Personality Disorder

Several years ago I had a meeting where a young graduate student, who was doing a practicum with one of the mental health care providers, started telling me about an amazing man he had met right there in the office.  The man, he said, was unbelievably intelligent, and responsible for all the progress in the company’s care program but couldn’t get the job he deserved heading up the agency because of staff jealousy. The young grad student was going to go to bat for the persecuted genius.  I didn’t need to be told this phenomenal person’s name. I knew him well. He was a patient of mine.

The truth. The man had a personality disorder (PD). This poor persecuted man had been recently released from a hospital for the “criminally insane” (archaic term but what it was called).  He had been incarcerated there after being caught baiting pre-teen girls.  I won’t share the gruesome details.  I somehow became the clinician responsible for his behavior program; i.e. keeping him out of trouble when the State turned him loose.  He lived with two other men with similar histories and full-time trained caregivers.  He had convinced authorities that he was cured and had gone for some years without any serious violations of the rules. 

There is no cure at this time for personality disorder (PD). People with PD almost always present as “normal” (whatever that is), very intelligent, even when they’re not, and being persecuted by an ignorant world that just doesn’t know or understand. They are always right and will throw a temper tantrum, even, as with this man, becoming violent and vindictive when their story or behavior is challenged.  Since I never saw a mild case, all of my PD patients were either in prison or a mental institution. I spent a lot of time trying to get judges to put them an institution instead of prison. Sadly, the judges all knew that the State would soon come along and discharge them and the process would start over.

Having convinced authorities that he was cured and not a threat to himself or others, this man gained more freedom even though there were always trained staff nearby.  It was a very short time later that staff caught him sneaking into a computer where he was cruising social media for young girls and had two pre-teen girls ready to meet him. It was also learned that he was telling at least one young woman at the sheltered workshop that he was going to marry her and take her away because he was really very rich and people were just jealous of him. Not surprised.  I’ve had a lot of patients with PD and they’ve all been very good at convincing the unsuspecting that whatever they say is true no matter how improbable it may sound. That might be because they really believe what they say so they speak from commitment. I’ve had physicians ask me why a patient was “incarcerated” until that “poor person” started acting out, throwing violent temper tantrums and telling people the physician was poisoning them.  

It is very hard for staff, and even clinicians, to keep in mind that people with PD are, in fact, mentally ill. Working with them is stressful and exasperating at best. It is made even more difficult by the PD’s total lack of remorse when they hurt someone, always blaming it on someone else, and their willingness to say absolutely anything to gain control or manipulate even to the point of making up horribly harmful lies. They can literally be caught with their hand in the proverbial cookie jar and swear it wasn’t them then become violent when they are not believed. When they make false statements about a caregiver the government has no choice but to investigate even if they know the person has PD and the statement is obviously false. This makes getting caregivers for them extremely difficult because, if the media gets hold of one of these false statements, it can destroy a person’s career and life.

Personality disorders are really quite frightening.  I was lucky.  I got through over thirty years of practice with no major accusations against me.  I think that is because, despite their thinking they are the smartest person on the planet they usually are far far from it, and they thought I had some tremendous authority that I didn’t really have.  I did get physically attacked on occasion and took a couple of good thumpings, but it was all in a day’s work.  It is very hard to balance their human/civil rights with keeping them, and those around them, safe. 

If you know a person with PD don’t confront them or try to deal with their behavior yourself.  Try to be patient with them and do your best to get them professional mental health help.