Category Archives: Psychotic Disorders

Serial Killers – Psychotic or Psychopathic?

Gary Palin: I see your points Robert, and your way more knowledgeable about these types of psychotic sociopaths than I am. When I saw the picture of Libby in the hat and how young and innocent she looked, this crime really struck a chord with me. When I was younger growing up in the 70’s this was relatively “uncommon,” but there were some (Charles Manson, etc) Also there were very few homosexuals, at least out in the open, and there were no transgender people ( not that I have disdain for them). This goes for where I grew up, but maybe in liberal California it was different for you.

I just wonder if this escalating type of violent crimes against women has anything to do with “feminism” and men feeling slighted and emasculated, and this is their way of rebelling against women. I think there may be a lot of truth to this.

I would bet in the 1950’s where divorce was uncommon, and families were mostly all the patriarchal type, when men were the head of the household, I think people and families were a lot happier than in today’s world, even though they didn’t have as much material wealth. Maybe you should do a blog on that subject, as you’re truly a student of human nature.

As far as being a student of human nature, I work in mental health. I have dealt with very few psychotic or psychopathic people, but I often have to rule out psychopathy or psychosis. In the group I am dealing with, I almost always rule it out. But to rule it out, you have to understand it.

Actually there were quite a few serials running around in the 1970’s. I like to think of the 1970’s as the Decade of the Serial Killer. There were an amazing number of them running around right here in California. We regularly had them running loose here in the LA area. Randy Kraft, the Hillside Strangler, the Toolbox Killers, the Sunset Strip Killers, Rodney Alcala, William Bonin, on and on. In California proper there was the Zodiac, the Hitchhiker Killer, and the Keddie Murders. Ted Bundy was running around the West.

My Mom thinks she saw Bonin and crew pick up a young male hitchhiker on a freeway entrance in Garden Grove. She thought that may have been the last ride that boy ever took.

A good friend of mine had an encounter with Randy Kraft and drank some beer and smoked some pot with him. The beer was one of Kraft’s specialty Valium-laced beers, but my friend caught on that something was wrong. Kraft tried to stop him from leaving the car, but my friend screamed at Kraft like a maniac, and Kraft was taken aback and let him go.

Back then we did not have DNA and advanced forensics, so most of these guys killed a number of times (4-10) before they were caught. It was so much easier to be a serial back then due to the more primitive forensics. Serials often targeted regular females or males, but now a lot of serials are targeting druggy street prostitutes, truck stop whores, and other marginal women whose disappearance is not even known because they are so far outside of society. It is quite hard to catch these killers because they are targeting such marginal women who hardly anyone even knows. When the serial starts targeting ordinary members of society, it’s a bit easier to catch them.

I do not think the rate of rapes or rape-murders of women has gone up since the 1970’s. I have heard that child killings have been at a flat rate of ~150/year since the 1970’s. If anything, I would assume the rate of rapes and rape-murders has gone down since the 1970’s. Sure, there has been a much-needed backlash against the sexist hate movement called Feminism, but it doesn’t seem like men’s rage over it is causing us to rape and kill women at any higher rate than we ever had. Instead a lot of men seem to be dropping out of dating and dealing with women altogether for fear of a sexual harassment, sexual assault or fake rape charge. See the Men Going Their Own Way Movement for more on this phenomenon.

The concepts of psychosis and psychopathy are often confused in the public mind. How many times have you heard about “psychotic killers?” Thing is, when someone says that, they are almost never referring to killers who are actually psychotic. Instead they are referring to psychopathic killers and confusing them with people who are psychotic. Most people do not understand the difference between these psychological states, and this is the reason for the mix-up. Also most people assume that any maniac running around like Jack the Ripper slaughtering other humans for no good reason has to be insane or psychotic. They say this because to them such an act seems to be so outside of normal behavior that only a crazy person would do such a thing.

Psychosis and psychopathy are too different things. I suppose there are some cases where the two conditions overlap. Some paranoid schizophrenics seem to have also been psychopaths, but this is not common.

These sociopaths are not psychotic. This is an important thing to note. Only 2% of serials are psychotic. It is fairly easy to catch a psychotic serial because they are completely insane. It’s hard for crazy people to organize a trip to the bathroom, much less a serial killing spree.

Sociopaths and psychopaths are not the tiniest bit crazy. If they were even 1% nuts, they would be easier to catch. They are almost too sane in that they don’t have to worry about emotions slipping them up. These humans are like machines. If they are serials, then they are killing machines.

I would agree though that outside of the former definition of craziness which tends to emphasize impairment, sociopaths/psychopaths are indeed crazy. They’re morally crazy. And in some ways, these are craziest humans of all because they simply lack a conscience.

Instead of being crazy, sociopaths and psychopaths are better seen as sick. Or even evil. We need to take our analysis of these folks outside of the sanity/insanity paradigm and over into the moral universe of good/evil. These people aren’t crazy. They’re just evil, that’s all. This is the only way to properly understand such people.

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Filed under California, Crime, Evil, Feminism, Gender Studies, Man World, Mental Illness, Personality Disorders, Psychology, Psychopathology, Psychotic Disorders, Regional, Serial Killers, Sick, Sociology, Sociopathy, USA, Women

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