's every whim, invalidation, screaming and yelling, undermining the disciplinary efforts of one another), parents having multiple affairs, bad mouthing the other parent in front of the children and enlisting them as allies (triangulation), and general chaos at home. Is the author of the editorial really saying that none of these problems might explain the connection between childhood and adult psychiatric problems? Is that their argument?

If you don't believe that these patterns are common, I have two words for you: country music.

The closest the author of the editorial comes to this issue is reason #3. But notice the wording: ongoing instability is mentioned, but mostly things like poverty and living in bad neighborhoods. The nearest thing to family dysfunction that is mentioned is "lack of stable social support." Vague enough for you?

In reason #1, the authors seem to be blaming the child for the problems of the adults, rather than the other way around! They say, "exhibiting the behaviors that define conduct disorder in childhood may alienate peers and family."

Which do you think is more powerful and important: adults' behavior negatively impacting children, or children's behavior negatively impacting adults? This reminds me of a speaker touting Adderall at a grand rounds in our department who said, "If you had kids with ADHD, you might drink too much too!" In other words, he was saying that rambunctious children are a cause of alcoholism.

In reason #2, the authors do refer to environmental factors, but over-emphasize early ones. I guess the authors think either than family dysfunction ceases miraculously by virtue of a child turning 18, or that adults are not affected much any more at all by what their family members are doing to and with them. Sorry, but those assumptions are just plain nuts.

Before I quote what they listed as the three reasons, what is the connection I am implying to the issue of antipsychotic use in kids? It is this: instead of recommending family therapy, the doctors are just drugging the kids who act out in response to these problems.

Anyway, here are the reasons as they described:

1. Child psychopathology and adult psychopathology could have different causes, but experiencing mental health problems in childhood may directly or indirectly increase the risk for adult psychopathology. For example, exhibiting the behaviors that define conduct disorder in childhood may alienate peers and family, lead to curtailed education and incarceration, and increase the risk of brain and spinal cord injuries. In turn, these adverse consequences of childhood conduct disorder may place the individual at increased risk for later psychopathology and compromised adaptive functioning during adulthood.

2. It is possible that some or all of the causes of psychopathology across the life span operate early in life. That is, childhood psychopathology could predict psychopathology and compromised functioning in adulthood because they are both influenced by at least some of the same genetic and early environmental factors. Although there may also be later age specific causal influences, such enduring effects of early causal influences would foster the observed predictive association. At the level of mechanism, child and adult psychopathology would at least partly share atypical functioning in the same neurobiological processes in this case.

3. The predictive association between child psychopathology and adult psychopathology could reflect chronic or intermittent exposures to conditions that give rise to psychopathology when encountered across a life span. For example, psychopathology at all ages may be fostered by chronic economic instability, pollution, living in disorganized and violent neighborhoods, and lack of stable social support. To the extent that these causal environmental factors are stable across a person’s life, childhood psychopathology would reliably predict adult psychopathology even in the absence of a shared causal or mechanistic link between them. 

Book Review: "I, Mammal" by Loretta Graziano Breuning

"We mammals are curiously preoccupied with social hierarchy. You may say you don’t care about status, but if you filled a room with people who said that, they’d soon form a hierarchy based on how anti-status each person claims to be." ~ Loretta Breuning

            

Despite the protestations of those who like to think human beings are not part of the animal kingdom (What are we then, plants?), we have a lot in common with our fellow furry critters. Our brains have been shaped by thousands of generations of the evolution of both genes and culture.

In this fascinating book, the author focuses on something that we inherited very strongly from our biological past: our tendency to form hierarchical societies based on status. The group, and therefore our genes, survives attacks by predators and shortages of food by allowing the strongest among us to remain strong. Weaker members of the group survive by forming alliances with, and by deferring to, the strongest members of the heard.  

In human beings, because of cultural experiences and the fact that our cortexes can anticipate future consequences more so than any other mammal, status in a particular subculture may not be defined by brute strength against predators, but by a wide variety of status markers - musical talent, scientific discoveries, or even, as illustrated by the quote at the beginning of the post, by who in a group is the least outwardly concerned with what the majority of the herd thinks of status markers.

Hierarchy challenges among primates are relatively rare since the risks are often too high. However, as the so called alphas or dominant herd members - often defined by different parameters in males and females or in different primate species - show signs of weakness, such challenges become more common. Younger members of the group may begin to assert their own dominance through oppositionalism.

The animals that are close to the top of the hierarchy but not at the top - let's call them the betas - often extensively cater to the alphas and cling to their alliance with the alphas tenaciously, often at the cost of being under great stress. They tend to be the most status conscious individuals in the group, because they have the most to lose. As the author wryly observes, they're number two, so they try harder.

The author makes the case that we concern ourselves with status in response to what she calls the "happy" brain chemicals - dopamine, serotonin, oxytocin, and endorphins - which are released in very short spurts under certain environmental conditions, and induce us to do more of whatever activities seemed to promote them in the past. Our impulses to do so are not based on conscious thoughts but are automatic reactions to the activities of the more primitive part of the brain, the limbic system. While the thinking part of the brain, the cerebral cortex, can over-ride these tendencies, doing so feels extremely unpleasant is therefore most difficult.

The author admits that she is oversimplifying the roles of the "happy chemicals," and indeed is doing so drastically. These chemicals not only work together as she points out, but are involved in many different brain and bodily functions besides those to which she attributes to them. Additionally, they regulate one another in highly complicated feedback loops with input from many other chemicals such as GABA, cortisol and glutamate.

However, the simplified view is still helpful because it does provide us with an amazingly plausible understanding of some of the behavior of mammals, including ourselves, that otherwise may seem inexplicable. The author talks about how oxytocin rewards animals for sticking with the herd. Serotonin prods us to take a certain degree of risk in going out and getting our survival needs like food satisfied. 

Dopamine rewards us when we anticipate getting our needs met. Interestingly, it does not reward us after the needs have already been met, which might explain why initially thrilling experiences can suddenly "get old." Endorphins block pain, but only in situations such as when we need all of our strength to flee in order to survive.

The author emphasizes over and over again that she is describing what is happening normally within mammals, and that status behavior is often not based on conscious deliberation. The author is in favor of our endorsing our needs for status as well as being proud rather than overly humble about our accomplishments as a way of avoiding chronic dissatisfaction - which is often then blamed on members of our own status heirarchy who are higher in it than we are. However, she points out that tendency to strive for status is not right or wrong, it just is, and she is definitely not saying that it is what always should be. 

I understand why she feels the need to repeat this, as members of the habitually-offended community will miss the point the first twenty times it is made. Hower, it does make parts of the book repetitive and monotonous. But that is a minor quibble.

I learned some very interesting things from this book that I never knew. Did you know, for example, that there are 10 times more neurons connecting the brain to the eyes than the other way around? Our brain literally tells our eyes what to look for as well as what to look at among the myriad of things surrounding us in our environment.

Did you know that Gorilla fathers in the wild often search for a good family to give their daughters to - just like the people in many cultures who arrange marriages for their offspring?

The author does not discuss "schema" formation per se, but does talk about how past experiences become the dominant mode of responding automatically and without thought to the social environment between the ages of 2 and 3 - during and after the period during which the child is most dependent for survival on getting the attention of the primary caretakers. Nerve tracts formed by observing the behaviors of the parents become stronger and also develop thicker sheathes of a coating made of a substance called myelin, which greatly increases the speed of nerve conduction. 

After they are formed, these tracks then begin to function as if the individual were on autopilot. We only notice our behavior when it no longer seems to "work" on those around us. This is partly why parental behavior is so powerful in triggering our automatic repetitive behavioral responses.

Another aspect of our powerful urges to create status hierarchies is basic to the formation of neurotic (confused, conflicted, and amibivalent) behavior. This is easiest to see in dogs, but I believe it applies to kids as well. It was discussed extensively by Cesar Millan, TV's "dog whisperer."

Dogs will presume that they are the alpha animal in a household  - unless the owner acts like he or she is the alpha, and acts that way consistently. To create a neurotic dog, treat them as if they are the pack leader by catering to them, but then punish them when they act out the normal response to being a pack leader: aggression. Then follow the punishment with lots and lots of affection, which again causes the dog to feel like the alpha. Repeat over and over. The dog becomes neurotic "because it can't make sense of the social reward system" (p. 91). Readers of this blog may recognize a similar pattern that I describe when I write about problematic parenting styles.

In general, the ideas in the book apply somewhat more to automatic behaviors within a group than they do to automatic behavior between groups. As evolutionary biologist David Sloan Wilson points out, "Selfishness beats altruism within groups. Altruistic groups beat selfish groups. All else is commentary."

Evolution has also been shaped by kin groups and ethnic groups as well as by the evolution of human culture, in which the balance between collectivism and individualism has gradually evolved to favor the latter more than in past generations, as first described by Erich Fromm. These often competing forces comprise the evolutionary theory of  so-called multilevel selection.

Once again, however, oversimplifying reality can nonetheless help us understand important ideas that might otherwise be too murky.

Borderline Personality Family Dynamics: The Parents, Part II

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 that 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.

In Part I of this post, I described the one most common major issue - gender role conficts - and the resultant behavior patterns, that I have discovered leads individuals within a family to develop a severe conflict over the parenting role. In Part II, I will describe the other ones.

To repeat a caveat from the previous post: 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. 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 descendent.

Common issue #2 causing parental ambivalence over being parents: Untimely deaths. The loss of children, in particular, may make someone fearful over losing the others while, at the same time, may lead to parental resentment over the fears 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 was the parent of the therapist's BPD patient. 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 hyperconcern and insecurity. This is also an example of a parent giving up a child as a gift to a grandparent - the subject of my 10/15/2010 post.

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 - with which BPD is often confused these day by both incompetent psychiatrists and the public despite the fact that they do not look anything alike - in a parent may lead to the very chaos in families that generates BPD behavior in children. Children in such a family are at risk both biologically and 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 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 resent their own children. 

I     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.



•  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 the family become incapacitated for whatever reason, and the 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.

Such individuals often describe this state of affairs with statements such as “I never got to be a kid.” [This is not the reason, however, that Michael Jackson said that]. A similar situation occurs when parents who were infantalized by their own families of origin appear to be unable to take care of themselves. Their children then try to fill the power vacuum and take care of them 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 counter 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 reponsibility to provide a distraction to the parents' anger at one another by drawing anger on to themselves. This is one of the functions of the spoiler role.

Two or even several of these issues can present themselves simultaneously to a family, thus increasing parental ambivalence over the presence of children almost 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 of 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.

Borderline Personality Family Dynamics: The Parents, Part I

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 that 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 parent role as being an impediment to their personal fulfillment.

I also explained how the person with BPD develops the Spoiler role in response to the double messages that this emotional conflict leads such parents to give off to their children.

It's all well and good to try to understand the behavior of the individual with BPD in terms of a response to parental problems, but that just kicks the question of an explanation for the disorder back a generation. 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 special type of family genogram.  A genogram is sort of an emotional family tree, and is a mainstay of the type of family systems therapy designed by family therapy pioneer Murray Bowen.

Murray Bowen

Using historical figures and geneology records as illustrations, the book Genograms: Assessment and Intervention by Monica McGoldrick and Randy Gerson describes how genograms can be constructed .

Monica McGoldrick

The genograms described by Bowen therapists are, in my mind, incomplete.  They concentrate on which relatives were overinvolved or underinvolved with which other relatives, and whether these relationships were hostile or friendly.  IMO, this leave out an awful lot of important information.  Two individuals may easily have a hostile and enmeshed relationships with each other over one area of functioning, say work or love, and yet still be very distant, friendly and uninvolved with each other over a different area of functioning. 

In other words, these genograms omit the content of the family squabbles.  When the content is added to the genogram, one can then look for the historical experiences of the family that may have created the picture that is taking place in the present.

While I have indeed seen the parents of adult children who exhibit BPD in therapy and traced their genograms, I have also coached patients with the disorder themselves to construct their family's genogram.  We try to go back as far as we can to figure out what family experiences led to the parents' conflicts.  Sometimes the story goes back more than three generations and we may lose the historical scent, so to speak, in that no one alive knows what happened way back whenever.  Usually, however, certain patterns come to the fore.

In Part I of this post, I will describe the one most common major issue, and the resultant behavior patterns, that I have discovered leads individuals within a family to develop a severe conflict over the parenting role.  In Part II, I will describe some other ones.

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.  Rather, the issues in families that do have been magnified signficantly by an interacting tableau of historical events impacting the family and the individual proclivities of each and every family member and descendent. 

I will not describe the details of the magnification process here, but a full explanation can be found in my book, A Family Systems Approach to Individual Psychotherapy.

The most common cause of conflicts over the parenting role stems from cultural rules regarding gender role functioning.  Over the last century the opportunities open to women to explore their interests and ambitions have gradually expanded, and having a lot of children certainly put a damper on their ability to do this.  If a woman came from a family where the women were very bright and had a natural proclivity for being ambitious career-wise, this would often create difficulties for them since they lived in a male-dominated culture that was at best unfriendly to female career ambitions. 

To demonstrate how this might play out in a hypothetical family, I often discuss the evolving role of women in the United States since World War II. During the war, when all the men went off to fight, women in the United States entered the workforce in large numbers for the first time - in order to build the airplanes and tanks.  This phenomenon was known as "Rosie the Riveter." 

Some women found the experience of a career exhilerating, but when the war ended, they had to go back to just being wives and mothers once again.  The US govenment even made propaganda films thanking the women for their important work, but then encouraging them to go home and get barefoot and pregnant once again.  I have seen some of them; by today's standards they are positively jaw dropping. But effective. The Rosies did what they were told, and that is why we had the baby boom.

Rosie the Riveter

The daughters of this generation came of age in the sixties, when the women's liberation had started in earnest.  Women were more and more torn between the earlier gender role requirements and the new cultural opportunities expectations, and some women (as well as some men) did not make the transition very smoothly at all - for a variety of reasons.  One common reason: the Rosie the Riveters, having had a taste of the career world, would vicarioulsy live through the career aspirations of their daughters, but at the same time be extremely frightened by them.

Having children could easily bring the whole craziness to a head for some families.  Even today, parents feel very guilty about not spending as much time with their children as they would like, and they are often criticized at every turn by their own parents as well as the Phyllis Schlafly's of the world.  (Phyllis Schlafly was a career woman who made a career out of bashing career women).

Phyllis Sclafly

In doing genograms, one can often see just how far a family's operating rules lag behind the current cultural norms .  In anthropology, this problem is called cultural lag.  The cultural progression in Western nations, which is mimicked within certain families, was thus:  First, women really could not have careers at all.  Then, they could have careers, but only when they were single.  Then - and here is where many families with BPD members are stuck - they could only have careers when they had not yet had children.  Then, they could have careers even if married with children, but they had to give priority to the husband's career.  Last, both men and women were entitled to the same freedom.

Gender role confusion and conflict can, given the right combination of ingredients, create a nasty intrapsychic conflict over the very act of procreating. 

In Part II of this post, I will look at the rest of the historical factors and patterns that can create such a conflict: Deaths and illnesses, financial reverses, religious demands, parent-child role reversals, being the eldest child in a traditional family, and having children to "save the marriage."

Tangled Emotions

In a very funny sequence in the delightful new Disney animated fairy tale, Tangled, Rapunzel steps down from the tower that the woman whom she thinks is her mother has insisted she stay cooped up in all her life. She goes outside and touches the ground for the very first time - without that woman's knowledge.

She immediately experiences severe mood swings as she goes back and forth from the heights of ecstasy to the depths of despair over and over again in a very short time. One minute she is marveling at the feel of grass as she runs through. The next minute she is crying and wailing, "Oh, I'm a terrible daughter!" Soon thereafter she beams as she thrills in splashing through her first pool of water. Shortly after that she anxiously frets that she is hurting the woman who raised her and whom she loves.

The Harvard Guru of Drugging Children, Joseph Biederman, would probably diagnose her as bipolar.  The male character who entices Rapunzel to come down out of the tower, however, is a much better diagnostician.  He observes that she seems to be at war with herself.

Ah yes, neurosis.  That old Freudian psychoanalytic term that signifies a conflict going on within a person (intrapsychic conflict) that allegedly creates the severe anxiety and self-defeating behavior seen in patients who come for psychotherapy .  Different psychoanalytic, existential, and humanistic psychotherapy theoreticians (that is, those from certain schools of thought within the field) disagree over precisely what it is that "neurotic" people are most often conflicted, but they all stand by the concept.  

Freud thought the conflict was between our internalized values and our biological urges - most frequently aggression and libido (psychic and emotional energy associated with drives). 

Psychoanalyst Heinz Kohut thought it was over our needs to be validated, depend on others, and have a place to fit in within a family that may provide us with none of those things. 

Experiential therapists such as Carl Rogers and Fritz Perls thought it was over what our social system wants us to do and our need to self-actualize (achieve one's full potential through creativity, independence, spontaneity, and a grasp of the real world). 

Erik Erikson saw it as a struggle to negotiate different developmental stages over our lifetime, such as the struggle between the forces of identity and role confusion during adolescence or the struggle between the forces of integrity and despair in the elderly. 

Existential therapists think it concerns our need to find meaning and connection in an absurd universe in which our own death looms. 

Family Systems pioneer Murray Bowen thought it was between the forces of togetherness and the forces of individuality.

Almost all of the above concerns, one might note, center around a battle between doing what others expect of us and our own internal needs and desires.  Social conformity versus going our own way.  Such conflicts are hardly a novel or esoteric concept, and certainly they are well known to all of us.  Yet the term neurosis has almost disappeared from the psychiatric lexicon.  A huge mistake, in my opinion.

The term neurosis was all over the place in the first two editions of the diagnostic bible of the American Psychiatric Association (APA), the DSM, until the DSM III came out in 1980.  Then it was unceremoniously dropped.  To be sure, it had been invoked as a causative factor in disorders and behaviors which we now know it had no business being associated with, such as severe obsessive-compulsive disorder and homosexuality.

Just because it was not one of the major causative factors for some psychiatric or behavioral conditions does not mean, of course, that it is not a major causative factor in any of them.  Surely all of us think twice about doing what we want to do when we might be disowned by our parents or thrown in jail if we indulged ourselves.  Yet we still have our own powerful personal needs and desires.  That such conflict creates anxiety in us which can lead us to some strange compromises is almost indisputable.

But starting with the DSM-III, the powers that be wanted the list of psychiatric disorders to be merely descriptive and not get into the highly controversial area of what actually causes them (etiology).  Saying intrapsychic conflict is a major cause of a disorder is just psychoanalytic theory, so the reasoning goes.  And analysts have without a doubt been wrong about a great many things.

So psychiatrists are now stuck with the only official list of diagnoses in medicine that avoids the whole question of the causation of disorders.  It's like a compendium of the symptoms of infectious diseases that never mentions viruses, bacteria, or parasites!