Behavior
Poisonality
Everyone knows someone like Amy, but even Mother Teresa had her off-moments.
Rewind ten years ago. Bill, who happens to be a writer, quickly puts together an obituary for his deceased father that gets featured as the lead obituary in a major newspaper, then delivers a moving eulogy at his service. Both the obituary and eulogy help Bill’s mother manage her grief and come to terms with her loss.
Fast forward ten years later. This time an aunt is being laid to rest. Bill’s mother happens to mention to her daughter that when her time comes she wants Bill to do her obituary and eulogy. As the casket is carried out, the daughter pulls her other brother aside and says in a voice quivering with rage, one that carries into the distant pews, “She really knows how to push my buttons!”
Everyone would agree that the daughter’s behavior is totally selfish and highly inappropriate, but is it consistent with a personality disorder? Consider:
Let’s suppose the daughter – call her Amy – had been especially close to her aunt and not so close to her mother. Suppose for two days, in her state of distress, she has been enduring a steady stream of sugar-coated insults from a mother she can barely stand. Then mom makes a seemingly innocuous comment that sets her off …
Let’s change the context. This time, suppose Amy had to cross three time zones to attend her aunt’s funeral. She has missed a night’s sleep which has triggered an irritable hypomania. During the service, she is literally crawling out of her skin. The air is oppressive, the people are making her claustrophobic, she can’t sit still, she wants to scream. Her mother says something, and she turns to her brother …
Distinguishing a bad hair day from a mood episode from a personality disorder meltdown is notoriously difficult. Even Mother Teresa had her off-moments, and no doubt Gandhi had unresolved issues he needed to work through. We all have feet of clay. Labeling someone with a personality disorder, then, is perhaps the most insulting and stigmatizing act one can visit upon an individual, even in the name of therapy and treatment. Reflect for a second the names psychiatry has bestowed on the four main personality disorders, lumped together into what are called cluster B personality disorders: Borderline personality disorder, antisocial personality disorder, narcissistic personality disorder, histrionic personality disorder.
You are not supposed to like these people, is the strong message attached to these labels. These people are poison, the message goes on to say. They lack empathy, they are impulsive, and only they matter. The golden rule doesn’t apply to them and neither do most of the commandments and other people's personal boundaries. Cut them out of your life, run away, treat them like lepers
And you thought depression and bipolar disorder carried a terrible stigma. Then again, if a family member or an acquaintance or a colleague at work is currently making your life miserable, you probably don’t have much sympathy. Life is like that.
Psychiatry effectively divides mental illness into two major categories, or axes. Depression, bipolar disorder, anxiety, schizophrenia, and other “clinical” illnesses occupy axis one and the personality disorders occupy axis two (there are five axes in all). Axis one, to oversimplify, is about chemical imbalances, axis two about unresolved emotional issues.
We all have personality issues in abundance, and that is the term of choice for this writer. This is not about US and THEM. Usually, we are talking about WE. The labels psychiatry employs are useful only to a point. Yes, we may think we know a narcissist when we see one, but the human psyche is way too complex to allow for easy pigeonholing, even when performed by the experts. For the sake of getting a discussion going, we will start with the standard labels, but please keep in mind these are overly broad generalizations that most of psychiatry finds in bad need of reforming:
Borderline Personality Disorder
Freudian psychiatrists came up with this term to describe what they saw as problem patients bordering on psychotic. The Freudians were way off the mark, as psychosis - close to the border or not - has nothing to do with borderline personality disorder. Emotionally unstable is a far more accurate description. Nevertheless, the name stuck, together with the legacy of borderline individuals being problem patients. Sympathetic hospital staff have been known to turn on individuals in distress once they have been handed this diagnosis.
The DSM, which was supposed to clean up the mess left behind by the Freudians, only left a lot of skeptics wondering whether borderline was in fact a true illness. This is because borderline and bipolar disorder are an almost exact overlay, with virtually no distinguishing symptoms. Unofficially, psychiatry is guided by the common stereotype of the moody and often hysterical teenage girl (or people who act like one) who may have abandonment issues, act impulsively, and engage in destructive behavior such as cutting. The illness is thought to occur in twice to three times as many females as males.
Susanna Kayson’s “Girl Interrupted” is the classic example of borderline personality disorder. Ms Kayson describes how she was shipped off to McLean Hospital outside of Boston back at a tender age in an era when she should have been attending Woodstock and going to college.
People living with someone who exhibits borderline tendencies typically describe the relationship as akin to walking on eggs: one minute all love and light, the next a hateful explosion or the sullen silent treatment. A borderline meltdown tends to have its roots in the individual’s lack of ability to handle any given social situation. Thus it can occur without warning. This tends to contrast with bipolars behaving badly, which typically flows in slower cycles.
(For more on borderline, check out my next article.)
Antisocial Personality Disorder
Serial killers generally fall into this class, but the diagnostic criteria is wide enough to include your abusive boss or scheming co-worker, or for that matter your brother who borrows your car and returns it without refilling the tank. According to the old joke, poor people with antisocial disorder are in prison, middle class individuals with this disorder are in therapy, and rich people with the label are CEOs. These are your classic sociopaths, out for number one, with no regard for others. “I’d walk over my own grandmother to re-elect Richard Nixon,” Watergate conspirator Chuck Colson once bragged. He wasn’t joking. He authored an “enemies list” of real and imagined political opponents to be singled out for special treatment, such as FBI harassment and tax audits.
You may recall about a decade back when an impasse between the White House and Congress resulted in the shutdown of the federal government. Tens of millions of people were sorely inconvenienced or distressed, their lives placed in jeopardy or put on hold as services were not performed and checks not delivered.
The principal reason for the shutdown was the now-discredited politician Newt Gingrich, who at the time was serving as Speaker of the House. Earlier, he had served his cancer-stricken wife with divorce papers. After the impasse was resolved, Mr Gingrich came clean. The reason he refused to negotiate with the President, he explained, was due to the fact that he had not been offered a better seat on Air Force One to attend a foreign dignitary’s funeral.
He said this without the slightest hint of embarrassment or shame. His bruised ego was more important than the lives of nearly 300 million citizens, and we were expected to sympathize with him. Now (in 2006), he is considering running for President. Some people never learn.
(Lest you think I am singling out Republicans, Chuck Colson changed his life and found Christ soon after being convicted, devoted himself to ministering to prisoners, and has become an inspiration to millions.)
Narcissistic Personality Disorder
One could just as easily classify Newt Gingrich as a narcissist, but he pales in comparison to Tom Cruise. As well as the occupational hazards of being filmdom’s reigning pretty boy for the past 20 years, this high school dropout knows more than the experts about psychiatric illnesses and even has the cures.
Often, one with narcissistic tendencies is compensating for lack of self-worth.
Histrionic Personality Disorder
All of us enjoy being the center of attention, but people like Tom Cruise tend to go about it by jumping on Oprah’s couch. Those inclined toward histrionic behavior also hate it when the spotlight turns to someone else, even a loved one. “Poor me” may also feature in their routine.
Meanwhile, Back at the Funeral Service
Let’s return to Amy. She could be having a bad hair day. She could be experiencing a mood episode. She could also be having a meltdown stemming from various personality issues.
Please make careful note of the term, various personality issues. We are not going to attribute Amy’s outburst to one full-blown personality disorder. She may have one, she may not. But in all likelihood, a number of things are going on, a bit of this, a bit of that. Amy may be a kind and loving person, but her funeral theatrics indicate that something is clearly wrong.
But does Amy know it? She looks at the people staring at her and wonders what THEIR problem is, then leaves the church as if nothing happened. Or, if she acknowledges something has happened, she has already justified it – clearly it was her mother’s fault, the one who knows how to push her buttons. If her mother is a saint, if cornered, Amy will find a way to demonize her.
Woe to the person who may challenge Amy, but even if all her defenses are unmasked, she can still play the pity card. Even when she admits she’s wrong, the attention is worth it. There is victory in defeat.
Therein lies the difference between a person experiencing a bad hair day or mood episode and one with personality issues. The former are typically mortified by their out-of-character behavior (once they have settled down). The latter happen to be right in character. There is no settling down, no remorse.
But before you congratulate yourself for not being like Amy, it pays to recall that we all have personality issues of some sort. And when a mood episode happens to converge in an unholy alliance with one of our issues, well maybe people prefer Amy's company to yours or mine. Perhaps you can't spot when this happens, but you can pick up clear hints from friends and family. "Just snap out of it" and "chill out," are good indications that you need to work on your mood episode. A clear injunction to "get over it," on the other hand, suggests that a major behavior course correction may be your best option.
But Before We Start Judging Amy
Clinicians need a lot more to go on than a single incident. Typically, they look for a pattern. Okay, let’s play spot the pattern with Amy: Has told mother 15 years running that she is six months from completing her doctor’s degree; Has had fights with every thesis advisor she has encountered; Says she will join an exercise program once she has finished her thesis …
Okay, we’re starting to pick up a pattern. But is it one that seriously impairs her life? Well, she doesn’t really need the doctorate, and it's not going to earn her extra frequent flyer miles at work. What about other aspects of her life, such as personal relationships? She likes to talk about steaming hot sex, but her last passionate fling was twenty years ago. She has never sustained a long-term intimate relationship, but then again she manages to attract a lot of friends.
Granted, these friends may have to cut her a bit of slack, such as the time she abused and stiffed a waitress because she couldn’t order from the children’s menu. And they roll their eyes when she says she’s going to have her own show on the Food Network, but she’s just crazy enough to pull it off. After all, she’s a good friend of Rachel Ray’s, and she wouldn’t be saying that if it weren’t true, right?
Yes, Amy may have issues, but her ability to manipulate and intimidate and draw attention to herself, not to mention the supreme self-confidence she exudes, are exactly the right stuff for personal success. If only she weren’t quite so normal she could be on the cover of People magazine.
No, the real test is when she returns home to her empty condo, alone with her thoughts and vulnerabilities.
It’s later in the day, and the funeral party has gathered for eats in the church rec hall. Now Amy is making nice with the family. She tells her mother how good she looks and she offers to take a nephew to London with her. Okay, she spoke in too loud a voice when she said the meatballs could have used a little cumin, and reaching for that second piece of cake after she just informed people of her diabetes may have raised eyebrows, but even cynical cousin Paula is flattered to hear they must “do lunch” sometime soon.
“I’m flying out to a business meeting in Santa Fe tomorrow,” she lets everyone know, as if to apologize for her early exit. She doesn’t tell them that the “business meeting” is really the latest round in a series of so-called self-improvement courses. She is “working on herself,” or rather some guru figure is working on her wallet. A few more ritualistic credit card transactions and Amy may qualify as a life coach. Someday soon, some individual is going to wind up paying good money to have Amy tell her how to run her life.
And I say to myself, what a wonderful world …
April 22, 2006, reviewed Feb 10, 2008
See Also This Companion Piece
Borderline Personality Disorder
A mood disorder may be the least of your problems.
Knowledge is Necessity
Copyright 2008 John McManamy Contact
My Book
“The perfect book for those of us living with mood disorders.”
Sue Bergeson, president DBSA
Order nowStay Informed: McMan's Report
