When Your Parent Has An Undiagnosed Mental Illness

“You’re not going and that’s FINAL.”

I’d somehow known it was my mom, but had answered my dorm room phone anyway. I’d been irritated enough to try and piss her off on purpose, so I told her I was going to visit a friend at another college for the weekend and needed to end our conversation before traffic got heavy. I let my inner 13-year-old loose with an overdramatic sigh as my response.

“Well, as long as we’re paying for your college education, we have a say in what you do with your time and where you drive that car,” my mom said.

Timing really is everything; it may be one of the only truly accurate cliches. Since this was late 2000 (pre-free long distance on cell phones), I was attached to a cord and forced to listen to her lecture while standing next to my desk. I had started cleaning to quell my as-yet undiagnosed extreme ADHD and at the moment the words “we’re paying for your college education” hit my eardrum, I was looking at the financial aid letter I’d gotten earlier that day.

I’d known that I paid for half my tuition through a scholarship I earned with grades and a good SAT score and that I had received some grants because my parents weren’t wealthy. But I had never really looked at the numbers until I decided to add a second major and realized I’d need a “super senior” semester to complete the extra coursework — only possible if they extended my scholarship. I had been assured that my grades were good and that since the extension was to add a major and not because I had goofed around, I should breathe easy.

But people with panic/anxiety disorders don’t sleep easy; I had been waiting for the reassurance I was holding.

“But, mom,” I said matter-of-factly, “you and dad aren’t paying for my education.”

I was grateful for the few thousand a year the government said they had to chip in, don’t get me wrong. But scholarships, grants, and loans, my parents weren’t even paying enough my senior year to cover room and board. I’d earned most of my education and was borrowing a large portion of the remaining costs — almost $25,000 by the time I graduated.

I was looking right at the numbers; finally an argument with my mom I was guaranteed to win!

“YES. WE. ARE,” she responded. “Every penny of what I earn goes to your education, how can you be so ungrateful?”

My mom never got paid enough as a paraprofessional (aka, a “teacher’s aide”) in an elementary school learning disabilities class, but if they paid her at least the minimum wage required by law, she couldn’t mathematically have been right. “Mom, I’m literally holding my financial aid papers for this year and my extra semester. I’m covering over $12,000 in scholarship, plus some grant money, plus the, like, $7,000 in loans. Elmhurst is only $24,000 a year. I appreciate what you’ve contributed, but it’s pretty unfair to say you and dad paid for my college education. That really devalues the work I did to get here and that I’ve done since I’ve been here.”

She let me get all of that out, so I thought I’d won. Instead, she brushed it off with a disgusted “Tsk-ugh” noise (the memory of which can still make my blood boil) and a “whatever you saaaayyy.” I hung up and let it go — a strategy I’d begun employing more and more.

Ten years later, mom and I were sitting in a coffee shop on Michigan Avenue after going on the Chicago Architecture Tour, having spent the day exploring the city. She rarely came to visit — I can count on one hand the number of times she visited in the 15 years I lived in the Chicago area, just two hours from her) — so I was packing in all the enjoyable, low energy, no pressure tourist activities. It had been a pretty good 24-hour stretch — minus her taking very personal offense at my recent decision to stop eating meat because I felt healthier. We’d even shared 10 solid, comfortable silent minutes in the Millennium Park Intelligentsia Coffee window watching people go by.

It wouldn’t last.

“I still don’t think you appreciate that your father and I paid for your college education,” she sighed.

It’s like the topics in my mom’s mind are sorted the way you fill a Pez dispenser: The next time something’s needed to fill a void, you just get whatever was waiting from when you last set it down. Relevance, accuracy, audience — all secondary to the flavor lurking behind the face of your favorite character from childhood. There isn’t an order; don’t try and find one. Accept the randomness.

I knew from my calculations that my parents had at most kicked in $15–20,000 toward my approximately $100,000 brain. But she still thought, and thinks, that she and dad completely paid for my education, and was bothered that I didn’t acknowledge it, a decade after the conversation in my dorm room where I asserted that numbers have a finite value I couldn’t spin in my favor even if I wanted to.

Again, I wasn’t ungrateful. But holding a grudge for years and being willing to ruin our first pleasant time together since probably my early teens? That is really something.

I’d had my first glimmer that maybe her overreactions and inflated sense of martyrdom (she’s the ONLY person who EVER did anything for her aging mother or sister, lemme tell you) weren’t an act designed to make me feel guilty as she tried to bend the numbers on my financial aid form to her will. Now, seeing the way her brain still prioritized that incident as though none of the conversations or cry fests or promises to listen to each other and do better and work on our relationship had happened — it sank in fully.

“It’s not her fault.”

Undiagnosed mentally ill parents are a particular type of challenge. How do we and our doctors craft the most effective therapy if a parent has resisted any form of mental health care, leaving us without a vital lens through which to filter our childhood? For almost 30 years, I thought, “If I could only figure out why mom is this way, I could navigate the minefield.” I thought I was smart enough and controlled enough and had a strong enough will to build a relationship for us without her help if I had to — or at least manage the broken one we had.

It wasn’t until that day, when I realized we quite literally didn’t live in the same reality, that I stopped trying — and stopped being angry.

My first real therapist had taken a guess at a diagnosis for my mom: borderline personality disorder (BPD) with narcissistic tendencies. Because she had been refusing to so much as go to counseling with me since I was a teenager, all Dr. R. could do was posit theories a bit uncomfortably. After a few sessions, however, she’d sourced a fair percentage of my residual anxiety and self blame to my childhood and agreed it might be helpful to use meaningful terms that at least described her behavior as I’d experienced it.

“You understand that, ideally, your mother would come in with you at least once. Have you asked her?”

I’d stuck out more sessions than I could afford (it took me more than two years to pay for the 12 appointments with her I that I managed to fit into my 90-hour work schedule) because Dr. R. had almost instantaneously gotten my communication style and my facial expressions. I just stared at her with my jaw clenched.

“Right. Well, keep looking for chances to ask her; try and make it about her if you can.”

That advice is straight out of the handbook for having a loved one with either or both clinical narcissism or BPD; there’s a lot of overlap. I have friends who have been diagnosed with BPD and they tell me that it makes communication particularly challenging. Even when they know they are having what they would themselves describe as an irrational reaction — in the moment and even sometimes later — emotions are powerful enough to override the thought that it’d be helpful to take some time and space.

The National Institute of Mental Health lays out the biggest complication for people with BPD and their loved ones: “Unfortunately, BPD is often underdiagnosed or misdiagnosed.” Often, the only uncomfortable symptoms are co-occurring disorders like depression — brought on by the complications of living with an untreated condition that can disrupt interpersonal relationships.

In my mom’s case, she complained to her family physician that she had trouble paying attention and was sometimes sad — a situation I know about because she talked about the meds she was on and her difficulty with them multiple times a day for most of my teen years. Because she’s been tasked with diagnosing learning disorders in children at her job since ADHD diagnoses exploded in the 1990s, she was a shoo-in to get her symptoms validated by a doctor who has a reputation in my hometown for being loose with his prescription pad. Avoiding other, likely more accurate diagnoses was always easy for my mom, as she’s informed and believable.

Once I could see a fit with her medical history, behavior patterns, and preferred medications, I used Dr. R.’s admittedly shaky initial diagnosis for several years to cursorily try and understand what my mom needed and how I could give that to her. But I hadn’t done all that much investigation into narcissism, because it’s such a familiar word, until it was laid out for me in a way that hit home. Hard.

I was reading Merrill Markoe’s Cool, Calm & Contentious: Essays on a plane about a year after the coffee shop incident, having picked it up because a review said she wrote about her challenging relationship with her mother. Chapter Five, “But Enough About Me: Narcissism for Echoes,” was a revelation. She describes trying to get through a Christmas season with the ingenious plan of taking her mother shopping to avoid the dreaded moment of having to pretend to love the gift that, when opened, was clearly something the giver (her mother) would love, not the receiver (Markoe). I related, having tried similar things myself. It doesn’t go well and Markoe is left wondering how it had blown up in her face. I was about to get a lesson in the difference between colloquial narcissism — generally understood to mean being full of oneself — and the clinical definition, which roughly boils down to not understanding the difference between self and other.

Markoe had also been encouraged to investigate narcissism by a therapist:

“Finally I could see how my mother (like every narcissist in good standing) was chained to a seesaw of two behavioral extremes: grandiosity and rage. Anything that happened to her inspired one reaction or the other. Things were either all good or all bad. If it wasn’t summer, it was winter.
Here, at last, was an explanation for that mysterious fight on Christmas. When my mother was allowed to be the one to pick out my clothing, it fed her grandiosity and she was pleased. But when I suggested that I had an idea I liked better than hers, I was calling her worthless and therefore humiliating her. If I wasn’t feeding her grandiosity, then I was provoking her rage.”

A thousand childhood, teenage, and young adulthood memories slammed into me at once like we’d hit unexpected turbulence. “Holy shit, there are other people like my mom.” I hadn’t truly understood the clinical definition until someone explained it in an anecdote I could relate to. I kept reading, hoping the secret to connecting with my narcissist was ahead.

“Here’s how it works: When a narcissist admits you into their inner circle, you haven’t just made a friend, you have been annexed by an imperialist country with only one resident,” the chapter continued. “Your borders have been erased. The subtext of all future interactions with this person, forevermore, will be: ‘What’s mine is mine and what’s yours is mine.’ Welcome to a world where there is no you!”

That was it. My mom’s cringing, crying, angry, and often downright hysterical reactions to my opinions on things that didn’t relate to or affect her (see: my decision not to eat meat for a few years) were because of the cognitive dissonance I created by expressing something she wasn’t thinking or feeling. Her reactions were genuinely rooted in distress. And she wasn’t able to summon empathy for my feelings, because for her there are only The Feelings — ones she doesn’t even realize she expects us to share. She isn’t ignoring my feelings or failing to consider them; they don’t exist for her. It simply does not occur to her to consider that I have separate feelings, any more than it occurs to most of us to get around by doing cartwheels everywhere we go. She and I cannot have a conversation where we both express how we feel and what we need because she can’t process my feelings any more than I can process what my good friend the astrophysicist does for a living.

Leon F. Seltzer, Ph.D, backs up Markoe’s depiction by doing a great job of bridging the gap between clinical and common language in his piece at Psychology Today: “6 Signs of Narcissism You May Not Know About: How can you recognize the fragility behind the narcissist’s grandiosity.” He goes beyond describing symptoms like (just to name a few applicable ones) “grandiose sense of self-importance,” “requires excessive admiration (regularly fishes for compliments, and is highly susceptible to flattery),” “has a sense of entitlement,” “is interpersonally exploitative,” “lacks empathy,” and “is often envious of others or believes that others are envious of him or her” to explain how those tendencies can play out with the untreated narcissist in your life. I nodded along to all six, pausing at length to soak in “highly reactive to criticism,” “inordinately self-righteous and defensive,” and “[p]roject[s] onto others qualities, traits, and behaviors they can’t — or won’t — accept in themselves.”

That last one happens so often, recalling an anecdote would take effort; it was just an everyday occurrence when we lived together, and after I moved away from the house, something that happened every time we talked.

Whether or not she would or could be officially diagnosed with BPD or narcissism, I finally had a set of tendencies and thought-patterns I could use to beef up my own empathy and resolve the last of my anger. By the time I was able to get back into therapy — consistently this time, thanks to the Affordable Care Act reducing the insurance barriers to mental health treatment — I was resigned to the idea that we might never have a real relationship. She seemed determined to make that decision for the both of us. I’d told her repeatedly that if she was interested in having a genuine relationship with the person I am, not the person she wishes I was (the person who is still annexed by her, largely thinking as she does about things), that I would always want that.

I love her; she is my mother. Adopted kids like me have a particular caretaking impulse; we want our parents to feel loved, like we’re theirs and they’re ours. And they are. Doc (as I lovingly call my therapist) tells me I’m healthy for being open and she’s glad that I’ve expressed it, whether or not my mom is able (ever) to hear it.

Are my doctors and I right about the from-a-distance diagnosis? I can’t be sure. According to my aunt, my mom is in therapy now — not just community or church-based counseling, but with a certified medical professional who would presumably be capable of an accurate diagnosis. The trick is that if we’re in the right ballpark, her condition(s) are challenging to assess and she’s had six decades on the planet as well as an abundance of validation for her dysfunctional relationship habits that make her a master at fooling acquaintances and medical personnel. Anyone only seeing her an hour a week (if it’s that often) would need a long period to discern what is real and what is real for her.

I don’t expect to ever have the answer, have confirmation, but the third-party assessment my therapists have helped me patch together have given us a framework for exploring what I experienced, why my mom pops in and out of my life at random, and why she has always reacted with such hostility to anything about me that is unexpected or different from her. I understand that her actions are neither personal, nor deliberate.

I got a text message from her just before this past Christmas — the first since the thank you for the Mother’s Day/birthday flowers I’d sent in May — as I was leaving Doc’s office. I looked at it with Doc. It simply said: “Katie, I want you to know I’m thinking of you. :) I hope this is a great Christmas for you and your best new year yet!”

Doc put her hand on my arm and said, in a very motherly tone, “That’s all she can do, Katie. That’s all she can do.” I nodded and smiled. “Yep,” I said. “Indeed it is.”