Friday, October 30, 2009

Being Right Part Two

I thought there might be a Part Two when I posted Part One of Being Right. Sometimes there has to be a Part Two.

In Part One we find me hopeful about people changing. It takes time, but even people who have to be right all of the time can change, can yield the point with or without therapy, if you play them right. A family systems approach works better than CBT, a cognitive behavioral therapy that falls with defensiveness on deaf ears, as in, What do you know?

Part Two, I'm sorry, is more depressing. I find that I can't change some people, not without medication to chill them down. They'll never yield the point, never be wrong. They're simply too afraid. And they have a disorder, probably.

If it's Schizophrenia, Paranoid Type, an Axis I disorder, you can't blame a person for being quite sure that there are enemies out there, that people are persecuting him. He's right about this, absolutely sure; they're listening through the telephone, the computer. Voices and imagined events are real, no convincing otherwise.

These are delusions. Even with help, without medication delusions can be hard to dislodge. Try and convince people who suffer from them that they're wrong. Good luck.

Being right is also a feature of Paranoid Personality Disorder (PPD), an Axis II, and we can't blame people for personality, either.

Nowhere does the word "delusion" appear among the diagnostic indicators of PPD (listed below) but the features imply that sufferers are delusional by virtue of their unfounded distrust. Because they hear no voices they're not technically delusional. It is their faulty construction of reality that makes them suspicious of others, not voices in their heads.

You can have both, an Axis I disorder like depression, addiction, or anxiety, and an Axis II, a dysfunctional personality. The latter can cause the former. People can get depressed because others don't like them; they can't look in the mirror to see how difficult they are to love. Hospitalized for the whole gestalt, even CEO's billionaires, people ostensibly doing just fine, functioning at the top of their game, get mentally sick.

Personality develops in childhood as our genetic predispositions are slapped with reality, the world out there. Some traits lie dormant until challenged by the hand we get, our families, friends, teachers, our luck. Yes, you actually can blame the family, and you can blame others (try that boarding school, orphanage, the Nazis, or a father who liked your little brother better) for bringing out the worst in you.

The problem is there's no pointing any one finger at any one person. Everyone's a product of someone else's stress in transgenerational theory, people who victimize have probably been victims themselves. If you go genetic, you have to start with Adam and Eve and all those other mamas and papas.

Surely some features of personality, especially the cute ones, the positive ones, aren't snuffed out with negativity, and they're genetic, for sure, our cadence, how we talk, joke around. We see our mannerisms in our children and grandchildren, we know they haven't copied us intentionally. There's wiring in there. Yet we all talk like Seinfeld. Would I lie?

The environment gives the nod, the go-ahead to both the good and the bad.

In Part One we discussed how when childhood stress is bad, as it is under the roof of abuse and neglect, unconscious decisions to cope with it aren't always good. Without parental coaching, how's a kid supposed to know what to do? So children make decisions, as in, T
Trust no one.
Don't tell me, I'm wrong. You're clearly wrong, and you're scary, and
You're not the boss of me now.
We call attributing, or casting unwarranted negative aspersions to people paranoia, and we're not talking the pot smoking kind. You can change that by getting straight, you know.

When paranoia rules in an otherwise normal personality, as in Paranoid Personality Disorder, there's no yielding the point, no being wrong about people and their intentions. The person suffering from paranoia is sure, 100% sure that. . .

He stole that money!

She cheated me out of the property!

She has my ring and won't give it back.

He thinks I'm stupid. I'll show him!

Very difficult to convince people like this that they are wrong about this, no matter how much cajoling, flattering, affirming, validating, you do.

Okay. Maybe with a lot of sex. But even with physical affection, I don't know, the odds are that the paranoia will come back again under stressful conditions.

This is why, by the way, medications are helpful, they help people buffer stress. It is also why some people don't want to take them. They don't want to be left vulnerable to exploitation and harm, psychologically "buffered" from the pain.

Here are the features of this intractable disorder.

301.0 Paranoid Personality Disorder:

A. A pervasive distrust and suspicion of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by 4 or more of the following:
(1) suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her

(2) is preoccupied with unjustified doubts about the loyalty or trust-worthiness of friends or associates

(3) is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her

(4) reads hidden demeaning or threatening meanins into benign remarks or events

(5) persistently bears grudges, is unforgiving of insults, injuries, or slights

(6) perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack

(7) has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.
B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects of a general medical condition.

No fun. Partners, spouses and children are often accused of cheating, lying, having affairs, manipulation. Friends and children of friends, housekeepers, baby sitters, business associates, deliberately plotting behind their backs. People look at them the wrong way, people wrong them, think they're oblivious, stupid.

These are angry people. Suspicious. Not obviously, sometimes, they won't always tell you their suspicious, but surely. Telling you might give you an edge.

There is a strong association with child abuse, and you can see why. If you can't trust your own parents to take care of you and protect you, to show you that they love you, that they believe in you, who can you trust? Or if you lived in a concentration camp, and every authority was a killing authority, every uniform or bunk mate a possible snitch, you learn to read aggression in people, even when there isn't any. You misinterpret facial signals, body language, tone of voice.

You learn to trust only yourself. You become impenetrable, are perceived by others as tough. Deep down you want others to adore you, to tell you that you're wonderful, and you may behave as if you believe you really are, but you're really not sure. This thread of insecurity runs through most personality disorders, you know.

People who suffer from Paranoid Personality Disorder are often afraid to put themselves in situations that are intimate, it makes them feel vulnerable, weak. They won't initiate an intimate conversation, and have buried their issues deeply, don't participate, necessarily, or appear disconnected, laugh when they shouldn't. Makes sense, right? How can you let a potential enemy get close? That's just plain dumb.

You don't make yourself vulnerable, tell people your true feelings, your fears, your sadness, if there's a chance of being punished.

That's another reason you have to be right, too. So you don't get punished.

therapydoc

7 comments:

Ivory said...
This comment has been removed by the author.
Ivory said...

... And sometimes, we are right.

In the beginning of my therapy, my T knew about the abuse I was subjected to. He had also discovered I suffered from DID. What he had learned in college gave him a preconception of DID that nearly had me committed to a psy hospital because he saw only my disorder and not the "big" picture of my family and my husband. He kept telling me I was too worried, too paranoid and that my husband was not trying to make me crazy. He insisted my husband would not be setting me up to be committed. After about 4 months of it, we found out my husband was doing all of those things. My husband had also been setting me up with my family.

That is probably an isolated case, I know, but it has made me wary of professionals - all of them. It seems that all patients are to "fit" some kind of model, or mold, and that's how we are treated. For a lot of disorders or illnesses, that is probably the best thing. For DID, it is not. Still, with all my negating and contradictions, I know that I am too paranoid and this post resonates with truth, especially about being punished. It seems all too often as a child, I insisted on telling the truth, on telling someone what was going on because I thought it was important. At every turn, I was made fun of, punished, and ignored. Too many times since becoming an adult, the very same thing has happened.

When I took Abnormal Psych in college, the professor told the class that all DIDs (when diagnosed) are immediately forced into a hospital for "treatment". I asked what kind of treatment and he said, "drug treatment." To me, that is punishment. It affected me in such an adverse way that I no longer wanted to go to therapy, I was terrified that my T's only purpose was to get me to confide in him so he could commit me. Nightmares plagued every night and it set back my therapy by at least a year. So, yeah, I am a bit paranoid.

Wonderingsoul said...

Thanks for another interesting read.
Some of the words used chilled me because i know they are my own.
I don't havea personality disorder, but the whole 'trust no one' thing? I have that.
No paranoia.
Just that, if there's even a sniff of punishment or hurt, I'm an iron clad fortress.

Thank you for making sense in your usual inimitable way TD.


Hope your not spinning TOO many plates.

WS

Syd said...

Interesting reading. It is hard for me to tell what would be a true paranoid PD versus the symptoms of alcoholism (perhaps the alcoholic has a PPD?). Categorizing people seems much more difficult than the taxonomic work that I do.

Anonymous said...

Wow. Sometimes I say, "Everything is as it should be" and some of the pressure of "what I should be doing" or "taking care of" eases off a little. I know I've got several issues. An eating disorder. After finding out I'm prediabetic, and working on losing weight and seeing myself eat stuff I don't really want and not exercising when I know it makes me feel better makes me wonder about the old "death wish" that everyone supposedly has and uses to explain doing bad things to themselves and have no other explanation for. I have to agree with the commenter who worries about the preconceived notions and that bit about being hospitalized really notches up my paranoia. Thank you Therapy Doc for writing this, it does give me some insight and stuff to think about. Maybe someday life will cooperate and I could hook up with a therapist, but it isn't here or now. Thanks for writing and hope all works out well for you.
Desert Dweller

Anna said...

My dad fit many of the part one issues, but not so many here. I think he fits more of the Axis II OCD things- love your post about that. Anyway, I see some crossover between the disorders, which I suppose is to be expected.
The bizarre thing he does- assigns explanation for things without logical reasoning. That's very difficult, especially with children who are bound to break things, because the punishment fits his reasons, not the crime itself. So you find yourself being forbidden to use a pen instead of a pencil. Huh?

Coming out of this lifestyle, CBT was pretty helpful for me, but it was for problems externally driven. I just had to learn to shut off Dad's voice in my ear. :)

lynette said...

what an intense post. i recently had a fellow blogger become extremely angry at me over a "heated" discussion on her blog -- i did not agree with her perspective -- and then she promptly blocked my access by hitting my ip addresses, and her next few posts were about narcissists and manipulative people, and (a recurrent theme on her blog) how they are "all around us" and cutting them out completely.

i feel more hesitant now in my writing, and the supportive little circle has been cracked. but there is nothing for me to do but let her be. it was simply a blogging thing to me.

i don't know for sure about there being a connection between what happened and her subsequent posts. i won't say one plus one equals two, but your post made me pause and say "huh".

silly little thing, isn't it? but when you have spent years in therapy working on finding your voice and coming out from under a bully, incidents like i mentioned, and the details in your post, can trigger a lot of recognition.

thank you -- i was so happy to see you posting today.