Personality Disorders
In this category we recognize, first of all, a range of problems that can be called personality disorders. We all have behavioral traits which are enduring patterns of perceiving, relating to, and reacting to ourselves and others in a wide range of contexts. These traits make us distinct individuals and are spoken of as our personality. In some individuals, certain traits become exaggerated to such an extent that they have serious inflexible and limited patterns of behavior. Often the inflexibility of the personality and its vulnerability to particular stresses results in real difficulties in social adaptation, leading to significant distress in the individual’s life. Some have a dependent personality, where the individual has difficulty making decisions, initiating projects on his own, or expressing disagreement. Such people go overboard to obtain the approval of others and are urgent in seeking relationships. Others have an avoidant type of personality, where they are unwilling to get involved in anything unless certain of being liked. Such people are preoccupied with being criticized and are inhibited in new situations because of feeling inadequate. The antisocial personality lacks the capacity to form proper relationships with others. They appear callous and self-centered, devoid of a sense of responsibility, and are given to immediate pleasures. They often lack social judgment, yet they are intelligent enough to devise rationalizations to convince themselves that their actions are reasonable and warranted. The obsessive-compulsive personality is preoccupied with orderliness, perfectionism and interpersonal control, at the expense of flexibility, openness and efficiency. The following description gives us an example of an obsessive-compulsive personality:
“Mrs. C., a 41year-old grocery store manager, comes for an evaluation at the insistence of the regional manager of the chain for which she works. She has failed to turn in the last four periodic reports on time, and her store has one of the lowest productivity ratings in the chain, even though she usually comes in earlier and stays later than any of the other managers and appears to be busy every minute of the day. Mrs. C. has frequent battles with her employees and has the highest turnover rate of employees in the chain. When confronted with these problems, she insists that her store is being run ‘properly’ and by the book — unlike the others in the chain, which are maintaining ‘shoddy’ standards.
“It is easy to identify the source of difficulty in the store. Mrs. C. insists that her employees shelve and arrange goods in exquisitely straight lines. She checks, double-checks, triple-checks, and quadruple-checks all her figures, which is why her periodic reports never get in on time. She micromanages every aspect of the store’s operation and, consequently, her meat and produce managers are always transferring to other stores. Instead of appreciating Mrs. C.’s constant supervision, her managers find it annoying and time-consuming. She is constantly drawing up charts, tables, graphs and employee directives. She spends much of her time each morning constructing an elaborate to-do list that she never finds time to complete.
“Mrs. C. has been married for fifteen years and has two children in their early teens. Her husband is a postal worker. Mr. C. reported to the therapist that until Mrs. C. began working at the store six years ago, they had lots of marital struggles because of Mrs. C.’s need to oversee and direct every aspect of his life. She had insisted on knowing where he was at every moment and had tried to plan all his leisure-time activities. He said that it was a great relief to him when she began to work at the store and became too busy to pay so much attention to his life. Mr. C. says that he and the children have a hard time persuading his wife to take a vacation and that it generally does not turn out to be much fun when she does agree to go. Mrs. C. plans their itinerary and activities minutely and insists that everyone must participate in what she has scheduled. Nothing is allowed to be spontaneous or unplanned, and everyone is expected to spend their time ‘productively’ even when on vacation.”
Anxiety Disorders
Another well-recognized manifestation of behavioral disturbance is that of anxiety disorders. This is one of the most frequently encountered forms of mental illness. In this category are such entities as phobias, stress disorders, and disorders causing panic attacks. Some people have a generalized anxiety disorder, where they worry all the time about almost everything. As may be expected, such individuals have (for various reasons) a high degree of anxiety, often accompanied by irrational fears. In addition to the intense and often disabling anxiety, they may experience physical symptoms such as pounding of their heart, sweating, trembling, shortness of breath, and lightheadedness. Anxiety disorders can affect children as well as adults, as the following example shows:
“Anne-Marie (not her real name) was a 10year-old girl from an intact, supportive family who was described as ‘anxious from birth.’ She had been a cautious, shy preschooler, but she adapted well to grade 1 and began making friends and succeeding academically. She presented several times with chronic, diffuse abdominal pain that was worst in the morning and never present at night. She had missed about twenty days of school during the previous year because of the pain. She also avoided school field trips, fearing the bus would crash. Her parents reported she had difficulty falling asleep and frequently asked for their reassurance.
“She was worried that she and members of her family might die. She was unable to sleep at all when anticipating a test. She could not tolerate having her parents on a different floor of the house from herself, and she checked the doors and windows in the evenings, fearing intruders.
“Her clinging, need for constant reassurance, and school attendance problems were both frustrating and upsetting to her parents.
“She had not experienced any traumatic events, although she reacted very strongly to the television images of September 11, 2001. One of her grandparents had died the previous year. A maternal aunt had recently been treated with fluoxetine [an antidepressant drug] for depression and was described as ‘a nervous person.’
“Anne-Marie has symptoms typical of a childhood anxiety disorder.”
Mood Disorders
Another very frequent manifestation of mental illness is that of mood disorders. In this category are the well-known entities of depression and manic-depressive illness. Depression is characterized by continuous feelings of sadness and emptiness, a markedly diminished interest in all activities, an inability to concentrate, insomnia, constant tiredness, and a feeling of worthlessness. Manic-depressive (or bipolar) disorder is characterized by periods of depression alternating with periods of elation, racing thoughts, tremendous energy, a decreased need for sleep, and extreme talkativeness. Kay Redfield Jamison, a professor at Johns Hopkins University and an international authority on manic-depressive illness, recounts her own experience with the disorder. Here is her description of how she felt:
“There is a particular kind of pain, elation, loneliness, and terror involved in this kind of madness. When you’re high, it’s tremendous. The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the power to captivate others a felt certainty. There are interests found in uninteresting people. ... Feelings of ease, intensity, power, well-being, financial omnipotence, and euphoria pervade one’s marrow. But, somewhere, this changes. The fast ideas are far too fast, and there are far too many; overwhelming confusion replaces clarity. Memory goes. Humor and absorption on friend’s faces are replaced by fear and concern. Everything previously moving with the grain is now against — you are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind. You never knew those caves were there. It will never end, for madness carves its own reality.
“It goes on and on. ... What then, after the medications, psychiatrist, despair, depression, and overdose? All those incredible feelings to sort through. ... What did I do? Why? And most hauntingly, when will it happen again? Which of my feelings are real? Which of the me’s is me? The wild, impulsive, chaotic, energetic, and crazy one? Or the shy, withdrawn, desperate, suicidal, doomed, and tired one? Probably a bit of both, hopefully much that is neither.”
Here we have seen a case where neurotic behavior can be coupled with occasional bouts of psychotic behavior, so that the line between “lunatic” conditions and behavioral disorders is sometimes blurred.