Tuesday, September 8, 2015

Pathological Jealousy

Jealousy is the anxiety that your friend or partner is closer to someone else than they are to you. It can come from having an inferiority complex oneself and not quite believing that anyone would want you over another.  Jealousy is usually related to time.  A person thinks that the other gives more time to someone else or even something.

"He puts more time into his sports shows, that he spends with me."

"She'd rather shop, that be with me."

"I think she likes my brother better than me."

The worst cases of pathological jealousy I have seen have been with alcoholism.  They're a subset of "paranoid disorder."  The paranoid disorder is the fear based trait of 'I and them" with them against me.  More commonly the highly attuned 'defensive' posture results in 'first strike thinking', what psychiatrists call "projection'.

" It's an eat or be eaten world.  Survival of the fittest.  (Psychopathic Lizard Like reasoning or  Sociopathic - wolf like thinking)....I'm afraid of anything different and unlike me.....  I don't know this. but I kill or destroy anything that is not me and not mine.   Everyone thinks like I do.  So they're thinking like me so I must destroy them before they destroy me. That's what I'd do."

"First Strike - 'defensive' thinking".

So with pathological jealousy the person who is jealous is really thinking I'd commit adultery so they must be thinking like I do so they're probably committing adultery.  Or they're going to leave me or they've going to steal from me.

I have seen a few cases of pathological jealousy with brain injury but that is uncommon where as pathological jealousy is common with alcoholism. I've seen it also with marijuana and cocaine.  So drug addiction and pathological jealousy run together.

I would hypothesize that addiction is associated with an "inferiority complex". A person with addiction is a slave to something outside themselves, the drug of choice, and therefore they see others as superior.  Self Pity is so common with addiction.  Therefore if the other person is superior then "if I was superior I'd take advantage of the other so they must be doing the same as me.'

Note that people who think others think like they do cannot imagine a higher level of cooperative relationship and hence live in the base 'eat or be eaten' 'paranoid' 'jungle ' reality.

Jealousy has always been an issue in human society, such that the  Biblical 10 commandments contain a clause, 'Thou shalt not covet thy neighbours (whatever) !".  Covetting is that fundamental.

Jealousy, "I want what you have' can be seen in the flip side as distorted admiration, "I want what you have' therefore I'll get a job and work and achieve what you have.  The thing about character traits is that they have a positive and negative pole.  Truthfullness without compassion can well be  cruel.

So jealousy is common and at low level experience not a concern. It's deemed pathological when the jealousy state is consuming and harmful to oneself or others.  Many a marriage has been destroyed by the delusional pathological jealousy of alcoholism and addiction.  Many a drug addicted alcoholic tyrant has lead his people to war because he covets what his neighbour has.  Jealous is destructive.

Pathological jealousy is combined with controlling behaviour.  Sociopathic or psychopathic "pimps' are commonly violently pathologicallly jealous and , tragically, the prostitutes, usually emotionally immature,  commonly interpret this as 'caring'.  Thirteen year olds are commonly learning to deal with jealousy in early adolescence. When it carries over to adulthood it's clearly evidence of a more deep seated developmental delay.

Obviously if the cause is alcoholism or addiction then the solution is stopping the alcohol or drug that is causing the brain damage which is showing as this particular form of paranoid state. In time when the chronic damage is stopped the healing can occur.  I have seen Pathological Jealousy caused by alcoholism disappear in months to a couple of years when abstinence is achieved.  I've not seen it resolve with any 'harm reduction' techniques.

Antipsychotic medications are the treatment of choice, often having major positive effect  in low dose.  Examples are seroquel (quetiapine) 25 mg three times a day, Abilify (aripiprazole) 2 to 5 mg a day, loxapine 10 to 50 mg a day, rispridone .25 mg three times a day.  The medication is titrated up against the persistence of the symptons.  Often too the antipsychotic is combined with an antidepresant such as prozac (fluoxetine) 20 mg or mirtazepine 30 mg,

Psychotherapy is aimed at first and foremost 'reality testing'.  Patients who are paranoid see psychotherapists as there, primarily to 'hear' their insaneity. Privately paid psychologists and counsellors make a fortune off paranoids as they support and agree with their delusions and listen to their insane schemes.  Unfortunately these therapists are sociopaths themselves and by doing this 'listening' and 'supportive' therapy entrench the paranoia.'

"Yes, Adolf Hitler, I feel how the Jews are so disturbing to you that you must gas them on mass. That must be so difficult. Tell me more about your feelings."

Freud's famous 'Ratman' psychoanalysis case of  shows just how difficult therapy is with paranoids. Freud, the great master, certainly had his work cut out with him there.

Alcoholics and addicts love to spend fortunes on psychiatrists, psychologists and counsellors with their own unresolved sociopathic and paranoid traits.  These poor examples of therapists collude with patholigically jealous ad infinitum.  They never "reality test' and they never set deadlines to change their drinking and drugging behaviour.  They're rich agreeable 'mommy loves you always' therapists who should be limitted to the adult equivalent of 'well baby care'.

Once you 'limit set' in therapy you separate the children therapists from the adults.  Positive transference is what all the untrained want to have.  Transference is the collective feelings of the patient to the therapists.  If you see a paranoid long enough or confront them by 'limit setting' then you will encounter 'negative transference'.   Usually they will be "fire you' and bad mouth you to everyone else,  They are the bread and butter of complaint organizations.  They complain to the authorities with delusional material all because you've told them to 'stop drinking' and that their 'marijuana' is the reason they think their wife is cheating on them.  You've sided with 'them' , their evil ex or their unloving partner. The paranoid patients want to use therapy to 'build a case'. Rich sociopathic children therapists want their money and see them till they turn then they 'fire' the patient.

"She put on lipstick and that proves that she has a boyfriend."

"Did she never where lipstick before."

"No she has always worn lipstick but the way she puts it on now is different."

Ugly is in the eye of the beholder.  The paranoid will take any detail and twist it to prove their insaniety.

"She cooked me my favourite dish because I know she thinks I'm onto her sleeping around."

Limit setting therapy can include things like

"Let's talk 5 minutes about your suspicions' and then I'd like to hear more about what you're doing about your alcoholism.  Or I'd like you to tell me why you think your mother loved your sister more....etc..etc. "

The point is that the therapy isn't 'controlled' by the insane person but rather that the therapist 'reality tests'.

"What you have shared with me could be concerning if I first believe that your husband was having an affair, but a court  would call all this 'circumstantial evidence.  Indeed as we know that 'pathological jealousy' is caused by alcoholism the best proof you could present that your husband is
having an affair is for you to stop drinking. I know when you tried to stop before that you couldn't stay stopped so what about going to AA or entering a treatment centre to deal with this. "

"This all must be very disturbing and anxiety provoking.  This medication rispiridone .25 mg might well be very helpful."

Building a therapeutic alliance with a paranoid may require one to avoid 'confronting' the delusion and listening at first but the question then is how long.  How many sessions of 'listening' and being 'aggreeable' is 'collusion' and 'money making' or actually therapeutic with a goal of recovery.

Some senior therapists believe that junior therapists should have a supervisor when they are doing therapy with the pathologically jealous or paranoids in general.  Freud found the Ratman very difficult.  These are not easy cases.

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