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mental health mondays :: bad mood disorder

or is it?
monday, you say?? yes. it's wednesday. more to the point, it's 11:48 on wednesday night, which means it's technically close to being thursday. but this is the post that was supposed to appear on monday, before my own mental health decided to rewrite the week's script a little.

thanks very much to those of you who sent well-wishes here and on facebook. i am doing better than i was yesterday and certainly better than i was on monday. things are gradually returning to normal, as they say.

so this is the final instalment of my look at personality disorders, wherein i look at psychiatry's red-headed step children, those ones we never like to talk about...

*

a friend posted this article on facebook a little while back, which raises some very good points about some very maligned mood disorders. lots of us are proud to say that we support those with mental illness, that we want increased funding to study and treat mental illness, and that we believe that the stigma against those with mental illness needs to be addressed and eliminated. but, and i believe this is entirely without meaning to in most cases, a lot of us also struggle to sympathize with certain disorders. and let's be honest: those conditions can be very difficult to sympathize with.

a few years back, dom and i visited toronto and i was showing off the city's collection of indie/ edgy video stores [pretty sure they're all gone now]. while we were inside one on queen street, a homeless person, speaking loudly to himself [i'm making a conscious effort not to use the word "raving" there] walked up and stood in the doorway, blocking it. he then proceeded to whip out is visibly filthy member and start masturbating. so there we are, wanting to escape, but also not wanting to get caught in a shower of hostile stranger jizz and not particularly wanting to live the waifish young woman at the counter alone in the store.

on reflection, i'm aware that this man was probably a victim of the massive cuts to hospitals in ontario [particularly toronto] in the 1990s and early 2000s. among the facilities that lost a large number of beds and staff was the centre for addiction and mental health, west on queen street. when i first moved to toronto, i remember being struck by the tragic spectacle of those who had been pushed out of the facility, still addicted, still psychotic and still in desperate need of help. unable to think of anything else to do, they had set up camp directly outside the centre, as if they were waiting to be let back in. i sympathized deeply, but i'd still make sure to walk on the other side of the street.

over the next six years i lived in the city, the abandoned gradually started to spread out. as a result, toronto, particularly queen street, has not just a homeless problem, but a psychotic homeless problem. these aren't just people who will ask you for change, but people who will stop in random doorways and masturbate in the middle of the afternoon.

i was aware of these things at the time, but i have to admit that the principle thing going through my head was "i want to get away from here". as the author of the linked article points out, psychosis, whatever causes it, can feel like a punch to our sympathetic gut. logically, we know these people aren't truly aware of their surroundings, or of the effects of their actions. but "trapped inside because a man is jacking off in the doorway" has a sort of immediacy that pushes everything else well into the background.

there's also that fear that interrupting, whether to escape or to try and engage such a person, could trigger aggression. statistically, people who are psychotic aren't prone to violence, but that doesn't help quell our natural inclination alerts us that we can have no idea what the person will do. our brains are hardwired to be cautious of unpredictability.

that said, i would still argue that psychosis is better viewed than the other disorders mentioned in the article, because we can clearly see there is something terribly wrong. it never occurred to me that the man masturbating in the doorway was just a selfish asshole who felt entitled to gratify himself wherever he wanted. as much as i was put off by the situation, any anger i felt was towards the government whose cuts had deprived him of the help he needed.

mood disorders are very different, because they are largely invisible. anyone can have them, they're difficult to treat and they can have a massive effect on a person's interactions with others. the internet is replete with advice about avoiding "toxic people" and how to judge if you're being manipulated by one. what's less commonly addressed, however, is that the people we categorize as "toxic" might have issues that go beyond being harmful, manipulative, and abusive. they may be sick in the same way that depressed people are sick. they may need help in the same way that the people turned away from the centre for addiction and mental health needed help.

mentioned in the article is borderline personality disorder, which is certainly one of the most problematic diagnoses a person can get. bpd is controversial in almost every way: there are those who debate whether or not the condition even exists, others argue that it should be treated as a subset of either bipolar [because of the characteristic swings in mood or emotion] or post-traumatic stress disorder [because of its high correlation with incidents of childhood abuse, gross neglect, or catastrophic separation]. in fact, there appears to be both a genetic and an environmental component, both of which are necessary to development of the disorder, which would actually indicate that it falls somewhere between the worlds of bipolar and ptsd.

one of the most controversial aspects of bpd, however, is its "gender gap": those diagnosed with it are overwhelmingly female. that has led to accusations that the disorder is a way of stigmatizing behaviour in women that would be acceptable in men [frequent anger, sexual promiscuity]. alternately, it's contrasted with antisocial personality disorder, where the overwhelming majority of sufferers are men. there are clear distinctions between the two, but both seem driven by an apparent callous disregard for others and frightening shifts in mood and emotion.

when you read a description of so-called toxic people, the characteristics look a lot like a list of symptoms of both borderline and antisocial personality disorder. they're generally manipulative and dishonest in order to get what they want, prone to violent emotional outbursts, they can be incredibly paranoid, hostile and negative about the rest of the world, and they tend to be focused on themselves, what they want, and on the benefits that any situation brings to them.

that sounds horrible, right?

well, consider what i said about the correlation between borderline personality disorder and childhood trauma. the same goes for antisocial personality disorder. so if these are people who are self-centred and harmful, it's usually because they were forced to learn some pretty extreme methods of self-preservation in order to survive their own childhoods. if they are manipulative or have a pathological fear of abandonment, it's because they were "programmed" to be that way in their formative years. if they are violent or prone to emotional aggrandizement, it's likely because they have a lot of righteous and unresolved anger about the circumstances in which they were forced to live their early lives. if they are unapologetically dishonest, it's because they were brought up in an environment where telling the truth was dangerous and where lying was, again, essential to survival.

interestingly, though, the original article that inspired this jog through the dark corners of personality disorders, has one glaringly obvious omission: narcissistic/ histrionic personality disorder. [i'm treating these two as a single subject, because the distinctions seem entirely driven by gender.] aside from the most extreme examples of antisocial personality disorder [serial killers, violent abusers of people and animals], i don't think that there is any group that is easier to hate than those with narcissistic personality disorder. perhaps because it's because their pain is hidden so well behind a wall of entitlement, self-importance and mistreatment of others. perhaps it's because, even when caught in criminal behaviour [you can read my theories on two high-profile cases here and here], they seem not just unapologetic, but still possessed of a sense that they are the ones who have been wronged.

this is where speaking up for the rights of people with mental disorders gets thorny. the vast majority of people with any of these disorders are not dangerous to the public at large, but that doesn't mean they can't inflict some pretty significant damage on those close to them. how far is sympathy supposed to extend? how much do you really want to defend someone who's caused real harm to others?

the fact that these people are potentially harmful is the reason we're told that their symptoms are a checklist for people we should make significant efforts to avoid. as if isolating them will solve the problem, rather than reinforce it. but how much personal risk is acceptable in the name of helping someone who is suffering? even lifesaving courses caution us not to put ourselves at risk to save someone else, lest we both end up dead. even if we realise that these people need help, it's likely that most of us would take a "nimby" attitude towards actually having one of these people in our lives. someone else can take care of them, thank you very much, we've all got our own problems. what's the point of treating someone medically if having them acknowledge their condition only makes people run away from them?

this just scratches the surface of what there is to deal with when it comes to dealing with "ugly" personality disorders, but the fact that it's not often addressed [or if it is addressed, it's often mocked as excuse-making for bad behaviour] shows just how uncomfortable subject is. in a world where we struggle to de-stigmatize and advocate for sufferers depression and anxiety, asking people to consider that manipulative, dishonest, or even violent behaviour might be deserving of some sympathy is a tall order. but the flip side is that we simply write people off as permanently damaged, unsalvageable. i don't even want to start going through the uncomfortable arguments that raises.

i've written a lot and thought more about the issue of mental disorders and, in the last month or so, about personality disorders in particular. a brief perusal through the history of mental health mondays should reveal that i'm a pretty passionate advocate for better mental health treatment. but i'll be honest: even i struggle with some of this. assuming, for the moment, that we leave out the extreme cases of antisocial personality disorder- the sadistic/ serial killers- and focus on the majority, there are personal risks to having someone with narcissistic, borderline, antisocial or histrionic characteristics in close proximity, especially if their disorder is untreated or inadequately treated. but a few decades ago, public discourse about mental disorders at all was rare. we enable progress by challenging ourselves to think and talk about things that are uncomfortable. so while it might not have provided much in the way of answers, i hope this little post has given you some things to think about. 

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