Tuesday, May 13, 2014

I'm Blogging for Mental Health 2014: Disney’s Movie "Frozen": Elsa as a case study in Borderline Personality Disorder

Don’t let them in. Conceal don’t feel. Don’t let them know. Let it go. Turn away and slam the door. Let the storm rage on, the cold never bothered me anyway.”  ~ Let It Go, from the movie Frozen

I’ve always enjoyed Disney movies. I can’t even count the number of times I sat with my children watching endless replays of The Little Mermaid, Beauty and the Beast and The Lion King. So, when Frozen came out I was eager to see it. However, Frozen has touched me in a way other Disney movies never have. The movie explores many deep psychological issues relating to sense of identity, social roles, rebellion, invalidation, feeling different, trying to be normal, self acceptance, emotional regulation, vulnerability, and relationships. This could explain why it sees to strongly resonate with many teens and young adults in a way that most Disney movies fail to do. My 22-year old son loves the movie and there is even a youtube video showing a group of hearty young marines gathered together singing its theme song.

In my work as a psychotherapist, I’ve helped many clients whose lives have been touched by borderine personality disorder. As I watched Frozen, it occurred to me that Elsa, the main character, showed many of the signs and symptoms of borderline personality disorder (BPD). BPD is a psychological condition characterized by poor impulse control and serious instability in mood, interpersonal relationships and self-image. People with BPD have a pattern of intense rages, bitterness, vindictiveness and punitiveness, which is usually significantly out of proportion to external realities. As a result, they frequently unwittingly sabotage and undermine themselves. People with BPD tend to have stormy relationships that swing from idealization and adoration to extreme rage, disappointment and devaluation, often without any apparent rhyme or reason. Because of their strong emotions and impulsive destructive anger they often feel like they are bad or evil and that they are doomed to harm anyone who loves them or gets close to them. They are highly sensitive to rejection and will often develop cold aloof exteriors as a way to manage their intense vulnerability. Retreating from relationships and withdrawing from the ordinary course of society as a way to handle their emotional dysregulation and impulsive behavior are classic BPD coping strategies.

Hopelessness, depression, social anxiety and feelings of being out of control are common features of BPD.  Chronic feelings of emptiness and identity confusion are typical as well. Unfortunately, those with BPD frequently engage in a dysfunctional type of thinking called emotional reasoning, such that if they feel it to be true, they believe it to be true, no critical thinking is engaged. People with BPD often see the world in terms of extremes, good vs evil, all vs none. They describe an internal tug of war within their own minds, a terrible struggle between their “emotional” mind and their “rational” mind. One way they handle this tug of war and their all or none thinking is through a dysfunctional regulatory coping strategy called splitting. In splitting, people with BPD “disown” or deny entire parts of themselves, frequently projecting them onto others. Splitting is especially common as a reaction to experiences of trauma or profound loss. Sometimes they even engage in self-harm as a way to punish the bad parts of themselves or they lash out as a way to inflict harm on those on whom they have projected the bad parts they have chosen to deny within themselves. Delusional thinking, paranoia, and dissociative reactions during times of severe stress are also common features of BPD.

People with BPD often grow up in emotionally invalidating environments. They typically describe feeling criticized or judged by those who were supposed to provide love and nurturance. In such families, legitimate concerns are rarely addressed directly, leaving children uncertain and confused. It’s hard to develop good judgment and adaptive coping skills when you aren’t getting healthy guidance, constructive feedback and positive encouragement from your parents. There are actually multiple paths to Borderline Personality Disorder and family dysfunction is only one of many risk factors. However, families of people who develop BPD are often characterized by poor communication, chronically mixed messages, absent contingencies, secrets, and shame.

Historically, Borderline Personality Disorder has been poorly understood by most medical professionals. Therefore, many doctors have misdiagnosed the disorder and advised patients and their parents to ignore the problems and hope that the condition will improve on its own with time. Symptoms of BPD can be significantly improved with psychotherapy. Treatment generally addresses the cognitive distortions, emotional dysregulation, relationship dysfunction and acting out that cause people with BPD and those who care about them so much misery. Since most people with BPD are very sensitive to rejection and abandonment, positive experiences of consistency, nurturance, emotional support and acceptance can be very healing.

Elsa demonstrates many classic borderline characteristics and life experiences. From early on, she sees herself as different (which she is). Many people with BPD don’t experience life and events in quite the same way as others. They are often different and highly sensitive relative to the norm. Elsa’s family is invalidating. They don’t help her manage or celebrate her uniqueness. Instead they pressure her to ignore it, control it, and keep it a secret. She pretends to be “good” and normal, instead of learning to be herself. She is never taught an adaptive way to regulate her emotions and impulses, so when she is playing with her little sister, she loses control. This loss of control harms her sister and is highly traumatic for her whole family. The “professional” they go to for help, doesn’t understand how to help Elsa handle herself adaptively either. Instead the family is told to act like nothing happened and to keep the traumatic event a secret. In her shame, guilt and confusion, Elsa isolates herself and her feelings of being dangerous to those she loves, different, bad and out of control continue to grow. Many individuals with BPD have an almost delusional sense of their own power and harbor serious fears that they will harm others with this power through their intense emotions and outbursts. We see this in Elsa’s fear that her inability to control her power will destroy those she loves.

As with many people with BPD, Elsa’s emotional problems escalate with adolescence. Elsa worries that the people and events of her coronation will trigger another episode like the one where she harmed her sister when they were young. She tries to be “perfect” and pretend everything is normal but she is unable to do it. It’s too much for her. She almost succeeds but ultimately, she loses control, unleashes the storm within and acts out without regard for how her actions will affect others or the kingdom for which she is assuming responsibility. In doing so, she undermines her coronation and sabotages her role as queen. As it turns out, she is completely unaware of the severe harm she has wrought. Instead of calming herself and dealing constructively with the aftermath of her actions she flees. She decides the most parsimonious way to handle her dangerousness is to isolate herself and keep others away. By choosing to be alone, she can stop pretending to be normal. She can avoid stress and vulnerability. She can insure she will never use her power to hurt anyone else.

Her emotions have been a roller coaster that she can’t get off. By isolating herself and building an ice castle to protect herself, she can stop pretending. She finally gets a break. In the song, Let It Go, she comes to some important realizations such as “it’s funny how some distance makes everything seem small and the fears that once controlled me can’t get to me at all. She comes to a degree of self-acceptance “The wind is howling like this swirling storm inside. Couldn’t keep it in, heaven knows I’ve tried.”, “Up here in the thin air, I can finally breathe. I know I’ve left a life behind but I’m too relieved to grieve.”, and of course, “Can’t hold it back no more, Let it go, let it go.”

When her sister attempts to rescue her from her self-imposed exile, Elsa’s reaction is once again out of proportion to the external reality. She vilifies those who want to help her and lashes out once again to push them away. And thus, once again, she grievously hurts the one person in the world who loves her, accepts her and wants to help her the most. Elsa’s mood swings and quixotic emotional changes are typical of people with BPD. She gets angry, the blizzard starts and just as suddenly it stops. She doesn’t know how to undo the damage her temper tantrums have unleashed and she feels helpless and hopeless.

Olaf is a particularly interesting character. He says Elsa made him so he knows how to find her. It appears that Olaf is the part of Elsa that she split off in her rage, shame and despair. He is the part of her that was innocent, loving, playful, joyful, funny and could handle stress with grace and equanimity. So long as the world is frozen, Olaf can exist on his own. When the world starts to thaw, Olaf begins to melt. Instead of letting him melt away she creates his own personal flurry to keep him alive and part of her life. He says, “Some people are worth melting for”. But she doesn’t allow Olaf to melt so she can keep the part of her that can experience love and joy alive, always.

Elsa’s healing comes about when she learns she is loved and will not be abandoned. Most importantly, she also learns to accept herself as she is, all the good and the bad. When she learns that she is loved and won’t be abandoned she becomes unfrozen and allows her healing to warm the world up and reverse the harm she has wrought. She allows love and joy back in to her life. She learns to manage her destructive impulses so she can handle them adaptively rather than lashing out when triggered by strong emotions. Elsa learns there is a place in the world for her. She is not so damaged, different or evil that the world is better off without her.

With love and support from those who care about her, Elsa saves herself and her kingdom. While her sister can enjoy romantic love and unfettered happiness, Elsa is still reserved. Romantic love is not yet in the cards for her. She still has to reconnect and rebuild herself. She must learn to manage her self and perhaps even learn that what she sees as a curse can also be a strength. She still has work to do. But her healing has begun. There is hope.

Read More About Mental Health Blog Day

I will be giving a TED talk on the changing face of friendship this winter. I would appreciate your help with my TED talk by clicking on the link below and completing my short survey.:

Check back for future blogs where I will be exploring the topic of friendship further and sharing the results of my survey.

Saturday, April 26, 2014

An introduction to my upcoming TED talk in a series of haikus

As mentioned in my earlier blogs, I am excited to be presenting at TEDxVailWomen on the topic of friendship. The amazing group of  women who will be presenting that day have been meeting online each month to develop our talks and support each other in our efforts. One of the presenters is a poet, which got us on the topic of poetry. We all decided to write haikus about our upcoming talks. Here's what I wrote:

Why can't we be friends?
If it's only about you
There's nothing for me

Your drama tires me
Stress, anger and resentment?
That's not what I want

When I feel lonely
And It seems like no one cares
Facebook friends are there

Are you a new friend?
You seem nice, I'm not sure yet
An acquaintance still

You are a great friend
Your kind funny sincere joy
Fills my empty places

A strong Friendship House
With the right people inside
Will keep your heart full

I would appreciate your help with my TED talk by clicking on the link below and completing my short survey.:

Check back for future blogs where I will be exploring the topic of friendship further and sharing the results of my survey.

Saturday, March 22, 2014

Loneliness Epidemic or Epic Connection? You Make the Call

Loneliness has recently been described as a silent epidemic. Surveys report that people now have fewer close friends then ever before. Experts assert that Facebook friends aren’t real friends and that the brave new world of social networking is making people more isolated and alienated than ever. A recent cover story in Oprah Magazine laments the demise of the simple phone call and warns that texting is an inadequate and potentially seditious substitute. Are people hiding from intimacy behind smart phones, social media, gaming and electronics? Or could our ability to interact via our devices in point of fact be an asset that is bringing us ever closer and creating genuine opportunities for socializing, emotional support and conversation? I find it interesting that many of these surveys, articles, and experts rarely provide a clear definition of the terms they study. What if we aren’t actually lonelier than before? What if what’s really called for is reconsideration of an outmoded conceptualization of friendship and loneliness?

Never before have we been so connected with such a diversity of choices and options for social interaction immediately at our fingertips. Does the data really justify experts’ warnings that these new alternatives are inferior to older established types of social interaction? Wasn’t the highly respectable telephone call once considered a new-fangled assault on conventional society? Don’t members of the old guard frequently voice dire predictions that fresh innovations are deficient and hazardous compared to their traditional time-honored counterparts? When you consider the rapid rate of change in our contemporary society, it’s reasonable to assume that how we look at friendship and loneliness needs to evolve at a comparable pace.  What we expect from marriage has undergone a radical transformation in the past 50 years.  Therefore, it seems plausible to presume that our conceptualization of friendship should be following a similar trajectory.

On a slightly different note, could it be possible that we might now have fewer closer friends because we are actually better off with fewer close friends? We are busier than ever before which means most of us have less time and energy to invest in our friendships than we did in the past. Many people in committed relationships consider their spouse or partner to be their best friend. Along with this partner, more friends at lower intensity may be the most parsimonious solution. In my opinion, an evolving mosaic of diverse friends accessible by telephone, online, and in-person seems the most elegant and practical antidote to “the loneliness epidemic”.

What about when a close friendship goes sour?  A chum who initially appears to be the answer to all your prayers can degenerate into a frenemy. Toxic and exploitative friendships are a dirty little secret no one usually admits to in polite company. Many people unquestioningly tolerate appallingly manipulative behavior in the name of close friendship. After all, who doesn’t aspire to having a BFF? But, what if you find your bestie requires too much time, effort, accommodation, frustration and discontent on your part with precious little in return? Should this one-sided level of compromise be required to keep a close friendship intact? Might it not be better to have several satisfying friendships of moderate emotional intensity with a lower overall risk of toxicity from any one person? Of course, all successful relationships will require some degree of work and negotiation but no friendship should be consistently inequitable, controlling or draining.  Your pals should lift you up, energize you and make you happy. You shouldn’t feel a sense of dread when the caller ID lights up with the phone number of someone who you call your best friend.

Or are we lonely because we give up too soon or we don’t value relationships as we should? Maybe we have all grown so selfish and self-absorbed that we can’t appreciate a good relationship when we have one staring us right in the face. What if our expectations have become excessively narcissistic, misguided and unrealistic? Perhaps the idealized images projected by TV, books and movies, seasoned with a sizeable dose of nostalgia, in combination with our fast paced, immediate-gratification culture have come together in a way that makes emotionally intimate friendship impossible or unsustainable. Maybe superficiality is the best anyone can really do and we should simply embrace it and be content with our lot.

Besides, how do you really know if someone is your friend anyway? Conversely, how do you know when someone who you think is your friend really isn’t? Frankly, how do you determine who is an asset in your relationship life and who is actually a liability? Who do you consider to be your friend? Is your next-door neighbor your friend or merely an acquaintance? What about your spouse, sibling or child? Is the barista you chat with every day when you pick up your morning coffee your friend? What about your coworkers or the other riders in your carpool or the person who works out next to you at the gym 3 times a week? Is the childhood buddy you talk to once every ten years at your high school reunion your friend? Can someone you’ve never met face to face really be your friend? Are all of your Facebook friends real friends? What about the people you play online games with every day? If virtual friends are real friends what does it mean when they can’t give you a hug, bring you soup when you’re sick or help you move that new couch into your apartment? We call dogs, “mans best friend.” Can a dog really be your best friend? The answers are not always easy or straightforward.

While we are on the subject, what exactly is a best friend, anyway? How do you decide when an acquaintance has become a friend? When is someone who was once your friend officially a friend no longer? All of these questions can get your head spinning and make you want to hide under the covers in sheer frustration.  To find the answers, it’s important to take some time to seriously consider your personal understanding of what friendship and loneliness mean in your own life. Your definition of friendship will be as unique as your fingerprint. It will help you determine who really is a friend to you and what significance this has for your sense of social support, interconnection and loneliness.

I am currently exploring the answers to these questions using a survey I’ve developed. In December, I will giving a TED talk on the topic of friendship. I would appreciate your input on my talk by clicking on the link below and completing my survey. 

Check back for future blogs where I will be exploring the topic of friendship further and sharing the results of my survey.

Sunday, March 2, 2014

The Changing Face of Friendship: A Brief Survey

I’m pleased and honored to be giving a TED talk at TEDxVailWomen in December. Giving a TED talk has been a bucket list item of mine for years.

TED is all about sharing ideas worth spreading. In the 9 minutes allocated for my talk I will be discussing the changing face of friendship. Loneliness appears to be a silent epidemic in modern society. Research finds that more people report feeling lonely than at any previous time in history. In my psychotherapy practice, clients frequently admit to intense feelings of loneliness and difficulty finding and maintaining friendships. One might think these feelings are specifically related to the reason, such as depression, anxiety, stress or family problems that is bringing the client to therapy in the first place. However, I hear this lament from many different types of clients, regardless of their reason for seeking therapy. Many of these clients are charming, interesting, successful people who report no significant problems with friendships in the past.

Because of my general interest in the topic, I frequently ask people about their friendships. I hear the same poignant messages over and over such as, “I used to have a lot of close friends but now I don’t.” or “I hardly ever see my friends anymore.” or "I have a lot of people I enjoy staying in touch with but I don't have anyone to help me if I'm sick or I need to move a piece of furniture." or "Once my best friend got married, our relationship was never the same again." or "I'm on Facebook all the time but it only makes me feel worse." or "Nobody takes the time to really talk with each other anymore and I miss it."

 All of this seems paradoxical in light of our constant connectedness through social networking and electronic devices. I hope that by understanding the changes in our lifestyles, expectations, attitudes and resources over the past few decades, we can find ways to achieve greater feelings of closeness, connection and intimacy and enjoy the many benefits of better social support.

I’ve created a short questionnaire to survey opinions, issues, trends and attitudes about contemporary friendships. I want to understand how people define the difference between a friend, a best friend and an acquaintance. I am curious how access to social media, technology and smart phones influences feelings of loneliness and connection. How much time do we actually spend in face-to-face vs virtual encounters with friends? Who is considered a friend? How is friendship defined for most people? Exploring what different demographic groups have to say about loneliness and friendship will also be very interesting.

Many people have asked how they might be able to help me with my talk and my friendship project.

If you would like to help, I have two requests. The first is that you complete the brief friendship survey I’ve created by clicking on the link below and that you share this link (or just this whole blog) with as many people as you can. This will give me lots of data to work with. 

My second request is that you share your own ideas about friendship with me, either through comments on this blog or by back-channeling me via email. If you would like to email me, please click the link below for the email address listed on my website. You can also message me through my professional Facebook page (link below). Sadly, whenever I directly post my email address on my blog I get bombarded by spam.

Here's some of what I would like to hear:

What are some of your own favorite friendship stories?
What is your opinion about why friendships have changed so much?
What you think makes someone a best friend?
How does an acquaintance become a friend?
How have you dealt with a toxic friendship?
How you define the word friend?
How have friendships in your work place changed over time?
Do you believe loneliness is a silent epidemic?
What factors do you think are contributing to people’s feelings of loneliness?
And anything else you might like to share about the topic of friendship.

Thanks so much for your help. I look forward to your answers!

Thursday, February 6, 2014

Social Media, Cyberbullying and Teens

This afternoon, I had the privilege of giving a presentation on social media, cyberbullying and teens at the Vail Ski and Snowboard Academy in Minturn, Colorado. The school, near Vail Ski Resort, has about 175 students in 5th-12th grades. The students are elite athletes training for professional competition and careers in skiing and snowboarding.  Before meeting the students, we were given a guided tour of the school. What a wonderful facility! And, I must say the view from every window was breath-taking.

Today's presentation was organized by the school's counseling office at the request of some of the middle school students who wanted more in-depth discussions about social media. There were three parts. Part I, presented by a local company called Mobloggy, discussed "branding" issues and how to create a social media presence that will create a positive brand for each athlete; a brand that sponsors will find desirable and appealing and enhances the athlete's overall possibility for a successful future in their chosen sport. Part II was my presentation, discussing positive responsible use of social media and how to handle cyberbullying. Part III was given by the Eagle County Sheriff's office and offered lots of information about the legal implications of irresponsible social media use and inappropriate photo sharing, with special emphasis on "sexting" and it's legal ramifications with regards to child pornography. It was very sobering and I hope it will help the kids think twice before sharing anything inappropriate online.

We did a separate presentation for the 7-12 graders and the 5th and 6th graders.  The 7th-12th grade group was the larger of the two. The kids really seemed interested and engaged. The second, for the 5th and 6th graders, was a relatively lighter version of the first. The information about sexting was omitted because it was deemed too graphic for kids this young. The younger kids really seemed to enjoy my part of the talk. They made lots of great comments and asked lots of good questions. Their openness and enthusiasm was really refreshing and made interacting with these students a lot of fun!

I hope the students and staff at the Vail Ski and Snowboard Academy found all of today's presentations educational and thought provoking. I can say it was certainly worth taking the afternoon off and driving out to Minturn for!

Here are copies of the powerpoint slides I created for my presentation today:

Copyright Jill Squyres PhD. 
Not to be used or copied without permission from the author