Which treatment for depression makes the “actual issue” go away? Also, how does one “work around” a personality disorder without changing the features of the disorder?
Are you saying that you can catch depression?
A combination of drugs, counselling, and lifestyle changes in my case. I expect it will return at some point, but I’m equipped to deal with it.
The working around a personality disorder is basically changing your behaviour, often through Cognitive Behavioural Therapy, to minimize the effects of the disorder on yourself and others.
No, that wasn’t the point of my analogy. But if you are asking whether depression can come and go, the answer is yes. So, my question is, if you accept that a physical illness can make someone act unpleasantly, and are prepared to put up with it, why would you not feel the same about a mental illness?
If you can change the behaviors of someone with a personality disorder, you are changing the indicators of the personality disorder. Without the behaviors, there’s essentially no disorder. Now, you might say that, for instance, with BPD one of the indicators is behavior driven by a fear of abandonment, and that a person might still continue to experience fears of abandonment, even if they learn more appropriate ways to deal with those fears or learn to cognitively intervene to reframe or replace those fears. However, there’s no real difference between that and helping someone with depression who experiences excessive guilt by helping them to process those feelings differently.
Again, a person with a personality disorder is expected to have a more persistent and pervasive course of disorder, but that doesn’t mean that their disorder is any more or less a true “part of them” than a person who experiences episodes of depression.
Yes, all disorders can come and go, and most do, with the caveat that some are notable for greater persistence and others for episodicity. But major depressive disorder doesn’t come and go in similar ways for everyone in the population. Some people are notably more predisposed to depression than others. I honestly don’t know what proportion of the population is so resistant to the flu that they never get it, but my suspicion is that individual variability in flu resistance is rather low, such that the majority of the population is vulnerable to flu when exposed to it. By contrast, the lifetime population prevalence of major depressive disorder is at most 20%, and perhaps as low as 8%.
Depression is not the same thing as depressive disorder, although they are related (obviously).
This is all getting away from the point, somewhat, which is to what extent people with mental issues should be treated differently than other people.
My point, which you’ve not actually addressed yet, is that someone with a temporary mental condition should be considered the same as someone with a temporary physical condition that affects their behaviour.
It is quite on point if you are trying to argue that people should be treated differently because they are assholes when they are depressed versus being an asshole because they have a personality disorder.
I have addressed it repeatedly by making clear that this is a non-functional distinction. For instance, there’s very little at this point to etiologically discriminate major depressive disorder from dysthymic disorder (and relatively little to discriminate them in terms of criteria), but a dysthymic disorder in adults is by definition required to be present for two years. Is that temporary? Also, people with depression show differences both in terms of premorbid indicators and in terms of residual symptomatology.
Another example would be schizophrenia. This is a disorder that clearly has biological roots. Yet, the manifestation of symptoms and degree of impairment fluctuate over time, and don’t onset typically until adulthood. Is the person with schizophrenia his or her true self when the symptoms are waning, or during childhood, and not his or her true self when the symptoms are waxing, or after onset?
Furthermore, personality disorders are not diagnosed until adulthood. So, is the person who ends up with a personality disorder in adulthood a “different person” when they are a child, or is there something about the onset of a personality disorder that turns them into not the person that they were supposed to be?
So, as I alluded to earlier, what’s the difference between a Cluster B PD and a plain old execrable jagoff, other than a diagnosis?
Is a person who hasn’t been diagnosed with a mental disorder their true self when they are happy and being kind, or when they are ill and being an arsehole?
But, to answer your question, a person with schizophrenia is “themself” when the illness is not active, based on testimony from schizophrenics. That is, they feel that the illness is causing them to act in a certain way.
That a personality disorder won’t be diagnosed until adulthood doesn’t mean it can’t manifest in childhood, just that children change so quickly that there can’t be the stability* needed to diagnose one. In contrast, children can and have been diagnosed with mental illness. No-one is, in the sense we’re using here, the same person as an adult as they were as a child.
*In the sense of a stable set of symptoms, not stable behaviour.
A not unreasonable question, at its foundation. However, if all we know about them is that they often act like a jagoff, there’s no way to tell whether or not they meet criteria for a personality disorder. Like any mental disorder, just showing one feature cannot be diagnostic. If all you know about a person is that they are frequently sad, they do not necessarily meet criteria for a mood disorder.
It would also depend, relatedly, on just how they act like a jagoff. Is their jagoffishness persistent over time and pervasive over contexts? Is it pathological and impairing? And what does their jagoffishness look like.
The cluster B personality disorders include Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder and Narcissistic Personality Disorder. Antisocial PD is typified by repeated rule or law violations or behavior that otherwise violates others rights and a lack of remorse for such behavior. Borderline PD is typified by dramatic interpersonal difficulties (conflicts, fears of abandonment, emotionally manipulative behavior), and difficulty regulating internal emotional states. Histrionic PD is driven by a desire for attention and competition with others for that attention. Narcissistic PD is driven by grandiosity, exaggerated self-worth, and a need to have those beliefs recognized by others.
So the issue is what is the function of their jagoffish behavior? What is the broader constellation of behaviors in which their jagoff qualities take form?
I’d say a schizophrenic, or a person with depression, or with the flu, is “themselves” all the time, because the schizophrenia or depression or the flu is part of who “they” are. They’d be a different person without the illness, sure, but the illness doesn’t keep them from being themselves. It just changes who they are.
The answer is yes. That is, they are the same person. If I’m bummed because it’s a cloudy day or the Steelers lost the Super Bowl, I’m the same person I would have been on a sunny day or after a victory.
Two questions: What is “the illness” (other than its label of course) and what is it that makes them act the way they do when “the illness” is not present?
Nonsense. First, your distinctions between behaviors and symptoms is illusory. Some behaviors are symptomatic of disorders and some are not. A behavior that is symptomatic of a disorder yields a diagnosis only if enough other symptomatic behaviors* are present along with associated impairment.
*Recognizing that some symptoms are clearly behaviors (e.g. psychomotor retardation) and some are processes ultimately measured by behaviors or self-reported internal states (e.g. changes in appetite, anhedonia or dysphoria). For the present purposes, there’s no utility in such distinctions here.
Furthermore, it’s nonsensical to suggest that children’s personality, behaviors or typical mood states fluctuate particularly more rapidly than adults or so rapidly that chronic diagnoses cannot be made. A child can certainly meet criteria for dysthymia, in rare cases schizophrenia, and autism, clearly a persisting disorder. I’ll wholeheartedly agree that indicators of a future personality disorder may be present from childhood, but meeting criteria for a personality disorder in childhood is something that just does not happen.
But this goes to my point. People are made up of dispositions and indicators of disorder that wax and wane over time, and for some people, they are more likely than others to manifest in a distinct disorder. But that person is not a different “person” when they are experiencing the disorder and when they are not. They are all responding to internal conditions (perhaps actuated or influenced by their environment, of course), but mental disorders are not like the Imperious Curse. They are functioning differently (and maladaptively) than they have at other times – their cognitions, emotions and behaviors are different than they are at other times – but they are the same person nevertheless. So there’s really no distinction (in terms of a person being him or herself versus a person somehow being influenced by some agent other than him or herself) between someone who experiences relatively brief episodes of changes in their functioning, as in a circumscribed period of major depressive disorder, someone who experiences a persisting disorder like dysthymia or schizophrenia, and someone who experiences a persisting disorder like borderline personality disorder.
And this is a real issue for a more important reason than whether or not we should hold someone to account for their behavior. People make decisions regarding treatment, and particularly regarding medication, based on the idea that somehow, this changes who they are, or who they are supposed to be. Some parents will refuse medication for ADHD because they somehow think doing so violates who their child is supposed to be. Why taking medication for ADHD violates who a child is supposed to be in some way distinct from a child taking medication for diabetes, I cannot fathom. Additionally, why making changes for someone with ADHD through behavioral treatment is okay, even though it reflects changing the person, whereas medication-related changes are not okay, is also beyond me.
If you really meant what you were saying, if someone were to come to you and say “I’m not myself today”, instead of understanding, and letting them off occasional annoyances, you would say “Begone, liar, and take your unpleasant ways with you!!”. No-one actually acts like that, and to pretend otherwise is pointless.
It’s observable, though, that people do act differently around people with BPD or schizophrenia than they do around people who are just having a bad day, or for that matter people with depression. This thread is supposed to be about why this happens, and whether it’s acceptable.
To answer your question about the nature of the illness - a mental illness is something that temporarily affects the mental state of a person. This will usually, but not always, have observable behaviours that can be used to diagnose it. What makes the person behave in a certain way when the illness is not present is their underlying personality.
This is distinct from a personality disorder, which, as the name implies, is part of the personality, not a change to it.
I think part of the problem is the *type *of “odd behavior” that the person is exhibiting, especially if it contrasts with their “normal behavior.”
Personal anecdote: I’ve been depressed for my entire adult life. I get sometimes better, and sometimes worse, but everyone who knows me expects me to be sort of down, and usually anxious about stuff that most people aren’t bothered by. They see this as my “normal” to the point that when I am really feeling “up” they notice and are happy for me that I’m feeling perky that day.
Contrast that with a hypothetical person who is bipolar or has BPD, and what is a positive change in me from my friends’ perspective becomes, with bipolar (massively manic episodes or huge depressions) a negative change, or in the case of the BPD person, a situation where their “normal” is so abrasive or a-social that they can’t handle being around it long enough to really see if there even ARE times when the person is different.
No, silly. If someone said to me, “I am not myself today,” I would assume that they meant they were feeling differently than they usually do. I wouldn’t assume that they meant they were a different person altogether, as in “Yesterday I was Tom, today I am George. (You should know, by the way, that George has a mental disorder, but Tom doesn’t).” Speaking of which, how do you know which person is the real person for someone with Dissociative Identity Disorder (formerly Multiple Personality Disorder)? If there is a “true self” and an “illness self”, which one is which?
It is also observable that people act differently around people with depression and people with ADHD. In fact, people with depression experience greater interpersonal problems than people without depression. More to this point, people with dysthymia experience greater social difficulties than people with major depressive disorder, presumably because there are more occasions where the person with major depressive disorder is not demonstrating symptoms that tend to alienate other people.
It happens because mental disorders are impairing, and almost all include impairments that affect how other people interact with them and perceive them. There’s no point in drawing distinctions about what is a mental disorder and what is not based on either the persistence of the disorder or whether other people are more likely to tolerate social-norm violating or noxious behavior.
And as for acting in different ways around others, absent other information, people do in fact typically have a bias towards making trait-based interpretations of other people’s behavior, rather than state-based interpretations. Whether someone, upon gaining a justification for someone’s behavior, alters their interpretation or their behavior in response is a matter of individual differences. Then again, another social psychology finding is that people will usually mitigate their interpretations of others behavior when offered any justification whatsoever, even if that justification is manifestly not actually justifying.
So autism is not a disorder? Schizophrenia is not a disorder? What about mental retardation? I think you have an overly rigid and static understanding of personality, and a misunderstanding of mental illness. At this point, however, I don’t think I can offer any further clarification. You are apparently resistant to change 