Insight, Defenses, and the Ego-Syntonic/Ego-Dystonic and Crazy/Sick Binaries in Axis 1 and 2 Disorders

For the first time in my life a week ago, I experienced the thing that a lot of depressives experience. They actually want to be depressed. They like to be depressed. The depressed mind tells them that depression is simply normality. They don’t want to get better because they’re already normal. Some deeply depressed people don’t even realize they are depressed.

They’re on the verge of suicide, cutting themselves, with a mood blacker than a redfish in a steaming New Orleans kitchen, snapping at everyone, paranoid that all the happy people are secretly making fun of them, but they’re completely normal. They stand up and scream at psychiatrist after psychiatrist who tells them that they are deeply depressed. They are not, dammit! They’re perfectly normal! And they storm out of the office until the next time with the new doctor.

Finally someone slips them a handful of pills, and they start popping them. The permanent night goes away and the sun comes out for once. As the dawn begins to clear into the sharp light of day, the reality hammer hits them hard, and they realize just how sick they were.

The problem with these disorders is the part of the body that is sick is the brain. A working brain is necessary to figure out if you’re ok or not, and when you’re brain isn’t working, you’re incapable of recognizing that you are ill.

One former employee told me that once, this person asked Musk if he ever worried about losing his mind.

Musk replied: “Does a crazy person ever look in the mirror and know that he’s crazy?”

There you have it. Straight from the mouth of the Devil Himself. And of course Musk is nuts. He’s Bipolar. Almost all of his crazy behavior is happening when he is manic or hypomanic or whatever. I can look right through that article about him and see the mania raging through his life, unacknowledged, and of course consequently unhindered. There is a connection between mania (hypomania) and creativity, and Musk is nothing if not creative. One wonders if he treated his illness if then his creativity might decline in tandem with his (hypo)mania. Many people with Bipolar Disorder report just that.

Mania has the curious characteristic of not only making you nuts, but blinding you to that fact. As we just saw, depression can do that too. And I’ve finally figured out firsthand what I have been observing for years now – that depressed people actually like to be depressed and literally do not want to get better. The depression makes them incapable of wanting to get better.

Of course in psychosis no one thinks they are ill. That’s why they call it psychosis.

Axis 2 disorders also blind the person to the fact that they are ill but they do so in a different way because in personality disorders, the brain is usually fine, it’s more that the person’s true character is ill. People with personality disorders aren’t even crazy or mentally ill in a sense. Instead, they are sick. Sick at their very soul, at the very essence. Soul-sick.

Think of a psychopath. Is he crazy? Give it up. Of course he’s not nuts. Crazy as a fox, sure. But anyone who has spent any time around these people realizes that somehow there is something terribly wrong with them. It’s almost as if they are not quite human. They are more like animals, or better yet, machines. While they are surely disturbed, it’s clear that they aren’t the slightest bit crazy. The psychopath is one of the sanest people you’ll meet. So what is he if he’s not nuts? He’s sick. What is sick? His soul is sick. We are almost outside of crazy/sane here into the other binary of good/evil.

People with personality disorders never think anything is wrong with them because it is the core self, the true you, the real personality, that is sick. No one wants to think they’ve got a crappy personality. Deep down inside, everyone is just fine. Or at least that’s all they know. How can you be anything other than yourself? You can’t. So how can being you be wrong? It can’t. You don’t know how to be anything other than you so your true core self can never be sick, and you couldn’t figure out how to not be yourself anyway even if it was.

Personality disorders, along with paraphilias, are typically ego-syntonic, and the characteristic of ego-syntonic disorders is that people don’t think anything is wrong.

On the other hand, the anxiety disorders do not seem to be ego-syntonic in general. They’re quite ego-dystonic. It’s like you’ve got a monkey on your back. The person with the anxiety disorder says, “Get these thoughts/feelings out of my head/body! Make them go away! I hate them!” These disorders are quite painful but their ego-dystonic nature makes people want to seek help.

The anxiety disorders have always been a stick in the mud for Freudian pleasure principle theory because they make the person so miserable. But that only works if you see them as defenses, and I don’t think anxiety disorders are defenses.

Want to talk defenses? Personality disorders, right this way, in Display Number 2 over here. A wild bundle of defenses crafted into the the most Rube Goldbergian fortress you’ve ever seen with trap doors, stairways to nowhere, fake walls, hidden rooms, booby traps, decoys, the whole nine yards. The fortress is so huge and fortified that it’s not even working to protect the person anymore.

This is a person that has constructed a fortress so huge and complex to protect themselves that, while it’s protecting them for sure, it’s also causing more problems than it solving. A case of the cure is worse than the disease. Sort of like a country that spends itself bankrupt on defense and doesn’t have enough left over for food.

In fact, the person themselves tends to disappear in Personality Disorders, and all you see is this wild swirl of defenses. Now and then you can glimpse the real person when they surface a bit for some air before plunging back down to the Axis 2 depths, but it’s usually pretty well hidden.

It’s often quite shocking to glimpse the real person because you’ve been looking at the personality disorder so long that you’ve come to think that the disorder is the actual person. On the other hand, it’s a good question. Is the personality disorder the person themselves? Is there a true self down there somewhere amidst the whirlpool of defenses? I’m not sure.

Of course anxiety disorders are not defenses. They thought psychoses were defenses too. People were “activating psychotic defenses.” Well, for a defense, I must say that a psychosis has to be one of the lousiest ways to protect yourself that I can think of. Of course psychoses are not defenses. Nor are mood disorders. The manic is not engaging in “flight into reality.” How on Earth depression defends against anything on Earth is beyond me.

The Axis 1 Disorders – the mood, anxiety, and psychotic disorders – are simply illnesses like the illnesses you get in the other parts of your body. Only these illnesses affect your brain. When you get physically ill, is that some sort of defense? No doubt in that case cancer must be the biggest defense of them all.

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