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mental health mondays :: undefined

words, especially when linked with a medical field, have meaning. but when it comes to mental health, there's a tendency to mix in terms that don't really belong. this week's post is a look at some of the most problematic.

yes, yes, i know it's tuesday, and i know it's wednesday, and more than two weeks from when i last posted here. the good news is that that's largely because i've had a lot of paying work. the bad news is... well, honestly, there's not a lot of associated bad news. i'm guessing many of you have noticed since i've started making mhm posts again that they're appearing every two weeks, which is something else that's dictated by commitments to stuff that actually puts cat food money in my bank account. the truth is that i am quite pissed at myself for being completely absent and missing monday's post, probably way more pissed than you, the reader, are about it.

but let's not dwell on my self-defeating thought patterns born of years of complex depression and anxiety, among other things. let's talk about mental health.

every now and then, i see a rise in stories in the news and in social media about mental health. [sadly, a lot of these tend to coincide with mass shootings in the united states.] a lot of those articles are interesting. some are vicious scapegoating. some are well-meaning but misguided. but what surprises me is that many of them mix together terms that have a clinical meaning with others that don't. furthermore, they mix them without articulating the differences between the two types, which is bound to confuse lay people trying to find out about an already confusing field.

so, i thought it would be interesting to look at some of the terms that we often hear/ read associated with psychology that aren't what they seem to be.

psychopath/ sociopath

when talking about the dangers of the mentally ill, people almost always fall back on one or both of these terms. they're great for stirring up images of cinema killers and profoundly dangerous individuals deficient in even the most basic human empathy. but, diagnostically speaking, psychopaths are a much trickier concept.

for starters, the two terms refer to different things, but those things overlap, which means that most people use them interchangeably. is it necessary to know the difference? well, a sociopath is understood to have some sort of vestigial conscience, while a psychopath doesn't, and that seems like it could be important. researchers generally feel that psychopaths are made- as in, their physical brains are different than those of others- while sociopaths are created through horrific environments. that tends to give psychopaths an advantage over sociopaths in terms of hiding their dark secrets. sociopaths are impatient, compulsive and erratic, less in control of their actions, while psychopaths learn quickly how to fit in and get what they need from others. that's why you see so many online quizzes about whether your boss, your partner, or someone else close to you is a psycho- not a sociopath. 

on the other hand, the bottom line with both is that they don't care about anyone other than themselves and are more easily spurred to violence than "regular" folk, so distinguishing between them under non-clinical circumstances is sort of like arguing about whether the reptile attacking you is an alligator or a crocodile. hell, even psychiatrists don't really distinguish between them: both are generally diagnosed with antisocial personality disorder. [although some medical establishments conveniently use multiple terms, because this wasn't confusing enough already.]

there isn't actually a mental disorder called psychopathy or sociopathy. although there's a checklist that's considered the holy grail of separating the acceptable wheat from the deviant chaff, being a psychopath isn't a diagnosis. that said, antisocial personality disorder isn't considered treatable in the way that other mood disorders are: it's not something that doctors generally believe can be corrected through therapy. if the condition abates, it's more likely because the patient can come to understand the consequences of their behaviour. and even then, there's always the risk that going through therapy just makes them better sociopaths. some of them will even figure out how to turn their disorder into an advantage because, as many have observed, psychopathic traits are valued by many societies, as long as there isn't a body count.

malignant narcissist

this is a term that gets mentioned a lot in columns about recognising abusive or exploitative behaviour, and while i haven't seen anyone claim it to be a specific personality disorder, articles about dealing with it [by expelling it from your life] present it as if it were. malignant narcissism is a term that has been around for about five and a half decades. the man who coined the term, psychoanalyst and sociologist erich fromm, described the personality type as "the quintessence of evil". it's worth noting, however, that much of fromm's work focused on social, cultural and political psychology, rather than on diagnosing individuals. others have used the term interchangeably with psychopathy.

the description that emerges of the malignant narcissist does sound a lot like it was cribbed from the hare checklist for identifying psychopaths, with one important distinction: it does not link the behaviour of the malignant narcissist with criminality. the indifference to every form of rule, including laws, is a primary characteristic of the psychopath, to the point where they are often incapable of staying on the right side of the law even in cases where an immediate gain would be offset by a greater problem like, say, the revocation of parole.

the other reference point for malignant narcissism is narcissistic personality disorder. unlike either malignant narcissism or psychopathy, npd has a clinical definition and is recognised as a mental disorder. it's interesting that the symptom list of npd sounds a lot like the hare checklist as well, but without the references to criminality and violence. however, disorders are not like psychopathy: people really suffer from disorders and are aware on some level that something is very wrong. an npd sufferer isn't likely to connect their pain with narcissism [hence why they initially seek treatment for something else], but the pain is there. [this is a distinction i talked about in a previous mhm, in reference to a certain world leader.]

malignant narcissism is said to combine aspects of both antisocial and narcissistic personality disorder, although it's not really a combination of any disorders, because it's still a profile that's entirely theoretical. the presentation of the malignant narcissist profile, however, immediately casts that person as something else that isn't a clinical category: a complete asshole. by combining the self-obsessed qualities of the narcissist with the viciousness and lack of empathy of the psychopath, a monster is created. and it's easy to view a monster as less than human. it also categorises them as something that is fixed in their patterns of behaviour, something that is unfixable. and articles about malignant narcissists are never about discovering whether you are one; they're always about identifying them among other people.


unlike the other terms on this [short] list, introvert has come to be something to be proud of. modern culture has been all about the extrovert: the person who can step in and command attention, who relates easily to others, who has seemingly boundless energy and who is willing to take risks in the interest of the greater reward. in recent times, however, there has been more and more discussion around the quiet awesomeness of the introvert, the person who is able to observe, focus, envision the greater picture, while having an uncanny eye for detail.

the term introvert has absolutely no clinical meaning, and insofar as it is connected to psychology, the connection comes through carl jung's sixteen personality types or through the biology-based theories of hans and sybil eysenck. there has actually been a lot of research done on people who fall into jung's introverted and extroverted categories and real, meaningful differences have emerged. introverts, for instance, tend to have lower blood pressure. introverts and extroverts process dopamine differently. introverts [in this case defined as having "impaired social function"] have larger amygdalas and thicker prefrontal cortex circuitry [essentially, grey matter]. that means that introversion has been studied to a far greater extent than malignant narcissism. and, since no one's presenting it as a mental disorder, that means there's no harm done, right?


the problem with how many media outlets portray introversion is that they equate it with a checklist of "symptoms". here's a list of nine signs. here's a more robust list, with twenty-three signs. here's a list of eight. and one with seventeen. this one has fifteen. this one only has ten, but they're "surprising" traits that introverts might not otherwise notice. these kinds of lists imply that there is a formula to being an introvert, and that there is a special set of needs and disabilities ["dear god no, not small talk!!!!"] that go along with being one.

the fact is that people are a combination of introverted and extroverted characteristics, and it's more important to recognise and value that people work differently than it is to cling to the "tenets" of one personality type or other. personally, i hate small talk, and i'm not good at it. but that doesn't mean that it isn't a useful thing. being able to say a few friendly words to someone is a skill that's valuable to acquire, because we're just not naturally going to fall into a discussion of the political perspective of foucault vs. chomsky on the elevator with someone we've never met. embracing those lists of traits too closely can amount to refusing to recognise that we are complex creatures who are not only subject to natural change, but who can learn new skills, even if they don't come naturally.

this term is the least problematic in terms of its use, but it's also the one that can undermine the largest number of people. we shouldn't be dismissive of any skill that doesn't come to us automatically. that's selling ourselves way short. 

that's it for today's list. i'm not so good at short, to the point posts, so a longer one would take me another week to complete. but feel free to share terms that you feel are overused or straight-up abused in discussions about psychology. but please do it in writing, because i work much better that way. i'm an introvert after all, by a 52/48 split last time i checked. 


as long as you're here, why not read more?


ok, so i've been lax about posting here. i apologise. there are reasons. i don't know if they'ree good reasons, but they include:

i've had a lot of work to do, which is nice because i'm a freelancer and things tend to slow down in the summer, so the more work i get now, the less i have to worry about later [in theory].i started watching the handmaid's tale. i was a little hesitant because i didn't actually like the novel very much; i found it heavy-handed and predictable. the series relies on the novel for about 80% of its first season plot but i nevertheless find it spellbinding. where i felt that the novel beat readers with its politics, the series does a better job of connecting with the humanity in the midst of politics. i'm dithering on starting season two because i am a serial binger and once i know damn well that starting the second season will soon consign me to the horrors of having to wait a week between episodes. i don't know if i can han…

i agree, smedley [or, smokers totally saved our planet in 1983]

so this conversation happened [via text, so i have evidence and possibly so does the canadian government and the nsa].

dom and i were trying to settle our mutual nerves about tomorrow night's conversion screening, remembering that we've made a fine little film that people should see. which is just about exactly what dom had said when i responded thusly:

me :: i agree smedley. [pauses for a moment] did you get that here?

dom :: no?

me :: the aliens who were looking at earth and then decided it wasn't worth bothering with because people smoked even though it was bad for them?
come to think of it, that might mean that smokers prevented an alien invasion in the seventies.

dom :: what ?!?!?

me :: i've had wine and very little food. [pause] but the alien thing was real. [pause.] well, real on tv.

dom :: please eat something.

of course, i was wrong. the ad in question ran in 1983. this is the part where i would triumphantly embed the ad from youtube, except that the governmen…

mental health mondays :: separate and not equal

given the ubiquitousness of racial disparities in the united states, there's no reason why we should be surprised that they exist in mental health care. unlike a lot of other areas, the people in power have acknowledged the problem for decades. but the situation isn't getting any better. 
the united states surgeon general documented the differences between white and non-white mental health care back in 2001 so we can assume that it was already a known problem at that point. two years later, a presidential commission said the same damn thing and groups like the national association for mental health seized on this to develop guidelines on how to bridge the ethnic gap. from the turn of the century through 2007, the number of papers and publications talking about the mental health care gap spiked. the issue was viewed as being on par with obesity when it came to urgent problems.

starting in 2004, researchers undertook a massive project that involved the records of nearly a quart…