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"

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