My Criteria for Judging Whether a Pattern of Behavior Should Be Judged as Potentially Indicative of 'Mental Illness'

I can understand that some people believe that to call a mental illness an "illness" is misleading, as they believe that there is not evidence of a physiological cause.  However, I think it is important to acknowledge that certain people fall into certain psychological patterns that are self-damaging.  And it is noticeable that:

1. The pattern consists of unusual behavior

2. The behavior is harmful to self, others, or both self and others

3. The behavior has a lot to do with some deeply-ingrained belief or propensity to believe

4. Even though only a minority of the population engages in such behavior, it is conducted by enough people for psychiatrists to notice a pattern.  That is, it's not confined to one person; there are multiple cases of it.

I think this raises the issue of what should or should not be considered an indication of mental illness.  First off, a behavior should not be considered a sign of mental illness just because it is unusual.  For instance, Albert Einstein wearing his hair the way that he did, was strange.  But I don't see how his having strange hair inflicted long-term damage on his life or happiness.  Therefore, Einstein having strange hair is not enough to be taken as a sign of mental illness.

Rather, I think that what makes a pattern a behavior a sign of mental illness is that it is severely damaging to others or at least to oneself.   However, I think a certain qualifier is in order.  If someone engages in a certain behavior, and this leads to his unhappiness primarily on account of other people disapproving of it, that is not sufficient for the behavior to be classified as a mental illness.

For instance, one might argue that Galileo invited great misery upon himself for publicly stating that the Earth revolves around the sun.  One might also say that, in terms of his social standing, he might have been better off if he never shared his knowledge.  Galileo speaking the scientific truth arguably did cause him great unhappiness, but the unhappiness was caused less by the behavior itself than by the social establishment's disapproval of it.  For instance, we can ask ourselves what effect Galileo's actions would have had in a society where everyone approved of him saying that the Earth revolved around the sun.  If everyone approved of Galileo's behavior, would it hurt him?  No.

Now, what of being gay?  Someone might argue that if someone publicly comes out as gay, that might cause him great unhappiness.  But that has more to do with widespread social disapproval of homosexuality than with homosexuality itself.  If someone came out as gay in a society where nobody disapproved of that, I don't think it would harm him.  Therefore, even though psychologists did classify homosexuality as a mental illness for most of the twentieth century, they were wrong to do so.

Therefore, I have this generalization:  a behavior does not indicate mental illness solely because it is unusual or because doing it openly would bring widespread social disapproval.  Rather, the behavior can properly be seen as an indication of mental illness if it is unusual and would bring harm to self or others even if everyone in society approved of it.

For example, what if, to relieve stress, I always got a blade and made cuts on my wrist?  Imagine, if you will, that nobody in society disapproves of this.  The fact of the matter is that even if everyone in society condoned it, my cutting myself would still pose a physical danger to me.  Therefore, self-cutting does deserve to be considered a psychologically disturbed behavior.

What if I purposely starved myself to become skeletally thin?   Even if everyone in society condoned it, the behavior would still be a physical danger to me.  Therefore, this, too, merits classification as a disturbed behavior.

Thus, I think these are the correct criteria for judging whether someone's actions might be indicative of mental illness:

1. The behavior is extremely dangerous to one's life or long-term well-being, or dangerous to the lives of others, and would be such even if everyone in society approved of it.

2. The behavior is unusual and practiced by a minority of the society's members, but still happens frequently enough for multiple cases of it to be documented.

Is it possible for an entire society to be mentally ill?  For instance, it was normal for Aztecs to believe that if they did not sacrifice someone -- ripping out his heart -- to appease supernatural forces, then the world would end.  That is a very harmful belief, and it caused much tragedy.  But as this belief was normal in that society, I do not think it was a sign of what is usually called mental illness; what I think it shows is that even very normal people are in danger of engaging in self-destructive actions when such actions become the social norms.

I think an entire society can become corrupted in a form of self-destruction; that is what happened to Germany under Hitler.  However, I think that is a phenomenon different from mental illnesses like self-cutting and self-starvation, which are difficult to make into social norms.

Patients With BPD Can Get Better ='-)

A study in Denmark shows that patients with Borderline Personality Disorder can indeed get better with additional treatment.  :'-)

More About 'Identity Disturbances'

Narcissistic Personality Disorder (NPD) is not the same as BPD.  A person can have one condition but not the other.  However, the conditions are not mutually exclusive either; someone can simultaneously suffer from both self-destructive maladies.

NPD, by the way, is often misunderstood.  People assume that narcissism refers to extreme self-love.  Actually, clinical narcissists don't really love themselves as they really are; nor does their pathology assist them in rationally achieving long-term happiness.  Rather, narcissism refers to fixating on maintaining a certain image of one's character -- such as having a certain type of reputation -- and of prioritizing this mere image above the actual long-term well-being of the real self.  Recall that, far from doing what was necessary to achieve his long-term happiness -- what was in his actual self-interest -- Narcissus let himself perish as he gazed at a mere surface image of himself.

Anyhow, here is a man who makes many vlogs about NPD.  Having been diagnosed with the condition, he considers himself an expert on it.  Many of his vlogs are interesting, but this one caught my especial attention.  Although all of the traits discussed in this video are traits he attributes to NPD, it sounds to me like he is describing the phenomenon of "Identity Disturbance" -- one of the nine main diagnostic criteria for BPD.  If someone suffers from "identity disturbances," it means that she does not have a healthy, consistent sense of her own identity, and thus periodically goes through what she deems abrupt and dislocating "changes" of personality, though what is consistent is that one attempts to appear successful, in some cases bragging that one is some big-shot real-estate investor.  No matter how much this is called "change," however, what sadly remains consistent is the continued lack of an authentic, independent sense of identity.  Even though the term "Identity Disturbance" is not used in this video, I think the video is very accurate in describing this phenomenon.

When you go through the vlogger's videos, you can see that he has a pretty bleak outlook on this sort of condition. He believes that professional help can assist one in mitigating the symptoms, but that full recovery is impossible. :'-(

I want to contradict that particular assessment. I think that when one finally decides to commit to life and long-term happiness, one really can heal for the long term. A return to psychiatric care is worth it. You owe it to yourself -- to your long-term happiness -- to try. :'-)

Scary Black-and-White Pic ='(

Actually, pics are not the most important thing.  What's important is the information.  I hope by now it is clear that pictures are less important on this blog than the essays, which provide insight.  All of the essay posts are worth reading.

I Will Always Care

Wishing a happy birthday to someone I care about.  Whether this is understood or not, your lasting happiness is of paramount importance.  I meant -- and mean -- everything that I have said.  :'-)

If You Know Someone Who Exhibits Suicidal Gestures, Are You a Real Friend to That Person . . . or a Sycophant?

 

As I've blogged before, someone having suicidal ideation does not always lead to that person attempting suicide, but it remains very dangerous.  It is dangerous both for that person who has the suicidal ideation, and those who care about him or her. That is why I have absolutely no tolerance for it. None. When I say that, I don't mean that I cast moral disapproval on those who experience suicidal ideation. What it does mean is that if someone I care about happens to display very prominent suicidal ideation, the ethical course is to intervene.


Michael Jackson Syndrome?
There is a common story about many self-sabotaging celebrities that goes something like this. The celebrity is on a very self-destructive path, which causes visible harm to him or her, as well as trauma for those who care about the celebrity's well-being. The self-destructiveness can be manifested in substance abuse, eating disorders, self-cutting, criminal behavior (or falsely accusing others of criminal behavior), or symptoms of morbid mental illness.

Even though such self-destructive behaviors do not necessarily mean that the celebrity consciously desires to commit suicide, in this particular post I will place all such self-destructive behaviors under the category of "suicidal ideation," "suicidal gestures," and "suicidal imagery." (A psychologist might dispute that as being too broad on my part.)

Because of the celebrity's socially prominent status and because the celebrity acts outwardly confident in public, most people around him or her are reluctant to address this issue. Often, these people keep silent and pretend not to notice the disturbing suicidal gestures.  Some members of the celebrity's entourage go even farther, complimenting or at least explicitly approving of the suicidal gestures. Such a person who refrains from confronting the celebrity is not a real friend but a sycophant. By playing along with the celebrity's self-imposed illusion that the celebrity's suicidal gestures are safe and acceptable, the suicidal gestures are normalized and tacitly encouraged. Far from being conducive to the celebrity's long-term happiness and well-being, this "accepting friend" amounts to a passive "enabler." Think of Hans Christian Andersen's famous story "The Emperor's New Clothes."

Once in a while, someone close (or who was once close) to the celebrity does try to confront the celebrity about such dangers, or urges other people in the celebrity's circle to compassionately address the issue. When this happens, the whistleblower is often marginalized, ridiculed, and devalued. That's terribly tragic, because the whistleblower has shown himself to be a real friend -- exactly what those hangers-on, who have failed to address the issue, have not been. Those real friends -- the concerned whistleblowers -- are sidelined, and the self-defeating celebrity surrounds him- or herself with "yes" men and sycophants who play along with the illusion that everything is fine and normal.They then ostracize the whistleblower as the maladjusted troublemaker.  (Again, it's like "The Emperor's New Clothes.")


A Problem for Non-Celebrities as Well
As I do not know the celebrities personally, I cannot claim omniscience about them; my interpretation of them can be mistaken. However, from what I've read of their biographies, I think the scenario I just verbalized can be largely attributed to Michael Jackson, Charlie Sheen, and Lindsay Lohan. But it doesn't just apply to famous entertainers.

For more than a year, I corresponded online with a very intelligent person whom I will call "Lucy." Lucy expressed interest in looking beautiful, and, of course, in the beginning that sounded perfectly safe. Increasingly, though, Lucy would post pictures of bony anorexic women (this is not humorous hyperbole; they were literally anorexic-looking) and labeling them as the sort of people she wanted to emulate. She posted disturbing photos of herself looking ever-thinner and frailer. She then wrote status updates complaining about really odd physical ailments, like temporary blindness. Such physical ailments are rare in someone of such a young age . . . but common among people who experience starvation and malnutrition. Frighteningly, a large number of "loyal friends" (translation: sycophants) clicked "like" on the disturbing pictures and announcements and encouraged it.

Eventually, a minority of Lucy's online friends -- people much wiser and ballsier than myself -- wrote to Lucy that they were concerned about her health. Not once did they morally criticize her or express full-blown rejection of her as a person . . . though she reacted as if she interpreted it that way. Lucy pointedly told these people that her self-starvation was none of their business.

If Your Suicidal Gestures Are Nobody Else's Business, Why Do You Post Them on Facebook, LinkedIn, or Wordpress?
The whistleblower friends thought that Lucy's response was rather inexplicable. Their thought was, "If you think that your suicidal imagery is none of my business, then why are you putting it on display in front of me and other people?"

Of course I can be wrong, but I think I know the reason. I suspect that on some level the suicidal gestures did disturb Lucy, and that is exactly why she shared images of it on Facebook. She did not want other people, however, to confirm her fear that she was placing herself in a dangerous situation. Insofar as a "cry for help" refers to the crier wanting other people to acknowledge the problem, this was not a traditional "cry for help." Rather, it was like some kind of game of "chicken" in which Lucy implicitly dared other people to comment on the dramatic and alarming change in appearance.

Insofar as people refrained from negative comment, or even complimented the disturbing images, Lucy felt vindicated that her suicidal gestures were actually safe and acceptable, and that her painful health problems were completely unrelated to her self-imposed starvation. The sycophants granted Lucy this short-term gratification, giving her "social proof" that the starvation wasn't a form of self-harm. As for the whistleblower friends who raised the issue, the sycophants reprimanded them and piously told them that they were the assholes.

I blocked Lucy on Facebook because I did not want to lend tacit support to that self-destructive tendency. I envy those who wrote to her about the issue, though, as they were the ones most helpful toward her, even though such positive effects are not obvious in the present.

I have known someone who is similarly self-destructive and who similarly exhibits "hints" of the inner pain. This person has informed me that this person has a long history of self-injury and of contemplating suicide. Almost two years ago, this person started posting a lot of suicidal imagery on Facebook, LinkedIn, and Wordpress. In this case, I did confront the person.


How to Compassionately Address a Self-Destructive Person Without Forcing an Argument
If you are in a similar situation, and you strongly care about that person -- the "Lucy" in your own life -- I urge you to address the issue. If you notice something is going on, and you say nothing, that helps normalize the suicidal ideation and self-defeating behavior. It implies that the self-destructiveness is normal and acceptable.

If someone has routinely displayed suicidal gestures to you in person or online (like on LinkedIn or Facebook), then it doesn't really fly for that person to say, "This is none of your business!" When someone has, on more than one occasion, shoved his or her suicidal imagery in your face, he or she has made it your business. If he or she fully believed that the suicidal imagery was not your business, he or she would not have put it on display in such a conspicuous fashion.

Often people are reluctant to confront their "Lucy" because they have this rationale: "My friend can be very scary and temperamental sometimes; even my friend's great height is physically intimidating. If I mention that I notice the suicidal imagery, it will just start a big argument. She will hold a grudge and not seek help, and nothing good will result from the confrontation. It will only make our relationship awkward."

In the past two years, I have become very familiar with that feeling -- that fear, that feeling too intimidated to say something. Quite frankly, though, if someone is exhibiting suicidal ideation and expects you not to address that, then the relationship is already awkward. More importantly, I think there is a way to compassionately address the issue without forcing an argument. I suggest that to your own "Lucy," you say something like this:

I strongly value your friendship; you mean a lot to me. When I see the [here, make a brief list of the disturbing gestures you've witnessed, such as the dead-body imagery or the defensive insistence on wearing the exact same clothes every day --S.H.], I can't help but think that you must have a lot going on. You don't have to talk about it if you don't want to. But I want to let you know that if you ever do want to talk about it, I am here for you. :'-)

I think that gesture is even more powerful when it comes from a close relative, like an uncle or aunt.

If the person you care about -- your "Lucy" -- happens to respond to you in an abusive/bossy/devaluing fashion, I recommend that you ignore it and reaffirm, "I know what I know.  If you ever want to talk about it, I am here for you.  :'-) " And if that person provides no response, or responds dismissively, that's OK; at least you showed where you stand.

Note that that approach does not force an argument, demand that the person change, or cast moral disapproval. It does, however, let the person know that you are aware of the suicidal gestures and that that is not something you condone. It conveys, through action, that you reject the suicidal gestures but still value the person qua person. Hence, it shows the person that you accept him or her while you refuse to play along with the ruse of normalcy -- that you refuse to help normalize the pathology.  I concede that the person who needs help might resent it as patronizing if you take this approach.  But all in all, it's the best available alternative.

I think that everyone has a right to their own harmless eccentricity. That is not the same as being an idle bystander when noticing a friend's suicidal gestures. This cannot be emphasized enough:  Suicidal gestures are not a lifestyle choice.

Narcissus Didn't Love Himself: The Echo

If you remember Ovid's rendition of the Greek myth, there was someone else who cared about Narcissus:  Echo.  And, like Echo, I repeat myself.

Someone can place so much emphasis on maintaining an outward image -- a public persona of strength and confidence -- while the true self inside is hurting and goes neglected.  But rather than maintaining this image, it is far better to tend to the happiness of the true self, and to resume getting the help one needs.  The tragedy was that Narcissus did not realize this.  But it did not, and does not, have to be that way. 

Narcissus Didn't Love Himself

Narcissism -- in both the clinical and colloquial sense -- is commonly considered malignant self-love.  But today it occurred to me that the Narcissus of Greek myth doesn't really love himself; he loves his reflection, which is merely a surface image.  The image has visual traits derived from the real Narcissus, but it is far from encapsulating the whole person. 

Narcissus focuses on maintaining the image -- just as some people maintain their outward persona -- while the needs of his true self go neglected.  Narcissus was therefore self-sacrificial; he sacrificed the life and fulfillment of the true self for a much lower priority, an image.

Look Alive, Mate

This should be obvious, but you're at your strongest when you present yourself to the world as what you really are: alive. :'-)

Dissociative Identity Disorder (formerly known as Multiple Personality Disorder)

When you look at the Wikipedia entry for Dissociative Identity Disorder (DID) -- formerly known as Multiple Personality Disorder -- you find that it has a number of possible symptoms that are also symptoms named in the nine main diagnostic criteria for BPD.  Some overlapping symptoms include:

• Depersonalization
• Depression
• Derealization
• Disruption of identity characterized by two or more distinct personality states
• Distortion or loss of subjective time
• Flashbacks of abuse/trauma
• [...] panic/anxiety attacks
• Identity confusion
• Mood swings
• Paranoia
• Pseudoseizures or other conversion symptoms [looks like epileptic seizures --S.H.]
• Self-alteration (feeling as if one's body belongs to someone else)
• Sudden anger without a justified cause
• Spontaneous trance states
• Suicidal and para-suicidal behaviors (such as self injury)
• Unexplainable phobias

March 1 Is Self-Injury Awareness Day

"Self-injury" refers to repeated, deliberate acts of physically harming oneself as a way to distract oneself from painful emotions. An example of self-harm is using a blade to make cuts on one's own wrists.

Someone can be a self-injurer without having Borderline Personality Disorder (BPD).  Moreover, someone can have BPD without being a self-injurer.  However, it should be noted that having a history of self-injury and self-harm is one of the nine main criteria for diagnosing BPD: "Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting..."  Of course, it is important to remember that even if one's self-injuring has gone into remission, that, by itself, is not proof of recovery from BPD if other self-sabotaging symptoms remain present.

March 1 is Self-Injury Awareness Day. Its symbol is the orange ribbon, as shown here:

A reminder to those who have a history of self-injury: you don't have to face this alone.  There are people who -- even if they have not self-injured themselves -- understand what you have gone through, and will always care about you:

More Dialectical Behavior Therapy Clinics on Oahu

I have previously blogged about websites providing contact information for mental health professionals on the island of O'ahu who treat Borderline Personality Disorder (BPD).  That is here and here. On those same posts, I provided links to a clinic on Oahu that provides Dialectical Behavior Therapy (DBT) for BPD.

Just now I found a website providing contact information for other clinics and therapists in Honolulu who provide DBT. Among those professionals, though, only one mentions having a strong focus on providing DBT.

I know that, deep down, you know that it's a good idea to return to getting the help you need. Have courage. The long-range happiness that you deserve is within your grasp. You only need to commit courageously to making it a reality. :'-)


UPDATE from Sunday, June 7, 2015:  Oh, wow; now this blog post is really outdated.  A good resource is the University Hospital of Northern Norway, also called Universitetssykehuset Nord-Norge in Tromsø, particularly the psychiatric center. What is not outdated is the importance of your long-range well-being. Regular psychiatric care is worth it for your happiness. :'-)

More About Possible Epilepsy-BPD Link

I have previously posted about whether there might be some hereditary connection between epilepsy and Borderline Personality Disorder (see here and here). Well, I have more findings on that.

I previously mentioned that Bipolar Disorder symptoms and BPD symptoms are often confused with each other. About one-fifth of those diagnosed with BPD are also diagnosed with Bipolar Disorder.

Well, it turns out there is strong evidence of a correlative link between the occurrences of epilepsy in one's family and of someone in the family exhibiting bipolar symptoms. Accordingly,

After thoroughly examining the data, the researchers discovered that 12 percent of the epilepsy patients showed signs of bipolar symptoms – approximately twice the amount of all the other disorders, and six times the amount of those with no illnesses at all.

You can see a PDF on that study here.

There is also the matter of psychogenic non-epileptic seizures (PNES). These seizures outwardly resemble epileptic seizures, but the sort of electrical activity in the brain that occurs in epileptic seizures are not detected in psychogenic non-epileptic seizures. However, there is a statistical correlation between someone having psychogenic non-epileptic seizures and exhibiting strong symptoms of diagnosable personality disorders, including BPD.

The drug carbamazepine (which has the brand name Tegretol) is used to treat epilepsy, bipolar disorder, and BPD alike.