“The Inner Landscape of the Psychopath,” by Hervey Cleckley

This is one of the finest descriptions I have ever read of the psychopath. I’ve been studying them for decades now, and I still don’t understand them. They simply don’t make sense. I can’t see how they can do what they do without feeling guilt or caring what others think. With this article though, I am at least starting to get a picture of the inner dynamics of the psychopath.

The work below is a classic, of course, and it is the first major work in psychiatry that attempted to describe psychopathy. It is still just as relevant today as it was 80 years ago. This is a chapter from Cleckley’s book.

It’s intense reading. It’s not so much hard to understand as it is dense. There are some many concepts packed into even one paragraph that it gets slow-going. This is especially true for me as, with an article below, I have to form a “picture” in my mind to truly understand a lot of the prose. When I write I also think in pictures. I get a picture, try to figure out what’s in it and what it’s about, and then set about describing the picture in words the best I can. Most art forms are similar. We writers make paintings and movies in our head, the raw material of our prose.

The section below is 31 pages including my mad scribbling. If there’s anything you can’t understand or follow in this piece, feel free to bring it up in the comments and I will try to explain it as I pretty much understood everything written below. It took me a while, but I did get it.

That said, this piece is a serious “brain fry.” I call brain fries any prose that pushes your mind to its absolute limits, like going to the gym and pushing your body to its limits. You have to go slow because there are so many concepts being pushed so quickly, but if you concentrate hard enough, you can figure out most brain fry prose. A lot of people who like simplistic writing or don’t want to work their brains at Autobahn speed probably think texts like this are a nightmare or a pain in the ass. They’re not having a good time when they’re reading it. It’s one frustration after another.

And just because I understood everything below doesn’t mean everyone else can. Keep in mind I have a genius IQ of 147. So a person with a 147 IQ can muddle through everything below and figure it all out. 99.9% of the population is below 147, and I don’t have the faintest notion how well they can get through stuff like this or how much they can understand of it at different IQ levels. If you understand everything below and know your IQ, you might want to comment to tell us that you got it all, give us your number, and tell us what sort of a ride it was machete slashing through this word tangle.

The Inner Landscape of the Psychopath

From: The Mask of Sanity, by Hervey Cleckley, 1941, 5th edition

The surface of the psychopath, however, that is, all of him that can be reached by verbal exploration and direct examination, shows up as equal to or better than normal and gives no hint at all of a disorder within.

Nothing about him suggests oddness, inadequacy, or moral frailty. His mask is that of robust mental health. Yet he has a disorder that often manifests itself in conduct far more seriously abnormal than that of the schizophrenic.

Inwardly, too, there appears to be a significant difference.

Deep in the masked schizophrenic we often sense a cold, weird indifference to many of life’s most urgent issues and sometimes also bizarre, inexplicable, and unpredictable but intense emotional reactions to what seems almost irrelevant.

Behind the exquisitely deceptive mask of the psychopath the emotional alteration we feel appears to be primarily one of degree, a consistent leveling of response to petty ranges and an incapacity to react with sufficient seriousness to achieve much more than pseudoexperience or quasi-experience. Nowhere within do we find a real cause or a sincere commitment, reasonable or unreasonable. There is nowhere the loyalty to produce real and lasting allegiance even to a negative or fanatic cause.

Just as meaning and the adequate sense of things as a whole are lost with semantic aphasia in the circumscribed field of speech although the technical mimicry of language remains intact, so in most psychopaths the purposiveness and the significance of all life-striving and of all subjective experience are affected without obvious damage to the outer appearance or superficial reactions of the personality. Nor is there any loss of technical or measurable intelligence.

With such a biologic change the human being becomes more reflex, more machinelike. It has been said that a monkey endowed with sufficient longevity would, if he continuously pounded the keys of a typewriter, finally strike by pure chance the very succession of keys to reproduce all the plays of Shakespeare.

These papers so composed in the complete absence of purpose and human awareness would look just as good to any scholar as the actual works of the Bard. Yet we cannot deny that there is a difference. Meaning and life at a prodigiously high level of human values went into one and merely the rule of permutations and combinations would go into the other.

The patient semantically defective by lack of meaningful purpose and realization at deep levels does not, of course, strike sane and normal attitudes merely by chance. His rational power enables him to mimic directly the complex play of human living. Yet what looks like sane realization and normal experience remains, in a sense and to some degree, like the plays of our simian typist.

In Henry Head’s interpretation of semantic aphasia we find, however, concepts of neural function and of its integration and impairment that help to convey a hypothesis of grave personality disorder thoroughly screened by the intact peripheral operation of all ordinary abilities.

In relatively abstract or circumscribed situations, such as the psychiatric examination or the trial in court, these abilities do not show impairment but more or less automatically demonstrate an outer sanity unquestionable in all its aspects and at all levels accessible to the observer. That this technical sanity is little more than a mimicry of true sanity cannot be proved at such levels.

Only when the subject sets out to conduct his life can we get evidence of how little his good theoretical understanding means to him, of how inadequate and insubstantial are the apparently normal basic emotional reactions and motivations convincingly portrayed and enunciated but existing in little more than two dimensions.

What we take as evidence of his sanity will not significantly or consistently influence his behavior. Nor does it represent real intention within, the degree of his emotional response, or the quality of his personal experience much more reliably than some grammatically well-formed, clear, and perhaps verbally sensible statement produced vocally by the autonomous neural apparatus of a patient with semantic aphasia can be said to represent such a patient’s thought or carry a meaningful communication of it.

Let us assume tentatively that the psychopath is, in this sense, semantically disordered. We have said that his outer functional aspect masks or disguises something quite different within, concealing behind a perfect mimicry of normal emotion, fine intelligence, and social responsibility a grossly disabled and irresponsible personality. Must we conclude that this disguise is a mere pretense voluntarily assumed and that the psychopath’s essential dysfunction should be classed as mere hypocrisy instead of psychiatric defect or deformity?

Let us remember that his typical behavior defeats what appear to be his own aims.

Is it not he himself who is most deeply deceived by his apparent normality?

Although he deliberately cheats others and is quite conscious of his lies, he appears unable to distinguish adequately between his own pseudointentions, pseudoremorse, pseudolove, and the genuine responses of a normal person.

His monumental lack of insight indicates how little he appreciates the nature of his disorder.

When others fail to accept immediately his “word of honor as a gentleman,” his amazement, I believe, is often genuine. The term genuine is used here not to qualify the psychopath’s intentions but to qualify his amazement. His subjective experience is so bleached of deep emotion that he is invincibly ignorant of what life means to others.

His awareness of hypocrisy’s opposite is so insubstantially theoretical that it becomes questionable if what we chiefly mean by hypocrisy should be attributed to him.

Having no major values himself, can he be said to realize adequately the nature and quality of the outrages his conduct inflicts upon others?

A young child who has no impressive memory of severe pain may have been told by his mother it is wrong to cut off the dog’s tail. Knowing it is wrong he may proceed with the operation. We need not totally absolve him of responsibility if we say he realized less what he did than an adult who, in full appreciation of physical agony, so uses a knife.

Can a person experience the deeper levels of sorrow without considerable knowledge of happiness? Can he achieve evil intention in the full sense without real awareness of evil’s opposite? I have no final answer to these questions.

Attempts to interpret the psychopath’s disorder do not, of course, furnish evidence that he has a disorder or that it is serious. For reliable evidence of this we must examine his behavior. Only here, not in psychopathologic formulations, can we apply our judgment to what is objective and demonstrable.

Functionally and structurally all is intact on the outside. Good function (healthy reactivity) will be demonstrated in all theoretical trials. Sound judgment as well as good reasoning are likely to appear at verbal levels. Ethical as well as practical considerations will be recognized in the abstract. A brilliant mimicry of sound, social reactions will occur in every test except the test of life itself.

In the psychopath we confront a personality neither broken nor outwardly distorted but of a substance that lacks ingredients without which normal function in major life issues is impossible.

Simon, Holzberg, and Unger, impressed by the paradox of the psychopath’s poor performance despite intact reasoning, devised an objective test specifically to appraise judgment as it would function in real situations, as contrasted with theoretical judgment in abstract situations.

These workers are aware that the more complex synthesis of influences constituting what is often called judgment or understanding (as compared to a more theoretical “reasoning”) may be simulated in test situations in which emotional participation is minimal, that rational factors alone by an accurate aping or stereotyping can produce in vitro, so to speak, what they cannot produce in vivo.

Items for a multiple choice test were selected with an aim of providing maximal possibilities for emotional factors to influence decision and particularly for relatively trivial immediate gratification impulses to clash with major, long-range objectives. The same items were also utilized in the form of a completion test. The results of this test on a group of psychopaths tend to support the hypothetical interpretation attempted in this book.

If such a disorder does indeed exist in the so-called psychopath, it is not remarkable that its recognition as a major and disabling impairment has been long delayed.

Pathological changes visible on the surface of the body (laceration, compound fractures) were already being handled regularly by medical men when the exorcism of indwelling demons retained popular favor in many illnesses now treated by the internist. So, too, it has been with personality disorders. Those characterized by gross outward manifestations have been accepted as psychiatric problems long before others in which a superficial appearance of sanity is preserved.

Despite the psychopath’s lack of academic symptoms characteristic of those disorders traditionally classed as psychosis, he often seems, in some important respects, but not in all, to belong more with that group than with any other. Certainly his problems cannot be dealt with, medically or by any other means, unless similar legal instrumentalities for controlling his situation are set up and regularly applied.

I believe that if such a patient shows himself grossly incompetent in his behavior, he should be so appraised. It is necessary to change some of our legal criteria to make attempts at treatment or urgently needed supervision possible for him, the most serious objections are primarily theoretical. Perhaps our traditional definitions of psychiatric disability can stand alteration better than these grossly defective patients and those about them can stand the present farcical and sometimes tragic methods of handling their problems.

This is not to say that all people showing features of this type should be regarded as totally disabled. It is here maintained that this defect, like other psychiatric disorders, appears in every degree of severity and may constitute anything from a personality trait through handicaps of varying magnitude, including maximum disability and maximum threat to the peace and safety of the community.

In attempting to account for the abnormal behavior observed in the psychopath, we have found useful the hypothesis that he has a serious and subtle abnormality or defect at deep levels disturbing the integration and normal appreciation of experience and resulting in a pathology that might, in analogy with Henry Head’s classifications of the aphasias, be described as semantic.

Presuming that such a patient does fail to experience life adequately in its major issues, can we then better account for his clinical manifestations? The difficulties of proving, or even of demonstrating direct objective evidence, for hypotheses about psychopathology (or about ordinary subjective functioning) are too obvious to need elaborate discussion here.

If the psychopath’s life is devoid of higher order stimuli, of primary or serious goals and values, and of intense and meaningful satisfactions, it may be possible for the observer to better understand the patient who, for the trivial excitement of stealing a dollar (or a candy bar), the small gain of forging a $20.00 check, or halfhearted intercourse with an unappealing partner, sacrifices his job, the respect of his friends, or perhaps his marriage.

Behind much of the psychopath’s behavior we see evidence of relatively mild stimuli common to all mankind. In his panhandling, his pranks, his truancy, his idle boasts, his begging, and his taking another drink, he is acting on motives in themselves not unnatural. In their massive accumulation during his career, these acts are impressive chiefly because of what he sacrifices to carry them out. If, for him, the things sacrificed are also of petty value, his conduct becomes more comprehensible.

Woolley, in an interesting interpretation of these patients, compared them with an otherwise intact automobile having very defective brakes. Such an analogy suggests accurately an important pathological defect which seems to exist.

In contrast with an automobile, however, the braking functions of the human organism are built into the personality by reaction to life experience, to reward and punishment, praise and blame, shame, loss, honor, love, and so on. True as Woolley’s hypothesis may be, it seems likely that more fundamental than inadequate powers to refrain is the inadequate emotional reactivity upon which the learning to refrain must be based.

Even with good brakes on his car, the driver must have not only knowledge of but also feeling for what will happen otherwise if he is to use them correctly and adequately.

Some of the psychopath’s behavior may be fairly well accounted for if we grant a limitation of emotional capacity. Additional factors merit consideration.

The psychopath seems to go out of his way to make trouble for himself and for others.

In carelessly marrying a whore, in more or less inviting detection of a theft (or at least in ignoring the probability of detection), in attempting gross intimacies with a debutante in the poorly sheltered alcove just off a crowded ballroom, in losing his hospital parole or failing to be with his wife in labor just because he did not want to leave the crap game at midnight (or at 3 A.M.), in such actions there seems to be not only a disregard for consequences but an active impulse to show off, to be not discreet but conspicuous in making mischief.

Apparently he likes to flaunt his outlandish or antisocial acts with bravado.

When negative consequences are negligible or slight (both materially and emotionally), who does not like to cut up a little, to make a bit of inconsequential fun, or perhaps playfully take off on the more sober aspects of living? Dignity might otherwise become pompousness; learning, pedantry; goodness, self-righteousness.

The essential difference seems to lie in how much the consequences matter. It is also important to remember that inclination and taste are profoundly shaped by capacity to feel the situation adequately. A normal man’s potential inclination to give the pretty hatcheck girl $100.00 would probably not reach awareness in view of his knowledge that this would result in his three children’s not having shoes or in his having to humiliate himself by wheedling from a friend a loan he will never repay.

If, as we maintain, the big rewards of love, of the hard job well done, of faith kept despite sacrifices, do not enter significantly in the equation, it is not difficult to see that the psychopath is likely to be bored. Being bored, he will seek to cut up more than the ordinary person to relieve the tedium of his unrewarding existence.

If we think of a theater half-filled with ordinary pubertal boys who must sit through a performance of King Lear or of Beethoven’s Ninth Symphony, we need ask little of either imagination or memory to bring to mind the restless fidgeting, the noisy intercommunication of trivialities, the inappropriate guffaws or catcalls, and perhaps the spitballs or the mischievous application of a pin to the fellow in the next seat.

Apparently blocked from fulfillment at deep levels, the psychopath is not unnaturally pushed toward some sort of divertissement. Even weak impulses, petty and fleeting gratifications, are sufficient to produce in him injudicious, distasteful, and even outlandish misbehavior.

Major positive attractions are not present to compete successfully with whims, and the major negative deterrents (hot, persistent shame, profound regret) do not loom ahead to influence him. If the 12-year-old boys could enjoy King Lear or the Ninth Symphony as much as some people do, they would not be so reckless or unruly.

In a world where tedium demands that the situation be enlivened by pranks that bring censure, nagging, nights in the local jail, and irritating duns about unpaid bills, it can well be imagined that the psychopath finds cause for vexation and impulses toward reprisal. Few, if any, of the scruples that in the ordinary man might oppose and control such impulses seem to influence him. Unable to realize what it meant to his wife when he was discovered in the cellar flagrante delicto with the cook, he is likely to be put out considerably by her reactions to this.

His having used the rent money for a midnight long-distance call to an old acquaintance in California (with whom he bantered for an hour) also brings upon him censure or tearful expostulation. Considering himself harassed beyond measure, he may rise from the dining room table in a petty tantrum, curse his wife violently, slap her, even spit on her, and further annoyed by the sudden weeping of their 6-year-old daughter, throw his salad in the little girl’s face before he strides indignantly from the room.

His father, from the patient’s point of view, lacks humor and does not understand things. The old man could easily take a different attitude about having had to make good those last three little old checks written by the son. Nor was there any sense in raising so much hell because he took that dilapidated old Chevrolet for his trip to Memphis.

What if he did forget to tell the old man he was going to take it? It wouldn’t hurt him to go to the office on the bus for a few days. How was he (the patient) to know the fellows were going to clean him out at stud or that the little bitch of a waitress at the Frolic Spot would get so nasty about money? What else could he do except sell the antiquated buggy? If the old man weren’t so parsimonious he’d want to get a new car anyway!

And why did he (the father) have to act so magnanimous and hurt about settling things last Saturday night down at the barracks? You’d think from his attitude that it was the old man himself who’d had to put up with being cooped in there all those hours with louse-infested riff-raff! Well, he’d thanked his father and told him how sorry he was.

What else could a fellow do? As for that damned old Chevrolet, he was sick of hearing about it. His grudge passing with a turn of thought, he smiles with half-affectionate, playfully cordial feelings toward the old man as he concludes, “I ought to tell him to take his precious old vehicle and stick it up his _____!”

Lacking vital elements in the appreciation of what the family and various bystanders are experiencing, the psychopath finds it hard to understand why they continually criticize, reproach, quarrel with, and interfere with him. His employer, whom he has praised a few hours before, becomes a pettifogging tyrant who needs some telling off.

The policeman to whom he gave tickets for the barbecue last week (because he is such a swell guy) turns out to be a stupid oaf and a meddler who can’t mind his own business but has to go and arrest somebody just because of a little argument with Casey in the Midnight Grill about what happened to a few stinking dollar bills that were lying on the bar.

It is not necessary to assume great cruelty or conscious hatred in him commensurate with the degree of suffering he deals out to others. Not knowing how it hurts or even where it hurts, he often seems to believe that he has made a relatively mild but appropriate reprimand and that he has done it with humor.

What he believes he needs to protest against turns out to be no small group, no particular institution or set of ideologies, but human life itself. In it he seems to find nothing deeply meaningful or persistently stimulating, but only some transient and relatively petty pleasant caprices, a terribly repetitious series of minor frustrations, and ennui.

Like many teenagers, saints, history-making statesmen, and other notable leaders or geniuses, he shows unrest; he wants to do something about the situation. Unlike these others, as Lindner has so well and convincingly stressed, he is a “rebel without a cause.”

Reacting with something that seems not too much like divine discontent or noble indignation, he finds no cause in the ordinary sense to which, he can devote himself with wholeheartedness or with persistent interest. In certain aspects his essential life seems to be a peevish bickering with the inconsequential.

In other aspects he suggests a man hanging from a ledge who knows if he lets go he will fall, is likely to break a leg, may lose his job and his savings (through the disability and hospital expenses), and perhaps may injure his baby in the carriage just below. He suggests a man in this position who, furthermore, is not very tired and who knows help will arrive in a few minutes, but who, nevertheless, with a charming smile and a wisecrack, releases his hold to light a cigarette, to snatch at a butterfly, or just to thumb his nose at a fellow passing in the street below.

A world not by any means identical but with some vivid features of both these underlying situations can be found in Huysmans’ Against the Grain and in Jean-Paul Sartre’s Nausea. In the satirical novels of Evelyn Waugh, also, an atmosphere difficult to describe sometimes develops – an atmosphere that may give the reader awareness of attitudes and evaluations genuinely illustrative of deeply distorted or inadequate reactions to life.

The leading characters depicted therein show a peculiar cynicism which is more conscious and directed and purposive than the behavior of the psychopath. But none of the characters presented show even an approximate awareness of what is most valid and meaningful and natural in human beings. A negative response to life itself, an aversion at levels more basic than ordinary morals or the infraconscious foundations of taste and incentive, is conveyed subtly and impressively.

It is difficult to illustrate by incident, by the expressed attitude of the characters depicted, or by any clearly implied evaluation of the authors the specific quality of what is evoked in these novels as the essence of an unhappy, mutilated, and trivial universe in which all the characters exist. The sense of pathology pervades to levels so deep that rational scrutiny cannot reach and meet the fundamental implications; nor can inquiry satisfactorily demonstrate its precise source.

If the actual world and man’s biologic scope were only that conveyed in these interesting works, it would perhaps be less difficult to account for obsessive illness and for the psychopath’s career as reasonable reactions to a situation where no course is possible except one profoundly pathological in one way or another.

Thoughtful contemplation of what is depicted in these works of fiction suggests a world as fundamentally altered as what Straus presents as the world of the obsessive patient. In the effective and terse implication of general emotional incapacity in these characters, the authors succeed in evoking awareness of a sort of quasi-life restricted within a range of staggering superficiality.

This, rather than those aspects of the works that apparently brought them popularity, may deserve high literary appraisal as concise and valuable communications of something that is by no means easy to convey in direct language. Such a superficiality and lack of major incentive or feeling strongly suggest the apparent emotional limitations of the psychopath.

What Straus and Havelock Ellis have brought out is not discernible in the reactions of the psychopath. It is, as a matter of fact, somewhat veiled in the reactions of most obsessive patients. Observation of the psychopath makes it increasingly plain, however, that he is not reacting normally to the surroundings that are ordinarily assumed to exist. I cannot clearly define the specific milieu which such a patient encounters and to which his reactions are related.

There is much to suggest that it is a less distinctly or consistently apprehended world than what Straus describes as the inner world of the obsessive patient. It is my belief that it may be a world not less abnormal and perhaps more complexly confusing. We should remember, however, that we have no direct evidence to prove that a deficiency or distortion of this sort exists in the unconscious core of the psychopath.

We can only say that his behavior strongly and consistently suggests it. This discussion has been based, of course. on a hypothesis that the psychopath has a basic inadequacy of feeling and realization that prevents him from normally experiencing the major emotions and from reacting adequately to the chief goals of human life.

Beyond the symptomatic acts of the psychopath, we must bear in mind his reaction to his situation, his general experiencing of life. Typical of psychoneurosis are anxiety, recognition that one is in trouble, and efforts to alter the bad situation. These are natural (“normal”) whole personality reactions to localized symptoms.

In contrast, the severe psychopath, like those so long called psychotic, does not show normal responses to the situation. It is offered as an opinion that a less obvious but nonetheless real pathology is general, and that in this respect he is more closely allied with the psychotic than with the psychoneurotic patient. The pathology might be regarded not as gross fragmentation of the personality but as a more subtle alteration. Let us say that instead of macroscopic disintegration our (hypothetical) change might be conceived of as one that seriously curtails function without obliterating form.

Let us think of the personality in the psychopath as differing from the normal in some such way. The form is perfect and the outlines are undistorted. But being subtly and profoundly altered, it can successfully perform only superficial activities or pseudofunctions. It cannot maintain important or meaningful interpersonal relations. It cannot fulfill its purpose of adjusting adequately to social reality. Its performance can only mimic these genuine functions.

The persistent pattern of maladaptation at personality levels and the ostensible purposelessness of many self-damaging acts definitely suggests not only a lack of strong purpose but also a negative purpose or at least a negative drift. This sort of patient, despite all his opportunities, his intelligence, and his plain lessons of experience, seems to go out of his way to woo misfortune. The suggestion has already been made that his typical activities seem less comprehensible in terms, of life-striving or of a pursuit of joy than as an unrecognized blundering toward the negations of nonexistence.

Some of this, it has been suggested, may be interpreted as the tantrum, like reactions of an inadequate personality balked, as behavior similar to that of the spoiled child who bumps his own head against the wall or holds his breath when he is crossed. It might be thought of as not unlike a man’s cutting off his nose to spite not only his face, but also the scheme of life in general, which has turned out to be a game that he cannot play.

Such reactions are, of course, found in nearly all types of personality disorder or inadequacy. It will perhaps be readily granted that they are all regressive. Behavior against the constructive patterns through which the personality finds expression and seeks fulfillment of its destiny is regressive activity although it may not consist in a return, step by step, or in a partial return to the status of childhood and eventually of infancy. Such reactions appear to be, in a sense, against the grain of life or against the general biologic purpose.

Regressive reactions or processes may all be regarded as disintegrative, as reverse steps in the general process of biologic growth through which a living entity becomes more complex, more highly adapted and specialized, better coordinated, and more capable of dealing successfully or happily with objective or subjective experience. This scale of increasing complexity exists at points even below the level of living matter.

A group of electrons functioning together make up the atom which can indeed be split down again to its components. The atoms joining form molecules which, in turn, coming together in definite orderly arrangement, may become structurally coordinating parts of elaborate crystalline materials; or, in even more specialized and complex fashion, they may form a cell of organic matter. Cells of organic matter may unite and integrate to form the living organism we know as a jellyfish. Always the process is reversible; the organic matter can decompose back into inorganic matter.

Without laboriously following out all the steps of this scale, we might mention the increasing scope of activity, the increasing specialization, and the increasing precariousness of existence at various levels up through vertebrates and mammals to man. All along this scale it is evident that failure to function successfully at a certain level necessitates regression or decomposition to a lower or less complicated one.

If the cell membrane of one epithelial unit in a mammalian body becomes imporous and fails to obtain nutriment brought by blood and lymph, it loses its existence as an epithelial cell. If the unwary rabbit fails to perceive the danger of the snare, he soon becomes in rapid succession a dead rabbit, merely a collection of dead organs and supportive structures, protein, fat, and finally, inorganic matter. The fundamental quest for life has been interrupted, and, having been interrupted, the process goes into reverse.

So, too, the criminal discovered and imprisoned ceases to be a free man who comes and goes as he pleases. A curtailment in the scope of his functioning is suffered-a regression in one sense to simpler, more routine, and less varied and vivid activities.

The man who fails in another and more complex way to go on with life, to fulfill his personality growth and function, becomes what we call a schizophrenic. The objective curtailment of his activities by the rules of the psychiatric hospital are almost negligible in comparison with the vast simplification, the loss of self-expression, and the personal disintegration which characterize his regression from the subjective point of view. The old practice of referring to the extremely regressed schizophrenic as leading a vegetative existence implies the significance that is being stressed.

Regression, then, in a broad sense may be taken to mean movement from richer and more full life to levels of scantier or less highly developed life. In other words, it is relative death. It is the cessation of existence or maintenance of function at a given level.

The concept of an active death instinct postulated by Freud has been utilized by some to account for socially self-destructive reactions. I have never been able to discover in the writings of Freud or any of his followers real evidence to confirm this assumption.

In contrast, the familiar tendency to disintegrate, against which life evolves, may be regarded as fundamental and comparable to gravity. The climbing man or animal must use force and purpose to ascend or to maintain himself at a given height. To fall or slide downhill he need only cease his efforts and let go. Without assuming an intrinsic death instinct, it is possible to account for active withdrawal from positions at which adaptation is unsuccessful and stress too extreme.

Whether regression occurs primarily through something like gravity or through impulses more self-contained, the backward movement (or ebbing) is likely to prompt many sorts of secondary reactions, including behavior not adapted for ordinary human purposes but instead, for functioning in the other direction. The modes of such reactivity may vary, may fall into complex patterns, and may seek elaborate expression.

In a movement (or gravitational drift) from levels where life is vigorous and full to those where it is less so, the tactics of withdrawal predominate.

People with all the outer mechanisms of adaptation intact might, one would think, regress more complexly than can those who react more simply. The simplest reaction in reverse might be found in a person who straightway blows out his brains.

As a skillful general who has realized that the objective is unobtainable withdraws by feints and utilizes all sorts of delaying actions, so a patient who has much of the outer mechanisms for living may retire, not in obvious rout but skillfully and elaborately, preserving his lines.

The psychopath as we conceive of him in such an interpretation seems to justify the high estimate of his technical abilities as we see them expressed in reverse movement.

Unlike the general with the retreating army in our analogy, he seems not still devoted to the original contest but to other issues and aims that arise in withdrawal. To force the analogy further we might say that the retiring army is now concerning itself with looting the countryside, seeking mischief and light entertainment. The troops have cast off their original loyalties and given up their former aims but have found no other serious ones to replace them. But the effective organization and all of the technical skills are retained and utilized destructively.

F. L. Wells has expressed things very pertinent to the present discussion. A brief quotation will bring out useful points:

The principle of substitutive reactions, sublimative or regressive in character, has long been known, but Kurt Lewin’s (1933) experimental construction of the latter is especially apt, if not unquestionable mental hygiene. A child, for example, continually impelled to open a gate it is impossible for him to open, may blow up in a tantrum, grovel on the ground, till the emotion subsides sufficiently for him to become substitutively occupied, as with fragments of gravel and other detritus he finds there, by which he forgets his distress about the gate. […]

The human personality has the adaptive property of finding satisfactions at simpler levels when higher ones are taken away, fortunately so if this keeps him out of a psychosis, otherwise if it stabilizes him in contentment at this lower level (“going native”) or if the satisfactions cannot be found short of a psychosis (MacCurdy, 1925, p. 367). All such cases have the common regressive factor of giving up the higher-level adjustment (opening the gate) with regressive relief at a lower level (playing with the gravel).

Another illustration given by Wells emphasizes features of the concept that are valuable to us:

Consider, for example, the group of drives that center about the concept of self-maintenance, the “living standards” of civilization. This means the pursuit of the diverse means to surround oneself with the maximum of material comfort in terms of residence, food, playthings, etc., for the purchase of which one can capitalize his abilities.

That the normal individual will do this to a liberal limit is taken in the local culture as a matter of course, probably more liberally than the facts justify. For this pursuit involves a competitive struggle beset also with inner conflicts (e.g., ethical), which by no means everyone is able to set aside.

Among regressions specific to this category are those undertakings of poverty common to religious orders, but this regression is quite specific, since these orders often involve their members in other “disciplines” from which the normal individual would flee as far (Parkman, 1867, Chap. 16).

It is quite certain, though hard to demonstrate objectively, that many an individual in normal life regresses from these economic conflicts only in less degree. He does not take the vow of poverty like the monastic, nor does he dedicate himself to the simplified life of the “South Sea Island” stereotype, but he prefers salary to commission, city apartment to suburban “bungalow,” clerical work to (outside) sales.

A thought expressed by William James in 1902 and quoted by Wells deserves renewed attention:

Yonder puny fellow however, whom everyone can beat suffers no chagrin about it, for he has long ago abandoned the attempt to “carry that line,” as the merchants say, of Self at all.

With no attempt there can be no failure; with no failure no humiliation.

So our self-feeling in this world depends entirely on what we back ourselves to be and do. It is determined by the ratio of our actualities to our supposed potentialities; a fraction of which our pretentions are the denominator and the numerator our success: thus, Self-esteem = Success/Pretensions.

Such a fraction may be increased as well by diminishing the denominator as by increasing the numerator.

To give up pretensions is as blessed a relief as to get them gratified; and where disappointment is incessant and the struggle unending, this is what men will always do.

The history of evangelical theology, with its conviction of sin, its self-despair, and its abandonment of salvation by works, is the deepest of possible examples, but we meet others in every walk of life. .

How pleasant is the day when we give up striving to be young-or slender! Thank God, we say, those illusions are gone. Everything added to the self is a burden as well as a pride.

Something relevant to the points now under consideration may be found also in Sherrington’s comment on reactions (or inlaid precautions) against unbearable pain or stress in the human organism. He says:

Again in life’s final struggle the chemical delicacy of the brain-net can make distress lapse early because with the brain’s disintegration the mind fades early – a rough world’s mercy towards its dearest possession.

There are, it seems, many ways for this to occur without signs of any change which we yet have objective means to detect, chemically or microscopically. Such changes may occur under the stimulus of agents that do not have direct physical contact with the brain or with any part of the body.

Withdrawal, or limitation of one’s quest in living, appears in many forms.

The decision for taking such a step may be consciously voluntary, but it seems likely that many influences less clear and simple may also play a part. In the earliest years of human life a great deal of complicated shaping may occur, with adaptive changes to promote survival by an automatic refusal (inability) to risk one’s feelings (response) in the greatest subjective adventures. In adult life such decisions sometimes emerge in clear deliberation.

The activity of the psychopath may seem in some respects to accomplish a kind of protracted and elaborate social and spiritual suicide. Perhaps the complex, sustained, and spectacular undoing of the self may be cherished by him. He seldom allows physical suicide to interrupt it.

Be it noted that such a person retains high intelligence and nearly all the outer mechanisms for carrying on the complicated activities of positive life. It is to be expected then that his function in the opposite (regressive) emotional direction might be more subtle than those of a less highly developed biologic entity.

The average rooster proceeds at once to leap on the nearest hen and have done with his simple erotic impulse. The complex human lover may pay suit for years to his love object, approaching her through many volumes of poetry, through the building up of financial security in his business, through manifold activities and operations of his personality functions, and with aims and emotions incomparably more complicated and more profound than that of the rooster.

When complexly organized functions are devoted to aimless or inconsistent rebellion against the positive goals of life, perhaps they may enable the patient to woo failure and disintegration with similar elaborateness and subtlety. His conscious or outer functioning may at the same time maintain an imitation of life that is uniquely deceptive.

Perhaps the emptiness or superficiality of life without major goals or deep loyalties, or real love, would leave a person with high intelligence and other superior capacities so bored that he would eventually turn to hazardous, self-damaging, outlandish, antisocial, and even self-destructive exploits in order to find something fresh and stimulating in which to apply his relatively useless and unchallenged energies and talents.

The more experience I have with psychopaths over the years, the less likely it seems to me that any dynamic or psychogenic theory is likely to be established by real evidence as the cause of their grave maladaptation.

Increasingly I have come to believe that some subtle and profound defect in the human organism, probably inborn but not hereditary, plays the chief role in the psychopath’s puzzling and spectacular failure to experience life normally and to carry on a career acceptable to society. This, too, is still a speculative concept and is not supported by demonstrable evidence.

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.

The Myth of Illegal Drugs Frying Your Brain and Permafried People

In response to Jason’s post here about drug use frying your brain, I have written this response. In general, the notion that the use of illegal drugs will fry your brain or make you permafried even after you quit is nonsense. In general, once you quit you go back to the intelligence and sanity level you were at before you started. Few people get permanently lowered intelligence or permanent mental illness from former drug use.

Most illegal drugs do not cause any permanent damage to your brain that would affect you permanently after you quit.

In all of my years using drugs, I have met 10,000’s of drug users and I never met one person who had used so much drugs that they were “fried” in the sense that they were permanently stupid or crazy after they quit using.

Cocaine

There may be some consequences far down the road – say, with Parkinson’s.

Jason’s article discusses an increased risk of Parkinson’s in former cocaine users. But it’s not really due to brain damages so much as changes in a certain receptor that make someone more vulnerable to a toxin. That’s not the same thing as having a fried brain.

I knew a heavy cocaine user who appeared to have neurological problems from the drug. But I am not sure if it persisted after he quit, if he ever did quit. But he’s the only person I’ve ever met like that, and even he wasn’t fried at all. He was still very intelligent and completely sane. However, he did appear to have some sort of brain damage. Whether it was permanent or not is not known.

LSD

I have known people who took LSD up to 700 times, and I know a number who took LSD 300 times. LSD doesn’t damage your brain anyway. It can cause some changes in the visual system due to permanent changes in serotonin receptors, but that just causes some perceptual problems, and this is mostly in people who have taken it 50+ times. It doesn’t change effect you in any way that changes the way you think or feel, in other words, it doesn’t make you stupid or nuts.

There are some very heavy former LSD users who seem to have permanent hallucinations, but those people took a lot of acid over a short period of time – like way, way too much acid. It’s not known what’s going on with them, but I suppose they are permafried in a sense.

LSD is a dangerous drug.

Cannabis

I know many people who have been smoking pot for 10, 20, or even 30 years, and there’s nothing wrong with any of them. You wouldn’t think there was anything wrong with them if you met them. They’re not damaged at all.

The pot lowering IQ discussed in Jason’s piece is only for use before you are 18. If you start using at age 18 or after, there’s no effect on IQ. People under 18 need to be very careful about pot because it can indeed lower their IQ’s a bit.

Pot doesn’t give you schizophrenia, period. The most it can do is trigger it if you are already vulnerable, but even then, most of those people would have gotten it anyway. But it can definitely bring it on sooner than it would have otherwise.

The rate of schizophrenia has been flat for 60 years, all through the 1960’s, 70’s, 80’s, 90’s, 2000’s and 2010’s, and all sorts of drug use rates for different drugs skyrocketed at various times in that period. In other words, neither cannabis nor any other drug is going to give you schizophrenia with one exception discussed below.

MDMA

MDMA is a very dangerous drug and it can definitely cause physical damage to your brain. It permanently lowers scores on a few aspects of intelligence tests such as vocabulary, but you mostly can’t notice any changes and there do not appear to be any changes in mental stability. In general, it doesn’t make you stupid or nuts.

However, there are some people called e-tards out there who took a lot of MDMA very frequently over relatively short of periods of time, and these people appear to be permafried. Mostly they seem a bit stupid.

However, I have heard that even these effects of MDMA go away after ~7-8 years if you stay away from the drug.

 

Speed is another matter but even that tends to clear up after you quit. There are some very heavy methamphetamine users, especially people who shot the drug, who have developed an illness that looks a lot like or possibly is paranoid schizophrenia.

There are some recorded cases out of Japan, and a friend told me about another case here in California. This is not a common outcome and even with all the heavy meth abuse that is going on nowadays, you don’t hear much about people being permafried in the sense that they become permanently mentally ill with paranoid schizophrenia.

Heavy Polydrug and Alcohol Abuse for Decades (30 years)

I have heard of one person who used huge amounts of drugs and drank very heavily over many years, starting as an adolescent. They are now off of everything, and they have a rather poor short-term memory and forget stuff a lot, but other than that, they are still extremely intelligent.

They are also a bit suspicious and paranoid, but not at the level of a paranoid psychosis. I suppose this man is permafried in a sense, but if you met him, you would not appear stupid or crazy.

Conclusion

Bottom line is a lot of that stuff can mess you up pretty bad while you are on it so you seem stupid, crazy, or even brain damaged. But most if not all of that tends to clear up when you quit. Permafried people who are permanently stupid or nuts from heavy drug use must be awfully rare because I haven’t met one in my entire life. The fried brains and permafried nonsense is mostly mythology.

Alt Left: No, the Dayton Shooter Was Not an “Antifa Shooter”

Right. The Dayton mass shooter was not the first “antifa mass shooter,” as the drooling, unhinged nutcase Andy Ngo insists. I don’t think this idiot deserved to get beat up by antifa, but he’s definitely a full-blown nutball.

Yes, Connor Betts was associated with the far left in the US and with the antifa portion of it with all of the behaviors that go along with that. He hated cops and fascists. His random shooting of nine innocent people outside of a bar in Dayton, Ohio had zero political overtones. “Antifa” does not advocate taking guns and killing innocent workers and other citizens. It advocates nothing of the kind.

Obviously mass shooters will often have a political ideology, especially in our ideologically blighted times. After all, they are adult Americans and nowadays most adult Americans have some sort of politics. In a nonpolitical shooting, a shooter may have any politics whatsoever from Far Left to Far Right and everything in between, and none of it matters one whit. That is because the shooting had nothing to do with politics, so the shooter’s politics is absolutely irrelevant.

By the way, the sex life of the shooter is also irrelevant. The Gilroy and El Paso shooters didn’t seem to do well with women, but neither was complaining about it, and there’s no evidence that misogyny or incel ideology had anything to do with the shooting. Believe it or not, any man can go on a mass shooting, from virgin to playboy. As long as the shooting has nothing to do with his sex life, obviously his sex life is utterly irrelevant.

The Dayton shooter did quite well with women, but he also had some serious anger towards them. Yet the shooting, which fired into a mixed crowd and killed more men than women in addition to killing his beloved best sister, was clearly not motivated by misogyny.

Instead, Connor Betts appears to have been suffering from sort of psychotic disorder, possibly Schizoaffective Disorder or Bipolar 1 Disorder. We know that he had been hearing external voices from an early age.

Politics in this country is getting seriously retarded with each passing day, and I blame both the Right and the Left for that because nowadays the Right and Left are equally deranged ideologically.

They don’t have much in common with each other except for a lack of connection with the real world and a tendency to lie, make stuff up, hallucinate, and engage in wild hyperbole and conspiracy mongering. Neither the Right nor the Left is as bad as the demonizers on the other side make them out to be.

Meth-induced Voices in Your Head Start with Pareidolia

Interesting article on meth-induced voices in the head deriving from long-term use of methamphetamine.

Eventually, and note that this happened with everyday use of crystal meth for a couple of years, there didn’t have to be any white noise to trigger the voices. Eventually I heard voices all the time, and they took on a different nature. They would sound just like real voices, coming from different directions and distance, so the sensation was enough to trick my brain into believing that I really heard the voices with my ears.
They became voices that mocked me, voices that ridiculed me, voices of imaginary observers to a mind that became increasingly paranoid and deluded. So it became much like a persecution complex, or paranoid schizophrenia.
At one stage I heard people talking about me at work, saying terrible things about me. I heard them through the walls. I heard them even when I was alone.

That sounds almost exactly like paranoid schizophrenia. I have heard that long-term meth use can lead to a permanent paranoid schizophrenia-type illness. Most of this data has come out of Japan where people have been injecting shabu or meth for many years. The cases involved subjects who had been injecting shabu every day for 10+ years. The illness was incurable.

Meth-induced voices in your head take you to a bad place, a real living hell on Earth. And many who go there don’t return. They end up permanently psychotic…
…I find this very interesting, in that it could mean that hearing voices is simply an expected side-effect of prolonged drug use. Further, I noticed many meth addicts who tended to believe in black magic and possession. Even when I was in rehab years ago, some residents there became convinced that a schizophrenic resident (who talked to himself and spoke in gibberish that they thought were “demonic tongues”) was possessed. No amount of attempting to reason with them would convince them otherwise.
So beware, voices in the head and apophenia leading to an irrational belief in the paranormal (as well as possibly in God in recovery) may well just be a side-effect of the high levels of dopamine as a result of frequent prolonged drug use. And it may be permanent.

This is interesting, implying that in some cases, the delusions never really go away. 
It’s interesting how the voices start up faster the longer they have been going on. For instance, if they have been going on a long time and you quit for a while, they will start up again full-blown after only a few days of meth use. This is a kindling effect and it is well known in cocaine use and bipolar disorder, especially manic episodes.
A heavy cocaine user will quit and then smoke cocaine one time. After only using it once, they are running around shutting all the drapes and talking about how the police outside can hear everyone so people need to quiet down.
In Bipolar Disorder, the more episodes you experience, the worse the illness until you get to the point where you are a somewhat manic all the time. Episodes come more often and healthy periods between episodes shorten. The episodes themselves become worse and last longer.

Meth-induced Voices in Your Head Start with Pareidolia

By Jerome

I’ve never written about this topic on this blog, although it was a frequent subject on my old blog. Maybe it’s time…
This subject is fascinating to me now, though it wasn’t always that way. In active addiction it was scary. It was something that I lived with for a few years, but what I find most interesting is how it started.
Firstly, you need to know what pareidoloia is. It’s defined as seeing patterns where none exist, and while that explains it technically, it doesn’t really make it clear what the psychological phenomenon actually is. Visual pareidolia is when we think we see shapes like faces in inanimate objects, like Jesus on a piece of toast, or a face on Mars.
But pareidolia is also when we think we hear voices or recognizable sounds through white noise. An example of the less well known auditory pareidolia is when you’re taking a shower or hear really loud rain falling on your roof, and you think you hear voices or your phone ringing through the noise. That was how my meth voices started. At first it was just ordinary pareidolia, where there was loud rain or wind and I thought I heard voices, but would realize immediately that it was my imagination.
But then something seemed to go wrong in my brain. Fragments of sound that sounded like voices evolved into much more. As months went by, it would happen more frequently, and any background noise, even noises that were not noticeable to most people, would trigger it. So what started out sounding vaguely like voices, after a few months became voices of people that I knew speaking unintelligible words. So it was like hearing a conversation from another room, one just out of earshot and not heard clearly. Then as time went by, it became actual words and sentences that I could make out.
Eventually, and note that this happened with everyday use of crystal meth for a couple of years, there didn’t have to be any white noise to trigger the voices. Eventually I heard voices all the time, and they took on a different nature. They would sound just like real voices, coming from different directions and distance, so the sensation was enough to trick my brain into believing that I really heard the voices with my ears.
They became voices that mocked me, voices that ridiculed me, voices of imaginary observers to a mind that became increasingly paranoid and deluded. So it became much like a persecution complex, or paranoid schizophrenia.
At one stage I heard people talking about me at work, saying terrible things about me. I heard them through the walls. I heard them even when I was alone. Eventually I isolated myself from the outside world and everything in my life was affected as I retreated into my own delusional world of suffering and pain.
Meth-induced voices in your head take you to a bad place, a real living hell on Earth. And many who go there don’t return. They end up permanently psychotic. I’ll probably revisit this topic and write about how it felt to live with those voices and the inevitable delusion, but today’s post is mostly about how they start.
I find it interesting to know that those voices do start with auditory pareidolia, which is something we all experience. Of course, if you’re a meth addict and you start to experience voices, it’s probably a great time to stop using. But you won’t, I know. Yet you need to recognize that when this happens, you can no longer try to convince yourself that you aren’t an addict.
When it reaches this point, you’re a long way past crossing a line from user to addict. You need to recognize that you have a serious problem, one that is affecting not only your life but those of all involved in it. Once the voices progress to the point where you hear them all the time, they don’t stop as long as you continue using. Even if you are clean for a long time and then relapse, the voices return in a few days, and then stick around as long as you use. At least that’s how it was for me.


Update: This article about apophenia (the spontaneous perception of connections and meaningfulness of unrelated phenomena), which is of course closely related to pareidolia, lists high levels of dopamine as a possible cause. Of course drugs like meth, and to a lesser extent cocaine and crack cocaine, cause tremendously high levels of dopamine, considerably higher than the levels that occur naturally. And all of those drugs cause voices in the heads of long-term users. Apparently high levels of dopamine might also cause belief in the paranormal, and EVP, among other things. (I’d considered mentioning EVP here anyway.)
I find this very interesting, in that it could mean that hearing voices is simply an expected side-effect of prolonged drug use. Further, I noticed many meth addicts who tended to believe in black magic and possession. Even when I was in rehab years ago, some residents there became convinced that a schizophrenic resident (who talked to himself and spoke in gibberish that they thought were “demonic tongues”) was possessed. No amount of attempting to reason with them would convince them otherwise.
So beware, voices in the head and apophenia leading to an irrational belief in the paranormal (as well as possibly in God in recovery) may well just be a side-effect of the high levels of dopamine as a result of frequent prolonged drug use. And it may be permanent.
Some of my most annoying Facebook “friends” are people I became acquainted with in rehab, who share Christian nonsense followed by “type Amen” all the time. I can’t bring myself to unfriend them somehow. The most annoying proponent of the sharing Jesus movement is a girl I remember from rehab who believed that she needed to eat sand. There was even a patch of sand set aside especially for her in the garden. (My greatest challenge in rehab was to refrain from pissing in her sand patch.) So ironically, some who hang on so desperately to Jesus in recovery may in my opinion do so simply because their brains are fried from all the drugs. Fortunately I’m not one of them. I guess I’m just lucky.

A Look at Cluster A Personality Disorders

Cluster A are the odd personality disorders. They’re not so much awful people as they are simply so odd and strange that you can’t have much of a human relationship with them. Their general theme is to drive people away from them in some way or another.
Schizoids are ok, but they are very annoying. It’s generally impossible to have any decent human relationship with someone like this because…well…they don’t do human relationships. I’ve talked to Schizoids but I have never really known one in real life. You are unlikely to run across a Schizoid in life because they are such extreme loners that they simply don’t get involved with other humans at all.
Schizotypals simply have a mild form of schizophrenia and are more or less impossible to deal with in ways that are similar to how schizophrenics can’t be dealt with but on a lesser scale. They are also quite suspicious and paranoid. They have awful social skills and conversations with them degenerate and start getting tangential and strange pretty quickly. They will give off a feeling of alienation and weirdness that would probably make you want to get away from them.
I had a girlfriend who had Schizotypal traits, but she was mostly just a Borderline. When she was off into her schizotypal strangeness, it was like talking to someone from another planet. She would be saying weird and odd things that didn’t make a lot of sense and the conversation had the creepy feel of someone who is way out there and is not really with the rest of us at all. I eventually broke up with her on the grounds that she was too crazy for me. It was like dating a Martian.
I’ve never met or talked to an actual full-blown Schizotypal, so I don’t know much about them. I don’t see how you can have a decent relationship with someone like this. They’re too crazy for that. You usually won’t meet schizotypals because they are extreme loners who don’t do human relationships. They are suspicious, withdrawn and don’t talk much. They give off vibes of trying to drive you away. When at home, they often get quite shut-in and don’t want to go outside.
Paranoids I do not understand very well, but I hear they are hard to deal with too. They can also often be angry. Their constant suspicion drives you crazy and relationships with these people must be hard to deal with. You often won’t meet Paranoids either because, well, they’re too paranoid! They shy away from most relationships too and even if you work with them, they probably won’t reveal much of their disorder. They also give off serious “get away from me” vibes.
None of these people are easy to get along with. It’s going to be hard to have a decent human relationship with any of these people.
Of course Cluster B’s are awful human beings. I’ve gone into them before on this site.
 
 

Schiz OCD Versus Psychosis: Differences and Interactions

Hassan Herrera: By saying “Anxiety processes can at times escalate all the way to psychosis.” You mean, for example a OCD’er getting through the fear of going psychotic can start experiencing psychotic symptoms coming out of the anxiety process? I catch sight of a post of you setting apart core process and where the symptoms come from. I hope i got myself across.

Never seen a case of Schiz OCD going all the way to psychosis, although I know a woman with schizophrenia and Schiz OCD in which the two sort of go together but not completely. She still has delusions that she does not doubt. She also hides symptoms a lot, which is very hard to figure out, though I can sometimes do it.
I don’t think the Schiz OCD went into the Schizophrenia, but the Schizophrenia dx obviously played into the Schiz OCD. It’s an extremely complex case. Never seen a case of Schiz OCD going all the way to psychosis, although I know a woman with schizophrenia and Schiz OCD in which the two sort of went together but not completely. She still has delusions that she does not doubt. She also hides symptoms a lot, which is very hard to figure out, though I can sometimes do it. I don’t think the Schiz OCD went into the Schizophrenia, but the Schizophrenia dx obviously played into the Schiz OCD. It’s an extremely complex case.
There is a Psychotic OCD but I have never seen a single case of it, and I have seen more OCD’ers than 95% of clinicians will ever see. I have seen cases that I worried were Psychotic OCD, but when you got it all untangled, they still had reality testing intact more or less, at least in terms of overvalued ideas. There is a sub-diagnosis of OCD with Overvalued Ideas.
The OCD symptoms in this case were extremely bizarre, and phenomenologically, they looked a lot like the sort of thing you see in Psychotic OCD. His symptoms appeared so psychotic that when I mentioned them to a retired clinician, she insisted that this person was psychotic and would not accept that they were not. Unfortunately I am not allowed to share the very interesting symptoms on here.
Psychotic OCD has a sort of a “look” to it along with typical delusions that are present in a lot of cases – it is a syndrome, in other words.
A classic case of Psychotic OCD would be a case where the obsessions have escalated into delusions. The people are typically not dangerous, as fear is a freezing agent, and OCD’ers tend to be shy or very shy, passive, introverted, and remarkably nonviolent. A classic case is a man sitting in a chair all day shaking like a leaf and going on about his obsessions, which have now reached delusional intensity. The old view was that Psychotic OCD’ers never got too far gone psychosis-wise, and it was quite easy to pull them out of the psychosis. A typical case might last three weeks.
However, we now have recent cases of Psychotic OCD going on for years that did not respond to treatment. Some responded to ERP oddly enough. Some of these people are so ill that they have become the homeless mentally ill like a lot of schizophrenics, carting their belongings around in a suitcase.
The main thing to note is that Psychotic OCD is rarely seen. However, when OCD is very bad, they can appear psychotic. Hence, OCD’ers are often misdiagnosed with psychosis of one form or another and put on antipsychotic drugs, which generally do not help them. I get clients all the time coming to me with a diagnosis of some form of psychosis. Once I figure out they are not psychotic and are usually instead Schiz OCD’ers with what I call fake delusions and fake hallucinations, I tell them to fire their psychiatrist and go doctor shopping until you find an MD who understands that you have OCD and not psychosis.
A lot of psychiatrists continue to misdiagnose OCD’ers with psychosis. The phenomenology of OCD is not understood well by many clinicians, and the fact that OCD when severe looks like psychosis but is not results in  a lot of misdiagnosis.
I think a Schiz OCD’er would be the last person to go psychotic, as the condition is predicated on continuous worry and doubt that they are going psychotic. If you have spent any time around psychotic people, that’s clearly not what’s going on. In psychosis the person never worries whether they are psychotic, nor are they are aware they are psychotic.
If you are worried about or are aware of being psychotic, then you cannot possibly be psychotic. That’s a rule out for psychosis right there. This is exactly what is going on in Schiz OCD, hence Schiz OCD is never psychotic by definition.

Paranoia, Aggression, Victimhood, and Assimilation: The Dilemma of the Jews

If you want to find out if someone is an anti-Semite, the last person you should ask is a Jew. This is because Jews see probably 10X more antisemites than actually exist. In other words, they’re paranoid.
One wonders why one would want to think that people who like you actually hate you or go about worrying all the time that many people in your day to day life surreptitiously hate you. If you go to a therapist with symptoms like that, you get diagnosed with a mental disorder. It’s called paranoia. When it gets very bad, it becomes Paranoid Personality Disorder and it gets even worse in a lot of psychoses, especially Paranoid Schizophrenia, Manic Psychosis, and Delusional Disorder.
If paranoia is a mental illness, does that mean that most Jews are nuts? Maybe. I’d much rather call Jews crazy than evil. Besides, it’s a lot more accurate.
But one wonders why the need for the paranoia? It’s simple. The Jews are a tribe, a human tribe. Judaism and Jewishness is simple a manifestation of human ethnocentrism found in every tribe. All tribes are paranoid about all the other tribes and have an extremely elevated view of themselves that implies that they are either the best people on Earth, the only people on Earth, or the first people on Earth. Paranoia tends to go hand in hand with grandiosity. After all, if you are a measly nothing of a man, why would all of these powerful entities be plotting against you all the time. The only way you could have all these people out to get you is if you were pretty damned important!
People with low self-esteem are not usually paranoid. They assume people don’t like them, often correctly. At any rate “people don’t like me” is an anxiety process related to low self-self esteem, anxiety, guilt and high inhibition. The classic process is Social Phobia. Social phobics often feel that people don’t like them because they are inferior. But that’s not paranoia!
Paranoids, instead, go far beyond the notion that people don’t like them. It’s so much worse than that. Paranoids believe that the people who don’t like you are actual enemies and they are plotting against you! And it’s associated with high self-esteem, not low self-esteem, and low levels of anxiety as opposed to high levels. Instead of anxiety and depression, the paranoid feels grandiosity and anger.
Now here we tie into the Jews.
Look a the description I just wrote of how paranoids act and feel and tell me that doesn’t sound exactly like some of the negative stereotypes of Jews.
Why be paranoid?
The Jews are paranoid because paranoia is the only thing that keeps them going. In the Middle Ages, they actually built some of those ghettos themselves in order to keep their people away from the Gentiles. In 1800, a proper Orthodox Jew would not only not dine with a Gentile. He would not even take tea with one! The Yemeni Jews are like this to this very day.
For centuries in the ghetto, the rabbis preached how the Gentiles hated them and how the Jews had to keep away from the Gentiles. In Medieval Spain, if a Jewish woman had sex with a Gentile, her community would punish her by cutting off her nose!
The Jews are remarkably inbred. They have existed for 2,000 years in the Diaspora and they are still remarkably pure. A good way to keep your tribe pure is to preach that all of the outsiders are evil people who hate you. Of course you don’t want to mingle with them, much less have sex with them.
So the Jews actually owe their very existence to centuries of paranoia along with all the attendant emotions that go along with it – grandiosity towards themselves, anger and hostility (not anxiety) towards non- Jews and basically aggressive, belligerent, chip on the shoulder mindset, which clinical paranoids also have.
All paranoids are victims. Not only that, but they are innocent victims. Innocent victimhood is a necessary state for the paranoia to develop in the first place. The Jews also are perennial victims. They are supposedly victims of centuries of oppression everywhere they  have gone and the future only holds the same if not worse. And of course the Jews are always innocent. They got thrown out of all those countries through no fault of their own. They dindu nuffin. Those Gentiles were just being irrational or insane and downright evil. Pure evil. Pure evil for no reason at all, the worst sort of evil of them all.
Hence it follows that Jews have a need to be victims. Hang around Jews long enough and it will become apparent that they actually desire and cherish their victimhood. In fact, in my opinion, victimhood is the most precious thing a Jew has. One thing you don’t do is take away a Jews sense of victimhood. It seems they will almost kill to keep that.
So what happens if you take away the paranoia and sense of victimhood from the Jews? Simple. The Jews go extinct. The only reason they persisted all this time was due to their hatred for non-Jews. The day the Jews stop hating non-Jews and seeing themselves as victims of all-encompassing anti-Semitism is the day the Jews start going out. Because once that happens, the Jews will have no reason not to assimilate and marry non-Jews.
And this is the Catch-22 of Jewish assimilation. And in fact some of these very arguments have been used by Jews themselves in the centuries-old debate about assimilation.

Are Schizophrenic People Smart?

Although of course schizophrenics vary in IQ, the research shows that lower IQ is associated with schizophrenia. Typically the lower IQ was present before the schizophrenia hit. Whether these people already had pre-schizophrenia and the low IQ was a signal of that or whether lower IQ is an independent risk factor is not known. I suggest the former.
I am not sure if schizophrenia itself, once it hits, causes an IQ decline, but it would not surprise me. The process of developing schizophrenia involves considerable damage to the brain. It makes sense that this brain damage, in addition to causing the disorder, also lowered your IQ.
In summary, people with schizophrenia tend to have lower IQ’s than normals on average, but the difference may not be large. I think it was only ~3 points.

How Can I Tell If I Have Paranoid Schizophrenia or Schizotypal Personality Disorder?

Answered on Quora.
Simple. If you had either one, you would probably not be asking this question right now.
If you had paranoid schizophrenia, you would not be asking this question because people with this illness do not recognize that they are ill, typically refuse to seek help, and also refuse to take medication. If you tell them they are ill, they will not agree.
If you had Schizotypal Personality Disorder (really mild schizophrenia) you would probably not be asking this either. These people probably do not believe there is anything wrong with themselves either, and they are typically too paranoid to go in for treatment. There is a forum for Schizotypals on the Net, and many of them are on there saying that they are too paranoid and distrustful to go to therapy.

Borderlands: Obsession, Delusion and Their Differential Diagnosis

The Borderland between Obsession and Delusion

Anxiety processes can at times escalate all the way to psychosis. I have had some OCD clients who I had a very hard time figuring out if they were psychotic or not. With one, I told a retired therapist of their symptoms, and the therapist immediately said, “Well, they’re psychotic. That’s a delusion.” The things that they believed or almost believed did look like psychotic delusions. However, they did not entirely believe them. OCD with Overvalued Ideas was probably a better diagnosis. There are a few cases of Psychotic OCD. I have never seen one though, although this case was getting close.
When OCD gets very bad, they appear psychotic. However, they generally are not, and in 95% of cases, I can figure out that they are not psychotic. That is because Severe OCD That Looks Psychotic has this particular look, feel, or vibe (gestalt) about it where the cases all give off this particular vibe. It’s like they are all reading off the same script in a sense.

The Problem of Psychotic People Hiding Symptoms

You get a different look, feel, or vibe (gestalt) with an actively psychotic individual, but they can be hard to figure out too because sometimes they lie about their delusions.
I have caught them hiding symptoms from me.
Some people with psychoses learn to hide symptoms because they figure out that every time they say “The FBI is after me,” someone grabs them and hauls them off to the hospital. So they continue to believe the FBI is after them, but they learn to shut up about it.
You look at what the person is doing in reaction to the thoughts. They thought the neighbors were hacking into their computer so they disconnected their computer from the Internet? Delusion. A person who just had the fear or obsession that the neighbors were hacking in would not disconnect the computer, and their description of the fear would be full of all of these strange doubts and uncertainties.

The Difficulty of Differentiating between Thoughts and Voices

Psychotic people sometimes refer to thoughts as voices. I had one client who referred to thoughts telling him to do bad things, in this case, to kill animals. He had recently killed five puppies in response to these thoughts ordering him to kill these animals. I suspected these were more than thoughts, so I had him describe them, and he said, “It’s a thought, you know. You hear it like someone standing next to you and talking.” Ok if you hear it outside your body like that, it’s not a thought, it’s a voice.
Some people with schizophrenia hear their thoughts spoken out loud in the environment, and they fear or believe that others can hear their thoughts being broadcast out there. However, if you corner them on it, some will try to deny it by saying that they just have very loud thoughts in their heads, and the thoughts are so loud that they worry or fear that maybe others can hear them. That’s not quite precisely a delusion, and it’s not a hallucination like the thought broadcasting. It’s off into the obsession/delusion borderland.

Schiz OCD – OCD with the Fear of Psychosis Theme

There is a type of OCD where the person fears that they are going psychotic. OCD’ers have made up a term called Schiz OCD for this illness, which is really OCD with the Fear of Psychosis as the theme. Some clinicians have complained to me about these “hokey names” for the different OCD types and accused me of making them up. I didn’t make up any of them.
The sufferers make up these names for the different themes that they have. I feel that the sufferers have a right to own their symptoms and illnesses and call them whatever they want to call them. That’s their right as sufferers.
Who are we to tell them that their name for their symptoms is the wrong name? Do we have a better name? Of course not. “We” are just arrogant clinicians who think we know these illnesses better than the sufferers themselves know them. I realize Schiz OCD is a confusing name, but it’s the name they picked, and we don’t have a better one, so let’s go with it.
They develop all sorts of “psychotic” symptoms, including fake delusions, fake hallucinations, and even perceptual disturbances. Once again the Schiz OCD symptoms have a completely different quality – look, feel, vibe or gestalt – than you get with someone who has actual delusions and real hallucinations. In addition, all of the Schiz OCD symptoms have a very similar quality across many different people – once again, it’s like they are all reading off the same script.

The Problem of Misdiagnosis in Schiz OCD

I have now seen more people like this than I can count, and I’m an expert on this illness. But I still get people with this type of OCD coming to me all the time with diagnoses of various types of psychoses, schizophrenia, psychotic depression, etc. They received these diagnoses from qualified clinicians such as psychiatrists and clinical psychologists. They were misdiagnosed in 95% of cases, so you see even skilled clinicians can’t tell this OCD type from a psychosis in a lot of cases.

Are People on the Schizophrenic Spectrum Less Intelligent?

Answered on Quora: 
Indeed, repeated studies have shown that schizophrenia is associated with a somewhat lower IQ – possibly 5–10 points. These studies showed that schizophrenics had lower IQ even before the schizophrenia developed.
Why schizophrenia is associated with lower IQ is not known, but schizophrenia is a disease of the brain, and it seems that whatever is causing the schizophrenia is also lowering the IQ.

Schizophrenia and Autism: Similarities and Differences

JohnnyHG writes: There is evidence schizophrenia is developmental like Autism. I would exclude the cases of diagnosis of someone with a history of drug use or brief psychotic hallucinations from environment. The fuck up just gets delayed – it’s latent, which is why it happens in one’s teens/early 20s rather than toddlerhood. But there are signs lasting years leading up to it if I am correct, prodromal? It doesn’t happen overnight.
Experts have watched videos of children who later went on to develop the condition and could pick them out after a while. Often poorer school grades, abnormal movements, and irritable behavior could be found. Plus the negative and cognitive symptoms overlap heavily with Asperger’s/ASD or just Autism Disorder. I believe they bundled it all up because there is too much heterogeneity, hence the distinction between AS and Autism was a bit artificial.
Some things seem to be opposites: clumsiness in autism vs. stupor/stiffness in SCZ, repetitive literal speech or no speech in autism vs alogia or garbled speech in SCZ, obsessiveness with one topic in autism vs apathy in SCZ, but stereotypies are shared and so are bizarre habits. However, there is a different flavor to them, hard to describe.
Do you believe it is neurodevelopmental or stick with the old belief it’s degenerative?

Thanks for the excellent comment. I share your views. I have long believed that schizophrenia is developmental. Really they are born with it or born with the tendency. With enough stress or genetic loading, they get schizophrenia, and if they have little stress or low genetic loading, they either get schizotypal personality disorder (really just mild schizophrenia) or they may get schizophrenia with a later onset.
There really are two things they are seeing in the early symptoms.
The first are the early symptoms – clumsiness, oddness, poor grades, irritability, etc. Those are childhood symptoms.
Then there is the prodrome which hits in adolescence at some point. This causes a slow deterioration over a few years’ period leading to the classic onset from 16-24. I was best friends with a man with paranoid schizophrenia for a year. I hung out with him every day that year. It was a most interesting experience!
At the time, he was 27 years old and he was in the prodromal phase of paranoid schizophrenia. It had been going on maybe since age ~22, so five years. A long slow prodrome is common in paranoid schizophrenia. He was hearing voices the whole time, but his charming personality was quite intact. He was half-Black, very good-looking, and very charming, and he attracted White women everywhere we went together. He later got slowly worse and worse, and after a while, he was not even talking much. I haven’t heard much about him since, as my relatives are telling me to avoid him.

Do Therapists Ever Think Their Clients are Unfixable?

Question from Quora:
Some people are utterly unfixable or even improvable, but they are quite rare.
There are clients who are just too far gone, and they cannot be helped at all. It is as if the person were a ceramic bowl that was dropped on a hard floor. The bowl is now in 100 pieces, and the person who dropped it is on the ground looking at the pieces and throwing up their hands. “Where do I start?” he asks in exasperation.
All sociopaths and psychopaths are unfixable by their very nature. We can’t cure the sociopathy and psychopathy because they don’t want to get better. They enjoy being antisocial, and they do not wish to change. However, we can get them to change their behavior. For instance, a homicidal sociopath may show up in the office. A good therapist may be able to convince this sociopath that acting on their homicidal fantasies would be one of the stupidest things that they could ever do. This sociopath may then be able to go through life without killing an innocent person. So we can’t fix sociopaths, but we can change their behavior somewhat, tone it down, or reduce the amount of damage they do to society.
All paraphilias are unfixable by their very nature. The paraphilia quite literally will not and cannot go away. It’s etched in stone.
Schizophrenia is largely unfixable. They need a great deal of medication, and even then in most cases, they are repeatedly hospitalized. A few can go on to lead somewhat normal or even successful lives, but these people still need continuous medication and regular psychotherapy. In addition, they need frequent interventions to stay out of the hospital.
Many illnesses such as OCD, Bipolar Disorder and Chronic Major Depression are unfixable by psychotherapy. Most of these people will need medication for the rest of their lives. However, psychotherapy can improve their conditions a lot at least in the first and last cases.
Long-term suicidality is very hard to fix. It tends to become chronic with repeated attempts over the years. The suicidal person is typically defiant and is furious with you for challenging their suicidality. You are expected to sympathize with their condition, which is actually a very bad idea. Most suicidal people are what I would call “defiantly suicidal.”
Personality disorders are generally incurable. Theoretically, they could be fixed, but these people almost never present for therapy, and when they do, it is often at the behest of others, and they do not really wish to be there or get anything done. People with personality disorders, like sociopaths, literally do not want to get better. They like their personality disorder, and they are incredibly resistant to change. There are some case reports of cures of personality disorders, but in general the prognosis is grave.
I have never been able to fix long term low self esteem, and I have tried with a few people. There is something about that condition that hammers itself into the brain as if into concrete. I do not know why, but long-term low self-esteem seems to be one of the hardest psychological problems to fix. Why this is, I have no idea. Perhaps someone else can offer some ideas.
In many cases, long-term mental disorders simply cannot be fixed or cured. However, with psychotherapy and drugs, people can often get much better than they were before. We need to stop thinking in terms of cures and start thinking in terms of amelioration.
I realize that many clinicians insist that most people can be fixed or cured of long-term conditions, but I think they are lying. They are probably trying to drum up business. Many clinicians fear that if word got out that a lot of long-term mentally ill people cannot be fixed or cured, people would stop coming in for therapy. There goes their paycheck. Therapists are a lot more money-oriented than most people believe, and don’t let anyone tell you otherwise. I know this field very well.
Clinicians have nothing to worry about. Even if a lot of conditions could only be ameliorated and not fixed, I am sure a lot of folks would show up to try to get some improvement. Some mental disorders are so painful that any improvement feels like a miracle cure to the client. A lot of people have given up on being cured anyway, just want to at least get better and are quite happy to do so.

The Untreatable Borderline Personality Disorder Client: A Therapeutic Nightmare

Borderline Personality Disorder (BPD)is one of the hardest disorders of all to treat. It can be improved with some therapies, but the road is long and hard. Many seem to go on for years or decades with little or no improvement. There are reports of cures, and I am familiar with a woman whose BPD cleared up at age 55 after having come on in childhood. That’s probably a typical cure. Decades of nasty illness followed by a lifting of the illness in middle age.
Many mental disorders improve in middle age, and even many personality disorders improve during this age period.
Schizophrenia often ‘burns out” in middle age, and florid positive symptoms are replaced by more negative symptoms.
Many anxiety disorders attentuate in middle age.
Even psychopaths often get better or at least less destructive in middle age, as many of them also burn out in a similar fashion as schizophrenics. A number of highly antisocial psychopathic men get better in middle age as the antisocial behavior attentuates. It is often replaced by depression, heavy drinking and a pessimistic, cynical, imbittered and misanthropic person who nonetheless does little damage to society anymore.
It should be noted the clients with BPD vary widely in their symptom pathology.  Some are much more functional than others. Quite a few can even function well at their jobs all day, but when they come home from work, they fall apart and shift into full BPD pathology.
However, some people with BPD are so ill that they seem nearly untreatable. It is these people who will be the subject of this post, not BPD’s in general. These people seem so far gone and broken that one wonders how anyone could ever even begin to put them back together again. I suppose some progress could be made, but the damage is so severe that I have a hard time seeing how even the best therapist could possibly fix these people in any significant way.
A typical case might be a young woman who, only in her late 20’s to early 30’s, already has 8 -13 suicide attempts and many hospitalizations behind her. She goes into the hospital on a regular basis. Therapy seems to do nothing but feed her pathology as she manipulates gullible new therapists to believe her lies, nonsense, and projections as the new therapist confuses symptom pathology with the truth. Drugs do almost nothing.
Diagnosis itself is often difficult because the BPD is so severe that the person often appears psychotic/delusional. One wonders what are delusions and what are not. Even the delusions do not seem to last for long, as they are dropped, changed around, added to or substituted in a wildly chaotic fashion.
Usually there is a lot of combativeness and involvement with the court system, as the extreme rage leads a litigious person.
Splitting is severe and textbook.
Self-image is so unstable that the person almost literally adopts the full personality and even persona of whomever is on their radar at the moment. The clinician needs to be prepared that this person will so identify with the clinician that they will adopt the therapist’s image and persona as their own. Boundaries nearly do not exist for these people, and they often fall in love with their therapists, try to seduce them, or on the other hand become furious at them to where sessions became rage attacks at the therapist, and the therapists is at odds of how to respond without violating ethics.
The client can become overtly suicidal even during sessions, and infatuation with the therapist can quickly split to where the therapist is the source of all evil. Homicidal threats and homicidal-suicidal threats against the therapist may now appear. The client then hospitalizes themselves due the “horrible trauma from the evil,  incompetent therapist” and soon finds sympathetic new therapist, typically a feminist woman, to unload her story on. The new female therapist forms an alliance with the client against the “evil male” former therapist and accuses him of damaging the client.
Commonly, the therapist gets angry and tells off the client. This leads to abandonment and a vengeance agenda against the therapist, who has now “irreparably damaged” the BPD and “caused them to spiral out of control.” Be prepared to get accused of abandonment, causing severe trauma in the client and making them dramatically worse. The client may become hospitalized due to allegations of damage from an incompetent therapist.
These people are so difficult and chaotic that many clinicians refuse to see Borderline patients. Some are on the record as saying that when they say a Borderline client coming their way, they hide under their desk until they go away. For a lot of therapists, these clients are nothing but trouble, and endless parade of drama and chaos. Therapy itself is chaotic, mercurial, and wild with severe splitting and often extreme idealization of the therapist for good or ill or both, interrupted by fairly regular hospitalizations. The therapist begins to wonder what’s in it for them and thinks you could not pay them enough to suffer through such clients. These clients make an excellent argument that therapeutic abandonment is the proper choice with some clients.

Do Psychologists Make Their Patients Aware of the Diagnosis of Narcissistic Personality Disorder or Sociopathy?

I recently answered this question on Quora.

Do Psychologists Make their Patients Aware of the Diagnosis of Narcissistic Personality Disorder or Sociopathy?

These personality disorders seem to carry a lot of social stigma, therefore are patients made aware of their diagnosis or does the therapist just continue behavioral therapy to treat the symptoms rather than informing them of the diagnosis?

I am not a psychologist. I am a counselor. I only work with one disorder, OCD, and I can quite accurately diagnose that condition, I assure you. Nevertheless, I am not allowed to give out legal DSM diagnoses. However, I can obviously give out my opinion on a diagnosis. I can also tell the person my opinion on what they do not have. For instance, I have gotten many clients with OCD who have been misdiagnosed with some sort of psychosis. I am an expert at telling the two apart. I simply tell them that in my opinion, they are not psychotic. Then I tell them to fire your clinician and go get a new one that will recognize the difference between OCD and psychosis (many clinicians are very poor at telling these apart).
Other than OCD/psychosis, I also have to make differential dx on OCD/sociopathy, violent thoughts, etc., OCD/pedophilia, pedophilic thoughts, etc. and OCD/homosexuality. In a limited number of cases, I told clients that in my opinion, they did not have OCD but instead had some psychotic disorder, or sociopathic traits, or pedophilia, or that they were homosexuals. Most of this differential dx is pretty straightforward.
I have never had any narcissistic clients, God forbid clients with NPD. One thing nice about working with OCD clients is that they are usually very nice people. Not all of them, mind you. But if they are not nice, there is often some other reason, for instance, Borderline Personality Disorder in an OCD client could possibly make them impossibly vicious, cruel, unstable, not to mention extremely crazy, far crazier than any OCD sufferer ever gets.
OCD by its very nature strikes nice people. The fact that they are so nice, meek and kind is actually one of the main reasons that they have the disorder in the first place! For the most part, only nice people get it, and the nicer you are, the more likely you are to get it. I will leave it at that for the moment and give you a chance to think of why that might be. I know why but it goes beyond the scope of this post at the moment.
But in general, I never even give my opinion on other anxiety disorders or on any mood disorders or personality disorders. I only rarely see clients who have psychotic disorders, and the two that I have seen were already diagnosed. I also very rarely see people with personality disorders, and the few that I have seen were all females with Borderline PD diagnoses. I did see one woman for two sessions with obvious Borderline Personality Disorder, but I had not figured it out yet in the first session, and by the second session, I declined to diagnose her. She has already been diagnosed by a psychiatrist from afar anyway. So apparently I am guilty of failing to dx a Borderline PD client.
The session was about her OCD, not her BPD and she was very nice through the whole session. It would have ruined the whole thing if I told her she had BPD, and I doubt if she would have accepted it anyway. At any rate, I am not allowed to give legal dx’s anyway, so it’s apparently proper for me not to diagnose someone!
That only comes up if there is differential diagnosis. I simply say that I not only can I not legally give these out but that I am not qualified to work with any condition other than OCD, which I can actually work very well with. If they want me to work on their depression or whatever, I tell them that I have no expertise or training in that area so I can guarantee nothing and it would be similar to talking to a friend or family member.
If I were able to give out diagnoses, I think I would simply give them out in most every case. Possibly if it might make a suicidal patient go over the edge, I might decline to give one out. But I will disagree with the clinicians below. In my opinion, physicians and other medical professionals in addition to all licensed clinicians should give out whatever diagnosis is appropriate. I feel it is a moral matter. The patient or client is simply owed a diagnosis on the part of the clinician or MD and I feel it would be remiss of the clinician or MD not to tell the patient what is wrong with them, and I mean everything that is wrong with them.
This is just my personal opinion and I believe there no ethical rules on the subject. Also I respect the clinicians below for not giving out diagnoses in cases where it would not be helpful. I simply feel that this is a case were morals or even the categorical imperative trumps pragmatics or even common sense.

False Memories in OCD

False memories are quite common when OCD gets bad. I have dealt with a number of people who were going round and round about false memories. They are not an extremely common symptom, but you do see them sometimes when the illness is bad. It’s generally a sign of a bad illness.
Ms. Z was periodically convinced that she killed people. She would have a conversation with someone for 5-10 minutes, then walk away ,and then suddenly think that she had killed them somehow during the conversation. Perhaps she had suddenly swung her fist out and beat them to death? Perhaps she had pulled out a knife and hacked them to death? Perhaps she had shot them with a gun? She would have all sorts of false memories of how she killed these people.
In the course of these false memories, she would become 100% certain that she had killed that person she was talking to in that store that day. In the next few days, she would ask around to people she knew if anyone got murdered or if she killed someone in the store that day. Of course she would always be told no. I’m sure her friends must have tired of answering these weird questions. As soon as she was told that no murder had occurred, immediately the firmly held belief that she had killed that person would vanish, and she would never think about it again. Until a little while later when she would be talking to someone again and then walk away and once again become convinced that she had killed that person…
Another woman, Ms. S., was a young college student. She was at a large California university that had a lot of long, winding trails with undergrowth. There were deep gullies on the sides of the paths that were overgrown with foliage. Ms. S. would be walking down the paths and as she walked, she passed all sorts of people coming her way. At some point, she would suddenly get an idea that she had grabbed one of the people coming her way and thrown them down into one of the gullies.
She had a pretty clear memory of who the person was she threw down there and exactly how she had done it. She would be overwhelmed with guilt, and she would take off down into the gully searching for the “body” of the person she had thrown down into the gulch. She did this on a pretty regular basis, and eventually the university wondered what she was doing floundering around in the gullies, and they sent the university police down there to see what she was up to. After a while, it become clear that she needed to go to the university counseling center.
In both cases, the women received a diagnosis of schizoaffective disorder in addition to OCD. This was an incorrect diagnosis, and it was based on the fact that for a short while after Ms. S  was clamboring around in the gullies or after Ms. Z became convinced that she had somehow killed someone she was talking to, that both women were absolutely convinced that they had either thrown someone down into the gully or had killed the person they were talking to in the store.
The diagnosis was incorrect because as soon as the women were told that there was no one in the gully or that they had not killed the person in the store, the “delusion” completely vanished and they didn’t think of it again until next time. Delusions just don’t go away like that. It’s not a very strongly held conviction if can vanish with a mere word of reassurance.
We look at the whole process in a holistic sense. What is the nature of the process? Is this a characterological process (personality disorder), a mood process (mood disorder like Bipolar Disorder or Depression), an anxiety process (OCD, PTSD, GAD, Panic Disorder) or a psychotic process (schizophrenia, manic psychosis, psychotic depression, schizoaffective disorder)? It is important to look at things in an intuitive sense and get the “smell” or “feel” of what the basic process is that you are dealing with.
In the case above, this is an anxiety process, specifically an OCD process. It’s not a psychotic process, despite the fact that it superficially resembles a psychosis.
Some of these folks with false memories actually go to the police station and turn themselves in for crimes that they did not commit.
“Hi, I am here to report a murder.”
“Ok, what happened?”
“Well I think I killed someone last night.”
“You think you killed someone?”
“Yes.”
“Well, where did this happen?”
“I am not sure. I think maybe the bridge over the river.”
“What time did this happen?”
“I’m not sure. Maybe midnight?”
“Who was the victim?”
“I’m not sure. I think it was a man, maybe.”
“What weapon was used?”
“I am not completely sure. I think it was a knife maybe.”
After a while the police started to get the message. He was not there to report a murder at all. He was there to find out whether or not he was a murderer!
As the conversation degenerated, the man started repeating, “How do you know if you killed someone or not?”
The police did not know what to say to that. After he left, the police were talking among themselves. “That’s so weird,” one of them said. “What does he mean, ‘How do I know if I killed someone or not?’ How could you not know something like that? That’s so weird.” The cops were shaking their heads.
 
As you can see, false memories are quite common in OCD when it gets very bad.
I dealt with them myself at one point in 1985 or 1986. I have to admit it was a pretty nutty way of thinking. I was so ashamed of my false memories (which I temporarily convinced myself were true) that I never told anyone except for a couple of therapists. I have not dealt with any false memory nonsense in over 30 years, and I hope I never have to deal with that again. It’s truly a crazy way to think.

Psychopathology of Serial Murderers

The primary problem with almost all serial killers is simply ASPD, Antisocial Personality Disorder, (derived) sociopathy or (primary) psychopathy. It is present in almost 100% of such cases. Most everything else is rather secondary to this primary character disorder, which is the most prominent symptom.

Very rare is the serial killer without this disorder, although there have been a few. I remember a long-distance trucker who turned himself when he walked into a Northern California police station with a woman’s breast in his top shirt pocket. He had camped out in forests while trucking and had picked up women and killed them. He kept the body of one in the truck for three or four days and drove around with it.

Experts said he was quite unusual in that they said he actually felt bad about what he had done. I wonder how bad he really felt though. You could not get me to drive around in a truck with a dead woman in the back for very long. I would go into severe panic pretty fast, stop the truck, and get out, and start walking or probably running away.

I would not be able to walk around with a woman’s breast in my shirt for long either. I would completely panic almost right away, take the shirt off, throw it on the ground, and start running. But then I am a pretty guilty type person with a strong conscience.

Based on that, while I am sure he may have felt some guilt for his killings, the fact that he was able to drive around in a truck with a dead woman in the back for 3-4 days shows without completely flipping out shows to me that he didn’t feel that much guilt, certainly not on the level that most of us would.

And the fact that he could rather calmly walk into a police station with a cut-off breast in his pocket without flying into total panic shows to me that he didn’t feel that bad about it. So guilt, even when it is present, is not as strong as in most of us, otherwise they would not have even done such horrible things in the first place.

Sexual sadism is also often present, and I have heard that Sadistic Personality Disorder is very common. Juvenile delinquency, voyeurism, exhibitionism, burglary, prowling, petty thievery, etc. typically precede the serial killings. When the serial killer starts killing, he usually has a fairly long rap sheet of more minor offenses. The murders are best seen as an escalation of a chronic criminal character type.

The ones who kill children are typically though not always preferential or fixated pedophiles. Certainly the ones who kill only children are preferential pedophiles. There is a type of pedophile called a mysoped, which is a sadistic pedophile. They are not very common. I doubt if 5% of pedophiles are like this, but these people are very dangerous. Probably almost all serial child killers are mysopeds, and these crimes often have a sexual basis.

95% of rapists are the type that rarely if ever go serial, but the sadistic rapist, composed of no more than 5% of rapists, is very dangerous. Most if not all rapist serial killers are sadistic rapists.

The rage rapist is dangerous, but he generally does not intend to kill his victim although he assaults her. If she fights back or gets difficult, he can fly into a rage and beat her so badly that she dies, but again he usually does not intend to kill. I doubt if these types go serial much if at all. Serial killers intend to kill; rage rapists do not.

Malignant narcissism, the disorder, believe it or not, of our wonderful President, is also present sometimes. Ted Bundy was a malignant narcissist. Yes, our wonderful President has the same mental illness as Ted Bundy! Comforting thought.

A few have Schizoid Personality Disorder, and some of the more disturbed ones have Borderline Personality Disorder.

Schizotypal, Paranoid, and Narcissistic Personality Disorders are rarely if ever seen in serial killers. Schizotypals are probably too disorganized and decompensated and just out and out strange to commit such crimes. The serial killer must blend in, and schizotypals do not do that. A few schizotypals have committed mass murders. James Holmes the Aurora Batman Theater Shooter, was a notable case. But note that he was caught immediately.

Paranoid PD is rarely if ever seen. These people tend to be rather retiring and like to hide away from a hostile world. They also do not like to call attention to themselves from a hostile world. They are suspicious and distrustful by nature, and this makes it hard for them to blend in well with ordinary society as serial killers often do.

Narcissists are usually too self-centered to kill. While narcissists are often very mean, the disorder is usually well-controlled in that the rage rarely escalates to homicide. There have been a few cases of NPD’s committing mass murder, usually of their families. The case of Jeffrey MacDonald, the mass murdering physician of Fatal Vision, seems to be such a case. This is a superb true crime book by the way.

Also narcissists think that if they kill, they will get caught, and if they are in prison or jail they will not be able to live this wonderful life they are supposed to be killing. They are “too cool to kill.”

Killing would mess up all their wonderful plans to exploit others and hold them up to contempt by millions of people, which the narcissist would have a hard time taking. The narcissist is “too good for prison.” Prison would be such a crushing blow to their self-image that it would very hard to take.

However, malignant narcissists can be very dangerous because this is a combination of psychopathy, sadism, Paranoid PD and Narcissistic PD. When you weaponize NPD with paranoia, sadism and particularly psychopathy, you create a dangerous illness.

Cluster C Personality Disorders like Passive-Aggressive Personality Disorder, Self-Defeating Personality Disorder, Dependent Personality Disorder and Obsessive Compulsive Personality Disorder are rarely if ever present in these types. These are PD’s where aggression is mostly displayed passively, and serial killers display aggression actively, not passively.

Mood disorders do not seem to be common. Bipolar Disorder is not common, and serial killers are rarely if ever depressed. They displace guilt and loathing outwards instead of pushing it inside of themselves as depressives do.

Depressives are passive, and depression acts as sort of a freezing agent in that it tends to immobilize people by its nature.

Men in general tend to either experience less depression than women or mask it with other things such as anger and rage, drinking, drugs, gambling, promiscuity, or even workaholism. It is simply not acceptable as a man to be depressed, so depressed men simply channel their depression into other things and say they are not depressed, they are just drunks or workaholics, for instance.

Substance and alcohol abuse issues are quite common with serial killers, but the better ones are more sober, as drinkers and dopers tend to be scattered and unreliable, and serial killers must be on the ball  24-7.

Only a few are psychotic. 2% of serial killers are psychotic. Psychotic people can barely organize a trip to the bathroom. How are they going to plot out elaborate and professional serial homicides?

They are motivated by many things, but your typical rape-murders or murders of attractive young women almost always have a sexual component. I would call these serial killings lust murders. The Germans coined the term.

Even among the lust-murders, there are a number of different types. Some are motivated by purely sexual desires, others get off specifically on killing and the power gained from it, others are hunter types who get pleasure from the hunt and chase as if they were hunting an animal, which they are of course, but when we refer to hunters, we are always talking about hunters of non-human animals.

A Bit About Paranoid Schizophrenia, with a Real Life Example

If you were going psychotic and hearing voices, you would not even know they were voices. When you first heard them, if you were in your home, you would go around looking for the person hiding in your house because it would sound exactly like a person talking in your home. You would search everywhere, under the bed, behind the couch, everywhere someone could hide.

I spent a year hanging out with a paranoid schizophrenic every day. He heard voices all the time, but he was convinced they were coming form the radio or the vents or wherever. For instance, he kept demanding that we take apart the radio in my car to find the recorder in there that was putting out the recordings.

When he first came over to my house, he said he heard someone down in the cellar, so we went down there to look, and there was no one there. I thought it was pretty weird at the time, and I did not know what to think of it, as I had just met the guy, and I did not know he had schizophrenia.

After I hung around with him a while, I started to put two and two together and realized that he was slowly developing paranoid schizophrenia. I figured this out because I had been studying mental illness for 25 years. I had never dealt with a paranoid schizophrenic up close and personal like that before, but he seemed to be a textbook case based on everything that I had read.

He was 28 years old, and the symptoms seem to have started when he was about 23 and at college. There is often a long slow prodrome with paranoid schizophrenia. So while it does have a later onset often in the late 20’s and early 30’s, there has often been a long slow prodrome going on characterized by slow deterioration for even up to five or ten years.

Paranoid schizophrenics do seem to function somewhat better than the rest of schizophrenics, possibly due to this later onset. Some of them have even married, had children, started on careers or opened businesses when the disease hits, so they have had some illness-free years in which to develop their personalities. Hence the personality is more intact in paranoid schizophrenia than with the other forms.

Later I would be over at his place, and he would hear the voices coming out of the vents. He lived with his Mom, and he insisted that his Mom put a recorder in there to harass him, and he wanted me to help him take the vent apart to “look for the tape recorder.” He had a lot of arguments with his Mom about her “putting the recorder in the vent.”

It was very difficult to deal with the guy because he heard the voices, and they were so loud and clear that he would whip around and say, “You hear that?” and he would point to the car radio or the vent or wherever. I always said no, and it was making him mad because the sound to him was clear as a bell, and it was absurd that I could not hear it. So he was always accusing me of being a liar and saying I did not hear the voices when really I did.

After a while, I started making excuses and saying things like I had a problem with my hearing.

The problem is do not want to agree with the person when they say they hear voices because you are just reinforcing their craziness, and pretty soon you will be working with the person to take your car radio apart to “find the microphone.”

Furthermore, it’s best not to reinforce their delusions either because you will just strengthen the craziness.

Actually it probably would not hurt to say you hear the voices too or agree with their delusions, but I always worried that it might make them worse.

For instance, a schizophrenic says someone is persecuting them. Well, you can either agree or not agree. If you agree, you run the risk of reinforcing their belief, and they might get so reinforced, convinced and angry that they assault the person.

Another problem is that I would take him places with me sometimes, say to my doctors appointments, while we were running about trying to get him an apartment. While there, say as we were leaving, he would insist that someone in the waiting room had said some particular insult to him. Actually no one had said anything to him, much less the insult that he heard. He would want to go back in the waiting room and challenge the person over the insult, and it would be rather difficult to convince him not to do that.

He had done very well in college and was a great basketball player but not such a good student. At one point, he had moved into an apartment with other people, but that all ended when he accused them of messing with him through the walls of the apartment. He also accused people of breaking into his car. He would go out to his car, and it would seem like someone had broken into it or messed with stuff inside. He eventually had to move out due to this, and he moved back home to live with his Mom.

I kept trying to get him into an apartment down in Fresno, but things kept falling apart. He would get into the new place, and it would have the damn recorders in it too, and he would accuse the guy was rented it to him of putting the recorders in there. I met one of the men who rented to him, and he was dumbfounded, shaking his head, and could not make sense out of my friend at all. His attitude was “Good God, what the Hell is the matter with this guy!?”

My friend was a mulatto, and he had a very charming personality along with being very goodlooking. Everywhere we went, he would walk up to young White women and chat them up in his usual engaging manner, and they would usually be very interested in him. He was quite a charmer and could really talk to the girls. It was insulting as the girls would always rather talk to the insane guy than to me who was not nuts, although I was in my 40’s at the time I must admit.

If you were out in public with him, and he was chatting up women or whatever, he would typically not seem crazy at all. Instead he would seem to be a perfectly normal, charming, extroverted guy.

I was never afraid of him. Everyone kept telling me he was dangerous, and they were all trying to get me to get rid of him as a friend. He didn’t seem violent to me, and I can read people pretty well. He did yell a lot but not usually at me – more at the folks who were “persecuting him.” The whole time I was with him, I would be looking at him and trying to read his mind (I am a very good mindreader) to figure out if he was going to do something violent. I never got any vibes off of him that he was going to be dangerous, so I wasn’t really worried about him.

However, people close to me eventually convinced me to ditch him, which was not easy. I saw him a few times later around town and gave him a couple of rides. Later he had somehow gotten a job at the local supermarket, but by that time, he was deteriorating even more, and he had become very quiet and would almost ever talk.

I later heard that he was down in my city roaming around on the streets and hanging out at the mentally ill drop-in place.

My friend would never admit to being even slightly mentally ill, and after a while I stopped confronting him about it. But I did try to get him to see a psychiatrist I knew under the guise of giving him some pills for his nerves to calm him down along with some other phony excuses. She was good at dealing with psychotic people who would not admit they were ill, and she would often succeed in surreptitiously giving them some antipsychotics under the guise of calming their nerves or other phony excuses. You have to be a bit sneaky with these people when they will not admit they are ill. I have known people who had psychotic or seriously mentally ill relatives who they were considering dosing with antipsychotics in their orange juice or coffee. I actually think that would be a morally proper act.

The problem in psychosis is that the person typically has no idea that they are ill. Whether they do not want to admit for psychological reasons such as stigma or whether they can’t realize they are ill because psychosis blinds the person to the fact that they are ill, I am not sure. I suspect some of both. Some people are episodically mentally ill, and when they get better, they will often not admit that they had been ill due to stigma or ego reasons.

The problem in psychosis is that the part of the body that is needed to recognize that you are ill is itself sick. The person can’t figure that they are ill because in order to do that, you usually have to be at least somewhat sane. In fact the presence of insight is an excellent diagnostic feature in mental illness, and the greater the insight, the better the prognosis.

Insight is also a very serious problem in Bipolar Disorder, even in the milder phase known as Hypomania.

OCD and Homicidal Thoughts

Homicidal thoughts or harming thoughts are quite common in a type of OCD called “Harm OCD.” It can get pretty bad. As a counselor and a sufferer, I have dealt with many people who had this particular type of OCD. In fact, they come to me all the time! I typically do some sort of differential diagnosis with them to make sure it’s OCD and not something more serious.
Below are some cases of obvious OCD or OCD-like thinking:

1. OK so one day me and my sister were just talking and all of a sudden I get this weird urge to choke her. I would never do that to her. I can’t even kill a bug and I’m not bi polar. This has happened again recently with my other sister, the thought just randomly occurs. If it helps I have been diagnosed with panic disorder. Please don’t be mean and say I’m a psychopath or I’m crazy. I need to know if any one else has experienced this to. Please help!
2. I do too sometimes. Sometimes while I’m driving I feel the urge to swerve into traffic. Sometimes for no reason I get the urge to choke my dog or hit her to death. (Of course I’d never do it.) It feels like you have no control over yourself. It feels like your actually about to do it but you don’t.
3. Believe it or not I’ve been through the exact same thing I had violent and sexual urges that I couldn’t control but I never hurt anyone I just always felt like I would, some specific urges I had were to drown my sister in the pool , every time I was someplace high up I would have a strong urge to jump off. I had these urges from age 10-15 and I was scared to be around people but I found out it is OCD look up OCD violent urges online.
I finally talked to somebody about it and said I was worried I would hurt somebody and they said the reason the urges don’t make me a violent dangerous person is because I’m worried about it were somebody dangerous would either not care or enjoy it.
4. i think everyone thinks these thoughts, not because you want to do them, but because your brain can think it. Its just putting yourself into a scenario, kinda like a daydream. Ive thought that way…”what if i just punched her…what if i slipped and fell and hit my head….what if i swerve into traffic??” tons of things will cross your brain…you’re human and its curiosity. I think you’re just fine. Unless you start getting the urge to actually follow through with it, or attempt it. Don’t sweat it.
5. Guys… I have that too. Sometimes ill sit and watch tv and suddenly ill have a random thought of killing my mom or hurting my dogs. Anyone in my house hold. I’m completely fine when these thoughts occur. I’m not mad, nor upset. And my family never did anything wrong to make me think such things…I would NEVER hurt anyone…
And it scared me. Sometimes i avoid certain objects i could hurt people with and i stopped watching my favorite crime shows. It all freaks me out now.. Ive asked a friend, and he has it too but not as extreme. More of a “what if” thing. He says im fine and he thinks everyone has these thoughts at one point.

Some of these folks may not even have OCD, but at any rate, all of these thoughts have an OCD-ish feel to them. It’s quite common for non-OCD’ers to get thoughts like this once in a while.
This case is more difficult:

Hello. This isn’t very easy for me to let go into the world, but I would like people’s opinions. I am on the other end of a 1.5 year bout with OCD and being terrified that I am going to indulge in homicide. Things are much better now, but yesterday at work, I got all my issues worked up in my head and at one point I genuinely wanted to indulge in homicide. I actually wanted to do it.
During that I had slight panic attacks running and of course it worries me that the curiosity of doing such an act is attractive. Now, I have read many posts here on how to self help your OCD, but this is the first time I have ever been genuinely attracted to the horrible thing I’ve been afraid of for such a long time, and that’s the difference between being afraid of intrusive thoughts and being attracted to them. Is that normal psychology for an OCD sufferer, do you think my thoughts got twisted in knots and then I deceived myself into thinking I wanted to do it, or do you think I should seek some help?

The thread goes on and on, and some folks are are telling him to go to the ER and check himself in. The guy who posted this is worried that he felt like he really wanted to do it. However, many of the OCD’ers I have dealt with have told me that they feel like they want to act on these thoughts. In every case, they were given a diagnosis of OCD by multiple clinicians. The thing is that OCD itself can make you feel like you want to do these things. It can also make you feel like you might or would enjoy them. All of this causes more panic, anxiety and attempts at thought suppression.
So if someone comes to me with classic Harm OCD stuff and then tells me that they feel like they want to act on these thoughts, I am not particularly worried. It’s probably more the OCD convincing you that you want to act on the thoughts or that you might enjoy them more than anything else.
This case is much more disturbing.

Hello, My name is Ryan. I’m 17 years old. I’m posting this here today because for quite some time i have been obsessed with murder, blood, torture, and rape. When I see someone walking down the road, my mind unconsciously comes up with random ways of torture I could try on them, I’ve been doing this since I was around 15, but now something’s changed – I feel its getting harder and harder to control, I’ve had to start journaling and drawing what I would like to do to my victims.
I feel I could take countless human lives and not stress about it. Will someone please tell me what’s wrong with the way I think? My parents told me its a stage, but I know it’s more. Just someone please try to give me insight on why this is happening.

I am honestly not sure what is going on with this guy, but one thing it is not is OCD. No way does a Harm OCD’er journal and draw pictures about torture, rape and murder. Forget that. The OCD’er would be terrified of having the thoughts in the first place, would not enjoy them at all, and would most likely viciously fight them from the first time they showed up until they went away, if they ever did.
The OCD’er doesn’t want those thoughts or feelings in his head for even one second. He would never just indulge in them for pleasure or write journals and draw pictures that delight in murder, torture and rape.
Truth is most Harm OCD’ers are so scared of their thoughts, etc. that they start avoiding all situations that might set them off, including any TV shows, movies or writing that has to do with murder, rape, torture, etc. If they watch or read something along those lines, they will feel serious anxiety and nearly have a panic attack.
In the thread, a few of them ask him questions to see if this is OCD. He says he enjoys the thoughts and feelings very much. That doesn’t sound like OCD one bit. However, he does say that he tries to resist them at times, but he can’t. Now that is very odd. But there may be occasional resistance with non-OCD stuff.
The fact that he feels like he could kill countless people without a single worry in the world is also disturbing. No way would an OCD’er feel that way.
It is interesting that a number of other commenters said that they had similar thoughts and feelings, especially when they were teenagers, and at some point, they just went away. That is very hopeful. I had assumed that once you get to the point where you are fantasizing about rape, murder and torture all the time, even to the point of doodling and journaling about your fantasies, you are pretty much gone. But apparently this is not so, and people can easily move out of this kind of thinking. That is a very good thing indeed.
The following are some cases of homicidal thinking in schizophrenia:

1. Yes but not intentional homicidal thoughts more like random ones that come in my head like if I see a bus pass by me sometimes I would have thoughts of breaking the windows with a baseball bat and screaming at the passenger or punching someone randomly passing by me but not of anger I barely get angry anymore just random thoughts.
2. Hi, I’m new here to this board. I was just curious if anyone feels these symptoms. I feel this way all the time. Whenever someone looks at me wrong. All I want to do is hurt or kill that person. I was recently hospitalized a couple months ago. I’m always scared to death. All I wanna do is crawl in to a dark room and cry. Sometimes when I’m driving I think what if I just turn the wheel and kill that jogger running.
Seriously I see a pdoc and have seen the same doc since I was a little kid. My pdoc says it’s just delusions. But it’s so real!!! I was diagnosed with paranoid sz. about 3 years ago. Does anyone feel this way? Please anyone I would love to know that I’m not alone here.
3. Hello Weenska, you most certainly are not alone. I get homicidal thoughts too. The scary thing is that they are all about killing children. You see, I work in a children’s’ hospital, and for some reason my mind is set on hurting the patients there. I get so nervous when I have to go clean a room with a patient sleeping in there.
The nurses are outside of the room sitting at the nurse’s station, and I’m alone in the room with the patient. While I’m cleaning I get evil thoughts of how I could swiftly kill the child without anyone seeing. My mind comes up with so many ways on how I could get away with it too. It’s like I’m constantly fantasizing about being a secret, mysterious child killer. Isn’t that awful?
4. I know I’m not a bad person and could never harm anyone. You’re not a bad person either. Why we get these kinds of thoughts flowing through our head is beyond me. I want you to know that whatever filthy person our minds may try and persuade us to be, that its not who we really are. 🙂
5. Princess is right, you’re definitely not alone! I have homicidal thoughts about my hubby. I don’t sleep well at night so a lot of the times I am just sitting in bed watching my hubby sleep. I would think about what it would be like to actually commit a murder. I can picture myself smashing his head in with a baseball bat, or poisoning his food, I even can see my self sneaking up on him and stabbing him in the back.
I’ve told him and at first he thought it was kinda funny, but now I can tell he’s sometimes a little edgy around me. I love him so much and I don’t want to lose him…To me, this is so much more than some kind of delusion. Its like the devil himself is tempting me. I hate feeling so sick and twisted inside. Anywho, yes I can relate. I know I’m not bad, and I will fight these thoughts off as hard as I can for as long as it takes!
6. I’ve always been a real docile person, but when I got sick I had some homicidal thoughts.
7. In 1980, I had a lot of violence in my head and I was afraid for about a week that I would get violent. It scared me and made me feel bad, but I managed to control it.
8. I get these thoughts of hurting people sometimes too. I haven’t acted on them so far.
9. I used to get terrible homicidal thoughts. There were command voices, and there were the videos/images that played in my head about terrible crimes I was committing. I have been hospitalized over 20 times, and many of these were for homicidal ideation. I would be taken to the inpatient unit and put in isolation because I could not control myself.
But after the fact when I would get re-stabilized on meds, my T told me that she did not think I had it in me to hurt another person. I have never hurt another person. I am generally very kind and calm. She wanted me in the hospital because she was afraid I would hurt myself. After I had the homicidal thoughts I would feel SO guilty about having the thoughts that I wanted to kill myself because I was such a “bad” person. But, I am not a bad person. Now I have been stable on Clozaril for 6 years, and I no longer have homicidal thoughts… ever.
10. From my perspective, It might b “normal” 2 have homicidal thoughts about some 1 I don’t like or doesn’t like me. But I have homicidal about the ppl i LUV the most! It’s like the thought pops up in my head then I got a whole bunch of cause n effect scenarios.
It could b like if i c a hammer on the table, I could bash my loved one in the head. Or it could b some insecticide, n I could add a dash of death 2 a meal. I mean yea, I been thru some bad shit, but this is just fucked up! After i realize what I just wuz thinking, then I start feeling all bad, then the potential bad endings, n it bothers me. I mean, I’m ain’t necessarily a bad dude, but damn that shit ain’t cool, feel me?
11. I get homicidal thoughts when I am deeply disturbed. I make up shit in my head on how I could kill someone and get away with it. I have really good self control, and I’m a good person, and it bothers me deeply. Most of my homicidal thoughts are about my brother though because he is clearly the Antichrist. I talked to God when I was actually planning on killing him and he stopped me. He’s a crackhead and pill popper big time and only uses my disabled mother for more crack money.
Luckily he has found a place to live so he doesn’t bang on our doors at 530 or call my phone anymore. He threatens a lot towards our family, but I can do so much more harm than he could. My father passed away in January and he was the only person who could keep him in line. The constant family feuds we’ve been having has at times caused me to the point of pure insanity. I talk about killing him openly with my family and how he just needs to die.
Of course, they’re very freaked out. I’ve always had homicidal thoughts even before schizophrenia. But they have just been getting worse about my brother. I think about killing other people sometimes, but it’s mostly my brother because he’s a piece of shit. This morning he came by again and I couldn’t sleep. I haven’t heard voices in over a week, they come and go, but this morning voices were telling me to murder someone.
12. When I read this post, I immediately remembered my early teen years, when my illness really started getting bad. I had my first hallucinations when I was about 14 or 15, and that’s when I started having thoughts of killing people. At first the thoughts were of killing people at school, like a random school shooting, and then killing myself. Then came the thoughts about killing my family members and then myself. I skipped school all the time because of it. I feel sick just typing this. I want to delete it and pretend it never happened.

This one is deeply disturbing. Some sort of homicidal thinking she had actually led to her trying to kill her brother, probably when she had schizophrenia:

I’ve had thoughts like that before too. I used to go to school with a girl who I thought was perfect. I wanted to kill her because I felt so flawed next to her. The point is, NEVER act on these impulses. Never hurt anyone or you will regret it horribly. I tried to kill my brother once and he avoided me for years (can you blame him?).

As you can see, homicidal thinking is extremely common in schizophrenia. In fact, the vast majority of schizophrenics seem to experience it at some time or other. Some of this stuff looks very OCD-ish to me. Whether it justifies an additional diagnosis of OCD or not, I have no idea. You will notice that in many cases, anti-psychotic medication specifically for schizophrenia made the thoughts go away. This implies that it was not an OCD process driving the thoughts but instead it was a schizophrenic process. If it was an OCD process, the anti-schizophrenic drugs would not have worked.
The question is how does the schizophrenic homicidal thinking above compare to the OCD-type ideation in quality? Honestly, I do not have the faintest idea.
One way it differs is that in schizophrenia it can take the form of command hallucinations ordering the person to commit violent acts. Fortunately, they do not give in to the thoughts most of the time. There is something a bit similar in OCD where the person experiences thoughts inside their head ordering them to carry out various homicidal and violent acts. The difference is that in OCD it will be a thought and in schizophrenia it will be an external voice. And in schizophrenia, there is much more likelihood that the person will act on it. The chance that a person with OCD will act on the thoughts is just about nil.
However, in schizophrenia, this thinking is much more dangerous as it regularly leads to episodes of violence. However, as you can see above, only one of the schizophrenics above ever acted on their homicidal thoughts, so in many cases, they are able to control themselves.
I have never worked with schizophrenics, and I don’t know how to deal with homicidal ideation in schizophrenia. I imagine it is a very tricky area to determine a schizophrenic with this type of thinking is dangerous or not.
People come to me after reading my articles. They are basically self-diagnosing with OCD, or they have already been diagnosed by a clinician. I have found that people are pretty good at self-diagnosis for this condition. They often write me telling me that it is as I could see inside their minds and tell them what was going on in there. All of the people who came to me with homicidal or violent thoughts had OCD so far, so I haven’t had to worry much about differential diagnosis. I did have one client who was truly homicidal, but that person was thinking in a completely different way and it wasn’t OCD driving the homicidal ideation, it was something else altogether. There wasn’t much I could do about that person either.
Unfortunately, I think most of the people who are truly dangerous are simply not going to show up for counseling or therapy. They either like to feel this way or don’t care, and they don’t see any problem with their way of thinking.

Drugs, Mental Illness and Psychiatrists

Sutanu writes:

Hi Robert,
Your article was very interesting, I have a very personal experience with schizophrenia and I do not know the role marijuana had to play in it. I have been a pot user since I was about 22. My wife was a cigarette smoker since age 18 and alcohol user since 20.
She started smoking pot since age 24 – sometimes 3-4 times a week sometimes once daily. Around the age of 29 she started developing symptoms of schizophrenia, which was full blown by the time she was 30 (with auditory hallucinations). She has been in treatment for the last nine years.
In the opinion of her psychiatrist, it was the use of pot that triggered and maybe even possibly caused the illness. Reading your article and your responses, I am now confused whether this is possible as you have said that the safe age to start on pot is 21. Would love to hear your thoughts on this.

Statistics show that there is no increased risk of schizophrenia after age 20. Your risk is almost all used by age 19 or 20 anyway.
Anyway, the cannabis-schizophrenia link does not appear to make any sense. Of all of the recreational drugs out there, cannabis is one of the easiest of all on your brain. Schizophrenia appears to be characterized by extensive damage to the brain. Since cannabis does not cause extensive damage to the brain, there is no way that cannabis could possibly cause the sort of brain damage that is present in schizophrenia.
Since the 1960’s, rates of cannabis use have gone through the roof and the rate of schizophrenia has been completely flat. In fact it has actually declined a bit. If cannabis were causing any schizophrenia at all, much less tons of schizophrenia, we would have expected rates to have increased if not skyrocketed since the 1960’s They have not, so the notion that cannabis or illegal drugs in general cause schizophrenia is very dubious.
I have known hundreds to thousands of cannabis users in my life. Two developed schizophrenia. One had very extensive meth use for decades. They other has a mother with schizophrenia.
It’s certainly possible that cannabis can trigger schizophrenia in a vulnerable person. However, those persons were probably going to get it anyway. Cannabis may bring schizophrenia on sooner than before. This is a tragedy as each year lost to the illness is a year is a lost year for the person who has it.
Psychiatrists are assholes. They all hate illegal drugs, and they think that illegal drugs cause tons of mental disorders. If you have a drug history and you go to a psychiatrist, the asshole will automatically and immediately say that the drugs caused your disorder, no matter which disorder you have or how little you drugs used. If you smoked one joint in your whole damned life, the asshole psychs will insist that it caused whatever you might have.
Psychologists on the other hand for some reason to not seem to have these same prejudices against illegal drugs and in general to not seem to blame illegal drugs for causing tons of mental illnesses.
My observation has been that heavy drug users sometimes appear to be mentally off in some way or another, and sometimes their behavior is disordered. In general however, the off mental behavior seems to clear up when the person stops using, and they just go back to their previous psychological state. I do not believe that drug use in general causes long term psychological damage persisting after the use of drugs has ceased.

The Man Who Thought He Was a Cat

Repost from the old site.
While I was at the university getting my Master’s Degree, I used to read a lot of journals. I really liked this one journal called the Journal of Nervous and Mental Disease. In one issue I found a case study of a man who suffered from the delusion that he was a cat! As a cat lover, I kind of enjoyed this case. I don’t think I’m a cat or anything like that, but sometimes I wonder if my two female cats make better companions than the women in my life.
He was a 40 year old man who worked as a technician in a laboratory. Considering his delusion, one of the most peculiar things about him was that he actually looked like a cat! He was kind of thick and heavyset and had a big full beard. All of this contributed to a rather strange appearance somewhat like the Lion Man in the Wizard of Oz.
The man stated flat out that he was actually a cat and not a human being. All attempts to disabuse him of this notion were met with airy dismissals. He had believed that he was a cat for a long time, possibly since childhood. He said that as as child and young man, he had spent a lot of time playing with cats, especially in open fields. He got down on all fours and walked around in fields and spent hours socializing with the cats out there. He continued to engage in this behavior to this day.
He said that cats had a special affinity for him, because they realized that he was actually a cat and not a human. Hence, he said that cats accepted him as a fellow cat and treated him as such. He said that cats are actually very intelligent – much more intelligent than people think they are.
Over the years rolling around in fields with cats, he learned that cats actually had a spoken language in their meows. He had finally learned this language over time and could now communicate with cats in their language. He also said that he had had sex with cats on many occasions out in the fields (How does one do this?).
Over time, he had learned that most people did not want to hear about the fact that he was a cat, so he had learned to stop talking about it. He was diagnosed with Delusional Disorder and it was recommended that he take an anti-psychotic. I am not sure of how the case resolved. I believe that he did not see any problem in being a cat and refused treatment.

More OCD and Psychosis: Differential DX

Let us look at some more cases from the Internet.
Case 1 here and here.

I’m trying to pin down one of my major symptoms that can and has completely impaired my life. My OCD revolves around harm, such as fears that I will harm someone, violent thoughts of harming someone, and even urges to harm someone. I don’t think I want to hurt anyone, but my OCD tells me differently. Sometimes I will get a violent thought when I am standing near someone, and I will not hurt them, but I will quickly walk away to avoid any chance of ever acting on my thought/urge.
Ok, here’s the weirdest part: Later on, after I have walked far away from people in order to avoid hurting them, I believe that I actually did hurt someone after all, and that my memory of avoiding him/her is a false memory, or I just forgot the true memory of actually harming the person in question. I truly have believed many times that I was a murderer, despite tons of evidence to the contrary.
Looking back, I realized I’ve wasted so much time believing I’d done something terrible and waiting to be locked up forever. However, at the time, my beliefs were unshakable and persisted despite all the evidence that my family/friends/counselor threw at me to try to convince me that I had done nothing wrong.
I think my OCD may involve hallucinations as well. Whenever I think I may have harmed someone I hear police/ambulance sirens. Coincidence? Maybe, I’m not sure. When my OCD started to improve at school I was hearing less sirens.
This is the situation I’m in. It started with me walking beside people on my (very hilly) campus that has a lot of ravines. I got the anxious thought “What if I pushed someone into one of the ravines?” So I’d actually go DOWN into ravines to search for bodies. Crazy huh?
Well, it got crazier. One day, the thought or belief (delusional) came into my mind: I DID push someone into the ravine and kill him/her. I compulsively searched, but I couldn’t search very well because I was embarrassed and scared because I was getting weird looks.
So I dropped out of school. And I believe that there is STILL a body in one of those ravines (even though I called my counselor numerous times asking if there were missing students and she always said no) and I checked the news for five weeks – nothing. No evidence, but I still believe I killed somebody.
I had to drive today as an OCD exposure and I had to drive very close to a bicyclist because he was hogging the road. I drove as far away from him as possible, even onto the curb to avoid him. Of course my senses were heightened and I would have felt a bump even if I sideswiped him, which I don’t think I did.
There was no damage to my car or anything, and when I drove back on the opposite side of the road cars were driving normally and I didn’t see emergency vehicles but I still believe deep down that I hit him. It sucks. And I can’t check the news either – in program we are discouraged from checking and other compulsions.

There is a lot of back and forth about this in various threads for some reason. She also has a dx of schizoaffective disorder, which is never explained. Various people feel that this symptom is a combination of OCD and a psychotic symptom, but I am not so sure about that. The part about searching the ravines is also OCD, though it’s rather extreme in that it made her drop out of school.
I honestly feel that this presentation is simply OCD of the Harm OCD type. The person fears that they will attack others, but they never do it. Apparently it’s all just fear.
Going back and checking over and over to make sure she didn’t kill someone or push someone into the ravine is also very OCD-like. A psychotic person simply says that they killed someone by pushing them into the ravine, and that’s that. There’s no going round and round about it, checking the ravines, calling people, reading the papers. That’s called “checking,” and it’s an OCD thing.
Although these symptoms are very disturbing in that they involve violence, a person with this type of OCD is very unlikely to act on the obsession, and probably will never act it. They are less likely to commit a violent act than anyone else. The presentation is rather strange in that most OCD folks don’t have this degree of certainty in the obsession.
The hallucinations of police sirens are odd. Some clinicians are saying that there can be hallucinations in OCD, but they are generally minor. The whole idea of hallucinations in OCD seems very strange to me, and I don’t know what to make of it. OCD experts claim that there are no hallucinations in OCD.
Case 2 and here

The other night I had a thought about gouging my dog’s eyes out; it was terrifying to me. I could never do that, but the thought alone was enough to keep me obsessing about it for hours. Made me very anxious.
Woke up the other day worried I was going to spontaneously run someone over or grab a knife and stab someone, like it would be a compulsion I couldn’t control. My therapist said that’s classic OCD.
Sometimes I hear music playing, like tonight I was hearing a band playing, but it turned out to be just some noise from the a/c cause i left the room and returned.
Sometimes I hear people saying “hey” or think I heard someone else say something when they didn’t, but that’s really not a big deal, I imagine everyone has thought someone said something once in awhile, but the music thing is pretty real.
It sounded like a parade going on outside my house, until I got up and moved around. Not a big deal, just enough to make me stop what I was doing and listen.

This is classic stuff – Harm OCD. In general, they never act on the thought, even if they are thinking of it 24-7. There is controversy on whether or not there have been cases of people acting on antisocial or violent obsessions. Some say there have been some cases, but I have never heard of any. I do therapy with some people who have this type of “harm OCD,” and I never worry that they will act on it.
Note that this person is also worried that they are going to go psychotic, just as Case 1 is obsessed with whether she is psychotic or not. The worry that one will go psychotic is pretty OCD like right there. People with psychotic disorders don’t generally worry about such things.
The part about the hallucinations is stranger. First of all, they are not hallucinations. He just thinks he is hallucinating. He heard the AC, and it sounded like music because he didn’t realize that it was the AC. We live in a noisy environment, and mechanical objects will often make sounds that sound like auditory hallucinations. Other noises in the environment can also fool you. These are called illusions, not hallucinations.
Case 3

I have thoughts that someone is going to poison me or slip me drugs or somehow do something “bad” to me. When I was a kid there was all the talk about people putting razor blades and drugs in Halloween candy; there was a rash of OTC drug packages that were tampered with that killed someone and had these drugs pulled from the shelf, and there was also a case of someone getting poisoned by their friends. This was all in a relatively short span of time.
I seem to have latched on to all of that in an unhealthy way.
I don’t think people are out to get me. I don’t think there’s a conspiracy to hurt me. What I fear is that there are a lot of nutty homicidal people out there, and they may decide to tamper with food or whatever, and that it would be my luck to be one of the unlucky people that would be the victim.
I’m afraid that people are crazy, unpredictable, and there’s just a lot of random Bad Shit out there that people do. I also worry that somehow food will be contaminated with deadly microbes – botulism is a fun one to worry about.
I know this is insane. I know that the likelihood of something like that happening is very small. Still, it can drive me to panic attacks and anxiety as well as some fun compulsions. If there’s only one of something left at the grocery store, I can’t buy it. I have to take the package of food that’s the second one back, not the first.
I inspect packages. I give my dog food that is “suspect” knowing that if she’s okay, I’ll be okay. I know it’s stupid and silly, but the actions reduce my anxiety so I don’t have a panic attack or start freaking out.
In some ways it feels like a fear of flying. It could happen, even if the chances are low. Very low.

Strange case. The doc said that these were symptoms of “paranoia,” but I don’t agree. I think it’s just OCD. Thing is, your food could be being poisoned at any time. Most of us just assume it is not and go ahead and eat it anyway. That’s all you can do in life really.
Case 4

I have similar thoughts. Whenever I go to the supermarket, I’m always thinking that the food that I’m about to buy has been tampered with. So for example, when I grab a jar of pasta sauce, I start to think that someone injected poison into the the jar.
So I put that jar back and grab the one behind it. But then I become convinced that the person who poisoned the jar would know that someone like me will be expecting the jar in front to be poisoned, so they must have put the poisoned jar in the second row instead. So then I put the second jar back because I get convinced that it may have been poisoned. Then I sit there debating the whole thing in my mind because I don’t know which jar to buy. Ultimately I just say fuck it and take one of them.
I also worry that people will tamper with my food at restaurants and food courts. So lets say I’m eating at a food court by myself and I sit at the table and realize that I forgot to get a straw, when I go back to food place to get a straw, I always make sure that I keep an eye on my food the whole time.

Not sure what to do with this one, but it looks like Case 3. The way he takes jars our and puts them back and stands in front of the shelf debating which jar to take looks awfully OCD like. It’s a Hell of a way to live your life though, I must say.
Case 5

I was at a comprehensive psychiatric clinic/ward recently, and one of the patients there had very bad OCD. He would often ask me for reassurance about things that really didn’t make any sense at all. On the night that his new roommate was moving in, he was terrified that he brought a bomb in his luggage. He asked me if I thought that his roommate brought a bomb, and I obviously told him no.
Later that night (maybe under an hour later), he decides to pull the fire alarm and make a run for it (he wasn’t able to get too far because of the severity of his OCD). I don’t believe that he ever actually thought that there was a bomb with complete certainty. The uncertainty just became so severe that for him to act as if there was actually a bomb became the better option. It was the only way that he could diffuse his anxiety.

As you can see, the illness gets pretty weird, but it’s just OCD. He pulled the fire alarm because he could not be completely sure that this roommate had not brought a bomb into his room in his suitcase.
Case 6

Does anyone else have such poor insight into their OCD that instead of knowing that its irrational, you think its real? For example, I think that I’m a dead person living in a fake world to the point that its considered delusional. I’m also paranoid to the point that I truly believe people are poisoning me because they have something against me.
My doctors are confused as to whether I have OCD with psychosis or just OCD. Multiple doctors have said they can’t tell, but most lean towards OCD. Anyone else experience this?
Also does anyone else hear voices in their head which aren’t their own but instead like a family member or a priest or even someone you don’t know?

Strange case. The responders are all saying that this is psychosis rather than OCD. I am inclined to believe them. He hears voices apparently, and believes that he’s dead and the world is fake. But he says he hears voices in his head. This is crucial? Are they really just inner voices like we all hear (in which case they are not hallucinations) or is he actually hearing them with his ears (in which they are auditory hallucinations). He also thinks people are conspiring to kill him.
Case 7

Ok I have a boyfriend, and he is 30 yrs old, he said he had OCD and phobias, lately after some stress, he came to me crying and asked, “What if no one else but me exists? I feel so lonely like I am alone in the universe and that everything else is fake.”
Then I asked him, “What r u talking about?” And he replied, “I walked out of my office onto the street, and I thought ‘if I see someone I know this thing I am thinking its true.'” He saw one of his colleagues, and now he thinks that this thought of his is true, and he is anxious and crying.
Do you find this normal for a 30 year old? Then he asked, “I thought, What if I am a cat?” He listened to some cats meowing, and he started crying and asked, “What if I am a cat???” Is this normal? He had lots of stress before he starting saying all these things; he was afraid that he had some serious illness but in the end he didn’t, and after that he started this paranoia.

I am afraid that this is just OCD, but it’s pretty serious. He is not psychotic, although the symptoms are strange.
Case 8

Years ago I went through a serious bout of depression. I had fits of rage and crying and purposely avoided friends and places I enjoyed. A doctor put me on Lexapro, an antidepressant. I got better. Years later, I have a new problem. I thought it was the same old depression with a new twist. But it’s not.
My last psychiatrist tried treating me for a problem I had. He diagnosed it as depression and said that I also had OCD. This was because I had a depressed mood and frequently battled thoughts of anxiety.
This doctor tried me on a few different medications. Either they had no effect or they had terrible effects. They made me more depressed, anxious, and at one point suicidal. They were all small doses, but they showed their effects within days. The drugs that had these disastrous effects were Imipramine and Lexapro.
I’m seeing a new doctor now. This one says the root problem is NOT depression or OCD. He says it’s psychosis. His reasons for his diagnosis are this:
The obsessive negative thoughts are a manifestation of the paranoia attribute of psychosis. These thoughts include worrying about getting diseases, worrying about dying tomorrow from something, worrying about aging or getting Alzheimer’s, worrying about thinning on top, worrying about getting diabetes, worrying that I might be schizophrenic, worrying that I got brain damage from the smell of a dry-erase marker, the list goes on and on.
Some of these are too irrational to list. Some days they’re tolerable, other days they make me anxious, even cry, or prevent me from doing my work.
Another symptom that I had described to both doctors was the fact that nearly every task that I start, or even think about starting, causes me stress and anguish as if it were some daunting job having to clean up after a hurricane. This is true for nearly everything I do, including things I enjoy doing. Hanging out with friends, just watching a movie alone, or painting which I love to do will sometimes feel this way and compel me to avoid these things.
The first doctor said that this anxiety over starting things was possibly ADD. He tried me on Ritalin for that with equally disastrous results. Then he tried me on biofeedback treatment. It improved my memory, that I am sure of. The second Doctor said that symptom was also due to psychosis because it shows there are two thoughts fighting each other simultaneously with each of these actions I take. Things do seem much easier for me when decisions are made for me.

Strange case. One thing for sure, this person is not psychotic. I don’t see the OCD. Where is it? The worries about bad things happening could be a variety of things, GAD, OCD or depression. In the context of the Depression that is going on, these could well be what we call depressive ruminations . Feeling like everything is too much is also not ADD, it is instead just a symptom of Depression. The inability to get things done or even start things in the first place is typical of depressives.
Case 9

When I saw my psychiatrist last year, he seemed to think I had OCD because I was having problems with various obsessions including a morbid fear of death or dying young and several compulsions (such as repeating actions and counting in sets of 4 whilst avoiding ‘bad’ numbers etc) to prevent bad things from happening or ward off my obsessive thoughts and images. I would often see images of myself lying dead in bed, and it would freak me out.
However that was a year ago. He wanted me to change to Anafranil at the time, and I freaked out because I have a fear of chemicals I am not familiar with and didn’t return to my next appointment thinking I could deal with it myself. It did lose its intensity after a while but didn’t go away completely. Now I seem to have developed a completely new obsession, if that is even what it is.
I fear that I am suffering from some kind of psychosis because I feel spaced out a lot of the time, as though I’m walking around in a dream state. I am also having problems with chronic daily headaches. I am now spending hours researching psychosis, schizophrenia and headaches on the internet. I am analyzing every single thought I have to check for signs of psychosis, and it is driving me around the bend.
How much research does one person need to do anyway? It’s not like im a Dr. and can diagnose myself? Why cant my brain just drop the subject until I have seen my Dr. about it again?
I have made an appointment to see my psychiatrist again shortly, but I am terrified that he will want me to try the Anafranil again. Not only do I have to contend with my original fear regarding changing medications (which in short is that I will take it, and I will have a bad reaction it and become ill or die) but now I have this awful fear that I will take it, get worse, won’t know what im doing and will hurt my son as a result.
I’m terrified, I couldn’t stand it if I hurt my son, the thought is making me feel sick. I am worried that I may not know what I’m doing and hurt someone or my son at the best of times, especially with feeling spaced out, but I am even more concerned that the Anafranil will make matters worse. It does say on the cautions list not to give it to patients who suffer from psychosis or schizophrenia.
I used to have a fear of hurting myself or my son in my sleep so I’m not sure if this is a variation of that one or not? I do know that my mother suffered with anxiety and depression and during her later years (65 onwards), she became paranoid and delusional. I am terrified that my depression and anxiety will take a similar course.
I also feel like I can’t organize my thoughts as well as I used to be able to. I will try to organize my household chores for the day, my brain will take one look at the washing pile and give up because it doesn’t quite know where to start! I also can’t remember when I took my medication. I’m on painkillers for sciatica and my headaches, and I will often need to debate with myself over when I took my last dose.
I will go to take one and will find myself thinking “Am I sure I haven’t already taken one?” to which I respond “I’m sure I haven’t, but I could have, but I don’t think I have anyway,” to which I respond again, “Am I sure I haven’t taken one? Perhaps I shouldn’t take it in case I have already taken one,” to which I then respond, “I’m sure I haven’t taken one,” and then start trying to retrace my steps over the last 4 hours to check I haven’t in fact already taken one.
I worry I will forget that I have taken one, take another one and overdose by mistake, become ill and then die as a result. I have tried writing down when I take one but then I find myself questioning if I have written it down correctly. I have tried putting out what I need for the day/hour, but then I worry I that I didn’t put them out correctly in first place.
Also I have a nagging feeling that I have forgotten something a lot of the time, and I don’t know what exactly. The last few times I’ve left the house, I’ve had to check I had my keys and purse 4 times before I even shut the door!
I feel like I’m developing early onset Alzheimer’s or something, its seriously doing my head in.
I also tend not to go out very much at the moment because I’m afraid I will forget who I am, where I live, get confused or not know what I’m doing and hurt someone when I’m outside. So I find myself only going out when I absolutely have to in order to avoid the anxiety it creates.

This really looks like OCD. It doesn’t look like anything else. The doubting about whether or not she has taken her meds, the fears of going psychotic, fear of medication, Harm OCD about her son, having to check for her keys over and over, the endless checking to see if she has schizophrenia or not, etc. The spacey feeling is disassociation, which comes from anxiety. Get rid of the anxiety, and the spacey feeling goes away.

Paranoia Versus Social Anxiety

As if people were not confused and idiotic enough about the mental disorders.
This is one of my pet peeves. Even very educated people don’t seem to know the slightest bit fuck-all about mental illness. I’m not really sure why this is. Most of them don’t have a dx, but many others do. Typically, the ones that do have never been formally diagnosed or treated by a clinician. This is really unfortunate.
There’s nothing really wrong with having a mental dx. If you have one, you have one, right? Isn’t it best to know, and to treat it as best you can, than to go on in denial, screwing up your life by acting crazy, denying that you have a problem, and not doing anything about getting better?
I am always stunned at the number of educated people who don’t even know the difference between neurotic and psychotic disorders. In addition to the third way split with the personality disorders, these are three of the top splits in mental illness. If you don’t understand the nature of these splits, you don’t know fuck-all about mental illness. If you don’t know anything about it, you have no right to talk about it, and you need to STFU.
This is a painful subject to me. I have OCD. That’s a neurotic illness, or more precisely an anxiety disorder. Anxiety disorders have a certain flavor about them, but the main one is that the person with the neurotic illness is still in touch with reality, that is, he is not crazy. Even Freud recognized this. In fact, he isn’t the tiniest bit crazy in any way, shape or form, which is what makes these illnesses so puzzling to deal with. In general, neurotics are not the slightest bit dangerous either.
I’m not sure why this is. Perhaps it is because of the nature of the person who gets these illnesses. This is often a very nice person. Nice, fearful, cautious, conservative. They are do-gooders. I’m told that people with OCD have the lowest rate of violence of anyone else, much lower than any random person.
So why are they non-violent? In addition to the reasons above, all of the energy is directed inwards, not outwards. This is characteristic of the introvert, and it why introverts are so nonviolent. The beloved extrovert externalizes most of his energy and almost all of his problems and issues, putting them onto other people. Hence, the average extrovert is many times more dangerous than the average introvert.
Indeed, almost all of the world’s serious violence is caused by extroverts. If all or nearly all of your energy is going inwards instead of outwards, you simply are not directing enough energy to the outside world to get violent, or even very aggressive. In order for substantial external aggression to occur, quite a bit of energy must be directed outwards towards the object(s) of the aggression.
With the introvert, so much energy has been exhausted going inwards that there is simply not enough reserve left over to put enough outwards to do anything violent. Combined with the introverts fears and worries, basic conservatism and do-gooderism and extremely high morals, and you just don’t see a lot of serious violence in these folks. Not to say some won’t fight back though. Some will, and people are always stunned at a counterattacking introvert.
They are ready to call the police, because they are sure that he must be insane or homicidal. This is because his behavior is so contrary to his nature. But even counterattacking, the introvert’s violence will be measured. He will throw food, dishes, water or books. If a serious object is flung, he will deliberately miss you. He will scream and yell and call you horrible names. If you really deserve it, he will punch you, but not very hard. Everyone has a breaking point.
Extroverts’ violence is much more likely to be the initial violent blow, to use fists or kicks or other weapons, or to have serious consequences. This is because the extrovert, by his nature, does not think of consequences of acts so much as the introvert does. He’s more likely to get caught up in things.
One of the things that is annoying about having OCD (other than having it) is dealing with all the dipshits who don’t understand it and insist that I must be crazy, a criminal, a killer, a rapist, a schizophrenic, a psychotic, a manic depressive, or some other bullshit. Some idiots keep on with these delusions after I have known them for years and they really ought to know better. It’s very frustrating!
Paranoia is totally misunderstood by your average dipshit. One of the prime splits in paranoia is between social anxiety and paranoia. It’s true that it’s a bit hard to tell the difference sometimes, but I am convinced that these are two completely different ways of looking at the world. They might as well be on two different planets.
The person with social anxiety may or may not be falsely evaluating situations. I have known folks who were afraid to go out because they thought that people thought that they were weird. Guess what? I knew these folks, and definitely, people did think they were weird! So that wasn’t a false analysis at all.
But many social anxiety types take this way too far. They assume that everyone that they know or meet hates them, usually because of some inadequacy that they may have. People are always talking about them behind their back. Whenever anyone laughs, they are laughing about them.
I’m convinced that this is probably a false analysis. The news is that most people are not looking at you all the time. If they are laughing, most of the time, they are not laughing at you. Sometimes they are looking at you, but you often can’t tell what the looks mean. Once in a while they might be laughing at you, but what of it? Let them laugh.
The problem here is that this person thinks that the world is focused on them. Not so. Most people are just thinking about their own stuff all the time and are not thinking about you at all. If you are acting very strange, a lot of people will be more likely to pay attention to you. The more normal you act, the less people will care.
I don’t generally think that everyone is looking at me. Most people seem to be ignoring me most of the time, which is the way it ought to be. When people are talking, most of the time, they surely are not talking about me. Every  now and then people seem to be talking about me. I try to figure out why, then adjust my behavior. Sometimes it’s something like, “Look at this guy staring at us.” In which case, I quit looking at them.
When people are laughing, I assume they are not laughing at me. A few times, I have caught some idiots laughing at me, and it pissed me off. I don’t know why they did it. Why doesn’t someone go interview them and ask them why? If I catch you doing that, I will hold it against you for a very long time, which is proper.
The truth that we are just not that important. We are grains of sand on the beach, blades of grass on the football field. Most people are not paying attention to you very much.
The paranoid takes this a lot further. The paranoid thinks people are watching them, following them, commenting about them in menacing ways, trying to kill them, trying to break into their homes, hatching conspiratorial plots against them, etc. In the vast majority of cases, this is simply not the case. Not only are folks too self-involved to notice you very much, but they surely have better things to do than hatch idiotic conspiracies against you.
Nevertheless, paranoids carry on with their paranoia. Why? For many, there is probably something wrong with their brains. They probably need to take a drug to make it go away. For others, they may have adopted an erroneous thinking style for some reason. For yet others, it seems to serve some sort of defensive purpose.
I don’t have much issues with paranoia. In fact, I’m the anti-paranoid. I tend to think that everyone likes me more or less and that no one or almost no one hates me. Sadly, this is just not true. I’ve definitely got some enemies out there. There are some others who just don’t like me. Where one ends and the other begins, I’m not sure. This is painful for me to acknowledge, so I keep falsely assuming that these folks are my friends. But they are not! And this causes me all sorts of trouble.
Where people may indeed by laughing at me, I am inclined to assume that they are not until proven otherwise. I assume that hostile persons actually are my friends, seeking out little bits of niceness amidst the emotional glaciers. Where people are talking about me, I assume they are not, or at best, it takes me a while to figure out that they are.
This anti-paranoia is probably better than being a paranoid, but it causes a lot of issues in that I am too friendly towards folks that just flat out don’t like me for whatever reason. I try to talk to them, and that’s typically a bad idea. I’m overcorrecting in the direction of mental health, but the best social actor is a very cautious person.
Here are some cases below, some of social anxiety, and some of paranoia.
Social anxiety first:
SA Case 1:

Well, what can I say? I am starting to believe that I genuinely suffer from one form of paranoia or the other. I started university last year and it has not been entirely easy, academically and socially. Although I have encountered feelings of anxiety and paranoia before in my life.If I am with a friend, who maybe has a closer friend with them who does not talk to me as much in the conversation, I always get the feeling that that other person does not want me around, or is slightly resentful of my presence. If someone I text does not text back, I assume it is because they do not want to talk to me, and just ignore or delete my text. I also feel they must be annoyed with me for bothering them, and wish I would leave them alone.
Also that they are only being polite with me in a conversation and eagerly want to talk to someone else who shows up.
When I am in shops or on the street, I presume they are watching me to see if I do something strange, so they can secretly laugh to themselves. Or if I have been in a group meeting, as soon as I walk away, they start making comments about how I acted. I also think people are going to make “look at loner/saddo” expressions when they see me on my own. I also panic and look to see if everyone else is with their friends.
I really want to be happy and stop looking behind my back for threats. I also don’t want to quit studying, and would like a job as an auxiliary nurse, as I do enjoy working with people on a professional level. I have one best friend and two or three other close friends, and people I talk to. However, I wonder if people pity me or think I am a loner because I do not go out clubbing or anything, and don’t have more buddies.
So do I suffer from paranoia, and/or low self-esteem? I really want to do something about this, and talk to someone professional who I can trust. But I am even afraid of a professional getting it wrong and putting me on a cocktail of drugs- which I don’t want! I would rather talk. I’m scared that I am just selfish, and want everyone to like me or at least think I am alright.

SA Case 2:

I have suffered with paranoia for most of my life and I’m now heading for 40. The worse time i have with it at work. I had a manager a few years back who bullied me and got me thrown out of my job and made it clear that it was because I was a threat to her position. Ever since then I fear that in any job I do that people are talking about me behind my back, unfortunately in my last long term job I had this did turn out to be true.

I am now in a job that is temp to perm and there has been issues in getting me perm and I cannot stop the thought that they never will and that they will get someone else in and they will take my place because of my paranoia as I am not fit to keep down a job.

The fear of being made unemployed and thus losing my place I live is tearing me to pieces. It hasn’t been helped by my parents pointedly telling me that if I ever need somewhere to live I could not live with them as the only spare space they have is reserved for my niece and nephew whenever they stay over.

I suffer badly with self esteem and I know that a lot of this stems back to my childhood as my mother was always telling me that I was an accident and that my younger siblings were planned and wanted. My mother also is still to this day very happy to tell anyone who wants that she has never been able to love me and only tolerated me because she gave birth to me.
I am doing my best to fight my paranoias but it is hard to keep going on your own.
My doctors refuse to listen to me and just want to prescribe drugs all the time, but they just make me very ill and the only option open me they state is lithium and i refuse to take that or any other antidepressants as they don’t solve the issues or actually help me.

SA Case 3:

I always think my friends don’t like me and people are out to get me and I don’t have any confidence in my self I think I am ugly and fat even though people tell me I am not I still think I am I also get depressed and angry very easily what can I do lol I’m glad I’m not the only one that feels like this though 🙂

SA Case 4:

I’ve always felt that, when I go down hallways with people in them, they’re looking at me, making fun of me, ridiculing what I’m wearing, my hair, no matter if they are or not. It’s even worse if I hear them talking about someone else, because then I just assume it’s me. No matter who I talk to, I feel like I’m annoying them, like no one wants to talk to me. Because of this, I don’t start conversations very often and only talk to a tight-knit group of friends.

I reminisce on old fights with my family and friends, thinking they still hate me over things that happened a long time ago. In essence, I guess it feels like everyone’s always out to get me, and that in reality, I’m a nuisance to everyone.

SA Case 5:

On a really bad day I hate people even looking at me – I image that they are thinking that I’m so ugly they really pity me. I hate it when people are walking behind me for the same reason. I’m sure that people hate being near or around me – and I agree with Ian that if I’m near a group of people and they start laughing I’m convinced they are laughing about me.

That ought to give you a basic flavor. The principle issue here is one of insecurity.
Now onto some real paranoia:
Paranoia Case 1:

I thought there was a camera in the lamp-post and a microphone in my button. I thought the cars behind were following me. People at work always seemed to use certain “phrases” – or I noticed them. Helicopters flew over our house and I was convinced they were spying on us and checking we were at home. I thought the phone was bugged.

I really noticed policemen – they seemed to be everywhere and police cars and vans were there because of me. I did not think there was something wrong with my thinking, I thought there was something wrong with society. Why didn’t society trust me’ I learnt in the end that maybe it was me not trusting myself and maybe I needed to do stuff that I “approved” of and felt good about.

Paranoia Case 2:

Like Alex I always think someone has come into my home and stolen the thing I can’t find. My son always says ‘who would want that’!’ it is a family joke now but I still think it immediately something is not where I thought it would be!

When very paranoid I think my phone is being tapped/I am being secretly filmed/being followed. I know it’s not real but at the same time it is real: ignoring these thoughts just help them to grow. I have nightmares about someone being in my flat when I am asleep.

I have started reading the book and am finding such reassurance from other’s personal accounts – such incredible relief to know I am fairly ‘normal’ for a paranoiac :o) I know why I feel the way I do but, before now, I didn’t have any solution to stop these thoughts.

Paranoia Case 3:

I always seem paranoid. I think when i hear people laughing, that they are laughing about me and slagging me off. The television, radio, books, mags all are disclosing personal information about me, like reading my mind. When i cant find something in my home i always think my friends or mother have stolen from me. I hate talking in groups because i think i am being judged by everyone.

Paranoia Case 4:

I hate my paranoia, i think people are going to attack me for no reason. I can’t get on public transport, i often think i hear the doorbell and there’s no one there. I hear people saying my name out in the street when I’m sitting in my room and there’s no one there. I think i hear the phone ringing as well. The doctor has put me on Seroquel (300mg) every day.

It’s taken over my life, I’m absolutely sick of it, I sometimes start to get really angry. I’m getting angry speaking about it now, it makes me feel stupid. Not right in the head. None of the doctors seem to want to help.

Paranoia Case 5:

I have had a lot of problems with anxiety in the past but recently I have been so scared all of the time. I often think people are following me, especially when I’m driving. Often I think that someone in front of me is slowing down and waiting to see which way I’m indicating then going the same way. I think people are watching me.

Tonight there was a car in the street outside and when he saw me looking out of the window he sped away. I cant stay at home on my own at night. I am just scared all the time that someone is going to harm me, try and break into my house or kill me 🙁

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Differential Diagnosis: Schizophrenia Versus OCD

From Yahoo Answers:

I have really aggressive thoughts sometimes. I don’t even understand why I have them. Usually (not limited to) they’re about hurting people. I feel really crappy about myself after these thoughts. I won’t go into all of my thoughts because some of them are really disturbing and they come out of no where sometimes. It’s surprising and then I start feeling like maybe I’m just a really evil person although I’m considerate of other people, most of the time.

I have a heart but sometimes I feel like how can I have a heart with these thoughts in my head! They don’t pop up in my head unless I think about it.

So then I thought well these thoughts might be schizophrenia, I started looking up what schizophrenia was. Then right as I saw the symptoms and examples of the symptoms I started like displaying the symptoms in my head. It’s almost like once I absorb an idea my mind plays on it.
Like when I saw this CSI episode where this person got poisoned with Cyanide, I started worrying about cyanide poisoning. When I read the symptoms of Schizophrenia where you have like hallucinations (Like voices in your head) I started making a voice in my head. Once these ideas are in my head I can’t get them out. It’s like they become apart of me.
Like sometimes I think “what if” all the time for every symptom of schizophrenia. Like people watching you. I started thinking: WELL, WHAT IF someone was watching me. Errr! I can’t get these thoughts out of my head and I think I’m starting to convince myself that I have schizophrenia. I’m scared.
I feel like a sicko.
My mind is also very contradicting: Like if I say I’m not a bad person my mind says “yes you are” and really self-deprecating thoughts. Every time I want to feel good about myself my mind will convince me that I shouldn’t and that I’m a sick freak who thinks horrible thoughts. I’m 19 about to be 20 soon and I heard schizo starts early 20s. I just don’t know what to do…I don’t have any insurance to go see a doctor. I’ve been a worry-wart ever since I was in elementary school.
Also, like schizo, I heard you hear voices in your head and you believe what they’re telling you. Like let’s say something says, “This is God talking to you!” and I’m an agnostic and I don’t really believe in God. I like create scenarios and voices in my head ever since I heard about schizophrenia. NEVER before.
It’s like my mind is trying to give me these symptoms it’s hard to explain. It’s like I know they’re my voices but I don’t understand why my voices are saying these things. It’s like WTF? :\

A most interesting case. This is a completely clear-cut case of OCD, screaming loud and clear across the landscape. I won’t tell you how I know this, but I know this illness like the back of my hand, since I have it. Been there, done that, ok?
Not that subtypes matter, but this person has a couple of subtypes of OCD.
The first is Harm OCD.
The second may as well be called Schiz OCD. This is a person who starts to worry that they have schizophrenia. In the case above, he is starting to invent crazy voices in his head due to his fear. These voices in his head are causing him to worry that he had schizophrenia.
This person clearly does not have schizophrenia. First of all, the voices in the head. The person with schiz hears these as actual voices with his ears, the same you would hear the voices of the people around you. The voices sound just like the external voices of persons near you, so much so that it is hard to figure out who is really talking and what’s just a hallucination. So the voices are not really in the head but in the ears, so to speak. We all have internal voices in our heads that we hear all day long. Nothing to be alarmed about.
The “what if” questions are typical of OCD. A person with schizophrenia or other psychosis simply says, “People are watching me.” If you try to question them about the belief, you run into a brick wall and get a big argument. It’s a rock-solid delusion, and all delusions are hard as stone.
The person also has “contradictory thoughts.” This is unfortunately quite common with OCD. The person thinks a good thought, like “I’m a good person,” and the OCD chimes in with a contradictory thought saying, for instance, “No you aren’t. You’re evil. You’re the most evil person on Earth.” These thoughts will probably be violently resisted.
When doing differential diagnosis, look first of all at how hard the person fights or resists the thought. The more ferociously the person fights or resists the thought, the more likely you are dealing with an obsession.
A good rule of thumb is: If you try to stop the thought, it’s an obsession.
Unfortunately, clinicians understand OCD very poorly, and I doubt if this person is going to get a good diagnosis or treatment. In particular, OCD patients these days are often diagnosed as psychotic and treated with anti-psychotic drugs.

Cannabis, Teens and Schizophrenia

Repost from the old site.
I received a mail today from someone who attended an interesting conference in the Midwest.
At a Mental Illness and Criminal Justice Conference today in Omaha, Nebraska, Dr. Frederick Frese, who is the Coordinator of the Summit County Recovery Project and Assistant Prof of Psychology in Clinical Psychology at NEOUCOM and Case Western Reserve U, and on the Board of Trustees for the National Alliance for the Mentally Ill, gave a session on teenage cannabis use and schizophrenia.
He has been a diagnosed paranoid schizophrenic for 40 years.
Frese stated that use of cannabis between the ages of 15 and 18 in persons who have a variant allele of the COMT gene will lead to an almost certain psychotic break by the age of 25. He said it’s because of the formative time that the brain is in during those years, in combination with that certain allele, together with cannabis use.
He said that if you have do not have the variant allele, no problem. Frese is so concerned about this that he and his team are going to start setting up genetic testing booths for kids at rock concerts because of the very real danger that the studies show exist.
I applaud Dr. Frese for the very real efforts he is taking to try to prevent schizophrenia in vulnerable youth.
I am dubious about how many kids this will save. The rate of schizophrenia has not gone up since the cannabis era began. This suggests that use of cannabis if anything will cause schizophrenia to occur sooner than it would otherwise occur, and it would occur anyway, just later.
The number of folks with this variant allele is high in absolute numbers, and many of them use MJ and don’t get schizophrenia. But it does cause a 10 times elevated risk. I think that Frese is wrong to say that it’s almost certain that these kids will get schizophrenia by 25 after smoking one jay between ages 15-18.
As I’ve said before on this blog, I have known 1000’s of cannabis users over my lifetime, many heavy users. The number who went on develop schizophrenia? Zero. This is why this whole subject makes me yawn.
I wish Frese good luck with his experiment though. Ideally, we could construct a good experiment this way. We could follow kids with the variant allele who wait til 19 to start MJ (Is this protective?) or avoid it period, with another group who did not avoid cannabis and see how many of each develop schiz and at what ages.
Tell the truth, I am quite concerned about use of cannabis by minors. I wish they would not do it. Period. Wait til you’re an adult!
I have OCD (another, though vastly less devastating, mental illness), and I have found that cannabis is actually a superb psychiatric drug for this illness. It works better than almost any med I have ever taken for this (The drugs work great at high doses, but nuke my sex drive, so what good are they?), and I have suffered for 26 yrs.
No clinician believes me when I tell them this; all insist that pot makes you mentally ill or worsens all mental illness or caused my problem in the first place (The gall of them!?), and all try to steer me to drug treatment or drug counseling when I tell them I use. I’m really getting tired of this shit. I’m 50 years old, and I’m being treated like a child.
I have some opinions about the mental health profession, but in general they are extremely low. For such a bunch of super-smart people, there sure is a lot of bullshit groupthink, scaredy-cat thinking and just general lack of an empirical outlook.

Problems of Democracy Under Capitalism

Repost from the old site.
I’ve always been opposed to public dishonesty, which is one of my problems with Communist states. They lied about so many things that now even when they tell the truth, people figure that “All Communists lie,” so they are unlikely to be believed even when they are honest. You get a “boy who cried wolf” syndrome.
Well, capitalists are pretty much the same. Almost all capitalists will always lie to defend their own interests. That is why whenever a businessman or business interest is quoted in the paper on some controversial issue, they are almost always lying. So it seems that in order to be a businessman in capitalist society, one must lie continuously.
There are cultures, such as Arab, Japanese, Thai and Filipino culture, where lying is definitely a state of art. American society proscribes all lying as evil, and your average American will tell you that he never lies. The Japanese mindset, which I subscribe to, is, “Only an idiot never tells a lie.”
So there is a time and a place for this sort of thing.
But in the sort of issues that we read about in our daily paper – controversial issues where two sides are sparring it out – you really want to figure out what’s going on. If the business side can be counted on to lie in defense of its interests nearly 100% of the time, this is very confusing. Especially when the media is so corrupted and dishonest itself that it’s not capable of sorting things out for you.
Fox News is a more or less 24 hour lie machine, but most Americans are too stupid to figure this out. American political campaigns are all about money and never-ending lying.
I can pretty much sort out the lies from the truth after a while, but it’s quite an effort. I figure most folks either don’t have the brains to do this, or they don’t want to know the truth, or they don’t care, or they don’t have the time.
Let me give you an example.
It is very hard for schizophrenics to tell hallucinated voices from regular voices. After a while, some of them get to where they can tell the hallucinated voices from the real voices.
Well, that’s what it’s like for me to winnow out the truth from the lies in our media. The media doesn’t’ really help you too much. I can figure this stuff out after a while, but it takes a lot of time. Time I figure most folks don’t have.
At any rate, elections that are nothing but waterfalls of money and lying are hardly exercises in democracy.
Under capitalism, typically the state is simply an arm of the business community. Some more progressive capitalist states (Europe, for instance) have gotten away from that somewhat, but it’s never really easy. Furthermore, nearly the entire media is usually controlled by the top 1% of the population, who use it to push their class interests at the expense of most everyone else, and surely the bottom 60-80%.
You would think that these things would be obvious to anyone living in a capitalist society, but toss that idea out sometime in a crowd and watch the hostile responses come back. It’s painful to admit that the media one loves so much is hostile and run by one’s class enemies. That hurts, and it makes you feel stupid. You’re reading your enemies’ propaganda, you idiot! That’s the message. People get their backs up.
In recent years in the US, the state has become more and more entwined with business interests, and hence has become more and more dishonest, just like the businesses that it is now essentially a part of. That is why the Bush Administration is a never-ending Lie Machine. That is why US administrations increasingly wage war on science – because under capitalism, businesses typically despise science.
Science is out to discover the truth, come Hell or high water. To the businessman, truth is whatever helps the bottom line and falsehood is whatever hurts the bottom line. If a businessman has to lie 20,000 times about 20,000 things to protect his bottom line, he will do it and not blink an eye. Then he will get up and start it all over again.
Since business sets the dominant cultural hegemony under capitalism, most capitalist societies will tend to be hostile to science.
So, living in a capitalist society, one is really swimming in an ocean of lies. Once you enter corporate culture, you need to become a lying sociopath like the corporation itself, or you are fired. The corporation is like an ant hill. Let us call this Lying Ant Hill. If the corporation itself is a sociopathic pathological liar, so must most of its component parts, the humans who make up the corporation.
An educated and aware populace is essential for democracy. Yet how is this possible in capitalism, where the elite-controlled media lies nonstop? Where the state itself is a lie factory for wealthy interests? Where business interests can never be counted on to tell the truth? You can be like me and try to get to the bottom of things, but it’s frustrating and time-consuming. Most folks have better things to do.
Democracy in most capitalist countries has serious problems. As long as the media is completely controlled by the wealthiest capitalist interests, the truth will be difficult to discover. The state itself can no longer be counted on, as it is captured by business interests and finds itself lying constantly to defend those interests.
In short, the classic Marxist argument that capitalist democracy has serious issues has a lot of truth.
The way out of the tunnel is to get some of the money out of politics via campaign finance reform. As almost all politicians are completely bribed and corrupted (bought and paid for), this solution is generally a nonstarter.
Media democracy is another route out. But it’s difficult due to high startup costs.
One solution would be to allow access to more of the radio band to local or pirate radio stations. The ferocity with which the government has attacked pirate radio shows how terrified the US state is of media democracy.
The TV band, which is mostly cable now anyway with up to 500 channels, should be in part licensed out to local entities. There should be channels available for all sorts of folks all across the political spectrum. If you’ve got the camera and the studio, do it yourself.
But the need to sell ads makes democracy in media under capitalism very difficult. Papers, radio, TV and magazines need to sell ads to survive, and hence necessarily become the mouthpieces of the business and corporate entities that advertise in their media outlets.
Progressive presses are usually only possibly via some wealthy benefactor who is willing to eat it on advertising in order to publish a Left or pro-labor paper. This is why public access channels are the only progressive and pro-people spots on the radio band – no ads. They are listener-supported, but listening to their endless fund drives makes you realize how tenuous their existence is.
Media democracy via licensing out the cable and radio spectrum to local outfits, however, is almost impossible because the government entities that license the spectrum out are completely controlled by corporate media interests.
Hence, our public airwaves, owned by you and me, worth billions of dollars, are given away to our class enemies for pennies on the dollar. The rest of us are then locked out of the band or even arrested if we try to break into the spectrum like the pirate radio guys did.
Even if public access is granted, the fact that we have allowed horribly abusive private cable TV monopolies everywhere in the US means that these companies would probably refuse to carry any progressive stations that somehow got on the air.
The Internet offered a breath of hope to this dismal state of affairs. The cost of publishing was down to just about zero, or at least nothing but time. The Communist dream (pure Communism, after the withering of the state) where media was so democratized that neighborhood media outlets sprung up everywhere and every man could be a journalist, seemed to be happening before our eyes.
The government and the big media are really scared. Progressive voices, anti-corporate voices (like this blog, for instance), could break into the media, and the circulation was limited only by how many readers you could somehow convince to come to the website.
Hence we see desperate efforts by the cable and telephone monopolies to create fast lanes on the Internet for big-money payers and slow lanes on the Net for everyone else, like for instance this site.
There is one important lesson here: capitalism never really tolerates dissent to its essential elite structures and business interests. They will allow dissent a lot of times, but the Hell if they will give it a voice or allow it any power.
Under capitalism, the elites and business interests have to control the media space, necessary to construct the Gramscian cultural hegemony.
In the Third World, dissenters against elite and business interests are regularly arrested, beaten, jailed, tortured and murdered. And if the voices get loud enough or strong enough, the capitalists will just launch a coup, overthrow the state, then launch an Argentine or Chilean style wave of terror to permanently shut folks up. If that doesn’t work, they will make the economy scream.
That’s “democracy” under capitalism in a nutshell. To put it mildly, it’s got some serious issues.

The 50 Craziest Rock Stars Ever

Here.
This article is pretty damn funny.
A lot of rockers are or were seriously nuts!
I’m having a hard time figuring out dx’s for a lot of these people. It seems to be something towards the more extroverted end. I suspect a lot of them are acting this way on purpose, sort of like a lot of artists act “deliberately insane.”
I only see a few who were obviously psychotic: Syd Barrett, Peter Green, Roky Erikson, Brian Wilson, Jim Gordon and Skip Spence for starters. I’m familiar with all these cases. They all had schizophrenia or schizoaffective disorder. It’s commonly said that they are all drug burnouts, but I doubt it.
For one thing, LSD does not appear to cause permanent psychosis. I’ve known too many completely normal folks who have taken it 100-300 times. It’s not even proven to damage your brain. The worst that can be said about it is that very heavy users sometimes do go psychotic and have to be hospitalized. Typically, they get better, but they often go back to heavy LSD use and become mentally ill again. No one has any idea how LSD even makes you temporarily insane.
All of these people simply developed schizophrenia. LSD can trigger schizophrenia, but no one knows how that works either. LSD-induced schizophrenia looks just like the rest of schizophrenia and it responds to the same drugs too. Since acid doesn’t damage your brain, I can’t see how it could cause schizophrenia. There are good reasons not to do acid, but fear of being permanently mentally ill is not one of them.
For the rest of them, dx’s are difficult. Some seem to have issues with narcissism and borderline personality disorder. Some were just seriously whacked out on booze and dope, often cocaine and/or heroin.
Ike Turner used cocaine for some 45 years until it killed him at age 76.
Sly Stone spent years on cocaine, even living on the streets smoking a crack pipe. No one quite knows what is up with Sly these days. He shows up at occasional performance, acts very strange, walks off stage in mid-show, gets on his motorcycle and rides away.
Rick James spent a good 15 years on a crack pipe.
Whitney Houston is ruined and is heavy into cocaine.
David Bowie went nuts on coke in the 1970’s, became full-blown psychotic and embraced Nazism.
Ol’ Dirty Bastard is on crack.
John Frusciante almost killed himself on heroin and coke.
Ozzy Osborne, Jerry Lee Lewis and Liza Minnelli were alcoholics.
Keith Moon was a drunk and a pillhead who liked to blow up toilets with dynamite for fun.
Elvis was a hardcore pillhead who apparently went insane from all the tablets.
Arthur Lee of Love spent 20 years abusing drugs heavily, became homeless, set buildings on fire and shot up his neighbor’s house.
Carlos Santana used acid heavily, then 20 years ago met up with an angel named Metatron who looks like Santa Claus who has been guiding his life ever since. He communicates with Miles Davis, a dead person, on a regular basis.
Miles Davis (while he was alive and not talking to Santana) spent years shooting heroin, beating his wife and just acting weird.
Little Richard spent years binging on cocaine, having sex orgies and sucking cocks in men’s restrooms.
James Taylor was a depressive and a heroin addict.
Some were suicidal.
Wendy O Williams sawed instruments in half with a chainsaw, then retired and blew her brains out.
Ian Curtis recorded some of the most depressing music ever made, then hung himself on the night of his US tour.
Adam Ant is a depressive.
Mariah Carey assaulted staff and reporters and slit her wrists.
Some like Courtney Love and Britney Spears simply cannot seem to function as adults.
Sinéad O’Connor is just a kook.
Lou Reed’s main problem is that he’s a terminal asshole.
R. Keely is just a weirdo with a taste for underage girls.
Sid Vicious assaulted fans, carved up his chest onstage, murdered his girlfriend, then OD’d on heroin as a grand finale.
Jaz Coleman, George Clinton, Captain Beefheart and Julian Cope are unclassifiable.
No one knows what’s up with Sun Ra.
GG Allin was just nuts, dx’d as narcissistic, Borderline PD and masochistic.
Michael Jackson was one of the weirdest of all. No one seems to know what was wrong with him. He seems to have been a homosexual pedophile. I’m familiar with most of his weird antics, but I never knew that he said he had fathered 2 “Aryan” babes named Prince 1 and Prince 2. Weird!
Just because you aren’t psychotic (and most of these folks are not) doesn’t mean you’re not nuts. You can be plenty nuts without being psychotic, plenty.

OCD and Social Anxiety Disorder: Differential Diagnosis

A new commenter confuses OCD with social anxiety disorder. Though I don’t know SA very well, they are clearly different illnesses. The problem is that there is overlap in all of the anxiety disorders, and in some cases, SA and OCD are both present.

You’re right about OCD including unwanted thoughts, but the shyness, nervousness, and anxiety sound more like social anxiety disorder or avoidant personality disorder.

No, nervousness and anxiety are prominent in all anxiety disorders. As far as shyness, this is just the kind of person that gets OCD. Social anxiety is a tough one, but OCDers don’t usually have this too bad. Most of the ones I deal with are more or less social on a regular basis. They’re hanging around people, but they are nervous.

It depends why they are avoiding people.

According to the DSM, if you are avoiding people due to one of the other Axis I disorders, then rule out SA. Keep in mind that people with schizophrenia and folks with some personality disorders like schizoid, schizotypal and paranoid personality disorders may also avoid people.

SA people avoid people due to massive anxiety relating to being around others. The anxiety is related to embarassment over doing something stupid or humiliating.

OCDers might avoid people due to the obsessions and the way that people react to them – heavy duty rejection. SA people are afraid they are going to be rejected in social situations, and social anxiety is pretty prominent.

Social anxiety is not necessarily so prominent in OCDers, but some have obsessions that tend to come out when they are around others. I dealt with this woman once who was afraid that when she talked to other women, she secretly made lesbian remarks to them. So she was nervous when speaking to women.

OCDers tend to be pretty nervous all the time. It’s not something that peaks when they get around others.

Harm OCD is a bad one, because they are afraid that they will hurt someone. It leads to a lot of avoidance.

If OCDers are treated well and treated as if they are normal people and not rejected or treated like shit, they will often hang around people a lot. And if you get rid of the obsessions, some will actually become social butterflies, since the obsessions might be the only reason for the introversion.

It’s true that extroverted obsessionals are quite rare, but that’s due to the nature of the illness. It only hits people with a certain personality, and that person is an introvert.

This Is Not Schizophrenia

Repost from the old site.

This is not schizophrenia. Let’s look at some symptoms here that a fellow is reporting in a weight-lifting forum. Many of the commenters are replying that the guy has “the beginnings of schizophrenia”, “mild schizophrenia” “schizophrenia”, etc, etc ad nauseum. Let’s take a look at his symptoms:

At night, no matter what I do. Not every night it always happens during the week when I have to work the next day, I cannot fall asleep. Music, TV, RX pills, Tylenol PM, melatonin. Even taken together, mixed and matched, I cant fall asleep sometimes. And my body is tired, but my brain wont shut up. And I’m not even thinking about anything important. Sometimes, just fucking music is playing.And it will keep my up, not sleeping 2-3-4 nights in a row. By the 3rd day, I feel delirious, and I didn’t want to train the other day, cause I was afraid I’d hurt myself from how slow, and tired my body felt. I’m trying not to smoke as much pot lately, cause I’m cutting, losing weight.

It’s effecting my home life, my job, my training, my relationships. Someone asked me if it was because I was depressed. I really don’t have much to be depressed about. I have a good job, I make good money, I get laid, my own place. If I’m depressed, I don’t know why.

It’s almost like I’m “tripping” is how much sense it doesn’t make -like when you’re on acid and your mind is racing and none of it applies to anything, or means anything. Random craziness.

I hear voices (not like telling me to kill or anything) but just random babbling and the voices change like they’re inhaling helium. It doesn’t make any sense. Other times, random songs play through my head and I cant shut them off. I can only control them by putting other songs in, but that causes me to strain my brain and think hard when I’m trying to relax my mind.

My head sometimes gets heavy too, like it weighs like 50 lbs, and my equilibrium gets off balance sometimes. Like a concussion.

OK, the guy is unable to control the thoughts in his head. Thoughts, crazy thoughts, random nonsense, just races through his head with little or no control over it at all. Songs, uncontrolled and unbidden, pop up in his head unbidden and play by themselves in his head.

He can’t shut any of this bullshit off, and the only way to stop the music is to substitute one stupid song for another. I am assuming the “voices” he is hearing are voices in his head, not outside of his head. Fortunately, you can hear all the voices in your head as possible without being mentally ill, though it really isn’t ideal.

It’s crucial to realize that psychotics who hear voices actually hear them with their ears, not in their minds. We all “hear voices” in our heads. Our “inner voice” is a voice inside of our heads. The idiot media and popular does not do us any good by refusing to differentiate these symptoms. Psychotic voices heard with one’s ears are transformed into “voices in his head”.

Obviously, if it’s sane to one one “inner voice”, it’s not psychotic to have more than one, or an unlimited number, though it’s not exactly ideal. You could even have animal sounds in your head.

Hang on.

OK, I just made some animal sounds in my head. There was a cow and a monkey and now there’s a lion. Does that make me schizophrenic? Come on.

If you follow the discussion, you will note that many of his friends on there tell him that he is developing schizophrenia. I do not believe he is doing any such thing, and this is not a symptom of incipient schizophrenia anyway.

I’ve been around folks in the prodrome of schizophrenia, and while their functioning was still ok enough, they were hallucinating (hearing voices) a significant part of the time. No amount of argument could convince them that the voices were not actually real, nor would they believe me when I said I didn’t hear them. This is a pretty typical picture of incipient schizophrenia.

Keep in mind that the vast majority of schizophrenics hear voices. In fact, if you don’t hear voices, I wonder if you really have schizophrenia.

What’s also interesting is that, terrifying and weird as these symptoms are, a number of the commenters admit that they have experienced them – they say they have had strange, out of control, unbidden random thoughts and music in their heads before. So, while it’s not optimal, this stuff seems to be pretty common.

What’s the diagnosis for out of control, random, unbidden thoughts and songs in your head? I say nothing. There’s no DSM dx that has a criteria like that as a sole criteria.

Just like “having a weird look in your eyes” does not give you a mental illness dx either. There are all sorts of folks walking around with all kinds of weird and crazy looks in their eyes. While it’s disconcerting, it’s not necessarily indicative of mental illness. There is no DSM dx for “has a weird or crazy look in their eyes.”

You need to be nuttier than just that. What gives people weird looks in their eyes if they aren’t nuts? Who knows? God knows what goes in people’s minds. But as long as your speech and behavior remains normal, you’re not mentally ill.

Why am I writing about this crap? I’m on a crusade to get people to quit being such morons about mental health. Even if we aren’t ill ourselves, it doesn’t help to give out false dx’s and go around accusing non mentally-ill folks of “being crazy”. It’s insulting, stupid and cruel.

Personally, I never refer to other humans with words like “weird”, “crazy”, “nuts”, etc.

Instead, I’m going to give you some specific description of their behavior, possibly with a potential dx. I can usually figure out what might be wrong with someone after spending a bit of time around them. I can almost always tell if they are psychotic or not, and usually if they are obviously dangerous or not.

Life’s tough for everyone and probably few of us make it out unscathed.