Friday, June 22, 2012

The modern psychiatric diagnosis: DSM

This was an interesting NY Times op-ed about the DSM, its origins, and questioning its continuing role in society, written by a former contributor to the DSM.

I was heavily involved in the third and fourth editions of the manual but have reluctantly concluded that the association should lose its nearly century-old monopoly on defining mental illness. Times have changed, the role of psychiatric diagnosis has changed, and the association has changed. It is no longer capable of being sole fiduciary of a task that has become so consequential to public health and public policy.

Psychiatric diagnosis was a professional embarrassment and cultural backwater until D.S.M.-3 was published in 1980. Before that, it was heavily influenced by psychoanalysis, psychiatrists could rarely agree on diagnoses and nobody much cared anyway.

D.S.M.-3 stirred great professional and public excitement by providing specific criteria for each disorder. Having everyone work from the same playbook facilitated treatment planning and revolutionized research in psychiatry and neuroscience.

Surprisingly, D.S.M.-3 also caught on with the general public and became a runaway best seller, with more than a million copies sold, many more than were needed for professional use. Psychiatric diagnosis crossed over from the consulting room to the cocktail party. People who previously chatted about the meaning of their latest dreams began to ponder where they best fit among D.S.M.’s intriguing categories.

The fourth edition of the manual, released in 1994, tried to contain the diagnostic inflation that followed earlier editions. It succeeded on the adult side, but failed to anticipate or control the faddish over-diagnosis of autism, attention deficit disorders and bipolar disorder in children that has since occurred.

Indeed, the D.S.M. is the victim of its own success and is accorded the authority of a bible in areas well beyond its competence. It has become the arbiter of who is ill and who is not — and often the primary determinant of treatment decisions, insurance eligibility, disability payments and who gets special school services. D.S.M. drives the direction of research and the approval of new drugs. It is widely used (and misused) in the courts.

Until now, the American Psychiatric Association seemed the entity best equipped to monitor the diagnostic system. Unfortunately, this is no longer true. D.S.M.-5 promises to be a disaster — even after the changes approved this week, it will introduce many new and unproven diagnoses that will medicalize normality and result in a glut of unnecessary and harmful drug prescription. The association has been largely deaf to the widespread criticism of D.S.M.-5, stubbornly refusing to subject the proposals to independent scientific review.

Many critics assume unfairly that D.S.M.-5 is shilling for drug companies. This is not true. The mistakes are rather the result of an intellectual conflict of interest; experts always overvalue their pet area and want to expand its purview, until the point that everyday problems come to be mislabeled as mental disorders. Arrogance, secretiveness, passive governance and administrative disorganization have also played a role.

There were a couple things I thought this this piece did a good job of illustrating.  First, that the history of the DSM wasn't Allah speaking directly to his prophet who then immortally inscribed these truths into the first issue of the DSM, but that it was largely just an attempt to assemble what most people thought about things out of the primordial ooze that was mainstream psychology as recently as a few decades ago.  Second, that despite these somewhat inauspicious origins, most people believe the word of the DSM like it is the bible, including decisionmakers like courts and legislatures.  Third, that there will never be a perfect DSM because of fundamental disagreements and the accompanying political machinations amongst the experts that write it.  So, in a word, the DSM is not the most reliable system in the world.

The conclusion:

Consumers should play an important role in the review process, and field testing should occur in real life settings, not just academic centers.Psychiatric diagnosis is simply too important to be left exclusively in the hands of psychiatrists. They will always be an essential part of the mix but should no longer be permitted to call all the shots.

101 comments:

  1. Replies
    1. I'm so proud of you :'D

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    2. give'm a golden star

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  2. Yes, let's allow armchair psychiatrists to review the data!

    How could that go wrong?

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    1. Yeah, I don't get that part, but I guess it's just taken way out of context.

      They already did that anyway with the DSM-III by sending it out to a bunch of consumers to test out before sending it for actual use by professionals.

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  3. You write so beautifully, ME. I wanted to talk about two people who seem like classic Narcs. One is a Mal Narc. The other is a regular Narc, shall we say.

    Since I have been a part of SW, I am more attuned to the personality/self and the various ways it is distorted. The Mal Narc is a ball of fluff under which is a speck of a person. The Mal Narc makes you want to punch him because his false self is so inflated. I think it is a visceral reaction to want to take his inflated self down a peg.

    The other person, the Narc, has some empathy, as Narcs do. The Mal Narc has the least, but still some. The small amount of empathy that the Mal Narc does have is an important attribute, though, as one can reach them through feelings. It is like water on a stone wall, but not impossible.

    However, the attribute of the Narc is the puffed up false self and the little true self. It is a distortion in humility.The Narc, as a true self, would be worth as much as anyone else i.e a human being. He just doesn't know it. The grand facade prevents him from finding out.

    I say this as I examine my own Narc qualities.

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    1. I thought that the mal narc is antisocial+high narc = sadistic

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    2. What is a high narc?

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    3. Anon 5:17
      Can you explain in more detail, please?

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    4. high yellow

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    5. If you didn't use the word narc, I would read what you have to say.

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    6. Am I supposed to care?

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    7. _srM-Kany
      Your psychological analysis makes as much sense as a fucking twisted pretzel, so please spare me.

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    8. haha outwitted, kany

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    9. Only, in Monica's mind. She's a legend in her OWN
      mind.

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    10. Monica, its fine that your simple, but don't call analysis you can't understand wrong just because you can't comprehend it.

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    11. No _srM-Kany, you really are talking bollocks half the time, it's just most people don't know enough to challenge you and those of us who do usually can't be bothered. For all your interest in Jung, when you start talking about people's 'subconscious' with such conviction, you come across like an Irish Elisabeth Hasselback

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    12. It's true you use the same few catchwords over and over even when they aren't really the right word for the context:

      subconscious
      archetype
      symbolism
      animalistic

      and so on.

      It's almost like you've only read one psychology book in your life. Rather, it sounds like jargon you picked up in Psychology 101. And somehow you apply this stuff to everything.

      Now, I'm sure you will start attacking my character in response, or call me snobby and pretentious, or whatever usual thing, although I'm not trying to pick a fight. Fighting with you is no fun because of the front you put up. Just saying that your impression management skills need fine tuning especially around intelligent and learned people.

      Monica, I like your new bitchy ways, and how you've stopped decompensating instead. At least under your usual username, that is. And I mean in general, not towards the missus specifically.

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    13. I have a BA cum laude from one of the top Universities in the US. I have a Masters degree in Psych, from another top University. I finished in a year and a half, instead of the usual two years. I had a 4.0 GPA. I can't understanding you, a bungling fool, who makes no fucking sense when she talks about Psychology. Laugh My Fucking Ass Off and Good

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    14. lol you guys are so entertaining. i will drink more and read more

      go Monica!

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    15. To Medusa

      Reaction formation is when a person DENIES the pathology in herself and SEES it in other people. It is classic Kany.

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    16. She doesn't always deny it. She'll be self-aware or not depending on convenience or argument.

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    17. No, she is in denial about herself, for the most part. No one could be that much of a jack ass and be otherwise. It doesn't fit.

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    18. I don't actually use archetype.

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    19. And nope, Monica. I'm just really that much of a jackass. :-D

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    20. Just because you are on a Sociopath blog doesn't mean that it has to DEFINE you.

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    21. Lol. Monica, I'm difficult to define.
      I don't like you so you never will, but if you knew me you'd like me.
      espite all the things you think you hate.

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    22. I have to say I find your intellect disappointing, despite your grades. It often astounds me education can have so little value. I'm looking forward to obtaining your degrees, so I can actually do something with it.

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    23. You are such a fucking idiot. Damn, to be so self deluded.

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    24. Lol. I'm really impressed Monica. I'm so proud of how far youve come. I can hardly believe you're the same person.

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    25. Medusa
      You have to ignore idiots. Don't engage. I learned that from a wise person who is one of my mentors. Don't engage idiots. It goes nowhere. They want you to engage. Walk away. You have nothing to prove. <3

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    26. I'm difficult to define.

      You seem to be obsessed with the idea of elusiveness. You can't stand Raven being elusive, so you tell her she's not as elusive as she thinks to passive-aggressively bring her down a notch, you are constantly trying to pierce my own aloofness as you see it (by calling it 'intimacy issues'), but then you turn around and call yourself hard to pin down?

      Seems clear to me that your desire here is to appear as the most 'mysterious' and 'interesting' person here. You try a little to hard, though.

      You have to ignore idiots.

      Then I'd have very little reason to be here :)

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    27. No, not everyone here is an idiot. Medusa. Many people are not. Grey, Post, Mee, V, Ellicit, Zoe, Alterego and more I am sure I have left out.

      I am in a position where I have been forced to learn to ignore idiots, as I could not have a current position that I have, if I didn't. Idiots want you to engage. That is their end game. They only want to tear you down. They don't care what you have to say. They want to make you look small, whatever you have to say.

      One must walk away. Not everyone on SW is an idiot. If that were the case, no one would come on. Don't sink to the level of the LOWEST one on here--Kany. Even Ukan has good things to say.

      Ignore shit and it will bother someone else. You can be sure of it.

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    28. It was just a joke. Of course I'm here for other reasons.

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    29. high narc is just my way to say as if they would score off the charts narcissistic.

      There was that post saying if you take a wildly narcissistic person who has antisocial pd, you get a mal narc - - a nasty, sadistic person, real high on him/herself.

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    30. Medusa, you're fucking dumb. I'm doing what you do. Why can't you see it? I'm embracing.you even are the one who said it. I have little to no identity, so fuck it. I'm adaptable. Undefineable. I'm not bringing raven down, I think she makes sense. Her mysteries are details, but overall, she makes sense to me. I'm not obsessed with shite. You are. I dont want to be interesting. Thats why i have no friends here and told everyone my story. Ive come here from the gate with nothing to hide. Maybe elusive is just my word of the week. Ive been doing that lately.
      And you do have intimacy issues. And I don't really give a shit if I'm wrong. You'll still grow up to be a bitter lonely woman... stuck in a level you can't seem to grow past so you'll just cling to it like its everything you have.

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    31. And Monica, you simplify things to an emotional level because you're not very bright. But you're getting better. Your list actually had a few smart people on it so I have hopes for you career choice.

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    32. Medusa
      This is what I have learned from doing it wrong, many tears and a wise mentor. If a person shows herself to be a stupid shit head, walk away. Don't stay to answer questions about if you are a cat woman or I am a dumb cunt. I am not a dumb cunt and you are not a cat woman. The only one that looks stupid is Kany. However, if you don't ignore her, you get embroiled in her stupidites and YOU look stupid, too.

      Ignoring is very hard, at first, but it gets easier. It is a skill. Ciera is an ugly bitch with an even uglier inside. She has NOTHING going for her or she wouldn't be so nasty. She only could marry a low functioning sociopath drug dealer. Big fucking Whoops. IGNORE

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    33. Lol. I don't actually have to say anything to you. :-) you make yourself look foolish all by your lonesome...
      wasn't it ciara?
      Whatever.

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    34. And how long have you been getting on so well with Medusa?

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    35. Monica, kudos on your new-found courage. It really suits you.

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    36. Right? I'm really impressed. I mean that Monica. Why, I remember when I was telling to stand up to me and tell me how much yo hate me. Now it comes naturally to you. Im really happy for you. I think you're learning so much.

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    37. I didn't do it for a stunt, Ciara. I don't like seeing you treat people like shit, people who have good things to say like Medusa and Alterego. You trap them, so there is no way out and then you jump them. Who the fucking shit do you think YOU are?

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    38. You're giving me way too much credit. Alter ego corners herself, and you're offending Medusa now, more than me to insinuate she's got anything in common with alter.

      Delete
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  5. now everyone will have to use icd-10 way to scew up dsm

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  6. The manual is bullshit and written by pharma, and those who make cash off the psychiatric fIeld. Psychiatric profiling is case-by-case because there are degrees of infinite characteristics. The best person to diagnose is you. Just figure out why you are feeling the fucked up way, honestly, and then do your best to fix it yourself.

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    1. TRUE Finger!

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    2. Also, figure out who all the assholes currently in your life, jealously trying to fuck you over, or hold you back somehow are. They just fucking drop them from your life completely.

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    3. More often than not I'd say diagnosing yourself is one of the worst ways to approach psychology... look at ego.

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    4. Hence the word "honestly", you fucking tard.


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    5. Finger is good. I nominate him for SW Therapist. Do I hear a second, on that?

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    6. No way. I am not good enough on the computer to pull that stunt, Ell.

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    7. So I diagnosed myself, because everything fits (more or less) AND I realised that my thinking fits too (well I don't want to get into details AGAIN and I blow at expresing what I want, but really, if you could only get inside my head), so I diagnosed myself. Then I came here and got confused. Had to roll everything from the begining and haven't received any new info about me. Probably the same thing would happen if I would visit a shrink. So the idea that the best person to diagnose me is me might be correct, but one might be wrong about himself.
      Finger, but why should I change myself? And how is it even possible?

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    8. Honestly, I don't even know why I am here. Only reason that I can find is that I couldn't refuse to use the comment bar (Grandiose sense of self-worth, Need for Stimulation, Poor Behavioral Controls/Impulsive Nature (impulsivity), Irresponsibility/Unreliability, Lack of Realistic Life Plan, Lack of Shame or Guilt, manipulativnes and parasitic lifestyle, tadaah :D )

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    9. I honestly don't think you're a sociopath Mee. That's the truth. Watching you on here I fail to see any urge to manipulate or even the capability. You seek approval from others, which is not grandiosity. You say you have poor behavioral controls but earlier you were saying you never committed a crime despite the urge to. You have a picture of dexter as your avatar, which is just silly. I think you need to explore yourself a bit more and explore psychology a bit more before you latch onto something like psychopathy.

      Once someone's brain believes something, the brain will start attributing everything around them to that belief, relevant or not, in order to justify that belief's existence. Something I learned in a book I've been reading recently.

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    10. Here I go again...
      Well, honestly:
      1. I write as anon too.
      2. You only see Mee for this place, I had no intention to turn out adorable...
      3. When I raise a question and seem desperate to find it out, I not only can get more real info about sociopathy (really stories, ect.), but people are more willing to help me.
      4. I am not a thief, murder, ect.
      5. I started watching dexter after spending a lot of time here. Honestly, I don't really like the character, but we have some similarities on the outside and he fits for the confused person image. Also I always had a hard time choosing something to represent me, because I have a hard time really relating to anything, ravens suggested pics were too silly, so...
      6. I'm young, so I search for approval, because, I don't know much about this shit.
      7. I'm young, so not much had happened for me yet. And I really won't open up too much here, since I can be recognized...
      8. I don't find any reason for a person to want to be a sociopath, so I would really want to get a name of that book. However, if symptoms on paper fits (ukan,don't pay much attention to my ideas that I'm principled, contoling myself because that's only how I see me, others would have a different opinion about a situation) so it indicates something. The funiest thing was that my arguments against being a socio turned to be the things socios do more than empaths. I have no feelings for the label, but I am obsessive and like finding answers and so on.
      9. I am young, so, even if I'm a sociopath, I'm still developing. I would probably be able to tell more sociopathic stories if I would came here 10-20 years later. Imo its a good thing, that I'm here now because I can learn what I shouldn't do.
      10. I might not be a socio (ignoring the fact about a perfect environment and dna and symptoms and differences from others in feelings, failure to understand emotional stuff, etc.) but:
      Normal person < mee < sociopath
      Any ideas??
      11. All this brain digging is bollocks, but its an interesting thing to do.

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    11. I started watching dexter when house ended. you can exclude grandiose self worth from reasons I write here, there's still plenty left.

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    12. + I was a smart kid, so I understood that killing, stealing is bad, well I used to steal anyway, but I knew what can get me in trouble and what couldn't.

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    13. And look at mee. Case in point. Thank you finger. How did I miss it?

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    14. The stories I have as an adult pale in comparison to the havoc I caused as a lad, Mee. That's the thing. As a youngster I was more grandiose and delusional not only about how great I was, but what I could get away with. I was a smart kid too. The police and the principals offices I sat in waiting for my parents would tell me how I was real smart and had amazing leadership skills. They were just disappointed that I would use my leadership skills to get other kids to join in my insane schemes and that I used my smarts to try to get away with it. Despite that I ended up in and out of juvenielle facilities, jail, and prison until I was 24. I'm now 30 and haven't been arrested since 24. I couldn't help myself when I was younger, like I can't help it now. Only difference between now and then is that I took getting other people to cause trouble for me and made it into a business.

      People generally cause a lot more trouble as teenagers. That's a fact. If you are not causing trouble now chances are you will be a even better adult. Psychopath teenagers, well just think about it. Imagine the amount of mischief they get in.

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    15. I agree with the missus here.

      Although I think Mee is just young and silly. He doesn't seem to take himself or anything too seriously in the end.

      But that's some glib shit you be posting, fingerfuck.

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    16. "Finger, but why should I change myself? And how is it even possible?"

      The point of life, the secret of it, is finding out how you, uniquely, feel the pleasure, enjoyment, and happiness pie. Maybe it is flavored better with big money, big power, and fucking beautiful people, but the main ingredient is always physical and mental health, and if you want to "feel good" deeply and lastingly, you have to find solutions to the detractors, the poison injecting assholes, and the points of vulnerability and consternation in your psyche. Don't take advice from the fucking fools up in here, create you own fucking advice.

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    17. Ha ha.
      UKan, well I never had troubles with police, was visiting principle, but I got away with many things due to reputation I formed. For example then I started a fight with one guy and we both were caught, even though I was responsible, I got away, because "he's a calm, nice inteligent boy, if he beated some guy, there had to be a reason!" I was raging most in kindergarten, calmed down a bit in primary school, but still do stuff even now.
      As Medusa pointed out, I really don't care about anything much. Maybe its a reason, why I was not as bad as you, UKan. I lack stimulation, have no goals, even for today (ill end up doing something, but i havent planned anything). And I really need stimulation for anything, and it has to be made by me.
      Also my lack of criminal activity could be because I'm a little bit paranoid. By the way I read that one of the differences between sociopathy and psychopathy is that sociopaths not always have criminal behaviour. If sociopath is a lazy psychopath, once again it fits me.
      + one example: I always want to kill my mom then she starts a conflict, because It's really annoying, but I know that I better not kill her, because she is useful and killing is bad, so during a conflict I have to pay some attention to my emotions and am more calm and rational on the outside, so my mother fails to influence me during it. I have more things I'd like to share, but I suffer from my average English and don't know what should be the main things in stories.
      To sum up, I wasn't a very peaceful child, I get in conflicts all the time, but I still have a reputation, I did many things, but they weren't big enough to involve police, so, as I said before there really are bader people than me.

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    18. Actually I'm a pretty strange individ. I'm not just good or just bad, its hard to define me. Let's say I blow up something and then sit calmly and play with toys :D

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    19. [Mee getting smarter]
      Okay I may have some traits, but it doesn't mean that I'm a socio. For example, lack of emotions can mean a ton of different things. Diagnosing myself was a stupid thing to do, because there's no gain from doing this.

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    20. The average person thinks he isn't.

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    22. Looking back on 2014 I can not believe how amusing and naive I was back then. Nevertheless, in spite of the occurring swear words picked up in this place and used solely for my communication here, the abundance of smiley faces and poor communication skills due to lack of knowledge of life and English I find the information I shared quite useful to determine my progress. What is more, regardless of the way those things were said and poorly picked examples I have to admit that my words were legit and the only thing missing back then was the capacity to understand the in-depth insight of others. The most decent outcome was that my comments stimulated other commentators share as well.

      Regarding my one and only deleted comment (located above) I did it because I decided that it was a little too personal and because I misunderstood Kany's comment. I thought she meant to say that "The average person thinks he isn't a sociopath..." I am well aware I'm far from average...

      Overall, it is fairly interesting to skim through the old posts, although I wish I wasn't as open.

      - Mee

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  7. Who needs a manual at all? Looks like someone here has it all fingered out!!

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    1. he's picking his nose

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  8. selfdiagnosis: assholl

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    1. prity sure that's not in the dsm woot i'm unique

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  9. Who wants to check out my Fb page?

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  10. I didn't tell you the next thing that happened in my story.. When I finally told my father my mother molested me, he said, "Let's look up the word molest in the dictionary."

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    1. and you had to show your father how your mother did you?

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    2. and now youare into milf's?

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    3. I am waiting for some real answers, but you all are cute *roll eyes*

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    4. What kind of answers do you want to hear? :)
      So you had no help from your father, and...

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    5. What is the question? And how many times did she
      molest you? Does she still have access to children?

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    6. The question(query) is that I never looked at my father, before. I thought he was the good one.

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    7. Monica, perhaps he was in shock from what you said to him. Maybe he couldn't think and reached for defining the word in some desperate bid to try and begin to understand?

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    8. YES Ell
      That is it! Thank you. That fits. I appreciate your help!

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    9. He might have thought you didn't know what the word meant...

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    10. @Monica

      your father sacrificed you to keep his illusion

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    11. @Monica

      Eden said in an earlier post we don't always have control over what we are and what we do. or not as much control as we think we have. or maybe no control at all? i don't remember exactly, but it was either before or after she called me a control freak (which i'm not arguing with).

      anyway, maybe she's right? you might want to consider that your parents did what they did because of the way they were either wired at birth or warped by life, more than out of any malice or weakness. they were what they were.

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    12. You are brilliant, Zoe x

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    13. Thank you Ell, Mee, V, Zoe and everyone who so generously offered help. I am at peace with it <3

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  11. The day a sociopath learns to relax the mind and not making efforts for motivation ,he/she is freed........

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    1. he gets bored you ment
      (or becoms a schizoid)

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  12. my dick
    i love wood in the morning
    the smell of victory

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  13. Man, I ran out of popcorn halfway through the comments. Good show to that "kany" person. I haven't seen such an enourmous idiot in awhile and it was refreshing to know that there are still those of myself who genuinely outclass others in this sociopathic realm. Come back and play when you aren't so overly emotional as to let an Internet article get you down and the comments so arousing to your almost biblical cause to parade yourself about like you've something that matters.

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    1. ^^^ Good perspicacity

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  14. Oddly enough, every time I hear or read about the DSM it reminds me of online pharmacy reviews talking about mental health meds and their attempt at curing some of those disorders.

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