Before we return to the complexities of personality and combat trauma, I’m afraid I must publish another musing on ”personality disorders.” And to do so, so sorry, I must venture back, à la Joseph Conrad’s Charlie Marlow, deep into the ultimate heart of darkness in my neck of the woods: psychiatric diagnosis. Kurtz was a pussycat in comparison.
To be fair, the business of psychiatric diagnosis is anything but a mom and pop matter. Markedly complex presentations of symptoms, cross-cultural variations in appearances, interprofessional squabbles, prejudices, ideologies, theories, double-blind studies: it’s a mess, in other words. Academics in my field have indeed worked hard to standardize ways of classifying the various psychiatric problems, including, e.g., post traumatic stress disorder (PTSD). In the bad old days (or so we’re continually told), we used evil, unvalidated theories to diagnose. Now, in the good new days, we use virtuous, validated theories, focused on series of “just the facts, ma’am” lists of signs and symptoms that truly would have made Jack Webb crack a smile
The different ways of looking at the components of an individual who struggles with mental illness–the theoretical basis for creating an Axis I and an Axis II in the first place–are now all the rage. “Axis I” disorders focus on those aspects of mental illness that seem to transcend a patient’s particular history, invade it even, with foreign experiences of sadness or hallucinations or confused thinking, among others. “Axis II” disorders, in contrast, focus on those aspects of mental illness that are one with a patient’s history, with his or her characteristic ways of managing emotional life, usually ways that do not end up endearing the person to those surrounding.
But remember, stick to the facts we can all know and tell: what does the person characteristically say? Do? Feel or not feel? Add ‘em up, compare and contrast, and voilà: you’ll have your appropriate diagnosis of a personality disorder (or for the faint of heart, personality traits), there for all the world (the key, in-crowd word is reliably) to see. No evil theories, just good observations. God is in His Heaven.
Now in the New Revised Standard Version of our Scripture (i.e., DSM-V), all of this will apparently undergo massive change (although, I’m proud to announce, I am not privy to those details, thank God in that Heaven). We wait with bated breath. Still, no matter what those smarter than I ultimately decide, I will forever consider individuals seeking treatment to fall into one of three broad categories. BIG-TIME CAVEAT: What follows is totally of my doing. No animals were harmed in the process, and the Secretary disavows any knowledge of my actions. Still, if you’ve come this far in these entries, you should probably know what I mean when I say someone is, among others, “personality disordered.” Here goes.
Everything is premised on the notion that people seek help when they are, in some way, suffering. It’s the conclusions that people draw from their sufferings that differentiate one group from another.
First is the group I call the “neurotics.” They’re easy enough to spot, the following being their mantra:
1) I am suffering.
2). Somehow I am/have been involved in the development and maintenance of this suffering, so therefore
3). You, professional, and I need to figure out how we can get this suffering to diminish/stop, i.e., fix it.
Ah, these are the folks we love to deal with, eh? Let’s pause and spend a few moments basking in their brilliant light.
Moving on . . .
Second is the group I call, sorry, “neurotics plus.” They’re a trickier crew, for their mantra is:
1) I am suffering.
2). Somehow I am/have been involved in the development and maintenance of this suffering–but I am/have been absolutely incapable of doing anything meaningful to effect any change in that suffering, so therefore
3). You, professional, are going to have find a way to fix it. I’ll wait.
Watch out for these folks, for they can be Greeks bearing gifts. Yes, they tell you that they know they need help, that they have gotten themselves into the messes they are in. But even if they say that they want to do something to fix their lives, they really, really, really, really, deep, deep, deep, deep down don’t believe for a moment that they’re capable of doing so. Nada, zilch, forget it.
They may be angry about this perceived state of affairs, resigned, miserable, all the above, you choose (or, rather, they choose). But these are the folks who come into your offices looking for ways to “improve themselves,” who then sit there in your offices–perched, more like it–anxiously awaiting the infusion of your wisdom that will bring about the result that will make all well. Yet when that result isn’t all the person had hoped? Maybe they get angry. Maybe they blame the gods. Maybe they blame you. Maybe they blame themselves for their ridiculous inability to accomplish anything–or something of that ilk. But then back they’ll come to your offices. Perched. Ready for the next infusion. It’s the chemotherapy approach to self-improvement: hang the bag, let it drip in, and see if any of it takes. I’ve heard vicious rumors that some of these folks keep journals with lists of names of the professionals whom they’ve burned out of house, home, and psychic stability.
Well, look at this way: they’re usually pretty nice. That’s a plus. I guess.
So, who then are these “personality disorders”? Well, check it out, the mantra of mantras: :
1). I’m suffering.
2). Something/someone “out there” (or, occasionally, my neurons “in here”) is causing the suffering, and if that something/someone/neuron bundle would just straighten up and fly right, then I wouldn’t be suffering. So therefore
3). Fix it, professional. Or fix them. Whichever. Just do it. That’s what I’m paying you for.
You know, it’s quite something, really. Did you realize that there are people in this world–lots and lots of people in this world–who really, really, really, really deep, deep, deep, deep down believe that they shouldn’t have to suffer? Who really, really, deeply, deeply believe that their baseline in life should be absolute contentment and lack of turmoil? Who equate “I’m suffering” to “Ergo you’re failing to do something about it”? People who really, deeply believe that a). there actually is a life without suffering and that b). such a life is not just their goal–but in fact their right?
I like to think of these folks as the ultimate Marilyn Monroes catching an emotional bite to eat over at the Brown Derby in Hollywood: like her, they never have to pay their bills. All they have to do is keep batting their eyes, puffing out their chests, (or tantruming), and eventually they get somebody else to pick up the emotional tab for them. What, me, apologize? Take some time away from what is engrossing me to focus on you? Pay you back emotionally for all you’ve invested emotionally in me? Like, are you for real? Hey, you don’t like it, take it up with my agent, right over there. And tell her that if she doesn’t get you off my back pronto, I’ll fire her and bring in some other dupe to pave my way and put out my fires.
That, in my humble opinion, is a person with a personality disorder. So now it’s time to get back to combat trauma–and veterans who aren’t always in the mood to be nicey-nice.