Jul 072011

Jonathan has posted on his own site, Porcelain Utopia, about the importance of getting the right diagnosis. In my opinion, nothing could be more important.

The armor of mental illness.

When I first met Jonathan in October 2006, I met him online and as a client. I was an editor living in Albuquerque, working for a firm based in Australia. Jonathan was living in Long Beach, California, and needed a screenplay edited. The job was assigned to me.

After I finished the job, Jonathan and I began to flirt via email, and at the end of November, Jonathan flew me out to Long Beach to meet him. It was a one-day trip, and in a 24-hour period, the level of his disorder wasn’t apparent. It became apparent when he flew me back out in December to stay a week.

It began with the money in general and my work in particular. I was still working for the editing company in Australia and needed the money, so I brought my laptop, and every morning I’d get up before Jonathan to do my editing.

Didn’t make Jonathan happy.

If he  saw that I was editing, he’d get miffed, tell me that he hadn’t flown me out so I could work for someone else. When I tried to explain that I needed to work, so I could pay my mortgage, the loan on my car, my utilities back home, he’d get confused.

“I thought you said you owned your house,” he told me.

“I do,” I said.

“If you own it, then what are you paying?”

“My mortgage.”

He didn’t understand.

Jonathan was also quite dependent on me. From the start. He asked me to go with him to his psychiatrist’s visits – twice a week – and I did.

So we brought up the issue of my needing to work with her. She and I both tried to explain the issue of mortgages, which he still didn’t understand.

As I write all this – how it was when I first met Jonathan – I can see that it might be difficult to understand how I got so deeply involved with Jonathan, so I need to mention a few other things.

First, I’m 24 years older than Jonathan, and, by nature, I tend to be a bit of a caregiver. I like relationships in which I’m the ‘stronger, more adult, more authoritative one,’ hence, I like to teach. I like to rescue animals. I like to help. And Jonathan’s confusion about mortgages was not the only indication that he didn’t understand money, and that, in my opinion, he shouldn’t be alone.

I met him online in October, met him face-to-face, for one day at the end of November, and in December I stayed with him for five days. That’s how little I knew him, and by December he had given me his social security number, his mother’s maiden name, his previous addresses, and the passwords to all his bank accounts. In addition, whenever I told him I needed to go home, he’d write me a check for $10,000 and ask me to stay. That behavior, combined with the age difference, how gentle he’d been with me (see previous posts), and my tendency to take care of those around me, pulled me to him, in a way I’ve never been pulled before.

I still feel a bit frustrated. I don’t think I’m getting across how alarmed I was that he was living alone. Jonathan’s family is wealthy. He lives on a trust fund. For him to have given me all his financial information when he didn’t know me and when he had access to money, frightened me. In addition, he relayed stories of how in the past he’d bought people cars, motorcycles, diamond necklaces.

I wanted to help, but it was so hard.

In 2006, Jonathan’s psychiatrist had diagnosed him as having a Personality Disorder Not Otherwise Specified (NOS) of which a large component was Borderline Personality Disorder.

Borderline is characterized by no firm sense of self, huge and rapid fluctuations in mood, black and white thinking, self-destructive behavior (including suicidal ideation and tendencies), and a slew of other symptoms. Borderline responds most effectively to long-term therapy, with the treatment of choice, currently, being Dialectical Behavior Therapy. Borderline generally – and I’m not a therapist and not a psychiatrist and whatever knowledge I have is based on extensive reading, but I am not an expert, by any means -uses medication to help a client in crisis, but long-term use of medication is not always necessary. In addition, a person diagnosed with a personality disorder generally is not delusional, and there is not a neurological dysfunction, and the person can, at some level, recognize the need for therapy. It becomes more a question of the person’s willingness to enter into therapy.

Again, I am not a therapist, and although I have an M.A. in English and have done doctoral work in Education, I do not have graduate-level training in psychology. However, when Jonathan’s psychiatrist told him his diagnosis, I read whatever I could on the personality disorder. I also read whatever I could on Tourette’s Syndrome, which Jonathan also has. I understood/understand why he was diagnosed with a personality disorder, most prevalently borderline.

When I met Jonathan – and up until August 2010 – his moods fluctuated hourly, what is referred to as rapid cycling. For example, he could wake up at 9 and love me and love his psychiatrist and be completely in love with all of life, and by 10, he could be completely paranoid about me, screaming at me, and calling his psychiatrist every racial epithet he could think of.

So I understand why and how he got diagnosed.

The problem is that the diagnosis didn’t encompass how confused his thinking could get, ie: the inability to understand mortgages, the belief that if people really needed gas for a cheap price, they could simply put an oil derrick in their backyard, or that diabetes was media hype.

The other problem is that with a personality disorder there is a suggestion that it is a person’s unwillingness to seek help that is the primary problem, and if the person could somehow be forced to deal with the consequences of his/her actions, then maybe the person would ‘choose’ to get better.

With schizophrenia or schizoaffective disorder, the issue of ‘choice’ is not so clear.

Frequently, at least according to Elyn R. Saks’ The Center Cannot Hold, people with schizophrenia have a problem staying on their meds. It’s not a question of choice. It’s a question of faulty thinking. And as I understand her work, the issue is that I take meds because I’m ill, and if I stop taking meds, it’s because I’m not ill. (I may have misunderstood.)

In Jonathan’s case, when he wasn’t on the right meds, his thinking was completely off, and I couldn’t reach him. The problem when someone is delusional, ie: when Jonathan told me diabetes was nothing but media hype, there’s no argument. You can’t ‘prove’ what you’re saying. I couldn’t ‘prove’ diabetes was a real illness with real, catastrophic effects if left untreated because Jonathan would simply respond that I was reading the wrong literature.

If a person is hallucinating, you can’t say, “No, that’s an hallucination. Tom is not standing in the corner,” because your argument will be met with “that’s because you can’t see him, only I can see him.”

And you can’t say – as I once tried – that you are in a no-win situation because then you will be asked why it’s so important to win? Why do you always have to “win?” Why can’t you just get along?

In short, if you try to argue against a delusion, you’ll end up in Wonderland, where nothing makes sense, and if you don’t know the person you’re dealing with has schizophrenia or schizoaffective disorder, you will – as I did – become frustrated and angry that the person keeps pulling you in circles.

However, if you know the person has schizophrenia or schizoaffective disorder, you stop fighting the delusion. You just stop. You don’t blame. You don’t get angry. You switch to a position of “oh, this person doesn’t speak my language, and even if shout, they’re still not going to understand.”

You learn to leave it be.

And once you leave it be, the frustration on both parts stops.

And although things may still be challenging at times, the anger and frustration isn’t thrown into the mix. The chaos lessens.

Hope emerges.







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