Psycho vs. psychotic (part 2)

The reader explains what it feels like to live the life of a psychotic (which description I'd be reckless enough to call important, particularly as I have traditionally thought of psychotics as the "truly crazy" disordered, when really their worlds don't seem so much more distorted than the worlds of the rest of us).

Based upon dictionary definitions of the word everyone is "psychotic", as etymologically it describes anything related to or affected by psychological and mental processes.

Despite their best intentions mental healthcare providers are essentially tasked with turning down the volume and ensuing productivity. I recently called my boss to task for making fun of a 'crazy homeless man' who was walking around talking to, and smacking, himself. These abhorrent behaviours are two that I perform from time to time; especially during more agitated mixed states when my guard is down and my mind throws open the flood gates to every thought and sensation it can barely handle. The distinction is, of course, that I have a shower and go to work; so my psychosis (and hence burden to society) isn't as bad. 

That I identify as a psychotic is because it fits my experiences between than as a sufferer of a disorder. By choice, but often not, my daily life features conspicuous manifestations of my inner landscape. Some months back I sat on a train biting teethmarks into my right hand, just because. My job involves a lot of running up and down stairs, and when I'm descending my hands contort into talons; and I've felt wings arching out behind me before. Paranoia and the odd aggressive display (including hissing and snarling at people) are possibly less attractive -  and possibly the parts which most people associate "psychotic" with. 

Over time I've come to struggle with the notion of a disease entity afflicting me. For the most part these unusual traits have no baring on anything I'm doing. The brilliant Darian Leader once wrote of a psychiatric patient who was quite sane, bar his vocal belief in a non-existent European country. A fully functional human being was effectively quarantined for a mishap of geography. 

As I'm not a psychopath it's difficult to try and describe any distinction between "you" and "us" (especially since I don't want to speak for anyone but myself). However it is telling that '-path' is tacked on the end there: a more naked disorder classification; though psychotic is a more loaded term I feel. Psychotics are totally out of control; violent paranoid schizophrenics busying themselves with senseless murder while psychopaths (as you will of course know) are all about Debussy and fava beans. 

At a push I think its about how one enters into the world. Maybe psychotics and psychopaths are (consciously or otherwise) naturally inclined to focus on/give credence to their own inner worlds more than "normal" people. Psychotics find little or no distinction between reality, the sensory and the imagined. For us there is no cure, rather a need to determine and discover how involved we can/want to be with others; whereas normals can't even conceive of having any alternatives. 

I've actually being laying out a lot of my experiences as a psychotic out on my own website, particularly in this article: http://causecatyljan.com/2013/08/19/psukhe/.  

Psycho vs. psychotic (part 1)

I had an interesting discussion with a reader on the relationship between the psychopathic and psychotic. I was expecting to see almost no relationship, but was surprised to see at least a few parallels, particularly in that we both experience the world in a way so different than neurotypicals and consequently are treated differently for it (unless we're pretty expert at hiding it):

I greatly enjoyed and admired your book. So much that I’d be reckless enough to call it important, given how it counters the standard model of the sociopath and gives a voice to others like you. 

Thanks to your book, I’ve concluded that I am not a sociopath. The question has long been there, and maybe - were I to go into detail about my life - my conclusion could challenged. 

Some years ago I was given the diagnosis which saved my life: ‘Bipolar Affective Disorder with Cyclothymic Tendencies” and a prescription for lithium carbonate. After a whole life of depression, violent outbursts, alcohol abuse, self-harm and one potent suicide attempt; I finally had something approaching an explanation. 

I’m grateful to be high-functioning (social workers have expressed surprise at this), and to be carving niches in life and work. I’m more focussed and hugely confident (with an ego my younger self would’ve been affronted by); though increasingly analytical, cold and emotionally detached. I work in retail and relish being able to alter my environment and personality, in order to sway my superiors (or indeed by-pass them altogether) as well as manipulating the buying decisions of customers. In my somewhat kaleidoscopic wetware I love the idea of “bending their will to my own.”  

In my head I maintain an almost comic book sense of personal mythology and continuity. My life and experiences cast in the light of my “emerging powers.” The fear and doubt and servility that characterised me is long dead, and now my concerns centre wholly upon increasing my own sense of achievement, in demonstrating (to myself I must stress) how much I can do, how much I can handle and how well I continue to evolve. 

I exist in a near perpetual state of hypomania (occasionally peaking into irrational ranting/noises inside my head) entwined with a calm, centred “mixed state” where cutting out an eye or slicing open my arms will quell some internal conflict/pain or simply because...reasons. [Un]logic I call it. 

It seems to me that some of what I describe could be considered sociopathic in nature. The difference between sociopathy and sociopathic traits is intriguing to me, because I now wonder if my continued evolution is in part down to adopting (consciously or not) such characteristics. Having to step back, take longer to assess what’s happening, increase the emotional distance. Forcing myself into calculated risks and being willing to follow my gut when boundaries become too much. 

I appreciate how unconcerned you seem with justifying or seeking sympathy for your sociopathy. How it is not a disorder needing a cure.  Perhaps another reader would raise an eyebrow about now, but I can only stutter from where I stand. 

He concluded with two questions: "How thin do you consider the line between psychopathic and psychotic can be? What can the “coping strategies” of one offer to the other and vice versa?" To which I replied:

I have myself often wondered about the beneficial aspects of sociopathic behaviors, particularly evolutionarily or as defense tactics against a hostile world. A lot of people that visit my site are from eastern europe. Is it because they've had to become gradually less emotional in dealing with harsh circumstances? I actually don't know that much about psychotics. So you would consider yourself a psychotic? You would probably be a better person to ask then, what is the difference?

You will always be my son

From a reader:


So tired of explaining my son and trying to figure out the dark mystery he is but your experience reflects a part of who my son is. At three diagnosed with Asperger's. Had some classic traits but still didn't quite fit the mold. Socially inept, uncoordinated, wanted friends but was awkward and inappropriate. The boy's IQ is 150. Thought that coping with all the Asperger's problems as a single parent with no support would be as bad as it would get. Then at 15 he had a "psychotic break" in which I came home from work as a case manager for mostly psychotic schizophrenics to find my own son crying hysterically begging me to stay away from him because he was having possible instrusive thoughts, not sure, and the urge to kill me. I stayed in clinical mode as I tried to calmly take his hysteria down and brought him to crisis. The clinician, who I knew and didn't really like me, told me to take him home and he would be okay. Oh yeah, he also told the clinician that he wanted to rape me. No big deal. I could handle it. And I did. Horrifying and heartbreaking.

At 16 he said he had begun hearing voices but I knew many clients who heard voices and my son did not present as they did. He never responded to the voices which is something people are compelled to do. Didn't make sense. Two weeks later he vividly described a visual hallucination saying that cops were at the door with guns drawn. He seemed fascinated by it. I had heard 100's of accounts of visual hallucinations and they weren't as clear as his.  About four months ago after complaining to me daily that he was having suicidal thoughts and the urge to strangle me I saw the intent in his eyes one day. Did not know this child. He was not my son. Back to crisis where he was clear and said he felt "good" in waiting area but presented as the perfect psychotic, demeanor, body language, voice when being evaluated by the clinician. This time he was taken to an adolescent psych hospital 90 miles away. I almost collapsed a few times that day during the process. I was so drained from weeks of waiting to be strangled. My denial enable me to cope but every time he would surprise me I involuntarily jumped and let out a small animal-like yelp. My subconscious knew to be scared.

While he was in the hospital everything changed as far as my perception of this innocent victim of mental illness. He would call several times a day crying and begging me to get him out. Then his voice changed and he was quite in control stating with hostility and threat that I'd better get him out AMA. One particular visit turned the switch in me. As he sat across the table crying and begging again making outragious complaints about staff and other patients I shut down and did not react. This accelerated his determination and manipulative tactics. He couldn't believe that I was calmly countering all he said. 

Then he began yelling and tried to leap across the table to get to me. I told him now I could really see the hatred and how much he really did want to hurt me. Not done, he put his hands around his neck in an effort to show he would strangle himself. His acting abilities did not impress me. I had been through so much in an effort to help him to this point, now I felt taken advantage of and betrayed. He had shown signs before of switching in seconds from the tortured victim to an arrogant kid just screwing around. He didn't know I had witnessed these incidents. And the lies were always there. He is home and still has the thoughts and urges. I don't know him anymore. Now that he knows I have caught on no more coming to me for sympathy just an uncomfortable distance. Need help. There is a Forensic Psychiatrist in San Jose, Ca not for from us, Dr. Arturo Silva, who has a theory that Asperger's can turn into psycopathic traits as a teenager. Been trying to get in touch with him but not successful. I feel in my gut he might have answers that I need. Can you help?


M.E.:

I don't know if there is anything I can do to help. If he is a sociopath, you should appeal to his self-interest. It does not help him to harm you because you are willing to financially support him through college, or whatever else it is. It sounds like he is around 17. You might want to talk to him about how when he turns 18, you will still be his mother and will support him in anyway you can, but he will be considered an adult by society. Anything he does after that could have very long lasting effects for him. Give him some facts about the average life expectancy of someone his age. Perhaps you two could "volunteer" at a prison? He should be rational enough to be educated in these ways. And if you acknowledge how he is different without judging him, things should be able to get better between the two of you. Say things like, "you will always be my son." Give him a sense of permanence. Explain to him the meaning of the phrase "don't defecate where you eat." Have him read the book "Lord of the Flies" and see how he feels about it. If he's not a sociopath, I don't think these things will work.

What exactly is psychopathy?

A reader sent this interesting article from one of our favorite researchers, Jennifer Skeem, whose previous attack on the PCL-R caused Robert Hare to take her to court and delay the publication before it was eventually released. The article is sort of an interesting primer on psychopathy and summary of the most recent research. She has her own ideas about the correct delineation of psychopathy that seems reasonable. First she discusses why there are so many ideas about what exactly sociopathy is:

As we will discuss, many of the controversies surrounding psychopathy stem from fundamental disagreements about its basic definition, or operationalization. The scope of phenomena encompassed by the term psychopathy has varied dramatically over time, from virtually all forms of mental disorder (psychopathy as “diseased mind”) to a distinctive disorder characterized by lack of anxiety; guiltlessness; charm; superficial social adeptness; dishonesty; and reckless, uninhibited behavior (Blackburn, 1998). Even contemporary conceptualizations of psychopathy contain puzzling contradictions. Psychopaths are often described as hostile, aggressive, and at times revenge driven (N. S. Gray, MacCulloch, Smith, Morris, & Snowden, 2003), yet they are also characterized as experiencing only superficial emotions (Karpman, 1961; McCord & McCord, 1964). They are impulsive and reckless, yet apparently capable of elaborate scheming and masterful manipulation (Hare, 1993). They can rise to high levels of achievement or status in society, attaining success in business and public life, yet present as criminals whose behavior is so poorly thought out and lacking in regard even for self-interest that they occupy bottom rungs of the social ladder

Given these contrasting depictions, it is scant wonder that some experts have concluded that the concept of psychopathy, as commonly understood, is disturbingly problematic: a “mythical entity” and “a moral judgment masquerading as a clinical diagnosis” (Blackburn, 1988, p. 511), “almost synonymous with ‘bad’” (Gunn, 1998, p. 34), “used by the media [to convey] an impression of danger, and implacable evil” (Lykken, 2006, p. 11). In the words of William and Joan McCord (McCord & McCord, 1964), two influential figures in the historic literature on psychopathy, “the proliferation of definitions, the tendency to expand the concept to include all deviant behavior, the discrepancies in judgment between different observers——these pitfalls in the history of the concept—— are enough to make a systematic diagnostician weep” (p. 56).

She then (optimistically) asserts that all is not lost, that sociopathy is a thing and we can figure out what that thing is through careful parsing of the literature and empirical evidence. First she dispels some myths:

• Psychopathy is synonymous with violence: "However, psychopathy can and does occur in the absence of official criminal convictions, and many psychopathic individuals have no histories of violence."
• Psychopathy is synonymous with psychosis: "In contrast with psychotic patients, psychopathic individuals are generally rational, free of delusions, and well oriented to their surroundings"
• Psychopathy is synonymous with antisocial personality disorder (ASPD): "The difference arises largely because measures of psychopathy include personality traits inferable from behavior, whereas measures of ASPD more exclusively emphasize antisocial, criminal, and (to a lesser extent) violent behavior."
• Psychopathic individuals are born, not made: "Contemporary understanding of the pervasive interplay of genetic and environmental influences in determining behavioral outcomes of various kinds argues against the likelihood that any psychiatric condition, including psychopathy, is entirely 'born' or 'made.'"
• Psychopathy is inalterable: "some recent empirical work has emerged to suggest that personality traits in general, and psychopathic traits more specifically, undergo change across major developmental transitions"

The article is quite long. I will probably keep going back to it over the next month or so and perhaps sharing things that I learn here.