Category Archives: Psychotic Disorders

False Memories in OCD

False memories are quite common when OCD gets bad. I have dealt with a number of people who were going round and round about false memories. They are not an extremely common symptom, but you do see them sometimes when the illness is bad. It’s generally a sign of a bad illness.

Ms. Z was periodically convinced that she killed people. She would have a conversation with someone for 5-10 minutes, then walk away ,and then suddenly think that she had killed them somehow during the conversation. Perhaps she had suddenly swung her fist out and beat them to death? Perhaps she had pulled out a knife and hacked them to death? Perhaps she had shot them with a gun? She would have all sorts of false memories of how she killed these people.

In the course of these false memories, she would become 100% certain that she had killed that person she was talking to in that store that day. In the next few days, she would ask around to people she knew if anyone got murdered or if she killed someone in the store that day. Of course she would always be told no. I’m sure her friends must have tired of answering these weird questions. As soon as she was told that no murder had occurred, immediately the firmly held belief that she had killed that person would vanish, and she would never think about it again. Until a little while later when she would be talking to someone again and then walk away and once again become convinced that she had killed that person…

Another woman, Ms. S., was a young college student. She was at a large California university that had a lot of long, winding trails with undergrowth. There were deep gullies on the sides of the paths that were overgrown with foliage. Ms. S. would be walking down the paths and as she walked, she passed all sorts of people coming her way. At some point, she would suddenly get an idea that she had grabbed one of the people coming her way and thrown them down into one of the gullies.

She had a pretty clear memory of who the person was she threw down there and exactly how she had done it. She would be overwhelmed with guilt, and she would take off down into the gully searching for the “body” of the person she had thrown down into the gulch. She did this on a pretty regular basis, and eventually the university wondered what she was doing floundering around in the gullies, and they sent the university police down there to see what she was up to. After a while, it become clear that she needed to go to the university counseling center.

In both cases, the women received a diagnosis of schizoaffective disorder in addition to OCD. This was an incorrect diagnosis, and it was based on the fact that for a short while after Ms. S  was clamboring around in the gullies or after Ms. Z became convinced that she had somehow killed someone she was talking to, that both women were absolutely convinced that they had either thrown someone down into the gully or had killed the person they were talking to in the store.

The diagnosis was incorrect because as soon as the women were told that there was no one in the gully or that they had not killed the person in the store, the “delusion” completely vanished and they didn’t think of it again until next time. Delusions just don’t go away like that. It’s not a very strongly held conviction if can vanish with a mere word of reassurance.

We look at the whole process in a holistic sense. What is the nature of the process? Is this a characterological process (personality disorder), a mood process (mood disorder like Bipolar Disorder or Depression), an anxiety process (OCD, PTSD, GAD, Panic Disorder) or a psychotic process (schizophrenia, manic psychosis, psychotic depression, schizoaffective disorder)? It is important to look at things in an intuitive sense and get the “smell” or “feel” of what the basic process is that you are dealing with.

In the case above, this is an anxiety process, specifically an OCD process. It’s not a psychotic process, despite the fact that it superficially resembles a psychosis.

Some of these folks with false memories actually go to the police station and turn themselves in for crimes that they did not commit.

“Hi, I am here to report a murder.”

“Ok, what happened?”

“Well I think I killed someone last night.”

“You think you killed someone?”

“Yes.”

“Well, where did this happen?”

“I am not sure. I think maybe the bridge over the river.”

“What time did this happen?”

“I’m not sure. Maybe midnight?”

“Who was the victim?”

“I’m not sure. I think it was a man, maybe.”

“What weapon was used?”

“I am not completely sure. I think it was a knife maybe.”

After a while the police started to get the message. He was not there to report a murder at all. He was there to find out whether or not he was a murderer!

As the conversation degenerated, the man started repeating, “How do you know if you killed someone or not?”

The police did not know what to say to that. After he left, the police were talking among themselves. “That’s so weird,” one of them said. “What does he mean, ‘How do I know if I killed someone or not?’ How could you not know something like that? That’s so weird.” The cops were shaking their heads.

 

As you can see, false memories are quite common in OCD when it gets very bad.

I dealt with them myself at one point in 1985 or 1986. I have to admit it was a pretty nutty way of thinking. I was so ashamed of my false memories (which I temporarily convinced myself were true) that I never told anyone except for a couple of therapists. I have not dealt with any false memory nonsense in over 30 years, and I hope I never have to deal with that again. It’s truly a crazy way to think.

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Filed under Anxiety Disorders, Law enforcement, Mental Illness, Mood Disorders, OCD, Personality Disorders, Psychology, Psychopathology, Psychotic Disorders

Psychopathology of Serial Murderers

The primary problem with almost all serial killers is simply ASPD, Antisocial Personality Disorder, derived sociopathy or primary psychopathy. It is present in almost 100% of such cases. Most everything else is rather secondary to this primary character disorder, which is the most prominent symptom.

Very rare is the serial killer without this disorder, although there have been a few. I remember a long-distance trucker who turned himself when he walked into a Northern California police station with a woman’s breast in his top shirt pocket. He had camped out in forests while trucking and had picked up women and killed them. He kept the body of one in the truck for three or four days and drove around with it.

Experts said he was quite unusual in that they said he actually felt bad about what he had done. I wonder how bad he really felt though. You could not get me to drive around in a truck with a dead woman in the back for very long. I would go into severe panic pretty fast, would stop the truck, get out and start walking or probably running away. I would not be able to walk around with a woman’s breast in my shirt for long either. I would completely panic almost right away, take the shirt off, throw it on the ground and start running. But then I am a pretty guilty type person with a strong conscience.

Based on that, while I am sure he may have felt some guilt for his killings, the fact that he was able to drive around in a truck with a dead woman in the  back for 3-4 days shows without completely flipping out shows to me that he didn’t feel that much guilt, certainly not on the level that most of us would. And the fact that he could rather calmly walk into a police station with a cut off breast in his pocket without flying into total panic shows to me that he didn’t feel that bad about it. So guilt, even when it is present, is not as strong as in most of us, otherwise they would not have even done such horrible things in the first place.

Sexual sadism is also often present, and I have heard that Sadistic Personality Disorder is very common. Juvenile delinquency, voyeurism, exhibitionism, burglary, prowling, petty thievery, etc. typically precede the serial killings. When the serial killer starts killing, he usually has a fairly long rap sheet of more minor offenses. The murders are best seen as an escalation of a chronic criminal character type.

The ones who kill children are typically though not always preferential or fixated pedophiles. Certainly the ones who kill only children are preferential pedophiles. There is a type of pedophile called a mysoped, which is a sadistic pedophile. They are not very common. I doubt if 5% of pedophiles are like this, but these people are very dangerous. Probably almost all serial child killers are mysopeds and these crimes often have a sexual basis.

95% of rapists are the type that rarely if ever go serial, but the sadistic rapist, composed of no more than 5% of rapists, is very dangerous. Most if not all rapist serial killers are sadistic rapists.

The rage rapist is dangerous, but he generally does not intend to kill his victim although he assault her. If she fights back or gets difficult, he can fly into a rage and beat her so badly that she dies but again he usually does not intend to kill. I doubt if these types go serial much if at all. Serial killers intend to kill; rage rapists do not.

Malignant narcissism, the disorder, believe it or not, of our wonderful President, is also present sometimes. Ted Bundy was a malignant narcissist. Yes, our wonderful President has the same mental illness as Ted Bundy! Comforting thought.

A few have Schizoid Personality Disorder, and some of the more disturbed ones have Borderline Personality Disorder.

Schizotypal, Paranoid and Narcissistic Personality Disorders are rare if ever seen in serial killers. Schizotypals are probably too disorganized and decompensated and just out and out strange to commit such crimes. The serial killer must blend in, and schizotypals do not do that. A few schizotypals have committed mass murders. James Holmes the Aurora Batman Theater Shooter, was a notable case. But note that he was caught immediately.

Paranoid PD is rarely if ever seen. These people tend to be rather retiring and like to hide away from a hostile world. They also do not like to call attention to themselves from a hostile world. They are suspicious and distrustful by nature and this makes it hard for them to blend in well with ordinary society as serial killers often do.

Narcissists are usually too self-centered to kill. While narcissists are often very mean, the disorder is usually well-controlled in that the rage rarely escalates to homicide. There have been a few cases of NPD’s committing mass murder, usually of their families.

The case of Jeffrey MacDonald, the mass murdering physician of Fatal Vision, seems to be such a case. This is a superb true crime case by the way.

Also narcissists think that if they kill, they will get caught, and if they are in prison or jail they will not be able to live this wonderful life they are supposed to be killing. They are “too cool to kill.” Killing would mess up all their wonderful plans to exploit others and hold them up to contempt by millions of people, which the narcissist would have a hard time taking. The narcissist is “too good for prison.” Prison would be such a crushing blow to their self-image that it would very hard to take.

However, malignant narcissists can be very dangerous because this is a combination of psychopathy, sadism, Paranoid PD and Narcissistic PD. When you weaponize NPD with paranoia, sadism and particularly psychopathy, you create a dangerous illness.

Cluster C Personality Disorders like Passive-Aggressive Personality Disorder, Self-Defeating Personality Disorder, Dependent Personality Disorder and Obsessive Compulsive Personality Disorder are rarely if ever present in these types. These are PD’s where aggression is mostly displayed passively, and serial killers display aggression actively, not passively.

Mood disorders do not seem to be common. Bipolar Disorder is not common, and serial killers are rarely if ever depressed. They displace guilt and loathing outwards instead of pushing it inside of themselves as depressives do. Depressives are passive, and depression acts as sort of a freezing agent in that it tends to immobilize people by its nature. Men in general tend to either experience less depression than women or mask it with other things such as anger and rage, drinking, drugs, gambling, promiscuity or even workaholism. It is simply not acceptable as a man to be depressed, so depressed men simply channel their depression into other things and say they are not depressed, they are just drunks or workaholics, for instance.

Substance and alcohol abuse issues are quite common with serial killers, but the better ones are more sober, as drinkers and dopers tend to be scattered and unreliable and serial killers must be on the ball  24-7.

Only a few are psychotic. 2% of serial killers are psychotic. Psychotic people can barely organize a trip to the bathroom. How are they going to plot out elaborate and professional serial homicides?

They are motivated by many things, but your typical rape-murders of murders of attractive young women almost always have a sexual component. I would call these serial killings lust murders. The Germans coined the term. Even among the lust-murders, there are a number of different types. Some are motivated by purely sexual desires, others get off specifically on killing and the power gained from it, others are hunter types who get pleasure from the hunt and chase as if they were hunting an animal, which they are of course, but when we refer to hunters, we are always talking about hunters of non-human animals.

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Filed under Alcohol, Antisocial, Borderline, Crime, Criminology, Depressants, Depression, Intoxicants, Mental Illness, Mood Disorders, Narcissism, Narcissistic, Pedophilia, Personality, Personality Disorders, Psychology, Psychopathology, Psychotic Disorders, Schizotypal, Serial Killers, Sex, Sociology, Sociopathy

Resolved: Transgenderism Is a Mental Illness

RL: I work in mental health, and I have to diagnose people a lot, or at least offer my opinion of a diagnosis as I cannot give out legal DSM diagnoses . I even have to do differential diagnosis constantly where I have to figure out which of two diagnoses a person has. Believe me, these cases can be very confusing.

Magneto: In your opinion, is being transgender a mental illness? I mean, I am aware of the statistics that gays/trans people have a far higher suicide rate than heterosexuals, which would seem to suggest that it is a mental disorder.

But it’s kind of hard to think trans are mentally ill when you are looking at a fucking sexy ass Asian ladyboy who is far hotter than any real woman you’ve ever been with. To be honest, I hope trans continues to become more mainstream and more men do the transition into females. Fine with me, more food to choose from, in my opinion.

Ha ha. So, more pussy, even if it’s fake pussy, eh? I’m not sure I am down with that.

 

Is transgenderism a mental illness. Of course it is. In most cases anyway. And the rate has gone up 600X since the 1970’s. If it is some actual biological condition in the brain like sexual orientation, one would not expect the rate to skyrocket like that.

Rates of biological conditions don’t change much. The rate of homosexuality has probably been 3% for a very long time. Homosexuality appears to be an incurable biological condition that gets wired up in their brains somehow. It is a developmental disorder like left-handedness and a number of other things. Something goes wrong hormonally in utero, and the result is male or in some cases female homosexuality. As it is a developmental disorder, would you expect the rates of left-handedness to go up 600X? Real biological conditions just don’t work like that. Why would the hormonal aberrations that cause homosexuality have gone up 600X? They wouldn’t. They would stay at some consistent rate that is close the the rate of things going wrong in utero.

Hence except in a few cases, transgenderism is not a biological disorder. I really feel for these boys who feel like girls from age 2 or whatever. I am willing to consider a biological disorder there.

Yet a biological disorder can also be a mental illness. Schizophrenia, Bipolar Disorder and even OCD look like biological disorders, and all are also mental illnesses.

These seems to be a “fad” disorder that a lot of folks are developing on their own in a similar way to how these therapists create mental illness in previously healthy girls who got molested. It’s a cool way of going crazy.

Studies in China show that ~3% of the population feels as if they are the opposite sex. So if we let this thing explode, we could end up with a 3% tranny population. In the past, these people became homosexuals (in itself a sort of transgenderism) or perhaps feminine men and masculine women.

When I was growing up in the 1970’s, we had this idea that all men and women have masculine and feminine components, even heterosexual ones. Just because a man has a feminine side or a woman a masculine one doesn’t mean he is not a man and she is not a woman, nor does it mean that either one is a homosexual.

I have a pretty strong feminine side myself, as many people used to think I was gay or bi. I’m not a Man’s Man at all. I’m not macho enough for that. I’m a Ladies’ Man who prefers the company of women. Most Ladies’ Men are not as masculine as Man’s Men.

I worry that if I were growing up today, I might have been sucked into this nonsense and decided that I was a tranny and I was really a woman or something insane like that.

If a man thinks he is a woman or a woman thinks she is a man, that is known as a delusion. It’s just not true. So they’re psychotic in a sense. And the treatment (sex change operation) doesn’t appear to make them any mentally healthier. So why do it? If the treatment doesn’t help the person, we stop doing it.

13% of people who have sex changes actually re-transition. So men who turn into women turn back into men, and women who think they are men turn back into women. If it was a real condition, one would not expect to see that. Homosexuals don’t suddenly decide to be straight. Left-handed people don’t decide to be right-handed one day. Transgenderism in childhood is highly transitory. 73% of transgender children are cured by adulthood. That is, by the time they are 18, they have abandoned the idea that they are the opposite sex. Biological conditions do not have such high spontaneous cure rates.

There have been quite a few spontaneous cures of transgenderism even in adulthood. There are a number of cases where a man was in therapy for transgenderism, and he showed up for therapy one day and announced that he’s no longer transgender. He’s really a man and realizes that and feels like one now. Then he gets up and walks out of the office. Just like that.

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Filed under Anxiety Disorders, Asia, Biology, China, Gender Studies, Girls, Heterosexuality, Homosexuality, Mental Illness, Mood Disorders, OCD, Psychology, Psychopathology, Psychotherapy, Psychotic Disorders, Regional, Schizophrenia, Science, Sex, Social Problems, Sociology

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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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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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