Mental Health

How to support the people you love

Laurie Edmundson, BA

Reprinted from "Families and Crisis" issue of Visions Journal, 2017, 12 (4), p. 19

I have had mental health problems my entire life. I was the kid who cried a lot and threw temper tantrums, then I was the kid who had unexplained stomach aches, then I was the kid with severe anger management problems.

I would kick, hit, scream and blow up at people for no reason; I was just a nightmare when I was angry. Then I was the girl with anxiety: I couldn’t go outside, talk on the phone or, basically, do anything that a “normal” person would be able to do.

Then my lashing out became even more dangerous: sometimes I would hurt those around me or harm myself. At the age of 19, after living through a never-ending cycle of one crisis after another, I received a diagnosis of borderline personality disorder.

Receiving a borderline personality disorder (BPD) diagnosis can be difficult: there is a lack of available and reliable information out there, and a lot of stigma associated with the disorder. I had heard for years from various counsellors and doctors that I had “borderline traits,” but I refused to accept it: all of the negative portrayals and false information I read online made it seem like BPD was a life sentence, but it doesn’t have to be. Only when I hit rock bottom and was lucky enough to connect with an amazing counsellor who explained everything I needed to know about BPD and my treatment options was I really able to accept and appreciate the diagnosis.

Once I got to that place, I realized that getting diagnosed was the best thing to have ever happened to me. It meant that I, as well as my friends and family, could understand what was behind my behaviours and the emotions I was experiencing, and I could finally start my recovery. Beginning dialectical behaviour therapy, a type of cognitive-behavioural therapy especially effective in the treatment of BPD, was what turned it around for me. Throughout the seven-month program, I learned life-changing skills and met other people who faced the same challenges I did.

Support of family

It is an understatement to say that my family relationships were tested many times prior to my diagnosis. My poor emotion regulation caused difficulties for family members; I had lashed out both physically and verbally, unable to cope with or understand my intense emotions.

It took them some time, but my parents are now incredibly informed about the disorder. Before I accepted treatment myself, my mom sought help at the Dialectical Behaviour Therapy Centre of Vancouver, where she learned about BPD and acquired the skills to help her as a parent of a child with the disorder. My father also became much more educated about mental health issues and is now the biggest supporter in my efforts to combat stigma and to teach the public about BPD. Sometimes when I am in crisis, it is still hard for my parents to know what to do. But if I say I need help—for example, if I need to get to the hospital emergency room—they do the best they can even if they do not fully understand what is going on.

Other family members affected by my disorder need longer to recover before they are able to forgive what happened in the years prior to my treatment. It is not easy for family and friends to live in a seemingly constant state of crisis, in which apparently random outbursts of verbal and physical aggression, ups and downs in relationships with others and suicidality caused distress in those around me.

Those who have known me for a long time see the changes in my functioning and have been able to move on from the past. The skills I have learned in therapy have helped me to regulate my emotions, deal with stress in healthier ways and function more effectively in interpersonal relationships. This has brought me closer to family and friends. And by learning about the disorder, we all understand better where some of my behaviours and emotions are coming from, and we are better equipped to see potential problems coming.

Support of friends

For a while, I was ashamed of my diagnosis and kept it very private, sharing it only on a need-to-know basis. After I finished a course of dialectical behaviour therapy in January of 2015 and was feeling much healthier and more grounded on my own, I began to tell my friends what was going on. BPD is not a commonly discussed disorder; my friends didn’t know what it was. But they were amazing about asking questions in a non-stigmatizing way and researching the disorder so they could better understand what was happening in my life.

I think of many of my friends as my family: they are my greatest support system. Not only do they keep me laughing and entertained and make me feel loved on a daily basis but they have also learned how to deal with a crisis when one arises. Since completing the therapy course, I spend most of my time happy, busy and in control of my emotions. There are, however, times when I still experience crisis (although these crisis periods are few and far between, and much less intense than they used to be before treatment). I don’t think I ever had a conversation with my friends about what to do if I was in crisis; they just somehow knew exactly how to help.

For example, in October of 2016, I experienced what was for me a very long crisis situation—brought on by a nasty combination of burnout, a medication change that didn’t work for me and some social stressors. Usually my crises come and go within hours or days, but this time I experienced almost a month of near-constant suicidality, urges to self-harm and constant anxiety.

Within hours of noticing something was wrong (within 24 hours after I began pulling back from work, feeling hopeless and becoming increasingly suicidal), my friends jumped to my rescue. One of them called me up and told me that I needed to come over for the weekend because I sounded like I “needed a friend.” It was a non-negotiable request: I went over and we just watched TV, talked and grabbed food together. I honestly believe that this is the best way to keep your friends and family safe when they are in crisis. You don’t have to talk about the problem, you just have to be there, keep them distracted and make sure they’re safe.

My friends are exceptional at decreasing my anxiety. Throughout that month, they never abandoned me, they never let me cancel plans, and they never let me be unsafe. They checked up on me regularly, made sure I was getting out of the house and listened to what was going on in my head whenever I needed them to.

How to help when the people you love are in crisis

Living with untreated BPD may involve a lot of crisis—for the individual with BPD and for their families and friends. The disorder can also be characterized by difficulties with interpersonal relationships, which can make accepting the support of family and friends—and supporting someone with BPD during a crisis—challenging. What I’ve learned is this:

1. Understanding the underlying causes of the behaviours of someone with BPD is key to repairing relationships and keeping everyone safe in crisis. It is important to educate yourself and your friends and family members about BPD and any other mental health issues you or your loved one with BPD might face.

2. The best way to be supported by and to support your loved ones is to spend time with them. Keep the person in crisis distracted and entertained while making sure

3. they are physically safe by being in their presence. In the midst of a crisis, someone with BPD may be unable to express or even think about what might help them in the moment. It can be helpful to discuss what to do in the event of a crisis before the crisis occurs—when the individual with BPD is mentally well.

4. BPD is treatable. An individual with BPD may experience crisis situations from time to time, but you can learn the skills to help yourself or your loved one to live a totally normal life and be a happy, healthy person.

Because of the stigma associated with BPD, and the erroneous assumption that the disorder is untreatable, it is easy for those living with BPD to lose hope—especially when the individual with BPD falls into the dark cycle of negative thoughts that often accompanies a crisis.

The most important thing I have learned is that there is hope. We are all human, and as humans we all have dark times that come and go. As long as we make a point of being there for the people we love, not only will we help decrease the likelihood of crisis but we will also keep them safe while they are waiting for the crisis to pass.