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Personality Disorders

 

In my Assessment and Diagnosis class last semester (for graduate school in Social Work), I had to spend a week studying the personality disorders. These are, at least for now, seen as the enduring pathological character traits people live with in their daily lives. The personality disorders are separated out from other mental health disorders because of their lifelong nature, and because, usually, the patient doesn’t see his or her behavior as problematic, which makes them very hard to treat. But more often than not, the personality disorders are used as epithets, by lay people and clinicians, to describe people who resist therapeutic help. The current list of personality disorders is broken into three clusters: the not-quite-schizophrenia-but-still-odd-and-occasionally-psychotic personality disorders; the criminal-manipulative-lacking empathy-selfish personality disorders; and the fearful-avoidant-dependent-obsessive-compulsive personality disorders.

 

 

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“Are you diagnosing me, Mommy?”

This small strip of the DSM (The Diagnostic and Statistical Manual of Mental Disorders) has come up recently, in our public dialogue, as people struggle to explain the president’s behavior. We don’t know if he has dementia, or some other mental illness or medical diagnosis, but we can certainly see traits that fit Narcissistic (grandiose and exploiting of others), Histrionic (melodramatic and attention seeking), Paranoid (preoccupied with doubts of loyalty in others), and Antisocial (lying, intentionally harming others, and lacking empathy) Personality Disorders.

The value of the personality disorders is that they give us categories to put people into when they consistently behave in abnormal ways, and categories can help us feel like we have some control, and some understanding, about what’s going on around us. But, are personality disorders actually mental illnesses, or something else? The personality disorders attempt to describe the perpetrator of domestic violence (Antisocial personality disorder), and the victim (Dependent personality disorder), as equally ill, and/or equally character disordered. Meaning that as a society we have as little compassion for victims as for perpetrators, something that is objectively true, but still horrifying. Other personality disorders are just lower level, and more persistent, versions of mental illnesses we already have in the book, like Obsessive Compulsive Personality Disorder, which is seen as different from Obsessive Compulsive Disorder (and, yes, that’s weird).

The personality disorders are the most extreme example of what’s wrong with the DSM: it focuses only on the negatives, the weaknesses, and the disorders of human beings, and never on the strengths that mitigate illness. The same person who has Major Depressive Disorder may also have a great support system that keeps her going. The same person who obsessively washes his hands or checks the lock on his door, maybe also obsessively study or work or create and accomplish great things. The same person who lives daily with Social Anxiety Disorder may have an even stronger need and desire to connect with other people, which allows her to reach out despite her fear.

Miss Cricket has her own reason for thinking that the personality disorders are unnecessary: she knows, in her gut, who to spend time with and who to avoid, and she doesn’t think she needs a diagnostic manual to help her. For her, it’s all about a complicated internal set of calculations, based on how much you smell like someone who gives out chicken treats (she is doing her best to teach Miss Ellie this wisdom as well). I have seen no mention of generosity with chicken treats, or any other positive character traits, in DSM 5. Clearly they have more work to do for the next edition.

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(Cricket transmits a lot of information through her butt. Who am I to judge?)

 

MSW

For the past few years, I’ve been taking psychology courses, to see if I liked them, and to work towards applying to a PhD or PsyD program in psychology. My therapist, an MSW, has spent a lot of her career being bossed around by people who had nothing like her level of experience and expertise, simply because they had doctorates, and she wanted better for me.

Sometime in the fall of 2014, though, it became clear to me that a doctoral program, of any kind, would not be possible right now. I would have to commit to full time coursework, plus field work, and my body just can’t take it, and neither can my mind. So then the question was, do I continue to float, taking more undergraduate psychology classes at the community college, or do I accept my current circumstances and apply to a social work program, most of which can be done part time, and after which I would be able to work in that field. (A Masters in psychology, at least in New York, wouldn’t qualify me for a job. This is a “social work state.”)

Cricket would prefer that I work towards a degree in Cricket Care. We could do three hours a day of training exercises, massage and physical therapy, plus an hour long walk at the beach. She’d be willing to give me a degree for that, or at least a certificate. I think Butterfly would rather we fostered dogs from the animal shelter, or set up a doggy hospital in the apartment, so that she could help nurse them back to health. The idea that I’ve chosen a course of study that doesn’t involve her, or make use of her talents, feels very selfish.

Cricket's exercise plan.

Cricket’s exercise plan.

Cricket’s walking plan.

Starting in December, after my last undergraduate psychology class ended, I put all of my energy into my application for graduate school in social work, including: writing my essay, asking for recommendations, and requesting transcripts from the different schools I’ve attended over the years. I kind of hoped I’d be rejected, though, because I wasn’t sure I wanted to go. The whole idea of preparing for any career that isn’t writing really bothers me. I know it’s the most practical option – since years of hard work have not yet led to becoming a published author, and because I have a deep interest in psychology and social issues. But, down to my core, I’m a writer. I’m a novelist and a memoirist. I write because I have to, and because I love it, and because it’s the most necessary thing in my life, next to breathing. Sometimes before breathing.

Butterfly understands. Sometimes ducky gets in the way of breathing too.

Butterfly understands. Sometimes ducky gets in the way of breathing too.

The program I chose accepted me for fall 2015, and it will take me four years to finish, instead of two, and the course work will be online, to leave me energy to do the field work in person. But I’m worried that the coursework will be boring, or even antagonizing, and bring on despair about the state of the world that even the puppies won’t be able to joy me out of. I’ve already started reading one of the textbooks and it is full of gobbeldy gook. Anything you could say in five words must be stretched out and twisted into fifty pages of verbiage. It’s a rule.

Maybe I should give my textbooks to Butterfly.

Maybe I should give my textbooks to Butterfly.

The girls are not readers, it’s just not their thing, and they see no value in collecting degrees, but they would love to spend more time each day learning and doing things. We have a new community garden at our co-op and four of the five plots haven’t been claimed yet. Cricket would love to have a plot of her own to work in. She’d probably end up planting chicken treats and chewy bones in her plot, but still, the digging would be very satisfying.

The social worker idea has grown on me over time, especially during the past three years at my synagogue, where, to a certain extent, social work is their religion, but I think both dogs have helped lead me here, too. Nine years of working with Cricket’s psychological issues has taught me tolerance and patience. She has taught me that even if someone will never be fully healed, you still do your best to help them live their best life. I would have wanted perfection for her, and Cricket has taught me that there is no such thing, or if there is, it’s really boring.

“Hi Mommy!”

But, but, but…I still don’t want to go. I want to write this blog, and walk my dogs, and revise my novels over and over again (okay, maybe not that last one). I want the life I promised myself, the life I recognize myself in. I’m afraid I will have to be a completely different person to succeed as a social worker, and I don’t want to be a completely different person. I kind of like who I am.

“We love you just the way you are, Mommy. Where are the treats?”

DSM Puppy

I took a class in Abnormal Psychology this past semester, and we learned about the Diagnostic and Statistical manual of Mental Disorders, published by the American Psychiatric Association. The DSM is similar to a field guide to birds, without the map to tell you where to find each colorful creature.

DSM-5_3D

There was a lot of excitement, from the teacher, about the new DSM 5 arriving in May, and I began to think, what would a DSM for dogs include?

My incomplete list of disorders:

Hyperbarkia – a disorder in the quantity of the barking and/or the level of hysteria. An occasional woof-woof to mark the passing of a neighbor, or a more persistent bark to note a stranger at the door, can both be within the normal range. Whereas an unending barking spree, lasting twenty minutes or more, or rising to operatic levels, can be a sign that the need-to-bark meter has jammed.

Bite-the-hand-that-feeds-you-disorder is self explanatory.

Cricket, a case in point

Cricket, a case in point

Foreign object eating disorder – eating rocks and sticks and plastic toys, because those trips to the vet are just so much fun!

Vacuum phobia – when dogs believe that the vacuum cleaner is a giant roaring monster, ready to devour every toy, treat, and dog in its way.

Mailman paranoia is the belief that the mail delivery person is coming to massacre the family, and the only thing standing in his or her way is a tiny barking dog. (I worry that this puts undue stress on Cricket’s heart.)

"Mailman! Mailman! Mailman! Mailman!"

“Mailman! Mailman! Mailman! Mailman!”

Scratching Addiction is when a dog can get hours of scratchies at a time and never feel like it’s enough. Having an endless void inside of you, that no amount of scratchies can fill, may lead to other addictions, like chicken. Not to be confused with a genuine allergic skin condition.

Butterfly, a borderline case of scratching addiction

Butterfly, a borderline case of scratching addiction

Bone hiding disorder – this can be a normal reaction to a sibling who steals bones, or it can be a miscalculation on the dog’s part, imagining that the humans would steal that dirty, spit covered nylabone, if only they could find it.

PGSD or Post-Grooming Stress Disorder results in flashbacks and tremors at the sign of clippers and the sound of bath water. This can be incredibly disabling and creates the false impression that dogs prefer to be dirty. They do not. They just believe that the process of becoming clean will kill them.

Cricket hates being wet

Cricket hates being wet

Overly Selfless Dog Disorder is common in Golden Retrievers and other therapy dogs. This disorder can result when a dog is so focused on pleasing her humans, or other dog siblings, that she doesn’t stand up for herself. These dogs can be so good natured and non-confrontational that others take advantage of them or ignore their needs. (Butterfly started out this way, refusing to fight with Cricket over food or leashes or toys. If Cricket wanted something, Butterfly would stand back and leave it to her sister. But she’s getting better at elbowing her way to the food and speaking up when she wants to go outside or eat Grandma’s chicken wings.)

Butterfly: "Who me?"

Butterfly: “Who me?”

Jumping Bean Disorder – Some dogs have this need to bounce that can’t be repressed. Jack Russells are known for springing so high into the air that they greet human visitors at eye level. (Butterfly has not managed this feat, but she is trying.)

a serious case (not my picture)

a serious case (not my picture)

Fear of Thunderstorms is very common. I imagine thunder sounds like a huge, unnaturally ferocious, dog standing outside of the house and barking to get in. (Butterfly gets very anxious. Usually she sleeps on her side of the bed, with maybe a paw stretched out to touch me. But during thunderstorms, she climbs on my chest and shakes. Cricket has no fear of the sound of thunder, but she doesn’t like to be out in the rain and get plinked on the head by rain drops.)

Flibbertigibbet Disorder is an unrelentingly positive attitude towards going outside for walks that causes the body to hop and twirl and race around in aimless circles, preventing the attachment of the leash.

Small Dog Syndrome is when dogs under fifteen pounds believe they can intimidate full sized humans, by growling. This is also assumed to work on Fed Ex drivers.

This is my incomplete list of disorders. Clearly further revisions and additions will be needed. This shouldn’t take more than twenty years.