Bipolar 2 From Inside and Out

Posts tagged ‘mental illness’

It’s Not That Simple

I’ve bitched before about the ads on TV for psychotropic drugs, and I’m about to do it again. The first ones that caught my eye were the ones that compared depression to holding up a smiley face mask in front of their face, while the person’s actual face exhibited sadness.

But it’s not that simple. Smiling depression is a thing, of course, but treating it is not as simple as taking away the mask and replacing it with a real smile. Psychotropics don’t work that way. Of course, since the ads are for psychotropics that are supposed to work quickly (though not as quickly as the ads imply), we can’t expect them to mention the years of struggle and therapy that go into improving the condition.

The next kind of commercials are a tiny bit better. They mention actual symptoms of depression: sadness, loss of focus, lack of interest in fun things, or an inability to do chores.

But it’s not that simple. Personally, I don’t think it’s a tragedy if the barista has to wait two seconds while I remember whether I want oat milk or if the family has to put away the laundry. These are obvious but probably not major symptoms of depression or symptoms of major depression. What about not getting out of bed for three days or not showering for a week or more? Crying all day about nothing or everything? Thoughts of self-harm or suicide? They just don’t make for good 60-second television. The long, lingering effects of depression are glossed over or ignored.

There are also ads for treatments for bipolar disorder, both types I and II. Most of them concentrate on the mania or hypomania side of the problem. Most of the ads use metaphors—climbing a tower of cards or going from darkness to light. Overspending is the issue most illustrated in regard to bipolar if you don’t count all the depression ads. I recall one that showed a woman who had bought a lot of expensive cameras and came to realize that she had overdone it.

But it’s not that simple. Bipolar disorder is a complex disorder that metaphors just can’t capture. Like depression, the ads concentrate on only one symptom, and don’t do a good job of creating those metaphors. (I’m just glad they don’t use a metaphor of someone on a swing.) I realize that it’s not likely that ads on TV will address hypersexuality, but what about the pressured speech, euphoria, irritability, bad decisions, and reckless behavior that go with mania?

Schizophrenia is probably the worst. The ads show not the disorder, but the lack of it—women saying, “I’m glad I don’t hear voices anymore” and “I’m glad I don’t still think everyone is looking at me” or men playing guitar to illustrate how “normal” the drugs make them.

But it’s not as simple as that. I admit that it’s not possible to portray some of the more frightening aspects of schizophrenia, which would probably only add to the stigma surrounding schizophrenia. But making it seem like one pill will cure it isn’t reasonable or accurate.

Then there’s tardive dyskinesia, also called TD. The ads do a competent job of giving examples of uncontrolled movements and how they interfere with a person’s life. The drug being advertised may indeed help with those.

But it’s not that simple. If you read the fine print at the bottom of the screen or listen to the rapid-paced list of possible side effects, you’ll notice that one of them is uncontrolled movements. WTAF? It gets rid of uncontrolled movements but may cause uncontrolled movements? Why take it and take the chance?

The ads I may hate the most are the ones that emphasize family. We see a woman folding the family’s laundry, grandparents romping with the kids at a park, and other idyllic scenes.

But it’s not that simple. Treating a mental illness is not something you do for the benefit of other people. It’s something you do for yourself, even if you don’t have a nuclear family or grandchildren or a large circle of friends. Granted, the people around you may be happy that you’ve found a therapy that works (and the ads almost never show a combination of drug therapy and talk therapy). That’s a side effect—a good one, but still not the intended effect of the psychotropic drug.

I attribute this primarily to the lack of inventiveness and understanding shown by people at the advertising agencies, as well as the tiptoeing around the whole subject of SMI. But what happens is that the viewers get an unrealistic view of both the disorders themselves and what the drugs can do to relieve them. It’s not simple, and the ads simply don’t reflect that.

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Dual Diagnosis and AA

Dual diagnosis, also called co-occurring disorders or co-morbidity, is one of the most complicated conditions that affect people with mental illness. The heart of dual diagnosis is that the person has both a brain illness and a substance use disorder (SUD). Estimates differ wildly as to how common dual diagnoses are, depending on differing definitions of dual diagnosis, for example. According to SAMHSA, 21.5 million Americans experience both SMI and SUD.

Alcoholics Anonymous, of course, is the best-known support group for alcohol abuse disorders. Narcotics Anonymous focuses on illegal drugs rather than alcohol. But there are fewer opportunities for people with dual diagnoses to find similar kinds of support. There is a group called Dual Diagnosis Anonymous (DDA), but it doesn’t have nearly the reach of the older, more familiar organizations.

So, how do dual diagnoses and substance use disorders share the support group space? Is the standard AA model open to or beneficial for people with dual diagnoses?

I recently spoke with Tony, a friend who has bipolar disorder and alcohol addiction. He’s currently in recovery in a treatment program that addresses both problems. Tony, who has been in the program for around six weeks, has started out in a sober house and with AA meetings. While he discusses his SMI, for now the primary focus of his treatment is substance abuse.

According to Tony, the relationship between AA and SMI support is sometimes fraught with contention. The history of AA doesn’t prohibit people with co-occurring disorders, but in practice, the situation can be different. Tony, in his early years of association with the organization, was dropped by his sponsor when he revealed his dual diagnosis.

Part of the problem Tony has found is that many people involved in AA are biased against the use of psychotropic drugs, even those properly prescribed by a psychiatrist and taken as prescribed. To them, drugs are drugs, and they are universally thought to be addictive. This is, according to Tony, an old-school and literalist interpretation of AA’s principles.

But if a person with a dual diagnosis goes off their psych meds, their condition can deteriorate. And untreated SMI can cause a person to self-medicate with alcohol, creating a vicious cycle. AA literature says that group members should not stop taking doctor-prescribed meds, but the problem persists. People with dual diagnosis may therefore avoid AA.

Of course, people can be addicted to prescription medications (whether they get them from their doctors or not). AA and NA can be extremely beneficial for them. Still, according to DDA, people with dual diagnoses can experience “a sense of ‘symptomatic difference’ between addicts and alcoholics and dually diagnosed persons. Some symptoms may result in disruptive behaviors during meetings, further alienating the dually diagnosed. Many dually diagnosed people experience increased levels of fear, anxiety and/or paranoia in group settings. Additionally, there is a common perception among some more traditional 12 Step members that medical management represents the ‘easy way,’ and do not consider those individuals who take prescribed medications to be ‘clean and sober.’ For these reasons, the feeling of ‘not fitting in’ at traditional 12 Step meetings is common for many individuals with dual diagnosis.”

A report published by the Veterans Administration of Virginia focuses specifically on the combination of PTSD and SUD. It notes, “Substance abuse co-occurring with PTSD is often a chronic disorder that
requires long-term help, which AA may provide” and that “aspects of 12-step activities may address core issues of trauma-related symptoms and enhance treatment outcomes.” However, it also discusses how the faith component of AA can be problematic: “Trauma, and PTSD-specific symptoms of loss of faith and hope for the future, may deter individuals from embracing the concept of a higher power and the directive to surrender…. Trust is shattered such that a benevolent spiritual force is hard to imagine, and so surrender to a higher power may be seen as impossible. Further, hypervigilance and the need to
maintain control are integral parts of a traumatic stress reaction, creating hardships in turning
over one’s will and life to God.”

DDA has developed 5 steps that coordinate with AA’s 12:

1. We admitted that we had a mental illness, in addition to our substance abuse, and we accepted our dual diagnosis.

2. We became willing to accept help for both of these diseases.

3. We have understood the importance of medication, clinical interventions, and therapies, and we have accepted the need for sobriety from alcohol and abstinence from all non-prescribed drugs in our program.

4. We came to believe that when our own efforts were combined with the help of others in the fellowship of DDA, and God, as we understood Him, we would develop healthy drug- and alcohol-free lifestyles.

5. We continued to follow the DDA Recovery Program of the Twelve Steps plus Five and we maintained healthy drug- and alcohol-free lifestyles and helped others.

Tony’s treatment program is focusing first on substance abuse programs, specifically achieving one year of sobriety, though in his shares at group, he does discuss his dual diagnosis. And he finds the spiritual component of his recovery to be essential. After his formal treatment ends in mid-January, Tony wants to continue working in faith-informed service to workers in the field—perhaps in a virtual capacity with the intention of helping prevent burnout.

I’m not in AA or DDA, but it seems to me that some discussion and communication between the two organizations would help matters.

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Say It With Casseroles

In the South, casseroles are known as “funeral food.” After a funeral, people gather at the home of the bereaved and bring casseroles for a kind of potluck. The idea is that the family shouldn’t have to entertain the mourners and shouldn’t have to cook for basically the rest of the week. Some people even bring frozen casseroles to extend the usefulness of the food offerings. Tuna noodle casseroles are popular. Chicken rice casseroles. Green bean casseroles. Shepherd’s pies. Eggplant parm. Tater tot casseroles. Frito pies. Lasagna. Sweet potato casseroles. Ham and potato casseroles. Broccoli cauliflower casseroles. Moussaka. Even one that’s simply called “Funeral potatoes.” There are plenty of cakes and pies, too.

Food is an essential when there’s a new baby as well. It’s assumed that the new parent or parents won’t have time to cook substantial meals, so plenty of frozen casseroles are supplied. Visitors don’t arrive en masse and don’t expect to be entertained. They often bring useful items like diapers and wipes. They expect a few minutes of conversation, a look at the infant if they’re asleep, or a chance to hold them for a minute. What they mostly offer is help. Cleaning. Babysitting for older children. Running errands. Preparing bottles if needed. Emotional support is a big form of support as well. Helping the new parent with self-care. Comfort items. Listening. Offering encouragement.

Even an illness or operation generates plenty of contact. People visit in the hospital, bringing flowers, treats, plushies, prayer circles, and more. They stay as long as you want or leave when you’re feeling tired. They ask if there’s anything they can bring you, and then they do. They ask if your plants need watering. When you come home, there may again be casseroles, especially if it’s been a major operation like knee replacement. There are offers of picking up groceries or medication. They ask what you need and, nine times out of ten, they follow through. They call to check up on you or just to talk.

It’s all different if you have SMI, however. SMI is just not a “casserole illness.”

If you have a public meltdown, no visitors, no encouragement. No casseroles.

If you spend time on a psych ward, no visitors, no flowers. No casseroles.

If you aren’t able to go to an event or meet for coffee, no sympathy, no prayer circle. No casseroles.

If you’re not able to get out of bed all week, no housekeeping, no errands run. No casseroles.

And if you survive a suicide attempt, no understanding, no acknowledgment. No casseroles.

I get it. I do. People don’t know what to say, so they don’t. They don’t know what you need, so they don’t offer it. They don’t know how to cheer you up (and they can’t), so they stay away. They’re afraid of psych wards, so they don’t visit.

Casseroles can’t hurt and might help.

What it all comes down to is stigma and ignorance. There are no social conventions that apply to those with SMI. Except for the most fortunate among us, we’re on our own.

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Promises Made

My husband and I have a pact regarding suicide. No, it’s not a suicide pact of the kind you read about in the newspapers. This is a pact aimed at preventing suicide.

Dan and I both have brain illnesses. He has depression, and I have bipolar disorder. We both take meds for them and are reasonably stable a reasonable amount of the time.

That wasn’t always true, however. At one point or another, we each have considered killing ourselves.

Dan’s episode happened when he lost a job that had started out successfully and well, but devolved into chaos, disappointment, and bad feelings. On the day he was let go, he was so upset that the people where he worked called an ambulance to meet him at our house and take him for a psych evaluation. But Dan has worked in some psych units, so he knew how to answer their questions without setting off any alarms that would cause them to keep him there.

Much later, however, he told me that he really had been suicidal at the time.

My brush with suicide came after my mother died. In the aftermath, Dan did something I thought was dishonest (I won’t go into details), and I catastrophized. I didn’t approve of his action and was alarmed when he said he would do it again in the same circumstances. I felt that if that happened, I would be compelled to drop a dime on him. Then he would be disgraced, lose his job, maybe even be subject to legal consequences. I couldn’t live with the thought of that, so I decided the only thing I could do was fix the situation and then kill myself.

If it seems like those are crappy reasons for suicide, well, they are, but they didn’t seem like it at the time. That’s the insidious nature of suicidal thoughts.

We didn’t just have thoughts, however. We had plans for how to do it. (When we were able to talk about it later, it happened that our plans were almost identical.)

What stopped us? I can’t speak for Dan, but I kept postponing the act until I had settled on a method. Then my meds kicked in and I didn’t feel the need anymore.

Now we have a pact. If either one of us thinks about suicide in the future, we’ve agreed to tell each other, generally by saying, “I’m having bad thoughts.” That’s our code for it. (If we have lesser bad thoughts, we say, “I’m having bad thoughts, but not the really bad ones.”) That’s our pact. We will let each other know if we’re feeling bad enough to consider it so we can get help for ourselves or for each other.

And when we say those words, we know to take them seriously and to talk about what we’re feeling and why. We help each other consider other, less lethal, responses. Fortunately, we have both abided by our pact.

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Prayer and Bipolar Disorder

My mother believed in the power of prayer, and thought I should do more of it. I can’t say she was wrong. She prayed for self-improvement (for God to take away her bitterness at a relative) and for social issues (returning prayer to schools). I don’t know whether she ever prayed for an end to my bipolar disorder (she kept most of her praying private between her and God), but I never have. I don’t think it works that way.

So, what do I think about bipolar disorder and prayer? I think there are many things about bipolar disorder that you could pray about.

You could pray that science finds better treatments for bipolar disorder.

You could pray that you find a support system that helps you (or give thanks for the one you already have).

You could pray that you find a therapist, or a therapy, or a psychiatrist, or a medication that helps you. (Though I would recommend putting some effort into doing this one yourself as well as praying.)

You could pray that you have the strength to get out of bed in the morning or the peace to sleep at night.

You could pray for understanding of what you’re going through—from another person, an employer, the world at large, or even yourself.

You could pray that you don’t do too much harm while in the grip of mania or depression.

You could pray that you will recognize when someone is reaching out to you and that you will have the ability to accept.

You could pray that you have the courage to reach out to someone else, and the wisdom to keep reaching.

In my opinion, what you can’t do is “pray away” the bipolar disorder. If you’ve got it, you have to find a way to live with it. If prayer helps you do that, more power to you. But, again, in my opinion, prayer is not a cure for the disorder. There are some things that are meant for religion or philosophy to make better, and things that science has a better shot at.

You can point to various miraculous remissions of cancer or other diseases, or make the argument that removing demonic possession would now be called healing of mental illness. And if those give you comfort or hope, again, good for you.

St. Dymphna is the patron saint of the mentally afflicted (though personally, I think she should be the patron saint of abused children). If she, or God, or some other higher power of whatever religion or denomination or sect can lessen your suffering, go for it.

I just don’t believe that you—or I—personally will be cured of bipolar disorder by prayer.

Feel free to disagree with me.

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What Does FINE Mean?

I get tired of acronyms—letters that spell out a word and may also stand for the first letters of a word. NASA is okay with me, but I dislike SMART goals, TSA, ATF, and every other government agency. Even more annoying are ones that go on too long and are mystifying to those not already in the know. For example, HHGttG stands for Hitch-Hikers Guide to the Galaxy to SF (science fiction) fans or SMoF (Secret Masters of Fandom).

There are also lots of slogans that make more or less sense, depending. Just Say No. Just Do It. Me Too. Hold My Beer. Keep on Truckin’.

Plenty of acronyms are associated with mental illness, too. SMI. AOT. CARE Courts. BPD. There’s also the infamous FINE. When someone asks how you are and you tell them, “fine,” what that really stands for is Freaked out (or fucked up), Insecure, Neurotic, and Emotional (or empty).

One acronym I’ve been seeing lately is ASK, which stands for Acknowledge, Support, Keep-in-touch. It’s meant to be the “Stop, Drop, and Roll” of how to help a friend who’s having emotional difficulties. I’ve seen PSA (another acronym) ads promoting it on Showtime and MTV (another acronym that is no longer valid). As slogans go, it’s not too bad, although Acknowledge seems a little vague until it’s explained, but Support and Keep-in-touch are pretty clear.

The acronym ASK is associated with the Active Minds organization. Their website is easily findable if you enter “Active Minds” into Google. (The search term ASK brings up too many unrelated hits.) The website it takes you to offers interactive YouTube and “digital experience” links that demonstrate the principles.

Less memorable is ALGEE Assess risk, Listen nonjudgmentally, Give reassurance and information, Encourage appropriate help, and Encourage self-help. It’s a “Mental Health First Aid Action Plan” for helping someone in mental or emotional distress. Assess risk refers to risk of suicide, which may be too complicated a task for non-professionals. The second E, Encourage self-help, refers to suggesting “self-care, self-help strategies, or other ways to get support, such as going out for coffee to talk things over.” Personally, I think the acronym ALGEE is not very memorable and the explanation of the letters is not exactly intuitive.

The slogan that I found most puzzling (although it did get my attention, so it was effective there) is “Seize the Awkward.” The phrase focuses on the idea that, while it may feel a little difficult or awkward to speak to a friend about mental health concerns, you should accept that feeling as natural, then move past the awkwardness and start a helpful or meaningful conversation. The Seize the Awkward website has a lot to offer. There are nine ads for young adults featuring popular or famous spokespeople from music, sports, and other categories. The Ad Council has also provided GIFs, Instagram images, and posters you can use to spread awareness on your own site or location. There is a Campus Toolkit which includes resources on break-ups, loss, suicide, LGBTQ suicide, and racism.

I hereby retract my objection to Seize the Awkward because of its memorability and thoroughness. It’s wonderful. Right up there with Just Do It.

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My Brazen Hussy Phase

This is me in my Brazen Hussy phase, back in my college days. The piano player is a friend that I sometimes went places with. (We tried dating once, but it was a total bust.) We decided to recreate a saloon girl-type photo at the piano in the student union building. There was a lot of hooting and cheering as we got in position. I didn’t have a saloon-girl outfit, so I dressed Western instead. The vest was one my mother made for me out of various calico fabric scraps. I don’t remember just when or where I got the leather hat, but it went with me throughout college and beyond.

My Brazen Hussy phase was the first time that hypomania hit, except for the many times that it appeared as anxiety before I went to college, and after.

As many people do the first time they experience hypomania, especially the sexual kind, I rather enjoyed it. I flirted and dated, which I never did in high school. I joined a sorority and went to frat parties. I enjoyed my first kiss and then many more. I had a mad crush on a musician and eventually got to know him too. He was exciting and passionate and awakened something in me that never even seemed to exist before. When he broke up with me, I went into a deep downward spiral. I won’t say that was why I took a year off college, but I was confused about my future, and that surely didn’t help.

Back in my hometown for the next year, I got my hypomanic mojo back. I engaged in what I knew was a risky relationship with a coworker. I kept up with him for years and told him about my former life as a Brazen Hussy and about my depression. We went out during the former and he stuck with me through the latter. But he always said he wanted Brazen Hussy Jan rather than timid, depressed Jan.

I was back in Brazen Hussy mode when I met the man who would become my husband. We were with a couple of women who already knew him and greeted him with a kiss. “Don’t I get one too?” I asked boldly and got one. He kissed me again around the campfire and followed me around all weekend. I basked in the attention. It was exactly what I needed at the time.

Shortly thereafter, I moved back to my hometown. But we conducted a long-distance relationship until finally he moved out to be with me and, eventually, we married.

I won’t say I never went back into Brazen Hussy mode again. Hypomania still affected me. I still got mad crushes and flirted outrageously. Finally, however, I was diagnosed with bipolar and properly medicated. I won’t say the Brazen Hussy mode went away entirely, but episodes were fewer and further between and easier to understand.

I didn’t originally mean this post to be so confessional, but hypomania and hypersexuality are a very real part of bipolar disorder that I didn’t miss out on in my younger years. And that I sometimes miss in my later years. I know that not having those surges of intense feeling is better for me. Nowadays, however, when my bipolar disorder kicks up, it’s generally bipolar depression. I’m a lot more settled now and don’t have much room in life for hypomania. When I experience it now, it usually manifests as anxiety again or mild euphoria and overspending.

But I’d be lying if I said I didn’t miss my Brazen Hussy phase from time to time.

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Support Group Spam

I belong to a number of Facebook support groups for mental illness issues such as anxiety, depression, and bipolar disorder. I’m even a co-moderator for one of them, Hope for Troubled Minds.

What’s troubling my mind right now is the scammers and spammers who try to take advantage of the group members.

There are the typical posts of course about how much they admire your comments and think your profile picture is very appealing. They’ve tried to friend you, but it hasn’t worked. Then they beg for an “add.” I know that as soon as I friend them, they’ll DM me with a wonderful opportunity. I find these posts annoying, but since I simply hide and block them when they happen to me, I don’t worry too much about them.

The ones that really bother me are those that are targeted to support group members specifically. Here’s one I’ve seen in various groups:

[Product] on Instagram helped me overcome Osteoporosis, fibromyalgia, autoimmune disease, LUPUS rheumatoid arthritis, ptsd, Chronic gastritis, chronic-pain, joint pain, muscles spasms, intense sweating, Raynaud’s Syndrome, inflammation, diagnosis, Fibromyalgia, skin-itching, ADHD, arthritis, spasms, swollen, blotchy hands, shingles, numbness, Anxiety, Autism, feet nerves, and flare-up permanently after taking various meds that didn’t work, look him up.

I suppose I should find it amusing that diagnosis, feet nerves, and flare-up are among the many disorders that the product is supposed to relieve. And the idea that any one product can alleviate PTSD, anxiety, and autism along with all the other listed conditions, is ludicrous.

Another piece of spam along similar lines says:

Truly, natural remedies do work. If they didn’t, we wouldn’t have used them for thousands of years. And, pharmaceutical companies wouldn’t be studying plants, taking extracts of them, and patenting them as lupus drugs.this is not a claim or lies I was totally relieved from pains of lupus disease and CFS by [Person]. His remedy is surely the best. I suggest you try him out if you are having any health challenges and also get cured too, give him a try

This piece of spam is less hyperbolic than the previous one, but it still appeals to people seeking relief from difficult-to-treat conditions. But why post it in a support group that deals with mental illness? It doesn’t address them directly. Perhaps the poster thinks that, since SMI is not thoroughly understood, people who live with it are desperate for any treatment, however unlikely or unconventional.

It’s easier for me to understand how the next bit of spam might appeal to the distraught and lonely people who find that SMI has shattered their most significant relationships. But again, it offers false hope of a “love spell” and the opportunity to become a millionaire.

My appreciation goes to [Person] for restoring back my relationship with his powerful love spell to bring my boyfriend back and also for setting my son free from Courtcase and helping a friend whom I recommend with money spell that made her a proud millionaire are you having any issues that needs urgent attention kindly contact

Finally, we have one that might actually appeal to someone who’s been in an emotionally abusive relationship.

Living with a narcissist can be very difficult due to the gaslighting and lies. If you are interested in obtaining a basic analysis of what your partner does in secret, there is a resource called [product] can provide you with access to text messages, call logs, emails, games, and social media activity (including deleted messages) send a direct message

Never mind that it’s the gaslighter who is more likely to use apps like this to keep track of their victim and isolate them from friends and family.

When I see posts like these, I report them to the group admins. What they do about them, I don’t know. I do know that I haven’t seen people trying to post similar spam in the group that I co-moderate. Unless a person is well-known to us, they must submit a message before it’s posted. So far, no one has proposed a spam post to our group. Occasionally something a bit off-topic, but that’s about it.

I think the spammers intend to prey on people they see as weak and vulnerable. And while there are people who post about their trials and tribulations with brain illnesses, they’re far from weak and vulnerable. You have to be strong and determined to live with them.

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The King Baby and the Narcissist

Almost everyone knows a grown-up in their life who has to be right all the time, has to be catered to, and blames everyone else for failures or unpleasant events.

That person is a King Baby. (Not to be sexist. There is also a Queen Baby.) It’s someone who never grew up, at least not emotionally. King Baby expects everyone to love him, take care of him, and solve all his problems for him.

Reference.com says that a King Baby: “is typically selfish, rejects criticism, complains, is obsessed with money and belongings and doesn’t feel like rules should apply to him. In short, he is someone who refuses to mature.” Tom Cunningham wrote the book (well, the 28-page pamphlet) on King Baby Syndrome in 1986. It’s still available from Hazelden, which is good because King Babies haven’t gone away, nor are they likely to.

King Babies view the world as their plaything and other people as someone whose only function is to meet their needs. Physically they are adults, but emotionally they are still infants. Typical King Baby remarks are, “That’s not fair,” “This is what I want,” “That’s not how I do it,” “Do this for me,” and “I’m the best at everything.”

Needless to say, King Babies are very trying to be around.

I learned about King Baby syndrome from my husband. Not that he has King Baby syndrome. But he used to work as a counselor with various therapy groups. One thing he told me was that when someone was trying to pull King Baby shit, one of the others might call him on it by saying, “Wah!”

King Baby goes by other names as well. Probably best known is Peter Pan, from an 80s pop psych book, The Peter Pan Syndrome. Years before that hit the bookshelves, though, writer Aldous Huxley produced a novel called Island, which talks about “dangerous delinquents” and “power-loving troublemakers” who are “Peter Pans.” In addition, he said, they are “boys who can’t read, won’t learn, don’t get on with anyone, and finally turn to the more violent forms of delinquency.” Huxley cited Adolf Hitler as an example.

King Baby syndrome is not an actual psychological diagnosis. It is not covered in the DSM. But the DSM does include Narcissistic Personality Disorder, which sounds remarkably like a King Baby:

  • exaggeration of accomplishments
  • saying they have done things they haven’t really done
  • acting or feeling more important than others
  • believing they are special and unique
  • having a need to be admired all the time
  • expecting to be treated differently, with more status than others
  • exploiting others to get what they want or need
  • pretending concern towards others or lacking empathy
  • being jealous and competitive with others
  • thinking that others are jealous of them
  • acting arrogant and superior

Narcissistic Personality Disorder is, of course, an official diagnosis in the DSM. King Baby is only someone you perceive as narcissistic but who hasn’t gone through the process that leads to a diagnosis. I’d hesitate to call someone a narcissist who hasn’t even talked to a psychologist or psychiatrist. But I have no problem labeling someone a King Baby.

So what do you do with a King Baby? My advice is to avoid them if possible. You can, like the people in my husband’s therapy groups, call the person out for their behavior, though it’s not likely to do any good. Often it’s best just to cut the King Baby out of your life. If you do, though, expect anger, blaming, and recriminations.

If you do have to live with a King Baby, perhaps the best thing you can do is to recognize the behavior when you see it happening and not fall into the trap of trying to meet the King Baby’s every need. This won’t make any difference in the King Baby’s behavior, of course. You’ll have to deal with pouting, sulking, poor-me talk, and even retaliation.

Because just as vampires never grow older, King Babies never grow up. They can’t and they won’t.

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Breach of Confidentiality

One of the things that people who see a therapist dread is a breach of confidentiality. Fortunately, it almost never happens. Therapists have client-therapist confidentiality that forbids it. It’s like the seal of the confessional for priests.

There’s an exception, however, and that’s the Tarasoff warning. Here’s how it came to be.

Way back in 1969, a young woman named Tatiana Tarasoff, a student at the University of California, Berkeley, was murdered. The killer was Prosenjit Poddar, also a student at the university. They knew each other and had gone on several dates. Unfortunately, as happens way too often, the couple had differing opinions on where the relationship should go.

Poddar became obsessed with Tarasoff. She was no longer interested. So he began stalking her. He had an emotional crisis and began seeing a therapist at the university medical center.

So far, it’s a pretty typical story of a relationship, a breakup, and an extreme emotional reaction. However, it soon became much more than that.

One day, Poddar admitted to his therapist that he wanted to kill Tarasoff. (He didn’t refer to her by name, but her identity was clear). The therapist said that, if Poddar kept issuing death threats, he would have to be hospitalized. Poddar stopped coming to therapy.

The therapist was left with a dilemma as to what he should do next.

The therapist and his supervisor decided to write a letter to campus police regarding the death threats. The police interviewed Poddar in the room he shared with Tarasoff’s brother. When Poddar denied everything and said he would stay away from Tatiana, the investigation was halted. The supervisor instructed the therapist to destroy all his case notes.

Of course, Poddar continued stalking Tarasoff and confronted her. When she tried to run away, he stabbed her with the knife he was carrying, killing her. He was arrested, tried, and convicted of first-degree murder (though he had tried to plea-bargain down to manslaughter). He served five years and was deported to his native India.

Tarasoff’s parents sued the university and the therapists on the grounds that they should have warned their daughter about the death threats. The therapists countered with the client-therapist confidentiality argument and won. Later, however, the case was retried and this time, in 1976, the Tarasoffs prevailed.

Since then, over half of US states have enacted “Tarasoff laws.” Others leave the decision up to the therapist. And Maine, North Carolina, North Dakota, and Nevada have specifically ruled that Tarasoff laws don’t apply there. The laws are still controversial. For one thing, the university therapists did call the campus police. For another, it leaves the burden of deciding whether a threat is credible solely on the therapist. And it left it up to the therapist whether to breach confidentiality. And there have been debates on whether Tarasoff warnings should be given regarding threats of physical violence that fall short of murder.

So, what’s a therapist to do? Warn clients that if they make threats, they’ll be reported? That can have the effect of causing the client to leave therapy. Guess—and it really is a guess—whether a threat is real or perhaps a fantasy? Err on the side of caution? Give priority to the confidentiality requirement? Risk a malpractice lawsuit brought by the client if the therapist does report the potential threat? A wrongful death suit for not acting in time?

Which prevails: the duty to warn a potential victim or the duty to preserve confidentiality? And is it a duty to warn or a duty to protect? (These distinctions have been made in some places.) We’ve become used to the phrase “harm to self or others” when it comes to involuntary treatment. But this question goes further. What does a therapist owe to a specific individual who may be killed? Sectioning the client? Reporting the threat to the police? Directly warning the potential victim?

It’s an awful lot to place on the shoulders of a therapist: determine the reality of a threat, make a prediction about future violent behavior, and determine an appropriate response. Weighing patient confidentiality and harm or death to another is a huge burden. But in the interests of there never being another Tarasoff-style murder, I’m coming down on the side of the duty to warn.

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Mental Health

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