Compulsive Liars

I once worked with a compulsive liar. A female sociopath who was brought into my life by a female minister who promoted the compulsive liar, knowingly or unknowingly The damage she did eventually cost me more than $50,000 and left me feeling utterly violated. It turned out that the references she provided were from men who had previously had business with her but not the business she claimed. Given their claims on her behalf, regarding her character, not her physical skill, in retrospect I concluded that she must have threatened them as she threatened me, extortion being part of her repertoire, or being the business minded type of older men who liked adolescent women and had no character themselves. She stole but what was more extensive was the dishonesty, compulsive lying which verged on pathological lying.
In retrospect I couldn't sort out what she was other than mean, deceitful and despicable in the foulest of ways. Sadly her lies incorporated a dozen women of stirling character whose character was then doubted by a truly dubious female doctor whose capacity for gullibility bordered on the insane. She ignored the truth of a dozen upstanding women preferring the repeated lies of a crack and apparent sex addict who'd used a female minister for her nefarious ends.
The 'enabling' doctor was brought into the 'con' which all the while was devastating the community, hurting me and hundreds of others. The girl and her pimp like boyfriend were white and particularly racist and well as loathing of the rainbow community, The doctor was a conservative white lady known for her inferiority complex coupled with a superiority complex known for her fawning way or belittling of male specialists depending on how much the male doctors deferred to her outdated ideas. As one female specialist said she was a cow who found her calf and to this brilliant and beautiful psychiatrist that explained everything though it didn't particularly help me. She lived in an ivory tower protected by male and female doctors who themselves would have had the street smarts to smell a rat long before she could if she ever did.
In the end I swore I'd have nothing more to do with sociopaths and compulsive liars. My mother had died that year. Rather than focussing on mourning and remembering her for her great achievements, I was distracted by the sordid indecent drama of the pervert lying lady and her old lady doctor promoter. The female minister was by no means an Oswald Chambers, had beat a quick retreat from the disaster she had sewed preferring only the lush robes of office. She was no longer needed as the dubious doctor was the latest host for the parasite who lied for money and lied for lying. In contrast, my mother, a Baptist Christian lady of high character, had lived a life devoted to the truth.
Yet here once again a rat has got in my chicken coup. Jesus said sweep the house of demons and don't let one back in or they'll bring more with them. I can actually chart the part I played letting them scurry that first day into the bag of feed. When I had a chicken coup, that one rat I saw that day eating the chicken's grain didn't seem like much. Yet within days I was carrying two bags more of feed each week to the chicken coup, all profit lost as a result of the infiltration of rats, all joy gone, and my back aching from the effort to feed the chickens whose food was being stolen en mass by the rats. Rat poison, 12 guage shot gun shells galore, drowning and a number of cats never did get rid of the rats. In the end I moved. Life is too short for good people to live among rats if there are alternatives. I sometimes think Vancouver with it's bike lanes and multibillion dollar marijuana industry, housing prices inflated by heroin trade and crack industry, is particularly ratty. Yet others argue it's a product of the times and the decline in morality and rise in relative ethics. "It could be worse, Goldman Sacs could be your neighbour," my Vancouver loving friend argues.
Compulsive liars are often called rats. They and their lies proliferate. I'm dealing with a male one now. Despite all my experience and training and after that female Eva Brawn experience I thought I was over having them sneak under my radar. Yet they're superficially charming. Their lives are compartmentalized with no one knowing the full extent of their deception or how many people they hurt or are hurting until later. They commonly borrow money or steal from everyone and only later do people who know them meet up and go 'aha'.
Dr. Robert Hare has written extensively about sociopaths and psychopaths and documents how many people have rats in their lives, how the rats live, how they breed and where they like to leave their droppings and what lives they devour. When I beat myself up for letting this latest one in, I was reminded by a friend that even Jesus, had his Judas. I gather from that maybe 1 in 12 people isn't all human but more a rat like, Gollum, character who CS Lewis would say looks for the architect in the wall of the building. As I heard chanted in Indian, 'they love things more than people'. They like shiny things, like pieces of silver.
I haven't raised chickens since the rats came. I moved away from that town and took up other pursuits. The rats were real but also a metaphor. I'd had to deal with a liar whose eyebrows grew together and was glad I got out before the good people we knew there were destroyed by drug dealers and other sociopaths. Rats are parasites so if you remove the host the rats die or go elsewhere. Rats don't live long and aren't welcomed anywhere but in dumps.
All recommendations about Compulsive Liars start with the recognition that whatever they say is not true. Personally once I note that a person who I'm not being paid to work with, treating pathological liars is part of my business, I know that everything that follows is a lie. In terms of transactional analysis the compulsive liar 'wins', 'gets a reward' by gambling on you 'buying' their latest lie. Commonly the 'lie' is 'seeded' in a group of half truths and even an occasional truth. This person in my life right now owes me thousands of dollars and has caused me to drive hundreds of miles to be 'paid' and adjust my schedule on several occasions to 'meet' with them to be 'paid' only every time they "lie". They 'conveniently 'forget' and 'miss' appointments. Even now they want me to again accomodate my schedule and life to their chaos and deceit. The cost and pain of being 'played' by a sociopath amounts to far more than thousands of dollars of initial 'help'.
Books are written about them with titles like 'soul suckers' and 'emotional vampires'. That's part of the pattern of 'compulsive liars'. They play on the good nature of their hosts. They feed on food meant for others. They're takers and players. The pleasure for the liar is to 'manipulate' others around them and to 'control' others. They get everyone playing their game and are called 'king baby' because their games are so juvenile. Their behaviour, were it not for their age and wearing long pants, would be perfectly appropriate in a toddler, a terrible 2, or even tolerable in 13 year old. It's just painful when these compulsive liars are masquerading as adults hiding diapers under their stolen big people clothing.
Commonly these sociopaths are drug addicts as well and one doesn't know if the drug addiction has begat the compulsive lying or the compulsive lying is just a component of the immature character of the person. Pathological lying is commonly associated with alcohol and marijuana. Drug users commonly lie partly because of the brain damage (reversible or irreversible) and partly because of the grandiosity and arrogance that goes with addiction. Addicts live in a false reality where they preen before a magic mirror of their own making excluding any truth since truth might topple their fantasy world.
At work we get the 'cheques in the mail' lie too but we refuse to do business with such folk after the first lie. Countless businesses have died because of liars and many an idealist has become a cynic, thanks to one too many liars or sociopaths.
Compulsive liars want you to play their game of 'believe me' and 'trust me' so the can get close or stay close. Then they can throw a rock through your window. They say "trust me" and "I promise" but this is never a 'reliable' response because they lack the character to be able to be as good as their word. They and their word are wholly foul. The consequence then is that all who deal with compulsive liars must consider everything they say as untrue until they 'prove' by demonstration and action and repeated demonstration and action over at least a year that they have given up the addiction of compulsive lying. Prisoners in jails want out because they don't like being around compulsive liars and sociopaths. They're like a collection of virus who need hosts to infect. Rats aren't happy just to be among rats. They infest homes, towns and cities. If they'd stay in the dumps no one would care.
In addiction circles where compulsive liars are common the sayings which apply are 'don't tell me, show me,' and 'if you talk the talk, walk the walk.'
Personally I am feeling again so violated that I want to just leave and go anywhere that compulsive liars aren't enabled and supported. I am so tired of being hurt by these children, sick as they are.
Psychodynamics tells us that they are usually a product of equally sick parents where one at least of the parents, either themselves were a compulsive liar or addict or one that rewarded compulsive lying. The organizations Adult Children of Alcoholics shares their experience of being victimized by addicts who compulsively lied and routinely broke promises to their family while maintaining a fake personna in the community. Those in 12 step programs are in recovery and seeking treatment for the damage done often so they don't pass along the damage done to them to their children. Not uncommonly I treated three and sometimes 4 generations of compulsive liars and sociopaths, usually on welfare, sometimes running corrupt businesses, often criminal, and simply not knowing a life better than 'lying' and happy as bottom feeders living in the dark and afraid to walk in the light regardless of the lies they tell themselves.
Al anon, the sister organization of alcoholics anonymous, teaches their members to 'detach with love' when dealing with the alcoholic and their compulsive lying.
Still, while it's true they are sick individuals, like pedophiles are sick individuals, it remains that when one has slithered into your life or been brought in by well meaning people ,it's hard to think of them compassionately as they wreck so much damage and waste such valuable time that could be used elsewhere. Their 'king baby' 'drama queen' antics, thoroughly delighted with the smell of their own poopoo, they smear it all over their hand and reach out to shake yours again and again, laughing each time they catch you in another of their countless shitty little lies. It's then you relish the old language of seeing them as evil and demon possessed and want to stake them on the lawn to discourage their likes from coming around. I encouraged a patient to forgive a relative who is a pedophile and hurt his family, but know that it's incredibly hard to forgive when what one really wants to do is revenge.
I listened to the new Tenth Avenue North album, Struggle yesterday and enjoyed the young song writer talking about long ago using up his 70 times 70 minutes of his 'forgiveness plan' but then remembering Jesus on the cross saying 'Forgive them for they know not what they do."
As psychiatrists I raised this topic at my recent convention, sharing about my own openess and generosity making me prey to sociopaths, how "boundaries' were such a static pre global arty luddite term for a post internet, facebook, spy camera everywhere world, when as medical scientists we did need 'membranes' instead and we talked together of this mutually sharing our experiences.
I shared how the beaurocrats reminded me of the drunken irish lawyer who'd picked bar fights always winning because he was the lawyer for the Hell's Angels and the Angels stood behind him and his adversary always 'stayed down'. Boundaries was good for them because they lived in medieval ivory towers and ruled but it lost relevance in the real world where real doctors negotiated their influence and lived among people and didn't 'dictate' to them as 'administratives' types preferred. We shared how the police, judges and lawyers who so often work alot with these unwashed heathens make a strong point of having highly selective personal circles. My detective friends don't want just anyone around their families because frankly they need a 'break' from compulsive liars and sociopaths. There might well be described as a group who use 'moats' more than anything else.
As psychiatrists we weighed the pros and cons of very tight 'boundaries'. When I graduated we were told not to share any personal information with patients, women and men couldn't wear wedding rings, all of us had private phone numbers we didn't share and our addresses were sacrosanct. I spent years working like that, treating patients like they were somehow 'infectious' and wearing my doctor persona like a Hazmat Suit. The lawyer at the College wears just such a Hazmat suit and I always think she is afraid of being infected by 'doctors'. As psychiatrists we learned that the 'stigma' of mental illness extends to the caregivers as well. It's equally why so many people think of lawyers as 'liars' because they are 'stigmatised' with their so often criminal clientele.
Having been stalked, had my windows shot out, had my dog killed, and my life repeatedly threatened all related to work I fully appreciated the women psychiatrist who today wouldn't have anything but a very restricted artificial relationship with her patients . She admitted she was afraid of many of them and was glad to have a place where she could share her fear. Alot of my colleagues 'cherry pick' the 'worried well' or work in 'student mental health' or leave clinical medicine all together to become administrative doctors or doctors who police doctors because they are afraid too. I loved an old College Registrar who shared he was always delighted when I'd chat with him and share my trials and travails because he told me it made him thank his lucky stars he wasn't back in front lines faced with such awful decisions with so few resources. He said he'd got burnt out and looked for an escape and eventually ended where he was, an amazingly wife and compassionate gentleman whose contribution to medicine was truly admirable.
The psychiatrist working in the jail told us as well he couldn't even share that he had cancer because an inmate 'gloated' and used that as 'ammunition'. Sociopaths love to learn something about people and then use 'name calling', saying things like 'faggot' to put down those around them. They even use words like "Christian" or "doctor" or "worker" in a twisted way making a "positive" appear negative because that's really a reflection of their internal 'bizzaro' psyche. The jail psychiatrist would say that a sociopath could tone the word 'mother' or 'father' in such a way as to make those beautiful words sound like smegma. Sociopaths live to 'chop the heads off others to make themselves look taller'. None of the jail psychiatrists told their patients the names of their wives or children partly to protect them from physical harm but also to protect themselves.
Hearing them share this I reflected that I'd done a similiar thing when I worked in jails and asylums. I was reminded of this when a patient recently stole my personal laptop and I wondered if I wasn't too old for this work. All my life doctors have been pilloried in the media and by the government whereas drug dealers seem to be celebrated and rewarded in this part of the world. When I told Dr. Hildes years ago I wanted to be a missionary doctor he told me I didn't have to leave Canada. He got me working with the Northern Medical Unit at the time but I know now that as one of the wisest men I had the priviledge to train with his insights regarding health care weren't just limited to Circumpolar Health.
The private psychiatrists like myself however especially the older men who worked in addiction psychiatry, often had long standing relationships with patients where their personal lives were an open book. A number of the psychiatrists had written books with extensive autobiographical material which made it rather moot what they shared but they too could talk as I did about the days when we had our walls bare and answered every question with a question. I shared too that the woman doctor I'd mentioned who'd been thoroughly conned by the female sociopath had still been doing that when she retired.
When I was a small town country psychiatrist everyone knew everything about me and the country psychiatrists described the same experience of being on display today. I loved Scott Peck's book, "People of the Lie" better than "The Road Less Travelled". Over the years I've treated cleaning ladies of the rich and famous and learned all manner of details which I'm sure were 'priviledged'. My colleague said he liked the 'privacy' of his life in Burnaby compared to when he'd worked in Asia where every household had so many 'servants'. "So much of what I've read about 'boundaries" is wholly ethnocentric and western because it doesn't take into account servants or families or multi culturalism", he said. They found the big city psychiatrists talk of 'boundaries' priviledged and irrelevant , not at all realistic when their kids were all in the same school as their patients and they were coaching soccer teams and attending Bible studies with patients. "These guys must live on the moon and see patients from another planet," the way they write. The addiction psychiatrists described their experiences of being open about their lives in 12 step meetings where their patients were and then learning that one patient befriended another patient in the waiting rooom. That was why my psychoanalyst mentor had separate exit on his office so no patients passed each other.
While everyone had had similiar experiences which had helped them in being 'human' and clearly did a tremendous service for their patients and 'fellow humans' each had had a 'bad experience'. That's what we shared too. This conference is one I attend because it encourages doctors to share. Then we discuss options and reflect on solutions without doing that typical administrative and beaurocratic 'blame and shame' game. These are real physicians, healers, and not just paper pushers and rubber stampers.
I was reminded of when I played guitar on stage and sang Paul Simon's brilliant song, "I am a Rock I am an Island." The line I loved most was "I touch no one and no one touches me."
We reminisced how easy it must have been for the psychiatrists doing lobotomies and certainly surgeons can stay aloof like the administrative doctors try to be but in the end humanity seems to prevail. Only Ralf Nader could withstand having his garbage gone through daily by security firms hired for millions of dollars to find dirt on him. No one ever did but in the end he was thought a 'boring' man. In the end I thought he'd make a change as a politician and president but the hoi polloi didn't want saints ,preferring dope smoking womanizer Clinton and former alcoholic Texas bad boy Bush to Nader, the man with the cleanest garbage in history. Ralf Nader, himself, a man of truth, didn't accept politics probably because he knew politicians daily had to deal with lobbyists some of who were by nature compulsive liars.
Like the other older psychiatrists at that meeting of sharing about 'boundaries' and 'ethics' I remembered my psychoanalytic teacher saying that he wouldn't share an elevator with a patient under any condition. Yet Freud had his patients come to his house where they smelt what his wife was cooking along with every other household nuance of that canny old master, now quite unfairly criticized by 'johnny come lately's who have all benefitted from his pioneering genius.
Given the lies told about me by the sociopath and the public domain of a particularly deceitful divorce, I chose "transparency" as a measure of safety. In a particularly fascist community which thrived on dark rooms and 'secret discussions' and knew it's own share of 'lies' ,I was even 'declared dead' by a colleague who I'd named for killing patients, Unfortunately for him and his patients, I was very much alive and he was found wholly negligent and given the mandatory wrist slap.
The professionalism of the day was protect the leader at all costs and sacrifice the young for the sake of the old. It was a particularly toxic environment with some of the most heinous of acts making front page news. What was so often overlooked was that the vetting bodies were complicit in the crimes. Compulsive liars and sociopaths are most blatant in their 'cover ups' which are clearly not just 'mistakes' but declare best of all that 'evil intent' and 'false motive' were definitely present.
The recent financial crisis where the Fanny Mae and Freddie Macs compulsively lied before Congress showed that despite the lessons the world had learned from Hitler , yet again sociopaths and compulsive liars could get under the radar of countries and do all manner of damage to the world. This wasn't Stalin or the bad Chinese or really bad North Koreans but Canada's neighbour, America with Americans doing it to their fellow Americans. They're like a disease that can't even recognise their own. They behave like children whose parents just never could get them to understand that basic rule 'don't shit where you eat'.
We should all know today, only the rich or irrelevant can truly have secrets. Transparency has such merit that Beverley McLaughlan, the head of the Supreme Court of Canada has made it her central theme. Instead of "judge Judy' on tv, we can look forward to a return to real judges on television like the days of Solomon when court was an open forum and the judge didn't cut deals in his or her chambers.
Given the experience of dealing with the female doctor who rejected the truth of a dozen women of stirling character preferring her own skewed view reinforced by a crack addicted pervert whose failure to report relapses were part of her history of compulsive lying, I learned that people will often 'believe' what they want to believe and refuse to let the 'facts' get in the way of their 'opinions'.
I depend as much today on prayer and Grace as I do on 'boundaries' or 'locks'. As an old saying goes about a servant who didn't tie up the camels and they were gone in the morning, when he said to the master, "But you always say trust Allah", the master replied, "Tether the camels and then trust Allah." As Christians say, you are the hands of God. So a spiritual life isn't one of work without faith but rather work and faith. In the beginning and the end, all is God.
I have also learned that it doesn't help to confront compulsive liars , just as it doesn't help to confront a sociopath. It's like telling a cannibal that they are a cannibal. Cannibals don't care about this information. What is important is to get your hand back before they get your arm. The only hope for a compulsive liar or a sociopath is if they are an addict as well. Addiction is a treatable medical condition.
But addiction, compulsive lying, and sociopathy all share in common that for treatment the person must have reached a bottom, be coerced to accept treatment through intervention or have a moment of clarity or age. Prochaska has written very clearly about Stages of Changes starting with Precontemplation, Contemplation, Determination, and finally Action. Modern day motivation therapy encourages us to no longer waste valuable resources on patients who are not themselves further along in the process. Compulsive liars and sociopaths love an audience. Transactional analysis and other therapies showed that they 'score' not by changing for the positive but by 'defeating' your helping them.
Usually toyboys and party girls grow up in their 50's and though they do immense damage to their children along the way they might themselves find truth within their life time some being simply developmentally delayed. Others learn 'toilet training' early while this group sociologically are 'challenged' as the pc language would say. They think their shit doesn't smell even but eventually may 'get it' though frankly the evidence does suggest that as often die young.
The most important point though is that those around compulsive liars and sociopaths do best to keep them out, recognise the rat when it gets in and as quickly as possible get out before they bring more rats or tell more lies.


- Posted using BlogPress from my iPad

Suburban Mayhem

This movie is genius. http://www.suburbanmayhem.com/main.html

The movie should be required viewing for all judges and juries. It's would make an ideal case study for any psychologists or psychiatrists with the question, "and what would you do differently".

It's an Australian production that could never have been made in America because quite frankly it could well be a metaphor for America. Winnipeg's Guess Who wrote the song banned throughout the US, America Woman. It was just this kind of woman the song was about. http://www.youtube.com/watch?v=gkqfpkTTy2w&NR=1

http://www.youtube.com/watch?v=DZVzH5yBFQA

Katrina is a clinically accurate portrait of the true female psychopath. Her sociopathic brother ends up in jail because the 'system' can deal with men but is wholly incapable of dealing with the new age female version of an ancient and most endearing mask of the devil. The movie shows just why the 'system' fails when it comes to women but it in no way enlightens us as to how things could be handled differently. With a docu drama twist, it is a truly violent action flick that turns into a witchy horror film. Like watching a snake dance I couldn't keep track of all the moves and didn't see the strikes coming when they did. That's the genius of writer and director. The acting is all superb.

The women and men in the movie are unable to deal with Katrina's sexual manipulations. A regular blue collar Cleopatra she demonstrates well how women can use sex and proxy violence for social terrorism. The movie captures the Eva Braun Syndrome to a tee. Absolutely a must see.

Writer: Alice Bell (only a woman could have the balls to write this!)

Director: Paul Goldman

Katrina: Actress Emily Barclay

Personality Disorder

Psychiatry is a hodge podge collection of venn diagram interconnecting overlapping diagnosis. The DSM Axial diagnostic system was an attempt to look at the various dimensions of a disorder and chart their biological psychological and sociological sources.

Axis I refers to the current and major focus of therapy whereas axis II refers to the personality traits or disorder, axis III any predominantly physical concern, axis IV social or environmental factors and Axis V the global assessment of functioning for the individual based on a scale that shows 100 as exceptionally well, below 50 as failing and lower requiring chronic social and psychological assistance or institutionalization.

Axis II, the personality disorder scale is generally speaking the least competently completed. There are many reasons but mostly 'personality' and 'character' are poorer understood today by average psychiatrists and unfortunately for the diagnostic class there are no pharmaceutical solutions to the treatment of personality. Personality disorders bring to the awareness of all that medications really predominantly manage 'symptons' and personality disorders are decidedly at greater risk for all the symptons of psychiatry but the treatment of choice is medication and psychotherapy not just medication alone.

Increasingly psychiatrists are little trained in psychotherapy, lack psychological mindedness and rely predominantly on medications for their income. There are even those psychiatrists who hold the medication pad like a cross between them and their patients.

Personality is considered to be a play of genetics and environment. The collection of coping skills that an individual leaves adolescence with were considered necessary for the individual to survive their family and early environments. They were adaptive to an extent but become decreasingly 'adaptive' over time till these habits of interaction finally fail to serve the individual in their interaction with society and they end up in the psychiatrists office with some evidence of 'dis-ease'.

Personality disorders don't just appear late in life otherwise a good clinician will consider 'organic personality disorder' which is a 'personality change' secondary to brain injury or other physically disturbing event. Generally speaking personality disorders are a "pattern of dysfunction" which can be seen in adolescence and continuing through adulthood until it culminates in need for treatment.

Usually personality disorders are more identifiable by others than by themselves. Many of the personality disorders "get under the skin" of others because it's obvious that their chronic 'coping' patterns are at the basis of the recurrent failures to achieve their ends.

Personality disorders derive mostly from the work of Dr. Carl Jung, Reich, Adler and others who looked at the complexity of the relationship of individual and society and how culture and individuals interacted.

Dr. Carl Jung made a major contribution by identifying the major division between the introvert and the extrovert. The DSM classifies these two types of personality as Cluster B for extrovert and Cluster C for introvert. Cluster A in the DSM is best described as "odd". They're the true eccentrics, the adult autistics and slightly schizophrenic sorts who muddle along without being really crazy but seem 'off' to most by their peculiar habits.

Cluster B is where the Antisocial Personality Disorder, Narcissistic Personality Disorder, Histrionic and Borderline Personality disorders are gathered. Much of the research that has helped us understand personality disorders in general has derived from the well funded research that has gone into the study of the Antisocial Personality Disorders.

The key here is 'context' and 'adaptation'. A person with the traits of 'antisocial personality disorder' might well use these positively by joining a police force or military rather than becoming a 'gang' member. Similiarly it's been said that to be a good criminal lawyer you have to have a fair measure of narcissistic personality disorder. The histrionic naturally makes a very good actress but might not be very good as a space shuttle pilot. The borderline is often similiarly described as a 'b' movie actress or actor because of the chaos that permeates their lives. They are the proverbial drama queens who become suicidal over a broken fingernail.

Cluster C personality disorders include the dependent, those who are constantly parasitically attaching themselves to others and abdicating from responsibility but then are dissatisfied by the eventual abuse that comes when the idealizations turn to devaluations. Obsessive compulsive personality disorders fit this category . Naturally if you are an accountant and obsessive compulsive your concern for detail and perfection might benefit your clients. The trouble is that the obsessive can't live with themselves worrying about their mistakes all night long.

The passive aggressive personality disorder is probably the most significant and least diagnosed of the cluster c category despite its commoness as a 'trait'. Indeed one of the ironies of psychiatry is that this field attracts more introverts than extroverts and specifically cluster c passive aggressives are forever 'punishing' extrover patients by 'punatively' labelling them as 'cluster b' personality disorders. Cluster B personality disorder in turn more commonly label cluster c personality disorders as 'those assholes". There's considerable black humor in the field of personality research and when one understands personality traits one can't help but see them in everyone and see why so commonly it's over emphasis or dependence on a 'trait' (coping mechanism) that is creating the 'problem' not so much the situation as the person in the situation will more commonly insist to all and sundry.

Now consider the paranoid. They might make a very good political or theological writer denouncing the evils and threats "out there' while never ever considering their own perceptual biases. The key thing is that this is a stable trait and that these individuals are generally functional but they're on the edge and like all the personality disorders the very characteristics that they have can cause them to 'go over the edge".

Tabloid newspapers make a heyday out of these times in these individuals lives. The histrionic 'flirting' with everyone suddenly is 'raped' and 'she/he' never saw it coming but everyone else would have described that person as a 'train wreck waiting to happen'. The obsessive compulsive one night 'break's' and finds themselves having gone from deep anxiety to chronic depression and now suicidal can't see why their life lead them to the psychiatric hospital yet those around always knew this person was 'wound too tight'.

The personality disorders have benefitted most from group therapies where their interactions with many people can be interpreted back to them. Too often in one to one therapy they simply 'discount' the 'opinion' of the therapist yet in a group it's harder to ignore a dozen others giving the same feedback.

Medications commonly are used symptomatically to help a person be able to hear advise and take in information without so much defensiveness. Anti anxiety medications, antidepressant medications and even anti psychotic medications are commonly the place where therapy begins because in crisis personality disorders are not 'open' to change. Indeed the very coping mechanisms that usually get them into the difficulties in the first place are the ways they hope to get out of the difficulty.

Hence the anxious antisocial personality disorder can't hear the 'recommendations' of the police officer because they're trying to figure out how to 'lie' their way out of this situation or 'fight' their way out. Medications can be used to reduce the anxiety and violence potential and give the person time to 'reflect' on their need to change if they don't want the same thing happening over and over again.

Increasingly the 'medicalization' of psychiatry has resulted in the 'fast food' approach to psychiatric problem solving. Hence, rather than looking at the 'why' the person has been in three relationships in which they've been beaten up or why they can't keep a job or have any long term friends, the medication approach is often solely a 'band aid' with the need for changing 'band aids' frequently or sometimes wrapping the patient up in metaphoric guaze. This is fine for 'crisis' management but the problem is that there is a need for much more.

Politically though, funding, and the approach to disease management is commonly based on addressing the 'crisis' and forgetting about the 'meaning' or the 'long term management' of whatever the 'crisis' was about. Crisis management is 'sexy'. The politicians love this sort of 'stop gap' measure but what is most commonly needed is the kind of thinking that is used in "rehabilitation medicine". Yet there is nothing 'sexy' about 'rehabilitation' or 'chronic care'.

So commonly in the present day system people were personality disorders are the most poorly treated and yet often have the greatest potential.

In the past there was great frustration in treating personality disorders for many because they didn't treat the addictions that commonly are part of the maladaptive coping armamentarium. Today it's recognized that treatment of addictions needs to precede the therapy for the personality disorders because the latter therapies of change are commonly 'anxiety' provoking and "uncovering" and encourage 'new, unknown," behaviours that increase the sense of 'vulnerability" and throw a person back to the addictive 'self soothing' behaviours if these aren't addressed first and in combination with the subsequent treatments, group and individual for the personality disorders.

Borderline personality disorder is commonly now understood to be untreated PTSD until proven otherwise. Anti social personality disorders are commonly understood today to be usually part of a 'context' where the behaviours which don't work in the 'greater society' are the very traits that permit 'survival' in the person's immediate environment. The movie, Clockwork Orange did a marvellous job of addressing the difficulties of treating an anti social individual without also treating the anti social individuals immediate 'group' and 'environment'. Passive aggressive only persist when they are not held accountable etc.

The successes in this field are so often the most gratifying for the therapists. These are usually the 'success stories' we read about where a person 'found themselves' or their 'life turned around'. It's one of the most exciting areas of psychiatry and tragically one that is often so poorly understood.