I Hate You—Don't Leave Me (9 page)

Dixie was the one bright spot in Margaret's life. Her other daughter, Julie, was already obese at age five and seemed a lost cause. But Margaret would do anything for Dixie. She clung to her daughter like a lifeline. But the more Margaret clung, the more Dixie resented it. She became more demanding, throwing tantrums and screaming about her mother's weight. The doctors could do nothing to help Margaret; they said she was manic-depressive and addicted to alcohol and amphetamines. The last time Margaret was in the hospital they gave her electroshock treatment. And now with Roger gone and Dixie always running away, the world was closing in.

After a few frantic months in Vegas, Dixie took off for Los Angeles, which was the same story as Vegas
:
she was promised cars and money and good times. Well, she had ridden in a lot of cars, but the good times were few and far between. Her friends were losers and sometimes she had to sleep with a guy to “borrow” a few bucks. Finally, with nothing but a few dollars in her jeans, she went back home.

Dixie arrived to find Roger gone and her mother in a thick fog of depression and drug-induced numbness. In all this bleakness at home, it wasn't long before Dixie fell back into her alcohol and drug habits. At fifteen she had been hospitalized twice for chemical abuse and was treated by a number of therapists. At sixteen, she became pregnant by a man she had met only a few weeks before. She married him soon after the pregnancy tests.

Seven months later, when Kim was born, the marriage began to fall apart. Dixie's husband was a weak and passive oaf who could not get his own life together, much less provide a solid home environment for their child.

By the time the baby was six months old, the marriage was over, and Dixie and Kim moved in with Margaret. It was then that Dixie became obsessed with her weight. She would go entire days without eating, and then eat frantically and voluminously only to vomit it all up in the toilet. What she couldn't get rid of by vomiting she eliminated in other ways: she ate squares of Ex-Lax as if they were candy. She exercised until sweat drenched her clothes and she was too exhausted to move. The pounds dropped off—but so did her health and her mood. Her periods stopped; her energy waned; her capacity to concentrate weakened. She became very depressed about her life, and for the first time suicide seemed like a real alternative.

Initially she felt safe and comfortable when she was readmitted to the hospital, but soon her old self returned. By the fourth day, she was trying to seduce her doctor; when he didn't respond, she threatened him with all sorts of retaliation. She demanded extra privileges and special attention from the nurses and refused to participate in unit activities.

As abruptly as she had gone into the hospital, she pronounced herself cured and demanded discharge, days after admission. Over the next year, she would be readmitted to the hospital several times. She would also see several psychotherapists, none of whom seemed to understand or know how to treat her dramatic mood shifts, her depression, her loneliness, her impulsiveness with men and drugs. She began to doubt that she could ever be happy.

It wasn't long before Margaret and Dixie were again fighting and screaming at each other. For Margaret it was like seeing herself growing up all over again and making the same mistakes. She couldn't bear to watch it any longer.

Margaret's father had been just like Roger, a lonely, unhappy man who had little to do with his family. Her mother ran the family much like Margaret ran hers. And just as Margaret clung to Dixie, so had her mother clung to Margaret, trying desperately to mold her every step of the way. Margaret was fed her mother's ideas and feelings—and enough food for a battalion. By the age of sixteen, she was grossly obese and taking large amounts of amphetamines prescribed by the family doctor to suppress her appetite. By the age of twenty, she was drinking alcohol and taking Fiorinal to bring her down from the amphetamines.

Margaret was never able to please her mother even as the constant struggle for control between them raged on. Neither could Margaret please her own daughter or husband. She had never been able to make anyone happy, she realized, not even herself. Yet she persisted in trying to please people who would not be pleased.

Now, with Roger gone and Dixie so sick, Margaret's life seemed to be falling apart. Dixie finally told her mother how Roger had sexually abused her. And before Roger left, he had bragged all about his women. Despite everything, Margaret still missed him. He was alone, she knew, just like she was.

It was time, Dixie recognized, to do something about the plight of this self-destructive family. Or at least herself anyway. A job would be the first priority, something to combat the relentless boredom. But she was nineteen years old with a two-year-old child and no husband, and she still hadn't graduated high school.

With characteristic compulsiveness, she flung herself into a high school equivalency program and received her diploma in a matter of months. Within days of obtaining her diploma, she was applying for loans and grants to attend college.

Margaret had begun to take care of Kim, and in many ways the arrangement looked like it might work: raising Kim gave Margaret some meaning in her life, Kim had built-in child care, and Dixie had time for her new mission in life. But soon, the system showed cracks: Margaret sometimes got too drunk or depressed to be of any help. When this happened, Dixie had a simple solution: she would threaten to take Kim away from Margaret. Both the grandmother and granddaughter obviously needed each other desperately, so Dixie was able to totally control the household.

Through it all, Dixie still managed to find time for men, though her frequent liaisons were usually of short duration. She seemed to follow a pattern: whenever a man started to care for her, she became bored. Distant, older men—unavailable doctors, married acquaintances, professors—were her usual type, but she would drop them the instant they responded to her flirtations. The young men she did date were all members of a church that was strictly opposed to premarital sex.

Dixie avoided women and had no female friends. She thought women were weak and uninteresting. Men, at least, had some substance. They were fools if they responded to her flirtations and hypocrites if they did not.

As time went on, the more Dixie succeeded in her studies, the more frightened she became. She could pursue a particular interest—school, a certain man—relentlessly, almost obsessively, but each success spurred ever higher, and more unrealistic, demands. Despite good grades, she would explode in rage and threaten to kill herself when she performed below her expectations on an exam.

At times like these, her mother would try to console her, but Margaret was also becoming preoccupied with suicide, and the roles often reversed. Mother and daughter were again shuffling in and out of the hospital trying to overcome depression and chemical abuse.

Like her mother and grandmother, Kim didn't know her father very well either. Sometimes he came to visit; sometimes she went to the house that he shared with his mother. He always seemed awkward around her.

With her mother detached and her grandmother ineffectual or preoccupied with her own problems, Kim took control of the household by the time she was four. She ignored Dixie, who responded by ignoring her. If Kim threw a tantrum, Margaret would cave in to her wishes.

The household was in an almost constant state of chaos. Sometimes both Margaret and Dixie would be in the hospital at the same time, Margaret for her drinking, Dixie for her bulimia. Kim would then go to her father's house, although he was unable to care for her and would have his own mother tend to her.

On the surface, Kim seemed oddly mature for a six-year-old, despite the chaos around her. To her, other kids were “just kids,” without her experience. She didn't think her particular type of maturity was unusual at all: she had seen old photographs of her mother and grandmother when they were her age, and in the snapshots they all had the same look.

In many respects, the Andersons' saga is typical of borderline cases: the factors contributing to the borderline syndrome often transcend generations. The genealogy of BPD is often rife with deep and long-lasting problems, including suicide, incest, drug abuse, violence, losses, and loneliness.

It has been observed that borderlines often have borderline mothers, who, in turn, have borderline mothers. This hereditary predisposition to BPD prompts a number of questions, such as: How do borderline traits develop? How are they passed down through families? Are they, indeed, passed down at all?

In examining the roots of this illness, these questions resurrect the traditional “nature versus nurture” (or,
temperament
versus
character
) question. The two major theories on the causes of
BPD
—one emphasizing developmental (psychological) roots, the other constitutional (biological and genetic) origins—reflect the dilemma.

A third theoretical category, which focuses on environmental and sociocultural factors, such as our fast-paced, fragmented societal structure, destruction of the nuclear family, increased divorce rates, increased reliance on nonparental day care, greater geographical mobility, and changing patterns of gender roles, is also important (see chapter 4). Though empirical research on these environmental elements is limited, some professionals speculate that these factors would tend to increase the prevalence of BPD.

The available evidence points to no one definitive cause—or even type of cause—of BPD. Rather, a combination of genetic, developmental, neurobiological, and social factors contribute to the development of the illness.

Family studies suggest that first-degree relatives of borderlines are several times more likely to show signs of a personality disorder, especially BPD, than the general public. These close family members are also significantly more likely to exhibit mood, impulse, and substance abuse disorders.
¹
It is unlikely that one gene contributes to BPD; instead, like most medical disorders, many chromosomal loci are activated or subdued—probably influenced by environmental factors—in the development of what we label BPD.

Biological and anatomical correlations with BPD have been demonstrated. In our book
Sometimes I Act Crazy
, we discuss in more detail how specific genes affect neurotransmitters (brain hormones, which relay messages between brain cells).
²
Dysfunction in some of these neurotransmitters, such as serotonin, norepinephrine, dopamine, and others, are associated with impulsivity, mood disorders, and other characteristics of BPD. These neurotransmitters also affect the balance of adrenaline and steroid production in the body. Some of the genes affecting these neurotransmitters have been associated with several psychiatric illnesses. However, studies with variable results demonstrate that
multiple
genes (intersecting with environmental stressors) contribute to the expression of most medical and psychiatric disorders.

The borderline's frequent abuse of food, alcohol, and other drugs—typically interpreted as self-destructive behavior—may also be seen as an attempt to self-medicate inner emotional turmoil. Borderlines frequently report the calming effects of self-mutilation; rather than feeling pain, they experience soothing relief or distraction from internal psychological pain. Self-mutilation, like any other physical trauma or stress, may result in the release of endorphins—the body's natural narcotic-like substances that provide relief during childbirth, physical traumas, long-distance running, and other physically stressful activities.

Changes in brain metabolism and morphology (or structure) are also associated with BPD. Borderline patients express hyperactivity in the part of the brain associated with emotionality and impulsivity (limbic areas), and decreased activity in the section that controls rational thought and regulation of emotions (the prefrontal cortex). (Similar imbalances are observed in patients suffering from depression and anxiety.) Additionally, volume changes in these parts of the brain are also associated with BPD and are correlated with these physiological changes.
³

These alterations in the brain may be related to brain injury or disease. A significant percentage of borderline patients have a history of brain trauma, encephalitis, epilepsy, learning disabilities, ADHD, and pregnancy complications.
⁴
These abnormalities are reflected in brain wave (EEG, or electroencephalogram) irregularities, metabolic dysfunction, and white and gray matter volume reductions.

Since failure to achieve healthy parent-child attachment may result in later character pathology, cognitive impairment on the part of the child and/or the parent may hinder the relationship. As the latest research strongly suggests that BPD may be at least partly inherited, parent and child may both experience dysfunction in cognitive and/or emotional connection. A poor communication fit may perpetuate the insecurities and impulse and affective defects that result in BPD.

Developmental theories on the causes of BPD focus on the delicate interactions between child and caregivers, especially during the first few years of life. The ages between eighteen and thirty months, when the child begins the struggle to gain autonomy, are particularly crucial. Some parents actively resist the child's progression toward separation and insist instead on a controlled, exclusive, often suffocating symbiosis. At the other extreme, other parents offer only erratic parenting (or are absent) during much of the child-raising period and so fail to provide sufficient attention to, and validation for, the child's feelings and experiences. Either extreme of parental behavior—behavioral over-control and/or emotional under-involvement—can result in the child's failure to develop a positive, stable sense of self and may lead to a constant, intense need for attachment and chronic fears of abandonment.