…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?
It’s
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