December 8, 2005

• Cluster B

  …with some excursions into Clusters A and C, and even possibly a
  little digression off Axis II onto Axis I.  Don’t expect to ever
  be able to pin me down on this topic.

  I have been incubating this essay for days.  I mentioned it to
  Greyfox in our nightly free-cell-minutes conversation last night, and
  got a big laugh out of him after I’d criticized DSM-IV’s classification
  system, when I said, “At least it’s better than what we had in the
  ‘fifties, when you were either psychotic or neurotic.”

  He related an anecdote about an old girlfriend who was in a therapy
  group for neurotics but somehow ended up sitting in with someone else
  from her group, on a group for psychotics.  After listening for a
  while to the sharing in that group, they turned to each other
  goggle-eyed and shared an unspoken exclamation to the effect that,
  “these people are REALLY nuts.”

  You probably had to be there.  …to get the joke, I mean. 
  But being there, in group therapy, would benefit any normal person in
  our culture.  Norms are a matter of statistical averages, and
  mental health is just not normal around here.   Quirks and
  kinks are the norm.  Virtually everyone exhibits addictive
  behavior in some form, the vast majority abuse at least one
  psychoactive substance, and most of us will, when asked, self-report
  several signs and symptoms of psychiatric disorders from either DSM’s
  Axis I (clinical, physical or biochemical-related disorders) or Axis II
  (behavioral disorders), or both.

  One of the saddest things about our sick culture is the stigma attached
  to getting mental health treatment.  Those boxes on employment
  apps and other forms that ask if you have ever been treated for a
  psychiatric condition, and then discriminate against you if you say
  yes, are like saying that it’s okay to run around with a disease, but
  not okay to go to a doctor to get it cured.

  I have been a patient in more than one psychiatric ward, have spent
  time in group therapy (as a client and as facilitator of groups), in
  one-on-one talk therapy (as client and as therapist), and in 12-Step
  recovery groups including Double Trouble in Recovery, which is for
  those of us with dual diagnoses, both addictions and psychiatric
  disorders.  The people I encounter in those therapeutic
  environments are in the aggregate both saner and happier than the mass
  of the herd running around in ignorance or in denial of their mental
  illnesses.

  When I was in school, as I mentioned, the field was divided into
  neurotics and psychotics.  Basically, psychotics were considered
  to be out of touch with reality, while neurotics were just
  touchy.  My first nursing job was in a small hospital without a
  discrete psychiatric ward, so I cared for people on the general medical
  and surgical ward who were being detoxed from drugs or were in
  restraints screaming out their psychotic lungs.

  One of our restrained and confused patients was a physician who
  practiced in that hospital.  Doctors make the worst patients, I
  learned from the older nurses then.  A gaggle of them giggling in
  the nurses’ station one night mentioned the hope that he would come out
  of that episode a little easier to work with.  He’d been a
  well-known neurotic, always fussing about something.  One of the
  nurses said, “Well, psychosis has always been the best cure for
  neurosis,” and the other nurses nodded sagely.

  My experience indicates that there’s some truth in that.  I’ve
  known a lot of people who went along in fairly bad shape,
  mental-health-wise, for a very long time, until they’d had a complete
  breakdown, gone on a balls-to-the-wall life-threatening drug binge, or
  just flipped out to the point where they were no longer able to feign
  sanity enough to get by in their daily life.  Following those
  breaks, “psychotic breaks,” they then recovered to a state much
  healthier than they’d been in before the break.

  Now that I’ve stated my credentials, my credo, and more than enough
  little anecdotes, let’s look at some specific mental
  disorders.   It doesn’t take much exploration through search
  engines to discover that crossover between Axis I and Axis II, and
  among Clusters A, B, and C on Axis II, is the norm.   It is
  far more likely that any addict will exhibit traits of several
  personality disorders (PD) than that he wont.  The majority of
  persons diagnosed with any PD have diagnoses of more than one. 
  Most people diagnosed with any PD or combination of PDs also have
  substance abuse issues.

  In my opinion, the reason for this lies in deficiencies of the
  classification system and not in any tendency among nutcases to be
  promiscuous in their nuttiness.  Actually, when discussing PD, it
  probably isn’t proper to refer to the people as nutcases.  In
  popular culture and the common lexicon, they are generally known as
  bitches and assholes, especially those in Cluster B.  Those in
  Clusters A and C can be assholes, too, but often are only weirdos.

  Cluster A: Paranoid | Schizoid
  | Schizotypal
  Cluster B: Antisocial | Borderline
  | Histrionic | Narcissistic
  Cluster C: Avoidant | Dependent
  | Obsessive-Compulsive

  My darlin’ spouse, my soulmate and partner in crime, Greyfox,
  takes his quirks primarily from Cluster B.  As for me, it’s one
  from column A and one from column C, if you want to believe the
  bullshit about psychic abilities being a sign of schizotypal PD. 
  Otherwise, I’m just obsessive-compulsive, and often justifiably proud
  of it, because when all else fails OCD gets things done.

  Greyfox is narcissistic and histrionic.  I didn’t know that when I
  met him.  I knew he displayed a lot of psychopathology but, as I
  said, when I was in school we weren’t talking in terms of PD and
  clusters and all that.  My daughter Angie
  first turned my attention toward PD and particularly NPD.  I had
  started getting some familiarity with its signs and symptoms even
  before Greyfox took the 4degreez personality test and diagnosed himself. 

  I had taken the test shortly before he did, but there were no surprises
  in it for me.  I diagnosed my own OCD almost 40 years ago, about
  the time I started transcending the “checking behavior” and other more
  pathological manifestations of it.  I had also previously encountered that
  schizotypal BS regarding psychic abilities.  I guess the origin of
  that misconception is connected with the common misconception that
  psychics are omniscient mind-readers.  I suppose that someone who
  imagined himself to be an omniscient mindreader would be
  schizotypal.  It’s semantics, after all.

  Anyway… Cluster B!  That’s where I was headed with this, isn’t
  it?  They are grandiose, have a sense of entitlement, lack
  empathy, tend to exaggerate both their successes and their little
  frustrations and ailments.  Suicide is prevalent in those with
  Cluster B PD, contemplated, attempted and completed.  They tend to
  lie and to con other people, often changing their names frequently or
  using aliases.  They are often impulsive, irritable and
  aggressive.  Reckless, irresponsible, exploitative, remorseless
  for the harm they do, and indifferent to the rights and welfare of
  others, if they don’t have criminal records, it’s usually just because
  they haven’t gotten caught.

  Unstable moods, self-image and relationships, and frequent displays of
  anger and/or fear characterize some of them.  They can be sexually
  seductive in behavior, vague and impressionistic in their style of
  communication, like to exaggerate, dramatize and call attention to
  themselves.  The fields of entertainment and politics are
  attractive to Cluster B personalities.  Being quite shallow and
  engaging in mostly superficial relationships, they tend to think of
  their relationships as more intimate than they are.  They have
  grandiose fantasies of success, wealth and power.   They
  crave admiration, tend to be envious of others and to imagine that
  others are envious of them.

  There are many theories regarding how these disorders begin.  One
  of the more prevalent theories is “nobody knows.”  A more credible
  one, in my opinion, involves abuse and/or neglect of certain essential
  interactions with caregivers in infancy and early childhood. 
  Nobody I have ever known who exhibits strong Cluster B tendencies wasn’t
  abused or neglected.  Nobody I’ve known who was abused and/or
  neglected has not experienced some of these tendencies, even if they
  have managed through treatment to transcend them.

  Leading edge, state-of-the-art research is finding correlations between
  these disorders and certain anomalies in brain chemistry and electrical
  activity.  Other researchers are finding permanent changes in the
  anatomy and electrochemistry of brains of abused or neglected children
  and of adults who have been traumatized through torture or great
  disasters, for example.  New and effective treatment modalities
  are making use
  of those research findings.

  The terms, “psychopath” and “sociopath” were once popular and used to
  refer to people who are now said to have PD.  Nicholas P. Swift,
  M.A., M.B.B.Chir. and Harpal S. Nandhra, M.B.B.S., M.R.C.Psych. have
  suggested the term, “borderpath”
  for those with Cluster B PD.  I say that anything that muddies the
  waters and confuses the issues more than they already are is a GOOD
  THING.  The nearer the psych professions come to discrediting DSM
  and its classifications and criteria, the closer we will all come to a
  saner society.

  In the last analysis, the answer is ABC:  it is ALL BRAIN
  CHEMISTRY… well, electro-chemistry really, but AEC isn’t all that
  catchy, is it?
  

  • 12:32 am
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