Category Archives: Schizophrenia

Do Therapists Ever Think Their Clients are Unfixable?

Question from Quora:

Some people are utterly unfixable or even improvable, but they are quite rare.

There are clients who are just too far gone, and they cannot be helped at all. It is as if the person were a ceramic bowl that was dropped on a hard floor. The bowl is now in 100 pieces, and the person who dropped it is on the ground looking at the pieces and throwing up their hands. “Where do I start?” he asks in exasperation.

All sociopaths and psychopaths are unfixable by their very nature. We can’t cure the sociopathy and psychopathy because they don’t want to get better. They enjoy being antisocial, and they do not wish to change. However, we can get them to change their behavior. For instance, a homicidal sociopath may show up in the office. A good therapist may be able to convince this sociopath that acting on their homicidal fantasies would be one of the stupidest things that they could ever do. This sociopath may then be able to go through life without killing an innocent person. So we can’t fix sociopaths, but we can change their behavior somewhat, tone it down, or reduce the amount of damage they do to society.

All paraphilias are unfixable by their very nature. The paraphilia quite literally will not and cannot go away. It’s etched in stone.

Schizophrenia is largely unfixable. They need a great deal of medication, and even then in most cases, they are repeatedly hospitalized. A few can go on to lead somewhat normal or even successful lives, but these people still need continuous medication and regular psychotherapy. In addition, they need frequent interventions to stay out of the hospital.

Many illnesses such as OCD, Bipolar Disorder and Chronic Major Depression are unfixable by psychotherapy. Most of these people will need medication for the rest of their lives. However, psychotherapy can improve their conditions a lot at least in the first and last cases.

Long-term suicidality is very hard to fix. It tends to become chronic with repeated attempts over the years. The suicidal person is typically defiant and is furious with you for challenging their suicidality. You are expected to sympathize with their condition, which is actually a very bad idea. Most suicidal people are what I would call “defiantly suicidal.”

Personality disorders are generally incurable. Theoretically, they could be fixed, but these people almost never present for therapy, and when they do, it is often at the behest of others, and they do not really wish to be there or get anything done. People with personality disorders, like sociopaths, literally do not want to get better. They like their personality disorder, and they are incredibly resistant to change. There are some case reports of cures of personality disorders, but in general the prognosis is grave.

I have never been able to fix long term low self esteem, and I have tried with a few people. There is something about that condition that hammers itself into the brain as if into concrete. I do not know why, but long-term low self-esteem seems to be one of the hardest psychological problems to fix. Why this is, I have no idea. Perhaps someone else can offer some ideas.

In many cases, long-term mental disorders simply cannot be fixed or cured. However, with psychotherapy and drugs, people can often get much better than they were before. We need to stop thinking in terms of cures and start thinking in terms of amelioration.

I realize that many clinicians insist that most people can be fixed or cured of long-term conditions, but I think they are lying. They are probably trying to drum up business. Many clinicians fear that if word got out that a lot of long-term mentally ill people cannot be fixed or cured, people would stop coming in for therapy. There goes their paycheck. Therapists are a lot more money-oriented than most people believe, and don’t let anyone tell you otherwise. I know this field very well.

Clinicians have nothing to worry about. Even if a lot of conditions could only be ameliorated and not fixed, I am sure a lot of folks would show up to try to get some improvement. Some mental disorders are so painful that any improvement feels like a miracle cure to the client. A lot of people have given up on being cured anyway, just want to at least get better and are quite happy to do so.

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

The Untreatable Borderline Personality Disorder Client: A Therapeutic Nightmare

Borderline Personality Disorder (BPD)is one of the hardest disorders of all to treat. It can be improved with some therapies, but the road is long and hard. Many seem to go on for years or decades with little or no improvement. There are reports of cures, and I am familiar with a woman whose BPD cleared up at age 55 after having come on in childhood. That’s probably a typical cure. Decades of nasty illness followed by a lifting of the illness in middle age.

Many mental disorders improve in middle age, and even many personality disorders improve during this age period.

Schizophrenia often ‘burns out” in middle age, and florid positive symptoms are replaced by more negative symptoms.

Many anxiety disorders attentuate in middle age.

Even psychopaths often get better or at least less destructive in middle age, as many of them also burn out in a similar fashion as schizophrenics. A number of highly antisocial psychopathic men get better in middle age as the antisocial behavior attentuates. It is often replaced by depression, heavy drinking and a pessimistic, cynical, imbittered and misanthropic person who nonetheless does little damage to society anymore.

It should be noted the clients with BPD vary widely in their symptom pathology.  Some are much more functional than others. Quite a few can even function well at their jobs all day, but when they come home from work, they fall apart and shift into full BPD pathology.

However, some people with BPD are so ill that they seem nearly untreatable. It is these people who will be the subject of this post, not BPD’s in general. These people seem so far gone and broken that one wonders how anyone could ever even begin to put them back together again. I suppose some progress could be made, but the damage is so severe that I have a hard time seeing how even the best therapist could possibly fix these people in any significant way.

A typical case might be a young woman who, only in her late 20’s to early 30’s, already has 8 -13 suicide attempts and many hospitalizations behind her. She goes into the hospital on a regular basis. Therapy seems to do nothing but feed her pathology as she manipulates gullible new therapists to believe her lies, nonsense, and projections as the new therapist confuses symptom pathology with the truth. Drugs do almost nothing.

Diagnosis itself is often difficult because the BPD is so severe that the person often appears psychotic/delusional. One wonders what are delusions and what are not. Even the delusions do not seem to last for long, as they are dropped, changed around, added to or substituted in a wildly chaotic fashion.

Usually there is a lot of combativeness and involvement with the court system, as the extreme rage leads a litigious person.

Splitting is severe and textbook.

Self-image is so unstable that the person almost literally adopts the full personality and even persona of whomever is on their radar at the moment. The clinician needs to be prepared that this person will so identify with the clinician that they will adopt the therapist’s image and persona as their own. Boundaries nearly do not exist for these people, and they often fall in love with their therapists, try to seduce them, or on the other hand become furious at them to where sessions became rage attacks at the therapist, and the therapists is at odds of how to respond without violating ethics.

The client can become overtly suicidal even during sessions, and infatuation with the therapist can quickly split to where the therapist is the source of all evil. Homicidal threats and homicidal-suicidal threats against the therapist may now appear. The client then hospitalizes themselves due the “horrible trauma from the evil,  incompetent therapist” and soon finds sympathetic new therapist, typically a feminist woman, to unload her story on. The new female therapist forms an alliance with the client against the “evil male” former therapist and accuses him of damaging the client.

Commonly, the therapist gets angry and tells off the client. This leads to abandonment and a vengeance agenda against the therapist, who has now “irreparably damaged” the BPD and “caused them to spiral out of control.” Be prepared to get accused of abandonment, causing severe trauma in the client and making them dramatically worse. The client may become hospitalized due to allegations of damage from an incompetent therapist.

These people are so difficult and chaotic that many clinicians refuse to see Borderline patients. Some are on the record as saying that when they say a Borderline client coming their way, they hide under their desk until they go away. For a lot of therapists, these clients are nothing but trouble, and endless parade of drama and chaos. Therapy itself is chaotic, mercurial, and wild with severe splitting and often extreme idealization of the therapist for good or ill or both, interrupted by fairly regular hospitalizations. The therapist begins to wonder what’s in it for them and thinks you could not pay them enough to suffer through such clients. These clients make an excellent argument that therapeutic abandonment is the proper choice with some clients.

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

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

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

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