Mental Health and Psychology Dictionary
ABCDEFGHI J KLMNOPQRSTUV W X Y Z
A
Acting Out
Defense mechanism. When an inner conflict (most often, frustration) translates into aggression. It involves acting with little or no insight or reflection and in order to attract attention and disrupt other people's cozy lives.
Affect is how we express our innermost feelings and how other people observe and interpret our expressions. Affect is characterized by the type of emotion involved (sadness, happiness, anger, etc.) and by the intensity of its expression. Some people have flat affect: they maintain "poker faces", monotonous, immobile, apparently unmoved. This is typical of the Schizoid Personality Disorder Others have blunted, constricted, or broad (healthy) affect. Patients with the dramatic (Cluster B) personality disorders - especially the Histrionic and the Borderline - have exaggerate and labile (changeable) affect. They are "drama queens".
In certain mental health disorders, the affect is inappropriate. For instance: such people laugh when they recount a sad or horrifying event or when they find themselves is morbid settings (e.g., in a funeral).
Ambivalence
Possessing equipotent - but opposing and conflicting - emotions or ideas. In someone with a permanent state of inner turmoil: her emotions come in mutually exclusive pairs, her thoughts and conclusions arrayed in contradictory dyads. The result is extreme indecision, to the point of utter paralysis and inaction. Sufferers of Obsessive-Compulsive Disorders and the Obsessive-Compulsive Personality Disorder are highly ambivalent.
Amnesia, Anterograde
Loss of memory pertaining to events that occurred after the onset of the amnetic condition or agent.
Amnesia, Retrograde
Loss of memory pertaining to events that occurred before the onset of the amnetic condition or agent.
Amok
Male-specific culture-bound syndrome: an alternating pattern of dissociation, brooding, and violence directed at objects and people. Provoked by real or imagined criticism or slight and accompanied by persecutory ideation, amnesia, automatism, and extreme fatigue. Sometimes co-occurs with a psychotic episode. Common in Malaysia (where it was discovered), Laos, Philippines, Polynesia (where it is called cafard or cathard), Papua New Guinea, Puerto Rico (mal de pelea), and among the Navajo Native-Americans (iich'aa).
Anhedonia
The loss of the urge to seek pleasure and to prefer it to nothingness or even to pain. Depression inevitably involves anhedonia. The depressed are unable to conjure sufficient mental energy to get off the couch and do something because they find everything equally boring and unattractive.
Anorexia
Diminished appetite to the point of refraining from eating. Whether it is part of a depressive illness or a body dysmorphic disorder (erroneous perception of one's body as too fat) is still debated. Anorexia is one of a family of eating disorders which also includes bulimia (compulsive gorging on food and then its forced purging, usually by vomiting).
Antisocial Personality Disorder (Psychopath)
APD or AsPD; Formerly called "psychopathy" or, more colloquially, "sociopathy". Some scholars, such as Robert Hare, still distinguish psychopathy from mere antisocial behavior. The disorder appears in early adolescence but criminal behavior and substance abuse often abate with age, usually by the fourth or fifth decade of life. It may have a genetic or hereditary determinant and afflicts mainly men. The diagnosis is controversial and regarded by some scholar as scientifically unfounded.
Psychopaths regard other people as objects to be manipulated and instruments of gratification and utility. They have no discernible conscience, are devoid of empathy and find it difficult to perceive other people's nonverbal cues, needs, emotions, and preferences. Consequently, the psychopath rejects other people's rights and his commensurate obligations. He is impulsive, reckless, irresponsible and unable to postpone gratification. He often rationalizes his behavior showing an utter absence of remorse for hurting or defrauding others.
Their (primitive) defence mechanisms include splitting (they view the world - and people in it - as "all good" or "all evil"), projection (attribute their own shortcomings unto others) and projective identification (force others to behave the way they expect them to).
The psychopath fails to comply with social norms. Hence the criminal acts, the deceitfulness and identity theft, the use of aliases, the constant lying, and the conning of even his nearest and dearest for gain or pleasure. Psychopaths are unreliable and do not honor their undertakings, obligations, contracts, and responsibilities. They rarely hold a job for long or repay their debts. They are vindictive, remorseless, ruthless, driven, dangerous, aggressive, violent, irritable, and, sometimes, prone to magical thinking. They seldom plan for the long and medium terms, believing themselves to be immune to the consequences of their own actions.
Anxiety
A kind of unpleasant (dysphoric), mild fear, with no apparent external reason. Apprehension or dread in anticipation of a future menace or an imminent but diffuse and unspecified danger, usually imagined or exaggerated. The mental state of anxiety (and the concomitant hypervigilance) has physiological complements. It is accompanied by short-term dysphoria and physical symptoms of stress and tension, such as sweating, palpitations, tachycardia, hyperventilation, angina, tensed muscle tone, and elevated blood pressure (arousal).
APD, AsPD - Antisocial Personality Disorder
Aphonia
Inability to produce speech (or sounds) through the larynx due to psychological, nonorganic, reasons.
Autism
More precisely: autistic thinking and inter-relating (relating to other people). Fantasy-infused thoughts. The patient's cognitions derive from an overarching and all-pervasive fantasy life. Moreover, the patient infuses people and events around him or her with fantastic and completely subjective meanings. The patient regards the external world as an extension or projection of the internal one. He, thus, often withdraws completely and retreats into his inner, private realm, unavailable to communicate and interact with others.
Automatic obeisance or obedience
Automatic, unquestioning, and immediate obeisance of all commands, even the most manifestly absurd and dangerous ones. This suspension of critical judgment is sometimes an indication of incipient catatonia.
Avoidant Personality Disorder
Social shyness and anxiety coupled with feelings of inadequacy, deformity, and dysfunction and with hypersensitivity to criticism, real or imagined. Sufferers of the disorder avoid interpersonal contact because they dread rejection, embarrassment, disagreement, and disapproval. They strive to ascertain that their counterparty likes them and approves of their conduct, or their choices, before they actually meet him (or her). They prefer solitary occupations and are very restrained and "cold" in intimate relationships. They limit their world, escape challenges and risks and stunt their personal growth and development by avoiding the new (e.g., unfamiliar people, novel activities, or pursuits).
They are mortified by shame and the possibility of being mocked, criticized, rejected, or ridiculed in public. They are prone to having ideas of reference (see entry). They are perceived by others as reserved, timid, and inhibited because they regard themselves as socially inept, repellant, unattractive, inferior, inadequate, dysfunctional, defective, or deformed. Some Avoidants develop Body Dysmorphic Disorders.
Avolition
Inability to initiate goals and goal-directed activities - or pursue them once initiated. Overpowering and pervasive lack of "will", perseverance, and stamina in various fields of life (work, self-care, intellectual tasks and interests, family life, etc.)
B
Blocking
Halted, frequently interrupted speech to the point of incoherence indicates a parallel disruption of thought processes. The patient appears to try hard to remember what it was that he or she were saying or thinking (as if they "lost the thread" of conversation).
Borderline Personality Disorder
BPD; Often diagnosed among women, it is a controversial mental health diagnosis. Borderlines are characterized by stormy, short-lived, and unstable relationships - matched by wildly fluctuating (labile) self-image and emotional expression (affect). They are impulsive and reckless - their sexual conduct is frequently unsafe, they binge eat, gamble, drive, and shop carelessly, and are substance abusers. They also display self-destructive and self-defeating behaviors, such as suicidal ideation, suicide attempts, gestures, or threats, and self-mutilation or self-injury.
The specter of abandonment provokes anxiety in the Borderline. They make frantic - and, usually, counterproductive - efforts to preempt or prevent it Clinging, codependent acts are followed by idealization and then by an abrupt devaluation of the Borderline's partner.
Borderlines have pronounced mood swings, shifting between dysphoria (sadness or depression) and euphoria, manic self-confidence and paralyzing anxiety, irritability and indifference. They are often angry and violent, usually getting into physical fights, throw temper tantrums, and have frightening rage attacks.
Under stress, some Borderlines become briefly psychotic (psychotic micro-episodes), or develop transient paranoid ideation and ideas of reference (the erroneous conviction that one is the focus of derision and malicious gossip). Dissociative symptoms are not uncommon ("losing" stretches of time, or objects, and forgetting events or facts with emotional content).
Borderline Personality Organization Scale (BPO)
Diagnostic test designed in 1985. It sorts the responses of respondents into 30 relevant scales. It indicates the existence of identity diffusion, primitive defenses, and deficient reality testing.
BPD - Borderline Personality Disorder
C
Catalepsy
The rigid maintenance of a position of the entire body or of an organ over extended periods of time ("waxy flexibility"). "Human sculptures" are patients who freeze in any posture and position that they are placed, no matter how painful and unusual. Typical of catatonics. See: Cerea Flexibilitas
Catatonia
A syndrome comprised of various signs, amongst which are: catalepsy, mutism, stereotypy, negativism, stupor, automatic obedience, echolalia, and echopraxia. Until recently it was thought to be related to schizophrenia, but this view has been discredited when the biochemical basis for schizophrenia had been discovered. The current thinking is that catatonia is an exaggerated form of mania (in other words: an affective disorder). It is a feature of catatonic schizophrenia, though, and also appears in certain psychotic states and mental disorders that have organic (medical) roots.
Catatonic Behavior
Severe motoric abnormalities, including stupor or catalepsy (motoric immobility), or, at the other end of the spectrum, agitated (excessive), purposeless, repeated motoric activity, not in response to external stimuli or triggers.
Also (apparently motiveless) resistance or indifference to attempts to being moved or to being communicated with (extreme negativism).
Catatonic behavior often comprises mutism, posturing (stereotyped motion), echolalia, and echopraxia.
Chinese Classification of Mental Disorders. The Chinese equivalent of the DSM. Currently in its second edition (CCMD-2). Recognizes culture-bound syndromes (e.g., Koro) as diagnosable and treatable mental health disorders.
Literally: wax-like flexibility. In the common form of catalepsy, the patient offers no resistance to the re-arrangement of his limbs or to the re-alignment of her posture. In Cerea Flexibilitas, there is some resistance, though it is very mild, much like the resistance a sculpture made of soft wax would offer.
Circumstantiality
When the train of thought and speech is often derailed by unrelated digressions, based on chaotic associations. The patient finally succeeds to express his or her main idea but only after much effort and wandering. In extreme cases considered to be a communication disorder.
Clang Associations
Rhyming or punning associations of words with no logical connection or any discernible relationship between them. Typical of manic episodes,psychotic states, and schizophrenia.
Clouding (Also: Clouding of Consciousness)
The patient is wide awake but his or her awareness of the environment is partial, distorted,or impaired. Clouding also occurs when one gradually loses consciousness (for instance, as a result of intense pain or lack of oxygen).
Cognitive Dissonance
The devaluation of things and people very much desired but frustratingly out of one's reach and control.
Involuntary repetition of a stereotyped and ritualistic action or movement, usually in connection with a wish or a fear. The patient is aware of the irrationality of the compulsive act (in other words: she knows that there is no real connection between her fears and wishes and what she is repeatedly compelled to do). Most compulsive patients find their compulsions tedious, bothersome, distressing, and unpleasant - but resisting the urge results in mounting anxiety from which only the compulsive act provides much needed relief. Compulsions are common in obsessive-compulsive disorders, the Obsessive-Compulsive Personality Disorder (OCPD), and in certain types of schizophrenia.
Concrete Thinking
Inability or diminished capacity to form abstractions or to think using abstract categories. The patient is unable to consider and formulate hypotheses or to grasp and apply metaphors. Only one layer of meaning is attributed to each word or phrase and figures of speech are taken literally. Consequently, nuances are not detected or appreciated. A common feature of schizophrenia, autism spectrum disorders, and certain organic disorders.
The constant and unnecessary fabrication of information or events to fill in gaps in the patient's memory, biography or knowledge, or to substitute for unacceptable reality. Common in the Cluster B personality disorders (narcissistic, histrionic, borderline, and antisocial) and in organic memory impairment or the amnestic syndrome (amnesia).
Conflict Tactics Scale (CTS)
Diagnostic test invented in 1979. It is a standardized scale of the frequency and intensity of conflict resolution tactics - especially abusive stratagems - used by members of a dyad (couple).
Confusion
Complete (though often momentary) loss of orientation in relation to one's location, time, and to other people. Usually the result of impaired memory (often occurs in dementia) or attention deficit (for instance, in delirium). Also see: Disorientation.
Recurrent dysfunctional behavior linked to troubling experiences regarded, in a specific locale by its native denizens, or in a specific culture, as aberrant or sick.
D
Defense Mechanism
A psychological process that protects or isolates a person from the effects of anxiety, internal and external stressors, and perceived or real dangers, usually by reducing, altering, or blocking his or her awareness of them. Defense mechanisms mediate the individual's reactions to emotional and physical hurt, inner conflicts, and stressors of all kinds. Most defense mechanisms are adaptive when first formed but later become maladaptive (e.g., splitting, acting out, projective identification, projection, intellectualization). Others - such as suppression or denial - can be adaptive in certain circumstances and if they are flexibly applied, are not severe, and are safely reversible. Defense mechanisms are measured and evaluated using the Defensive Functioning Scale.
Delirium is a syndrome which involves clouding, confusion, restlessness, psychomotor disorders (retardation or, on the opposite pole, agitation), and mood and affective disturbances (lability). Delirium is not a constant state. It waxes and wanes and its onset is sudden, usually the result of some organic affliction of the brain.
Delusion
A belief, idea, or conviction firmly held despite abundant information to the contrary. The partial or complete loss of reality test is the first indication of a psychotic state or episode. Beliefs, ideas, or convictions shared by other people, members of the same collective, are not, strictly speaking, delusions, although they may be hallmarks of shared psychosis. There are many types of delusions:
I. Paranoid
The belief that one is being controlled or persecuted by stealth powers and conspiracies.
2. Grandiose-magical
The conviction that one is important, omnipotent, possessed of occult powers, or a historic figure.
3. Referential (ideas of reference)
The belief that external, objective events carry hidden or coded messages or that one is the subject of discussion, derision, or opprobrium, even by total strangers.
The counterfactual conviction that unrelated events and people are somehow specifically meaningful to the person and intentionally effected. A patient with delusions of reference is convinced that he is the topic of malicious gossip, the victim of pranks, or the recipient of messages (for instance, through the media). See also: idea of reference, persecutory delusion.
Dementia
Simultaneous impairment of various mental faculties, especially the intellect, memory, judgment, abstract thinking, and impulse control due to brain damage, usually as an outcome of organic illness. Dementia ultimately leads to the transformation of the patient's whole personality. Dementia does not involve clouding and can have acute or slow (insidious) onset. Some dementia states are reversible.
Defense mechanism. Ignoring unpleasant facts, filtering out data and content that contravene one's self-image, prejudices, and preconceived notions of others and of the world.
Dependent Personality Disorder
DPD; A compulsive, pervasive, and excessive craving to be attended to and taken care of that leads to clinging, stifling, and humiliating or submissive behaviors. Codependents are paralyzed by their anxiety of being abandoned.
They are indecisive and demand constant and repeated reassurances and advice from a myriad sources, thereby "transferring" responsibility for their decisions to others. Codependents rarely initiate, though they often harbor repressed ambition, energy, and imagination. They lack self-confidence and distrust their own abilities and judgment.
This reliance on others leads to self-negating behavior. The codependent never disagrees with meaningful others or criticizes them, lest s/he loses the support and emotional nurturance they do or could provide. The codependent molds himself/herself and bends over backward to cater to the needs of his nearest and dearest and satisfy their every whim, wish, expectation, and demand. Nothing is too unpleasant or unacceptable if it serves to secure the uninterrupted presence of the codependent's family and friends and the emotional sustenance s/he can extract (or extort) from them.
The codependent feels helpless, threatened, ill-at-ease, child-like, and not fully-alive when alone. This acute discomfort drives the codependent to hop from one relationship to another. The sources of nurturance are interchangeable. To the codependent, being with someone, with anyone, no matter whom - is always preferable to being alone.
Feeling that one's body has changed shape or that specific organs have become elastic and are not under one's control. Usually coupled with "out of body" experiences. Common in a variety of mental health and physiological disorders: depression, anxiety, epilepsy, schizophrenia, and hypnagogic states. Often observed in adolescents. See: Derealization.
Derailment
A loosening of associations. A pattern of speech in which unrelated or loosely-related ideas are expressed hurriedly and forcefully, with frequent topical shifts and with no apparent internal logic or reason. See: incoherence.
Feeling that one's immediate environment is unreal, dream-like, or somehow altered. See: Depersonalization.
Dereistic Thinking
Inability to incorporate reality-based facts and logical inference into one's thinking. Fantasy-based thoughts.
Devaluation
Defense mechanism. Attributing negative or inferior traits or qualifiers to self or others. This is done in order to punish the person devalued and to mitigate his or her impact on and importance to the devaluer. When the self is devalued, it is a self-defeating and self-destructive act.
Dhat
Culture-bound syndrome in India which includes incapacitating anxiety attacks, hypochondriasis associated with self-reported painful ejaculation of sperm, discharge of foggy white urine, and overwhelming fatigue. Also see: Jiryan, Sukra Prameha, and Shen-k'uei.
A state of confusion about the date, place, time of day, or one's personal identity. One of the signs of delirium.
Displacement
Defense mechanism. Confronting someone weaker or irrelevant and, thus, less menacing when one cannot confront the real sources of one's frustration, pain, and envy.
Dissociation
Sudden or gradual perturbance in the continuous operation of high-level integrated functions, such as consciousness, memory, perception, and identity. Most dissociative disorders are transient, but some - such as the Dissociative Identity Disorder (q.v.) are chronic. Also see: Dissociative Amnesia, Dissociative Fugue, Dissociative Identity Disorder, Dissociative Trance Disorder.
DSM - Diagnostic and Statistical Manual
Diagnostic and Statistical Manual, currently at its fourth edition (text revision, also shortened as DSM-IV-TR). First published by the American Psychiatric Association in 1952, based on the sixth edition of the World Health Organizagtion's ICD. Contains a classification of all mental health disorders, organized into 17 diagnostic classes and based on literature reviews, data analyses, and field trials. Compiled by more than 1000 mental health professionals, working in committees. A fifth edition is expected in 2010.
Dyssomnia
Primary disorder of the amount, quality, or timing of sleep and wakefulness. Insomnias and hypersomnias are dyssomnias.
E
Imitation by way of exactly repeating another person's speech. Involuntary, semiautomatic, uncontrollable, and repeated imitation of the speech of others. Observed in organic mental disorders, pervasive developmental disorders, psychosis, and catatonia. See: Echopraxia.
Involuntary, semiautomatic, uncontrollable, and repeated imitation of the movements of others. Observed in organic mental disorders, pervasive developmental disorders, psychosis, and catatonia. See: Echolalia.
F
Defense mechanism. Seeking gratification - the satisfaction of drives or desires - by constructing imaginary worlds that, gradually, are preferred to reality.
Flashback
A vivid recurrence of past experiences, memories, or emotions, often triggered by specific events, words, or sensory cues. Common in Post Traumatic Stress Disorder (PTSD).
Rapidly verbalized train of unrelated thoughts or of thoughts related only via relatively-coherent associations. Still, in its extreme forms, flight of ideas involves cognitive incoherence and disorganization. Appears as a sign of mania, certain organic mental health disorders, schizophrenia, and psychotic states. Also see: Pressure of Speech and Loosening of Associations.
Folie a Deux (Madness in Twosome, Shared Psychosis)
The sharing of delusional (often persecutory) ideas and beliefs by two or more (folie a plusieurs) persons who cohabitate or form a social unit (e.g., a family, a cult, or an organization). One of the members in each of these groups is dominant and is the source of the delusional content and the instigator of the idiosyncratic behaviors that accompany the delusions.
Formication - See Hallucination
Fugue
Vanishing act. A sudden flight or wandering away and disappearance from home or work, followed by the assumption of a new identity and the commencement of a new life in a new place. The previous life is completely erased from memory (amnesia). When the fugue is over, it is also forgotten as is the new life adopted by the patient.
G
Gender Dysphoria
The aversion to and rejection of one's gender identity and biological sex, their physical attributes and the social roles attendant to them. Often leads to attempts to change one's sex through hormone therapy and surgery.
Gender Identity
The inner conviction that one is either a male or a female.
Gender Role
Masculine or feminine behavior patterns, attitudes, preferences, and personality traits within a given culture.
Delusional or non-delusional inflated evaluation of one's knowledge, power, worth, importance, identity, accomplishments, rights, assets, or prospects. Typical of certain personality disorders, such as the Narcissistic.
H
False perceptions based on false sensa (sensory input) not triggered by any external event or entity. The patient is usually not psychotic - he is aware that he what he sees, smells, feels, or hears is not there. Still, some psychotic states are accompanied by hallucinations (e.g., formication - the feeling that bugs are crawling over or under one's skin).
There are a few classes of hallucinations:
Auditory - The false perception of voices and sounds (such as buzzing, humming, radio transmissions, whispering, motor noises, and so on).
Gustatory - The false perception of tastes
Olfactory - The false perception of smells and scents (e.g., burning flesh, candles)
Somatic - The false perception of processes and events that are happening inside the body or to the body (e.g., piercing objects, electricity running through one's extremities). Usually supported by an appropriate and relevant delusional content.
Tactile - The false sensation of being touched, or crawled upon or that events and processes are taking place under one's skin. Usually supported by an appropriate and relevant delusional content.
Visual - The false perception of objects, people, or events in broad daylight or in an illuminated environment with eyes wide open.
Hypnagogic and Hypnopompic - Images and trains of events experienced while falling asleep or when waking up. Not hallucinations in the strict sense of the word.
Hallucinations are common in schizophrenia, affective disorders, and mental health disorders with organic origins. Hallucinations are also common in drug and alcohol withdrawal and among substance abusers.
Histrionic Personality Disorder
HPD; Histrionics - mostly women - resemble narcissists in their attention seeking behaviors and marked discomfort when not at the center of attention. Yet, unlike narcissists, histrionics are empathic, sentimental, and overly emotional. They are sexually seductive and provocative and people often find them embarrassing, annoying, or outright repulsive.
The histrionic glides from one relationship to the next, constantly experiencing shallow emotions and commitments. The Histrionic's speech is impressionistic, disjointed, and generalized. She uses her physical appearance and attire as bait. Histrionics often mistake the depth, durability, and intimacy of their relationships and are devastated by their inevitable premature termination.
Histrionics are the quintessential drama queens. They are theatrical, their emotions exaggerated to the point of a caricature, their gestures sweeping, disproportional, and inappropriate. They are easily suggestible and over-reactive.
HPD - Histrionic Personality Disorder
Hwa-byung
Culture-bound syndrome in Korea, attributed to suppressed anger (roughly translated as "anger illness"). Symptoms include extreme fatigue coupled with sleep disorder (mainly insomnia), panic, terror of imminent doom or death, dysphoria, anhedonia, indigestion, anorexia, dyspnea, diffuse pains, palpitations, and a feeling of congestion or mass in the epigastrium. See: panic attack..
Hyperacusis
Painful hypersensitivity to sounds, noises, and voices.
Hypersomnia
Pronounced tendency to oversleep at night coupled with a difficulty to remain alert or awake during the day and undesired, abrupt, and uncontrolled diurnal episodes of sleep.
Hypnagogic and Hypnopompic - See Hallucination
I
Weak delusions of reference, devoid of inner conviction and with a stronger reality test. The counterfactual feeling that unrelated events and people are somehow specifically meaningful to the person and intentionally effected. A patient with ideas of reference may feel that he is the topic of malicious gossip, the victim of pranks, or the recipient of messages (for instance, through the media). Ideas of reference are common in some personality disorders. See also: delusion, persecutory delusion.
Defense mechanism. The attribution of positive, glowing, and superior traits to self and (more commonly) to others.
Illusion
The misperception or misinterpretaion of real external - visual or auditory - stimuli, attributing them to non-existent events and actions. Incorrect perception of a material object. See: Hallucination.
A loosening of associations. A pattern of speech in which unrelated or loosely-related ideas are expressed hurriedly and forcefully, using broken, ungrammatical, non-syntactical sentences, an idiosyncratic vocabulary ("private language"), topical shifts, and inane juxtapositions ("word salad"). Incomprehensible speech, rife with severely loose associations, distorted grammar, tortured syntax, and idiosyncratic definitions of the words used by the patient ("private language"). See: Loosening of Associations; Flight of Ideas; Tangentiality.
Intellectualization - see: Rationalization
Insomnia
Sleep disorder or disturbance involving difficulties to either fall asleep ("initial insomnia") or to remain asleep ("middle insomnia"). Waking up early and being unable to resume sleep is also a form of insomnia ("terminal insomnia").
Intersex Condition
Androgyny. The appearance and manifestation, in one individual, of the characteristics of both sexes, male and female: reproductive organs, physical form, and sexual behavior.
Isolation of Affect
Defense mechanism. Avoiding conflict and anxiety by separating the cognitive content (for instance, a disturbing or depressing idea) from its emotional correlate and, thus, casting away threatening and discomfiting feelings.
K
Koro
Culture-bound syndrome in south and east Asia (and, more rarely, in the West, especially among immigrant communities). Episodic abrupt and overwhelming anxiety that one's sex organs (penis, vulva, nipples) will recede into one's body and cause death. Recognized as a valid mental health diagnosis by the Chinese (in the Chinese Classification of Mental Disorders - Second Edition - the CCMD-2). See also: Shuk yang, Shook yong, Suo yang, Jinjinia bemar, Rok-joo.
L
Lability
Abnormal, repetitive, rapid, and sudden fluctuations in both affect and affective expression. Characterizes certain personality disorders, such as the Borderline.
Latah
Term used in Asia to describe a syndrome of reactions to sudden fright which include echopraxia, echolalia, command obedience, and dissociation in a trance-like state. Mainly found among middle-aged women. Also called amurakh, irkunii, ikota, olan, myriachit, menkeiti (in Siberia), bah tschi, bah-tsi, baah-ji (Thailand), imu (Sakhalin, Japan), mali-mali and silok (Philippines).
Locura
Term used in Latin America (and among Latino immigrants in the USA) to describe severe and chronic psychosis, usually inherited, and induced by difficulties and crises in the patient's life. The syndrome includes agitation, incoherence, hallucinations (both auditory and visual), unpredictable (typically violent) beahvior, and inability to interact socially.
Thought and speech disorder which involves the translocation of the focus of attention from one subject to another for no apparent reason. The patient is usually unaware of the fact that his train of thoughts and his speech are incongruous and incoherent. A sign of schizophrenia and some psychotic states. See: Incoherence; Flight of Ideas; Tangentiality.
M
Macropsia
Visual misperception of objects as larger than they are. See: Micropsia.
Magical Thinking
The mistaken conviction that effects and events in the external world are caused or prevented by one's thoughts, words, or actions - frequently in defiance of the laws of physics and formal logic. It is normal in early childhood but pathological thereafter when it forms part of personality and other mental health disorders.
Visual misperception of objects as smaller than they are. See: Macropsia.
MMCI-III
Millon Clinical Multiaxial Inventory. Diagnostic test composed of 157 true-or-false items.
The MCMI-III consists of 24 clinical scales and 3 modifier scales. The modifier scales serve to identify Disclosure (a tendency to hide a pathology or to exaggerate it), Desirability (a bias towards socially desirable responses), and Debasement (endorsing only responses that are highly suggestive of pathology). Next, the Clinical Personality Patterns (scales) which represent mild to moderate pathologies of personality, are: Schizoid, Avoidant, Depressive, Dependent, Histrionic, Narcissistic, Antisocial, Aggressive (Sadistic), Compulsive, Negativistic, and Masochistic. Millon considers only the Schizotypal, Borderline, and Paranoid to be severe personality pathologies and dedicates the next three scales to them.
The last ten scales are dedicated to Axis I and other clinical syndromes: Anxiety Disorder, Somatoform Disorder, Bipolar Manic Disorder, Dysthymic Disorder, Alcohol Dependence, Drug Dependence, Posttraumatic Stress, Thought Disorder, Major Depression, and Delusional Disorder.
Scoring is easy and runs from 0 to 115 per each scale, with 85 and above signifying a pathology. The configuration of the results of all 24 scales provides serious and reliable insights into the tested subject.
MMPI-II
Minnesota Multiphasic Personality Inventory. Diagnostic test composed of 567 true-or-false questions arranged in three validity scales and ten dimensional clinical scales. The latter measure hypochondriasis, depression, hysteria, psychopathic deviation, masculinity-femininity, paranoia, psychasthenia, schizophrenia, hypomania, and social introversion. There are also scales for alcoholism, post-traumatic stress disorder, and personality disorders.
The interpretation of the MMPI-II is now fully computerized. The computer is fed with the patients' age, sex, educational level, and marital status and does the rest.
Mood
Pervasive and sustained feelings and emotions as subjectively described by the patient. The same phenomena observed by the clinician are called affect. Mood can be either dysphoric (unpleasant) or euphoric (elevated, expansive, "good mood"). Dysphoric moods are characterized by a reduced sense of well-being, depleted energy, and negative self-regard or sense of self-worth. Euphoric moods typically involve an increased sense of well-being, ample energy, and a stable sense of self-worth and self-esteem. Also see: Affect.
Mood Congruence and Incongruence
The contents of mood-congruent hallucinations and delusions are consistent and compatible with the patient's mood. During the manic phase of the Bipolar Disorder, for instance, such hallucinations and delusions involve grandiosity, omnipotence, personal identification with great personalities in history or with deities, and magical thinking. In depression, mood-congruent hallucinations and delusions revolve around themes like the patient's self-misperceived faults, shortcomings, failures, worthlessness, guilt - or the patient's impending doom, death, and "well-deserved" sadistic punishment.
The contents of mood-incongruent hallucinations and delusions are inconsistent and incompatible with the patient's mood. Most persecutory delusions and delusions and ideas of reference, as well as phenomena such as control "freakery" and Schneiderian First-rank Symptoms are mood-incongruent. Mood incongruence is especially prevalent in schizophrenia, psychosis, mania, and depression.
Multidimensional Anger Inventory (MAI)
Diagnostic test invented in 1986. Assesses the frequency of angry responses, their duration, magnitude, mode of expression, hostile outlook, and anger-provoking triggers.
N
Pathological narcissism is a pattern of traits and behaviors which signify infatuation and obsession with one's self to the exclusion of all others and the egotistic and ruthless pursuit of one's gratification, dominance and ambition. Most narcissists (50-75%, according to the DSM IV-TR) are men. See: Narcissistic Personality Disorder (NPD) below.
Narcissistic Personality Disorder
NPD; one of a "family" of personality disorders ("Cluster B"), which includes the Borderline PD, Antisocial PD and Histrionic Personality Disorders. It is often diagnosed with other mental health disorders ("co-morbidity") - or with substance abuse and impulsive and reckless behaviors ("dual diagnosis").
It is estimated that 0.7-1% of the general population suffer from NPD. The onset of narcissism is in infancy, childhood and early adolescence. It is commonly attributed to childhood abuse and trauma inflicted by parents, authority figures, or even peers.
NPD is treated in talk therapy (psychodynamic or cognitive-behavioral). The prognosis for an adult narcissist is poor, though adaptation to life and to others can improve with treatment. Medication is applied to side-effects and behaviors (such as mood or affect disorders and obsession-compulsion) - usually with some success.
The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Text Revision (DSM-IV-TR), 2000 (The American Psychiatric Association, Washington D.C.) defines NPD as "an all-pervasive pattern of grandiosity (in fantasy or behavior), need for admiration or adulation and lack of empathy, usually beginning by early adulthood and present in various contexts."
The Narcissist feels grandiose and self-important (e.g., exaggerates accomplishments, talents, skills, contacts, and personality traits to the point of lying, demand to be recognized as superior without commensurate achievements). Is obsessed with fantasies of unlimited success, fame, fearsome power or omnipotence, unequalled brilliance (the cerebral narcissist), bodily beauty or sexual performance (the somatic narcissist), or ideal, everlasting, all-conquering love or passion. He is firmly convinced that he or she is unique and, being special, can only be understood by, should only be treated by, or associate with, other special or unique, or high-status people (or institutions).
The narcissist requires excessive admiration, adulation, attention and affirmation - or, failing that, wishes to be feared and to be notorious (Narcissistic Supply). He feels entitled. Demands automatic and full compliance with his or her unreasonable expectations for special and favorable priority treatment.
The narcissist is "interpersonally exploitative", i.e., uses others to achieve his or her own ends. He is devoid of empathy. Is unable or unwilling to identify with, acknowledge, or accept the feelings, needs, preferences, priorities, and choices of others. He is constantly envious of others and seeks to hurt or destroy the objects of his or her frustration. Suffers from persecutory (paranoid) delusions as he or she believes that they feel the same about him or her and are likely to act similarly.
The narcissist behaves arrogantly and haughtily. Feels superior, omnipotent, omniscient, invincible, immune, "above the law", and omnipresent (magical thinking). Rages when frustrated, contradicted, or confronted by people he or she considers inferior to him or her and unworthy.
Negativism
In catatonia, complete opposition and resistance to suggestion.
Neologism
In schizophrenia and other psychotic disorders, the invention of new "words" which are meaningful to the patient but meaningless to everyone else. To form the neologisms, the patient fuses together and combines syllables or other elements from existing words.
NOS - (abbr.) Not Otherwise Specified
NPD - (abrr.) Narcissistic Personality Disorder
O
Obsession
Recurring and intrusive images, thoughts, ideas, or wishes that dominate and exclude other cognitions. The patient often finds the contents of his obsessions unacceptable or even repulsive and actively resists them, but to no avail. Common in schizophrenia and obsessive-compulsive disorder.
Obsessive-Compulsive Personality Disorder
OCPD; The Obsessive-compulsive are concerned with control, both mental (self) and interpersonal (others) and with its symbolic representations. They are perfectionists and rigidly orderly or organized. According to the DSM, such people lack flexibility, openness and efficiency.
Obsessive-Compulsives are preoccupied with lists, rules, rituals, organization, perfection, and details. As a result, they are indecisive and unable to prioritize. They are constantly worried that something is or may go wrong and value their rigid schedules and checklists more than the activities they relate to or the goals they are supposed to help to achieve.
OCPDs are workaholics. They sacrifice family life, leisure, and friendships on the altar of productivity and output. Yet, they are not very efficient or productive.
Some OCPDs are self-righteous or even bigots. Their excessive conscientiousness and scrupulous, unempathic and inflexible tyrannical conduct precludes having meaningful, compromise-based, long-term relationships. They regard their impossibly high work ethic and moral standards as universal and binding. They are unable to delegate tasks to others, unless they can micromanage the situation to fit their unrealistic expectations. Consequently, they trust no one, are stubborn, and difficult to deal with.
Some OCPDs are so terrified of change that they rarely discard acquired but now useless objects, change the outlay of furniture at home, relocate, deviate from the familiar route to work, tweak an itinerary, or embark on anything spontaneous. They also find it difficult to spend money even on essentials. This tallies with their view of the world as hostile, unpredictable, and "bad".
OCD - Obsessive-Compulsive Disorder
OCPD - Obsessive-Compulsive Personality Disorder
Omnipotence
Feeling or acting as though one possesses special or magical powers or faculties, far superior to his peers. As part of the defense mechanism of (pathological) narcissism, it serves to ameliorate or sublimate emotional conflict and cope with internal or external stressors. Often co-occurs with omniscience, magical thinking, ideas of reference, and persecutory (paranoid) delusions.
Overvalued Idea or Person
An unreasonable and sustained belief in the value or veracity of an idea (overvalued idea) or a person (idealization) that is not supported by other observers or by the believer's culture or society. As opposed to a delusion, overvalued ideas are sometimes reversed in the face of evidence to the contrary.
P
A form of severe anxiety attack accompanied by a sense of losing control and of an impending and imminent life-threatening danger (where there is none). Physiological markers of panic attacks include palpitation, sweating, tachycardia (rapid heart beats), dyspnea or apnea (chest tightening and difficulties breathing), hyperventilation, light-headedness or dizziness, nausea, and peripheral paresthesias (an abnormal sensation of burining, prickling, tingling, or tickling). In normal people it is a reaction to sustained and extreme stress. Common in many mental health disorders.
Sudden, overpowering feelings of imminent threat and apprehension, bordering on fear and terror. There usually is no external cause for alarm (the attacks are uncued or unexpected, with no situational trigger) - though some panic attacks are situationally-bound (reactive) and follow exposure to "cues" (potentially or actually dangerous events or circumstances). Most patients display a mixture of both types of attacks (they are situationally predisposed).
Bodily manifestations include shortness of breath, sweating, pounding heart and increased pulse as well as palpitations, chest pain, overall discomfort, and choking. Sufferers often describe their experience as being smothered or suffocated. They are afraid that they may be going crazy or about to lose control.
Paranoia
Psychotic grandiose and persecutory delusions. Paranoids are characterized by a paranoid style: they are rigid, sullen, suspicious, hypervigilant, hypersensitive, envious, guarded, resentful, humorless, and litigious. Paranoids often suffer from paranoid ideation - they believe (though not firmly) that they are being stalked or followed, plotted against, or maliciously slandered. They constantly gather information to prove their "case" that they are the objects of conspiracies against them. Paranoia is not the same as Paranoid Schizophrenia, which is a subtype of schizophrenia.
Paranoid Ideation
Ideas (usually, not entirely delusional) that involve suspicions or beliefs that one is being singled out for persecution, harassment, unfair treatment, or elimination. When more severe, known as persecutory delusions (see Paranoid Personality Disorder).
The paranoid firmly believes that the world is malevolent, hostile, ominous, and unpredictable. He distrusts others and suspects them of harboring ulterior motives and sadistic or self-interested wickedness. People are out to exploit, harm, get, or deceive him or her - even without good or sufficient cause. Such convictions usually extend to the paranoid's family members, friends, coworkers, and neighbors. The paranoid doubts their loyalty. But many paranoids are also besieged by persecutory delusions which place the paranoid at the center of conspiracies and collusions involving various organizations and institutions.
They cower at home, planning their defenses, plotting and counter-plotting, weary of any attempt to communicate with him. To them, any information, even the most trivial, is a potential future weapon. Moreover, even the most benign gestures, comments, or events assume threatening proportions, nefarious meanings, malicious intent, and occult and debasing outcomes (see: Ideas of Reference). Paranoids are hypersensitive and unforgiving. Every remark is automatically and immediately interpreted as an insult, injury, attack, or slight directed at the paranoid, his personality, or reputation - and provokes aggression. Inevitably, paranoids are socially isolated and appear to be eccentric.
Parasomnia
Abnormality of conduct or unusual physiological reactions during sleep or in the transitions between sleep and waking (for instance, hypnagogia, hypnopompia, sleep paralysis, and night terrors).
Parorexia
Eating disorder. Having an unnatural appetite or lack thereof (e.g., in anorexia).
Passive Aggression
The expression of indirect and unassertive aggression towards others as a way to relieve stressors (both internal and external) or to cope with emotional conflicts. Overt compliance or even obsequiousness masks covert hostility, resentment, resistance, and sabotage. Often occurs when the individual's hidden wishes are not gratified or when independent action or performance is demanded without the granting or acquisition of commensurate autonomy, authority, skills, or powers.
Perseveration
Repeating the same gesture, behavior, concept, idea, phrase, or word in speech. Common in schizophrenia, organic mental disorders, and psychotic disorders.
Deeply ingrained, stable, maladaptive, all-pervasive, lifelong behavior patterns manifested from early adolescence and affecting all the dimensions of the patient's life: career, interpersonal relationships, and social functioning.
Patients with personality disorders - except those suffering from the Schizoid or the Avoidant Personality Disorders - expect preferential and privileged treatment, present with numerous symptoms, frequently second guess the diagnosis and disobey the physician. Such patients feel unique, are self-preoccupied, and suffer from grandiosity and a diminished capacity for empathy. They are socially maladaptive, emotionally labile, manipulative and exploitative, trust no one and find it difficult to love or share.
Personality disorders are often comorbid with other personality disorders, with Axis I disorders, with mood and affective disorders and with anxiety disorders and are characterized by a host of defenses - splitting, projection, projective identification, denial, intellectualization. The patient does not, on the whole, find his personality traits or behavior objectionable, unacceptable, disagreeable, or alien to his self (he or she is ego-syntonic, not ego-dystonic). Substance abuse and reckless behaviors are also common ("dual diagnosis").
The patient tends to blame others or "the world" for misfortunes and failures. Thus, under stress, he or she tries to preempt (real or imaginary) threats by influencing the environment to conform to his or her needs.
Personality disorders are not psychoses and do not involve hallucinations, delusions or thought disorders (though psychotic "microepisodes", mostly during treatment, occur in the Borderline and Narcissistic Personality Disorders). The patients are fully oriented, with clear senses (sensorium), good memory and a general fund of knowledge.
Phobia
A persistent, unfounded, and irrational fear or dread of one or more classes of objects, activities, situations, or locations (the phobic stimuli) and the resulting overwhelming and compulsive desire to avoid them.
Dread of a particular object or situation, acknowledged by the patient to be irrational or excessive. Leads to all-pervasive avoidance behavior (attempts to avoid the feared object or situation). See: Anxiety.
Posturing
Assuming and remaining in abnormal and contorted bodily positions for prolonged periods of time. Typical of catatonic states.
Poverty of Content (of Speech)
Persistently vague, overly abstract or concrete, repetitive, or stereotyped speech.
Poverty of Speech
Reactive, non-spontaneous, extremely brief, intermittent, and halting speech. Such patients often remain silent for days on end unless and until spoken to.
PPD - Paranoid Personality Disorder
Pressure of Speech
Rapid, condensed, unstoppable and "driven" speech. The patient dominates the conversation, speaks loudly and emphatically, ignores attempted interruptions, and doesn't care if anyone is listening or responding to him or her. Seen in manic states, psychotic or organic mental disorders, and conditions associated with stress. See: Flight of Ideas.
Prodrome
Early symptom or sign of a disorder (mainly a mental health disorder).
Projection
A defense mechanism to cope with internal or external stressors and emotional conflict by attributing to another person - usually falsely - thoughts, feelings, wishes, impulses, needs, and hopes deemed forbidden or unacceptable by the projecting party.
Projective Identification
A defense mechanism to cope with internal or external stressors and emotional conflict by casting thoughts, feelings, wishes, impulses, needs, and hopes deemed forbidden or unacceptable by the projecting party - as justifiable and predictable reactions to another person's actions or words ("triggers"). The projecting party sometimes induces in that other person the triggering behavior so as to justify his or her reactions.
Psychomotor Agitation
Mounting internal tension associated with excessive, nonproductive (not goal orientated), and repeated motor activity (hand wringing, fidgeting, and similar gestures). Hyperactivity and motor restlessness which co-occur with anxiety and irritability.
Psychomotor Retardation
Visible slowing of speech or movements or both. Usually affects the entire range of performance (entire repertory). Typically involves poverty of speech, delayed response time (subjects answer questions after an inordinately long silence), monotonous and flat voice tone, and constant feelings of overwhelming fatigue.
Psychopath - See Antisocial Personality Disorder
Psychosis
Chaotic thinking that is the result of a severely impaired reality test ( the patient cannot tell inner fantasy from outside reality). Some psychotic states are short-lived and transient (microepisodes). These last from a few hours to a few days and are sometimes reactions to stress. Persistent psychoses are a fixture of the patient's mental life and manifest for months or years.
Psychotics are fully aware of events and people "out there". They cannot, however separate data and experiences originating in the outside world from information generated by internal mental processes. They confuse the external universe with their inner emotions, cognitions, preconceptions, fears, expectations, and representations.
Consequently, psychotics have a distorted view of reality and are not rational. No amount of objective evidence can cause them to doubt or reject their hypotheses and convictions. Full-fledged psychosis involves complex and ever more bizarre delusions and the unwillingness to confront and consider contrary data and information (preoccupation with the subjective rather than the objective). Thought becomes utterly disorganized and fantastic.
There is a thin line separating nonpsychotic from psychotic perception and ideation. On this spectrum we also find the schizotypal personality disorder.
Q
Qi-gong Psychotic Reaction
Acute, transient psychotic episode or microepisode, also involving dissociative, paranoid, and nonpsychotic symptoms. Often occurs after participation in the Chinese practice of qi-gong ("exercise of vital energy"). Included as an official diagnosis in the second edition of the Chinese Classification of Mental Disorders (CCMD-2).
R
Rationalization
The elaboration of incorrect but reassuring, coherent, self-serving and "rational" explanations (narratives) to conceal the true motivations for one's thoughts, actions, or emotions. Used to avoid emotional conflict or to cope with stressors (both external and internal).
Reaction Formation
The repression of one's unacceptable behavior, thoughts, or feelings and their replacement with diametrically opposed behavior, thoughts, or feelings as a way to manage emotional conflict and cope with stressors (both external and internal).
Reality Sense
The way one thinks about, perceives, and feels reality.
Reality Testing
Comparing one's reality sense and one's hypotheses about the way things are and how things operate to objective, external cues from the environment.
Relationship Styles Questionnaire (RSQ)
Diagnostic test invented in 1994. Contains 30 self-reported items and identifies distinct attachment styles (secure, fearful, preoccupied, and dismissing).
Repression
The exclusion from conscious awareness of disturbing memories, thoughts, ideas, and wishes in order to manage emotional conflict and cope with stressors (both external and internal). The emotions associated with the excluded content usually remain conscious.
Residual (Phase)
The final phase of an illness. Occurs after remission of the main symptoms or the full syndrome.
Rorschach Test
Diagnostic test comprised of 10 ambiguous inkblots printed on 18X24 cm. cards, in both black and white and color. The cards and the diagnostician's questions provoke free associations in the test subject. These are recorded verbatim together with the inkblot's spatial position and orientation. The patient can then add details and comment on his choices.
Scoring is based on the parts of the cards referred to in the subject's responses (location), the correspondence between the blot and the answers provided (determinant), the content of the responses, how unique or common they are (popularity), how coherent are the patient's narratives (organizational activity), and how well does the patient's percept fit the card (form quality).
The interpretation of the test relies on both the scores obtained and on what we know about mental health disorders. The test teaches the skilled diagnostician how the subject processes information and what is the structure and content of his internal world. These provide meaningful insights into the patient's defenses, reality test, intelligence, fantasy life, and psychosexual make-up.
S
Schneiderian First-rank Symptoms
A list of symptoms compiled by Kurt Schneider, a German psychiatrist, in 1957 and indicative of the presence of schizophrenia. Includes:
Auditory hallucinations
Hearing conversations between a few imaginary "interlocutors", or one's thoughts spoken out loud, or a running background commentary on one's actions and thoughts.
Somatic hallucinations
Experiencing imagined sexual acts couple with delusions attributed to forces, "energy", or hypnotic suggestion.
Thought withdrawal
The delusion that one's thoughts are taken over and controlled by others and then "drained" from one's brain.
Thought insertion
The delusion that thoughts are being implanted or inserted into one's mind involuntarily.
Thought broadcasting
The delusion that everyone can read one's mind, as though one's thoughts were being broadcast.
Delusional perception
Attaching unusual meanings and significance to genuine perceptions, usually with some kind of (paranoid or narcissistic) self-reference.
Delusion of control
The delusion that one's acts, thoughts, feelings, perceptions, and impulses are directed or influenced by other people.
SCID-II
The Structured Clinical Interview (SCID-II) was formulated in 1997 by First, Gibbon, Spitzer, Williams, and Benjamin. It is based on the language of criteria for personality disorders in the the DSM-IV. Its 12 groups of questions correspond to the 12 personality disorders. The scoring is simple: either the trait is absent, subthreshold, true, or there is "inadequate information to code".
The SCID-II can be administered to third parties (a spouse, an informant, a colleague) or self-administered (in a reduced format with 119 questions).
Schizoids are often act as automata ("robots"). They appear cold and stunted, flat, and "zombie"-like.
Schizoids are uninterested in social relationships or interactions and have a very limited emotional repertoire. Their affect - the expression of whatever emotions they do possess - is poor and intermittent.
Schizoids are loners. They confide only in first-degree relatives - but maintain no close bonds or associations, not even with their immediate family. They gravitate into solitary activities. Their sexual experiences are sporadic and limited and, finally, they cease altogether.
Schizoids are anhedonic - find nothing pleasurable and attractive - but not necessarily dysphoric (sad or depressed). They pretend to be indifferent to praise, criticism, disagreement, and corrective advice (though, deep inside, they are not). They are creatures of habit, frequently succumbing to rigid, predictable, and narrowly restricted routines.
The set of genetic and physiological traits that define a person as male, female, or uncertain (androgynous). Usually consist of external genitalia, internal and external sex organs, secondary sex signs (such as quantity and distribution of body hair and size and shape of breasts), and karyotype.
Shared Psychosis - See Folie a Deux
Shenjing shuairuo
(Literally, "neurasthenia" in Chinese). A form of mood or anxiety disorder that manifests as overpowering physical and mental fatigue coupled with dizziness, headaches or migraine, diffuse pain, difficulty to concentrate and perform tasks, sleep disorders, and memory loss. Usually co-morbid with gastrointestinal dysfunction, irritability, excitability, lability, and disturbances of the autonomic nervous system. Included as an official diagnosis in the second edition of the Chinese Classification of Mental Disorders (CCMD-2).
Shin-byung
Culture-bound syndrome in Korea. The illness progresses from general unease, anxiety, somatic complaints (weakness, dizziness, fear, parorexia, insomnia, and gasrointestinal problems) to dissociation (expressed as possession by ancestral spirits).
SIDP-IV
The Structured Interview for Disorders of Personality (SIDP-IV) was composed by Pfohl, Blum and Zimmerman in 1997. It also covers the self-defeating personality disorder from the DSM-III. It is conversational and the questions are grouped into 10 topics such as Emotions or Interests and Activities. There is a version of the SIDP-IV in which the questions are grouped by personality disorder. The scoring classifies items as present, subthreshold, present, or strongly present.
Sociopath - See Antisocial Personality Disorder
Splitting
"Primitive" defense mechanism, which begins to operate in very early infancy. It involves the inability to integrate contradictory qualities of the same object into a coherent picture. This leads to cycles of idealization and devaluation of the unintegrated object.
Stereotyped Movement (or Motion)
Repetitive, urgent, compulsive, purposeless, and non-functional movements, such as head banging, waving, rocking, biting, or picking at one's nose or skin.Common in catatonia, amphetamine poisoning, and schizophrenia.
Stressor
Event or change in life which precipitates or coincides with the onset or exacerbation of a mental health problem or a dysfunctional behavior.
Stupor
Restricted and constricted consciousness akin in some respects to coma. Activity, both mental and physical, is limited. Some patients in stupor are unresponsive and seem to be unaware of the environment. Others sit motionless and frozen but are clearly cognizant of their surroundings. Often the result of an organic impairment. Common in catatonia, schizophrenia, and extreme depressive states.
Sublimation
The conversion and channeling of unacceptable emotions into socially-condoned behavior.
T
Inability or unwillingness to focus on an idea, issue, question, or theme of conversation. The patient "takes off on a tangent" and hops from one topic to another in accordance with his own coherent inner agenda, frequently changing subjects, and ignoring any attempts to restore "discipline" to the communication. Often co-occurs with speech derailment. As distinct from loosening of associations, tangential thinking and speech are coherent and logical but they seek to evade the issue, problem, question, or theme raised by the other interlocutor.
Thematic Appreciation Test (TAT)
Diagnostic test comprised of 31 cards. One card is blank and the other thirty include blurred but emotionally powerful (or even disturbing) photographs and drawings. Subjects are asked to tell a story based on the content of the cards. The TAT was developed in 1935 by Morgan and Murray.
The patient's reactions (in the form of brief narratives) are recorded by the tester verbatim. Some examiners prompt the patient to describe the aftermath or outcomes of the stories, but this is a controversial practice.
The TAT is scored and interpreted simultaneously. Murray suggested to identify the hero of each narrative (the figure representing the patient); the inner states and needs of the patient, derived from his or her choices of activities or gratifications; what Murray calls the "press", the hero's environment which imposes constraints on the hero's needs and operations; and the thema, or the motivations developed by the hero in response to all of the above.
Thought Broadcasting, Though Insertion, Thought Withdrawal
See: Schneiderian First-rank Symptoms
Thought Disorder
A consistent disturbance that affects the process or content of thinking, the use of language, and, consequently, the ability to communicate effectively. An all-pervasive failure to observe semantic, logical, or even syntactical rules and forms. A fundamental feature of schizophrenia.
Gender dysphoria which involves an overwhelming desire to assume the physiological characteristics and social roles of the opposite sex.
U
Undoing
Trying to rid oneself of gnawing feelings of guilt by compensating the injured party either symbolically or actually.
V
Vegetative Signs
A set of signs in depression which includes loss of appetite, sleep disorder, loss of sexual drive, loss of weight, and constipation. May also indicate an eating disorder.
APA Reference
Staff, H.
(2009, September 17). Mental Health and Psychology Dictionary, HealthyPlace. Retrieved
on 2024, October 10 from https://www.healthyplace.com/personality-disorders/malignant-self-love/mental-health-and-psychology-dictionary
The Narcissistic Psychopath - How Do I Get Rid of Him?
Divorcing the Narcissist and the Psychopath
Question:
I finally mustered the courage and determination to divorce him. But he refuses to let go, he threatens me and stalks and harasses me. I am sometimes afraid for my life. He is also a convincing pathological liar. I am afraid he will turn the judge against me...
Answer:
I am not a divorce lawyer and, therefore, cannot relate to the legal aspects of your predicament. But I can elaborate on three important elements:
I. How to cope with your narcissist throughout the prolonged process?
II. How to expose the manipulations of the narcissist in court?
III. What to expect of the narcissist as your divorce unfolds? Will he become violent?
Divorce is a life crisis - and more so for the narcissist. The narcissist stands to lose not only his spouse but an important source of narcissistic supply. This results in narcissistic injury, rage, and all-pervasive feelings of injustice, helplessness and paranoia.
I. How to Cope with the Narcissist, Psychopath, Bully, or Stalker
If he has a rage attack - rage back. This will provoke in him fears of being abandoned and the resulting calm will be so total that it might seem eerie. Narcissists are known for these sudden tectonic shifts in mood and in behavior.
Mirror the narcissist's actions and repeat his words. If he threatens - threaten back and credibly try to use the same language and content. If he leaves the house - leave it as well, disappear on him. If he is suspicious - act suspicious. Be critical, denigrating, humiliating, go down to his level. Faced with his mirror image - the narcissist always recoils.
The other way is to abandon him and go about reconstructing your own life. Very few people deserve the kind of investment that is an absolute prerequisite to living with a narcissist. To cope with a narcissist is a full time, energy and emotion-draining job, which reduces the persons around the narcissist to insecure nervous wrecks.
For practical tips for coping with your narcissist or psychopath - read the following articles:
- What is Abuse?
- Coping with Your Abuser
- Avoiding Your Abuser I The Submissive Posture
- Avoiding Your Abuser II - The Conflictive Posture
- Reconditioning the Abuser
- Reforming the Abuser
- Contracting with Your Abuser
- How to Cope with a Narcissist
- How to Cope with Your Paranoid Ex
- Avoiding Your Paranoid Ex
- Coping with Your Stalker
- The Stalker as Antisocial Bully
- Coping with Stalking and Stalkers
- Getting Help
- Domestic Violence Shelters
- Planning and Executing Your Getaway
II. The Narcissist in Court
How can you expose the lies of the Narcissist in a court of law? He acts so convincing!
A clear distinction has to be made between the FACTUAL and the PSYCHOLOGICAL pillars of any cross-examination or deposition of a narcissist.
It is essential to be equipped with absolutely unequivocal, first rate, thoroughly authenticated and vouched for information. Narcissists are superhuman in their capacity to distort reality by offering highly "plausible" alternative scenarios, which fit most of the facts.
It is very easy to "break" a narcissist - even a well-trained and prepared one.
Here are a few of the things the narcissist finds devastating:
Any statement or fact, which seems to contradict his inflated perception of his grandiose self. Any criticism, disagreement, exposure of fake achievements, belittling of "talents and skills" which the narcissist fantasizes that he possesses, any hint that he is subordinated, subjugated, controlled, owned or dependent upon a third party.
Any description of the narcissist as average and common, indistinguishable from many others. Any hint that the narcissist is weak, needy, dependent, deficient, slow, not intelligent, naive, gullible, susceptible, not in the know, manipulated, a victim.
The narcissist is likely to react with rage to all these and, in an effort to re-establish his fantastic grandiosity, he is likely to expose facts and stratagems he had no conscious intention of exposing.
The narcissist reacts with narcissistic rage, hatred, aggression, or violence to an infringement of what he perceives to be his entitlement.
Narcissists believe that they are so unique and that their lives are so cosmically significant that others should defer to their needs and cater to their every whim without ado. The narcissist feels entitled to special treatment by unique individuals.
Any insinuation, hint, intimation, or direct declaration that the narcissist is not special at all, that he is average, common, not even sufficiently idiosyncratic to warrant a fleeting interest will inflame the narcissist.
Add to this a negation of the narcissist's sense of entitlement - and the combustion is inevitable. Tell the narcissist that he does not deserve the best treatment, that his needs are not everyone's priority, that he is boring, that his requirements can be catered to by an average practitioner (medical doctor, accountant, lawyer, psychiatrist), that he and his motives are transparent and can be easily gauged, that he will do what he is told, that his temper tantrums will not be tolerated, that no special concessions will be made to accommodate his inflated sense of self, that, like everyone else, he is subject to court procedures, etc. - and the narcissist will lose control.
The narcissist believes that he is the cleverest, far above the madding crowd. Contradict the narcissist, expose, humiliate, and berate him:
"You are not as intelligent as you think you are"
"Who is really behind all this? It takes sophistication which you don't seem to possess"
"So, you have no formal education"
"You are (mistake his age, make him much older) ... sorry, you are ... old"
"What did you do in your life? Did you study? Do you have a degree? Did you ever establish or run a business? Would you define yourself as a success?"
"Would your children share your view that you are a good father?"
"You were last seen with a Ms. ... who is (suppressed grin) a (domestic, stripper, receptionist...) (in demeaning disbelief)".
I know that many of these questions cannot be asked outright in a court of law. But you CAN hurl these sentences at him during the breaks, inadvertently during the examination or deposition phase, etc.
Read more:
- The Guilt of the Abused - Pathologizing the Victim
- Conning the System
- Befriending the System
- Working with Professionals
- Interacting with Your Abuser
III. What to Expect
Narcissists are often vindictive and they often stalk and harass.
Basically, there are only two ways of coping with vindictive narcissists:
1. To Frighten Them
Narcissists live in a state of constant rage, repressed aggression, envy and hatred. They firmly believe that everyone is like them. As a result, they are paranoid, suspicious, scared and erratic. Frightening the narcissist is a powerful behavior modification tool. If sufficiently deterred - the narcissist promptly disengages, gives up everything he was fighting for and sometimes make amends.
To act effectively, one has to identify the vulnerabilities and susceptibilities of the narcissist and strike repeated, escalating blows at them - until the narcissist lets go and vanishes.
Example:
If a narcissist is hiding an embarrassing or self-incriminating fact - one should use this to threaten him. One should drop cryptic hints that there are mysterious witnesses to the events and recently revealed evidence. The narcissist has a very vivid imagination. Let his paranoia do the rest.
The narcissist may have been involved in tax evasion, in malpractice, in child abuse, in infidelity - there are so many possibilities, which offer a rich vein of attack. If done cleverly, noncommittally, gradually, in an escalating manner - the narcissist crumbles, disengages and disappears. He lowers his profile thoroughly in the hope of avoiding hurt and pain.
Most narcissists have been known to disown and abandon a whole PNS (pathological narcissistic space) in response to a well-focused campaign by their victims. Thus, the narcissist may leave town, change his job, abandon a field of professional interest, avoid friends and acquaintances - only to secure a cessation of the unrelenting pressure exerted on him by his victims.
I repeat: most of the drama takes place in the paranoid mind of the narcissist. His imagination runs amok. He finds himself snarled by horrifying scenarios, pursued by the vilest "certainties". The narcissist is his own worst persecutor and prosecutor.
You don't have to do much except utter a vague reference, make an ominous allusion, delineate a possible turn of events. The narcissist will do the rest for you. He is like a little child in the dark, generating the very monsters that paralyze him with fear.
Needless to add that all these activities have to be pursued legally, preferably through the good services of law offices and in broad daylight. If done in the wrong way - they might constitute extortion or blackmail, harassment and a host of other criminal offences.
2. To Lure Them
The other way to neutralize a vindictive narcissist is to offer him continued narcissistic supply until the war is over and won by you. Dazzled by the drug of narcissistic supply - the narcissist immediately becomes tamed, forgets his vindictiveness and triumphantly takes over his reclaimed or new "property" and "territory".
Under the influence of narcissistic supply, the narcissist is unable to tell when he is being duped. He is blind, dumb and deaf to all but the song of the NS sirens. You can make a narcissist do ANYTHING by offering, withholding, or threatening to withhold narcissistic supply (adulation, admiration, attention, sex, awe, subservience, etc.).
Read More:
APA Reference
Vaknin, S.
(2009, September 17). The Narcissistic Psychopath - How Do I Get Rid of Him?, HealthyPlace. Retrieved
on 2024, October 10 from https://www.healthyplace.com/personality-disorders/malignant-self-love/the-narcissistic-psychopath-how-do-i-get-rid-of-him
Can the Narcissist Become Violent?
- Read about School Shootings
- Read Interview with Lehr Beidelschies
- Read about Guns and Narcissists
- Watch the video on Narcissism and School Violence
Question:
I am afraid of my ex-Narcissist. He stalks me, harasses me, threatens me verbally. Can he become real violent? Am I at risk? I am mostly worried about my children. Will he do something bad to them to get back at me?
Answer:
Pathological narcissism is a spectrum of disorders. People suffering from the full blown, all-pervasive, personality distorting mental health disorder known as the Narcissistic Personality Disorder (NPD) - are, indeed, more prone to violence than others.
Actually, the differential diagnosis (=the difference) between NPD and AsPD (Antisocial PD, psychopaths) is very blurred. Most psychopaths have narcissistic traits and many a narcissist are also sadists. Both types are devoid of empathy, are remorseless, ruthless, and relentless in their pursuit of their goals (the narcissist's goal is narcissistic supply or the avoidance of narcissistic injury).
Narcissists often use verbal and psychological abuse and violence against those closest to them. Some of them move from abstract aggression (the emotion leading to violence and permeating it) to the physically concrete sphere of violence.
Many narcissists are also paranoid and vindictive. They aim to punish (by tormenting) and destroy the source of their frustration and pain.
There are only two ways of coping with vindictive narcissists:
1. To Frighten Them
Narcissists live in a state of constant rage, repressed aggression, envy and hatred. They firmly believe that everyone is like them. As a result, they are paranoid, suspicious, scared and erratic. Frightening the narcissist is a powerful behavior modification tool. If sufficiently deterred - the narcissist promptly disengages, gives up everything he was fighting for and sometimes make amends.
To act effectively, one has to identify the vulnerabilities and susceptibilities of the narcissist and strike repeated, escalating blows at them - until the narcissist lets go and vanishes.
Example:
If a narcissist is hiding a personal fact - one should use this to threaten him. One should drop cryptic hints that there are mysterious witnesses to the events and recently revealed evidence. The narcissist has a very vivid imagination. Let his paranoia do the rest.
The narcissist may have been involved in tax evasion, in malpractice, in child abuse, in infidelity - there are so many possibilities, which offer a rich vein of attack. If done cleverly, noncommittally, gradually, in an escalating manner - the narcissist crumbles, disengages and disappears and lowers his profile thoroughly in the hope of avoiding hurt and pain.
Most narcissists have been known to disown and abandon a whole PNS (pathological narcissistic space) in response to a well-focused campaign by their victims. Thus, a narcissist may leave town, change a job, desert a field of professional interest, avoid friends and acquaintances - only to secure relief from the unrelenting pressure exerted on him by his victims.
I repeat: most of the drama takes place in the paranoid mind of the narcissist. His imagination runs amok. He finds himself snarled by horrifying scenarios, pursued by the vilest "certainties". The narcissist is his own worst persecutor and prosecutor.
You don't have to do much except utter a vague reference, make an ominous allusion, delineate a possible turn of events. The narcissist will do the rest for you. He is like a little child in the dark, generating the very monsters that paralyze him with fear.
Needless to add that all these activities have to be pursued legally, preferably through the good services of law offices and in broad daylight. If done in the wrong way - they might constitute extortion or blackmail, harassment and a host of other criminal offences.
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2. To Lure Them
The other way to neutralize a vindictive narcissist is to offer him continued narcissistic supply until the war is over and won by you. Dazzled by the drug of narcissistic supply - the narcissist immediately becomes tamed, forgets his vindictiveness and triumphantly takes over his "property" and "territory".
Under the influence of narcissistic supply, the narcissist is unable to tell when he is being manipulated. He is blind, dumb and deaf to all but the song of the NS sirens. You can make a narcissist do ANYTHING by offering, withholding, or threatening to withhold narcissistic supply (adulation, admiration, attention, sex, awe, subservience, etc.).
School Shootings
Healthy narcissism is common in adolescents. Their narcissistic defenses help them cope with the anxieties and fears engendered by the demands and challenges of modern society: leaving home, going to college, sexual performance, marriage, and other rites of passage. There is nothing wrong with healthy narcissism. It sustains the adolescent in a critical time of his life and shields him or her from emotional injuries.
Still, in certain circumstances, healthy narcissism can transform into a malignant form, destructive to self and to others.
Adolescents who are consistently mocked and bullied by peers, role models, and socialization agents (such as teachers, coaches, and parents) are prone to find succor in grandiose fantasies of omnipotence and omniscience. To sustain these personal myths, they may resort to violence and counter-bullying.
The same applies to youths who feel deprived, underestimated, discriminated against, or at a dead end. They are likely to evoke narcissistic defenses to fend off the constant hurt and to achieve self-sufficient and self-contained emotional gratification.
Finally, pampered adolescents, who serve as mere extensions of their smothering parents and their unrealistic expectations are equally liable to develop grandiosity and a sense of entitlement incommensurate with their real-life achievements. When frustrated they become aggressive.
This propensity to other-directed violence is further exacerbated by what Lasch called "The Culture of Narcissism". We live in a civilization which condones and positively encourages malignant individualism, bad hero worship (remember "Born Killers"?), exploitativeness, inane ambitiousness, and the atomization of social structures and support networks. Alienation is a hallmark of our age, not only among youngsters.
When societies turn anomic, under both external and internal pressures (terrorism, crime, civil unrest, religious strife, economic crises, immigration, widespread job insecurity, war, rampant corruption, and so on), narcissists tend to become violent. This is because communities in anomic states offer little by way of externally-imposed impulse control and regulation, penal discipline, and rewards for conformity and 'good behavior". Narcissists in such settings of disintegration become serial and mass killers on a greater (Hitler) or smaller scale.
Interview with Lehr Beidelschies
Q: What is your background with NPD?
A: The content of my Web site are based on correspondence since 1996 with hundreds of people suffering from the Narcissistic Personality Disorder (narcissists) and with thousands of their family members, friends, therapists, and colleagues.
I am the author of Malignant Self Love: Narcissism Revisited. (number 1 bestseller in its category in Barnes and Noble).
The Web site "Malignant Self Love - Narcissism Revisited" is an Open Directory Cool Site and a Psych-UK recommended Site.
I am not a mental health professional though I am certified in psychological counseling techniques by Brainbench.
I served as the editor of Mental Health Disorders categories in the Open Directory Project and on Mentalhelp.net. I maintain my own websites about the Narcissistic Personality Disorder (NPD) and about relationships with abusive narcissists here. You can read my work on many other Web sites: Mental Health Matters, Mental Health Sanctuary, Mental Health Today, Kathi's Mental Health Review and others.
I am also the editor of the Narcissistic Personality Disorder topic, the Verbal and Emotional Abuse topic, and the Spousal Abuse and Domestic Violence topic, all three on Suite101, as well as the moderator of the Narcissistic Abuse List and other mailing lists (c. 6000 members). I write a column for Bellaonline on Narcissism and Abusive Relationships.
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Q: Have you ever encountered someone with NPD who had extreme violent behavior as a result of the disorder?
A: It is difficult to say whether as a direct result of the disorder or of other psychological dynamics but, yes, I came across people who were either diagnosed with NPD, or struck me as suffering from NPD and who were also violent. They inhabited the seam between the narcissistic and antisocial personality disorders (between pathological narcissism and psychopathy).
Q: If so, what often triggered this behavior? Could you perhaps provide some examples?
A: Invariably, violent behavior was triggered by frustration, perceived to be a threat to the integrity and veracity of the False Self. In other words, if the narcissist could not achieve gratification, or was criticized, or encountered resistance and disagreement - he tended to turn violent. He felt that his grandiose fantasies were being undermined and that his sense of entitlement due to his uniqueness is challenged. this often happens in prison where the atmosphere is paranoid and every slight, real or imaginary, is magnified to the point of narcissistic injury.
Q: How easy is it for most narcissists to be pushed into violence?
A: Pathological narcissism rarely appears in isolation. It is usually co-morbid with other personality or mental health disorders. Substance abuse and other forms of reckless behavior are common. The best predictor is past violence. But it is safe to say that narcissists who also abuse alcohol or drugs and who have been diagnosed with psychopathy or the antisocial personality disorder are very likely to be consistently violent in different settings.
Q: After committing a violent act, how will the narcissist deal with his/her actions?
A: The narcissist has alloplastic defences. He does not accept responsibility for his actions. He accuses others or the world at large for provoking or aggravating his outbursts of violent behaviour. He feels immune to the consequences of his actions by virtue of his inbred superiority and entitlement. Narcissists are also mildly dissociative. They sometimes go through depersonalization and derealization. In other words, some narcissists sort of "watch themselves" and their life from the outside, as one would a movie. Such narcissists do not feel fully and truly responsible for their acts of violence. "I don't know what came over me" - is their frequent refrain.
Q: Do you know of any instances where a person with NPD has murdered as a result of his/her outbursts?
A: Many serial killers have been diagnosed as narcissists - but I personally am not acquainted with one personally (laughing).
You may wish to quote from this:
Serial Killers as a Cultural Construct
Q: What kind of background shapes a violent narcissists? Is there any difference to that of a narcissist with less violent tendencies? Is there such a thing?
A: There is no research pertaining to this question. From my experience, violent narcissists come from dysfunctional and abusive families.
There are a million ways to abuse. To love too much is to abuse. It is tantamount to treating someone as an extension, an object, or an instrument of gratification. To be over-protective, not to respect privacy, to be brutally honest, with a sadistic sense of humor, or consistently tactless - is to abuse. To expect too much, to denigrate, to ignore - are all modes of abuse. There is physical abuse, verbal abuse, psychological abuse, sexual abuse. The list is long.
Narcissists who have been exposed in childhood to abusive behaviours by parents, caregivers, teachers, other role models, or even by peers would tend to propagate the abuse and behave aggressively, if not violently.
Q: What about the victims of crimes committed by narcissists? Is it often someone they know?
A: Not necessarily. Any person - known to the narcissist or not - who is perceived by the narcissist to be a source of frustration is in danger of becoming the victim of violence. If you disagree with the narcissist, criticize him, or deny him the unfettered and instantaneous fulfillment of his wishes - you become his enemy and the target of his unwelcome attentions.
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Q: Are the treatments for violent narcissists different from those of non-violent narcissists?
A: Only in adding specific medication to the mix of talk therapy and medicines which are used in treating NPD.
Q: To your knowledge, has the presence of NPD ever been used as a defence for criminals in the court system?
A: Suffering from a personality disorder does not constitute a defence in any country I know of. It is often raised as a mitigating circumstance but never as a defence. Nor, at least in the case of pathological narcissism, can be used as one. Narcissists are fully aware of the difference between right and wrong and are fully capable of controlling their impulses. They simply do not care enough about their victims to do so. They lack empathy, are exploitative, feel entitled and superior and thus regard other people as objects or as extensions of themselves.
Guns and Narcissists
Q: Should I tell my narcissist that I have a concealed weapon? I want to deter him.
A: My advice is to conceal the weapon both physically and verbally.
For two reasons:
One, narcissists are paranoids. NPD is often co-morbid with PPD (Paranoid PD). The presence of a weapon confirms their worst persecutory delusions and often tips them over the edge.
The second reason has to do with the balance of power (or rather balance of terror) complex.
In his mind, the narcissist is superior in every way. This fantasized and grandiose superiority is what maintains the precarious equilibrium of his personality.
A gun - the virile symbol that it is - upsets the power relations in favor of the victim. It is a humiliation, a failure, a mockery, a defying challenge. The narcissist will likely seek to restore the previous poise by "diminishing" his opponent and "containing" the menace.
In other words, the presence of a gun guarantees conflict - sometimes a potentially lethal one. As the narcissist - now terrified by his own deranged persecutory phantasms - seeks redress, he may resort to the physical elimination of the source of his frustration (to battering, or worse).
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next: The Narcissistic Psychopath - How Do I Get Rid of Him?
APA Reference
Vaknin, S.
(2009, September 17). Can the Narcissist Become Violent?, HealthyPlace. Retrieved
on 2024, October 10 from https://www.healthyplace.com/personality-disorders/malignant-self-love/can-the-narcissist-become-violent
The Pathology of Love
The unpalatable truth is that falling in love is, in some ways, indistinguishable from a severe pathology. Behavior changes are reminiscent of psychosis and, biochemically speaking, passionate love closely imitates substance abuse. Appearing in the BBC series Body Hits on December 4, 2002 Dr. John Marsden, the head of the British National Addiction Center, said that love is addictive, akin to cocaine and speed. Sex is a "booby trap", intended to bind the partners long enough to bond.
Using functional Magnetic Resonance Imaging (fMRI), Andreas Bartels and Semir Zeki of University College in London showed that the same areas of the brain are active when abusing drugs and when in love. The prefrontal cortex - hyperactive in depressed patients - is inactive when besotted. How can this be reconciled with the low levels of serotonin that are the telltale sign of both depression and infatuation - is not known.
Other MRI studies, conducted in 2006-7 by Dr. Lucy Brown, a professor in the department of neurology and neuroscience at the Albert Einstein College of Medicine in New York, and her colleagues, revealed that the caudate and the ventral tegmental, brain areas involved in cravings (e.g., for food) and the secretion of dopamine, are lit up in subjects who view photos of their loved ones. Dopamine is a neurotransmitter that affects pleasure and motivation. It causes a sensation akin to a substance-induced high.
On August 14, 2007, the New Scientist News Service gave the details of a study originally published in the Journal of Adolescent Health earlier that year. Serge Brand of the Psychiatric University Clinics in Basel, Switzerland, and his colleagues interviewed 113 teenagers (17-year old), 65 of whom reported having fallen in love recently.
The conclusion? The love-struck adolescents slept less, acted more compulsively more often, had "lots of ideas and creative energy", and were more likely to engage in risky behavior, such as reckless driving.
"'We were able to demonstrate that adolescents in early-stage intense romantic love did not differ from patients during a hypomanic stage,' say the researchers. This leads them to conclude that intense romantic love in teenagers is a 'psychopathologically prominent stage'".
But is it erotic lust or is it love that brings about these cerebral upheavals?
As distinct from love, lust is brought on by surges of sex hormones, such as testosterone and estrogen. These induce an indiscriminate scramble for physical gratification. In the brain, the hypothalamus (controls hunger, thirst, and other primordial drives) and the amygdala (the locus of arousal) become active. Attraction transpires once a more-or-less appropriate object is found (with the right body language and speed and tone of voice) and results in a panoply of sleep and eating disorders.
A recent study in the University of Chicago demonstrated that testosterone levels shoot up by one third even during a casual chat with a female stranger. The stronger the hormonal reaction, the more marked the changes in behavior, concluded the authors. This loop may be part of a larger "mating response". In animals, testosterone provokes aggression and recklessness. The hormone's readings in married men and fathers are markedly lower than in single males still "playing the field".
Still, the long-term outcomes of being in love are lustful. Dopamine, heavily secreted while falling in love, triggers the production of testosterone and sexual attraction then kicks in.
Helen Fisher of Rutger University suggests a three-phased model of falling in love. Each stage involves a distinct set of chemicals. The BBC summed it up succinctly and sensationally: "Events occurring in the brain when we are in love have similarities with mental illness".
Moreover, we are attracted to people with the same genetic makeup and smell (pheromones) of our parents. Dr Martha McClintock of the University of Chicago studied feminine attraction to sweaty T-shirts formerly worn by males. The closer the smell resembled her father's, the more attracted and aroused the woman became. Falling in love is, therefore, an exercise in proxy incest and a vindication of Freud's much-maligned Oedipus and Electra complexes.
Writing in the February 2004 issue of the journal NeuroImage, Andreas Bartels of University College London's Wellcome Department of Imaging Neuroscience described identical reactions in the brains of young mothers looking at their babies and in the brains of people looking at their lovers
"Both romantic and maternal love are highly rewarding experiences that are linked to the perpetuation of the species, and consequently have a closely linked biological function of crucial evolutionary importance" - he told Reuters.
This incestuous backdrop of love was further demonstrated by psychologist David Perrett of the University of St Andrews in Scotland. The subjects in his experiments preferred their own faces - in other words, the composite of their two parents - when computer-morphed into the opposite sex.
But is it erotic lust or is it love that brings about these cerebral upheavals?
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Body secretions play a major role in the onslaught of love. In results published in February 2007 in the Journal of Neuroscience, researchers at the University of California at Berkeley demonstrated convincingly that women who sniffed androstadienone, a signaling chemical found in male sweat, saliva, and semen, experienced higher levels of the hormone cortisol. This results in sexual arousal and improved mood. The effect lasted a whopping one hour.
Still, contrary to prevailing misconceptions, love is mostly about negative emotions. As Professor Arthur Aron from State University of New York at Stonybrook has shown, in the first few meetings, people misinterpret certain physical cues and feelings - notably fear and thrill - as (falling in) love. Thus, counterintuitively, anxious people - especially those with the "serotonin transporter" gene - are more sexually active (i.e., fall in love more often).
Obsessive thoughts regarding the Loved One and compulsive acts are also common. Perception is distorted as is cognition. "Love is blind" and the lover easily fails the reality test. Falling in love involves the enhanced secretion of b-Phenylethylamine (PEA, or the "love chemical") in the first 2 to 4 years of the relationship.
This natural drug creates an euphoric high and helps obscure the failings and shortcomings of the potential mate. Such oblivion - perceiving only the spouse's good sides while discarding her bad ones - is a pathology akin to the primitive psychological defense mechanism known as "splitting". Narcissists - patients suffering from the Narcissistic Personality Disorder - also Idealize romantic or intimate partners. A similar cognitive-emotional impairment is common in many mental health conditions.
The activity of a host of neurotransmitters - such as Dopamine, Adrenaline (Norepinephrine), and Serotonin - is heightened (or in the case of Serotonin, lowered) in both paramours. Yet, such irregularities are also associated with Obsessive-Compulsive Disorder (OCD) and depression.
It is telling that once attachment is formed and infatuation gives way to a more stable and less exuberant relationship, the levels of these substances return to normal. They are replaced by two hormones (endorphins) which usually play a part in social interactions (including bonding and sex): Oxytocin (the "cuddling chemical") and Vasopressin. Oxytocin facilitates bonding. It is released in the mother during breastfeeding, in the members of the couple when they spend time together - and when they sexually climax. Viagra (sildenafil) seems to facilitate its release, at least in rats.
It seems, therefore, that the distinctions we often make between types of love - motherly love vs. romantic love, for instance - are artificial, as far as human biochemistry goes. As neuroscientist Larry Young's research with prairie voles at the Yerkes National Primate Research Center at Emory University demonstrates:
"(H)uman love is set off by a "biochemical chain of events" that originally evolved in ancient brain circuits involving mother-child bonding, which is stimulated in mammals by the release of oxytocin during labor, delivery and nursing."
He told the New-York Times ("Anti-Love Drug May Be Ticket to Bliss", January 12, 2009):
"Some of our sexuality has evolved to stimulate that same oxytocin system to create female-male bonds," Dr. Young said, noting that sexual foreplay and intercourse stimulate the same parts of a woman's body that are involved in giving birth and nursing. This hormonal hypothesis, which is by no means proven fact, would help explain a couple of differences between humans and less monogamous mammals: females' desire to have sex even when they are not fertile, and males' erotic fascination with breasts. More frequent sex and more attention to breasts, Dr. Young said, could help build long-term bonds through a " cocktail of ancient neuropeptides," like the oxytocin released during foreplay or orgasm. Researchers have achieved similar results by squirting oxytocin into people's nostrils..."
Moreover:
"A related hormone, vasopressin, creates urges for bonding and nesting when it is injected in male voles (or naturally activated by sex). After Dr. Young found that male voles with a genetically limited vasopressin response were less likely to find mates, Swedish researchers reported that men with a similar genetic tendency were less likely to get married ... 'If we give an oxytocin blocker to female voles, they become like 95 percent of other mammal species,' Dr. Young said. 'They will not bond no matter how many times they mate with a male or hard how he tries to bond. They mate, it feels really good and they move on if another male comes along. If love is similarly biochemically based, you should in theory be able to suppress it in a similar way.'"
Love, in all its phases and manifestations, is an addiction, probably to the various forms of internally secreted norepinephrine, such as the aforementioned amphetamine-like PEA. Love, in other words, is a form of substance abuse. The withdrawal of romantic love has serious mental health repercussions.
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A study conducted by Dr. Kenneth Kendler, professor of psychiatry and director of the Virginia Institute for Psychiatric and Behavioral Genetics, and others, and published in the September 2002 issue of Archives of General Psychiatry, revealed that breakups often lead to depression and anxiety. Other, fMRI-based studies, demonstrated how the insular cortex, in charge of experiencing pain, became active when subjects viewed photos of former loved ones.
Still, love cannot be reduced to its biochemical and electrical components. Love is not tantamount to our bodily processes - rather, it is the way we experience them. Love is how we interpret these flows and ebbs of compounds using a higher-level language. In other words, love is pure poetry.
Interview granted to Readers' Digest - January 2009
"For what qualities in a man," asked the youth, "does a woman most ardently love him?"
"For those qualities in him," replied the old tutor, "which his mother most ardently hates."
(A Book Without A Title, by George Jean Nathan (1918))
Q. The Top 5 Things Women Look for in a Man, the top five qualities (based on an American survey):
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- Good Judgment
- Intelligence
- Faithful
- Affectionate
- Financially Responsible
Why is this something women look for in men - why is it important?
How does this quality positively affect a relationship or marriage?
How do women recognize it?
A. There are three possible explanations as to why women look for these qualities in men: the evolutionary-biological one, the historical-cultural one, and the psychological-emotional one.
In evolutionary terms, good judgment and intelligence equal survival and the transmission of one's genes across the generations. Faithfulness and a sense of responsibility (financial and otherwise) guarantee that the woman's partner will persevere in the all-important tasks of homebuilding and childrearing. Finally, being affectionate cements the emotional bond between male and female and militates against potentially life-threatening maltreatment and abuse of the latter by the former.
From the historical-cultural point of view, most societies and cultures, well into the previous century, have been male-dominated and patriarchal. The male's judgment prevailed and his decisions dictated the course of the couple's life. An intelligent and financially responsible male provided a secure environment in which to raise children. The woman lived through her man, vicariously: his successes and failures reflected on her and determined her standing in society and her ability to develop and thrive on the personal level. His faithfulness and affections served to prevent competitors from usurping the female's place and thus threatening her male-dependent cosmos.
Granted, evolutionary constraints are anachronistic and social-cultural mores have changed: women, at least in Western societies, are now independent, both emotionally and economically. Yet, millennia of conditioned behavior cannot be eradicated in a few decades. Women continue to look in men for the qualities that used to matter in entirely different circumstances.
Finally, women are more level-headed when it comes to bonding. They tend to emphasize long-term relationships, based on reciprocity and the adhesive qualities of strong emotions. Good judgment, intelligence, and a developed sense of responsibility are crucial to the maintenance and preservation of functional, lasting, and durable couples - and so are faithfulness and being affectionate.
Soaring divorce rates and the rise of single parenthood prove that women are not good at recognizing the qualities they seek in men. It is not easy to tell apart the genuine article from the unctuous pretender. While intelligence (or lack thereof) can be discerned on a first date, it is difficult to predict traits such as faithfulness, good judgment, and reliability. Affections can really be mere affectations and women are sometimes so desperate for a mate that they delude themselves and treat their date as a blank screen onto which they project their wishes and needs.
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Q. What are the top 5 Things Men Look for in a Woman, the top five qualities?
Why is this something men look for in women - why is it important?
How does this quality positively affect a relationship or marriage?
How do men recognize it?
A. From my experience and correspondence with thousands of couples, men seem to place a premium on these qualities in a woman:
- Physical Attraction and Sexual Availability
- Good-naturedness
- Faithfulness
- Protective Affectionateness
- Dependability
There are three possible explanations as to why men look for these qualities in women: the evolutionary-biological one, the historical-cultural one, and the psychological-emotional one.
In evolutionary terms, physical attractiveness denotes good underlying health and genetic-immunological compatibility. These guarantee the efficacious transmission of one's genes to future generations. Of course, having sex is a precondition for bearing children and, so, sexual availability is important, but only when it is coupled with faithfulness: men are loth to raise and invest scarce resource in someone else's progeny. Dependable women are more likely to propagate the species, so they are desirable. Finally, men and women are likely to do a better job of raising a family if the woman is good-natured, easy-going, adaptable, affectionate, and mothering. These qualities cement the emotional bond between male and female and prevent potentially life-threatening maltreatment and abuse of the latter by the former.
From the historical-cultural point of view, most societies and cultures, well into the previous century, have been male-dominated and patriarchal. Women were treated as chattels or possessions, an extension of the male. The "ownership" of an attractive female advertised to the world the male's prowess and desirability. Her good nature, affectionateness, and protectiveness proved that her man was a worthwhile "catch" and elevated his social status. Her dependability and faithfulness allowed him to embark on long trips or complex, long-term undertakings without the distractions of emotional uncertainty and the anxieties of letdown and betrayal.
Finally, men are more cavalier when it comes to bonding. They tend to maintain both long-term and short-term relationships and are, therefore, far less exclusive and monogamous than women. They are more concerned with what they are getting out of a relationship than with reciprocity and, though they often feel as strongly as women and can be equally romantic, their emotional landscape and expression are more constrained and they sometimes confuse love with possessiveness or even codependence. Thus, men tend to emphasize the external (physical attraction) and the functional (good-naturedness, faithfulness, reliability) over the internal and the purely emotional.
Soaring divorce rates and the rise of single parenthood prove that men are not good at recognizing the qualities they seek in women. It is not easy to tell apart the genuine article from the unctuous pretender. While physical attractiveness (or lack thereof) can be discerned on a first date, it is difficult to predict traits such as faithfulness, good-naturedness, and reliability. Affections can really be mere affectations and men are sometimes such narcissistic navel-gazers that they delude themselves and treat their date as a blank screen onto which they project their wishes and needs.
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back to: Abuse, Abusive Behaviors: Table of Contents ~ next: Mental Health and Psychology Dictionary
APA Reference
Vaknin, S.
(2009, September 16). The Pathology of Love, HealthyPlace. Retrieved
on 2024, October 10 from https://www.healthyplace.com/personality-disorders/malignant-self-love/the-pathology-of-love
The Pathological Charmer
The narcissist is confident that people find him irresistible. His unfailing charm is part of his self-imputed omnipotence. This inane conviction is what makes the narcissist a "pathological charmer". The somatic narcissist and the histrionic flaunt their sex appeal, virility or femininity, sexual prowess, musculature, physique, training, or athletic achievements.
The cerebral narcissist seeks to enchant and entrance his audience with intellectual pyrotechnics. Many narcissists brag about their wealth, health, possessions, collections, spouses, children, personal history, family tree - in short: anything that garners them attention and renders them alluring.
Both types of narcissists firmly believe that being unique, they are entitled to special treatment by others. They deploy their "charm offensives" to manipulate their nearest and dearest (or even complete strangers) and use them as instruments of gratification. Exerting personal magnetism and charisma become ways of asserting control and obviating other people's personal boundaries.
The pathological charmer feels superior to the person he captivates and fascinates. To him, charming someone means having power over her, controlling her, or even subjugating her. It is all a mind game intertwined with a power play. The person to be thus enthralled is an object, a mere prop, and of dehumanized utility.
In some cases, pathological charm involves more than a grain of sadism. It provokes in the narcissist sexual arousal by inflicting the "pain" of subjugation on the beguiled who "cannot help" but be enchanted. Conversely, the pathological charmer engages in infantile magical thinking. He uses charm to help maintain object constancy and fend off abandonment - in other words, to ensure that the person he "bewitched" won't disappear on him.
Pathological charmers react with rage and aggression when their intended targets prove to be impervious and resistant to their lure. This kind of narcissistic injury - being spurned and rebuffed - makes them feel threatened, rejected, and denuded. Being ignored amounts to a challenge to their uniqueness, entitlement, control, and superiority. Narcissists wither without constant Narcissistic Supply. When their charm fails to elicit it - they feel annulled, non-existent, and "dead".
Expectedly, they go to great lengths to secure said supply. It is only when their efforts are frustrated that the mask of civility and congeniality drops and reveals the true face of the narcissist - a predator on the prowl.
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next: The Pathology of Love
APA Reference
Vaknin, S.
(2009, September 16). The Pathological Charmer, HealthyPlace. Retrieved
on 2024, October 10 from https://www.healthyplace.com/personality-disorders/malignant-self-love/the-pathological-charmer
The Insanity of the Defense
"You can know the name of a bird in all the languages of the world, but when you're finished, you'll know absolutely nothing whatever about the bird... So let's look at the bird and see what it's doing - that's what counts. I learned very early the difference between knowing the name of something and knowing something."
Richard Feynman, Physicist and 1965 Nobel Prize laureate (1918-1988)
"You have all I dare say heard of the animal spirits and how they are transfused from father to son etcetera etcetera - well you may take my word that nine parts in ten of a man's sense or his nonsense, his successes and miscarriages in this world depend on their motions and activities, and the different tracks and trains you put them into, so that when they are once set a-going, whether right or wrong, away they go cluttering like hey-go-mad."
Lawrence Sterne (1713-1758), "The Life and Opinions of Tristram Shandy, Gentleman" (1759)
II. The Concept of Mental Disease - An Overview
IV. The Biochemistry and Genetics of Mental Health
V. The Variance of Mental Disease
VI. Mental Disorders and the Social Order
VII. Mental Ailment as a Useful Metaphor
I. The Insanity Defense
"It is an ill thing to knock against a deaf-mute, an imbecile, or a minor. He that wounds them is culpable, but if they wound him they are not culpable." (Mishna, Babylonian Talmud)
If mental illness is culture-dependent and mostly serves as an organizing social principle - what should we make of the insanity defense (NGRI- Not Guilty by Reason of Insanity)?
A person is held not responsible for his criminal actions if s/he cannot tell right from wrong ("lacks substantial capacity either to appreciate the criminality (wrongfulness) of his conduct" - diminished capacity), did not intend to act the way he did (absent "mens rea") and/or could not control his behavior ("irresistible impulse"). These handicaps are often associated with "mental disease or defect" or "mental retardation".
Mental health professionals prefer to talk about an impairment of a "person's perception or understanding of reality". They hold a "guilty but mentally ill" verdict to be contradiction in terms. All "mentally-ill" people operate within a (usually coherent) worldview, with consistent internal logic, and rules of right and wrong (ethics). Yet, these rarely conform to the way most people perceive the world. The mentally-ill, therefore, cannot be guilty because s/he has a tenuous grasp on reality.
Yet, experience teaches us that a criminal maybe mentally ill even as s/he maintains a perfect reality test and thus is held criminally responsible (Jeffrey Dahmer comes to mind). The "perception and understanding of reality", in other words, can and does co-exist even with the severest forms of mental illness.
This makes it even more difficult to comprehend what is meant by "mental disease". If some mentally ill maintain a grasp on reality, know right from wrong, can anticipate the outcomes of their actions, are not subject to irresistible impulses (the official position of the American Psychiatric Association) - in what way do they differ from us, "normal" folks?
This is why the insanity defense often sits ill with mental health pathologies deemed socially "acceptable" and "normal" - such as religion or love.
Consider the following case:
A mother bashes the skulls of her three sons. Two of them die. She claims to have acted on instructions she had received from God. She is found not guilty by reason of insanity. The jury determined that she "did not know right from wrong during the killings."
But why exactly was she judged insane?
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Her belief in the existence of God - a being with inordinate and inhuman attributes - may be irrational.
But it does not constitute insanity in the strictest sense because it conforms to social and cultural creeds and codes of conduct in her milieu. Billions of people faithfully subscribe to the same ideas, adhere to the same transcendental rules, observe the same mystical rituals, and claim to go through the same experiences. This shared psychosis is so widespread that it can no longer be deemed pathological, statistically speaking.
She claimed that God has spoken to her.
As do numerous other people. Behavior that is considered psychotic (paranoid-schizophrenic) in other contexts is lauded and admired in religious circles. Hearing voices and seeing visions - auditory and visual delusions - are considered rank manifestations of righteousness and sanctity.
Perhaps it was the content of her hallucinations that proved her insane?
She claimed that God had instructed her to kill her boys. Surely, God would not ordain such evil?
Alas, the Old and New Testaments both contain examples of God's appetite for human sacrifice. Abraham was ordered by God to sacrifice Isaac, his beloved son (though this savage command was rescinded at the last moment). Jesus, the son of God himself, was crucified to atone for the sins of humanity.
A divine injunction to slay one's offspring would sit well with the Holy Scriptures and the Apocrypha as well as with millennia-old Judeo-Christian traditions of martyrdom and sacrifice.
Her actions were wrong and incommensurate with both human and divine (or natural) laws.
Yes, but they were perfectly in accord with a literal interpretation of certain divinely-inspired texts, millennial scriptures, apocalyptic thought systems, and fundamentalist religious ideologies (such as the ones espousing the imminence of "rapture"). Unless one declares these doctrines and writings insane, her actions are not.
We are forced to the conclusion that the murderous mother is perfectly sane. Her frame of reference is different to ours. Hence, her definitions of right and wrong are idiosyncratic. To her, killing her babies was the right thing to do and in conformity with valued teachings and her own epiphany. Her grasp of reality - the immediate and later consequences of her actions - was never impaired.
It would seem that sanity and insanity are relative terms, dependent on frames of cultural and social reference, and statistically defined. There isn't - and, in principle, can never emerge - an "objective", medical, scientific test to determine mental health or disease unequivocally.
II. The Concept of Mental Disease - An Overview
Someone is considered mentally "ill" if:
- His conduct rigidly and consistently deviates from the typical, average behaviour of all other people in his culture and society that fit his profile (whether this conventional behaviour is moral or rational is immaterial), or
- His judgment and grasp of objective, physical reality is impaired, and
- His conduct is not a matter of choice but is innate and irresistible, and
- His behavior causes him or others discomfort, and is
- Dysfunctional, self-defeating, and self-destructive even by his own yardsticks.
Descriptive criteria aside, what is the essence of mental disorders? Are they merely physiological disorders of the brain, or, more precisely of its chemistry? If so, can they be cured by restoring the balance of substances and secretions in that mysterious organ? And, once equilibrium is reinstated - is the illness "gone" or is it still lurking there, "under wraps", waiting to erupt? Are psychiatric problems inherited, rooted in faulty genes (though amplified by environmental factors) - or brought on by abusive or wrong nurturance?
These questions are the domain of the "medical" school of mental health.
Others cling to the spiritual view of the human psyche. They believe that mental ailments amount to the metaphysical discomposure of an unknown medium - the soul. Theirs is a holistic approach, taking in the patient in his or her entirety, as well as his milieu.
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The members of the functional school regard mental health disorders as perturbations in the proper, statistically "normal", behaviours and manifestations of "healthy" individuals, or as dysfunctions. The "sick" individual - ill at ease with himself (ego-dystonic) or making others unhappy (deviant) - is "mended" when rendered functional again by the prevailing standards of his social and cultural frame of reference.
In a way, the three schools are akin to the trio of blind men who render disparate descriptions of the very same elephant. Still, they share not only their subject matter - but, to a counter intuitively large degree, a faulty methodology.
As the renowned anti-psychiatrist, Thomas Szasz, of the State University of New York, notes in his article "The Lying Truths of Psychiatry", mental health scholars, regardless of academic predilection, infer the etiology of mental disorders from the success or failure of treatment modalities.
This form of "reverse engineering" of scientific models is not unknown in other fields of science, nor is it unacceptable if the experiments meet the criteria of the scientific method. The theory must be all-inclusive (anamnetic), consistent, falsifiable, logically compatible, monovalent, and parsimonious. Psychological "theories" - even the "medical" ones (the role of serotonin and dopamine in mood disorders, for instance) - are usually none of these things.
The outcome is a bewildering array of ever-shifting mental health "diagnoses" expressly centred around Western civilisation and its standards (example: the ethical objection to suicide). Neurosis, a historically fundamental "condition" vanished after 1980. Homosexuality, according to the American Psychiatric Association, was a pathology prior to 1973. Seven years later, narcissism was declared a "personality disorder", almost seven decades after it was first described by Freud.
III. Personality Disorders
Indeed, personality disorders are an excellent example of the kaleidoscopic landscape of "objective" psychiatry.
The classification of Axis II personality disorders - deeply ingrained, maladaptive, lifelong behavior patterns - in the Diagnostic and Statistical Manual, fourth edition, text revision [American Psychiatric Association. DSM-IV-TR, Washington, 2000] - or the DSM-IV-TR for short - has come under sustained and serious criticism from its inception in 1952, in the first edition of the DSM.
The DSM IV-TR adopts a categorical approach, postulating that personality disorders are "qualitatively distinct clinical syndromes" (p. 689). This is widely doubted. Even the distinction made between "normal" and "disordered" personalities is increasingly being rejected. The "diagnostic thresholds" between normal and abnormal are either absent or weakly supported.
The polythetic form of the DSM's Diagnostic Criteria - only a subset of the criteria is adequate grounds for a diagnosis - generates unacceptable diagnostic heterogeneity. In other words, people diagnosed with the same personality disorder may share only one criterion or none.
The DSM fails to clarify the exact relationship between Axis II and Axis I disorders and the way chronic childhood and developmental problems interact with personality disorders.
The differential diagnoses are vague and the personality disorders are insufficiently demarcated. The result is excessive co-morbidity (multiple Axis II diagnoses).
The DSM contains little discussion of what distinguishes normal character (personality), personality traits, or personality style (Millon) - from personality disorders.
A dearth of documented clinical experience regarding both the disorders themselves and the utility of various treatment modalities.
Numerous personality disorders are "not otherwise specified" - a catchall, basket "category".
Cultural bias is evident in certain disorders (such as the Antisocial and the Schizotypal).
The emergence of dimensional alternatives to the categorical approach is acknowledged in the DSM-IV-TR itself:
"An alternative to the categorical approach is the dimensional perspective that Personality Disorders represent maladaptive variants of personality traits that merge imperceptibly into normality and into one another" (p.689)
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The following issues - long neglected in the DSM - are likely to be tackled in future editions as well as in current research. But their omission from official discourse hitherto is both startling and telling:
- The longitudinal course of the disorder(s) and their temporal stability from early childhood onwards;
- The genetic and biological underpinnings of personality disorder(s);
- The development of personality psychopathology during childhood and its emergence in adolescence;
- The interactions between physical health and disease and personality disorders;
- The effectiveness of various treatments - talk therapies as well as psychopharmacology.
IV. The Biochemistry and Genetics of Mental Health
Certain mental health afflictions are either correlated with a statistically abnormal biochemical activity in the brain - or are ameliorated with medication. Yet the two facts are not ineludibly facets of the same underlying phenomenon. In other words, that a given medicine reduces or abolishes certain symptoms does not necessarily mean they were caused by the processes or substances affected by the drug administered. Causation is only one of many possible connections and chains of events.
To designate a pattern of behaviour as a mental health disorder is a value judgment, or at best a statistical observation. Such designation is effected regardless of the facts of brain science. Moreover, correlation is not causation. Deviant brain or body biochemistry (once called "polluted animal spirits") do exist - but are they truly the roots of mental perversion? Nor is it clear which triggers what: do the aberrant neurochemistry or biochemistry cause mental illness - or the other way around?
That psychoactive medication alters behaviour and mood is indisputable. So do illicit and legal drugs, certain foods, and all interpersonal interactions. That the changes brought about by prescription are desirable - is debatable and involves tautological thinking. If a certain pattern of behaviour is described as (socially) "dysfunctional" or (psychologically) "sick" - clearly, every change would be welcomed as "healing" and every agent of transformation would be called a "cure".
The same applies to the alleged heredity of mental illness. Single genes or gene complexes are frequently "associated" with mental health diagnoses, personality traits, or behaviour patterns. But too little is known to establish irrefutable sequences of causes-and-effects. Even less is proven about the interaction of nature and nurture, genotype and phenotype, the plasticity of the brain and the psychological impact of trauma, abuse, upbringing, role models, peers, and other environmental elements.
Nor is the distinction between psychotropic substances and talk therapy that clear-cut. Words and the interaction with the therapist also affect the brain, its processes and chemistry - albeit more slowly and, perhaps, more profoundly and irreversibly. Medicines - as David Kaiser reminds us in "Against Biologic Psychiatry" (Psychiatric Times, Volume XIII, Issue 12, December 1996) - treat symptoms, not the underlying processes that yield them.
V. The Variance of Mental Disease
If mental illnesses are bodily and empirical, they should be invariant both temporally and spatially, across cultures and societies. This, to some degree, is, indeed, the case. Psychological diseases are not context dependent - but the pathologizing of certain behaviours is. Suicide, substance abuse, narcissism, eating disorders, antisocial ways, schizotypal symptoms, depression, even psychosis are considered sick by some cultures - and utterly normative or advantageous in others.
This was to be expected. The human mind and its dysfunctions are alike around the world. But values differ from time to time and from one place to another. Hence, disagreements about the propriety and desirability of human actions and inaction are bound to arise in a symptom-based diagnostic system.
As long as the pseudo-medical definitions of mental health disorders continue to rely exclusively on signs and symptoms - i.e., mostly on observed or reported behaviours - they remain vulnerable to such discord and devoid of much-sought universality and rigor.
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VI. Mental Disorders and the Social Order
The mentally sick receive the same treatment as carriers of AIDS or SARS or the Ebola virus or smallpox.They are sometimes quarantined against their will and coerced into involuntary treatment by medication, psychosurgery, or electroconvulsive therapy. This is done in the name of the greater good, largely as a preventive policy.
Conspiracy theories notwithstanding, it is impossible to ignore the enormous interests vested in psychiatry and psychopharmacology. The multibillion dollar industries involving drug companies, hospitals, managed healthcare, private clinics, academic departments, and law enforcement agencies rely, for their continued and exponential growth, on the propagation of the concept of "mental illness" and its corollaries: treatment and research.
VII. Mental Ailment as a Useful Metaphor
Abstract concepts form the core of all branches of human knowledge. No one has ever seen a quark, or untangled a chemical bond, or surfed an electromagnetic wave, or visited the unconscious. These are useful metaphors, theoretical entities with explanatory or descriptive power.
"Mental health disorders" are no different. They are shorthand for capturing the unsettling quiddity of "the Other". Useful as taxonomies, they are also tools of social coercion and conformity, as Michel Foucault and Louis Althusser observed. Relegating both the dangerous and the idiosyncratic to the collective fringes is a vital technique of social engineering.
The aim is progress through social cohesion and the regulation of innovation and creative destruction. Psychiatry, therefore, is reifies society's preference of evolution to revolution, or, worse still, to mayhem. As is often the case with human endeavor, it is a noble cause, unscrupulously and dogmatically pursued.
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next: What is Abuse?
APA Reference
Vaknin, S.
(2009, September 16). The Insanity of the Defense, HealthyPlace. Retrieved
on 2024, October 10 from https://www.healthyplace.com/personality-disorders/malignant-self-love/the-insanity-of-the-defense
In Defense of Psychoanalysis - Introduction
Introduction
No social theory has been more influential and, later, more reviled than psychoanalysis. It burst upon the scene of modern thought, a fresh breath of revolutionary and daring imagination, a Herculean feat of model-construction, and a challenge to established morals and manners. It is now widely considered nothing better than a confabulation, a baseless narrative, a snapshot of Freud's tormented psyche and thwarted 19th century Mitteleuropa middle class prejudices.
Most of the criticism is hurled by mental health professionals and practitioners with large axes to grind. Few, if any, theories in psychology are supported by modern brain research. All therapies and treatment modalities - including medicating one's patients - are still forms of art and magic rather than scientific practices. The very existence of mental illness is in doubt - let alone what constitutes "healing". Psychoanalysis is in bad company all around.
Some criticism is offered by practicing scientists - mainly experimentalists - in the life and exact (physical) sciences. Such diatribes frequently offer a sad glimpse into the critics' own ignorance. They have little idea what makes a theory scientific and they confuse materialism with reductionism or instrumentalism and correlation with causation.
Few physicists, neuroscientists, biologists, and chemists seem to have plowed through the rich literature on the psychophysical problem. As a result of this obliviousness, they tend to proffer primitive arguments long rendered obsolete by centuries of philosophical debates.
Science frequently deals matter-of-factly with theoretical entities and concepts - quarks and black holes spring to mind - that have never been observed, measured, or quantified. These should not be confused with concrete entities. They have different roles in the theory. Yet, when they mock Freud's trilateral model of the psyche (the id, ego, and superego), his critics do just that - they relate to his theoretical constructs as though they were real, measurable, "things".
The medicalization of mental health hasn't helped either.
Certain mental health afflictions are either correlated with a statistically abnormal biochemical activity in the brain - or are ameliorated with medication. Yet the two facts are not ineludibly facets of the same underlying phenomenon. In other words, that a given medicine reduces or abolishes certain symptoms does not necessarily mean they were caused by the processes or substances affected by the drug administered. Causation is only one of many possible connections and chains of events.
To designate a pattern of behavior as a mental health disorder is a value judgment, or at best a statistical observation. Such designation is effected regardless of the facts of brain science. Moreover, correlation is not causation. Deviant brain or body biochemistry (once called "polluted animal spirits") do exist - but are they truly the roots of mental perversion? Nor is it clear which triggers what: do the aberrant neurochemistry or biochemistry cause mental illness - or the other way around?
That psychoactive medication alters behavior and mood is indisputable. So do illicit and legal drugs, certain foods, and all interpersonal interactions. That the changes brought about by prescription are desirable - is debatable and involves tautological thinking. If a certain pattern of behavior is described as (socially) "dysfunctional" or (psychologically) "sick" - clearly, every change would be welcomed as "healing" and every agent of transformation would be called a "cure".
The same applies to the alleged heredity of mental illness. Single genes or gene complexes are frequently "associated" with mental health diagnoses, personality traits, or behavior patterns. But too little is known to establish irrefutable sequences of causes-and-effects. Even less is proven about the interaction of nature and nurture, genotype and phenotype, the plasticity of the brain and the psychological impact of trauma, abuse, upbringing, role models, peers, and other environmental elements.
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Nor is the distinction between psychotropic substances and talk therapy that clear-cut. Words and the interaction with the therapist also affect the brain, its processes and chemistry - albeit more slowly and, perhaps, more profoundly and irreversibly. Medicines - as David Kaiser reminds us in "Against Biologic Psychiatry" (Psychiatric Times, Volume XIII, Issue 12, December 1996) - treat symptoms, not the underlying processes that yield them.
So, what is mental illness, the subject matter of Psychoanalysis?
Someone is considered mentally "ill" if:
- His conduct rigidly and consistently deviates from the typical, average behavior of all other people in his culture and society that fit his profile (whether this conventional behavior is moral or rational is immaterial), or
- His judgment and grasp of objective, physical reality is impaired, and
- His conduct is not a matter of choice but is innate and irresistible, and
- His behavior causes him or others discomfort, and is
- Dysfunctional, self-defeating, and self-destructive even by his own yardsticks.
Descriptive criteria aside, what is the essence of mental disorders? Are they merely physiological disorders of the brain, or, more precisely of its chemistry? If so, can they be cured by restoring the balance of substances and secretions in that mysterious organ? And, once equilibrium is reinstated - is the illness "gone" or is it still lurking there, "under wraps", waiting to erupt? Are psychiatric problems inherited, rooted in faulty genes (though amplified by environmental factors) - or brought on by abusive or wrong nurturance?
These questions are the domain of the "medical" school of mental health.
Others cling to the spiritual view of the human psyche. They believe that mental ailments amount to the metaphysical discomposure of an unknown medium - the soul. Theirs is a holistic approach, taking in the patient in his or her entirety, as well as his milieu.
The members of the functional school regard mental health disorders as perturbations in the proper, statistically "normal", behaviors and manifestations of "healthy" individuals, or as dysfunctions. The "sick" individual - ill at ease with himself (ego-dystonic) or making others unhappy (deviant) - is "mended" when rendered functional again by the prevailing standards of his social and cultural frame of reference.
In a way, the three schools are akin to the trio of blind men who render disparate descriptions of the very same elephant. Still, they share not only their subject matter - but, to a counter intuitively large degree, a faulty methodology.
As the renowned anti-psychiatrist, Thomas Szasz, of the State University of New York, notes in his article "The Lying Truths of Psychiatry", mental health scholars, regardless of academic predilection, infer the etiology of mental disorders from the success or failure of treatment modalities.
This form of "reverse engineering" of scientific models is not unknown in other fields of science, nor is it unacceptable if the experiments meet the criteria of the scientific method. The theory must be all-inclusive (anamnetic), consistent, falsifiable, logically compatible, monovalent, and parsimonious. Psychological "theories" - even the "medical" ones (the role of serotonin and dopamine in mood disorders, for instance) - are usually none of these things.
The outcome is a bewildering array of ever-shifting mental health "diagnoses" expressly centred around Western civilization and its standards (example: the ethical objection to suicide). Neurosis, a historically fundamental "condition" vanished after 1980. Homosexuality, according to the American Psychiatric Association, was a pathology prior to 1973. Seven years later, narcissism was declared a "personality disorder", almost seven decades after it was first described by Freud.
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|
APA Reference
Vaknin, S.
(2009, September 16). In Defense of Psychoanalysis - Introduction, HealthyPlace. Retrieved
on 2024, October 10 from https://www.healthyplace.com/personality-disorders/malignant-self-love/in-defense-of-psychoanalysis-introduction
Persecutory Anxiety
Positive feelings (about oneself or pertaining to one's accomplishments, assets, etc.) - are never gained merely through conscious endeavor. They are the outcome of insight. A cognitive component (factual knowledge regarding one's achievements, assets, qualities, skills, etc.) plus an emotional correlate that is heavily dependent on past experience, defense mechanisms, and personality style or structure ("character").
People who consistently feel worthless or unworthy usually overcompensate cognitively for the lack of the aforementioned emotional component.
Such a person doesn't love himself, yet is trying to convince himself that he is loveable. He doesn't trust himself, yet he lectures to himself on how trustworthy he is (replete with supporting evidence from his experiences).
But such cognitive substitutes to emotional self-acceptance won't do.
The root of the problem is the inner dialog between disparaging voices and countervailing "proofs". Such self-doubting is, in principle, a healthy thing. It serves as an integral and critical part of the "checks and balances" that constitute the mature personality.
But, normally, some ground rules are observed and some facts are considered indisputable. When things go awry, however, the consensus breaks. Chaos replaces structure and the regimented update of one's self-image (via introspection) gives way to recursive loops of self-deprecation with diminishing insights.
Normally, in other words, the dialog serves to augment some self-assessments and mildly modify others. When things go wrong, the dialog concerns itself with the very narrative, rather than with its content.
The dysfunctional dialog deals with questions that are far more fundamental (and typically settled early on in life):
"Who am I?"
"What are my traits, my skills, my accomplishments?"
"How reliable, loveable, trustworthy, qualified, truthful am I?"
"How can I separate fact from fiction?"
The answers to these questions consist of both cognitive (empirical) and emotional components. They are mostly derived from our social interactions, from the feedback we get and give. An inner dialog that is still concerned with these qualms indicates a problem with socialization.
It is not one's "psyche" that is delinquent - but one's social functioning. One should direct one's efforts to "heal", outwards (to remedy one's interactions with others) - not inwards (to heal one's "psyche").
Another important insight is that the disordered dialog is not time-synchronic.
The "normal" internal discourse is between concurrent, equipotent, and same-age "entities" (psychological constructs). Its aim is to negotiate conflicting demands and reach a compromise based on a rigorous test of reality.
The faulty dialog, on the other hand, involves wildly disparate interlocutors. These are in different stages of maturation and possessed of unequal faculties. They are more concerned in monologues than in a dialog. As they are "stuck" in various ages and periods, they do not all relate to the same "host", "person", or "personality". They require time- and energy-consuming constant mediation. It is this depleting process of arbitration and "peacekeeping" that is consciously felt as nagging insecurity or, even, in extremis, self-loathing.
A constant and consistent lack of self-confidence and a fluctuating sense of self-worth are the conscious "translation" of the unconscious threat posed by the precariousness of the disordered personality. It is, in other words, a warning sign.
Thus, the first step is to clearly identify the various segments that, together, however incongruently, constitute the personality. This can be surprisingly easily done by noting down the "stream of consciousness" dialog and assigning "names" or "handles" to the various "voices" in it.
The next step is to "introduce" the voices to each other and form an internal consensus (a "coalition", or an "alliance"). This requires a prolonged period of "negotiations" and mediation, leading to the compromises the underlies such a consensus. The mediator can be a trusted friend, a lover, or a therapist.
The very achievement of such internal "ceasefire" reduces anxiety considerably and remove the "imminent threat". This, in turn, allows the patient to develop a realistic "core" or "kernel", wrapped around the basic understanding reached earlier between the contesting parts of his personality.
The development of such a nucleus of stable self-worth, however, is dependent on two things:
- Sustained interactions with mature and predictable people who are aware of their boundaries and of their true identity (their traits, skills, abilities, limitations, and so on), and
- The emergence of a nurturing and "holding" emotional correlate to every cognitive insight or breakthrough.
The latter is inextricably bound with the former.
Here is why:
Some of the "voices" in the internal dialog of the patient are bound to be disparaging, injurious, belittling, sadistically critical, destructively skeptical, mocking, and demeaning. The only way to silence these voices - or at least "discipline" them and make them conform to a more realistic emerging consensus - is by gradually (and sometimes surreptitiously) introducing countervailing "players".
Protracted exposure to the right people, in the framework of mature interactions, negates the pernicious effects of what Freud called a Superego gone awry. It is, in effect, a process of reprogramming and deprogramming.
There are two types of beneficial, altering, social experiences:
- Structured - interactions that involve adherence to a set of rules as embedded in authority, institutions, and enforcement mechanisms (example: attending psychotherapy, going through a spell in prison, convalescing in a hospital, serving in the army, being an aid worker or a missionary, studying at school, growing up in a family, participating in a 12-steps group), and
- Non-structured - interactions which involve a voluntary exchange of information, opinion, goods, or services.
The problem with the disordered person is that, usually, his (or her) chances of freely interacting with mature adults (intercourse of the type 2, non-structured kind) are limited to start with and dwindle with time. This is because few potential partners - interlocutors, lovers, friends, colleagues, neighbors - are willing to invest the time, effort, energy, and resources required to effectively cope with the patient and manage the often-arduous relationship. Disordered patients are typically hard to get along with, demanding, petulant, paranoid, and narcissistic.
Even the most gregarious and outgoing patient finally finds himself isolated, shunned, and misjudged. This only adds to his initial misery and amplifies the wrong kind of voices in the internal dialog.
Hence my recommendation to start with structured activities and in a structured, almost automatic manner. Therapy is only one - and at times not the most efficient - choice.
APA Reference
Staff, H.
(2009, September 16). Persecutory Anxiety, HealthyPlace. Retrieved
on 2024, October 10 from https://www.healthyplace.com/personality-disorders/malignant-self-love/persecutory-anxiety
Sex or Gender
"One is not born, but rather becomes, a woman."
Simone de Beauvoir, The Second Sex (1949)
In nature, male and female are distinct. She-elephants are gregarious, he-elephants solitary. Male zebra finches are loquacious - the females mute. Female green spoon worms are 200,000 times larger than their male mates. These striking differences are biological - yet they lead to differentiation in social roles and skill acquisition.
Alan Pease, author of a book titled "Why Men Don't Listen and Women Can't Read Maps", believes that women are spatially-challenged compared to men. The British firm, Admiral Insurance, conducted a study of half a million claims. They found that "women were almost twice as likely as men to have a collision in a car park, 23 percent more likely to hit a stationary car, and 15 percent more likely to reverse into another vehicle" (Reuters).
Yet gender "differences" are often the outcomes of bad scholarship. Consider Admiral insurance's data. As Britain's Automobile Association (AA) correctly pointed out - women drivers tend to make more short journeys around towns and shopping centers and these involve frequent parking. Hence their ubiquity in certain kinds of claims. Regarding women's alleged spatial deficiency, in Britain, girls have been outperforming boys in scholastic aptitude tests - including geometry and maths - since 1988.
In an Op-Ed published by the New York Times on January 23, 2005, Olivia Judson cited this example
"Beliefs that men are intrinsically better at this or that have repeatedly led to discrimination and prejudice, and then they've been proved to be nonsense. Women were thought not to be world-class musicians. But when American symphony orchestras introduced blind auditions in the 1970's - the musician plays behind a screen so that his or her gender is invisible to those listening - the number of women offered jobs in professional orchestras increased. Similarly, in science, studies of the ways that grant applications are evaluated have shown that women are more likely to get financing when those reading the applications do not know the sex of the applicant."
On the other wing of the divide, Anthony Clare, a British psychiatrist and author of "On Men" wrote:
"At the beginning of the 21st century it is difficult to avoid the conclusion that men are in serious trouble. Throughout the world, developed and developing, antisocial behavior is essentially male. Violence, sexual abuse of children, illicit drug use, alcohol misuse, gambling, all are overwhelmingly male activities. The courts and prisons bulge with men. When it comes to aggression, delinquent behavior, risk taking and social mayhem, men win gold."
Men also mature later, die earlier, are more susceptible to infections and most types of cancer, are more likely to be dyslexic, to suffer from a host of mental health disorders, such as Attention Deficit Hyperactivity Disorder (ADHD), and to commit suicide.
In her book, "Stiffed: The Betrayal of the American Man", Susan Faludi describes a crisis of masculinity following the breakdown of manhood models and work and family structures in the last five decades. In the film "Boys don't Cry", a teenage girl binds her breasts and acts the male in a caricatural relish of stereotypes of virility. Being a man is merely a state of mind, the movie implies.
But what does it really mean to be a "male" or a "female"? Are gender identity and sexual preferences genetically determined? Can they be reduced to one's sex? Or are they amalgams of biological, social, and psychological factors in constant interaction? Are they immutable lifelong features or dynamically evolving frames of self-reference?
In rural northern Albania, until recently, in families with no male heir, women could choose to forego sex and childbearing, alter their external appearance and "become" men and the patriarchs of their clans, with all the attendant rights and obligations.
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In the aforementioned New York Times Op-Ed, Olivia Judson opines:
"Many sex differences are not, therefore, the result of his having one gene while she has another. Rather, they are attributable to the way particular genes behave when they find themselves in him instead of her. The magnificent difference between male and female green spoon worms, for example, has nothing to do with their having different genes: each green spoon worm larva could go either way. Which sex it becomes depends on whether it meets a female during its first three weeks of life. If it meets a female, it becomes male and prepares to regurgitate; if it doesn't, it becomes female and settles into a crack on the sea floor."
Yet, certain traits attributed to one's sex are surely better accounted for by the demands of one's environment, by cultural factors, the process of socialization, gender roles, and what George Devereux called "ethnopsychiatry" in "Basic Problems of Ethnopsychiatry" (University of Chicago Press, 1980). He suggested to divide the unconscious into the id (the part that was always instinctual and unconscious) and the "ethnic unconscious" (repressed material that was once conscious). The latter is mostly molded by prevailing cultural mores and includes all our defense mechanisms and most of the superego.
So, how can we tell whether our sexual role is mostly in our blood or in our brains?
The scrutiny of borderline cases of human sexuality - notably the transgendered or intersexed - can yield clues as to the distribution and relative weights of biological, social, and psychological determinants of gender identity formation.
The results of a study conducted by Uwe Hartmann, Hinnerk Becker, and Claudia Rueffer-Hesse in 1997 and titled "Self and Gender: Narcissistic Pathology and Personality Factors in Gender Dysphoric Patients", published in the "International Journal of Transgenderism", "indicate significant psychopathological aspects and narcissistic dysregulation in a substantial proportion of patients." Are these "psychopathological aspects" merely reactions to underlying physiological realities and changes? Could social ostracism and labeling have induced them in the "patients"?
The authors conclude:
"The cumulative evidence of our study ... is consistent with the view that gender dysphoria is a disorder of the sense of self as has been proposed by Beitel (1985) or Pfäfflin (1993). The central problem in our patients is about identity and the self in general and the transsexual wish seems to be an attempt at reassuring and stabilizing the self-coherence which in turn can lead to a further destabilization if the self is already too fragile. In this view the body is instrumentalized to create a sense of identity and the splitting symbolized in the hiatus between the rejected body-self and other parts of the self is more between good and bad objects than between masculine and feminine."
Freud, Kraft-Ebbing, and Fliess suggested that we are all bisexual to a certain degree. As early as 1910, Dr. Magnus Hirschfeld argued, in Berlin, that absolute genders are "abstractions, invented extremes". The consensus today is that one's sexuality is, mostly, a psychological construct which reflects gender role orientation.
Joanne Meyerowitz, a professor of history at Indiana University and the editor of The Journal of American History observes, in her recently published tome, "How Sex Changed: A History of Transsexuality in the United States", that the very meaning of masculinity and femininity is in constant flux.
Transgender activists, says Meyerowitz, insist that gender and sexuality represent "distinct analytical categories". The New York Times wrote in its review of the book: "Some male-to-female transsexuals have sex with men and call themselves homosexuals. Some female-to-male transsexuals have sex with women and call themselves lesbians. Some transsexuals call themselves asexual."
So, it is all in the mind, you see.
This would be taking it too far. A large body of scientific evidence points to the genetic and biological underpinnings of sexual behavior and preferences.
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The German science magazine, "Geo", reported recently that the males of the fruit fly "drosophila melanogaster" switched from heterosexuality to homosexuality as the temperature in the lab was increased from 19 to 30 degrees Celsius. They reverted to chasing females as it was lowered.
The brain structures of homosexual sheep are different to those of straight sheep, a study conducted recently by the Oregon Health & Science University and the U.S. Department of Agriculture Sheep Experiment Station in Dubois, Idaho, revealed. Similar differences were found between gay men and straight ones in 1995 in Holland and elsewhere. The preoptic area of the hypothalamus was larger in heterosexual men than in both homosexual men and straight women.
According an article, titled "When Sexual Development Goes Awry", by Suzanne Miller, published in the September 2000 issue of the "World and I", various medical conditions give rise to sexual ambiguity. Congenital adrenal hyperplasia (CAH), involving excessive androgen production by the adrenal cortex, results in mixed genitalia. A person with the complete androgen insensitivity syndrome (AIS) has a vagina, external female genitalia and functioning, androgen-producing, testes - but no uterus or fallopian tubes.
People with the rare 5-alpha reductase deficiency syndrome are born with ambiguous genitalia. They appear at first to be girls. At puberty, such a person develops testicles and his clitoris swells and becomes a penis. Hermaphrodites possess both ovaries and testicles (both, in most cases, rather undeveloped). Sometimes the ovaries and testicles are combined into a chimera called ovotestis.
Most of these individuals have the chromosomal composition of a woman together with traces of the Y, male, chromosome. All hermaphrodites have a sizable penis, though rarely generate sperm. Some hermaphrodites develop breasts during puberty and menstruate. Very few even get pregnant and give birth.
Anne Fausto-Sterling, a developmental geneticist, professor of medical science at Brown University, and author of "Sexing the Body", postulated, in 1993, a continuum of 5 sexes to supplant the current dimorphism: males, merms (male pseudohermaphrodites), herms (true hermaphrodites), ferms (female pseudohermaphrodites), and females.
Intersexuality (hermpahroditism) is a natural human state. We are all conceived with the potential to develop into either sex. The embryonic developmental default is female. A series of triggers during the first weeks of pregnancy places the fetus on the path to maleness.
In rare cases, some women have a male's genetic makeup (XY chromosomes) and vice versa. But, in the vast majority of cases, one of the sexes is clearly selected. Relics of the stifled sex remain, though. Women have the clitoris as a kind of symbolic penis. Men have breasts (mammary glands) and nipples.
The Encyclopedia Britannica 2003 edition describes the formation of ovaries and testes thus:
"In the young embryo a pair of gonads develop that are indifferent or neutral, showing no indication whether they are destined to develop into testes or ovaries. There are also two different duct systems, one of which can develop into the female system of oviducts and related apparatus and the other into the male sperm duct system. As development of the embryo proceeds, either the male or the female reproductive tissue differentiates in the originally neutral gonad of the mammal."
Yet, sexual preferences, genitalia and even secondary sex characteristics, such as facial and pubic hair are first order phenomena. Can genetics and biology account for male and female behavior patterns and social interactions ("gender identity")? Can the multi-tiered complexity and richness of human masculinity and femininity arise from simpler, deterministic, building blocks?
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Sociobiologists would have us think so.
For instance: the fact that we are mammals is astonishingly often overlooked. Most mammalian families are composed of mother and offspring. Males are peripatetic absentees. Arguably, high rates of divorce and birth out of wedlock coupled with rising promiscuity merely reinstate this natural "default mode", observes Lionel Tiger, a professor of anthropology at Rutgers University in New Jersey. That three quarters of all divorces are initiated by women tends to support this view.
Furthermore, gender identity is determined during gestation, claim some scholars.
Milton Diamond of the University of Hawaii and Dr. Keith Sigmundson, a practicing psychiatrist, studied the much-celebrated John/Joan case. An accidentally castrated normal male was surgically modified to look female, and raised as a girl but to no avail. He reverted to being a male at puberty.
His gender identity seems to have been inborn (assuming he was not subjected to conflicting cues from his human environment). The case is extensively described in John Colapinto's tome "As Nature Made Him: The Boy Who Was Raised as a Girl".
HealthScoutNews cited a study published in the November 2002 issue of "Child Development". The researchers, from City University of London, found that the level of maternal testosterone during pregnancy affects the behavior of neonatal girls and renders it more masculine. "High testosterone" girls "enjoy activities typically considered male behavior, like playing with trucks or guns". Boys' behavior remains unaltered, according to the study.
Yet, other scholars, like John Money, insist that newborns are a "blank slate" as far as their gender identity is concerned. This is also the prevailing view. Gender and sex-role identities, we are taught, are fully formed in a process of socialization which ends by the third year of life. The Encyclopedia Britannica 2003 edition sums it up thus:
"Like an individual's concept of his or her sex role, gender identity develops by means of parental example, social reinforcement, and language. Parents teach sex-appropriate behavior to their children from an early age, and this behavior is reinforced as the child grows older and enters a wider social world. As the child acquires language, he also learns very early the distinction between "he" and "she" and understands which pertains to him- or herself."
So, which is it - nature or nurture? There is no disputing the fact that our sexual physiology and, in all probability, our sexual preferences are determined in the womb. Men and women are different - physiologically and, as a result, also psychologically.
Society, through its agents - foremost amongst which are family, peers, and teachers - represses or encourages these genetic propensities. It does so by propagating "gender roles" - gender-specific lists of alleged traits, permissible behavior patterns, and prescriptive morals and norms. Our "gender identity" or "sex role" is shorthand for the way we make use of our natural genotypic-phenotypic endowments in conformity with social-cultural "gender roles".
Inevitably as the composition and bias of these lists change, so does the meaning of being "male" or "female". Gender roles are constantly redefined by tectonic shifts in the definition and functioning of basic social units, such as the nuclear family and the workplace. The cross-fertilization of gender-related cultural memes renders "masculinity" and "femininity" fluid concepts.
One's sex equals one's bodily equipment, an objective, finite, and, usually, immutable inventory. But our endowments can be put to many uses, in different cognitive and affective contexts, and subject to varying exegetic frameworks. As opposed to "sex" - "gender" is, therefore, a socio-cultural narrative. Both heterosexual and homosexual men ejaculate. Both straight and lesbian women climax. What distinguishes them from each other are subjective introjects of socio-cultural conventions, not objective, immutable "facts".
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In "The New Gender Wars", published in the November/December 2000 issue of "Psychology Today", Sarah Blustain sums up the "bio-social" model proposed by Mice Eagly, a professor of psychology at Northwestern University and a former student of his, Wendy Wood, now a professor at the Texas A&M University:
"Like (the evolutionary psychologists), Eagly and Wood reject social constructionist notions that all gender differences are created by culture. But to the question of where they come from, they answer differently: not our genes but our roles in society. This narrative focuses on how societies respond to the basic biological differences - men's strength and women's reproductive capabilities - and how they encourage men and women to follow certain patterns.
'If you're spending a lot of time nursing your kid', explains Wood, 'then you don't have the opportunity to devote large amounts of time to developing specialized skills and engaging tasks outside of the home'. And, adds Eagly, 'if women are charged with caring for infants, what happens is that women are more nurturing. Societies have to make the adult system work [so] socialization of girls is arranged to give them experience in nurturing'.
According to this interpretation, as the environment changes, so will the range and texture of gender differences. At a time in Western countries when female reproduction is extremely low, nursing is totally optional, childcare alternatives are many, and mechanization lessens the importance of male size and strength, women are no longer restricted as much by their smaller size and by child-bearing. That means, argue Eagly and Wood, that role structures for men and women will change and, not surprisingly, the way we socialize people in these new roles will change too. (Indeed, says Wood, 'sex differences seem to be reduced in societies where men and women have similar status,' she says. If you're looking to live in more gender-neutral environment, try Scandinavia.) "
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APA Reference
Vaknin, S.
(2009, September 16). Sex or Gender, HealthyPlace. Retrieved
on 2024, October 10 from https://www.healthyplace.com/personality-disorders/malignant-self-love/sex-or-gender