Category Archives: Psychotic Disorders

Is Psychiatry a Pseudoscience?

Vancouver! Vancouver! This is it!: I think Mr Lindsay would do well to read Crazy Like Us if he hasn’t already.

Is psychiatry a pseudoscience?

Yes and no. That is, the phenomena of mental illness are genuine, but their investigation is sorely lacking in rigor. This added to the fact that psychiatry is a business in the US and the Anglosphere more generally results in huge over-diagnosis, pathologizing difference, etc., and children are the easiest marks for this con.

As someone who works with people who have actual diagnosed DSM disorders on a regular basis, I definitely think that a lot of these things are real, and they are indeed disorders. We actually try very hard not to pathologize anything that could remotely be seen as normal conduct, and we cast a wide net for that phrase.

The people I deal with have Axis 1 disorders, and they are suffering from the most incredible pain and misery. Many of them are almost literally living in Hell. I lost one client to suicide. Further, the disorder often makes it very hard for them to function well in society. It’s not uncommon that I have clients who have been hospitalized, sometimes on multiple occasions.

Axis 2 is real too. Those are real disorders. I have known some people on Axis 2 (personality disorders), and trust me, they are not normal in any way, shape or form. Mostly they are making other people miserable, but the disorder is usually screwing up their own life in a big way too.

As far as psychiatry being a pseudoscience, well, I get people who are misdiagnosed all the time. I’m not allowed to give legal DSM diagnoses, but I tell them my opinion on what they have and how they are misdiagnosed. Often I get people diagnosed psychotic who are not psychotic at all.

Some of them are pretty crazy, but just because you feel really nuts does not mean you are psychotic. Psychosis is a loss of touch with reality. If you are not out of touch with reality, you are not psychotic. Psychosis is grossly misdiagnosed in the US. If you feel really crazy, you get diagnosed “psychotic.” It is just the field’s way of saying “this person is seriously crazy.” But seriously crazy is not the same thing as psychotic. You would not believe how nuts people can feel without being psychotic. Your world can get seriously weirded out when you are not even psychotic at all.

I also get people who are mis-prescribed all the time. Psychiatrists hand this stuff out like candy and they severely play down the side effects.

In short, yes it’s a real science, but we don’t have formal tests like lab tests or X-rays to actually make a perfect diagnosis. So we have to go on symptoms, and it can be quite hard to diagnose a mentally ill person correctly. I have dealt with people who had been diagnosed with 10-15 different disorders. There was no way that they currently had all of those conditions when I spoke to them. This person was extremely ill though, I would agree with that. Unbelievably ill.

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Filed under Health, Medicine, Mental Illness, Personality Disorders, Psychology, Psychopathology, Psychotherapy, Psychotic Disorders, Science

The Nature of Denial in Various Mental Disorders

It is very hard to accept that you have a mental illness. Even a minor one. Most people who don’t have one act like they would not accept it even if they did. I have known many people in my life with untreated and even undiagnosed issues that went on for years, if not lifetimes.

Anxiety disorders are different because they are so painful and ego-dystonic but even there a lot of folks don’t want to admit it. The fact that almost everyone has low levels of anxiety on a regular basis nowadays does not help matters and it enables you to think you are just like everyone else.

Manics are notorious for not admitting they were ill. I have known a number of them in my life and probably 50% refused to admit that they had it. It is not helpful that the manic seems quite normal to many of his friends drawn in by the overblown charm of the hypomanic. I have sat in rooms with flagrant, raving, idiotic hypomanics charming the whole room with their grandiosity. I sat there shaking my head. It’s obviously an illness. Yes, it’s possible to be too damn happy. Hypomania is a case of excessive happiness. They are so happy, they’re nuts! If you do not believe that hypomanics are crazy, spend some time around one if you get a chance. This is not normal, healthy happiness, which I actually believe that there cannot be too much of, despite society saying that being too happy is “not adult” and “acting like a child.”

Schizophrenics almost all deny that they are ill. It is a hallmark feature of the disorder. Even after they have been told countless times that they have schizophrenia, even after multiple hospitalizations, even after years on antipsychotic drugs, they still insist that they don’t have schizophrenia. This is not so much a denial mechanism as a feature of the disorder. The disorder is such that it blinds you to the fact that you even have it! This disorder feels completely real, as if this is the normal way that life is.

OK, suppose you went to classes at college yesterday. The next day you tell people that you went to college yesterday, and everyone laughs at you and says no you didn’t. And to make matters worse, says you’re crazy for thinking you went to school yesterday. What would you think.? You remember full well that you went to school the other day. You remember it loud and clear. How they can they say that some obvious thing that I clearly experienced did not happen. After a while, they start thinking it’s everyone else that’s nuts and not them.

Almost all people with personality disorders deny that they are ill, as mentioned above. Everything is everyone else’s fault, and they go through their whole lives like that.

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Filed under Anxiety Disorders, Mental Illness, Personality Disorders, Psychology, Psychopathology, Psychotic Disorders, Schizophrenia

Mental Health Diagnosis: More of an Art Than a Science

A commenter writes:

How can they be “pretty damn good” and “wrong”?

Because diagnosis of mental illness is much more of an art than a science, that’s why. It’s almost impossible to get it right every time. It’s not uncommon for people to have maybe 10-15 different diagnoses. This is because psychiatric diagnosis is murderously hard. I don’t blame most clinicians for getting it wrong. It’s nothing like the diagnosis of physical illness at all.

I see a number of people with OCD who got misdiagnosed as psychotic, but that’s actually pretty common, and looking at their symptoms, I don’t blame the clinician for dx’ing them as psychotic.

When OCD is very bad, they appear psychotic, and the people I am thinking of have symptoms that appear exactly like psychotic symptoms, except they are not. They have what I call “fake delusions”, “fake illusions”, “fake hallucinations”, along with a lot of derealization and depersonalization, etc. Sometimes they can even get actual perceptual distortions, which makes things even stranger.

These people who have a form of health anxiety where they worry that they are going psychotic, and then they develop a lot of “fake psychotic” symptoms psychosomatically in the same way that patients develop fake physical symptoms psychosomatically as part of some hypochondriasis.

I know more about this stuff than the vast majority of clinicians, and I have seen more people with this problem than most clinicians will ever see. I have seen scores of people with this problem, maybe 50-75. I have gotten to the point where I can tell “Schiz OCD” (OCD with the fear of schizophrenia/psychosis theme) apart from true psychosis, but it’s not clear or easy at all if you haven’t dealt with a lot of these people. Actually it is not even easy for me sometimes.

Furthermore, in the course of diagnosing these people, you will get a few people who are actually psychotic, and you have to tell them apart from the Schiz O’ers. They are much more ill than the Schiz O’ers, but their symptoms are extremely confusing and they seem to have OCD going along concurrently with some sort of psychotic process. They are very confusing.

I don’t think mental health workers are inept, and I work in the field myself. And I do not think they are crazy at all. Most of the ones I have dealt with were amazingly sane.

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Filed under Anxiety Disorders, Mental Illness, OCD, Psychology, Psychopathology, Psychotherapy, Psychotic Disorders

The “Crazy” Personality Disorders: Schizotypal Personality Disorder

People with Schizotypal Personality Disorder can often appear quite crazy. Schizotypals really just have a mild case of schizophrenia. They can function but often not very well, and others think they are weird, odd, strange, crazy or disturbing. They never seek help, in part because they are often quite paranoid. Many are capable of working, especially if they work alone. Some are highly intelligent. They prefer to be alone.

They often do not take care of themselves personally by not showering or shaving or wearing old clothes with holes in them. They can have poor personal hygiene because they might think hygiene is not important.

Many of their relatives have schizophrenia, and they score the same as schizophrenics on tests such as eye movement and eye tracking tests where schizophrenics score abnormally. It appears that whatever causes schizophrenia, possibly a gene, is fully expressed or fully triggered in schizophrenics. Perhaps schizophrenics get a higher genetic loading for the illness.

In Schizotypals, perhaps the gene does not fully express or maybe they get a lower genetic loading for the illness. About 15% of Schizotypals eventually develop Schizophrenia. They can have brief psychotic breaks.

James Holmes, the young man who shot up the Aurora theater, was an excellent case study for Schizotypal PD. If you want to understand this illness, study this man and his life.

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Filed under Crime, Mental Illness, Personality Disorders, Psychology, Psychopathology, Psychotic Disorders, Schizophrenia, Schizotypal

A Bit About Paranoid Schizophrenia, with a Real Life Example

If you were going psychotic and hearing voices, you would not even know they were voices. When you first heard them, if you were in your home, you would go around looking for the person hiding in your house because it would sound exactly like a person talking in your home. You would search everywhere, under the bed, behind the couch, everywhere someone could hide.

I spent a year hanging out with a paranoid schizophrenic every day. He heard voices all the time, but he was convinced they were coming form the radio or the vents or wherever. For instance, he kept demanding that we take apart the radio in my car to find the recorder in there that was putting out the recordings.

When he first came over to my house, he said he heard someone down in the cellar, so we went down there to look, and there was no one there. I thought it was pretty weird at the time, and I did not know what to think of it, as I had just met the guy, and I did not know he had schizophrenia.

After I hung around with him a while, I started to put two and two together and realized that he was slowly developing paranoid schizophrenia. I figured this out because I had been studying mental illness for 25 years. I had never dealt with a paranoid schizophrenic up close and personal like that before, but he seemed to be a textbook case based on everything that I had read.

He was 28 years old, and the symptoms seem to have started when he was about 23 and at college. There is often a long slow prodrome with paranoid schizophrenia. So while it does have a later onset often in the late 20’s and early 30’s, there has often been a long slow prodrome going on characterized by slow deterioration for even up to five or ten years.

Paranoid schizophrenics do seem to function somewhat better than the rest of schizophrenics, possibly due to this later onset. Some of them have even married, had children, started on careers or opened businesses when the disease hits, so they have had some illness-free years in which to develop their personalities. Hence the personality is more intact in paranoid schizophrenia than with the other forms.

Later I would be over at his place, and he would hear the voices coming out of the vents. He lived with his Mom, and he insisted that his Mom put a recorder in there to harass him, and he wanted me to help him take the vent apart to “look for the tape recorder.” He had a lot of arguments with his Mom about her “putting the recorder in the vent.”

It was very difficult to deal with the guy because he heard the voices, and they were so loud and clear that he would whip around and say, “You hear that?” and he would point to the car radio or the vent or wherever. I always said no, and it was making him mad because the sound to him was clear as a bell, and it was absurd that I could not hear it. So he was always accusing me of being a liar and saying I did not hear the voices when really I did.

After a while, I started making excuses and saying things like I had a problem with my hearing.

The problem is do not want to agree with the person when they say they hear voices because you are just reinforcing their craziness, and pretty soon you will be working with the person to take your car radio apart to “find the microphone.”

Furthermore, it’s best not to reinforce their delusions either because you will just strengthen the craziness.

Actually it probably would not hurt to say you hear the voices too or agree with their delusions, but I always worried that it might make them worse.

For instance, a schizophrenic says someone is persecuting them. Well, you can either agree or not agree. If you agree, you run the risk of reinforcing their belief, and they might get so reinforced, convinced and angry that they assault the person.

Another problem is that I would take him places with me sometimes, say to my doctors appointments, while we were running about trying to get him an apartment. While there, say as we were leaving, he would insist that someone in the waiting room had said some particular insult to him. Actually no one had said anything to him, much less the insult that he heard. He would want to go back in the waiting room and challenge the person over the insult, and it would be rather difficult to convince him not to do that.

He had done very well in college and was a great basketball player but not such a good student. At one point, he had moved into an apartment with other people, but that all ended when he accused them of messing with him through the walls of the apartment. He also accused people of breaking into his car. He would go out to his car, and it would seem like someone had broken into it or messed with stuff inside. He eventually had to move out due to this, and he moved back home to live with his Mom.

I kept trying to get him into an apartment down in Fresno, but things kept falling apart. He would get into the new place, and it would have the damn recorders in it too, and he would accuse the guy was rented it to him of putting the recorders in there. I met one of the men who rented to him, and he was dumbfounded, shaking his head, and could not make sense out of my friend at all. His attitude was “Good God, what the Hell is the matter with this guy!?”

My friend was a mulatto, and he had a very charming personality along with being very goodlooking. Everywhere we went, he would walk up to young White women and chat them up in his usual engaging manner, and they would usually be very interested in him. He was quite a charmer and could really talk to the girls. It was insulting as the girls would always rather talk to the insane guy than to me who was not nuts, although I was in my 40’s at the time I must admit.

If you were out in public with him, and he was chatting up women or whatever, he would typically not seem crazy at all. Instead he would seem to be a perfectly normal, charming, extroverted guy.

I was never afraid of him. Everyone kept telling me he was dangerous, and they were all trying to get me to get rid of him as a friend. He didn’t seem violent to me, and I can read people pretty well. He did yell a lot but not usually at me – more at the folks who were “persecuting him.” The whole time I was with him, I would be looking at him and trying to read his mind (I am a very good mindreader) to figure out if he was going to do something violent. I never got any vibes off of him that he was going to be dangerous, so I wasn’t really worried about him.

However, people close to me eventually convinced me to ditch him, which was not easy. I saw him a few times later around town and gave him a couple of rides. Later he had somehow gotten a job at the local supermarket, but by that time, he was deteriorating even more, and he had become very quiet and would almost ever talk.

I later heard that he was down in my city roaming around on the streets and hanging out at the mentally ill drop-in place.

My friend would never admit to being even slightly mentally ill, and after a while I stopped confronting him about it. But I did try to get him to see a psychiatrist I knew under the guise of giving him some pills for his nerves to calm him down along with some other phony excuses. She was good at dealing with psychotic people who would not admit they were ill, and she would often succeed in surreptitiously giving them some antipsychotics under the guise of calming their nerves or other phony excuses. You have to be a bit sneaky with these people when they will not admit they are ill. I have known people who had psychotic or seriously mentally ill relatives who they were considering dosing with antipsychotics in their orange juice or coffee. I actually think that would be a morally proper act.

The problem in psychosis is that the person typically has no idea that they are ill. Whether they do not want to admit for psychological reasons such as stigma or whether they can’t realize they are ill because psychosis blinds the person to the fact that they are ill, I am not sure. I suspect some of both. Some people are episodically mentally ill, and when they get better, they will often not admit that they had been ill due to stigma or ego reasons.

The problem in psychosis is that the part of the body that is needed to recognize that you are ill is itself sick. The person can’t figure that they are ill because in order to do that, you usually have to be at least somewhat sane. In fact the presence of insight is an excellent diagnostic feature in mental illness, and the greater the insight, the better the prognosis.

Insight is also a very serious problem in Bipolar Disorder, even in the milder phase known as Hypomania.

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Filed under Mental Illness, Psychology, Psychopathology, Psychotherapy, Psychotic Disorders, Schizophrenia

What Are the Definitions of Normal and Abnormal?

My concept of normal means “what most people do.” Therefore, by that definition, unfortunately heterosexuality is normal and homosexuality, no matter which way you want to look at it, is simply abnormal behavior. Now this abnormal behavior may simply be natural in the many homosexuals who simply got wired up that way as they cannot change it.

But we can say the same thing about so many other things, including many chronic illnesses like schizophrenia. Sure it is natural for schizophrenics to have schizophrenia because that’s how they got wired up. On the other hand, schizophrenic thinking and behavior is simply abnormal because 99% of the population does not think or behave like this and 97% of the population doesn’t even think or behave that way a little bit.

We can also define abnormal and not only minority behavior but also minority behavior that, if engaged in by the majority, would be a very bad thing.

If a majority of society were homosexual, that would not be a good thing at all. In fact, it would be utterly abnormal and society may well collapse. Therefore homosexual behavior is abnormally because surely you can’t have a world where everyone acts this way.

Schizophrenia is abnormal because if a majority of people were schizophrenic or even quasi-schizophrenic (Schizotypal Personality Disorder), society would not work at all, and in fact it would probably completely collapse. You can’t have a world where everyone is schizophrenic.

The problem with defining abnormal as minority behavior is that we run into problems. Being a great football player is abnormal in a sense. Only a few folks are like this. But society would not collapse if everyone were great at football. Society might be pretty weird, but it wouldn’t fall apart.

You can think of many other examples of behaviors that are objectively good or positive but are minority behaviors because the majority don’t behave that way.

In order to get out of that conundrum, we should define abnormal as:

1. Minority behavior.

2. Behavior that is either non-adaptive or would be highly destructive if a majority displayed the behavior.

 

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Filed under Heterosexuality, Homosexuality, Mental Illness, Personality Disorders, Psychology, Psychopathology, Psychotic Disorders, Schizophrenia, Schizotypal, Sex

Numbing Out As Either a Symptom-Derived or Core-Derived

Messi writes:

Schizoids are really attached to their aloofness for some reason. I don’t really get it, it just makes me feel vulnerable and trapped.

As for the neurology vs. psychology argument, I’m not sure. Some parts are unquestionably neurological – you can’t “think” your way out of flat affect. Yet at the same time, the most effective tips are usually psychological.

It seems like their 2-levels of schizoid-ness. There’s the emotional depersonalization and blunted affect, which can only be fixed through physical changes like sleep deprivation, anemia or medication, and the psychological layer beneath it with the withdrawal and vulnerability. You can’t work on the bottom layer without breaking through the top first.

It is looking like the top layer of schizoidness is the symptom cluster and it seems to be biological. In this case the numbing is core-derived in the brain. This can only be altered as Messi points out by actually changing your brain.

The commenter points out that he doubts if you can think your way out of a flat affect. I would add that I doubt if you can think your way to a true flat affect either.

What is the difference between flat, blunted and constricted affect? A therapist told me I have constricted affect but not a blunted or flat affect.

I used to be very emotional but I just deliberately and gradually numbed myself out in order to cope with a lot of ugly life stresses. At the time, I could not think of any other way to cope. Every time something awful would happen to me or around me, I would feel myself numbing out just a bit more. It seemed to be a perfectly logical thing to do. I wasn’t even thinking about it or whether or not it was a good idea, I was just doing it without questioning it as there didn’t seem to be any alternative.

I do not really mind that much but it is true that a lot of people really do not like it one bit. They think I am Spock or a robot. It’s not true as I do have emotions, but it more than they are muted in terms of showing them to the outside world. I have been trying to get my emotions back for many years now since I pretty much deliberately killed them off, but I do not seem to be able to do so. Why that is I have no idea.

I know a lot of wildly emotional people, mostly females.

Quite a few girlfriends have been like this. I remember once I was lying in bed with a girlfriend one morning and she was looking at me and suddenly she looked stunned and she said, “You don’t have any feelings. How come you don’t have any feelings?” She was a notorious emotional rollercoaster, probably a Borderline, though she was wildly, head over heels, out of her mind in love with me. I said, “I don’t want to end up like you. Look at you. That’s what happens to emotional people. Your emotions are all over the place, here, there and everywhere. I don’t want to be like that.” She seemed to think that was a pretty good answer.

Also I look around at Man World and it seems like in US Man World, a lot of men have pretty much cut off or shut down their feelings. That seems to be simply a normal way of being a mature, adult, masculine man. We use words like “businesslike, controlled and stable” to refer to these people. So I feel that by numbing out, I am just being a normal, masculine man in my society. What’s wrong with that? Men are not supposed to be all emo.

I remember when I was pretty emotional, it seemed like every time I got emo people, mostly men, would start giving me a hard time about it. They acted like I was screwing up or blowing it by showing those emotions. I guess the message really is, “You’re acting like a girl.”

The whole message I got is that in Man World they want you pretty much shut down. One thing was for sure, that’s that you can’t get sad. In and in the world of offices, you can’t get mad either. The life of many middle class men in our society seems to be, “You can’t get mad and you can’t get sad.” Of course a lot of them do anyway, so what you find is a lot of men masking rage and especially depression with drugs, alcohol, gambling, sex, workaholism, and probably numbing out.

I hear that all sorts of folks numb themselves out and you should not confuse this symptom-derived numbing with core-derived personality structure numbing, which may be biological, as in the case of schizophrenia, schizoid PD and schizotypal PD.

In the former type a formerly emotionally full person simply numbs out as a defense mechanism to cope with life. Probably emotionality is recoverable somehow and anyway, in most cases, they are probably not as numbed out as you might think. A lot of them probably have emotions that they are just hiding pretty well.

In the latter case the numbing out is a core essential part of the personality structure, possibly biologically mediated. If it is biologically derived, there was never a full emotional life to numb out in the first place. They were numbed out biologically from Day One.

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Filed under American, Biology, Culture, Gender Studies, Man World, Mental Illness, Neuroscience, Personality Disorders, Psychology, Psychopathology, Psychotic Disorders, Schizophrenia, Schizotypal, Symptoms

A Case of Schizotypal Personality Disorder

From here, an apparent case of Schizotypal Personality Disorder. I do not understand this disorder very well. It seems like they might have something wrong with their brains. It is much more common in close relatives of those with schizophrenia. It almost looks like a very mild form of schizophrenic illness. I’ve never had a client with this problem, I’ve never seen a case of it in my life, and I would have a hard time diagnosing it.

If there is something wrong with their brains, then why call it a personality disorder? Is there any evidence that this is actually a defensive structure or personality style as opposed to more of an Axis 1 type symptom-based rather than Axis 2 core-based illness?

Although I have never seen a case of it, this case history looks remarkably like what I think it looks like. Note that this man has received two diagnoses from afar, Paranoid Schizophrenia and Schizotypal Personality Disorder. Paranoid Schizophrenia is not correct. An unmedicated full blown Paranoid Schizophrenic would not have been regularly employed for long after the onset of illness. He would not have married three times and fathered a son after the onset of illness. His behavior and attire would not remarkably improve after a woman married him and could more or less take care of him. An untreated schizophrenic would not have it together no matter how much mothering his wife gave him.

This man has never been hospitalized or diagnosed, and I doubt if he has ever set foot in a clinician’s office. Part of the problem with getting types to come in is that they are so nuts and paranoid that they literally are too crazy and suspicious to come in to see a clinician. Obviously the clinician is one of the enemies who is plotting against him.

This man obviously doesn’t think there is anything wrong with him, so that’s another reason why he will never show up. I think it is quite clear that this man is not normal in any way, shape or form, and he is so ill that his behavior goes way beyond eccentricity and free-sprited Bohemian creative type all the way off into serious pathology and craziness. It looks like this illness also limits his life in some pretty important ways too. But apparently he doesn’t think he has a problem. If there’s any problem, apparently it’s with other people. Which is pretty Axis 2-like right there.

My dad is very messed up. Extremely. He was abusive and traumatized my whole family.

His appearance is pretty eccentric. His hair and beard are wild and stained from cigarettes. He wears really dirty clothes covered in industrial glue or varnish from his job…in public. This all goes away if his wife (who he’s had three of) takes care of him.

He has really intense, sometimes bizarre beliefs about politics. I remember him once calling me up to talk about how his wife was “stealing his liberty.” As in the liberty due him from the founding fathers of the US.

He’s paranoid to an extreme. He used to throw the telephone away because he thought people were listening. He thinks that people stalk him. He thinks co-workers are secretly taking nude photos of him and putting them on the internet. I can tell you he has NEVER used a computer let alone the internet…all because he’s paranoid.

He used to call me up after watching a news report about terrorism to warn me about the NYC subway I take to work everyday. I tried to reassure him by telling him my particular train is not a target because it isn’t well used. He told me that’s what, “they wanted me to think.”

He strongly dislikes most institutions: banks, universities, and governments.

He has no friends at all. Never has.

He spends his time in basements or attics.

He’s very smart, but has no interest in making money to support himself.

My mom and his former wife, an LCSW, think he’s schizophrenic. My therapist says he sounds like a schizotypal.

BUT…if you asked if he was paranoid, he’d say no. If you asked if he was eccentric, he’d say he just thinks differently from most people (with a kind of superior attitude). If you asked why he doesn’t have friends, he’d say he prefers being alone.

Regardless, anyone else can easily see that he’s really, seriously, an odd person.

Any of this make sense to people dx with schizotypal?

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Filed under Mental Illness, Personality Disorders, Psychology, Psychopathology, Psychotherapy, Psychotic Disorders, Schizophrenia, Schizotypal

The Lowdown on Psychotherapy

Juliette Kochenderfer-Moore writes:

I also question why some people want to work in therapy sometimes, and the endless job titles have my head spinning.

Is a  therapist the same as a counselor? What the hell is a psychotherapist? A psychoanalyst? Are a psychologist and psychiatrist the same thing?

Seriously. Most of them seem totally bored out of their minds at what they do for a living. Why are we paying bucket loads of money to go get labeled and undergo “treatment,” of which the success rate is dubious?

Most are not bored, most therapists enjoy what they are doing, I have liked most of my therapists, and I thought most of them were very smart.

Also it can be very good money. Licensed therapists can make a lot of money.

Anyone can be a “counselor” in California. Even you can. But hardly anyone does it because realistically, who is going to pay you good money to sit there and listen to their problems?

A psychotherapist is someone with a credential – in California, either a Clinical Psychologist, a Psychiatrist, a Masters in Social Work, or a Licensed Clinical Social Worker.

A psychoanalyst practices Freudian psychoanalysis. This seems to be going out, as a lot of it has not stood up to scientific scrutiny.

A psychologist is a Clinical Psychologist. They have a PhD. Most of them are extremely good.

A psychiatrist is an MD. They are medical doctors. I don’t like them quite as much as the Clinical Psychologists. I think Clinical Psychologists actually understand psychology and the psyche better than Psychiatrists. Nowadays Psychiatrists are mostly just drug pushers. If you want drugs, you need to go to a Psychiatrist.

Therapy is costly. I think psychotherapy is a luxury good that is available only in wealthy societies. You don’t really need it, but it can really make you feel better. I am convinced that many to even most 3rd World people could benefit from psychotherapy, but their societies are too poor, so they cannot afford these things.

Labeling is generally a good idea. Only 14% of the population has a personality disorder. That’s not a lot. Most people with a PD diagnosis definitely are very difficult people at best, I assure you. I say this because I have known a number of Personality Disordered persons for decades, and they are truly impossible and infuriating human beings. There is no way on Earth that is normal behavior. It’s not acceptable to act abrasive and annoying such that you screw up your own life and that of everyone around you. That’s not a definition of mental health.

Most people with anxiety disorders really have them. If you do diagnosis properly, and you put the person on the right drug, it is amazing what you can do.

I think it is incredible just how “syndromal” a lot of these conditions are. I work with OCD people, and this is a syndrome if I ever saw one. All of these people seem like they are reading off the same script. I know them so well that I can almost spot one half a mile away blindfolded. Also I can practically crawl up around in the brains of my clients and tell them exactly what they are thinking because I know exactly how this illness makes you think.

The Personality Disorders are also very “syndromal,” often shockingly so.

Why so many mental disorders look nearly as syndromal as physical disorders is a mystery, but I think a good answer might be that of all of the possible ways of acting crazy, humans are somehow limited to a small subset of all such craziness due to the limitations of the human brain and condition. In other words, because there are only a certain number of ways to go nuts, humans tend to go nuts in very syndromal like patterns that look a lot like physical illnesses in the way they seem to come as a “package.”

Some people are so nervous that they just do not function well. Others are going round and round about other anxiety like conditions. Panic Disorder is crippling. PTSD is a very bad illness.

Depression is real. I have known some depressives who simply cannot function at all due to extreme depression. It is almost like they have a physical condition.

Bipolar disorder is as straight up syndrome, and these people are just not well. It’s not even really ok to be hypomanic. They’re not rational, they don’t act very sensibly, and the irritable ones are insufferable jerks who quarrel and fight with everyone all the time. Full blown mania is so non-adaptive that the person almost needs to be committed so they don’t completely destroy their lives during the episode.

It’s not ok to be psychotic. Psychotic people cannot function and are often a danger to themselves or others. They desperately need to be treated.

Schizophrenia is a full-blown illness in which there is something wrong with their brains.

Many of these illnesses are highly genetic, with Manic Depression and OCD showing some of the highest loadings of all, near 85%. Obviously these people simply have something wrong with their brains.

Psychotherapy is overpriced, but we are all doing therapy with each other all the time. Anytime you talk to any of your friends or loved ones about any psychological stuff they have going and try to give them advice on how to deal with it, you are doing therapy. Anytime you try to help people to live their lives better, function better, quit making dumb mistakes and stop engaging in unhealthy behavior patterns, you are doing psychotherapy.

The problem is that most people do not want to help you get over your troubles or teach you how to function better and quit doing nonadaptive things. Also therapists have a lot of training, and they are simply better than your ordinary person off the street at such things.

But really anytime you talk to a very wise person who gives you a lot of good wisdom on how to live your life, solve your problems, function better and stop doing non-adaptive things, you are basically getting psychotherapy, as the best therapists are simply very wise people who help you by sharing some of their wisdom with you.

Psychotherapy works very well, and it certainly works as well as the competition.

What is the competition?

Get better on your own? Talk to your friends and family get them to talk you out of it? Go to church? Read some books? Get a girlfriend or boyfriend? Get a better job? Move to a new area? Join a cult? Join a self-help movement? Go to the gym? Read Manosphere Blogs and learn Game?

None of that stuff works as well as psychotherapy for helping people with diagnosed proven psychological disorders. And none of it works as well as psychotherapy for even problems in living, growth work (trying to grow as a person) or deep work (trying to delve into the depths of your psyche and figure yourself out).

The only thing that works better than psychotherapy for a lot of things is drugs. These are psychiatric drugs and they do have a lot of side effects.

Really the best treatment is psychotherapy + drugs.

I deal with OCD’ers. When OCD is very bad, I feel that psychotherapy is useless. The person’s mind is just too far gone for the therapy to do any good work. It’s like banging your head into a wall. You can do the therapy over and over, but it won’t sink in because there is something wrong with your brain. Therapy with a messed up brain is like filling up the gas tank of a car with serious mechanical problems. That gas won’t get you very well (in other words, it won’t even work well) until you fix the car so it can run well enough to even use the gas in the first place. Once you fix up the car, now you can put gas in it, change the oil, check the fluids and all of that, and that’s finally useful.

On the other hand, drugs alone don’t seem to really cut it. I have found that when you are on a really good drug, you can start using all the great stuff you learned in psychotherapy, and now the therapy really starts working. The sad thing is that psychotherapy works best on a fairly healthy brain. You have to get your brain into a fairly healthy place to where the therapy can even function at all.

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Filed under Anxiety Disorders, Depression, Health, Medicine, Mental Illness, Mood Disorders, OCD, Personality Disorders, Psychology, Psychopathology, Psychotherapy, Psychotic Disorders, Schizophrenia

Behavior in Manic Episodes: An Overview

Jason Y writes:

Seems like some of them can go into a rage when not on meds. Breaking phones, computers.

I do not know much about schizophrenic violence, but I can definitely attest on a first hand basis that during the manic phase of manic depression, people can be quite violent.

There are different types of manic episodes: Hypomanic, euphoric,  and irritable/angry/violent/paranoid. They can also be psychotic at times, but manics usually are not psychotic.

This post will describe the irritable/angry/violent/paranoid manic.

These types tend to be psychotic for briefer periods and wild, violent, dangerous,  and criminal yet not psychotic for longer periods

They can be very verbally hostile and violent, pretty much trying to pick fights and start fights with various people nearly every day. They scream, yell, threaten and menace people a lot. They also do minor violence like throwing food around, throwing objects, breaking windows, throwing cordless phones. In addition, they smash toilet seats and they are very found of smashing holes in walls and doors.

It is not uncommon for them to acquire weapons during this phase, either guns or knives. Sometimes the guns don’t even work, but they use them to threaten their enemies anyway. Showdowns with enemies with one or more parties armed with guns, knives or swords are fairly common. Manics grab baseball bats, poles and sticks and chase enemies, usually ordinary strangers, down streets howling abuse at them and throwing the weapon at the stranger as the stranger runs away in terror. The manic will explain that the stranger out for a stroll at night was really one of the enemies in an elaborate disguise.

Mania is a time of extreme aggression, guaranteed violence, regular menace and often enough brandishing of weaponry.

Housemates of manics often end up arming themselves to defend against the manic, often with knives. Some carry weapons around with themselves fulltime to defend against possible attacks by the manic. Housemates frequently pull weapons, often household knives, on manics in self-defense during fights and showdowns.

They also steal a lot like drug addicts, and if you live with them, pretty soon you are going to have to start hiding your money, car keys, dope, etc. They will even sneak into your bedroom at night while you are sleeping to steal car keys, money, etc.

They are basically a total menace and a lot of them act like sociopathic criminals and seem to become almost completely evil. A guy I know has a relative who goes manic from time to time and when he goes manic, my friend says, “He turns into Charles Manson.”

They have no attention span whatsoever and are always leaving doors open, leaving the stove on with things cooking on it, forgetting things, etc. They start something, get halfway through it, get distracted and go off to something else so everything ends up half done including meals and just about any task. Their personal hygiene declines a lot for some reason. Often they take to wearing the same clothes for days on end. They sleep in their clothes, often with the lights on and music blaring. It’s not uncommon for them to start smelling bad after a while, possibly because they sleep in their clothes, don’t change their clothes often, etc.

If they are smokers, they will dramatically increase their smoking often by 2-3X the previous level. If they are drinkers, they will often drink very heavily to the point where they are drunk most of the time. If they are driving around when they do this, they will soon get one or more DUI’s.

Property destruction is very common, either their own or other people’s property. They may even destroy most of their own property for no apparent reason. They can also destroy other people’s property, smash up objects or steal others clothing, pile it and set it on fire. They may also set some of their own property on fire, especially clothing.

Manics commonly make public loud, often violent and menacing public scenes which can attract the attention of the police. The manic runs out to the divider of a major highway, takes off their shirt, screams and yells violent threats and sets the shirt on fire in the highway median. Or the manic runs onto a highway median with a baseball bat and runs up and down the median swinging the bat wildly and threatening their enemies.

Arrest and imprisonment during a manic episode is very common. The friend I quoted above says the family member who goes manic always gets arrested at least once during most every manic episode. They are often arrested for minor crimes like DUI or disturbing the peace. Often people who are victimized by the manic are reluctant to press charges because the manic is so obviously insane that it seems wrong to hold them criminally responsible for whatever they have done. If they are arrested, they are usually released very quickly. The manic will raise Hell in the jail, destroying his cell, rattling the bars of his cell endlessly and engaging in a lot of loud screaming and yelling, often with threats or violent overtones. They raise such Hell in jail that they often attract the attention of jailers. The ensuing confrontation will typically end up with the manic being beat up, sometimes badly, the by the jailers and police in the jail.

Sometimes manics are out in public looking and acting so crazy that police officers take them in simply because they seem so out of it. The officers do it our of sheer concern for the manic’s safety. The manic simply appears too out of it to be wandering about in public. In these cases, the manic will be held for a day or two at most and then released.

They usually do not go psychotic but sometimes they can become psychotic. Often they are seriously crazy, but if you closely examine them and think about what they are saying, doing and believing, they really are not psychotic. They aren’t crazy, they are “wild and crazy.”

For instance, a manic, dressed in rags with wild eyes, may thrown up their arms and yell, “I am Jesus Christ!” If you ask them if they are really Jesus, they will forget about and move on to some other topic, or say it was a joke or an allegory.

But sometimes there are psychotic episodes, often paranoid psychoses. If a manic does not have a single enemy on Earth, they will quickly accumulate a number of enemies within a few months of a manic episode. Many of the people encountered during the episode will be transformed by the manic into “enemies.” These can include friends, family members, employers, drug dealers, bank employees, police, etc. If you are in close proximity to a manic for a few months and don’t manage to get transformed into an enemy, consider yourself lucky.

They may stop eating because housemates are poisoning their food. Housemates, friends or banks are typically accused of stealing their money and many conflicts result as the manic confronts the “thieves” about the “stolen money.” For instance, a manic may blow through a large bank savings of say $10-15,000 very quickly in a matter of a few months in the middle of an episode. Then when they realize they have no money, they will accuse the bank of stealing their money. This will result in numerous trips to the bank and angry, sometimes menacing or even violent arguments, confrontations and showdowns with the “thieves” at the bank.

The enemies may make regular rounds to their home, leaving calling cards and destroying things here and there. The enemies come by the house and damage the manic’s vehicle. They set up surveillance stations outside the manic’s home where they keep the manic under surveillance at all times. They may become convinced that the world is going to end.

Confidence increases greatly. A single male manic who rarely dates suddenly has a girlfriend.

Most manics are not hospitalized during their episodes unless they are wildly psychotic. But wildly psychotic manics are atypical. More common is the wild, violent behavior, fleeing delusions and paranoia. Often others make frequent attempts to hospitalize the manic by calling the police. However, many manics, curiously enough, no matter how crazy they are acting, are able to remarkably pull themselves together and present themselves as quite sane when the police show up. If hospitalized, they quickly become “sane” in the hospital and are ordered to be discharged. They can become angry, threatening, menacing and even violent towards psychiatrists who are evaluating them for admittance. Some manics appeal their hospitalization, go to court, appear completely sane and are ordered released. When the police show up to take in a manic on a 5150 (danger to oneself or others) commitment call, 80-90% of the time, the manic will pull themselves together and appear completely sane to the officers. Manics can be wildly manipulative and conniving like the finest psychopaths and they can even earn the sympathy of the police officer. The manic expertly spins a brilliantly elaborated made-up stories, often with the full range of emotions from outrage to tears in a performance rivaling that of a professional actor. The manic will go on about how these evil people who called the cops on them were victimizing them and committing crimes against him in all sorts of ways. The police who have come to commit the manic often end up being won over by the manic, side with the manic and blame the victims for the “crimes” they have committed against the “poor, innocent” manic.

The fact that the craziest manics around can completely pull themselves together and appear cool as a cucumber and sane as can be leads many to believe that manics are engaging in a lot of this behavior on purpose and there may be something to that.

Manics stay up all night long making all sorts of racket, playing loud music and occasionally screaming, yelling and threatening others. You never sleep well with a manic in the house. They sleep, if at all, only a few hours a day, and often at odd hours, typically in the daytime with no particular regular schedule.

They are absolutely unaware that they are ill no matter how crazy they are. They hardly sleep at all. They quickly blow through any money they have and then they are broke and begging or menacing everyone around them for money. Then the manic begins to sell or pawn off all of their possessions in order to get money.

The vast majority of ordinary people have no understanding whatsoever of manic-depressive illness and are unable to identify mania even when it is displayed right in front of their face. Charming hypomanics are often regarded as completely sane and even exemplary people. People who meet them think they just met the coolest person around and are mystified at others who insist that the manic is ill. Angry, irritable, paranoid manics are typically not recognized as ill as almost everyone has zero understanding of mania. Hence there are various attempts to explain the behavior away via other explanations. Laypeople often think that these types of manics are on drugs such as glue, meth or cocaine. Others simply think the manic is a frightening, menacing, dangerous, violent criminal type of person who belong in a jail or prison. They look at a manic and can’t see the illness so they simply see a criminal who needs to be put away. Others think the manic is simply an unstable, hotheaded, violent type, a crank, a kook or a loose cannon ho should be avoided at all costs.

If they have a job, they are guaranteed to lose it in the manic phase because no one will continue to hire any human being who acts like that. Sometimes they can get another job, but then they will lose that one too. If they have an apartment, they will get evicted. And a number of times, they even lose their vehicles in a variety of ways. Bottom line is unless you have some rescue system, a manic episode is a short trip to homelessness.

The manic episode ends after 5-8 months. They often start in the spring and end in the fall, often beginning right around the spring equinox and ending right around the fall equinox. At other times, an episode begins around the fall equinox and ends around the spring equinox. The episodes seem to be tied into the seasons in some unknown way, possibly having to do with the number of daylight hours in the day.

When the episode ends, the manic’s life lies in ruins. If he had a car, it’s now gone. Any job they had was lost and any new jobs they got during the episodes were lost. If they had an apartment, they were evicted. They will have sold or pawned most of their possessions. Their body bears the brunt of 6 months of heavy drug, alcohol and tobacco use. They have destroyed most if not all of their friendships and burned through most of their relationships. These people generate a lot of hatred in others and it is common that former friends and relatives say they hate the manic, never want to see them again and with they were dead. The manic comes to, the episode ends, and unbelievably, the manic is often back to their old self, which is typically as normal as anyone else you might meet walking down the street. It is very hard to believe that this completely normal person was a crazed, terrifying maniac only a few months prior.

The manic is none the wiser for all of his wild and dangerous and destructive adventures. In fact, he has learned nothing at all except maybe that people are mean and the world is out to get them.

The manic typically refuses to acknowledge that they were ill during the episode and instead tries to explain it away in different ways. The doctor gave them some pills that made them “a little wild.” it was all the fault of those pills. They manic was “sick” or “not feeling well” or “upset.” The manic will continue to nurse all of the conflicts that they developed during the episode. The manic will blame others for all of the bad things that happened during the episode, the loss of vehicle, job or jobs, housing, arrest and imprisonment, hospitalization, fights, violence or showdowns, and loss of income, which will be blamed on “the thieves.” Even many years later, the manic will remember the episode as a time of great injustice when thieves stole money from them and everyone around them turned into evil criminals who endlessly victimized them for no reason. Housemates or others who pulled weapons on the manic in self-defense will be referred to as maniac criminals who tried to kill the poor, innocent manic. The loss of the vehicle will be blamed on others, usually “the thieves.” The employers will be referred to as terrible people who unjustly fired the manic for no reason whatsoever. All behavior done in the episode, no mater how crazed or insane, will either be denied or explained away as completely logical. A manic takes all of his expensive electronic equipment to the balcony of his apartment and throws it down to the ground, smashing $1,000’s worth of TV’s, record players, CD and DVD players, guitars, speakers, amps, musical equipment into pieces on the ground. Years later, the manic will righteously defend this behavior as completely rational and angrily blame the people who called the police on him as evil, horrible people who got him arrested for no reason at all.

If you tell the manic they were mentally ill during that period, they will either laugh it off or more commonly will angrily deny it. Some manics even threaten to beat up or punch out anyone who says they are mentally ill. When well, former manics often assault those who say they were mentally ill during the period or who say that the former manic has mental illness that needs treatment.

Manic depressive illness is hard to treat. They are usually not ill enough to be committed even during wild episodes. While manic, they have no insight whatsoever and aggressively deny that they are ill. It’s hard to treat somebody who angrily denies that they are ill in the first place. When they come out of the episode, they are often quite sane, so it appears that there is nothing to treat in the first place, and the manic has typically framed the episode in such a way as to explain it is something more than mental illness.

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Filed under Corrections, Crime, Law enforcement, Mental Illness, Mood Disorders, Psychology, Psychopathology, Psychotherapy, Psychotic Disorders, Symptoms