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.