Tuesday, September 16, 2014

In-house #3 -- Youthfulness and personality disorder

I propose a very casual definition of personality disorder: It’s to be neurotic ego-syntonically.  Neurosis is to be driven, usually blindly, to achieve spurious, screen needs.  For example, a real need is to be loved in babyhood, infancy, childhood.  Failing that, false needs form and proliferate with time: to crave chocolate or comfort food or certain textures, to tremor and have emotionally escapist “ADHD”; needing promiscuous sex, seeking riches or adulation of the masses or serial “successes”; to masturbate while your wife is in the next room, to masturbate intellect for its own sake, to be suicidal.  Ego-syntonic means ‘in attitudinal harmony with one’s nature.’  Therefore, to be personality disordered is to emotionally, ideationally and behaviorally endorse one’s dysfunction, to be holistically in sync with it.

Compare two qualities – depression and dependence – with their personality disorder incarnations.  A person with depression does not like it, would rather feel better.  A person with Depressive Personality Disorder* –

“The essential feature is a pervasive pattern of depressive cognitions and behaviors that begins by early adulthood and that occurs in a variety of contexts. . . . The depressive cognitions and behaviors include a persistent and pervasive feeling of dejection, gloominess, cheerlessness, joylessness, and unhappiness.  These individuals are overly serious, incapable of enjoyment or relaxation, and lack a sense of humor.  They may feel that they do not deserve to have fun or to be happy.  They also tend to brood and worry, dwelling persistently on their negative and unhappy thoughts.  Such individuals view the future as negatively as they view the present; they doubt that things will ever improve, anticipate the worst, and while priding themselves on being realistic, are considered by others to be pessimistic.”
– feels validated in his misery, would not want to ameliorate it because it is the correct response to a miserable world.  A quadriplegic dependent on his evil stepmother would love to be free of her, to be independent.  But someone with Dependent Personality Disorder –

“The essential feature of Dependent Personality Disorder is a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation. . . . The dependent and submissive behaviors are designed to elicit caregiving and arise from a self-perception of being unable to function adequately without the help of others. . . . Individuals with Dependent Personality Disorder have great difficulty making everyday decisions (e.g., what color shirt to wear to work or whether to carry an umbrella) without an excessive amount of advice and reassurance from others.  These individuals tend to be passive and to allow other people (often a single other person) to take the initiative and assume responsibility for most major areas of their lives.  Adults with this disorder typically depend on a parent or spouse to decide where they should live, what kind of job they should have, and which neighbors to befriend.”**
– feels good to be abject, incomplete, incapable on his own.  It is, it seems to him, his right soul.

The other personality disorders, including Borderline, Narcissistic, Histrionic and Antisocial, also conform to my definition.  Though in some ways qualitatively different, they all contain the distillate of a harmonious attitudinal set.

Yet, there have to be other bases to personality flaw.***  I – and I am sure most clinicians – have seen individuals who reek of personality disorder yet do not seem to have a broad complacency about their erroneous life.  What is it we see in them?

I am thinking of three women I treated twelve years ago.  In their mid-to-late forties, they looked fifteen years younger.  Each had an adolescent-bright character and manner, lacked the gravitas of her age, pulsed a kind of naïve alacrity.  Yet all had had the strength to escape from abusive, narcissistic men – the kind that smell like a rose in court as they trash the “hysterical” woman – and could eventually see them for what they were.  All were acutely rational (though with an emotional coloration), did not have a subservient mentality, worked and lived independently.  None were especially manipulative, cut herself, went briefly psychotic, threatened suicide, caretaked the world, oozed pain or pitifulness or rage or cynicism, devalued then idealized a partner, saw all-good then all-bad.  All three were disrespected by some of their children, loved by the others.  Two lost custody to their husbands, one gave up custody.

What created the strong flavor of personality disorder?  There was one flagrant sign that has remained for me unstudied, a tangent sitting in a far-off corner: All three women had produced an artificial child, a latency-age adult, a storm-and-stress soap-opera mini-intellectual delivering psychological correction and disdain to her weaker mother.  In other words, their progeny were personality disordered.

Another sign was the youthful air, the lightness of tone and girlish lift of eyebrow that I found bewitching as a Siren’s call (neurotic magnets pulling together).  And then another sign: The women lived on a lilting plane of ideas and explanations, not perception.  It turns out they did not see the world, but only their own youthful pain.

Many ideas, emotionally orchestrated, but like a smoke cloud swirling high that is still related to its fire: They had been burned in childhood and had never left it, but the thoughts tried to race to safety.  In two women it was religion.  In the other –

One understanding that came out of session’s discussion was that client has an obdurate, fixed conviction that there are no good men in the world.  Or alternately – when she briefly softens the delusionality of that conviction – that there may be some, but they are (a) married to other women; or (b) incapable of being in a relationship with her.  Here, we were coming closer and closer to the feeling-core that caused her to nix the idea of a ‘good man’ and made her certain that she can never be a part of a healthy relationship.  One sub-factor in the delusional equation is client’s equally fixed belief that the man must always have somewhat more power, more ‘leadership’ in the relationship.  She was able to see the childhood-victim base of this belief.
– a philosophy that kept her safe, in her blind fortress, from all the loss of nurture.

If we combine the youthfulness suspended in time, her living in a thought cloud above the fire, the weakened, needy and envious soul of an adult-child victim, we’ll see that her own child was nursed at the breast of his mother’s propaganda and defenses – not a peaceful, sensual nursing but one replaced by the mutterings of neurosis.  I have seen a fair number of these youth and it always causes me a painful, aggressive frustration.  I want to say: Lose your damned mind!  Kill the absurd sophistication.  You are a terrible psychologist.  Be a kid again – just play!

These women were forever young, forever themselves, not at odds with their dysfunction, ego-syntonic.  Maybe this is because they are, in a silent deep place, forever hoping to be led by hand to adulthood by a loving, good father.

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* A DSM-IV hypothetical diagnosis (page 788) that I consider as valid as any other.

** DSM-IV, page 721.

*** I am bypassing Masterson’s and any other theory of the failure of the mother-child bond.

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Comments are welcome, but I'd suggest you first read "Feeling-centered therapy" and "Ocean and boat" for a basic introduction to my kind of theory and therapy.