The Asshole Diagnosis - And the Asshole Paradox

Finally, it's out in the open. On April Fools Day, I reran my two previous "Asshole" blog posts. The first one, Psychiatry Comes Up with New Diagnosis of Asshole, reported that the new diagnosis offers neither symptoms nor a description, but that "you know one when you see one." The piece noted that bipolars have complained bitterly since the dawn of time over being confused with assholes.

So have sociopaths. As Charles Manson from his prison cell observed: "For years, assholes have been giving us sociopaths a bad name."

So who are we talking about, really? In a comment to my first piece, Registered Psych Nurse wrote:

You do know that this unofficial diagnosis has been used by staff in cutting edge mental health units for decades already. It is an optional term for antisocial or borderline personality disordered individuals, as part of staff dark humor and calling spades spades really. Not all a-holes have aspd or borderline PD it is true, but the vast majority with these disorders do qualify as a-holes.

She goes on to say:

Certainly there is an issue with borderline PDs being misdiagnosed as bipolar disorder - hence the borderline a-holes are bringing an undeserved bad name on real bipolars. Blame the pharmaceutical companies, they encourage Drs to shunt the borderlines under the bipolar classification because this way it's allowable to prescribe more drugs to them. Not ones that they need but oh well. I guess the pharmaceutical pushers may be a-holes too.

Thank you, Registered Psych Nurse for finally putting the issue on the table. Screw being polite. Screw being PC. Let's embrace Registered Psych Nurse for calling it as it truly is, namely: Borderline is the true Asshole diagnosis.

Hear me out:

I got motivated to investigate this in depth about five years ago when I was on the board of a state DBSA back east. It turned out our board was way over-represented by assholes. It also turned out that since these individuals predictably lacked the capacity to hold down a job or a relationship they had all the time in the world to drive people like me crazy.

Since I had the bad luck to be temporarily serving as board president, I had to be nice to these assholes. I put up with their manipulations and lying and backstabbing, their petty complaints, their hissy fits, their meltdowns, their gossip, their personal abuse, their poison pen emails ... It goes on and on. And on and on.

This can't possibly be bipolar behavior, I reasoned. This has to be something else. Then a light went off.

For years, psychiatry has been treating all emotionally volatile individuals as if they had bipolar.  That is beginning to change, but we have a long way to go. Last year, in recognition of May as borderline personality disorder month, I did a four-part series on borderline, which essentially boils down to this:

When those with mood disorders respond to treatment they go back to being nice people again (or at least only minor dickheads). Those with borderline remain assholes.

Now here's the tragedy, as I see it: A true asshole is totally unaware of his or her condition. They act as if the whole rest of the world is at fault. They don't want to change. This is very much the opposite of someone seeking out psychiatric or therapeutic services. They know something is wrong. They want to change.

But they're frustrated in their mission if they're given a bipolar diagnosis. They seek help willing to take responsibility, and instead are sent out the door with a prescription and a sense of absolution.

This is an entirely different proposition from those who have received a correct diagnosis, who have accepted their diagnosis, and are willing to put in the work. Call it the asshole paradox: Simply by owning up to the fact of being an asshole, you are well on your way to becoming an ex-asshole.

(Think of the individual in the picture caught on the horns of a dilemma.)

So, yes, let's call a spade a spade: Borderline is the asshole diagnosis. But let's also recognize the asshole paradox.

Let's also recognize the exceptional bravery of those who are willing to own up to their diagnosis in the company of others. It would be so much easier for them to hide behind a bipolar diagnosis. Trust me, the stigma of having bipolar is nothing compared to what those with borderline have to put up with. A little enlightenment from the rest of us is long overdue.

As for true assholes, screw 'em.


Further reading from Knowledge is Necessity:

May is Borderline Personality Disorder Awareness Month
Borderline Personality Disorder - Searching for Respect
Piecing Together the Borderline Puzzle
The Borderline Personality Disorder Matzoh Ball