Can an Extravert Do My Job?

This is from a recent article on mcmanweb, which in turn is based on three pieces I did for HealthCentral's BipolarConnect. At the moment, I am back in my element of restorative splendid isolation following a Saturday of being on conspicuous public display during our NAMI San Diego Walk.

The NAMI San Diego Walk video I posted a couple of days ago lends the impression that I'm an extravert who thrives amongst people. Wrong! It's very complicated, but chances are a lot of this applies to you, as well. Let's get crackin' ...  

In a post from last year, I reported that most of us with mood disorders are introverts rather than extraverts, which brings on a dangerous tendency to isolate. This in turn makes us sitting ducks for depression.

I am a card-carrying introvert. I can testify to this. But neither introversion nor extraversion is all good or all bad, though not everybody sees it that way. "What's concerning me," commented one of my readers, "Jane", on HealthCentral's BipolarConnect, "is that the pdocs of the world have decided we need to be a nation of Rotarians."

Nothing against Rotarians, but you get the picture. Give me a nice quiet cave on a mountain top in the most remote region of Tibet for the next ten years, any day of the week. But eventually, I must return to a world of Rotarians. I may be a one-man majority in my personal cave, but out in the real world three out of four individuals on this planet are extraverts.

So, the ex's have it. Extraversion IS the norm, with introverts the outsiders, struggling to fit into a world set up for the numerical majority.

If anything, psychiatry is collaborating with our oppressors. Personality tests based on the five factor model (FFM) measure for positive traits, including extraversion. The new version of the DSM, due out in 2013, incorporates the FFM into its new criteria for personality disorders, focusing on what it sees as the negative trait of introversion. This might be forgivable if extraversion/introversion were only a small piece in the personality puzzle, but that is hardly the case. The FFM, for instance, also tests for "openness" and "agreeability." An "agreeable" personality to an introvert is hardly going to be an agreeable personality to an extravert, and guess who is likely to be doing the assessing? As Freda at BipolarConnect remarked:

Where [introversion] was once, some years back, considered quaint and "tolerable," it is now considered snobbish, offensive, and completely not accepted, at least in my circle of the world. ... I am repeatedly informed and I must be trained and taught and given "coping skills" to master.

It gets worse. The FFM fails to measure for traits that play into our strengths, such as introspection, insight, imagination, and creativity. In other words, psychiatry - reflecting the world-at-large - values sociability over personal reflection, superficial social connections over deep thinking, pat answers over nuanced problem-solving, and conformity over breaking the mold.

Off the top of my head, George W Bush would be psychiatry's ideal poster boy. Is something very wrong with this picture?

What psychiatry fails to recognize is that someone out there needs to be generating ideas and new ways of looking at the world, and these tend to come from the type of people who enjoy being alone over long stretches of time, or at least know how to function in solitude. Even those who perform in public are obliged to master their craft in lonely settings. Writers definitely need to be alone. Same with those in science and technology and a host of other disciplines.

How does an extravert handle these situations? Not too well. As Diana reports on her younger sister:

She dies a thousand deaths each night she is alone. She lives for companionship and would almost rather be with the wrong person than to be alone. She is either on the phone or with someone or planning her next outing - all the time. ... And when she is alone, she feels abandoned.

Ironically, when we introverts do surface, we are often mistaken for extraverts, precisely because we're bubbling with fresh thoughts and ideas, much to the amusement (or consternation) of the extraverts in our company. But if they are fascinated (or appalled) by us, we quickly become bored with them, unless they, too, can feed us new insights.

Extraverts thrive in glad-handing, banal-conversation situations. We suffocate. The air we breathe is in our nourishing and stimulating private world. Diana's sister can't hack it in this environment, yet she is considered the normal one, an FFM-DSM model of perfection.

To each his own, you may say. If only that were the case. But not with the extravert majority judging us.

Could an extravert do my job? I asked in a post on Bipolar Connect. Over six weeks in the beginning of 2011, I hunkered down in my quiet corner of the universe, blotting out all distractions, completely overhauling my website. This involved being at the keyboard at about nine every morning, and calling it a day around midnight, seven days a week, with frequent (but mostly solitary) breaks in between.

I was totally in my element. By contrast, an extravert - a citizen in "a nation of Rotarians" -  would be climbing walls. Or, perhaps Citizen Rotarian would have attempted to drag me out the door, thinking he was doing me a favor.

Oh, and by the way, introversion nearly killed me (though that was much earlier).

The extraverts are right about one thing. Strange things happen to our brains when we shut ourselves off from the outside world for too long. Extraverts need to come up for air, fast, which is why they could never do my job. But, eventually, there comes a time when I can't do my job, either.

They can't spend too much time in my world. I can't spend too much time in theirs. But for my own sanity, I do need to set aside special time for their world. Of all things, once I acclimate myself to the chill waters, I do enjoy myself. I perk up, I become animated. Neurons spark. I make connections.

But the effort drains me, and I have to return to my world. It's all about balance. My concept of balance is very different from an extravert's concept of balance, or, for that matter psychiatry's concept of balance. We're the minority. The majority out there is never going to understand us. They think that what's good for them is good for us. They're wrong, of course, but every once in awhile they're right.

Postscript: My post-Walk recuperation ends today. I'm meeting a couple of mental health advocates for the first time for lunch in a restaurant with valet parking. Shit! The place probably has tablecloths, too, which means no jeans for me. The last time I wore dress slacks had to have been six months ago, which I recall throwing very carefully on the bedroom floor. I think they're still there. I'll be fine ...

Introversion and Isolation

The following is a chopped-down version of an article I published on mcmanweb in 2003, plus some additional observations to reflect my current thinking on the topic ...

In May 2003, I asked my Newsletter readers to take an online Myers-Briggs personality test and email the results, along with their diagnosis.

The Myers-Briggs type indicator (MBTI) begins with eight personality functions in contrasting pairs - Introvert (I) or Extrovert (E), Intuitive (N) or Sensing (S), Thinking (T) or Feeling (F), and Judging (J) or Perceiving (P).

The Introvert/Extrovert dichotomy relates to people drawing their energy from being alone or with people rather than simply being either shy or outgoing. Thinking and Feeling are self-explanatory. Sensors tend to focus on the here and now while Intuitives look for meaning and possibilities. Judgers prefer structure in their lives over the messy flexibility of Perceivers.

Falling within these four temperaments are 16 distinct personality types, defined according to the eight paired personality functions, thus INFP, ESTJ, etc.

I analyzed the first 100 responses. Most readers also sent in their diagnosis, nearly all with depression or bipolar disorder. Since most people with bipolar disorder are depressed more than manic, it is safe to conclude that this poll was dealing with a mostly-depressed population. Approximately three-quarters of the respondents were women.

The first eye-popping result was 83 percent of those who replied were introverts, which sharply contrasts with the 25 percent to be found in the general population. According to one reader, who had a strong extrovert score four years ago and a much weaker one when responding to this poll: "Over the last four years I've sunk into a very isolated existence. The mania has worsened despite changes in medication/dosages and I spend most of my time sleeping and avoiding large social functions. I do slightly better in small social gatherings, but up until just a couple of months ago I didn't go anywhere or see anyone other than my immediate family within our house."

The best is yet to come: There were 17 INFJs and 14 INFPs, the largest populations in this study, the "mystics" and "dreamers," respectively, who only account for one percent each of the general population. These groups turned up in higher than expected numbers in at least two online MBTI tests, which may explain the large turnout here.

As for the extroverts: Possibly because it was just one letter off INFP, there were seven ENFPs, “visionaries” who would fit right in with the mystics and dreamers, the only category of extrovert over-represented in this poll. Since other versions of extroverts have descriptions such as “enforcers,” “adventurers,” “helpers,” and “jokers,” you can see what we are missing.

One of the few psychiatric studies using the MBTI, by David Janowsky MD of the University of North Carolina, also found a preponderance of introverts (as well as feelers) among a depressed population.

Several readers commented that their results varied on circumstances and phase of illness. Stephanie wrote that "when manic I'm as sociable as Bette Midler on cocaine and when I'm depressed, seriously come not near me."

Carol, who came up ENTJ back in college and again a couple of years ago when working for a mutual fund company, observed that "if I may draw a conclusion, those of us who can break through isolation and make contact with others, could be better able to keep the depression at bay."

In the meantime, we are left with the disquieting knowledge that our illness can isolate ourselves to the point of virtual no-return. Another study by Dr Janowsky found that 84 percent of 64 suicidal patients he examined were introverts, leading the him to observe:

"The issue of social isolation has been mentioned as a potential risk factor for suicidality. The introverted individual almost certainly has trouble reaching out to others, especially in times of stress and need. Thus the social isolation of introversion may set the scene for suicidality."

In a 2001 article appearing in Current Psychiatry Reports, Dr Janowsky cites various studies to support the proposition that "increased introversion predicts the persistence of depressive symptoms and a lack of remission" (and conversely that extroversion can improve outcomes).

The obvious antidote is to do whatever it takes to get out of the house and into the company of others. This is generally easier said than done, given the nature of our illness, but the stakes are enormous in what could very well be the most important aspect of our treatment.

***
Based on what I have learned and experienced since writing this article nearly seven years ago, I would make some major changes to include the positive features of introversion. On a personal note, I am an INFP and a hermit by nature. What makes my day is connecting two seemingly unrelated thoughts alone in my room or while out on a walk in the middle of nowhere. I do perk up around people, and in these situations I get mistaken for an extravert, but the effort drains me and I find myself relieved to be back in my comforting isolation.

I pity those who have no comprehension of my rich inner world, but when I originally wrote this piece I realized my isolation was killing me, as it had nearly killed me at other times in my life. Accordingly, I made deliberate efforts to get out amongst people, which no doubt reduced my risk of depression, and had the unexpected result of helping me find the kind of ease within myself that had eluded me my whole life.

Getting out amongst people back then was like plunging into ice water. It’s much easier now, but the water is still cold. Your views, please ...