Category Archives: Psychopathology

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

Newsflash: Many Surgeons are Controlled Sociopaths

A new trick among surgeons is to take one operation and chopping it up into four smaller operations and double their money. There are actually popular seminars for surgeons showing them exactly how to do this. What a sleazy ripoff!

However, many other physicians frown on this scummy behavior. A physician who does this can lose their hospital privileges and get sued. When I worked as a paralegal, most of my time there was spent working on the defense of a sociopathic lowlife physician who did exactly that, and that was exactly what was happening to him. Local hospitals had revoked his privilege, and a number of his former patients were justifiably suing his crooked ass. And I was getting paid to legally defend this guy. It was morally trying to make a living defending slugs like this, but the money was good, and I sloughed off the guilt. Doubt if I would do it again though. Some jobs actually cause moral injury, in my opinion.

This arrogant dirtbag was suing the hospitals who had revoked his privileges! And we were helping him do that, and getting paid from his unlimited money supply in the process. The arrogance. I see narcissism, and it looks like some sociopathy too.

It’s not well known, but many physicians are controlled psychopaths. The field of surgery is full of them. And you wondered why so many surgeons have the reputation of being the worst arrogant physicians of them all. These professionals have learned to channel their sociopathy into quasi-legal avenues in order to become “legal criminals.” But these folks do a lot of damage. Look at our politicians corporate executives? Just how many are not controlled psychopaths?

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Filed under Ethics, Health, Law, Medicine, Mental Illness, Narcissism, Operations, Personality, Personality Disorders, Philosophy, Psychology, Psychopathology, Scum, Sociopathy

Updated July 16: Profile of the Evansdale Child Killer

This is an update to my previous profile. The previous profile was of the Evansdale Child Killer, but I also thought maybe he was responsible for the Delphi Murders. I have now decided that he was not involved in the Delphi Murders at all despite a remarkable set of coincidences between the two. However, I continue to believe that he did the Evansdale Child Murders either alone or with an accomplice.

I have added quite a few things to the profile and I removed all references to the Delphi crimes. I have more to add, so this may be updated later.

Note to commenters: Please stop referring to Unsub as a pedophile. He may well be one, but that’s something that can be determined from this crime as it was not a pedophilic offense. Instead, this was a hebephilic offense. And the perpetrator could certainly be seen as a hebephile, although he’s not necessarily one. If you want to refer to the nature of the offense, use the word hebephilic instead of pedophilic. If you wish to refer to Unsub’s paraphilia, please refer to him as a hebephile and not a pedophile.

Thank you so much for this. I am getting tired of words being misused. And now we are being scientific on the board.

Note 2 to commenters: I am really getting sick and tired of saying this, but most of the material below is made up of rumors and my own opinions and theories. None of that is represented as fact. The only thing that is represented as fact as statements sourced from LE or the media.

And incidentally, the way I wrote up the case is precisely how detectives work a case. Detectives do not work cases using the scientific method. If they did, they would hardly solve one case. It’s more “We believe this for now…this is true for now…at the moment, this is what we think happened…we believe…” They are throwing out endless theories about what really happened and accepting them as (temporary) facts. They are then continuously revising and throwing out theories and creating new ones.

Being  a detective is about being wrong. Not just once, but being wrong over and over so many times your head will want to come off. If you can’t handle being wrong, then detective work is surely not for you. Finally detectives arrive at enough information to file a case against someone, but a lot of that is not factual either. They believe he did the crime. They believe that this, that, or the other happened with no way to really prove it – it’s just what they conjecture.

If he is convicted, then the theory that he did the crime is validated as fact, but I am not sure what other evidence is. And even court decisions are not scientific fact because they get overturned all the time. There are not a whole lot of 100% certain, clear scientific facts in LE work, detective work on the judicial system itself. A good portion of the decisions made turn out to be theories, temporary but unstable facts, beliefs, hunches and guesswork, all represented as fact in the court.

If you have issues with theories, opinions and what not, just quit reading and get the Hell off my site right now and never come back. I am really getting sick and tired of this BS.

Profile of the Evansdale Child Killer

by Robert Lindsay

The initial Unsub profile of the Evansdale Child Killer was written on February 25 with an update on February 28. I have updated it a lot with new information. Major changes were made in the profile.

I have been wrong many times in the past about all sorts of things, and of course I could be completely wrong about this too. But this time, I do strongly believe that the Unsub described below may be the man responsible for both of this crime.  

I am not a professional in this area. I am amateur, a dilettante. This is done more for my own entertainment as a hobby than as a profession. I do not claim that this profile is an accurate behavioral profile of the Unsub of the sort that the FBI produces regularly. I am just some amateur who is fooling around. So keep that in mind.

I am not stating this as fact. Things below may or may not be true. I believe much of the below is true because I have been able to document it as fact. Other things are more up in the air and are simply opinions that are strongly held by me. 

Profile

First of all, let us look briefly at the crime.

More than one killer? This is not known. The fact that Unsub may be a member of a network of pedophiles adds weight to the theory that he may have had a partner. Perhaps the network brings men together who share common criminal interests.

Purpose of killings? There has been much suggestion of why these killings occurred, to try to prevent identification, for sex trafficking, or a mistake because one of the girls ran, scream or freaked out. None of these are true. This pair of girls was abducted for the specific purpose of rape and murder for thrills. These were thrill kills. Unsub is the sort of man who gets a strong erection when he thinks about raping and murdering little girls. This is what gets him off. As the intention was murder from the start, sadly neither girl stood a chance.

How did Unsub arrive at the crime scene? He drove to it with his vehicle, parked it near the abduction site, and abducted the girls.

Where are the girls raped and murdered? I believe that both girls were quickly removed from the abduction sites and taken away somewhere to a motorhome where they were raped and murdered. These motorhome was parked in a remote, out of the way place for three weeks. At some point during this three week period, the girls were raped and killed.

Disposition of victims. After he raped and murdered the girls, he drove them to a dump spot. In Evansdale, it was 20 miles away from the abduction site.

Body dump spot: The bodies were dumped at near a stream in a park.

Abduction zone: Unsub committed his abductions in parks near bodies of water like streams, that have one or more bridges, especially railroad bridges.

Dump zone: After he killed the girls, he dumped the bodies 20 miles away.

Crime time: The crime was committed on the 13th of the month, possibly because 13 is an unlucky number. The crimes were committed on Friday the 13th, which is an especially unlucky day.

Sick humor: Unsub seems to have a sick sense of humor. He abducts and kills on unlucky days like the 13th as if to say, “This is your unlucky day, girls! Rape and murder, ha ha!”

Left town and did not come back for some time: Unsub left town the day of the abductions. No one knew where he was, but I believe that he took the girls away in his motorhome to a very remote place where he raped and tortured them. He stayed there for three weeks. At some point, in this three week period, the girls were raped and murdered. He was not seen at any point while he in this remote place.

Destroys evidence by three weeks: Unsub worked very carefully to remove all evidence within three weeks of the killings. He sold the motorhome three weeks after the abduction, but first he cleaned it very thoroughly, wiping down the whole structure. removing newspapers or pillows from the windows and throwing away all sheets.

Method of killing:  Unknown. I believe he really enjoys this part of the crime. This is where the crime reaches an ultimate peak experience for Unsub, a once in a lifetime great feeling or rush.

Unsub is 59 years old.

Unsub is a pedophile, a heterosexual pedophile. He likes little girls from age 2-12, mostly around age 6-10.

Unsub may be a nonpreferential pedophile. That means he is may also attracted to adult females, and he may enjoy having sex with them regularly. Not all pedophiles are exclusive. Nevertheless, his sexual preference is for girls age 6-10. His attraction to adult females is lower than to little girls, but may still be adequate for adult heterosexual functioning. He does not like women his own age though. If approached by a woman his own age, he will tell her that he only dates young women. If he dates adult women at all, he will probably confine himself to the youngest ones possible. He has had sex with boys in the past, but only if he dresses them up in girls’ clothes so they look like girls, as he is a heterosexual pedophile

Unsub is also sexual sadist. He has been a sexual sadist since no later than age 14, but he has been repressing the sexual sadism at least to the extent of not being murderous. At some point before five years ago, this control has broken down and is no longer repressed. This has coincided with an increasingly menacing look to him.

In appearance, Unsub is balding with white hair. In the past, he had stringy long blond hair. He had a goatee and mustache in recent years, but lately he has shaved most of it off except for a mustache and bit of a goatee.

Unsub looks downward instead of looking people straight in the eye. This could give the impression of “looking down at others.” This is intentional, as I feel that Unsub does indeed look down on others. He thinks very highly of himself, is narcissistic and thinks he is better than others. He also thinks he can outsmart police, and I believe he has been doing just that for the last five years when he has been getting away with murder.

Unsub altered his appearance since the Evansdale murders. In the past he had rather long stringy blond hair, a mustache and a goatee. He altered his appearance after the  Evansdale killings by shaving off the beard.

In the past, Unsub was often smiling and seemed happy go lucky. He looked harmless enough. He was surely molesting children, but he was not violent yet, so his face remained open and friendly.

In recent years, Unsub’s face has gotten angrier. He has been slowly developing an air of menace. This is because he has been transforming from a nonviolent pedophile into a violent pedophile. While in the past his fantasies were about non-coerced sex with children, they have now turned much more violent, and now he mostly fantasizes about rape and murder of girls age 6-10. Why he changed from a nonviolent to a violent pedophile is not known.

Unsub was paunchy for most of his adult life from age 40 on. Around 15 years ago at age 45 and probably for some time prior, he was heavier. His excess weight mostly went to his width, so he looked something like a football lineman. After age 45, he lost a lot of that weight. He has retained somewhat of a paunch since at least age 40. From 2012-present, he remained with this thinner frame, but I believe he retains a paunch to this day.

Unsub is not a happy serial killer. Instead he is a tormented one. Since the murders, he has grown much darker. He has also aged prematurely and looks much older than he did even a few years prior to the murders. His smile is gone and has been replaced by a look of sadness and especially rage. Now he looks downright mean. His friends have reacted to this by telling him he has aged. Others said things like, “Cheer up! Smile!”

Somehow this double homicide aged him and made him much sadder and angrier. This means that the Evansdale killings significantly stressed him out. Even though these type of crimes stress him out, he still commits them. That is because he is driven in some way to commit crimes like this. It is a sort of addiction. He is addicted to rape and murder.

Unsub has few hobbies other than pedophilia. He likes to hang out in local places like taverns, coffee shops, pool halls, etc. Here he likes to relax with friends and shoot the bull. He is a member of a pool-shooting league.

Unsub’s writing appears somewhat uneducated. He makes some spelling errors that an educated American never makes. However, in his rural Iowa area, he is about as educated as most people he knows, as most of them write about as poorly as he does.

His IQ is not particularly high. It is probably ~105-110, but he probably acts less intelligent than that. This can be seen in his poor writing style.

Unsub graduated from high school. He graduated from a religious college. Unsub is not good at completing scholarly tasks. He starts them and quits or takes a long time to fulfill his educational goals. For instance, he took 10-15 years to complete a four year college degree. He has a hard time sticking to tasks and has a tendency to drag things out. Why he does this is not known.

Unsub’s employment is working class. He repairs objects in some way. He is quite good mechanically. He works as a computer consultant or repairman, a mechanic, a truck or school bus driver, or at a factory.

However, he has the same desultory attitude towards work as he has towards school. Bottom line is that Unsub is a bit lazy. He would rather kick back and enjoy himself than work or go to school. He has a problem with sticking to either work  or school. Many tasks are started but never finished, but this does not bother Unsub much.

Unsub has not always been like this. This lackadaisical style developed in middle age. As a young man, he was much more productive. At one point he even owned his own business. I am not sure about how successful this business was though.

Unsub was in the US military. He participated in one of our Middle Eastern wars. I do not know when he joined the military. However, he  suffered some sort of an injury in service and was sectioned out. This was about 25 years ago.

I believe Unsub is quite religious. He is an evangelical Protestant Christian like so many in the surrounding area. He graduated from a religious college. He is probably very active in his local church, where he is regarded no doubt regarded as a great man. He probably has a number of friends through this church. How he reconciles his strong religious faith with raping and murdering little girls is hard to figure.

Although he has been losing his looks since his mid-50’s, Unsub was an attractive man until quite recently. He had a sexy appearance in a sort of bad boy, devilish way. He appeared masculine and handsome in a tough guy way.

Women in the local area were attracted to him due to his good looks. Even after age 50, he continued to attract attractive, sexy women all the way down to age 30. A number of the local younger women used to think he is “hot” or “cute.” No doubt this has gone to his head somewhat, and he thinks of himself as a ladies man.

Unsub is a fixated pedophile and has been so since age 14 at the latest. His pedophilia is one of the major themes of his life. I do not believe he has been controlling his pedophilia, and I think he has been molesting girls for quite some time. He may have gotten quite good at it. I believe that many people do not realize that he is a pedophile. He is still probably close to some members of his family and their friends. They probably do not suspect him of being a pedophile.

Unsub has married two, and he has a number of children and stepchildren through these marriages. Relations with one ex-wife probably are not good. The marriage ended bitterly, and there were some court battles with the ex-wife accusing Unsub of various outrages in an attempt to get full custody of the children. They had joint custody for a while, but there were big scenes and battles associated with this, so it didn’t work out well. Unsub and the ex-wife have engaged in big fights in public in broad daylight.

At least one of his ex-wives has a low opinion of him. This is because she has experienced his sociopathy firsthand. Unsub was been very mean and cruel to her during their marriage.

This ex-wife is now deathly afraid of Unsub and regularly tell people this. She accuses him publicly of being a pedophile and a sociopath. She considers Unsub to be a very dangerous person. She has accused him publicly of molesting specific girls and even boys. She tried to turn him in over this, but it didn’t go anywhere. If asked about this, Unsub probably says she is making this up as a bitter ex-wife.

I believe his children may also suspect Unsub of being a pedophile. Nevertheless, they continued to visit him in joint custody after the murders. However, after some court battles, his ex-wife has now retained sole custody of most of the children. Unsub retained custody of no more than one child. In addition, the ex-wife has moved out of the area quite a ways away to another state. Her location is 400-600 miles away from her previous one.

The ex-wife has several children of her own, four or more. The ex-wife continued to have kids into her 40’s. I believe that Unsub has molested at least some of his children and that this molestation went on for years. I believe he dressed two of his stepsons up like girls and molested them for years. I am unsure of how good his relationship is with his children, but at least some of them accuse him of being a pedophile. The children are all minors or they were when Unsub was still married.

Unsub has not always resided in the Iowa area. He was born in Ohio. Then he lived for a decade in Texas. Then he lived for 19 years in Tennessee. He moved to Iowa ~25 years ago, when he was ~35 years old.

The killer does not live in either Evansdale. He’s not that stupid. But I do believe he lives or at least used to live near there. He resides or used close to Evansdale.

I believe that Unsub took the Iowa girls to a motorhome of his. He then drove the motorhome to a remote area somewhere and was not seen for three weeks when he was in this place.  Within 12 hours of the Evansdale abduction, he left the area in  Evansdale where he was staying with a relative. He stayed away for at least three weeks.

It was in this motorhome that he raped and killed those girls. He blocked out the windows with either pillows or newspapers and may have even soundproofed the vehicle in order to do this. Afterwards he cleaned the motorhome as thoroughly as he could.

Unsub does not have a lot of money, but I  he owns or did own a modest home in Iowa close to Evansdale. He may used to own a motorhome which he used in this crime and then disposed of. His principal residence has the appearance of a sparsely or poorly-furnished bachelor residence. The walls are white with a white carpet. It is not even well-lit inside, and the residence has a dim look about it, even in daytime.

Unsub is is divorced and he lives alone. He probably has little girls over at his residence from time to time, but I am not sure if he molests them there or not. He has some photographs of little girls in his residence. I do not know if he collects child pornography, but he probably has a significant collection of photos of cute little girls obtained in a variety of places. He has some photos of himself with a little girl or two next to him.

Unsub continues to drive a fairly nice car. This car is a red Ford compact.

In the Evansdale killings, there was talk of a white SUV in the area where the girls disappeared. It was never proven to have any connection with the murders. I believe that Unsub used that white SUV to commit the Evansdale crimes. It is known that he did own a white SUV around 2012-2013, but it was broken down when last photographed. Nevertheless, photographs do show a white SUV parked next to his garage.

Unsub seems to take these murders rather hard. They take their toll on him. The Delphi Murders upset him because for a time he was considered a suspect but I believe he did not commit the Delphi Murders and has been ruled out. However, he is aware that people are now actively linking him to the Evansdale killings, and this is making him worried and highly stressed out. A couple of months ago, Unsub vanished from his central Iowa city. He seemed to vanish off the face of the Earth and has not been seen since. I believe he was feeling the heat from being a Delphi suspect and he is also worried that more people are pointing the finger at him over the Evansdale murders.

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Filed under Crime, Criminology, Girls, Iowa, Law enforcement, Lolitas, Mental Illness, Midwest, Pedophilia, Personality Disorders, Psychology, Psychopathology, Regional, Serial Killers, Sex, Sociology, Sociopathy, USA

Do Psychologists Make Their Patients Aware of the Diagnosis of Narcissistic Personality Disorder or Sociopathy?

I recently answered this question on Quora.

Do Psychologists Make their Patients Aware of the Diagnosis of Narcissistic Personality Disorder or Sociopathy?

These personality disorders seem to carry a lot of social stigma, therefore are patients made aware of their diagnosis or does the therapist just continue behavioral therapy to treat the symptoms rather than informing them of the diagnosis?

I am not a psychologist. I am a counselor. I only work with one disorder, OCD, and I can quite accurately diagnose that condition, I assure you. Nevertheless, I am not allowed to give out legal DSM diagnoses. However, I can obviously give out my opinion on a diagnosis. I can also tell the person my opinion on what they do not have. For instance, I have gotten many clients with OCD who have been misdiagnosed with some sort of psychosis. I am an expert at telling the two apart. I simply tell them that in my opinion, they are not psychotic. Then I tell them to fire your clinician and go get a new one that will recognize the difference between OCD and psychosis (many clinicians are very poor at telling these apart).

Other than OCD/psychosis, I also have to make differential dx on OCD/sociopathy, violent thoughts, etc., OCD/pedophilia, pedophilic thoughts, etc. and OCD/homosexuality. In a limited number of cases, I told clients that in my opinion, they did not have OCD but instead had some psychotic disorder, or sociopathic traits, or pedophilia, or that they were homosexuals. Most of this differential dx is pretty straightforward.

I have never had any narcissistic clients, God forbid clients with NPD. One thing nice about working with OCD clients is that they are usually very nice people. Not all of them, mind you. But if they are not nice, there is often some other reason, for instance, Borderline Personality Disorder in an OCD client could possibly make them impossibly vicious, cruel, unstable, not to mention extremely crazy, far crazier than any OCD sufferer ever gets.

OCD by its very nature strikes nice people. The fact that they are so nice, meek and kind is actually one of the main reasons that they have the disorder in the first place! For the most part, only nice people get it, and the nicer you are, the more likely you are to get it. I will leave it at that for the moment and give you a chance to think of why that might be. I know why but it goes beyond the scope of this post at the moment.

But in general, I never even give my opinion on other anxiety disorders or on any mood disorders or personality disorders. I only rarely see clients who have psychotic disorders, and the two that I have seen were already diagnosed. I also very rarely see people with personality disorders, and the few that I have seen were all females with Borderline PD diagnoses. I did see one woman for two sessions with obvious Borderline Personality Disorder, but I had not figured it out yet in the first session, and by the second session, I declined to diagnose her. She has already been diagnosed by a psychiatrist from afar anyway. So apparently I am guilty of failing to dx a Borderline PD client.

The session was about her OCD, not her BPD and she was very nice through the whole session. It would have ruined the whole thing if I told her she had BPD, and I doubt if she would have accepted it anyway. At any rate, I am not allowed to give legal dx’s anyway, so it’s apparently proper for me not to diagnose someone!

That only comes up if there is differential diagnosis. I simply say that I not only can I not legally give these out but that I am not qualified to work with any condition other than OCD, which I can actually work very well with. If they want me to work on their depression or whatever, I tell them that I have no expertise or training in that area so I can guarantee nothing and it would be similar to talking to a friend or family member.

If I were able to give out diagnoses, I think I would simply give them out in most every case. Possibly if it might make a suicidal patient go over the edge, I might decline to give one out. But I will disagree with the clinicians below. In my opinion, physicians and other medical professionals in addition to all licensed clinicians should give out whatever diagnosis is appropriate. I feel it is a moral matter. The patient or client is simply owed a diagnosis on the part of the clinician or MD and I feel it would be remiss of the clinician or MD not to tell the patient what is wrong with them, and I mean everything that is wrong with them.

This is just my personal opinion and I believe there no ethical rules on the subject. Also I respect the clinicians below for not giving out diagnoses in cases where it would not be helpful. I simply feel that this is a case were morals or even the categorical imperative trumps pragmatics or even common sense.

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Filed under Anxiety Disorders, Borderline, Ethics, Health, Medicine, Mental Illness, Narcissistic, OCD, Personality Disorders, Philosophy, Psychology, Psychopathology, Psychotherapy, Psychotic Disorders

The Problem of Overdiagnosis in Mental Health

Zed: Most of psychology is whack bullshit considering the Jewish involvement. As many Jews are in medical field, they coin new terms to swindle money. While I am not calling entire psychology bullshit, it’s being stretched to include even normal behaviors. Lots of people are scared that normal behaviour like anger, happiness, crying would be branded as some kind of disorders. I looked up on it. There are many people I could identify as having passive aggression with its definition. It hardly matters, as they appear normal, and to brand them as some kind of mentally ill is a Jewish ploy. What have Jews called their pet groids who’re almost symbolic with destruction? Nothing!! That’s Jew psychopathy for you.

I guess I will have to disagree with you there.

If your personality seems normal to most everyone else, and if it is not ruining your life, we would say it’s not pathological. Only 14% of Americans have a personality disorder. That’s only one in seven. I work in the field though, and I have been studying psychology most via auto-didact for most of my life, and now I actually work as a psychological counselor. The more I work in this field, the more I think that in general, the field is onto something.

There is a lot of misdiagnosis around. I’ve been diagnosed psychotic a number of times by clinicians. That’s all wrong. I’ve never been psychotic a day in my life except when Trash drove me insane.

I received a diagnosis of Depression just the other day, and I think it’s wrong.

This same guy also insisted that I was either psychotic or used to be solely on the basis that I use marijuana. Last time I used it was 3 1/2 years ago, but no matter. Everyone who smokes pot is delusional according to this guy.

I was also recently diagnosed with “narcissism” but he said I did not meet criteria for Narcissistic Personality Disorder, thank God. I despise narcissists, so I contacted my favorite old therapist who I have not seen in 10+ years. He told me that I was not a narcissist. He said that instead I had something called “high self-esteem.” He said high self-esteem is often confused with narcissism, but it’s not the same thing.

In my own practice, I try very hard to avoid Diagnosis Creep. I think we should diagnose people with the absolute minimal number of disorders. A lot of times, someone will meet partial criteria for a couple of disorders, but we can’t give them full diagnosis. I have met partial criteria for GAD and Panic Disorder before, but I doubt if I meet any of those criteria now. If you want to check partial criteria, you will get a lot more people, but those are not full disorders. Diagnosing someone with a mental disorder is pretty serious business. I think we should do so as sparingly as possible.

For instance, of course passive aggression is everywhere. I have been accused of it myself. But in my entire life, I have only met one person who I felt actually met criteria for Passive Aggressive Personality Disorder. His personality is seriously screwed up by this problem, and it makes him a very annoying person to be around. He’s simply not normal. Not only is he passive aggressive, but his PA is so extreme that in my opinion it demands to be called some sort of mental disorder. I would very much object to the idea that this man’s behavior is normal or healthy at all. God forbid that it might become more common.

I would agree with you though that overdiagnosis is a very serious problem in the biz. Sometimes I wonder how much of it is money-driven. There is a tendency of clinicians to look at people, especially clients, as being much more ill than they really are. Their limits on normal behavior are quite ridiculous in my opinion. When you walk in that room, you’re the Sick One, and they are the Healthy One or the Sane One.

As a peer counselor, I try to get away from all that. The first thing I assure my clients is that I’m nuts too! I usually point out that I’m not nearly as nuts as they are (I don’t put it that way usually), but I was at some point, and if I got this much better, they can too! When they go down the list of their symptoms, I often tell them that I have experienced such symptoms myself, but that was a long time ago, or that I used to feel that way a lot, but I worked my way out of it, as I found that that was not a healthy way to walk through life. My basic attitude is, “I’ve been there too.”

In fact I am so sick and tired of playing the Sick Role while the clinician plays the Sane Role or Healthy Role that I have not been in therapy for a few years now. I’m graduated anyway. They told me I’m well enough that they don’t need to see me anymore anyway. I was on the state’s dime, so my care can be rationed which is fine with me.

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Filed under Mental Illness, Narcissism, Personality, Personality Disorders, Psychology, Psychopathology, Psychotherapy

Repetition in OCD and Other Disorders

Optimus Prime: Fair enough, he’s said what he wanted to say and has repeated it a gazillion times. As you said, the man cannot control himself. Robert, apart from NPD does he suffer from OCD as well?

Sure, I actually wish Trash well honestly. He’s just not a good fit for the site.

OCD does not = constant repetition. The thoughts repeat in the brain (definitely in my case), and some of the compulsions can be repetitive, but that is because they are trying to get it right or perfect or make perfectly sure they did it right.

That’s not what is going on here. This is different. We are looking at NPD as the primary process here.

It’s like he’s not sure you heard him the first time, so he’s saying it again or shouting it to make sure you heard. Also I think he is in love with the sound of his own voice.

I will admit that Trash is a talented and even entertaining writer. He makes this cool statement or analogy and then he repeats it in the next post because he thinks it’s such a neat little bit of prose. It often is a nice sentence or phrase, but you are not supposed to repeat it no matter how damn good the image is. You say it once and move on. He’s saying it again because he thinks it is a nice image, and he is impressed with himself, so he says it again to make sure you heard him the first time, like what people do when they say something and get no response. They often repeat it because they are not sure you heard them the first time.

I do not wish to single this man out as being “Mr. Crazy.” Face it, we’re all nuts.

And as we are dealing with a personality disorder here, I would like to point out that in my opinion, we all have disordered personalities of varying degrees. I think we all have adaptive personalities to varying degrees too.

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Filed under Anxiety Disorders, Mental Illness, OCD, Personality Disorders, Psychology, Psychopathology

Face It: No One Has a Healthy Personality

All of us have healthy and sick aspects of our personalities. It’s more or less normal to be nuts. Life takes its toll. Life wounds all heels and all of the rest of us too. I am not sure if there are any truly healthy people. If you went through 25,000 people, you might find one healthy person. I had a therapist once who told me that he had dealt with 20,000 in his career, and he hadn’t met one healthy person yet. He was of the opinion that there was no such thing. The general idea then would be to try to be least nuts and the most healthy that you can be and banish ideas such crazy, sane, unhealthy and healthy.

Sure we all have disordered personalities, but some people have personalities that are so disordered that we say they have a problem. We do not like to dole out diagnoses like candy, and there has been a strong movement nowadays to avoid pathologizing normal behavior. It’s a huge backlash against the DSMization of mental illness or the medical model as they put it. But I am a fan of the medical model. In my work, I have found that it is pretty much valid.

We call something a disorder if it making you miserable or seriously impairs your ability to function. It also may well be getting in the way with other people as others may  be reacting badly to your disorder.

In the case personality disorders, these folks generally think they are fine and that there is nothing wrong with them. The problem is with everyone else.

So who says they’re nuts? Well the problem is that in the PD’s we are dealing with a personality that is so far along the disordered spectrum that even other people start thinking that there is something  seriously off about this person’s personality. It has to be pretty bad as humans are tolerant folks, and most of us are aware that we’re at least a bit nuts themselves. People with PD’s are abrasive, annoying and exasperating and often cause a lot of impersonal chaos and drama. In other cases, the PD makes it very hard for the person to function socially. The person seems so strange and weird that others simply do not wish to deal with them. We think this is a problem because the PD is seriously getting into the way as far as functioning.

There continue to be arguments about the validity of some disorders.

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Filed under Mental Illness, Personality, Personality Disorders, Psychology, Psychopathology

Self-Defeating or Masochistic Personality Disorder

SDPD or MPD is an interesting concept. It’s more than being a battered woman.

Ever heard of the guy at work who meekly says, “Hey, it’s Friday night at 5 PM. You all go home. It’s a weekend night, and you need to get home early to have fun for the weekend. Don’t worry that your work’s not finished. I will stay here tonight and finish up your work for you.”

His behavior is masochistic in a nonsexual sense. He’s going to suffer like Jesus for the sins of the rest of you (not finishing your work). Don’t worry. You will be saved when Work Jesus finishes your work at 11 PM and trudges out of the office bleary eyed and alone. He doesn’t deserve to party. He’s on this Earth to suffer. He’s Work Jesus.

“You all go off and have fun now. I’ll just stay here and suffer alone. Don’t let me make you feel guilty or anything like that.”

Ever known anyone like that?

 

 

 

 

 

 

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Filed under Mental Illness, Personality Disorders, Psychology, Psychopathology

Passive-Aggressive Personality Disorder as a Valid Concept

This post deals with a concept called Passive Aggressive Personality Disorder that has risen, died and been resurrected a few times by the psychiatric community.

I read a recent article on Passive Aggressive PD that cheered on the fact that it was in the trash can now. The implication was that we are all passive aggressive sticks in the mud in one way or another.

Perhaps that is true, but I have met some people who are so passive-aggressive that they are frustrating, annoying, abrasive, exasperating and most of all infuriating.

You give the person a car to work on, and he says it will be done in  a week. It’s not done in a week, and he had all the time in the world. He is just being a stick in the mud as usual. You keep calling him. Three weeks later, you start to get angry. He completely blows up at you, as it’s you that are the problem, not him. The fact that it has been three weeks and he hasn’t even looked at the car yet is your problem, not his! He is outraged that you are such a terrible person that you bothered him about this. He is also self-righteous, as he thinks waiting three weeks for no damn reason was  completely reasonable!

You finally get the car back maybe six weeks later, and he “forgot” to fix a couple of things that he promised to fix. Whoops! He didn’t forget. He intentionally refused to fix them to get back at you for being reasonable and asking him to keep his end of the deal! We can’t have that! To this person, your concept of fairness is an outrage!

Now you look at the rest of the person’s life, and you see that passivity is the normal way of reacting with the world since a very early age. You go down the passive-aggressive checklist, and you check off at least five numbers.

This person is ill not because they are passive-aggressive. We all are, and if you ask some of my female ex’es and even current best friends, I am notorious, though I cannot see it. But the person above has become so passive aggressive that it is messing up their lives. In addition, it is starting to blow up a lot of their relationships, and as the anecdote above suggests, it’s probably getting in the way or making money. His passive aggression is turning him into a major asshole.

I would argue that this person is ill and that their personality is so disordered that we ought to diagnose it and call it Passive Aggressive Personality Disorder. I think we ought to bring back PAPD as a concept despite this dumb dimensional model that DSM-5 is forcing us to use.

Every met anyone like this?

Most of the other trashed PD’s are the same. I am certain that Depressive Personality Disorder exists. Someone very close to me is a textbook case. It’s quite rare, but it’s real. Sadistic Personality exists and so does Self-Defeating of Masochistic Personality Disorder. These two were thrown out by idiot feminist clinicians who thought that woman batterers would be labeled as ill with SPD and they would use it to try to get out of punishment.

They also thought that battered women would be prejudiciously labeled as SDPD or MPD, and this would be a blame the victim thing. Well, sometimes you need to blame the victim in sense. It takes two to tango. And many battered women would indeed qualify as SDPD.

I think you all know what Sadistic Personality Disorder looks like as most of you have probably had the misfortune of meeting one.

 

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Filed under Feminism, Gender Studies, Mental Illness, Personality Disorders, Psychology, Psychopathology