Tuesday, November 3, 2009

Judging Amy - Part I

Following is a chopped-down version of the article, Poisonality, from mcmanweb:

Rewind a bunch of years ago. Bill treats his mom to a cruise.

Fast forward to the present. An aunt is being laid to rest. Bill's mom happens to mention the cruise to her daughter. As the casket is carried out, the daughter pulls her other brother aside and says in a voice quivering with rage, one that carries into the distant pews, “She really knows how to push my buttons!”

Everyone would agree that the daughter’s behavior is highly inappropriate, but is it consistent with a personality disorder? Consider:

Let’s suppose the daughter – call her Amy – had been especially close to her aunt and not so close to her mother. Suppose for two days, in her state of distress, she has been enduring a steady stream of sugar-coated insults from a mother she can barely stand. Then mom makes a seemingly innocuous comment that sets her off …

Let’s change the context. This time, suppose Amy had to cross three time zones to attend her aunt’s funeral. She has missed a night’s sleep which has triggered an irritable hypomania. During the service, she is literally crawling out of her skin. The air is oppressive, the people are making her claustrophobic, she can’t sit still, she wants to scream. Her mother says something, and she turns to her brother …

Distinguishing a bad hair day from a mood episode from a personality disorder meltdown is notoriously difficult. Even Mother Teresa had her off-moments, and no doubt Gandhi had unresolved issues he needed to work through. We all have feet of clay. Labeling someone with a personality disorder, then, is perhaps the most insulting and stigmatizing act one can visit upon an individual, even in the name of therapy and treatment. Reflect for a second the names psychiatry has bestowed on the four main personality disorders, lumped together into what are called Axis II cluster B personality disorders: Borderline personality disorder, antisocial personality disorder, narcissistic personality disorder, histrionic personality disorder.

You are not supposed to like these people, is the strong message attached to these labels. These people are poison, the message goes on to say. They lack empathy, they are impulsive, and only they matter. The golden rule doesn’t apply to them and neither do most of the commandments and other people's personal boundaries. Cut them out of your life, run away, treat them like lepers

Then again, if a family member or an acquaintance or a colleague at work is currently making your life miserable, you probably don’t have much sympathy. Life is like that.

Let’s return to Amy. She could be having a bad hair day. She could be experiencing a mood episode. She could also be having a meltdown stemming from various personality issues.

Please make careful note of the term, various personality issues. We are not going to attribute Amy’s outburst to one full-blown personality disorder. She may have one, she may not. But in all likelihood, a number of things are going on, a bit of this, a bit of that. Amy may be a kind and loving person, but her funeral theatrics indicate that something is clearly wrong.

But does Amy know it? She looks at the people staring at her and wonders what THEIR problem is, then leaves the church as if nothing happened. Or, if she acknowledges something has happened, she has already justified it – clearly it was her mother’s fault, the one who knows how to push her buttons. If her mother is a saint, if cornered, Amy will find a way to demonize her.

Woe to the person who may challenge Amy, but even if all her defenses are unmasked, she can still play the pity card. Even when she admits she’s wrong, the attention is worth it. There is victory in defeat.

Therein lies the difference between a person experiencing a bad hair day or mood episode and one with personality issues. The former are typically mortified by their out-of-character behavior (once they have settled down). When personality comes into play, the issue is far more complex. There may be no settling down; the behavior in question may be part of one's default setting (though change is possible). Or, there may be only a small window for remorse before Amy's world once again closes in on her, overwhelms her.

We all know people like Amy, but before you congratulate yourself for not being like her, it pays to recall that we all have personality issues of some sort. Besides, we need a lot more to go on than a single incident, more like a pattern.

To be continued ...

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