December 28, 2009

"She Said She Had Breast Cancer-- But She Lied"

glamour cover.jpg
if it's in here, it must be about breasts

It's worth reviewing an old story because wrong is forever.

Suzy Bass, a math teacher at a private high school, had breast cancer:

Because Bass had recently moved to Knoxville and was single, two Webb staffers--Julieanne Pope, 43, and Terri Ward, 51--became her part-time caregivers. "I left my cell phone on my nightstand every night in case she needed anything," says Ward, the dean of faculty.... When Bass was too sick to teach, they'd cover her classes. And they kept a steady stream of casseroles and smoothies going to her condo. "We'd visit and she'd be shaking, pale and so sick," says Pope, Webb's technology coordinator. At school Bass would cover her head--bald from chemotherapy--with a knit cap, and limp from the tumor in her foot.

Except she didn't: she made it all up.

Listening to Bass detail the outrageous lengths she went to over the years to fake her symptoms is chilling.... Bass learned to draw convincing-looking radiation dots on her neck with a permanent marker... She would also roll up a bath towel, stretch it between her hands and rub it back and forth against her neck as fast as she could to give herself "radiation burns." She shaved her own head with a razor and made herself throw up from chemotherapy "nausea" in school bathrooms.

She did it for years, at multiple schools, with everyone, including her parents.

Why?  Not for the money-- she didn't ask for any disability pay/leave.  So?

II.

I wish this was a joke: the article first suggests it's bipolar disorder.

Despite all that effort and time Bass spent learning how to appear sick, she claims that every time she feigned having cancer, she truly believed she was ill. "In my mind, I didn't lie to anybody," she says.

Could someone honestly believe she is dying while actively lying about it? That's part of the puzzle Bass's counseling team is attempting to piece together. "It is certainly possible that given her diagnosis of bipolar disorder, Suzy could have truly believed she had cancer," says Marvin Kalachman [who is treating her.]

Note the construction of his explanation: the "known" quantity is "she has bipolar" and because of that, it is assumed she could believe her lies.  But in reality, we don't know she has bipolar and we certainly don't know that she actually believes her lies.  We only know that she lied.  But he's accepted her story and given her an alibi.

This is the real danger of the overdiagnosis of mental illness: it prevents any further analysis  of the symptoms.  The debate from this point on will be about whether she has bipolar, not whether her symptoms-- in this case believing her lies-- are real.

I don't have to wait long for an example, here's the next paragraph:

"It's possible for a bipolar patient to experience delusions lasting days or weeks during an episode, Dr. McInnis [professor of psychiatry at the University of Michigan and a leading expert on bipolar disorder] explains. In Bass's case, however, she went to great lengths to fake symptoms--not a hallmark of bipolar delusions, he notes.
He is correcting the diagnosis: bipolar delusions don't look like this.  "Delusions," as in "she believes them."

III.

Fortunately, the article abandons bipolar as an explanation (though not as her diagnosis), and instead turns to something that is even more wrong:

Marc Feldman, M.D., a world-renowned psychiatrist, has treated more than 100 women who have faked serious illness... he believes he has her diagnosis: Munchausen syndrome, a psychological disorder in which someone feigns or self-induces illness to get attention and sympathy...these people know that they are lying, but typically don't know why they're compelled to do so. 
You'll be tempted to disagree with me: "this sounds exactly like what she has."

And, he says, a diagnosis of bipolar disorder does not rule out Munchausen syndrome. Currently Bass's counselors have not diagnosed her with Munchausen syndrome and say they are primarily focused on treating her bipolar disorder
The problem with the article's and the doctors' assessments is that they are being fooled by the content of her lies and not the form.  Because the focus of the article is cancer, because she's faking a medical illness, the explanation must be some other medical (psychiatric) illness.

What everyone does agree on is that this is a woman who will need help for a long, long time.
"I feel sorry that she's sick, but I don't want her to do it to anyone else."
"I just wish we'd found the right doctor for her 15 years ago."
Bass is currently unemployed, a medical recommendation.  "... I'm sick and I'm working on it every day," she says.
If she had lied for monetary gain, no one would assume it's a psychiatric condition, but because the gain is non-financial, she must be ill.  That's because in America, only crazy people do things for no money.

IV.

The content of her lies suggests Munchausen's; if this was accurate, you'd worry about this:

But if Bass herself can't promise that one of these days she won't suddenly start faking breast cancer, melanoma or some other disease, how do I know she won't? How does anyone?
Because she "fakes medical illness for sympathy" the reflex is to focus on the words "medical illness," but where you should focus is on "for sympathy."  Munchausen's doesn't predict what was in retrospect obvious to her students-- she lied about everything.

List of things said by Suzy Bass most of us believed...

Had Breast Cancer...Lie
Worked for NASA...Lie
Played basketball for Florida State...Lie
Got hit by a tornado...twice....Lie
Good friends with Archie Manning...Lie
Had dinner with Vince Young, Mike Vick, and T.O....Lie
Wrote 3 textbooks....Lie
Name is Suzy Bass...Possibly a lie

Oddly, the Glamour article misses a lie that was right in front of them:

In the fall of 2005, the school nominated Bass for the prestigious Disney Teacher of the Year Award. "[Bass] may be the finest teacher/inspiration I have ever been associated with in 32 years of education," Jim Gottwald, the Paulding County principal told the Athens State University newsletter.
The actual quote is "Dr. Bass."

Meanwhile, it lists some lies Bass herself revealed, but doesn't recognize their importance:

She once pretended she had a fiancé who died on 9/11, that she'd played basketball at Florida State University and that she'd starred in the North American tour of Mamma Mia! "What I did was wrong, and I'm willing to stand up and admit that," Bass says, "but it doesn't change that my intent was never to hurt anyone. Never. I'm not that kind of person."
 
The point here is that the faking of cancer is completely incidental to her life's narrative, what is important is the faking.  She faked cancer because, simply, it worked very well.  If she could have gotten sympathy and esteem and identity from faking being a basketball pro, then the article would be called "She Said She Played For The Celtics-- But She Lied!" and it would have appeared in Sports Illustrated.

V.

"So you think everyone is a narcissist?"  No, but when you see elements of it, you can make some predictions.

Before everyone goes bananas, I am not judging Suzy Bass-- I'm not saying she is a good person or bad person.  "Narcissist" isn't synonymous with "jerk"-- I'm using all of these terms to describe what I see, and make predictions about the future in order to help her and others like her.

The worst thing that can happen to a narcissist is a narcissistic injury-- in which their desired, constructed identity is revealed to be invented.  In her case, it was literally fake, not just psychologically fake. 

What happens in narcissistic injuries?  Rage and violence.  But, as a woman with limited targets for rage, it gets turned inwards: depression, suicide.

In 1995, when she was found not to have Hodgkin's disease she went into a psych hospital for several weeks.  And, eventually, she had to move-- new location, new relationship, maybe even a new "identity"-- but for sure you don't stay put, exposed to everyone.

At her second job in Dallas, GA, where she was found to be faking stage II ductal breast cancer, she was able to get away and find refuge at her parents house-- where her parents still believed she had cancer.  Identity intact.

She eventually went to Knoxville, where she got the math teacher job and ultimately was exposed again, this time also to her parents.  Now no solace anywhere.  

Once she left Knoxville, Bass admitted herself into an Alabama psychiatric ward and she told doctors she no longer wanted to live.

The Munchausen is wrong, not because it's formally wrong but because it is incomplete, in the same way as saying "it's a thirst disorder" when it's diabetes.   If people are watching for "medical lies" as a clue to her condition they will inevitably miss the next set of non-medical lies and, importantly, the suicide attempt that is likely to result if those are exposed.

The problem isn't that this is a woman faking medical illnesses.  The problem is that this is a  ghost, and it's faking an identity.  There are a lot of Suzy Basses out there.

---
http://twitter.com/thelastpsych





Comments

Wow! What a great case stu... (Below threshold)

December 28, 2009 7:12 PM | Posted by Meat Robot: | Reply

Wow! What a great case study, with a great analysis on top. I've never clinically run across such a florid example of pseudologia fantastica, but this would be a great teaching case for residents on how not to get led down the garden path to Munchausen's.

It would also be interesting to know which, if any, symptoms of bipolar disorder she actually exhibited, other than grandiosity and a likely expansive affect when the mask was working well. If forced at gunpoint, I *might* grant flight of ideas instead of pseudologia.

Is narcissism everywhere? In a narcissistic age, it sure is.

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Why are we ghosts? Why is i... (Below threshold)

December 28, 2009 7:36 PM | Posted by Wonders: | Reply

Why are we ghosts? Why is it so mechanical. With so much effort applied, and its not always done with lies and deceit but with ordinary everyday events ~ "I am the person who does the house work, I do my assignments on time, I am creative" ~ why does it remain (or even start) as only a cover and is not just who we are? I wonder...

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Narcissism isn't everywhere... (Below threshold)

December 28, 2009 7:57 PM | Posted, in reply to Meat Robot's comment, by Claudius: | Reply

Narcissism isn't everywhere...in the general population Narcissistic personality disorder accounts for 1% of the population. Roughly 300million ppl in US means that there should be 3 million narcissists. I think it's far fetched to say it's the "Age of Narcissism"...rates of depression are much, much higher. It kind of seems like narcissism is a little dog barking loudly.

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Is Suzy Basses narcissism a... (Below threshold)

December 28, 2009 8:45 PM | Posted by Anonymous: | Reply

Is Suzy Basses narcissism a learned behaviour (chosen) or a brain chemical imbalance?

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"Is Suzy Basses narcissism ... (Below threshold)

December 28, 2009 9:51 PM | Posted by Golly G. Willikers: | Reply

"Is Suzy Basses narcissism a learned behaviour (chosen) or a brain chemical imbalance?"

Learned behaviors are all consciously chosen, and Cartesian dualism is assumed. Those are pretty big assumptions to pack into the question.

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Identify what a "brain chem... (Below threshold)

December 28, 2009 10:25 PM | Posted by Anonymous: | Reply

Identify what a "brain chemical imbalance" is, and maybe someone here will have a clue as to what you are talking about. Thanks.

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I read this article and I r... (Below threshold)

December 28, 2009 10:48 PM | Posted by Anonymous: | Reply

I read this article and I reflect on some of the charts handed off to me, and... I gotta ask: Did I miss a memo somewhere that explained how now we'd be using the term "Bipolar Disorder" as a euphemism for "Personality Disorder"? Because so far just about every putative "bipolar" to come through my door has turned out not to meet the criteria of bipolar I or II (or cyclothymia) but to meet the criteria of PTSD+Borderline (sometimes with a side of some other personality disorder). I'm waiting for a chart that just frankly reads Axis I: 301.83 "Bipolar"

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How much of this is under a... (Below threshold)

December 28, 2009 10:55 PM | Posted by Anonymous: | Reply

How much of this is under any meaningful voluntary control of hers? If the answer is "most of it", I'm perfectly comfortable responding to "they will inevitably miss [...] the suicide attempt that is likely to result if those are exposed" with a big, fat "so?".

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Ask yourself if this 1% is ... (Below threshold)

December 28, 2009 11:17 PM | Posted, in reply to Claudius's comment, by Anonymous: | Reply

Ask yourself if this 1% is only inclusive of formal diagnosis. Then ask how many cases may go unreported.

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I would argue that narcissi... (Below threshold)

December 29, 2009 1:07 AM | Posted by Anonymous: | Reply

I would argue that narcissism is unlikely to explain this sort of behavior, as narcissism typically involves a rational sort of mask - to be admired and/or feared, to be powerful, to be influential... the identity of a narcissist is not simply fake, but it is grandiose in some way. Narcissistic lies make sense.

The fact that this woman constructed a fake identity centered around being ill speaks of a mental problem more... severe... than garden variety narcissism.

You say munchausens is to this case as thirst is to diabetes... I think you have it backward. It's more accurate to say that lacking a genuine self ('narcissism') is to mental illness as thirst is to diabetes. Narcissism as you are defining it (not being a real person, being constructed of projected images with nothing underneath) is prerequisite to most/many major mental problems. Crazy people cannot have a real self. They're crazy. Their brain doesn't work right. I mean, if mentally stabilized then a genuine self may emerge but by definition all actively crazy people have a bit of a void where self should be. If functional enough, this may look vaugley like narcissism.

The difference between ordinary narcissism and what this woman is doing, is that this woman's behavior is completely illogical. It is not a normal goal to want to be thought of as dying for attention. Narcissism is grossly inadequate to explain it. When people's behavior and goals are chronically illogical, the old brain isn't working and this is mental illness.

This, to me, seems somewhere in between narcissism (rationally motivated lies/delusions/false behavior) and psychosis (irrationally motivated lies/delusions/falseness).
It is narcissism-like in the sense that this woman probably does know the difference between reality and fantasy, and this woman does get positive emotional feelings when the lies are validated/reinforced ("supply").
It is psychosis-like in the sense that this woman's false world is irrational and completely bizarre to others. The lies of a narcissist make sense and are common goals/aspirations. The lies of this woman and others with munchausens don't make any sense at all and we struggle to fully understand why anyone would cast themselves in that light. I suppose sympathy feels good in a way, but... it's just so bizarre.


Just my thoughts.

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Claudius, I certainly agree... (Below threshold)

December 29, 2009 1:08 AM | Posted, in reply to Claudius's comment, by Meat Robot: | Reply

Claudius, I certainly agree that Narcissisitic Personality Disorder prevalence sits relatively low, but sub-syndromal narcissisitic traits are far more broadly prevalent, particularly within the construct of borderline personality organization. Unfortunately, I can't provide hard data on who has BPO (a la Kernberg), since aspects of the construct are inferred. Then again, not everything that counts is countable.

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meat robot - so you don't t... (Below threshold)

December 29, 2009 1:18 AM | Posted, in reply to Meat Robot's comment, by Anonymous: | Reply

meat robot - so you don't think this is munchausens?

Note that it is very likely munchausens represents a specific subtype of pathological lying. This is much in the way classic anorexia nervosa restrictive type represents a subtype of OCD and anxiety disorder combination... Or, methamphetamine abuse is a specific type of substance abuse disorder.

Anorexia nervosa restrictive type *is* obsessive/compulsive + anxiety disorder, but a specific type of obsessive compulsive behavior (not eating certain amounts/things/types), a certain type of anxiety/fear of consequence (of not doing the food/activity rituals, of gaining weight, of not losing weight).

Munchausens syndrome *is* pathological lying, but it is pathological lying about a very specific thing (illness), for a specific reason (the way it feels to be sick).


It is possible to have these comorbid and is probably very, very common since they are likely etiologically related. I would wager that generalized compulsive lying is more frequent in munchausens patients. I would wager that other types of OCD/anxiety are very frequent in anorexia nervosa restrictive type patients.

Why do we make the distinction, then? Because anorexia nervosa has special circumstances not found in other types of OCD - mainly, severe starvation, with an unusually high frequency in a certain population (young and female). Because munchausens is a special type of compulsive lying, with a specific sort of motivation (to feel sick). Because meth users have certain health issues and risk factors that alcoholics don't have.


If you disagree (that munchausens IS a type of compulsive lying) I would be very interested in hearing the difference. I would be even more interested in hearing why this woman is a compulsive liar but *not* a munchausens patient.

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The whole piece revolves ar... (Below threshold)

December 29, 2009 1:25 AM | Posted by AA: | Reply

The whole piece revolves around people failing to treat "truth" as something objective and important. It's a willful distortion of what is in favor of might, because it is a lot easier to seem than to actually be. Everyone wants to be an astronaut/doctor/superhero when they grow up, but no one actually wants to go through flight school/med school/horrific genetic mutations to do so. They might still do all those things, but not because they're inherently important-- just essential to the identity they've picked. Narcissus didn't like being beautiful, he liked being seen as beautiful.

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First, I find it interestin... (Below threshold)

December 29, 2009 1:26 AM | Posted, in reply to Golly G. Willikers's comment, by Anonymous: | Reply

First, I find it interesting how everyone has assumed she is indeed a narcissist, simply because Alone told you she was. Thinking, deficit, you all have it.

Second, it is obvious most all personality traits (including "narcissism") are a combination are chemicals and learning. Nothing is purely learned or purely biological, psychosis mania and depression (genuine depression, not dysphoria) excluded. A better question is, is narcissism more of a biological phenomenon or is it mostly a learned/culturally/socially created one? My take on this: it varies widely from patient to patient. Narcissist A may have much more of a biological influence than naricissist B. Empathy, an aggressive/dominant temperament, the ability to feel fear... the brain makes that happen, you know. Lacking empathy/fear and having more aggression predisposes to narcissism and antisocial behavior.
That's why these afflictions predominantly exist in men (constitutionally more aggressive and less empathetic than women).


Third, learned behavior is not chosen. It's learned. Learning is rarely conscious or purposeful.

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anon 10:48... assuming you ... (Below threshold)

December 29, 2009 1:39 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

anon 10:48... assuming you are a real medical professional (which you probably most certainly are not), you must be an *excellent* caregiver. You automatically assume every bipolar (female, though you've not said it, we all know you are more cricital of the female patients) is actually a borderline with PTSD. Fantastic, golf clap.
I bet you do the same thing with PTSD that other doctors do with bipolar - lower the diagnostic bar to meaninglessness. It can't be bipolar, but being yelled at by her dad too much caused PTSD/borderline. Or something.
I highly doubt your "patients" (if you are even a doctor) meet the strict criteria for PTSD or borderline, either.


I really don't understand why so many people laugh at the idea of subsyndromal bipolar, but clamor all over the idea of PTSD/borderline explaining things.

My take? This comes from an intrinsic need to blame your patient. Bipolar/depression label encourages lack of blame. PTSD/borderline encourages a perspective of "it's your fault for not coping better".


Note, I am very much on the fence here. I definitely see an overdiagnosis of bipolar, but just as often I see every female emotional patient being described as PTSD or borderline, which is just as much of a load of bullshit, if not moreso. PTSD has become a joke. Many so called borderline patients aren't borderline very much, either. "Oh you don't need rages/outbursts... and you don't need unstable relationships... and you don't need to feel empty". At the end of the day, people are being told they are borderline simply for being sensitive and non-compliant.

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One more thing. Then I'll s... (Below threshold)

December 29, 2009 1:43 AM | Posted by Anonymous: | Reply

One more thing. Then I'll stop blowing up the responses.

Has anyone considered the fact her bipolar disorder might actually be another sign of her pathological lying/fictitious disorder? Bipolar and mental illnesses are a favorite target for munchausens, after all.

For all we know, she went to a psychiatrist and made up a big fat lie about depressive episodes and manic episodes that happened in the past. "I didn't sleep for 2 weeks, I thought I was god... what is this doctor?" Dx: manic depression, and all the psychological benefits of feeling sick.

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You make good points, and p... (Below threshold)

December 29, 2009 2:12 AM | Posted, in reply to Anonymous's comment, by Meat Robot: | Reply

You make good points, and perhaps Munchausen's is a sub-type of pseudologia fantastica. The good old Baron himself, as far as I know, didn't actually fabricate symptoms (please correct me if I'm wrong). For me, a key distinction between PF and Munchausen's is the deliberate manufacture of symptoms. Now, clearly this woman did go to great lengths to manufacture symptoms, so she'd qualify for the diagnosis.

For me, however, the key of this case is in not stopping with the fascinating diagnosis. A bit more digging into collateral history from the students reveals a remarkably grandiose pattern of lies. I agree with many commenters that bipolar disorder is a lame duck in this case, and I also agree that the diagnosis itself is handed out like Pez. Sometimes I'd like to grab my colleagues by the lapels and give them a good shake.

Now, perhaps PF is commonly comorbid with Munchausen's. These are such rare tigers that I don't think we really have the data we need. So, that I must grant simply out of intellectual honesty.

The old bipolar vs borderline issue rages on and on, but I agree with the commenter above that this probably results from a lack of diagnostic specificity. I have a colleague who, honestly, believes that he has only encountered one borderline patient in his entire career, but he sure codes a lot of Bipolar II on his charts (see above about lapels and shaking). So, not only do those patients *not* get psychotherapy, but they get fat and diabetic to boot from antipsychotics. Not all borderline hatred of psychiatry is transferential devaluing. A lot of us are useless schlubs.

Borderline/PTSD and chronic traumatization. Another fascinating area. Worked with a guy who looked to all the world like a male borderline, admitted depressed after a suicide attempt. However, after some aggressive treatment of mood, anxiety, and chronic pain, along with psychotherapy around sexual abuse issues, all features of borderline personality set like the dying sun, never to return. The guy looked borderline cross-sectionally, but careful longitudinal history didn't confirm onset in young adulthood with a stable course.

One day I'll actually know a thing or two about psychiatry.

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The funny thing is, the bip... (Below threshold)

December 29, 2009 2:56 AM | Posted by EloquentRT: | Reply

The funny thing is, the bipolar diagnosis plays right into her narcissism. Now she doesn't even have to fake an identity -- Glamour publicized one for her. "I have bipolar disorder. I did all these horrible things, and I'm so sorry, I'm so heartbroken. But I have a disease, so it's not really my fault." And even the author of the story feels pity for her. She actually does get to be the star in the movie about her life -- play her cards right, and she could be on Oprah (or whoever takes over for Oprah in our hearts and minds and televisions). Who says dreams don't come true?

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Uhh what about the people w... (Below threshold)

December 29, 2009 4:21 AM | Posted by Anonymous: | Reply

Uhh what about the people who actually have "bipolar" disorder? Is this article insinuating that all "bipolar" people are liars?

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This is the same anon, MR..... (Below threshold)

December 29, 2009 4:32 AM | Posted, in reply to Meat Robot's comment, by Anonymous: | Reply

This is the same anon, MR...

Actually, the baron was also a pathological liar, according to wikipedia. His career of lies began with him telling general false fantastic tales about himself. These were published in a book called "The Surprising Adventures of Baron Münchhausen."
http://en.wikipedia.org/wiki/M%C3%BCnchausen_syndrome

Baron Munchausen may be the first case study of the comorbidity / relationship between pathological lying and munchausens syndrome ;D


You know... I think the borderline vs bipolar / therapy vs meds is a false dichotomy.
People who meet the borderline diagnosis with high specificity have brain problems. Every day we are learning more about the brain weaknesses in the borderline illness (errr "personality disorder").
People who meet the bipolar 1/2 diagnosis with rapid cycling and mixed states often have comorbid personality disorders, borderline features.
http://www.psycom.net/depression.central.bordbipol.html

Mood stabilizers do help many borderlines. Somehow this myth got started that medication doesn't help a borderline. *shrug*. No it won't help like, a tendency to overreact, abandonment concerns, but general mood lability or depression does respond... and the mood lability with resultant rages/outbursts is a major reason borderline is so impairing.

Therapy does help bipolars. Many bipolars pick up all sorts of self destructive coping mechanisms... drugging and drinking and things like that. Learning how to cope with having affective episodes is useful, as useful as medicine to stop the episodes. Not all bipolars cope equally well. Some can remain rather functional even while unstable, others are very low functioning laying in bed/not going to work while depressed, drinking doing drugs and partying while manic or what have you. This is mostly a personality /learning coping thing not entirely explained by the phenomenon of cyclical/episodic illness.


Bipolar, classic manic depression, is obviously MORE biological than borderline, but "borderline personality" is itself a very biological disorder.

It is presently being argued that PTSD has little to do with genuine (i.e.strictly meeting the criteria) borderline PD.
The idea that trauma causes borderline came about from self report from borderlines themselves. That's like concluding that schizophrenia is caused by the FBI implanting chips in people's brains to monitor their thoughts. Or, that mania is caused by god giving people a special mission.
Of course borderlines are going to experience life as more traumatizing, of course borderlines are more likely to report their prior histories as traumatic. The question is, did this "trauma" cause borderline, or does borderline mean every little thing that happens to you is perceived as traumatic? One study found that the rate of various types of abuse/trauma in a given sample of borderline patients wasn't particularly higher than a non-borderline sample. I believe that.


I also believe borderline is a sad ass dumping ground diagnosis... sorta like bipolar II. The diagnostic criteria is very loosely adhered to or symptoms are exaggered/stretched to sloppily fit. If you're female and emotionally distressed, you may be labeled bpII, or you may be labeled borderline. It all depends on how big of an asshole is the psychiatrist you are talking to, I guess. The fair way of doing things is to avoid labels if a patient does not fit sufficiently. No one is cautious now days. Insurance, etc.

Yes, we know a lot of people are called bipolar w/o meeting the criteria fully. We always hear about the bipolar patients who aren't really bipolar. But this also happens with borderline. No one talks about the fake borderline patients who are not impulsive, do not self harm, really don't have rages, etc. In a young female patient any remote sort of discord or disagreement or general discontent with things is seen as a sign of borderline. I see this a lot on the mental health blogosphere. The sad part is when the patient actually believes the label and starts identifying their problems/discord as "borderline", ignorant of just how maligning that really is. Sensitivity and questioing one's fit in the world is out of fashion, I think. last time I checked, aren't people in their late teens early 20s SUPPOSED to feel a bit of an existential crisis about where to fit in? Isn't some "emptiness" a normal part of that? It really pisses me off when teenagers are labeled borderline. It used to be that extreme irrational thinking and outbursts and feeling a little empty/lost/no stable identity were part of an angsty adolescence. And, normal.
That's like labeling the extreme/irrational moods of children with rapid cycling bipolar disorder (oh... wait...sh*t).

Too much rambling.

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anon 4:21 ... don't worry, ... (Below threshold)

December 29, 2009 4:34 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

anon 4:21 ... don't worry, your average joe has no f8king idea what bipolar disorder is about anyway. Most people think bipolar disorder is about being moody and unpredictable (more like borderline). Other people think it is about being really crazy and psychotic (more like sz).

It really doesn't matter if glamor adds to the misinformation by characterizing bipolar as having anything to do with pathological lying/munchausens. The mainstream will never really understand what bipolar disorder is about anyway.

It was more clear when it was named manic depression. You've mania. You've depression. That's it.

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Thanks for the clarificatio... (Below threshold)

December 29, 2009 4:54 AM | Posted by Anonymous: | Reply

Thanks for the clarification. Its absolutely horrible how this stigmatizes the illness further though. I know that myself personally, am very honest. To a degree where it may even harm myself in the case where it may get me something I want. Call it emotional self-harm...

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What's most impressive is h... (Below threshold)

December 29, 2009 10:16 AM | Posted by Jess: | Reply

What's most impressive is her parents involvement. They knew she was capable of lying, but were sufficiently reassured.

I worked with someone like her. His entire life appeared to be fabricated. He stated he worked with the CIA during the Bay of Pigs. He could spend long periods of times talking about his experiences at places he'd probaly never been. A fellow worker had a conversation for the better part of an hour about a person that didn't exist, since the fellow worker fabricated the personality to draw him into the conversation.(He told me he had done this to see if his suspicions were well founded.)

My thoughts at the time were that an accusation of lying would have been devastating, and think the others I worked with felt the same. We never pushed for truthful answers, and he continued to live with his fabrications.

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Anon - "I would argue that ... (Below threshold)

December 29, 2009 12:20 PM | Posted, in reply to Anonymous's comment, by brainchild: | Reply

Anon - "I would argue that narcissism is unlikely to explain this sort of behavior, as narcissism typically involves a rational sort of mask - to be admired and/or feared, to be powerful, to be influential... the identity of a narcissist is not simply fake, but it is grandiose in some way. Narcissistic lies make sense."

She was certainly exerting a great deal of power and manipulative control over those she was getting to look after her. Narcissists have no problem retreating into being "the victim" when other tactics don't work, they're just grandiose about their suffering and use it to manipulate others. Narcissists often use the empathy of others and exaggerations/lies about their suffering to manipulate people. While people tend to feel more betrayed and outraged when they're conned via empathy than by grandiose stories, narcissists are mainly concerned with how they can manipulate others to fill their needs or desires. It's quite possible for someone to both think they're better than others and to see themselves as a victim. I've never actually met an narcissist who doesn't consider themselves a victim - it's always someone else's fault they're not yet the most important person in the world and they truly do feel victimized when their needs or desires are thwarted. Sure they go on the attack when their manipulations don't work but that's a result of feeling victimized. Seeing oneself as a martyr - when one obviously only cares about one's image - is a form of grandiosity and delusion in and of itself.

Now, that doesn't prove this woman has a NPD but it doesn't exclude it either simply because she resorted to dramatically faking illness. She told plenty of grandiose lies about being a star of some kind too. She's now achieved even more attention for herself and used it to become the celebrity and center of attention she obviously craved to be. Think about it for a moment, wouldn't a narcissist prefer to be grandiose patient who is a star than an ignored and merely average well person?

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Anon sez: "You know... I th... (Below threshold)

December 29, 2009 12:35 PM | Posted by medsvstherapy: | Reply

Anon sez: "You know... I think the borderline vs bipolar / therapy vs meds is a false dichotomy."

I do not think it is a false dichotomy. It may be foolish to assume a choince, versus combo treatment, but the distinction between the two is very real.

On the psychotherapy side, we have extensive, scientific, empirical theories regarding the etiology of a significant portion of psychological maladies. These are supported by experimental manipulation, but phisiological indicators, etc. Additionally, our theories, developed in clincial settings as are the various beliefs in biologically based brain chemical imbalances, lead to theory-orietnted interventions that are proven to be effective, adn to be effective by workign through theoretically predicted mediators.

For example: depression can be predicted by negative life events and by a ruminative cognitive style. This shows up in the Attributional Styles Questionnaire, and other psychometrically validated measures. Rumination on negtive moods explains the male/female difference in depression prevalance, and depressive rumination can be experimentally invoked, resulting in temporarily depressed mood, compared to a comparison group. Also, by well-recognized, well-established, manualized cognitive therapy, you can change cognitions, and measure this through the course of psychotherapy, and see cognitions change, and see a subsequent change in mood. Also, relapse into depression, while more challenging to study, has ben documented to be related to a slip back into the depressive style of thinking, often related to some negative life events nudging things in that direction, or failure to stick to the more favorable styles of thinking.

Personality disorders are more complicated (that's an understatement), but there is an empirical evidence base which explains, predicts, and provides paths to effective treatments.

The "neurotransmitter" explanation of depression has no such theory-and-evidence basis. The empirical support is at the observational level: some deperssed people are given some chemical known to have some efefct on the brain's neurotransmitters somewhere, but where is not really well known.

Last and others do a great job of laying down the physiological basis for psych med side effects way more strongly than anyone has laid down the theory-and-evidence base for the "serotonin hypothesis" of depression.

Changes in brain structure and function have even been documented as epiphenomena as a depressed cohort progresses through psychotherapy.

Why the big deal? There are down-sides to "medicalization." There are side effects to medications that simply are entirely absent in psychotherapy. There are public policy implications, such as: why ias lifetime coverage of psych meds never questioned, but a psychotherapist has to ask the HMO for five-more-sessions every month? Why give disability benefits to someone with depression, if it is a reversable condition?

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MR said: Not all borderlin... (Below threshold)

December 29, 2009 12:48 PM | Posted, in reply to Meat Robot's comment, by InTheWild: | Reply

MR said: Not all borderline hatred of psychiatry is transferential devaluing. A lot of us are useless schlubs.

Ah. You made my day with this observation.


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One thing that has occurred... (Below threshold)

December 29, 2009 1:00 PM | Posted by Anonymous: | Reply

One thing that has occurred to me regarding the over diagnosis of bipolar disorder in women - it seems to be a diagnosis more commonly handed out to women, but that's purely anecdotal on my part - is that the basic fact that women do have an entirely natural and healthy monthly hormonal cycle that influences mood and thinking seems to get ignored. This often becomes more extreme during menopause and peri-menopause, when hormonal activity is changing and more extreme. Since there's a long history in psychiatry of pathologizing women's natural biological functioning - particularly when it's inconvenient for others - AND women often aren't aware they're in peri-menopause until they're well into it and/or aren't familiar with their own cycles, a lot of women are likely to present their emotional/psychological symptoms without connecting them to a natural (if not always pleasant) biological change. Women have emotional cycles, it's how we're built. That doesn't mean they can't cause problems for us, it just means labeling it "bipolar disorder/manic depression" is falsely pathologizing women and means that the symptoms get treated rather than the root cause. I've got to wonder if appropriate hormonal therapy makes more sense - if this is what's going on, of course. It's just a theory but it does seem a bit like an updated version of "female hysteria" and our cultures general discomfort with emotions and derision of "sensitivity" as weakness (sounds a bit like how narcissists function! ;-)

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medsvstherapy - "The "neuro... (Below threshold)

December 29, 2009 1:35 PM | Posted, in reply to medsvstherapy's comment, by brainchild: | Reply

medsvstherapy - "The "neurotransmitter" explanation of depression has no such theory-and-evidence basis. The empirical support is at the observational level: some deperssed people are given some chemical known to have some efefct on the brain's neurotransmitters somewhere, but where is not really well known."

Very true, we're still unraveling what's actually going on in the brain during depression. Recent research seems to indicate that older (no longer under patent) medications work better on depression than newer (still under patent SSRIs). SSRIs seem to actually effect anxiety rather than depression. That said, it's no wonder pharmaceutical companies hide the results of studies that show that SSRIs don't do much to treat depression when not in tandem with psychotherapy. After all, it appears that if we consider the new evidence, it means that only the talk therapy was actually treating depression. Talk therapy also has the added bonus of considering the person in their environment/context. Depression is a social/environmental disease as well, we're social animals and emotional wounds cause us no less suffering than purely physical ones. We recognize this in relation to direct family dynamics but often not as much in cultural/general social dynamics. If someone feels isolated and unseen, talking to someone who listens and cares can be the first step to feeling positively reconnected to other human animals.

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"MR said: Not all borderlin... (Below threshold)

December 29, 2009 1:52 PM | Posted, in reply to InTheWild's comment, by brainchild: | Reply

"MR said: Not all borderline hatred of psychiatry is transferential devaluing. A lot of us are useless schlubs."

Well, psychiatrists and psychologists are just people. In general - but specifically within medical specializations - there's a human tendency to view everything as a nail when you're armed with only a hammer. Surgeons tend to look for surgical solutions, psychiatrists who prescribe tend to look for neurochemical/pharmaceutical solutions, psychiatrists and psychologists who focus on talk therapy look for solutions via the kind of talk therapy they practice, etc. Most of these people aren't trying to bash anyone's brains in with their hammer, quite the opposite usually, it's just that not everyone's a nail...sometimes that loose screw is better dealt with by using a screwdriver but if you don't recognize that you're looking at is a screw and not a nail then a lot of damage can be done.

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An interesting article abou... (Below threshold)

December 29, 2009 2:21 PM | Posted by brainchild: | Reply

An interesting article about a study that looks at over/mis-diagnosis of bipolar disorder.

http://www.sciencedaily.com/releases/2009/07/090729100936.htm

[excerpt]
"Zimmerman and colleagues note that "we hypothesize that in patients with mood instability, physicians are inclined to diagnose a potentially medication-responsive disorder such as bipolar disorder rather than a disorder such as borderline personality disorder that is less medication-responsive."

In their previously published study that concluded bipolar disorder was over-diagnosed, they studied 700 patients. Of the 700 patients, 145 reported they had been previously diagnosed as having bipolar disorder; however, fewer than half of the 145 patients (43.4 percent) were diagnosed with bipolar disorder based on the SCID. The authors state that the over-diagnosis of bipolar disorder can have serious consequences, because while bipolar disorder is treated with mood stabilizers, no medications have been approved for the treatment of borderline personality disorder. As a result, over-diagnosing bipolar disorder can unnecessarily expose patients to serious medication side effects, including possible impact to renal, endocrine, hepatic, immunologic and metabolic functions.

Zimmerman concludes, "Because evidence continues to emerge establishing the efficacy of certain forms of psychotherapy for borderline personality disorder, over-diagnosing bipolar disorder in patients with borderline personality disorder can result in the failure to recommend the most appropriate forms of treatment."

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Wow! What a fantastic disc... (Below threshold)

December 29, 2009 2:51 PM | Posted by Meat Robot: | Reply

Wow! What a fantastic discussion thread. These are issues I have tried, unsuccessfully, to raise with my colleagues throughout residency and now as a consultant at the coal-face.

It is amazing how easy medication funding is to come by, even if the best evidence supports psychotherapy or shows no difference. Pharmacoeconomic studies consistently demonstrate that a typical 1 to 3 year course of medications for a depressive episode is far more expensive than 15 or 20 sessions of psychotherapy with periodic maintenance sessions over the same time course. And in reality, you don't even really need to do a study. An envelope, pencil, and calculator will do just fine.

One of my former professors of psychotherapy during residency constantly rails against the unquestioned move to meds without taking into account best evidence or patient preference. He did a detailed study of his own practice, looking at large series (n=80) of consecutive cases. He captured all medical costs for 2 years pre and 2 years post-therapy. In the huge bulk of cases, physician visits (for any reason), hospitalizations (for any reason), medication use (again, for any reason) declined and were actually lower than normal population averages in the region. As the cherry on the cake, he was then able to demonstrate that the systemic cost savings simply in the first two years accounted for approximately twice the amount he billed for all services.

Well done psychotherapy is expensive up front, but from a system perspective, it pays for itself.

Is borderline in the brain? Sure, of course. So are learning disabilities. Doesn't mean we stick those kids on meds, though. We treat with learning specialists. And of course, if I'm working longitudinally with a borderline pt who experiences an attachment loss, I'm absolutely vigilant for depression, which is going to be coming quicker, and more severely, with a longer time course. And I'll absolutely treat aggressively with the kitchen sink.

The science of what works for whom (hat tip to Fonagy) is still quite young. It's barely been a century since Breuer and Freud's breakthrough with hysteria. With such an amazing start, no wonder the early analysts thought you could use analysis for anything. Too bad they didn't read Freud.

And not only is the "whom" getting more clearly defined, as the discussion about Alone's case demonstrates, but the "whats" themselves keep changing and (I hope) improving. We're always going to be chasing a moving target. I haven't figured out yet whether that's elating or frustrating.

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medsvstherapy - "There are ... (Below threshold)

December 29, 2009 3:31 PM | Posted, in reply to medsvstherapy's comment, by brainchild: | Reply

medsvstherapy - "There are side effects to medications that simply are entirely absent in psychotherapy."

True but psychotherapy isn't necessarily risk free - there can also be situations where an inappropriate form of talk therapy can actually deepen depression. How often do you think therapists think "hey, maybe my area of expertize is wrong for this person and making them worse" - particularly since there are so many different forms of talk and psychotherapy that are often at odds with each other in terms of theory and practice.

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You're missing the point. D... (Below threshold)

December 29, 2009 3:34 PM | Posted, in reply to Claudius's comment, by Anonymous: | Reply

You're missing the point. Do you believe depression and narcissism are mutually exclusive?

And as far as clinical diagnosis of narcissistic disorders, the numbers mean very little. Everyone is looking for depression, no one is looking for narcissism. Except for Alone.

Overdiagnosis does mean a problem. But the problem is not as obvious.

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Anon wrote - "And as far as... (Below threshold)

December 29, 2009 4:24 PM | Posted, in reply to Anonymous's comment, by brainchild: | Reply

Anon wrote - "And as far as clinical diagnosis of narcissistic disorders, the numbers mean very little. Everyone is looking for depression, no one is looking for narcissism. Except for Alone."

Let's not forget that narcissists are also going to try to manipulate any therapist too and that our cultural ideal for successful men is inherently narcissistic. (We do tend to be more horrified by NPD in women because ruthless women go against the cultural ideal that women be nurturing and empathetic.) If a therapist has a blind spot, a narcissist is sure to find and exploit it. And to leave in anger if their narcissistic needs aren't met or they don't feel like they have the upper hand. Also, like BPD, NPD is generally considered very difficult to treat and there's no pill to treat it with.

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Anon - "I would argue that ... (Below threshold)

December 29, 2009 5:29 PM | Posted by brainchild: | Reply

Anon - "I would argue that narcissism is unlikely to explain this sort of behavior, as narcissism typically involves a rational sort of mask - to be admired and/or feared, to be powerful, to be influential... the identity of a narcissist is not simply fake, but it is grandiose in some way. Narcissistic lies make sense."

It's interesting that so many people see the image that a narcissist constructs as being who they are - rather than a cover and rationalization of anti-social behavior and a false image. This seems like a side effect of idealizing certain kinds of narcissistic behavior and goals in our culture so that they seem "rational". Sure if your main aim in life is to get what you want and the consequences to others be damned (or rationalized away).

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I know the books say border... (Below threshold)

December 29, 2009 5:56 PM | Posted by Meat Robot: | Reply

I know the books say borderlines and narcissists are tough to treat, but personally I haven't found that to be the case. I just call them on their shit in the session and make no effort to disguise my own irritation. They often find it extremely validating to work through little misalliances, as I'm often the first person they've ever met who willingly expresses irritation but also stays present and engaged and aligned with the broken self struggling toward health.

Anyone else find this to be the case clinically?

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I find the above comments o... (Below threshold)

December 29, 2009 7:54 PM | Posted by Anonymous: | Reply

I find the above comments on what this "is" to miss the point. Only psychiatrists would involve themselves in such inane and meaningless debates. All that wordy speculation is nothing but just that. I very much enjoyed the primary post because without saying it directly, he makes it clear that this is all just bullshit perpetrated by a pathological, anti-social human being. She should be jailed or at the very least socially shunned as far as I am concerned not treated as ill. Cancer is illness and antisocial behavior cloaked in pseudo DX is not. Instead to validate their own identity, psychiatrists debate descriptive descriptions confusing them with explanations. He gets this and some of those posting seem to miss this point. Who gives a fuck why this waste of a human being does this. I am not sure if she is much more narcissistic than the psychiatrists who actually think her DX explains anything about what she has been doing, but she sure seems to be more clever than they are.

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"a biological influence"</... (Below threshold)

December 29, 2009 8:58 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

"a biological influence"

Like what? Name a biological influence responsible for NPD.

This is generally known as a "faith-based" assertion.

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Depression and narcissism a... (Below threshold)

December 29, 2009 9:58 PM | Posted, in reply to Anonymous's comment, by Claudius: | Reply

Depression and narcissism are certainly NOT mutually exclusive, but don't you think that more therapists would be catching on to such a "pandemic"? For example, 3% of males (western society) have APD...if you DOUBLED the rate of diagnosis for NPD (for males and females) you'd have a whooping 2% of the population. Still 1% short of APD rates for males. So why aren't we worried about the sociopath pandemic? I'm sure, again, that there are narcissistic "traits" with which people are diagnosed (not full fledged NPD), but still, if these rates were so abnormal (even "sub-types"), wouldn't the statisticians notice these changes?

If narcissism is so prevalent, prove it. I want hard evidence. If you have some, the benefit is for you, not me. I'm sure you'll flip the mental health community on its ass and win a Nobel Prize. My challenge stands.

To bring home the point I made in the first post about the little dog barking; I don't believe narcissism is a pandemic, but it sure is loud.

Many of the "narcissists" described in Alone's posts have been reported on the main stream media. Well of course narcissists will be reported on the media, they are attention seeking by nature, so the most severe cases will act in a way that gives them media attention. What does the media care? "Look, another nuthead who can increase our ratings and make us money!" People talk about these narcissists, heck, even write entire blogs about them. For those of us who watch the news and read Alone's posts, it would seem like narcissism is a big problem.

It may seem like a "narcissism pandemic" because of all the cases Alone can analyze from the media, but media cases are by no means a random sample from a population.

When we look at the world through the lens of the media, we are not looking at reality. We are looking a small sample of reality.

I agree with Alone's stance in this article and many of his articles, but if he spent the rest of his life writing articles, he still wouldn't cover all 3 million cases of NPD. Although, from our point of reference in reading this blog, it would seem that narcissism is the only problem. It is important to understand this while watching the news or reading Alone's posts.

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Just curious, do those of y... (Below threshold)

December 29, 2009 10:31 PM | Posted by Anonymous: | Reply

Just curious, do those of you who are mental health professionals tell your patients when they have NPD?

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"they are attention seeking... (Below threshold)

December 29, 2009 11:52 PM | Posted, in reply to Claudius's comment, by Anonymous: | Reply

"they are attention seeking by nature"

Simply not true. They are attention-seeking to the extent that it is the proper behavior for the character they are playing.

Mostly, what Alone writes about (in regards to Narcissism), is how people like you misunderstand it, or think of it exclusively in DSM terms.

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Dude, if "Only psychiatrist... (Below threshold)

December 30, 2009 5:51 AM | Posted, in reply to Anonymous's comment, by Meat Robot: | Reply

Dude, if "Only psychiatrists would involve themselves in such inane and meaningless debates," what the hell are you doing in the middle of it?

And if you make the shyster debate move and say you're only observing and commenting, then why the hell are you observing and commenting on an "inane and meaningless debate?"

Hypocrite.

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Just chiming in to say that... (Below threshold)

December 30, 2009 6:19 AM | Posted by fraise: | Reply

Just chiming in to say that I don't find this discussion between psychiatrists to be "inane" or "meaningless" at all - quite the contrary, this has been a fascinating discussion to follow. It's reassuring to see psychiatry professionals asking so many questions, debating options, and generally holding patients as human beings, complex individuals, in need of healing.

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"formal diagnosis"... (Below threshold)

December 30, 2009 1:51 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

"formal diagnosis"

LOL

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1. <a href="http://www.beha... (Below threshold)

December 30, 2009 6:04 PM | Posted, in reply to Anonymous's comment, by Claudius: | Reply

1. Diagnostic criteria for 301.81 Narcissistic Personality Disorder
(cautionary statement)

(4) requires excessive admiration

2. "For narcissists, outcomes are irrelevant-- process is what matters. Getting her back is way less important than being connected to her-- sorry, her being connected to him-- whatever the form: love, hate, fear. It's all good."

If you choose to use the movie definition, at least look at Alone's old posts. By both the "movie" definition you ascribe to and by the DSM definition it is clear that narcissists love attention, be it good (admiration as stated in the DSM & Alone) or bad (Alone). What they hate is when there is nothing at all (a lack of attention, of any connection).

Although your argument is bunk, I should have clarified more for other reasons. Mea culpa. NPD pts are attention seeking but it's for different reasons than say, borderline PD. The main difference is that those with NPD have a grandiose idea of how special they are. So they think they deserve attention.

As for thinking of it "exclusively" in DSM terms...well, hell, how else are we supposed to define it? I'm sorry but science posits concrete definition of terms, even seemingly vague psychiatric ones. How can one ever hope to study that which is not concrete, or at least has some specific criteria that are agreed upon? It may not be webster's definition or a philosophical definition, but it's what is used. You can't just change how narcissism is defined at your own whim. Even if the "movie" definition of narcissism is more correct, don't bitch to me about it--I didn't define the terms. Like I said before, do something about it.

The DSM is subject to change. Get published, create a "movie" theory. If the evidence is there, you will have no issues. You will get noticed. You will make millions of dollars, too. Until concrete evidence is shown that this view of n is better than the traditional view, I will stick to the DSM guns.

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Psychiatry is a science? <... (Below threshold)

December 30, 2009 8:26 PM | Posted by Anonymous: | Reply

Psychiatry is a science?

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I have worked diagnosing “c... (Below threshold)

December 30, 2009 10:36 PM | Posted by clinician 1: | Reply

I have worked diagnosing “chronically mentally ill” for ten years now as a licensed social worker. I am bored by it, was after six years. Nothing really new.

Bipolar I is easy to spot and there is a hx. Bipolar 2 is consistent in it’s acting out. Bipolars who go off meds are NPD and/or have borderline features. Bipolar ADHD and BPD look similer except when you start to see the “I’m a victim of my choices” diatribe.

BPD does not improve with medication. It slows them down but they still think exactly the same way.
YES. Some clients have BPD features and have ability for insight and can connect and do remarkably well. It is rare. Most are comorbed.

This woman is a manipulative liar, this is her drug, and she is anti social. I see this client rarely; they are usually always drug addicts. They are all NPD and half are anti-social. The only thing that stops them is consequences. Giving her a nifty Dx enables her.

I had a friend named Claire who lied about breast cancer and embezzled 30 grand from this editor. She went to jail in front of her children and had to borrow the money to pay the guy back from family-enablers. She already had her boob job buy now. That was the hoax-to get a boob job. She was anti-social for a period of time- turning 40 crises-and will not be trusted or respected by anyone who knew her. She had to marry a born-again alcoholic and attend church every Sunday to get her rent paid.

People act out- people can express personality disorders when under pressure- life pressure and psychological pressure of identity disturbance. Her Narcissism poked its head out.

But this lier- she is all NPD. She was not willing to work on an identity or suffer as we all do who are healthy- with FALLING SHORT. No one really wants to think and suffer. They want to escape and this makes on all kinds of axis 2 disorders and drug addicts.

Love this discussion and blog!

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Oh- and all of you out ther... (Below threshold)

December 30, 2009 11:06 PM | Posted by clinician 1: | Reply

Oh- and all of you out there that see people-especially personality disorders and drug addicts as having poor characters- (character flaws in alcoholics a. is the same as cluter B personaltity disorders)-making poor choices and being very manipulative- you are correct. Making assholeness a mental illness lets people off the hook to do work on themselves. Mental illness is NOT an excus for bad behavior.
Unfortunatly- many therapists and psychiatrists do not tell the person they are personality disordered so they can charge for therapy and medication management.
That is the best reason for cutting mental health services here in Cali. All the Depression and Anxiety billing for actual axis 2 that are not being TOLD and cut off if they do not read all they can about it and make an effort. Tax payer beware!!!!!

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Clinician and Patient: Two... (Below threshold)

December 31, 2009 1:34 AM | Posted, in reply to clinician 1's comment, by Anonymous: | Reply

Clinician and Patient: Two co-dependents telling lies to each other.

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Claudius, I'm all for speci... (Below threshold)

December 31, 2009 2:02 AM | Posted, in reply to Claudius's comment, by Meat Robot: | Reply

Claudius, I'm all for specificity, to a point.

It will be very interesting to see what the DSM-V committee comes up with in terms of categorical vs dimensional diagnosis. I think dimensional will do a better job of carving nature at its joints, but I wonder about the clinical utility. Down at the coal-face, we like being able to place a patient into a discrete bin.

Surely, though, you're aware of the extensive work on how problematic the categorical system has proven to be when operationalized. The average pt who qualifies for any personality disorder diagnosis, appears to qualify for about 2.8 diagnoses, when interviewed under reasonably controlled conditions using an instrument like the SCID. A dimensional system might clear up a lot of that mud.

Also, would be curious to hear your thoughts on Kernberg vs Kohut narcissism.

To the commenter who asks if psychiatry is a science? No! It is a clinical specialty of medicine. It is one which relies heavily on science, but it is not a science, just like dentistry is not a science. It also happens to work on helping with problems in areas where the science remains immature and where there are also essentially contested issues which in themselves are not scientific at all but rather ethical and political, such as whether or not the state has the right to detain persons who appear to be at risk but have broken no laws.

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Hi, this is the anon who w... (Below threshold)

December 31, 2009 4:18 AM | Posted, in reply to medsvstherapy's comment, by Anonymous: | Reply

Hi, this is the anon who was writing all the bangin' replies at 4 in the morning.

When I said that it was a false dichotomy, I did not mean that bipolar/borderline were the same (although I do think they may be etiologically related conditions)... I meant that the idea of "psychological" vs "physiological" is false. Bipolar is both psychological and physical, as is borderline. Bipolar is, in reality, marginally more physiological than borderline is, and that is *only* because there are no truly effective medications for the brain weaknessees of a borderline (being unable to moderate emotional stimuli due to certain brain weaknesses, according to the latest research, is what likely causes borderline perceptions/behaviors). There ARE, however, very effective medications for acute mania, and semi-effective medications for mania prophylaxis.

Just because there isn't yet a medication for pathological emotional processing (a physical brian function, processing emotion) does not mean it isn't physically real. That's like saying: "We don't have a cure for your cancer... so your cancer is obviously psychological. Get therapy to cope with having cancer, it's all in your head you big fIckup".

Oh, and re: depression/ruminating.

Yea, I'm really f*cking tired about hearing that depression is caused by thinking/rumination. It's complete BS. Again, that's like saying schizophrenia is caused by the FBI implanting chips in peoples brains. Depression is caused when your brain stops feeling things correctly/at all. It might be possible that SOME types of depression are caused by ruminating, but I would argue the vast majority of people with *genuine* depression have brain abnormalities which lead up to both the chronic ruminating thinking style as well as the exacerbations known as major depression.

If depression were about thought patterns, if it weren't chemical and physiological, people's moods would not respond to euphoriants like opiates? If depression were about thought patterns, why do 50-60% of depressives experience remission after total sleep deprivation? If depression is about thinking, why did my depression improve after I started using bright light therapy? Why did my depression begin after the summer left? Why was I NOT ruminating in the summer, but then all of a sudden I was ruminating in the fall?

In short: it's a big fat smelly load of bullsh*t. Depression is just as physically real as mania and psychosis, just because depressives usually seem "sane" (not always, psychotic depression etc) doesn't mean their brain is working tip top.

No one would ever suggest that mania and psychosis were caused by thinking styles. They would be laughed out of the room.

Fact: just because you can't see it, doesn't mean it isn't real.

As a depressive, I damn well know something is wrong with how my brain is working when I am going through it. I respond to things that affect me physically: bright light, warm temp, summer. I am rarely depressed in the summer, I am usually quite energetic at that time and I feel very motivated.

Do people with cyclical and recurrent depression have cyclical and recurrent ruminating personality patterns, too? LOL.

Really people need to sit down / shut up about this.

Depression is caused by a whole lot of things - metabolic abnormalities, vascular abnormalities, circadian rhythm disorders, *what ever*...
To say that depression is caused BY RUMINATION, is like saying coughing is caused BY TUBERCULOSIS. Uh, maybe 1% of the time, maybe.


Oh, and, it is a big fat red herring to say that the serotonin/neurotransmitter hypothesis is inadequate... I agree, but it doesn't mean that depression is caused by ruminating / thinking style. Yes, you are right, the neurotransmitter theory is inadequate and probably wrong. But no, that does not mean depression is psychological... all it means is that we don't really understand depression.

Go read about sleep deprivation and depression. It's interesting. People can be suicidal or catatonic, but if you keep them completely awake for 1x night, they feel better. If you scan their brains, the metabolic activity more resembles non-depressives. I've experienced this personally, I respond very well to sleep deprivation.


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Let me add as a brief footn... (Below threshold)

December 31, 2009 4:26 AM | Posted by Meat Robot: | Reply

Let me add as a brief footnote to your interesting post that, while rumination may not cause depression, cognitively combating ruminative thoughts can be the beginning of a way out, regardless of depressive etiology, for medication non-responders or for patients who simply prefer psychological approaches to treatment.

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anon 12/29 1p...Wome... (Below threshold)

December 31, 2009 4:52 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

anon 12/29 1p...
Women seek help for mental problems more often than men do.
My dad is nuts, he just doesn't talk about it.
My sister is nuts, she sees someone.

Women do tend to have more rapid cycling bipolar disorders, but saying that is caused by hormones is sorta like saying that celiac disease is caused by eating wheat or something. I mean, in a way it is, but in a more accurate way, it isn't at all. In people with the mental illness of manic depression, mood destabilizing factors such as a rising and falling estrogen/progesterone (normal female physiology) is a trigger for affective episodes. It's well noted that hormones cause affective episodes in bipolar disorders - cortisol, testosterone, estrogen, progesterone, adding or subtracting these makes people go crazy, if they are prone to it.

Note that this is not "normal" moodiness. Women may be constitutionally "moodier" than men, hormones may play a role in that...

... but this has nothing at all to do with hormonally mediated affective episodes in manic depression. This is a real phenomenon. Do some research.

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12/29 9:58: claudius... NAI... (Below threshold)

December 31, 2009 6:24 AM | Posted, in reply to Claudius's comment, by Anonymous: | Reply

12/29 9:58: claudius... NAIL ON HEAD.

Glad to see there's another perosn on this blog who can still think for themselves.

I really am quite amazed by the # of people who just blindly accept what they are told, without even bothering to run it by their logical fact checking mental software. What are the odds that narcissism is an epidemic problem? Where is the evidence? Are there allternative explanations? Why is this guy so sure it's narcissism? He strikes me as a post grad student trying to come up with an original clever idea for a thesis or something. It's like, yea, there are MULTIPLE perspectives to take on these issues. You think everything is narcissism. I don't.
There is a mindless cult who agrees.

I find followers to be very fascinating people. There is a certain type of person out there who is capable of dogmatic faith and blind agreement... they don't judge ideas, they judge people. If they judge a person favorably, they then agree with all of his ideas. They can gradually over time lose esteem in a perosn, but if they hold a person in high/authoritative esteem, they are almost physically incapable of disagreeing completely with anything he says. At *best* they are only capable of a humble admission of uncertainty... they need more time to agree, they assure the leader.

I don't, fucking, understand that shit. It should be studied, and if it is studied, I want to read about it.
This is how people join heavensgate cult and such. It's an important physical brain vulnerability in certain humans.

I believe there is a certain subset of humans simply not meant for independent thought; they are mentally wired to loosely and quickly evaluate who is the "leader", once determined, they forfeit any further thought and simply assimilate/meld with the "leader's ideas". They are like canines, they aren't meant to operate individually at all, they are only designed to identify and assimilate with the pack leader.

Really, really strange.

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Ever... (Below threshold)

December 31, 2009 6:32 AM | Posted, in reply to clinician 1's comment, by Anonymous: | Reply


Everything you just said suggests you are quite a crappy and useless social worker.
"Bipolar 1 is easy... bipolar II acts out... bipolars who don't take meds are narcissists and borderlines". What. The. Fcuk?
Um, yea, okay.

You sound like a cretinous grunt worker who is suffering from either a case of inflated self importance (i.e. you get high manipulating the lives of people in distress), or you are suffering from a case of chronic frustrating and dissatisfaction with your work (i.e. you are burnt out and don't give a shit which explains your flippant and highly prejudicial/stereotyped view of your patients).


Out of curiosity, why do bipolar II's act out? Where/why did you form this opinion?

FYI: there are more personality issues than "narcissism" and "borderline", but miserable, passive aggressive and destructive types like yourself wouldn't recognize that.
Either way, I am very frigging glad I don't have to work with you in any way.

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anon - "Women do tend to ha... (Below threshold)

December 31, 2009 8:59 AM | Posted, in reply to Anonymous's comment, by brainchild: | Reply

anon - "Women do tend to have more rapid cycling bipolar disorders, but saying that is caused by hormones is sorta like saying that celiac disease is caused by eating wheat or something. I mean, in a way it is, but in a more accurate way, it isn't at all. In people with the mental illness of manic depression, mood destabilizing factors such as a rising and falling estrogen/progesterone (normal female physiology) is a trigger for affective episodes. It's well noted that hormones cause affective episodes in bipolar disorders - cortisol, testosterone, estrogen, progesterone, adding or subtracting these makes people go crazy, if they are prone to it."

You missed my point entirely. I wasn't saying women who are manic depressive are simply having PMS or that it causes bipolar disorder, which is how you seem to have interpreted it (so you could trot out yet another analogy perhaps?). I was talking about over/mis-diagnosis of bipolar disorder in women in the light of psychiatry and medicine's very long history of pathologizing women's natural functioning and the importance of proper diagnosis - funny that you instantly leapt up to talk down to me and didn't listen! (I'm not offended, I find it funny and revealing.) Psychiatry is still not entirely free of some very profoundly prejudiced (and ideological and non-evidence based) ideas about normal/natural. There are, of course, also fantastic psychiatrists, psychologists and GPs (GPs are the ones prescribing lots of SSRIs and other psychiatric meds).

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anon - It's also kind of hi... (Below threshold)

December 31, 2009 9:22 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

anon - It's also kind of hilarious that you equate people agreeing with you to them being an independent thinker!

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"marginally more physiologi... (Below threshold)

December 31, 2009 12:04 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

"marginally more physiological" LOL. How about some data for that?

"genuine depression" LOL. Gen-u-ine!

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Phone call for Anon 6:24:</... (Below threshold)

December 31, 2009 1:16 PM | Posted, in reply to Anonymous's comment, by Meat Robot: | Reply

Phone call for Anon 6:24:

"Pot, this is kettle. You're black."

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Ah, dualism...so simplistic... (Below threshold)

December 31, 2009 1:40 PM | Posted by brainchild: | Reply

Ah, dualism...so simplistic and such an attractive cognitive trap, even for people who should know better. The whole psychological vs biological (mind vs brain) dichotomy is silly - unless you happen to prefer religion over science and think the mind exists without the body. It's as outdated and reactionary as the nature vs nurture debate. It's mind AND brain - psychological and biological - and nature AND nurture. Neuroplasticity, it's pretty cool. You can shape your brain through how you use your mind, you can shape your experience of mind through how you change your brain. It's a two way street.

It's a bit like how people trot out "normal" as being equivalent to "healthy" or "functional" to reveal they're blithely unaware of neurodiversity and really relying upon the current social conventions rather than treating their patient as an individual.

One reason I enjoy Alone's blog - whether I agree with him or not about specific things - is that he looks at how "normal" and pervasive narcissism has become in our culture (meaning Americanized corporate/consumer vs people/citizen driven cultures - this plays out slightly differently in different Western countries and America is decidedly more indivualist than many other nations that have more prosocial cultures). That doesn't mean everyone's a narcissist, but it does create an environment that promotes narcissism as desirable and acceptable, even glorious and ideal (rather than recognizing it as being antisocial behavior that's actually pretty pathetic and childish at the end of the day).

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Dear Anon 12/30 8:26pm,... (Below threshold)

December 31, 2009 7:02 PM | Posted, in reply to Anonymous's comment, by Claudius: | Reply

Dear Anon 12/30 8:26pm,

"Psychiatry is a science?"

Oh boy, what a skeptic you are taking shots at the field which attempts to explain the least understood organ in the body (the brain if you need me to add and subtract for you). I applaud you for you academic insight.

Instead of pissing on the pinnacle of human understanding of mental illness thus far, how about you spend your time developing a better method for 1) treating mental illness and 2) theoretically understanding it than is already available.

I'm sure whatever ideas you have will work much better than roughly a hundred years of research and clinical work performed by thousands of phds and medical doctors. People before our modern age weren't smart, after all they didn't have TVs. So what would they do, read or something? And everyone knows that all research is bullshit and all doctors are con men. They don't want to help people or understand reality, they want monies from big pharma!!!

How about we burn all of those books and research papers, it's not science anyway. If you don't like the fumes, you can use them as toilet paper instead.

Anon 12/31 6:24am: Watch this, he discusses the "blind leader" tendency. Sagan FTW

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Clarification: It's inheren... (Below threshold)

December 31, 2009 7:09 PM | Posted by Claudius: | Reply

Clarification: It's inherently obvious, especially to those working in or studying any mental health field, that psychiatry is a flawed science. But it's getting better. And it will continue as we continue to better understand the brain. I am not suggesting not to question it, but to respect it. Whether one accepts its flaws or not, for now, it is the best science we have for treating mental illness.

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You seem to be describing N... (Below threshold)

December 31, 2009 7:32 PM | Posted, in reply to Claudius's comment, by Anonymous: | Reply

You seem to be describing Neurology. If I ever develop a brain disease, I won't be going to a psychiatrist.

If what the PSYCHIATRISTS are saying is true, well, then we don't need psychiatrists, we just need Psychologists and Neurologists.

Keep painting yourself into a corner.

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Anonymous, you've gone from... (Below threshold)

January 1, 2010 6:00 PM | Posted by Meat Robot: | Reply

Anonymous, you've gone from merely irritating to just about paranoid. If you don't want to go to a psychiatrist, fine, but the, why are you here, badgering and ranting away? Troll much?

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<a href="http://www.ajp.psy... (Below threshold)

January 1, 2010 7:16 PM | Posted, in reply to Anonymous's comment, by Claudius: | Reply

Professor Joseph B. Martin, Dean of Harvard Medical School and a neurologist by training, wrote that "the separation of the two categories [psychiatric vs neurological disease] is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway."

Your distinction is a purely philosophical/political one and has nothing to do with better understanding mental disorders. You seem to have some personal animosity for the field of psychiatry.

All three fields are barking up the same tree. We don't yet know exactly what causes say, schizophrenia, but assuming monism is correct there should be biological causes that can explain it entirely (although we don't completely know them yet). One day all three fields may be one if/when there is an underlying theory that explains mental and physical neurological disorders. Maybe then they'll do away with the term "psychiatry" so it makes you feel better.

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What everyone here has done... (Below threshold)

January 1, 2010 9:39 PM | Posted by moia: | Reply

What everyone here has done has fallen into the trap of medicalizing assholes.
This woman isn't mentally ill, she is a selfish twat. Twats enjoy fucking with people and that is all she is doing and probably laughing her ass off about it too. If she can fake dying she can fake remorse and she is doing it for personal gain.Anyone who cant see the gain is blind to it because they want, no need for it to be medical.
See, if it is mental illness then there is a reason for her abhorrent behaviour so we all scramble for it because it makes us feel warm and fuzzy...we have solutions to medical issues!!!(that don't make us look like stupid fools for falling for her bs dying story)
But if it just some asshole behaving like an asshole so they can have everyone doing everything for them then what?
They then have to suck it up and realize they've been treated like stupid fools and God forbid our own egos accepting we have played and played brilliantly.It cant be that, we are too smart for that, it has to be an illness..ahhhh that feels so much better.
Children pretend illness all the time for gain, a day away from school, extra cuddles from mom and dad but we don't monetize those benefits.......maybe try pretending all this attention for her was just like stealing $20 bills...you are being robbed but you cant see it...heh
And here we have medical professionals arguing over medical diagnosisis for a selfish asshole who has nothing wrong with her except she was smarter and slyer than everyone around her and she robbed them of their time, their energy and their compassion and lets be serious she probably "borrowed" thousands of dollars in "loans" from all these people.
There is no medical or psychiatric diagnosis unless the DSM has recently included being a sneaky selfish asshole.
Giving her a diagnosis is EXACTLY what she wants, it's another sucker play and she is so smart she knows it and once again she is being taken care of...it's ingenious really.
Fifty years ago if someone pulled this and got caught it was jail time and an ass kicking to straighten her out but in our new world order of everyone who behaves badly must be mentally ill very bad people are having a wonderful time....free drugs!!, free food and lodging!! Sympathy and understanding!!
Really the rest of us are just stupid not to climb aboard the asshole train and wait for the nice mental health community to rush in and tell everyone we are terribly ill and all we need is.........love.
wake up, you are being played and because you are the narcissists you cant stand the idea.

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You seemed to have missed b... (Below threshold)

January 1, 2010 10:00 PM | Posted, in reply to Meat Robot's comment, by Anonymous: | Reply

You seemed to have missed by point. If "psychiatric" illnesses are say, pancreas diseases, then I'd go to an endocrinologist.

If "psychiatric" illnesess are brain diseases, why aren't they being treated by neurologists? Why aren't neurologist claiming expertise?

What is the usefulness of psychiatry, if we're talking about brain diseases? When all of the "science" shows frontal lobe abnormalities (or whatever), will Psychiatrists pass the baton to neurologists, or maybe bccome a sub-specialty?

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moi - "What everyone here h... (Below threshold)

January 1, 2010 10:25 PM | Posted, in reply to moia's comment, by brainchild: | Reply

moi - "What everyone here has done has fallen into the trap of medicalizing assholes. This woman isn't mentally ill, she is a selfish twat."

What excludes her from having a personality disorder AND being an asshole? If she has a NPD, of course she acts selfishly and is trying to manipulate people for her own gain. NPD usually equals asshole who manipulates people through their empathy, or any other means available to them. The question is, why does it outrage YOU so much and provoke such a display of extreme hatred and vitriolic language from you? The sexist and abusive tone you're using screams "asshole", which is more than slightly ironic. You seem to be taking something that has nothing to do with you very personally and be assuming yourself to be much superior to everyone else.

Someone having a personality disorder doesn't excuse their behavior but being aware of this can give insight into why they're behaving a certain way and perhaps, if properly diagnosed, lead to appropriate treatment.

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anon - "What is the usefuln... (Below threshold)

January 1, 2010 10:38 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

anon - "What is the usefulness of psychiatry, if we're talking about brain diseases?"

Are you familiar with neuroplasticity? That how one uses one's brain influences the physical structure of the brain?

Also, you seem to be mistaking disorders with diseases. For instance, Autism isn't a disease even though there's a biological basis for it. Narcissistic personality disorder isn't a disease, it's a personality disorder (that may or may not have an underlying biological basis).

Clearly if someone has brain cancer, a neurosurgeon is appropriate and a psychiatrist is useless to treat the cancer (but may be very useful to the patient in terms of emotional support and coming to terms with having brain cancer). But, if someone has a NPD a neurosurgeon is useless (certainly at this point in time).

Cognitive science is the arena where neurobiology, psychology/psychiatry and related areas of study overlap.

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Anon, thanks for clarifying... (Below threshold)

January 1, 2010 10:40 PM | Posted, in reply to Anonymous's comment, by Meat Robot: | Reply

Anon, thanks for clarifying.

You might find medical reality a lot more blurry than you realize. There is lots of overlap in terms of what gets treated by whom, and co-management is common. There's no neurology bin where brain diseases get deposited.

Then there's also the practical matter of clinical expertise. Even if we ever demonstrate beyond a shadow of a doubt that, say, bipolar disorder is a "brain disease," that doesn't mean neurologists will suddenly take training courses on how to prescribe lithium. There's simply too much knowledge to be acquired to think psychiatry will disappear into neurology and psychology.

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"Even if we ever demonstrat... (Below threshold)

January 1, 2010 10:57 PM | Posted, in reply to Meat Robot's comment, by Anonymous: | Reply

"Even if we ever demonstrate beyond a shadow of a doubt that, say, bipolar disorder is a "brain disease," that doesn't mean neurologists will suddenly take training courses on how to prescribe lithium."

That's my point. Why not? I'm talking about newly trained neurologists learning how to treat Bipolar Disorder in school and residency. Honestly, adding Schizophrenia, Bipolar, and MDD to the course work would not be difficult, and all of the other (uhh)BS goes to Clinical Psychology (most of which they already know).

For what it's worth, NPs and in some states Psychologists already pratcitice what is essentialy Psychiatry, with just 1-2 years of extra training. The idea that Psych NPs practice "Nursing" is obviously a joke.

"Too much information" to pass out really isn't a problem, in terms of getting rid of psychiatry.

Psycholgists and Neurologists should be able to do the job.

I have read numerous exams from all 3 disciplines, and, by far, psychiatrists offer the least amount of insight or descriptive detail. Psych PhDs and Neurologists offer the most, in terms of advanement of therapy and neuroscience. Just about every new psychiatric advancement in the last 10 years has actually been a Nuerological discovery.

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We have psychology and Neur... (Below threshold)

January 1, 2010 11:12 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

We have psychology and Neurology. What is this THIRD thing that you speak of? What questions do these two disciplines not cover that necesitates psychiatry? What will not be addressed--that can't be addressed by some other discipline--if psychiatry disappears?

Psychopharmacologists should be trained by Neurology departments.
Therapists should be trained by Psychology departments.


Autism should be able to be managed by a psychologist and a neurologist. What is this third area that needs attention?

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But neurology departments a... (Below threshold)

January 2, 2010 2:11 AM | Posted by Meat Robot: | Reply

But neurology departments are busy training neurologists. I don't think I get your point. It appears you're trying to be very clever, but perhaps too clever by half. If you want super-neurologist-psychologists who treat all neurological and mental disorders, I eagerly await your proposed curriculum.

Let's go even further. After all, all disease is simply pathophysiology or pathology of the body, so really, why don't we simply have internists and surgeons?

And why stop there? Really what we need are super-duper-doctor-surgeons who treat all mental and physical problems.

Oh wait, we did have that, and that was about 100 years ago. But then knowledge exploded, and it simply became impossible to keep up.

And if you think treating schizophrenia is easy, perhaps you should consider spending some time on a psychiatric inpatient unit to see what's involved.

I still don't get your argument. Do you really think neurologists aren't busy enough? Are you a neurologist with a slow practice? What gives with this pseudo-Szaszian attempt to define psychiatry out of existence? It's sophomoric.

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anon - "Honestly, adding Sc... (Below threshold)

January 2, 2010 9:29 AM | Posted, in reply to Anonymous's comment, by brainchild: | Reply

anon - "Honestly, adding Schizophrenia, Bipolar, and MDD to the course work would not be difficult, and all of the other (uhh)BS goes to Clinical Psychology (most of which they already know)."

So anything that's not classifiable as schizophrenia, manic depression or MDD is "BS"? You're also making claims for clinical psychology that clinical psychology doesn't make for itself and seem to misunderstand the nature of the mind and brain, and the relationship between the two.

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Respectfully, I'll try agai... (Below threshold)

January 2, 2010 2:07 PM | Posted, in reply to Meat Robot's comment, by Anonymous: | Reply

Respectfully, I'll try again. Please just answer this one question, and perhaps I'll be wrong about the issue.I'm not asking this based on how the disciplines are divided today. I'm arguing that an unncessary discpline exists. We only need two.

What areas of mental illness cannot (in theory) be answered by psychology and neurology? (I'm not asking as it stands TODAY, as I am arguing that how it stands today is not correct. I'm asking, if you look at what the disciplines SHOULD be composed of). 100% of all questions related to behavior, mind, and brain can/should be answered without psychiatry (unless it's a sub-specialty of N).

Neurologists should study brain abnormalities that may exist in Serotonin pathways, or structural abnormalities such as in the amygdala, and prescibe medication. Cl Psychologists should study irrational thought patterns, motivation,relationshiops etc. and provide therapy. What else is there?

FYI, the BS about Pschology was tongue-in-cheeck, and I apologize if it was distracting.

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"Let's go even further. Aft... (Below threshold)

January 2, 2010 2:17 PM | Posted, in reply to Meat Robot's comment, by Anonymous: | Reply

"Let's go even further. After all, all disease is simply pathophysiology or pathology of the body, so really, why don't we simply have internists and surgeons?"

It sounds like you think I'm arguing against specialization, which I'm not.

We don't have TWO areas claiming a SPECIALTY of a single organ.

We don't have TWO types of specialists treating liver diseases.
And, if we did, one would be a sub-specialty of a larger, more general category.

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You are EXACTLY right. Libe... (Below threshold)

January 2, 2010 2:20 PM | Posted, in reply to moia's comment, by Clinician I: | Reply

You are EXACTLY right. Liberal babies get upset at me for seeing shitty people COMPLETELY taking advantage of tax payer’s money.
They have character flaws and are NOT being held accountable for their behavior by being given axis 1 diagnosis, therapy, and medication. Period.

The person-anonymous who was so angry at me for holding "mentally ill" bullshit accountability is exactly that liberal, idealistic baby who can not handle the FACT that we are being suckered and it costs us billions. The ego of the men who have come up with most of this crap that includes abhorrent behavior is about their egos and creating jobs. Drug addiction as a disease-what a croc of shit. It's a poor coping skill and a physical dependency. The entire BS about- prove narcissism is increasing! It has been called different things-that’s all. Like addiction. Like divorcing when you have young children, like not seeing your children when you are divorced, moving away from the father to get him "back". All those ways parents suck-narcissism. Not focusing on making your marriage work, being present with your children, not "using", etc.
Of course i love this discussion, but I am not so self important that i do not see a complete lack of values in people. And I am not religious. In fact i hate religion. I do see people with no values or ethics ALL the time.
So, love your no BS radar.

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What gives with this pseudo... (Below threshold)

January 2, 2010 2:22 PM | Posted, in reply to Meat Robot's comment, by Anonymous: | Reply

What gives with this pseudo-Szaszian attempt to define psychiatry out of existence?
What gives with this Meat Robot (great name) attempt to define psychiatry into existence? No one would naturally separate the diseases of an organ into two specialities. The divide exists soley because we incorrectly thought about "mental illness."

Now that we know, why keep the irrational separation.

So, fill in the blank.


If it's a brain disease, see a neuroglogist.

If it's a lifestyle, relationship,existential, or "mind" problem see a psychologist.

If it's a ______________, see a psychiatrist.

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"What gives with this Meat ... (Below threshold)

January 2, 2010 3:03 PM | Posted by Anonymous: | Reply

"What gives with this Meat Robot (great name) attempt to define psychiatry into existence? No one would naturally separate the diseases of an organ into two specialities. The divide exists soley because we incorrectly thought about "mental illness.""

We still think incorrectly about mental illness. In fact we seem to be thinking more and more incorrectly:
http://bipolarblast.wordpress.com/2009/12/30/robert-whitakers-new-book-is-available-for-pre-order/

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That's me, 'emp', posting a... (Below threshold)

January 2, 2010 3:05 PM | Posted by emp: | Reply

That's me, 'emp', posting above comment. Not anonymous having a conversation with himself.

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re: psychiatry disappearing... (Below threshold)

January 2, 2010 3:33 PM | Posted, in reply to Meat Robot's comment, by smartanon: | Reply

re: psychiatry disappearing once all diseases of the mind are identified physiologically in the brain...

No, this won't happen. If, tomorrow, we identified the exact brain defect that causes manic depression, if we were to find out exactly what is going on in the brain to cause that, it is very likely manic depressives would then be seen by neurologists. It would no longer be considered mental illness but a neurological disorder, like any other neurological disorder which has a behavioral component (such as seizures). This is probably true.

Psychiatrists are useful for two types of brain diseases:
1) Those without any known etiology
2) Those with a strong behavior or thought disturbance

The types of clients a neurologist sees always fit one of those two criteria. They have a brain disease with a distinct and known etiology (e.g. seizures occurring in the temporal lobe), and/OR the patient is not markedly thought, emotionally, or behaviorally disturbed.

Psychiatry is where brain diseases no one understands are dumped. If we understood schizophrenia better, if we knew what was going on, why people ended up that way, sz would probably umbrella under neurology. These clients w. schizophrenia, which is almost certainly NOT a distinct/single disease entity, would be then properly renamed/diagnosed as appropriate - after the genetic deletions, autoimmune processes, what have you. If they don't know why you're schizophrenic, you're called a schizophrenic. If they DO know why, it's given a pathophysiologically (or narcissistically) motivated name, but either way, it is given a proper name which validates the physiologically real process occurring to the brain. E.g. 22q11.2 deletion syndrome, or "DiGeorges Syndrome". If it were never identified, these patients would be called schizophrenics (or manic depressives ultra rapid cycling).

Even if a patient has a very distinct brain disease (e.g. types of dementias / parkinsons), if there is a marked behavioral disturbance, the patient will probably be seen by a psychiatrist. This is the second usefulness of the psychiatrist: to make unacceptable behavior more acceptable.

This heralds back to psychiatrists early days - of being a psuedo-medical profession to control or abuse societies undesirables, losers freaks and fuckups, throw aways and retards. Back before pharmaceutical companies made teenagers want to be bipolar, before it convinced everyone they were ADHD, before it made people not think twice about taking an SSRI... back then, no one ever would be associated with psychiatry. Psychiatry is where you ended up when you were a total hopeless mental invalid who really couldn't stop the process of being assimilated into psychiatry. And, only the supremely mentally defective OR those who were socially isolated in some way ever saw a psychiatrist. There wasn't really outpatient psychiatry, you sorta went to the nuthouse and stayed there a long time, or possibly forever.


Psychiatry will always be around, because it is the profession that deals with socially unacceptable behaviors and thoughts. Dementia is a good example. If grandpa is punching nursing home staff insisting he has to go to his house to get ready for work tomorrow, grandpa is going to end up on risperdal or seroquel at a low dose, after being seen by a geriatric psychiatrist. Grandpa was never a psych patient, but he is 80 years old with dementia. A neurologist isn't going to help him, because there isn't a cure for dementia.

As long as disrupted and abnormal behavior/thought exists, psychiatry will as well.

Neurologists do not deal with behavioral disturbance, other than perhaps to note it as a symptom of a neurological disorder.

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We don't have two specialti... (Below threshold)

January 2, 2010 3:44 PM | Posted by Meat Robot: | Reply

We don't have two specialties for a given organ? You're kidding, right? Let me give a few examples which I hope you'll find non-controversial:

1) General cardiology, Invasive cardiology, cardiac imaging, nuclear cardiology (there's 4, and let's not forget pediatric cardiology)
2) General neurology, epileptology, neuroradiology, invasive neurology, neuropathology (5, and I've left some of the list which could genuinely be viewed as not sufficiently subspecialized)
3) General respirology, respiratory oncology, bronchoscopy

Anyway, I think this idea of "no two specialties per organ" is a totally arbitrary move, and it is simply at odds with reality.

No doubt, psychiatry, psychology, and neurology are students of a common organ, but so what? If you want to extend the metaphor, you could quite easily decide that we don't need anthropology, since really, culture just reduces to things the brain does. Where does it stop?

Now, what does psychiatry uniquely treat? You yourself have mentioned it many times: psychotic disorders, mood disorders, anxiety disorders, substance disorders, disorders secondary to general medical conditions, eating disorders, personality disorders. Just because other practitioners can legitimately be involved does not mean that the unique expertise of psychiatry somehow fails to exist.

In short, psychiatry attempts to treat the mind, via pharmacological and psychotherapeutic routes. Yes, "the mind" is a construct, but a very useful one. And yes, psychologists treat this too. Ok, so what? Couldn't we just as easily say that, given the existence of psychiatry and neurology that psychology is redundant? Where does that get us? And sure, nurse practitioners can effectively treat a lot of mental disorders. They're also pretty glad to know that they've got a psychiatrist in their back pocket when a problem is complex.

Or, put it this way. A neurologist is referred a patient who manifests unusual motor and sensory disturbances. The neurologist concludes the diagnosis is somatization or perhaps conversion. I suspect that neurologist would be a pretty sad panda if suddenly there was no psychiatrist to refer the patient to.

Or, hey, let's keep playing! Maybe it's psychiatrists who could learn neurology, and we could be rid of neurologists. We all go to medical school, so we start with the same foundation of knowledge. Then, given that psychologists treat what psychiatrists are already treating, let's get rid of them too. Ta da! Psychiatrists are uniquely poised to treat brain diseases and mind diseases, given their intimate working knowledge of the interface.

This argument of yours cuts many ways.

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The fill in the blank que... (Below threshold)

January 2, 2010 4:13 PM | Posted, in reply to Meat Robot's comment, by Anonymous: | Reply

The fill in the blank question...Want to give it a shot?

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"General cardiology, Invas... (Below threshold)

January 2, 2010 4:25 PM | Posted, in reply to Meat Robot's comment, by Anonymous: | Reply

"General cardiology, Invasive cardiology, cardiac imaging, nuclear cardiology (there's 4, and let's not forget pediatric cardiology)"

yes, various types of sub-specializations within a single speciality. Its' STILL cardiology, not an entirely different branch of medicine.


I don't think you tried very hard. Or you misundertand me.
We'll pick up the issue at another time.

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To Anonymous: Meat Robot to... (Below threshold)

January 3, 2010 2:29 AM | Posted by Larry Fuse: | Reply

To Anonymous: Meat Robot totally destroyed you with his 3:44pm post. Obviously you are in denial. You should really go see someone about your denial issue. Otherwise shut the fck up please.

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Hey Clinician 1 - the simpl... (Below threshold)

January 3, 2010 2:49 AM | Posted, in reply to Clinician I's comment, by smartanon: | Reply

Hey Clinician 1 - the simplistic and highly prejudicial characterizations of your patients is strong evidence you are a completely useless WASTE of a clinciian. You are a WASTE of taxpayer money, if anyone at all is. You are the sort of useless paper pushing burnt out do nothing that really doesn't need to be working with people in distress at all. The bias, indifference, and resentment you have toward the people you are supposed to try to help speaks louder than all of your "experience".

I'm a nurse. I'm very familiar with the issue of burnt out (or never lit up) practitioners.

If anyone is a waste, it's you buddy. If you hate your job and all your patients so much, work in a post office or something.

I'm still looking for a rational answer as to why all bipolar patients who don't take meds are "narcissists or borderlines". Don't you think medication side effects and subjective perception that medication does not much add to quality of life has something to do with it? Do you even bother caring to understand how your patient is feeling at all?

There's this myth out there that bipolar is a highly treatable illness and everything will be alright if you take medicine. Medicine has side effects. It makes people feel tired, it doesn't always eliminate the most troubling symptoms (which for many bipolars is actually depression), it often makes you fat if youre on APs, and stupid and bald as well if you're on ACs. I can understand why someone might want to stop their meds, especially if it is a bipolar II w/o mania, or if they are the sort that doesn't get relief from them.

Not that I think it's a good idea, but I can at least understand why someone would do that, and I don't think it indicates narcissism or borderline (which, I've discovered, are often bullshit labels arbitrarily thrown at people you don't like very much).

No sympathy for addicts? Addicts usually have mental illness and/or a f*cked up early life. My father is a drunkard but his life has been abysmally terrible. I am surprised he does as well as he has.

I really recommend you get into another field. You don't seem to care about people very much, nor do you think people can be helped. Why are you wasting government money being in this field, wasting everyones time pretending to help people?

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"I really recommend you get... (Below threshold)

January 3, 2010 7:10 AM | Posted, in reply to smartanon's comment, by Fcking Duh: | Reply

"I really recommend you get into another field. You don't seem to care about people very much, nor do you think people can be helped. Why are you wasting government money being in this field, wasting everyones time pretending to help people?"

Because she is a narcissist. And she needs the income so that her narcissist identity can remain intact.

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"Because she is a narcissis... (Below threshold)

January 3, 2010 10:22 AM | Posted, in reply to Fcking Duh's comment, by Anonymous: | Reply

"Because she is a narcissist. And she needs the income so that her narcissist identity can remain intact."

Sure it's not a borderline personality disorder? Clinician1 seems extremely jealous of the attention the patients are getting and to have a very profound need to feel superior (while denying their own very obvious problems). Calling themselves "clinician" when they're a social worker is also a bit grandiose. Whatever the case, the incredible hostility expressed towards the people Clinician is meant to be caring for and helping makes me think of Nurse Ratched. What a nightmare for the poor people who have to deal with someone so obviously abusive of vulnerable people - and I bet they get away with it because she says that the victims are just "crazy/faking it/making it up" when and if they report clinician. Clearly clinician should really be a patient and not in any kind of position of caring for others or even minor power over others.

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Anonymous (or Anonymi, not ... (Below threshold)

January 3, 2010 12:48 PM | Posted by Meat Robot: | Reply

Anonymous (or Anonymi, not sure if you are one or many), not really sure what else to say or add. You said, "No two specialties per organ," and I said, "How about 5?" You then say, "Yeah, but it's still cardiology." Umm, dude, that's called Cherry Picking. If you look at my other example of neurology, neuropathology and neuroradiology, those are very different specialties all attending to the brain.

As to filling in the blank, oh dear god, how many times are posters on this thread going to have to say what psychiatrists treat that neurologists and psychologists do not? And you will continue to make your shyster, "Yeah, well, with training, they could" move. Well, guess what, with sufficient time and training, just about anyone could do anything. Is this really an argument in favour of or against anything? We could have physicians learn how to build houses. Could we then say that all house builders should be GP's, because the housebuilders aren't really doing anything unique? It's simply a perverse argument. Don't you see that?

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just clicked onto that link... (Below threshold)

January 3, 2010 2:20 PM | Posted by the0ther: | Reply

just clicked onto that link about "dr bass". saw her picture there. damn. if i were born female looking like that...i would think that everything in life is a lie. poor thing.

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Yes, if you can't see the d... (Below threshold)

January 3, 2010 2:51 PM | Posted, in reply to Larry Fuse's comment, by Anonymous: | Reply

Yes, if you can't see the difference between Geriatric Cardiology and Pediatric Cardiology AND Caridology and Endocrinology, then you are not very bright.

I am glad that when I say no two specialties cover the same organ, he lists multiple examples of THE SAME SPECIALTY.

So, again, name two specaililtes that manage the Liver. Oh, Geriatric Internal medicaine, Pediatric Internal Medicine...that's not very bright. Now if the answer were Podiatry and Internal Medicine, that would actually be an answer to the question.

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Cardiology Critical ... (Below threshold)

January 3, 2010 2:58 PM | Posted, in reply to Meat Robot's comment, by Anonymous: | Reply

Cardiology
Critical care medicine
Dermatology
Emergency medicine
Endocrinology
Gastroenterology
Geriatrics
Haematology
Hepatology
Infectious diseases
Actual answers: Nephrology
Neurology
Oncology
Pediatrics
Pulmonology
Rheumatology
Sleep medicine


Meat Robots Answers: Cardiology for Medicaid Patients, Cardiology for Private Pay Patiens, Cardiology in Virginai,


If Neurologist were building houses, I'd suggest that we reevaluate why. Glad that you agree that when Psychiatirsts start treating brain diseases, we need to ask why.

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Serious Anonymous, do you r... (Below threshold)

January 3, 2010 4:14 PM | Posted by Anonymous: | Reply

Serious Anonymous, do you really think the liver and the brain are the same? You seem to be arguing from a place of complete ignorance regarding both brain and mind! You also seem to have no clue what psychologists, psychiatrists and neurologists actually do.

The brain is an organ that gives rise to the mind, it's hardly equivalent to the liver. The brain can be influenced by the mind, and the mind is influenced by the brain.

1. Generally speaking, psychologists don't prescribe and aren't MDs, this makes their training inadequate to treat people with schizophrenia and they rarely do without the support of an actual MD (unless they happen to be an MD themselves). Their tool is talk therapy, they treat all kinds of people who DON'T have brain diseases but need help with relationship issues, behavioral problems, identity issues, grief, existential angst, etc. Depending on what kind of psychologist they are, the range of therapeutic approaches used is vast! Their specialty is dealing with the mind.

2. Psychiatrists are MDs specialized in the brain AND mind, they can prescribe which is why they are usually deal with patients with schizophrenia and other issues. They use both drugs and talk/behavioral therapies.

3. Neurologists deal with the physical brain and deal with diseases and injuries that neither psychologists or psychiatrists do. They don't deal with the mind.

Since you brushed off what psychologists deal with as BS (your claim to be joking rings hollow since you're so fixated on the idea that only "brain diseases" are worth treating) you seem to be totally dismissing the mind and the relationship between brain and mind purely to promote your prejudice against psychiatrists.

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Ehm, forgive me, but I got ... (Below threshold)

January 3, 2010 6:32 PM | Posted by A Girl: | Reply

Ehm, forgive me, but I got lost somewhere in the sea of anonymous responses. Exactly why would it be better to be treated by a neurologist and a psychologist rather than a psychiatrist? Do neurologists possess any diagnostic tools that psychiatrists do not?

Also, might I point out that it is a rather simple courtesy to pick a name for yourself? None of the fields are obligatory, so it is not like you need to enter an email adress if you enter a name, and if you can't be bothered remembering to do it, you can always check the box "Remember personal info." It may seem like a small thing, but it would make life easier for those of us who like following the debates that spring up in these comments. Thank you :)

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Ahh, Anonymous, now I see y... (Below threshold)

January 3, 2010 6:34 PM | Posted by Meat Robot: | Reply

Ahh, Anonymous, now I see your game. Ok, your last two posts clearly indicate that you are thoroughly disingenuous, to the point of not even reading my posts. Your argument has collapsed into sophomoric ridicule, and you stick to utterly refuted nonsense.

Get back under your bridge, troll.

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Sorry if I added to the con... (Below threshold)

January 3, 2010 7:11 PM | Posted, in reply to Anonymous's comment, by brainchild: | Reply

Sorry if I added to the confusing number of Anonymice here - I wrote the the post to Anonymous that started like this...

Serious Anonymous, do you really think the liver and the brain are the same? You seem to be arguing from a place of complete ignorance regarding both brain and mind! You also seem to have no clue what psychologists, psychiatrists and neurologists actually do.

The brain is an organ that gives rise to the mind, it's hardly equivalent to the liver. The brain can be influenced by the mind, and the mind is influenced by the brain.

(Though I'd assume that it was evident that I'm not the other anonymous who's arguing blindly against the ongoing existence of psychiatry. Too bad it's a blind argument since there is a valid discussion to be had about how these disciplines - and even different theories and practices in these disciplines - interact and interrelated. Particularly since there can be some conflict between them at times and there are valid criticisms that can be made about all.)

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I agree it is reassuring to... (Below threshold)

January 8, 2010 2:01 PM | Posted, in reply to fraise's comment, by Andy: | Reply

I agree it is reassuring to see people who say they are clinicians discuss their patients in such an open and honest way.

Referring to patients as:
"Useless schlubs"
"assholes"
"its"

Patients thoughts and feelings as:
"diatribes"
"shit"

...and talking about how bored they are with their jobs.

I can honestly say if I ever get depressed to the point where I can't get out of bed I would rather commit suicide then see one of you useless pieces of shit and walking wastes of flesh for help.

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Actually you've made my poi... (Below threshold)

January 8, 2010 6:05 PM | Posted, in reply to brainchild's comment, by Anonymous: | Reply

Actually you've made my point: Brain (neurology), mind (psychology), and what else is there?

Because the brain is differnt than the liver, we have two disciplines: Neurology and Psychology.

How about naming that magical third thing for us?

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No Anonymous, you've just m... (Below threshold)

January 8, 2010 11:58 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

No Anonymous, you've just missed the point yet again due to your bias and are trying to cover for your ridiculous assertion the brain is equivalent to the liver or spleen. That "third" thing is the relationship between mind and brain. Really, the mind/brain is complex enough that it can be studied and treated from a variety of angles and different approaches work best for different problems.

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Bass's behaviour is that of... (Below threshold)

January 14, 2010 12:47 PM | Posted by La BellaDonna: | Reply

Bass's behaviour is that of a sociopath (what I, in my limited experience, had identified to me as consistent with sociopathic behaviour). The PRIMARY goal is PITY - pity, because that is the tool the sociopath (what LP describes as a narcissist/what I learned was "sociopath") uses to achieve whatever else it is the sociopath wants: attention, money, sex, the use of the pool, all the chocolates - the end result doesn't have to make sense to anyone else, just the sociopath, and PITY opens the gate to making it possible.

Normal people aren't looking for pity - not all the time. Of course they want sympathy in a troubling situation - people who'd like to hear "I'm so sorry" when something awful has happened aren't sociopaths or narcissists! But when the channel is set to All Pity, All The Time, it's because the sociopaths are interested in manipulating the listener into a specific response, generated by the Pity: often, but not always money. Sometimes it's as simple as not having to go to work to support themselves (... which does seem to fall under money, doesn't it?), sometimes it's as simple as being the Center of Attention, which Bass certainly was.


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Well there was something ob... (Below threshold)

March 30, 2010 12:07 PM | Posted by TS: | Reply

Well there was something obviously wrong with her. I'm not sure I would have favored bipolar has the diagnosis. I have worked with, went to school with and talked with bipolar people and none of them were the type to make up an illness...especially not actively make it up. This woman had to go to great lengths to make people believe she was sick and dying. But who knows, the definition of mental illnesses seem to change so frequently that maybe it is bipolar. I don't buy it, but then again, I'm not her doctor.

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I am only 50 but can’t beli... (Below threshold)

April 21, 2010 10:33 PM | Posted by basketball shoes: | Reply

I am only 50 but can’t believe how everyone needs advice on how to survive an economic disaster or how anyone even got into an bad economic situation. Health problems should be the only excuse.basketball shoes

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It is aggravating when anti... (Below threshold)

April 29, 2010 11:38 PM | Posted by bpladybug: | Reply

It is aggravating when anti-social people who commit crimes with no remorse, whether the school teacher and the under age boy (Mary Kay LeTourneau) or this disturbed, deceitful woman with some factitious disorder! And lots of murderers too. And then their attorney announces they are bipolar! argh!!!

I am bipolar 1, a professional, over age 50. I do not even tell people about my BP 1 because of the additional stigma which these disturbed, violent, lying crackpots create in the public imagination.

My mental health care team is a neurologist and a psychologist who specializes in CBT. I am pleased with my care. We did find the magic cocktail which keeps me stable. (lithium/seroquel/neurontin) Yeah, I know it supposedly does not work. But it helps me. Sometimes I wonder if I need an actual Psychiatrist because it is BP 1 after all. Fortunately I have not been near an ER or hospital in years. With my clients I am considered 'lively and emotional'. Beats paranoid, suicidal, and manic any day. LOL I try to have some humor with my brain disorder.

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She is classic--classic NPD... (Below threshold)

June 29, 2010 3:14 AM | Posted by sjf: | Reply

She is classic--classic NPD. These lovely folks have a personality disorder, not a mood disorder like bipolar or PTSD. It is not hard to figure out the motive behind any of her lies if you have lived with a narcissist. The manipulation of her coworkers, friends, and family maintains her narcissistic supply. As the OP stated, it is easy to focus on the fact she was faking physical illness, but that is immaterial, merely her chosen instrumentment. And contrary to some posters' statments, she had everything to gain--sympathy, companionship, becoming "mistress" over those taking care of her, and perhaps most importantly, a probable reduction in accountability and oversight in work performance due to her perceived illness. There is no cure, no magic pill. Narcissists are simply wired this way...so sad for those in their path. If they make it into therapy, they are nearly always diagnosed as bipolar or PTDS by well-meaning but gullible therapists. They lie to create the background to sustain the diagnosis. When a therapist gets too close to the truth, the N moves on. But when they are able to sucker a therapist, they gain, again, the supply--the sympathy, the master/mistress of the game notion, the excuses from accountability...see the pattern?

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She is psychotic...case clo... (Below threshold)

January 17, 2011 8:06 AM | Posted by Anonymous: | Reply

She is psychotic...case closed.

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if not, how much does it co... (Below threshold)

July 1, 2011 4:44 AM | Posted by Jimmy Choo Shoes: | Reply

if not, how much does it cost? Thanks a lot!


Jimmy Choo Shoes

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Because it's not been said ... (Below threshold)

November 2, 2011 12:51 AM | Posted by Nepeta: | Reply

Because it's not been said (maybe too many clinicians and not enough patients?) ...

Even *IF* the role of psychiatry can be subsumed under neurology and psychology, what effect will this have on patients?

My care demands both "neurological" and "psychological" intervention (what mental illness realistically doesn't?) because *BOTH* are factors in my illness. My illness is "complicated" (be honest, whose isn't?) and I will not improve without both.

I do not want multiple doctors for this. Doctors are terrible at communicating with each other, IME, and may barely understand each other, or be dismissive of each other. I believe this results in *POOR*, not to mention *CONFUSING*, care. it compromises the doctor/therapist-patient relationship/s, which is *IMPORTANT*.

I like that I have a doctor who specialises in the care of disorders requiring both interventions. It is *EASY*. It *WORKS*. My illness is confusing enough without having to constantly translate/educate doctors/psychologists/etc. on things that *I* may barely understand, not being a medical/mental health professional (been there).

Regardless of whatever word-play or ideological debate you want to engage in, psychiatry is probably the most pragmatic way of addressing mental illness.

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This lady was my Calculus 2... (Below threshold)

July 19, 2012 7:45 PM | Posted by Monkeybob: | Reply

This lady was my Calculus 2 teacher from late May 2012 to mid June 2012. She is not a great teacher by any means and she kept (probably lying) that she was going to be losing her left leg within the next few months. She was fired for not doing a great job and the college apparently knew about her past.

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