Q. My niece has been diagnosed by 3 different therapists with severe BPD; her condition has become so dangerous that her 9-year old daughter was removed from her home by DSS. Still, she denies that there is anything wrong with her and "blames" others, as well as "past wrongs" she has suffered, for the crisis situation she now finds herself in.

Can you suggest anything at all that we, her caregivers, can do to get her to face up to the reality of her condition? I am getting so worn out, and fearful for her, at the same time. A psychiatrist who evaluated her for about 30 minutes said that she was not in need of in-hospital treatment; yet if she does not face up to her problem, she could lose custody of her daughter for good, and that seems to be all that matters to her. ..to ensnare her child into the cocoon of her own sickness so that the child never will have a chance to realize her own "separateness". The child is living with me temporarily and I can already see signs of her "splitting," while struggling for her own identity. She is fiercely loyal to her mother and will do almost anything to "cover up" for her.

 

A. I'm sorry to hear of your difficult situation. It sounds from your description that the mother is much too sick to make good decisions for herself or for her daughter. When illnesses become so profound that they clearly interfere with parenting and functioning, then psychiatrists usually are comfortable with instituting some legal action that prevents the mentally ill person from being the primary parent to a minor child. Unfortunately, the illness is so difficult to identify and demonstrate to professionals or social service agencies, that a physician isn't comfortable pushing the legal system. At this time, my best advice to you is to document, document, document. Write down dates, times, and problems you are witnessing. Indicate the action you took and the response you got (either from a professional, the person ill, or whom ever you contacted). Be very detailed oriented. Write down exactly what you saw and what you experienced. When it comes time to talk with her, the police, DSS, the psychiatrist, use your documentation to support your concerns.

As you know, it is very difficult to be in the middle of this sort of situation. Remember to try to just "be there" for the daughter and refrain from trying to get her to take sides or act against her mother. As you experienced, children are very unlikely to turn away from their parent regardless of the parents' behavior. Just try to be a consistent, caring adult for the daughter. Sometimes this means not saying anything negative about the parent in question.