Sunday, December 14, 2014

How Do You Define Friendship? Results From My Friendship Survey

Friendship is kind of like love. You know it when you see it but trying to come up with a clear and universal definition can make your head ache. As a psychotherapist, I hear people talk about relationships all the time, but I found myself wanting a broader understanding of people’s views on friendship. So, I put together an online survey about it. It’s clearly a topic near and dear to our hearts because over 600 people responded. I asked a lot of different questions about friendship and got hundreds of detailed responses. People shared their most interesting and poignant perspectives when I asked them to write about how they defined friendship.

photo courtesy of Robin Smirnov

Some noteworthy comments about how hard it is to pin down a good definition include:

'Friendship' is a weird, nebulous concept. I wish I had some good theory of friendship, but I mostly just know it when I see it.

I don't have a great definition, but I know it's critical to my life.
Friendship comes in so many forms today it is difficult to define.

Trust and authenticity came up over and over:

Friendship is having someone you like, respect, and trust who likes, respects, and trusts you.

Friends are the people you trust enough to be yourself with
Friends should be trustworthy, honest and supportive.
A friend should be authentic, available, committed to my spiritual, mental and emotional growth.
A friend is someone who trusts me, and is trustworthy.
The level of trust changes and the conversations become deeper, a great need to keep in contact. Levels of intimacy in sharing, confiding, being there.

Connection and acceptance were considered crucial for close friendships:

Friends accept and acknowledge each other's differences as a part of who they are, and only try to change them if they actually want to change.
Friendship is about accepting, I think. It's about sharing some value or interest or goal and seeing that shared piece and treasuring it.
I define friendship as enduring and non-judgmental but I'll tell you the truth, it’s about connection.
Friendship is a bond between two people that fosters intimacy and connectedness.
I know I have a friend when I can be myself 100%.
Those that accept and embrace weird personality quirks and don't shame each other for them.
I would hope that unconditional affection and love, caring and compassion are all part of it.

Comfort and joy in each other’s company, doing things together, and having shared interests were also highly endorsed:

Friendship is someone you do things with like going to dinner, lunch, or shopping in your free time. I find it easier to maintain a friendship with someone who lives close by, has the same relationship status, has children similar in ages to yours, and has similar interests.
You should be able to relax around a friend and they should make you feel positive about yourself.
My friends share my interests, values and goals. They are responsive, respectful, and keep their judgments to themselves.
Friendship is when two or more people mutually enjoy the presence of one another. It is something that happens naturally. You cannot force it. Traits that I prefer include being a good listener, great with advice, emotional support, as well as being able to open up to me in return. I know I have a friend when I can be myself 100%.
Loyalty, honesty, sense of humour, ability to listen as well as converse, warmth, ability to give feedback in a kind manner.
Feeling comfortable and enjoying another's company. Trust, honesty and integrity. When you feel truly comfortable spending time together.
A friend is someone who is non-judgmental towards me, shares some interests, is interested in me as a person and someone I enjoy spending time with.
Friendship is enjoying the other person's company, bonding with each other and being there emotionally.

Loving and having affection for one another was also a common component:

I would hope that unconditional affection and love, caring and compassion are all part of it.
What I look for in a friend is someone who likes me, of course. Someone that's easy to talk to and who I can get along with really well.
The comfort, enjoyment and ease of being in anothers' company. Joyful anticipation of meeting/talking, taking a genuine and heartfelt interest in the other person.
A friend cares.
A friend is someone that you go out of your way to make time for, do things for, and care for. It is born out of love and care, generally through time/experiences/circumstances. It is work to be a good friend, and the rewards are similar to completing any difficult project/goal.
Friendship is having someone you like, respect, and trust who likes, respects, and trusts you. Trust, love, kindness, patience, sharing, related interests, support.
Trust, love, kindness, patience, sharing, related interests, support.
In our friendship, we have each other's backs, trust each other and love each other.
We are friends if we love each other. We are best friends when I love them more than myself, and vice versa.

Knowing each other well, being able to count on one another and supporting each other during the hard times were frequently cited:.

Friends support each other in hard times and celebrate together in good times.
Friendship is the ability to count on someone for both practical and emotional needs.
Friends hold you up when you can't hold yourself up. They have your back at all times but also hold you accountable. They're loving, compassionate, firm, and constant
Remembering what/who is important for them.
Friendship is being available to someone when they need you no matter how long it has been since you have seen or spoken to them.
Once you feel like you can call someone if you need help without feeling as though you are a burden, that's when someone becomes a friend.
Friendship is helping each other out, just because you want to. It's taking an interest in another's life.
A friend is someone who can be counted on to be there when the chips are down.
Friends are close. They know me. They understand.

People also made some interesting points about those who seemed like friends but weren’t. The popular term for this type of person is a frenemy. It’s clear from some of the responses that frenemies have caused considerable pain to those who thought they were really their friends.

I've had friends where we constantly bump heads and it's almost as if the friendship was a competition and I don't think that's healthy.

Someone I thought was my very best friend told me after my divorce that my depression made her depressed and she didn't want to be around me.
People have become selfish and have misplaced values.
It is hard to see that long-term friendships can still end. I thought that after age 50, our friendships were cemented for life, but was recently dropped by two women I thought of as good friends.
Compassion, empathy, open-mindedness are important but often lacking in society.
By my own definition, trust is the key variable in friendship, so I'm not certain anyone I don't trust can possibly be a friend. I'm a bit sad to reach that conclusion, especially since my own struggles to trust those around me may prevent close relationships.
A friend is someone you can share secrets with and know you won't be judged by labels, but just by your character. A friend is someone who is there for you through successes and failures but doesn't use it as gossip material.
Because of social media, friends of friends are more able to cause trouble with other friends, causing an uprising in cynical activities.
Some of the characteristics of a true friend include trustworthy, kind, considerate, caring, not controlling, secure personality, available, patient, encouraging, rejoices in your success- not jealous.

I want to express my most sincere gratitude to those who shared their opinions and stories about friendship with me. Check back for future blogs where I will be exploring the topic of friendship further and sharing more results from my survey.

Here is the link if you would like to respond to my friendship survey:

Monday, August 11, 2014

Good-bye Dear Mork: Reflections on the Tragic Suicide of Robin Williams

While it’s always hard to hear about someone taking his own life, it is especially hard to learn that someone who brought us as much laughter, joy and poignancy as Robin Williams did was in enough pain to decide suicide was the only answer. Robin Williams was a brilliant comic and gifted actor. I think his genius came from an overwhelming empathy for others paired with a lightening fast wit. His active mind nimbly skipped from one idea to the next, making creative leaps no one else could fathom until he articulated them.  He recognized both the glorious connectivity and essential aloneness in the basic human condition.  I think the pain and beauty of this understanding is what eventually broke his heart.  He tried to medicate the pain away with alcohol. It appears he won the battle but lost the war. After a long period of productive sobriety, eventually addiction once again reared its ugly head. This time, apparently it triumphed to the detriment of us all.

I “sorta kinda” met Robin Williams once. It was during his Mork and Mindy days. I had recently moved to Los Angeles for graduate school and was disappointed that I hadn’t yet crossed paths with a single celebrity. I flew back to NY to see my family. Upon my return I was waiting at the baggage claim at LAX when I saw him. There was no question in my mind that it was Robin Williams. He was wearing Mork’s signature baggy white carpenter pants, a striped shirt and rainbow suspenders. He was off by himself, almost as if standing in his own private bubble. My first inclination was to dash over, give him an exuberant hug and ask for his autograph. But I could tell he would not welcome this minor explosion of enthusiasm on my part so I refrained. I watched him out of the corner of my eye. I felt like I was missing my big chance for my first celebrity encounter. But I felt too much respect for his obvious desire for privacy so I did nothing.

Whenever I watched him in his movie roles or doing stand-up, I always contrasted the quick humor and glib confidence with the uncomfortable young man I observed at LAX. I’ve seen the pain behind the humor in many of those who make us laugh. The frantic cheery manic mask they cultivate often covers an essential awkwardness, a social discomfort and myriad fears that others will judge them and find them wanting. If you aren’t sure what to do, just make people laugh, right? Everyone will like you and want you around and your worries will be allayed, at least for the time being. Throw in a little alcohol and drugs and the fears are numbed away, until you sober up. Then, after the temporary reprieve, the toxic internal voices resume the incessant mutter of their dangerous damaging messages. And there’s nowhere to hide until the next drink, hit or comic performance begins the cycle anew.

My heart goes out to Robin Williams and all who loved him. I don’t presume to imagine the personal hell he must have been going through. But in taking his own life, he has just transferred his pain onto those he leaves behind.  Had he been thinking clearly, I don’t think he ever would have made such a choice. Suicidality is characterized by tunnel vision that convinces you everything is hopeless. This clouded judgment persuades those afflicted that the only way to end their pain is to end their lives. Suicidal people feel like the only solution is death and that’s simply why they do it. Those who have survived a suicide attempt usually express gratitude. The tunnel vision has often been moderated by the aftermath of the attempt and they appreciate their second chance at life.

Dear Mork, thank you for the gift of laughter. I deeply regret that it came at the expense of your own heart. I am so sorry we were unable to repay the debt you were due and help you see you could still choose life at this darkest of times. To everyone touched in any way by this tragic death, please remember that suicide is never the answer. When things get bleak and hopeless, ask for help. There is something worth living for, you've just lost sight of it. If you are feeling suicidal remember you can call the National Suicide Prevention Hotline at 1-800-273-8255. There is always someone who can help.

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 seems 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.

Take a look at the talk I gave at TEDxVail called "Why Can't We Be Friends"

Want to take my Friendship Survey to help me understand the changing face of friendship?

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