Tuesday, June 19, 2007

Nations As Personality Disorders

I had occasion yesterday to discuss with a personality-disordered young woman whether she would be staying beyond the 10 days of her emergency petition. She greatly minimized what she had done to get herself into hospital; every sentence that came out of her mouth included some blame for others. Even when she made a show of saying she was accepting responsibility, she would undo that before she came to the end of the sentence. I know I was acting like a teenager yelling at my mother because she wouldn’t listen to me. I was angry and said that I’d like to kill her but she knows I would never do that and put me here anyway.

After 30 years of doing this, I have a mental checklist of things people say when they get into situations where they do not want to hear the truth. This woman, who is a prescription drug addict who would rather be some other diagnosis (which would entitle her to anxiolytic medications) made three of those checklist statements within 60 seconds. It is seldom worth carrying such a conversation farther unless you are willing to adopt far more indirect tactics of introducing unpleasant realities.

This is not very different from many online debates I participate in. To go further, it is not very different from many of the national and international debates we have. These are not mere disagreement and different perspectives, which can usually be negotiated and reach some accommodation. These are simply refusal of one side to accept any responsibility, or even any slight modification of their premise. Even when making a show of taking responsibility, they are actually only blaming, for example: I don’t think the Democrats are perfect in this. I fault them for letting the Republicans get away with it.

Noticing the parallels between the pathological arguments of individuals and of groups, I went back to my Underground DSM-IV, my collection of frequent statements made by psychiatric patients and what they actually mean. In the section under personality disorders, I found many things which matched up with political realities today. The following list is a compilation of statements about pathological individuals. Observe how many are used by nations as excuses. You may have to stretch a bit to see equivalences such as foreign aid = therapy, or economic/military interventions = hospitalizations. I am thinking in particular of the Arab/Muslim nations and their narcissistic style, plus the Western European elites and their high-functioning borderline style. (People who are used to working with these categories might also find it enlightening to reflect on nations with histrionic, schizoid, antisocial, and paranoid styles. Comments welcome.)

When a patient claims that the hospital doesn’t know him, and therefore has no right or foundation for evaluating him, he means that the objective evidence should be ignored in favor of his rationalizations. Related: “No one is listening to me,” means “no one is agreeing with me.”

Pts. referring to length of time they have been in hospital as an argument for privileges or discharge means they still don’t get it.

The wife or mother of the violent sociopath who says “I just want him to get help” is going to take him back (See “I need therapy,” next.)

“I need (undefined) therapy.” Means I feel bad and think I will feel better if other people listen to me endlessly. Our other offerings, including group therapy, won’t be considered real therapy. Other variations include “I haven’t gotten any therapy here.”

Identifying “low self-esteem” as your problem means you want someone else to fix it. Self-esteem (in the popular sense, not the older, precise sense) is entirely subjective. Self-respect is based on actions. Seeking self-esteem is seeking to feel better without doing anything, and does you no good. But no matter how far down you go, you can always do something to increase your self-respect.

Paranoids have an uncanny ability to make their worst fears come true. Eventually, everyone is watching them and trying to stop them from (fill in the blank)

Borderlines seeking cool alternative diagnoses have an uncanny ability to locate only private therapists who can’t help them. (Note: for the international equivalent, it may be helpful to think of academic opinions and the NYTRB here)

People who have a “problem with women,” or “problem with men,” reveal behaviorally in about 24 hours that they don’t do well with the other gender either. Ditto for “problems with authority.” Those folks also tend to show “difficulty working independently” and “difficulty sharing responsibility.” What’s left?

Punching the wall is not something to be congratulated for just because you wanted to hit a person instead. You are still rehearsing violence. In fact, you are ably demonstrating how unconcerned you are with your own pain and will use that to intimidate others.

Intense borderlines tend to live near the hospital and interact with each other. When any one of them dies, or especially if one commits suicide, several others will have short memorial admissions to the hospital.

When a patient challenges your credentials, no credentials will be good enough. There will always be something you lack. “Oh, so you’re not a psychonutritionist.”

When a patient – and some providers – claims a “right to be angry,” there will be a sudden shift in the meaning of ordinary words. That one is entitled to ones own feelings and opinions will be made to equal “I am justified yelling at people. Or worse”

France is a glamorous borderline personality disorder – the cause? An abusive incestuous relationship with Germany. Much of European politics suddenly becomes clear if you keep this in mind. The rescuing Americans are the bad parent who didn’t rescue enough, and so get blamed more than the perpetrator, who she has now gone back to live with.

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