Shithouse rat

I'm a bipolar writer in the Naked City. I'm not playing with a full deck. I don't have all my dots on the dice. My cheese is sliding off my cracker. I don't have both oars in the water. I'm a bubble off plum. In other words, I'm crazier than a shithouse rat. These are my stories. Comments--short or long, nasty or nice--always welcome!

Saturday, October 08, 2005

The pause that depresses

In case anyone hasn't noticed, I sometimes write about mental illness. After all, I AM bipolar II, and BG is schizophrenic--or so the docs say.

But lately I've also been tossing around a lot of diagnostic terms willy-nilly: obsessive compulsive personality disorder, borderline personality disorder, and so on. And of course, there's a world of difference between me playing psycho detective with Robo-dentist and other wackos, and a shrink making an "official medical determination." (Or is there?)

For quite awhile, I've been contemplating a piece on the DSM,or Diagnostic and Statistical Manual for Mental Disorders--aka the bible for the psychiatric profession. This unwieldy tome of mental malfunctions is the tool shrinks use to diagnose patients and assign them a handy numerical code useful to all involved--including pharmaceutical and insurance companies. Let's take--oh, for example--attention deficit/hyperactivity disorder. Funny how so many American kids today seem to have it--and lucky they are to have a wonder drug like Ritalin available to treat them all, hmmmm?

In any case, there certainly seems to be a steady rise in the number and type of disorders to be found in the DSM. I like to joke that nowadays, everyone formerly known as an asshole or oddball now has a DSM diagnosis to call their own.

But right now, I have a problem very close to home that involves a physical as well as psychological disorder. My ex-boyfriend of 20 years has just been diagnosed with myotonic dystrophy, a form of muscular dystrophy. It is genetic in origin, which means that other members of his family might also have it. Although symptoms and severity vary, sufferers can be at great risk for heart or respiratory complications. Some eventually wind up in wheelchairs; life expectancy is often shortened. Symptoms can include nerve/muscle problems, heart problems, and behavioral disorders and even facial characteristics which are thought to be caused by the disease--in other words, they are likely organic in nature. Some suffer from a diminished IQ--even retardation--particularly children who present with the illness.

I could write a lot at this juncture about my ex-b/f, but suffice it to say that I am very distraught over this. I spent most of yesterday trying to find out everything I could about the disease, and in doing so I stumbled across some links and studies that indicate that people with myotonic dystrophy can develop a certain cluster of behavioral traits which seemed to fit L, my ex, very well. Another study went even further and categorized these behaviors as often fitting the criteria for certain personality disorders, including passive aggressive personality disorder.

I have always felt that my ex was passive agressive, in the offhand sense one says someone is anal retentive. But when I looked at the symptoms for this disorder, it fit my "x" to a "t". Many of the behavioral and personality patterns that had caused so many problems for him, myself and others over several decades were described there to an UNCANNY degree--and had worsened in later years. These included his negative attitude toward work and authority which caused him to be fired from a job he'd been able to hold onto for 15 years, albeit with difficulty. Just as some of the physical symptoms (such as cataracts in his 30s) had been present for a long time, certain aspects of his personality that I'd lived with for many years were now spelled out for me in black and white. Aside from the bare-bones link above, another site went into much more detail about the disorder, and this also fit him perfectly.

Although it is probably wise to be skeptical about the fact that virtually everyone can probably fit at least some of the DSM criteria for something--and thus, perhaps, find an "excuse" for their maladaptive behavior--advances in brain studies have begun to show that many criminals seem to have organic brain damage. For example, sociopaths may have deficits in the part of their brain which regulates impulse control and empathy for other's suffering. So what kind of moral/existential dilemma does this present us with? When it comes to our brains, is there such a thing as true free will?

In any case, this situation has made me think even more about the nature/nurture dichotomy in mental illness, and wonder how much of the difficult behavior I'd experienced with L over the years was really "himself" versus a disease-- in a very real, undeniable sense. I also recalled that his older brother, who seemed to share some of the same personality traits, had died quite suddenly several years ago. Since an autopsy was never performed, the cause of death is pretty much of a mystery.

I think It is only human nature to try to explain and categorize human behavior so as to make some sort of sense of it--while at the same time trying to determine if a given trait is preordained or can be modified--or both. Religious people might explain homosexuality as a sin; some may feel the person is possessed by an evil force, while others may view it as a wholly deliberate and voluntary choice . Astrology, which I happen to believe in at least to some extent, categorizes people according to the time and place of their birth. Each sign has traits which can be embraced in a positive or negative way, according to the individual's self-awareness and will.

In psychology and psychiatry, there is also a conundrum concerning nature (and hence, more pessimistic determinism) versus nurture. Although psychoanalysis tended to focus on environmental factors, especially early childhood experiences, now the pendulum has swung around to the point where the answer to many disorders seems to involve drug therapy--and thus the presumption that one's disorder is a least partially beyond one's control.

Perhaps the ultimate irony is that I had recently done my own little psychoanalytical analysis of L's behavior. I thought I'd figured out why he was the way he was--it all had to do with his family and childhood experiences, or so I thought.

I will probably post more on this, but I just wanted to say that I appreciate everyone's comments here to date, and I will go back and respond to all. Right now I'm a bit distracted though, so please do excuse me.

25 Comments:

At 10:43 AM, Blogger Timothy said...

I am so sorry to hear you are distraught. I have wondered many times about one of my exes having passive-aggressive personality disorder. No, there is no difference from you and a PHD making guesses. You are perhaps more accurate and I would trust you first. When I worked in the psych hospital, the PhD’s would see the kids for less than 5 minutes the whole 5 or 7 days the kids were there. How can they be accurate? They can not! One of the “doctors” there, who was actually from Wyoming, said curing depression is no different from curing cancer. I strongly disagree. The numerical code is a product of the insurance companies. Therefore all about money. The insurance companies want codes so they can assign payment structures and not have to look at medical terms. After all, they are not educated in mental health, only business. Unfortunatly, money rules the type or amount of treatment a person recieves. Imagine the power the insurance companies have now over your life. I agree, is their really Free Will when one has an organic brain issue? Perhaps not and that would explain poor impulse controls. However, if one believes in past life and reincarnation, perhaps there is still an existential explanation. For example, Karma. Nature vs. nurture. In my opinion and my professional experiences, it is a combination of both. Can one absolutely control their thoughts and actions? We create our own realities. What we think, therefore, we are and if we think we can not control it and we need meds to control it, then that is how it is for us. I can not master my thoughts and actions at all times, so why would I expect it of others. The concern I have is that a person will accept the label absolutely and use it as an excuse to be lazy and live in their wounds and not learn or grow and totally rely on drugs. I tell myself that I just have to work harder than a ‘normal’ person, if there is such thing as a normal person. I do not have all the answers. I know what works for me and what does not work. There is a choice, but perhaps our choice was made before we came back into this life time. Perhaps we had very little choice but to pay off some bad Karma, or maybe I am just schizophrenic as they taught me my way of thinking is in college.

GREAT blog!!!! Thank you!!!

 
At 12:07 PM, Blogger Timothy said...

In all fairness to the psychiatrists and PhD’s, I should not be so critical. I am sure their are many of them who actually care and want to help people. I just have not met any, yet. My instructor for my graduate level course “Abnormal Psychology” is, or was at the time 4 years ago, a PhD clinical psychologist. She told us in class that those diagnosis codes were forced on the APA (American Psychological Association) and against their better judgments. If a shrink does not assign a client a code after the initial visit, they can not bill for services. Although it is possibly, it is highly unlikely one can be successful financially without insurance reimbursements or from government programs such as Medicaid or VA benefits. One of the “doctor’s” at the psych hospital I worked at said he could diagnose severe/clinical depression with one question. Excuse me, but isn’t that a little arrogant? Of course he was young and pretty and a Yuppie wanta be who talked to any female who would listen about his penis extension or what he called a BMW. Most PhD’s will tell you it takes several visits to get the person to begin telling whole truths and details, let alone be able to make good educated diagnoses. They can however, and often do, change their original diagnose. Takes lots of paper work and fighting with the insurance companies, but it can be done. It all comes down to money. Unfortunately, we all have to have it. Even in Wyoming were we can still hunt and gather. Money rules. All of the kids I saw at the hospital were insurance or self-pay. The vast majority got released far too soon because they did not have insurance coverage. The doctors could not claim AMA (against medical advise) on their early releases because it was mandated by the insurance company for payment coverage. Most of them all came back and not just once. In a short 2 month period, one 14 year old, who just happened to be born on the exact same day and years as my son, was in 4 times. Each time she had to be let out after 3 days because that is all her mother’s insurance company would pay. This girl did not want to go and she told every one she needed more help. By the way, her mother made a few extended visits of her own while I was there, too. That girls’ biggest issue: low self-esteem. At one point, I wanted to get a PhD and be a licensed counselor. I wanted to make a positive difference and to help others and to make some positive changes in this flawed system. However, I got denied acceptance into grad school, 6 times. My negative experiences just lead me to where I am now, so maybe I should not be so judgmental. I just wanted to help those kids. Many told me I did and that I was the reason they were able to get out. Insurance coverage for mental health issues is new in my life time. Back in the 70’s, they would cover nothing or very little. I am glad they do now because millions of people can get help. There are tons of positive advancements, but the system is still ruled by money, not by a desire to help others. Better treatment means less pay-outs.

 
At 3:14 PM, Blogger Assorted Babble by Suzie said...

Personality disorders and human behaviors are definitely mysterious and it seems to have many meaning behind why ones react as they do.

It appears only in this last decade to where new names including disorders, syndromes, etc. are being attached to one's individual symptoms.

Doing my own research I seem to understand many of my illnesses the best and then share with the knowledge of doctors...also found they appreciate it too.

Take care of yourself. Your friend, Suzie

 
At 5:39 PM, Blogger Walker said...

I'm sorry to hear you are distraught about your ex's newly found disorder.
But and with no real knowledge of peoples mental problems, I find that many things are being discovered of late about mental illness. Or should I say new forms of mental illness.
The problem I am having is, are they true illnesses or just zealous doctors looking to make names for themselves by creating a new form of desease to cure. Thus eating up resources that are needed to help people who are truly ill.
There are people who are ill and need help but I think that many of the new things being discovered are non existant or just forms of something else that are said to be new.
Doctors tend to over diagnose people and speculate more on mental desease than any other. It's a guessing game by the looks of it.
How can you medicate all our kids (lets face it there are more kids on ritaline latley than not)and not expect problems down the road.
Look there is a happy kid , get the ritalin.
At the rate new mental deseases are being dicovered we'll all eventually have one.
I think many of the mental problems people face today are not hereditary but products of our social evolution.
The stress to succeed, the quest for popularity to be accepted. All of this is the major cause of mental problems.
My concern here is with all the mental problem they believe exist, how many are truly deseases and not just by products of frustration and how many are true deaseases, so that we can treat the ones that have physical mental problems and the others need counceling.
Was I just rambling? Yup I think so, I better get back to football.
:)

 
At 8:09 AM, Blogger Danny said...

Elvira:


Sorry to hear about your ex. I'm truly at a loss for words. Hang in there, ok?

 
At 8:24 AM, Blogger Justine said...

Elvira, I’m sorry to hear your very significant ex has this awful illness. It must really churn up a lot of stuff from the past. Hearing about people getting something like this really hits you hard in the guts. I’m sorry to hear you are distressed. Of course you are. How else could you be.

This was a thought provoking post. For me, about ex’s and could have beens and ‘What on EARTH was wrong with my ex?” And about illness and responsibility – absolving yourself of responsibility… I didn’t come up with any answers but I had a good chew of the bone.

As for my own condition (living), I wouldn’t be game to look up a diagnostic book. I’m the worst hypochondriac!

BTW 18/4/78 :-)

Ditto what Danny said.

 
At 9:13 AM, Blogger Timothy said...

This is such a bummer for your ex bf. You are a good person to be so concerned. I can think of 2 or 3 of my exes who would welcome the news of me being fatally ill or worse than dead. Too bad for them. Please, do not beat yourself up over this.

 
At 1:38 PM, Blogger Leslie said...

I know how you feel. I have severe scoliosis and I have been temporarily diagnosed with possible fibromyalgia. Knowledge is the first step. Hang in there. It does get better.

 
At 2:04 AM, Blogger jane said...

wow, isn't it something when the scales are removed from our eyes & we can suddenly 'see'. i'm sorry that L has this disease, hopefully there is some medication that can alleviate some of this.
Your question of free will. That's very interesting & one I've never thought of in that light. I suppose everybody could argue this to support their belief system. I just know that when I'm exposed to something insightful like this, it will inevitably be a recurring (sp) theme/thought that I will be reminded of sometime soon & have an AHA moment. (hope that made sense)
You're a great person & a warm, caring person. I hope you are feeling a little better soon.

 
At 12:40 PM, Anonymous Dennis said...

re: the ADD

I am sure the behavior patterns etc are real enough, but I'm not sure they all need the Ritalin. Sometimes some therapy in the woodshed along with lots of chores and close supervision will work wonders.

actually, I'm 51 years old and I think I might have ADD. But, I don't want ritalin or a trip to the woodshed. LOL

-DJR

 
At 1:33 PM, Blogger Nikky Egland said...

Are you a psych major by any chance? Not many people know about the DSM for instance. I know I can be passive aggressive, like talking very quietly when my hubby and I argue but saying the most scathing things...

 
At 2:51 PM, Blogger jessie said...

thanks for the post on ocpd. i have met with my therapist and he thinks this may very well be a real possibility. hopefully i can finally get some releif.

 
At 8:56 AM, Blogger Brink Craven said...

E--Finally had a chance to visit your blog--so much going on these days. Ive been so out of of it.

Im so sorry to hear about L. That truly sucks. I hope this disease is at least somewhat managable. And I also hope your not feeling guilty for not knowing what was up and thinking his behavior issues might be due to a mental illness. How could you have known? I just know your propensity toward guilt, so Im trying to head this off at the pass :-) Thing is what you said was right on. We all have this urge to try and diagnose people to "make sense" of the sometimes very confusing and distrubing things that are happening with them. It seems to be very much a part of human nature to make an attempt to 'figure things out'. Just like folks in the Mental health biz, many of which are trying to figure out thier own stuff and attending school for 6 or more years to do so. So I dont think its at all unusual or bad or freaky or anything. It just seems to be a part of our mental hard wiring--it makes us feel safe or something--yeah like all that stuff--if we could just find the "answers" and put them all in a neat little package, everything would be safe and cozy. Once and for all.

Anyway,enough of my philosophical babbling-- my best wishes to you, L and family.
be well and love eachother yall.

 
At 8:17 AM, Blogger elvira black said...

Timothy:

Wow--thanks for the fantastic comments. It's great to get the persepective of someone who's seen a lot of the mental health profession from the inside as you have. As you say, the system is imperfect but probably infinitely better than it used to be. But you're right-- the revolving door and 5 minute diagnosis doesn't seem viable at all.

I also tend to belive in karma. Though I don't know if we literally have past lives, I think karma works its magic even in this one, since I believe the golden rule pays off in the end.

As far as the DSM and diagnoses--mental illness is still a ephemeral mystery. There's really little in the way of a "scientific" (empirically provable) diagnosis, and a lot of it is dependent on self-reporting by the patient. I think it might be useful to listen to what patient's loved ones have to say as well, since they know the person on a day to day basis.

The last time I was hospitalized, I had a month's coverage but stayed in several more weeks and paid out of pocket--not that it did diddly squat really.

Yes, it's true that money talks, but there's no getting around the fact that we do live in a consumer-driven, capitalist society. Despite it's flaws, I honestly don't think anyone's come up with a more viable system as of yet. As with everything else, there are always those who will abuse the system for selfish/greedy ends.

I'm sorry about the grad school/psych counselor thing, but maybe it's for the best. You sound like such a caring person that the system would probably tear you apart emotionally. Even the best shrinks have to kind of distance themselves or else they will go crazy themselves--and I think more than a few of them are to begin with, though not always in a "good" way lol...

 
At 8:21 AM, Blogger elvira black said...

Suzie:

I agree--I think finding out as much as one can and being proactive about asking questions and providing relevant info to any doc--shrink or otherwise--is good. For better or worse, in this day and age we are all considered "health consumers" and "expected" to take some responsibilty for working with the doc. The trick is getting a good doctor who listens and will meet you halfway.

 
At 8:35 AM, Blogger elvira black said...

Walker:

You said:

"I think many of the mental problems people face today are not hereditary but products of our social evolution.The stress to succeed, the quest for popularity to be accepted. All of this is the major cause of mental problems."

I couldn't agree more. Modern/postmodern life can be an existential horror show. There's a great book called "learned optimism" by Martin Seligman that deals with this issue. He asks: why has the rate of depression increased exponentially with every generation since the turn of the century? His answer, in part: many of the social foundations we used to have are gone, and our culture strongly stresses individual achievement and fierce competition--if you succeed, you're somebody; if you fail, you fail alone, and failure is seen as an almost unforgivable "flaw." Whatever one thinks of religion, it did provide some sort of comfort and stability in the olden days--along with family, community, and all the rest. This meant that if you had a bit of trouble, you didn't have to tough it out alone, and the sun didn't rise and set on your individual and all-too- human foibles.

I think Dr. Seligman owes you a few royalty checks--lol!

 
At 8:44 AM, Blogger elvira black said...

Timothy:

Thanks for your kind words. Yes, how did you know--I've been riddled with guilt for quite a while, feeling like I emotionally abandoned my ex. Plus, we still worked together for years, and share a coop (we're now getting ready to sell). L just couldn't seem to move on and in fact got worse and worse. But at least now I can see that his condition probably led to a lot of his deterioration, and some of the problems we had in out relationship too. I am starting to come to terms with this now, and trying to let some of the guilt go. In a way, I also think it is a relief for him to realize there was probably an organic cause for much of his dysfunctional behavior.

 
At 8:46 AM, Blogger elvira black said...

Danny:

Thank you...your kind words mean a lot to me.

 
At 9:24 AM, Blogger elvira black said...

Justine:

Thank you so much! As far as looking up all the conditions--it's a carryover from psych major days--you know, one week of an intro psych course and you're analyzing everyone you know--yourself included. i think most psych majors are trying to figure themselves out first and foremost anyway.

Ah, Aries--a force to be reckoned with--lol...

 
At 9:29 AM, Blogger elvira black said...

Leslie--

So sorry to hear about your conditions. When I was lying there with (severe) muscle aches and pains from the flu I started to wonder if something more permanent was going on--and pondered how awful it is to have a chronic, painful, debilitating physical condition. Life can be challenging enough without that added burden. Although severe mental illness can also stop you cold, I had a renewed appreciation for what day to day struggles a physical disability can entail. Take care and be well.

 
At 9:35 AM, Blogger elvira black said...

Jane:

Thank you so much! I was overwhelmed by all the terrific responses here--everyone had tons more to add to the topic, which I love to see. Though I've only known you for a short while, I've seen and read enough to know that I'm indeed fortunate to have encountered you here in the wilds of cyberspace!

 
At 9:40 AM, Blogger elvira black said...

Dennis:

Though I am no Tom Cruise, I do have a bone to pick about Ritalin abuse. It definitely seems to have devolved into a 1984 style means of social engineering for overworked teachers and overwhelmed parents. There's just no way that suddenly all these kids need a pill because they're acting like...well..kids! You know, fidgeting, running around, not paying attention, acting up. Sure, if unchecked this can lead to chaos, but I just don't buy the notion that a pill is the answer to an entire generation of kids's shenanigans. The Ritalin thing is gonna turn around and bite us all on the ass.

Woodshed...hmm... I don't wanna go there either!

 
At 9:47 AM, Blogger elvira black said...

Nikky:

Yes, back in the day I had an undergrad double major in psychology and sociology. I still do a lot of reading about these and other topics, so at some point the DSM came into play.

The thing with disorders is they're not really disorders unless they significantly affect normal everyday functioning. Like, checking the stove 2 or 3 times before you leave the house is no biggie--checking it 50 or 100 times might throw more of a monkeywrench into your day and your life. And everyone has personality traits and quirks--which doesn't mean they're dysfunctional--just human. Sometimes a little passive agressive behavior might be necessary to avoid other...well.. more extreme strategies (lol).

 
At 10:10 AM, Blogger elvira black said...

Jessie:

I'm glad to hear that your therapist is trying to work it out with you. In my case, I think the OCPD was somewhat alleviated as I got older and started to take life and work a tad less seriously. Perfectionism is a dead end, or was for me. I also think that, despite feminism, women (at least boomers like me) still absorbed mixed messages and missed cues about the then male dominated corporate game. Thing is, I realized that maybe joining the game wasn't necessarily the answer--maybe a kindler, gentler, more androgynous work culture might be better for all.

 
At 10:16 AM, Blogger elvira black said...

Brink:

Thank you, my dear friend...as usual, you are right on.

In the case of L, I will never know for sure which came first--the chicken (his psysiological disorder) or the egg (his dysfunctional coping and behavioral skills)--or maybe the checken and the egg were both hatched at the same time. Although I am very concerned, I do fell less wracked by guilt than I did before. And though the search for categories and meaning will always be there, I doubt that the mysteries of the mind will ever be completely revealed--which is part of what makes it so fascinating, at least for me. Thank you for your kind wishes and thoughts!

 

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