Mental Illness- Let’s start with the basics

Anxious, wicked, and psychotic are different things

There are three broad groups of mental illness: mood disorders, personality disorders, and psychotic illness. Let’s use an example to clarify the different groups. Imagine a middle-aged mom (we’ll call her Shelly) who is on the way to pick up her kids from school. Imagine that she is already thirty minutes late and she is stuck in traffic. She has a cranky four-year-old in the back seat who is adamant that he needs to go to the bathroom use the toilet right now. Packed into a traffic jam, horns are blaring, no cars are moving, and with a kid screaming in the back, any healthy person might get frustrated. However, how a healthy person behaves and how Shelly acts are different.

Mood disorders ^[1]

Mood disorders are very common. Common ones are generalized anxiety, major depression, bipolar disorder, etc. Almost everybody has a specific anxiety issue called panic disorder. On a regular basis, provoked or for no reason, Shelly goes into a panic cycle. That is what happens in the scenario that I am describing. Shelly feels like “I’m going to die if I don’t get out of here – immediately. “Her heart pounds, mind races, breathing accelerates, palms sweat, etc. etc.  Instead of driving to the school, she diverts to the E.R. for what she is sure must be a heart attack. The result is that the child has to wait in the principal’s office until Dad can leave work to come to pick him up. The people who are close to Shelly pay a big price for her anxiety and panic disorder. It’s not just about the three thousand dollars for the ER visit. Her family people around them must suffer the disruption caused by Shelly’s loss of control due. For example, in this case, the child in the back wets himself, grandparents must come to pick him up at the ER. Dad misses an important meeting. All the other children, friends, and family are worried to death because everyone thinks that Shelly is dying.

Personality disorders ^[2]

in early childhood, Every person should start to develop a sense of who they are (our character and ego) and how they will relate to the world (personality). This development usually follows a predictable progression. ^[3] Unfortunately, some people never learn to think of themselves as independent human beings. They never develop a sense of value and capacity. Consequently, they don’t have a foundation for an organized and stable personality. Most people have suffered from interaction with the worst group of personality disorders; the “Cluster B’s.” These are Narcissism, Borderline, Antisocial and Histrionic personality disorders.^[4]

The core feature of personality disorders is a primitive sense of extreme vulnerability. Dealing with them can be like trying to interact with the spoiled two-year-old mind in an adult body. It’s difficult for healthy people to understand how callous, cruel, and destructive these patients can be.  For example, most of us are very familiar with the extreme form of narcissistic personality disorder (malignant narcissism).   The patients can be self-centered in the extreme and incapable of empathy.  It is hard for healthy people to comprehend the depth and breadth of destruction that people with a “Cluster B” illness and similarly afflicted people will cause in the pursuit of their immediate self-interest.  The more you try to reason with them, the more intense their rage. the more love than you show them, the more vicious they act.

In our example, we’ll now pretend that Shelly has a borderline personality disorder. Let’s look at how she reacts; it’s very different than the example where we ‘said’ she had panic disorder.  Borderline Shelly goes into a rage. She screams at the child, calling him vile names, says horribly hurtful things, and utterly out of proportion to any mistake that the child could have possibly made. Her rage is just as unpredictable as her cycles of excessive love and affection.

The only treatment is intense psychotherapy with an expert psychologist several times a week for years. These patients will rarely do any self-reflection, much less painful psychotherapy because they are extremely averse to admitting that there is any problem with them in the first place. Although they sometimes ‘mellow’ in the fifties, they don’t grow as people. Everyone around them walks on “eggshells” – they live with the never-ending excessive love- uncontrollable hate cycles.

Schizoaffective disorders and schizophrenia ^[5] (hell on earth)

People with psychotic disorders, such as schizoaffective disorder and schizophrenia, have unreal sensory perceptions (hallucinations) that appear very real to them. Let’s take the example of schizophrenia. Each subtype of schizophrenia has periods of worsening or improving. But once present, schizophrenia can’t be cured. The most dangerous extreme version is paranoid schizophrenia.^[6] They hear, see, and feel imaginary threats to their life and wellbeing on a near-continuous basis. Their suffering is on a level that no one without the disease can even remotely comprehend. And the disease can be dangerous- nobody knows this better than a patient who lives with it.

If Shelly had paranoid schizophrenic and she was in the situation that I describe, he reaction might be like this: Shelly sees, hears, and feels demons, riding in chariots of fire, surrounding her car, intent on boiling her and her kids in oil.  In a full-blown “psychotic break^[7] ”, Shelly might even hear the archangel Gabriel command her to take a gun and ‘blow away’ the hideous creatures (who are actually the human drivers of the other cars).  And she might well get the gun out of the glove compartment and do it.

Everyone, especially Shelly will agree that the act of shooting innocent people is horrible. But no one should challenge Shelly’s imaginary reality that shooting the demons is defending herself and her kids from an assault by Lucifer and his minions. Remember, this disease has nothing to do with personality or mood. Hallucinations can only be managed with medication. But the real tragedy of the disease is that the medicines leave the patient in a “zombie” – like state. Patients say that while on meds, they can’t love, and/or feel anything at all.  Besides that, their body is so sluggish that walking is even a chore.

Nonetheless, their choices are stark: A. live life with fewer hallucinations, but medically deprived of humanity- (awake but comatose) or B. live inhumanely in near-total isolation (usually on the street). Unknown millions of schizophrenics choose homelessness. It’s not a disease to wish even on your worst enemy. With all of that as background, let’s now talk about a real patient.

^[1] https://www.mayoclinic.org/diseases-conditions/mood-disorders/symptoms-causes/syc-20365057

^[2] https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463

^[3] https://www.verywellmind.com/erik-eriksons-stages-of-psychosocial-development-2795740

^[4] https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463#:~:text=Cluster%20B%20personality%20disorders,disorder%20and%20narcissistic%20personality%20disorder.

^[5] https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443

^[6] https://www.psycom.net/paranoid-schizophrenia

^[7] https://www.nami.org/Blogs/NAMI-Blog/March-2017/Understanding-Psychotic-Breaks