Florid and Invidious Psychoses Compared

The person with a diagnosis of a disorder that has involved psychotic features can suffer from two kinds of alienation from reality:

·         Florid psychosis. This involves frank delusions and/or hallucinations. The person hears or sees phenomena not perceived by anyone else. For example, I once perceived the day turn into night (on a day without a violent storm) when floridly psychotic.

·         Invidious psychosis (this is my own term.) These are the frequent instances of the person’s not being amenable to reason. The person gets a notion in his or her head that is impossible to shake loose.

The second kind can be worse than the first for family and friends in the picture. The affected person may have good insight into the disease process so far as florid psychosis goes, and perhaps other symptoms as well, but sees the invidious psychosis as merely that “reasonable minds may differ.” Only, his or her reasoning at such an hour is mere pseudo-logic, and does not show common sense.

I am subject to invidious psychosis when under severe stress. Between my Bipolar Disorder and my brain injury, my judgment is always less good than that of someone without these problems, and my weakness to the point of invidious psychosis becomes manifest in very difficult times.

For example, even though I am a Republican, President Donald Trump’s election filled me with such foreboding that until after Inauguration Day by which time I had adapted to the situation, I could not make sound decisions about major issues. Fortunately, I have a loving family who did and do step in to assist me when I lack good judgment.

Invidious psychosis begins “down a slippery slope.” That’s why I call it, “invidious.” Weeks can elapse before the person becomes irrational. This latency just increases the affected person’s confidence that there is “nothing wrong” with him or her….

Excuses, excuses....

All disabilities confer selective advantage, even if only via the responses of others who have learned from the situation. “Selective advantage” is a biological term for that which is helpful to the survival of the species.

But for many a disabled person, the chief advantage of being disabled is to himself or herself.

Erving Goffman, sociologist, in Asylums (1975), built upon the work of Talcott Parsons and others to define the “sick role.” Being diagnosed confers the advantage of restrictions on going to work, or freedom from it. In a “total institution” such as he described, like the closed psychiatric unit in a hospital, patients undergo “the mortification of self.”

A rock-bottom aspect of the self in American culture is being able to give a reply concerning a vocation to the query, “What do you do?” In a psychiatric unit, one does nothing of one’s normal adult life, just art therapy, music therapy, and suchlike. These recreational therapies do not bode well for self-esteem, because when the sole activities, they do not allow the patient to contribute to his or her loved ones (unless it happens that the person’s vocation or important avocation is artistic, musical, etc.)

Many disabled people tend to make excuses for themselves, by manufacturing instances of their truly dominant symptom, in order to obtain some benefit. They may manufacture frequency of the symptom, severity of the symptom, or both. This is true of disabled people with or without psychiatric disabilities.

This behavior is very different from the American Psychiatric Association's Diagnostic and Statistical Manual V’s diagnoses of factitious disorder or of malingering. The person whom I am describing, who makes excuses for himself or herself, is genuinely disabled and is not mimicking a medical condition for sympathy (which is factitious syndrome,) or for a financial or legal advantage (which is malingering.)

And, indeed, it may just be true that everyone, disabled or not, tends to “milk sympathy” by exaggerating his or her problems in conversations with family or friends. Since I know that I do this, and since I am disabled, I am inclined however to think that it is a tendency that may be engaged in frequently by people with disabilities.

“Injustice Collecting" Does Not Help an Employee

If a person indulges in collecting injustices against himself or herself, and reciting them to anyone who seems willing to listen—it rubs others the wrong way!

If an employee has this trait, interacting with co-workers, supervisors, and clients/customers becomes even more difficult than for an employee who lacks this trait but still has a psychiatric disability. (Indeed, in this day and age of blanket media coverage of mass shooting rampages, many listening may fear that such a person may be about to commit such a criminal spree.) While of course seasoned forensic psychiatrists are unable to predict violence in the workplace or elsewhere with any accuracy to speak of, co-workers and supervisors may think that they can.

People most likely to be injustice collectors are those with paranoid features and, in some instances, those with PTSD.

(Those who in groups proclaim injustice against themselves as a group, being a minority of some kind, have no difficulty maintaining gregarious presence in the workplace or in greater society. Unless an individual identifying with such a group happens to be a person with a psychiatric disability that includes paranoia, or in some instances, PTSD, he or she will have no more difficulty “getting along” than any of his or her peers. That is to say about a person with a psychiatric disability free of paranoia or PTSD, he or she will be able to get along to the extent that [s]he has a good socialization history.)

It would be helpful in programs designed for vocational rehabilitation of people with psychiatric disabilities to discourage the trait of injustice collecting.

The Snowball of Vocational Inexperience

A person with few friends with whom to practice social interactions is at a disadvantage in the workplace. It is harder for him or her than for most people to get along with co-workers and to respond properly to supervisors.

This deficit in experience (and opportunities for learning skills) can lead to such a person’s being susceptible to being terminated—laid-off or even fired—from his or her first job.

Such a spotty employment history often snowballs into the person’s having misunderstandings in his or her next job (once secured,) due to:

·         A relative lack of knowledge of job skills needed in the industry or profession; and,

·         A relative lack of knowledge of the culture of the particular (new) employer’s. This is because the characteristics of a typical worksite are likely similar within an industry or profession.

So on his or her next job, it is even more likely (than on the prior job) that it will be difficult for the person to be promoted to a better position. And his or her being terminated from a subsequent job is likewise even more likely.

Some aspects of almost every job involve promotion (sales or marketing.) This activity is feasible only to the extent that the employee has “people skills.” And such are hard to learn for the first time on the job itself, without a firm foundation in earlier life.

The lack of many friends in adolescence and early adulthood, which can be the situation for many people diagnosed with serious mental illness, can snowball into later vocational inexperience.

Lonely, Impaired Young People Are at a Disadvantage Throughout Their Careers

The extracurricular activities that people who become disabled with a psychiatric disability that is severe had engaged in during high school and college may tend to be less social than those of their peers. Thus, they may have fewer friends at that time, and will in later life have fewer old friends.

If such a person is an exception to the above generalization, because (s)he became severely disabled in his or her thirties instead of twenties, he or she would have amassed time to blossom. But even an outgoing soul like this may find that former friends fall away upon diagnosis and relapses. Other people don’t know how to strike up a conversation, or more to the point keep it going, with a person who is severely impaired. It’s a turn-off to see suffering up close. (This sentence is true of all tragic life events, from a death in the family to a criminal conviction, but there is less social acceptance for a mental illness than for other vagaries of life.)

The few “replacement” friends one is able to make tend to be in the disability community, either that generally or specific to psychiatric issues. If a truly “normal” person befriends one, G-d has smiled. (I have enjoyed the friendship of Ruan Frenette, met through mental health advocacy, for two decades. She is really stable and free of any psychiatric symptoms. Almost all my other “replacement” friends have been closet depressives—or remain at arm’s length from me. Of course, as a person with both physical and psychiatric disabilities, I am rather a “downer,” sunny smile notwithstanding!)

In the last decade, diagnosis of psychiatric disabilities has undergone a quantum shift, with adolescents and even children found to meet diagnostic categorization, far more than in previous generations. Youngsters and young people receive labels today that tell them that they are at best, “special,” and at worst, “crippled.” Who would not withdraw? And thus make fewer friends than their age-mates.

There will be no one to seek them out in later days to reminisce about shared sports, clubs, and competitions. They (like their peers) may engage mega-minutes with their screens, but they (unlike their peers) make fewer friends from shared life activities in those years of formation.

Skills of getting along with others are fundamental in employment of almost any sort. The situation of having had few good friends to practice with does not bode well for career success.

An Introduction to Responsibility for the Person with a Severe Psychiatric Disability

From an adult lifetime of severe PTSD and often-severe Bipolar Disorder, I have noticed in myself deleterious behaviors that have seemed to be common also among those whom I’ve met along the way who seem to have been, or are, as impaired as I. These behaviors that I am noting cause dismay to employers, family, and friends alike. Thus, I have chosen as the topic of my fourth book (RESPONSIBILITY)  brief essays on ethics, which I am interspersing with autobiographical examples. I am drafting parts of the manuscript as Psychiatric DisABILITIES.blogspot.com blog posts. I would hope that some person similarly situated would take to heart an error or two of mine and craft a resolution from it for himself or herself.

Yes, my brain’s being scrambled is due to the expression of my genotype in the face of environmental influences—but, hey!—I have had a great deal to do with my failures in life. There do be character flaws typical of at least some people with such psychiatric disabilities as those I have. (These disabilities used to be called “severe and persistent mental illness,” but are now called simply “severe mental illness” out of respect for those who have recovered.)

The first set of blog posts describe employment; the second, family relationships.

But, it’s important before writing anything else to circumscribe the domain of my comments. If a person is ill enough to be in the hospital, that is no time to admonish him or her to buck up or to change his or her ethics. Nor for however long it may take for stabilization. This sub-acute care could go on for years—even decades--if further hospitalizations follow apace. Ditto when medications and other treatments need to be changed frequently.

Eventually, however, there comes a time when realistic limits and/or norms should be set for the disabled person, as they are for any other person. It is part and parcel of equality. Be certain, though, of my meaning. It is unrealistic to expect a person who has met the rigorous standards set by the United States Social Security Administration for the finding of a “mental impairment” (psychiatric disability) to be able to return to work, unless under medical guidance. And expecting a disabled person with a long psychiatric history to find work for which he or she has neither training nor experience is futile. It causes that person to resent the other, and frustration for the other.

(Specifically, if a disabled person overspends on credit, which is a typical problem for someone with severe Bipolar, it is sensible to encourage him or her to spend no more than income [from Social Security, for example.] No one will be pleased if someone tries to force him or her to be gainfully employed with remuneration at the net level of money that he or she is expending.) For that matter, as Charles Dickens wrote in David Copperfield, through the character of Mr Micawber, spending less than an income of twenty pounds has the “result [of] happiness,” but spending more has the “result [of] misery,” whether or not the spender happens to be a person with a psychiatric disability!

People are complicated, and just because someone may have a certain set of impairments does not at all mean that he or she has little or no capacity to give, produce, create, and love. Many talents, and even world-class genius, can be found in people with such disabilities as severe mental illness. Just consider Vincent Van Gogh!

A Preface of Gratitude

Before beginning a major series of posts on the impact of psychiatric disabilities on one’s character, I should like to thank G-d for the many miracles that He has bestowed upon me.

·         I am able to start a new book, RESPONSIBILITY (my fouth book,) and have access to the web to be able to write short segments as blog posts.

·         He has given me a loving family.

·         My many good friends include a great number who come to see me for one-on-one tea parties.

·         G-d has graced me with being able to bake well, to cater those teas.

·         He has given me the ability to read:

o   Thereby, the cooking skills that were taught to me in seventh-grade Home Economics have been honed so that I can use up (in a delicious manner) whatever groceries I happen to have on hand—useful for a person who lives on a fixed income.

o   Furthermore, that ability to read has given me pleasures of world, British, and American literature as well as skills beyond cooking, derived from taking to heart reference materials of all sorts.

·         Where would I be without the eyesight to enjoy Nature and to read? Yes, if vision is diminished or taken from me, I shall adapt, but I am so grateful to the Good L-rd for this gift.

·         G-d has apparently given me the ability to write a phrase that I am told is not unpleasant to scan.

So, to paraphrase lyricist Mr Folliott Sandford Pierpoint, I say:

                L-rd of all, to Thee I raise, This my hymn of grateful praise!