Personality, Meet My Friend Shovel

There are a few recent articles floating around on psychopathy (aka Antisocial Personality Disorder in the DSM) in young children, the catalyst being in the New York Times featuring a violent nine year old who couldn't stand his younger brother. While that may sound like many nine year olds, the article describes behavior that is beyond the realm of what one would consider healthy to the individual and his family.

The article, as well as the comments, raised a few questions in my mind. One was on the treatment/research project the parents admitted the kid into. This program utilized behavioral modification, which works quite well for changing distressing behaviors for many issues (smoking, overeating, potty training) when implemented properly. However, it doesn't seem to work all that great for a lot of adults with an Antisocial personality diagnosis - if you really think about it, rewarding "good" behavior probably won't work all that great with these folks unless you're giving them a million bucks per incidence of "goodness" - so I wondered why on earth they would try such a thing on kids who supposedly face the same challenges.

Second, I have heard enough stories on PTSD issues being diagnosed as Antisocial - PTSD being induced by actions that are so horrific I once had to leave in the middle of a lecture to go throw up in the bathroom because the idea of doing such a thing to a child makes me want to hunt down people and make their lives miserable. Can't imagine how the person who manages that brand of psychological hell minute by minute feels. (On the bright side, I've run into quite a few success stories on good therapy and emotional support resulting in a complete 180 in terms of empathy and sense of meaning)

The notion of personality makes my head hurt a bit. I once asked a teacher, a trained psychoanalyst, for a definition of personality. He gave me a similar answer to what I've read and received by others: Personality is more or a less a person's view of the world and how they interact with it, and the bulk of it is formed in early childhood. I told him I didn't care for something that implies permanence, but he said that people can certainly improve to points where less-than-helpful personality traits are rarely an issue, but it's never ultimately different.

I'm not sure how I feel about this idea, which is pretty common in the mental health realm as well as with the general public. Nothing seems all that permanent, atleast on this earth (afterlife, who knows). My skin is showing a fine line or two, my hairdresser recently said I have three gray hairs (she refused to pluck them, to my frustration), my shoe size went up by a half after pregnancy, I'm constantly shedding skin cells. The box elder trees that came with our yard continue to grow, my next door neighbor has a new dog, pop music seems to get more intolerable by the year, and our country has gone from significant patriotism to a severe distrust of more or less everyone in charge. Life is one of those things that is in constant flux - bodies, culture, nature. I really can't figure out why in the heck people are so stuck on the idea that personality is permanent when nothing else is.

I do have a theory. I suspect the roots of the notion that personality is permanent is in the idea of mind/body dualism - basically the mind (personality, behaviors) is a separate entity to the body. This idea mostly came out of the thought that the mind = the soul. Seeing as that psychology is of the more recent fields to come out of philosophy (per ancient Western philosophers, thought more or less boiled down to mathematics or philosophy - including religion), it's unsurprising that it continues to include the idea of a permanent personality.

Besides the idea of how free will ties into the mind (I mean, if the mind = the soul and the soul is what we are born with and the soul is God-given, why in the heck are we to blame for some of our suckier aspects? Why would we even bother trying to change if change is futile? Why is it that therapy and life experience can significantly change our views of the world? Um, aren't we supposed to be responsible for our actions? Oh, and what about a possible translation for soul in Hebrew being "to breathe?"), it makes me think of Traumatic Brain Injury (TBI) and personality changes.

Personality, meet my friend shovel. If I took a shovel to your head enough times without managing to kill you, you could very well end up with a number of mental health challenges - including a change in personality. We have a diagnosis for this phenomenon in the DSM. One could argue that TBI is permanent, but then again, the nature of an individual's TBI is not. Early intervention for TBI can provide significant improvement in the challenges folks with TBI manage, and some may experience little issue after treatment depending on just how hard I hit you with that shovel and a myriad of things we plain don't know about the brain. Additionally, TBI challenges can grow worse without intervention. And people diagnosed with TBI are human like everyone else and have many of the same experiences as every other person on the planet, which will affect their perceptions of the world as they age.

Don't get me wrong, I have no problem with souls. I just don't think it has anything to do with brains, atleast for our intents and purposes in this universe.

We know the brain changes. We also know how ingrained behaviors, whether we're born with them or they're conditioned or a mix, are an utter bitch to change. Doable, but painful. Despite our knowledge that the brain changes, we can't seem to predict what treatment is going to work with what person at this point in time. It doesn't mean we should assume behavior that fails to serve someone can't be improved or even eliminated just because we don't know how to help the person sitting in the chair across from us.

So shove it, deterministic naysayers. You may think I'm being an optimistic grad student who will wise up by the end of my first clinic day, but I am one of many who one would think wouldn't be optimistic for anyone diagnosed with something psych-related. Multiple suicides in the family. Mental health outside of "normal" severely stigmatized by both father's and mother's families. Mom diagnosed with out-of-control Schizophrenia (which gets harder for her to deal with by the year) when I was three; Dad doing the depression, alcohol, sobriety, alcohol, sobriety, AA, depression, therapy, AA, depression.

But now a tortoise-paced ascent into some level of happiness.

Me from suicidal, angry elementary school kid to happy kid to suicidal and angry to determined to depressed to a weird cycle of who knows what to hypomania to mellowness to more depression.

But now feeling good about things, even with past dissociation and self-injury and avoidance of people.

Then there are the testimonials of Clifford Beers, Mary Ellen Copeland's mother, Kay Redfield Jameson, Carrie Fischer, Marsha Linehan, Ken Steele, and many others. And most dear to me, all of the wonderful coworkers and individuals I have served who identify as those with psych diagnoses - including personality - who have experienced change, better or worse at times.

Rather than assume people with Antisocial personality diagnoses are screwed forever, or assuming many have it at all, or assuming it manifests in incredibly young children, maybe we should carefully work with these folks with a nudge towards recovery. And, ya know, show some empathy (Do unto others). It's tough, and at times senseless, to judge how far one can go in life.

Your shrink is insane

My school divides up summer into two condensed semesters. I am taking the first off because I was going to absolutely lose my shit if I didn't take a break. There has been a strong correlation between me starting graduate school and me being incredibly displeased with life. I hate that I took time off because it will just prolong my time in school, and yet I would have been stuck taking classes over because I'd end up dropping them anyway mid-semester, thus prolonging time in school.

It isn't that learning how to be a therapist is an intellectual exercise, despite the many, many classes on theory. There are two-to-three year programs that are significantly more intense than what I am doing: physician assistant, law, genetic counseling, nurse practitioner, etc. The culture of my graduate program along with my marshmallow personality makes for an emotionally draining experience for me. A good portion of it lays in the fact that I hate criticism. By that I mean I will cry and ruminate for hours after some constructive criticism. Shit, my first year I cried in two separate classes in the same semester. In front of people. It was absurd. Now I just pop Ativan before presentations. As it turns out, I'm not the only one who does that - so yes, your shrink likely takes psychotropic medication.

There is a chance my "personality" falls partly into the Avoidant camp. Kind of funny, huh, considering my field? I make a strong effort to ignore the garbage my brain spouts off, and while I do find myself often weeping in my car or in a bathroom stall or on my husband's shoulder, I try to put my mental crap aside and do what I enjoy doing. I spent a good chunk of time working in human services, and I didn't have issues with the people I was trying to assist even if there was a small amount of swearing, derogatory comments, or attempts at theft when I was standing in front of a group of ten people (The swearing, comments, and theft weren't all that common - we all have bad days, though).

Academia, and the rest of life, is intense for me. Even if someone is being incredibly gentle and sneaking in compliments throughout the conversation, I take it to mean I am an inexplicably worthless piece of a human being with nothing worthwhile to contribute to society and should just find a nice cardboard box to move into because I will never be able to do my job/marriage/parenting with any level of competence and I am hated with a fire of fury hates. I know on one level this is bullshit and on another level it is utterly true, and I let those contradictions peacefully exist in my head while generally giving the rational part the benefit of the doubt. It took a year and a half of DBT to get to that point. I would say that it gets easier, but that would be a lie.

For whatever reason, the line of "I suck at life" thinking will pop out even if I know the person is being an idiot and projecting their issues onto me. A teacher or two of mine has gotten borderline nasty with me because I didn't agree with their theoretical orientation (I lean towards third wave behavioral) during a lecture. I don't honestly care about your choice of theory - I think different people respond to different techniques and it takes all kinds in the mental health field - but I guess it's a big fucking deal to some folks. I think I'm very polite about the whole thing, and a classmate or two has even told me so at the end of classes. I can't even say I sound remotely critical, because I don't think I do. But who knows.

If you're wondering, those two teachers had two different theoretical orientations.

Along with that is the attitude that students and new therapists have little level of skill - it's almost criminal we unleash them on people - and thus they have no right to an opinion. Example: an instructor told one of my classes not to criticize a diagnosis made by a supervisor or a senior member of a team. Diagnoses are funny. Is it Bipolar or Schizoaffective? Generalized Anxiety or OCD? Hoarding or frat boy slob? A lot of subjectivity goes into making a diagnosis, and there often isn't a correct answer. Here's my problem, though: if a clinician is going to slap a Cluster B personality disorder label on someone just because the person they're working with gets pissed off at them for not returning calls or being late to appointments (I've seen it happen), I might just have to step in and say (tactfully) that is some bullshit - freshly limited-licensed or not. Restraints in the middle of a hallway even if someone has voluntarily checked themselves in? (I'm against restraints anyway - they aren't evidenced-based and are just plain mean - but seriously? I've heard that story more than once) Some things simply aren't okay, and you don't need ten years of experience under your belt to figure that out.

Ugh. I have been frequently wondering why I am bothering. I can take what a client/resident/individual served/whatever dishes out with no problem, but supervisors and teachers make me want to curl up into that cardboard box and wait for winter to come and freeze me over. I have another year of this pain to go, and it hasn't felt worthwhile since I left my decent-paying job to try to finish up school quickly last June. It hasn't helped that I had some depression and a viral infection from Hell at the end of the fall semester partly resulting in tanked grades, and another viral infection that lasted a month and a half during the winter semester that made life way too difficult, and wicked back pain that made it nearly impossible to sit or stand for more than five minutes, and now there's some mystery pain that is possibly autoimmune-related (Oh yeah, and my winter semester grades sucked - before fall, I had a 4.0 GPA).

Twenty grand in student loans aside, my husband told me some people try to stay oblivious to everything that is wrong with the world and some people are aware of what's wrong and aren't afraid to address it, and I'm one of those people with awareness, and I should stick it out because I would be able to really help some people, and blah blah. I don't know if this is worth the few shreds of rational thinking I have left.

It's strange...I've talked to other students in other fields who say they get treated like professionals...and then that has not been the experience of me and many of my classmates. Unless my opinion is that of the elder's, it is worthless. Don't ask me how I'd be able to swing agreeing with everyone, considering so few people agree on much of anything. Yeah, my perception is clouded, but I know it's not just me based on conversations I've had with other people in my program.

I think from here on out I'm going to keep quiet as possible, only speak if required for a grade, and make sure I don't give my opinion at any point. That might be the only way I survive graduate school. I want to quit. I want to quit so so so much. The only reason why I'm not quitting is the debt.