Helping an angry person – Part 2

Managing your own anger is hard enough, but what do you do when you need to help someone else? After all, you  don’t really know what is going on in that person’s mind, and you can’t change their actions. All you have is some minor influence based on second or third hand knowledge of their situation.

Last time [Link] we covered a basic understanding of anger, assessing the risk/severity of anger, how insight plays a part in someone’s ability to change and when to leave.

Boy throwing paper in a temper tantrum. Rage. Anger.
Rage – an extreme version of anger

Why you might stay with an angry person

There are several excellent reasons to stay with an angry person. Four of the most common reasons are:

Transitional Anger

If the person is coping poorly with a temporary stressor – such as the end of a work contract, poorly managing grief, or a conflict with a family member – then the anger should resolve when the temporary situation does.

Once the situation has resolved and the anger dissipates it is time to have a serious sit down talk about what happened and why that reaction was bad due to how it affected other people. Remember to include in part of this discussion avenues for better managing anger so as not to create aggressive consequences. If this happens semi frequently, then the person should probably see a counsellor about their anger management problem.

Statue of grieving person
Grief – a common phase is anger, but it is generally short term.

Safety

Abusive partners use fear to keep their victim controlled. When the victim (measured by who is scared of the other in the relationship) tries to leave, the perpetrator will frequently escalate their violence (various methods to create fear – such as physical assault, sexual assault, intellectual and emotional abuse, destruction of property etc) in an effort to reassert dominance and control. The risk of murder increases significantly at the point of or shortly after leaving.

This is not to say that all angry people are perpetrators of domestic violence, or that if they are that they will intend to or accidentally kill their victim.

The risk increases and the victim may not feel safe to leave without a good exit strategy. This leaves the person trying to de-escalate the aggression and violence of their perpetrator.

On a side note, I have mostly tried to leave this section gender neutral as it is often assumed that men are not victims or that perpetrators cannot be women. This is not true, however it should be noted that most harm is done by males and that is mostly against females. It is also important to note that most males are not abusive, nor are most females.

Progress

The angry person has insight into their anger and the consequences of it and don’t like the effect. In this case people will often stay with their angry person in the hopes of either the return of the person they fell in love with, or an evolution to a new relationship.

As life is not binary – black or white – there is no stay or don’t stay advice for this. Each case must be assessed on its own merits. If your safety is reasonable and the angry person is making good headway into changing – attending counselling, communicating, making actual changes – then staying can be good.

Signs that it is not good are that you seem to be the source of anger, the person is making token changes that don’t actually make a difference and once you back off they return to their previous behaviours or the risk to you becomes too high.

Dependency

Dependency comes in two permutations that are not necessarily exclusive. On the one hand, you may need the angry person due to financial, social or some other factor. Leaving them may seem to be more harmful to you than good.

Another key factor is they may be dependent on you. For example, if your under aged child has anger issues, you can’t just leave them. Instead it is important to work a way through issues with the help of professionals.

Other vulnerable demographics are disabled people and the elderly. Again professional help is generally available for these situations. If the person has insight they may chose to go to a facility, there are community supports available or perhaps they person has lost insight and can be moved to a suitable facility. See your doctor to gain options for your local area.

Tempering Anger

Once you have decided to stay, it is important to categorise your angry person. They either have insight into their actions (explained in the previous post) or they don’t.

Insight

If the angry person has insight into their actions and is motivated to change, then they will be willing to go to counselling to seek anger management. This can be done in group sessions or individual sessions. There will be more than one – it takes time and dedication to change a bad habit. Sometimes the counsellor is not the right one for the angry person, so they need to persist in finding a compatible counsellor/facilitator. Gaining skills to manage anger is a process.

You and/or they can read up on self anger management here [link].

That is great for what they can do to help themselves, but the question still remains – what can you do to help them?

Assessment

Angry people are generally angry for a reason. Charitably they are angry because they feel threatened and unable to meet the threat in a dispassionate way, thus they escalate in aggression to meet  the perceived threat. When someone is already feeling pressured or stressed, excuses can be made to vent out frustration, excusing their anger.

The assessment section is to try to primarily ascertain what is the cause, if possible, for the anger; and secondarily how strongly are they reacting. Ideally this is done via a conversation with the angry person.

Communication

Keeping lines of communication is essential to resolving anger quickly, but it isn’t always feasible. The angry  person is likely already feeling threatened and may perceive questioning as a threat or an excuse to be aggressive.

Having a conversation with the person before they are angry about agreed upon signals to identify concern and ways they can assure a lack of anger, or a need for space is important. Remember that the last thing people who are angry want to hear is the phrase “calm down”. Instead ask questions, starting with short answer and working your way up to conversation. Start with an observation like “you seem a bit miffed/angry/peeved/frustrated [pick one]” and let them voice or indicate an affirmative or negative such as “yeah” or a head nod. If they affirm, then perhaps it may be suitable to ask “are you okay?” allowing for a short response. If that goes well, open a conversation with “what’s up?” or “want to tell me about it?”

Sometimes whens you are in a crowd it is bad form to ask “are you angry?”, so having a code phrase like “green light or red light?” where green indicates things are going okay and red indicates problems allow for you to support your angry person without alerting everyone to the situation.  Your angry person may have a code phrase to tell you they need to go out and get some air.  Having these codes available to you both that have been organised when they are feeling cool and level headed is essential.

Giving Space to Support Self Management

There are various methods to self manage. Often taking oneself out of a bad situation is a first good step, or doing a distraction to shift focus away from the source of anger, or helping oneself to a drink (not alcohol – that can fuel anger or detract from self control). Take a look at our Anger [Link] page to look at more self-management techniques.

When to Judge

While the angry person may not be responsible for their mood, they are responsible for their actions. It is more than possible to be furious and do nothing. It is important to challenge bad behaviours – aggression and passive aggression – and not take responsibility for the actions of another.

However it is important to consider timing. A calm discussion to explore the consequences to actions is civil and likely to have a good outcome, while pointing out the other person is being bad in the middle of an enraged temper tantrum is basically poking the angry bear. Keep in mind that as feelings become stronger, the ability to think rationality decreases.

Above we talked about communication and phrase words. Things like “you are scaring us/me” or “you seem really furious” or “is it punching bag time?” are observations and prompt the angry person to regain control of themselves. If this is ineffectual, then it is time to get out for a while to be safe.

Judging is not a bad thing. Holding onto that judgement despite newer facts is.

Next time [link] we will be covering how to help someone with no insight.

Helping an angry person – Part 1

Managing one’s own anger is challenging, but managing another’s can seem impossible. While the common answer to facing someone else’s anger is to walk away, if you are in a relationship with them, that isn’t always the best solution. Here is some ways that you can help.

Frustration indicates anger
Feelings of frustration are an indication of anger

Understanding Anger – a Quick Recap

First of all, we will recap a bit about how anger works and operates. For a full write up on this, go here [link].

Anger is the feeling we have to tell us something is wrong, and by wrong we mean detrimental to our wellbeing.  If someone gives you a $100 door prize, you don’t generally feel angry about it, yet when someone tries to take that $100 from you, anger is a fairly common response. If someone offers you a cup of coffee you don’t feel angry, but if someone tells you to drink that coffee, you do.

The first example was about loss resource and the second was about lost choice.

Anger comes in a spectrum of levels. Annoyance, frustration, seething, anger and finally rage. There are, of course, more versions – but let’s keep this somewhat simple.

When you can address the thing you are angry about and resolve it, you feel less angry. When you can’t, your anger rises. We can resolve problems by putting up with them (passive and passive aggressive), solving them (assertive and aggression) and avoiding them (running away).

Passive

It will take more resource to fix the problem than putting up with it. Waiting a while will likely mean the thing goes away.

Passive Aggressive

It is still not worth fixing, or trying to fix it will make it worse. However there is a rising feeling of aggression that wants to be vented, so either sabotage the thing, redirect aggression to a safe outlet, or internalise the aggression in self harm.

Assertive

Try to solve the problem like adults – it takes two to make this work.

Aggressive

Use force to make it fixed.

Avoidance

It isn’t going away, it isn’t listening to reason, you can’t use force to fix it, so get out and get away.

Primary vs Secondary Response

While anger is a basic feeling, one of the basic 6 feelings (Joy, Anger, Sadness, Fear, Surprise, Disgust), it may not be the first feeling you feel when presented with an event. If it is, then it is the Primary Response – that thing that happened really annoyed me.

Often, though, anger is a Secondary Response. The thing may trigger fear first and anger second. Trying to resolve the anger without addressing the initial fear well lead to resistance to calming down and potential retriggering of anger because fear is still present.

It is common for many cultures to channel any non joy basic feeling into a secondary response of anger. Disgust leads to anger, surprise leads to anger etc. This is often because we are not well versed in dealing with these other feelings, and or they are not perceived as allowable feelings, but anger is. This makes it particularly tricky to manage both the primary and secondary response to the event that triggered an emotional response.

A full rundown of this section on anger can be found here.

Managing Another

There is quite a difference between recognising your own anger and managing that versus understanding someone else’s anger and managing them.

First of all, from an egocentric perspective, you can look at your own feelings and triggers with much greater clarity than you can guess what another person is feeling and why. Secondly you can take direct steps to manage your own anger (walk away, breathing etc) but only indirect steps to manage the angry feeling in someone else.

Necessarily managing another person is tricky. You run the risk of either enabling their behaviour or triggering a greater anger response.

Impact

Sometimes your loved one is angry once in a blue moon, sometimes they are angry all of the time. Sometimes the level is mild and sometimes it is terrifying.  Sometimes it is warranted and sometimes it makes no sense. All of this has an impact on you and others.

Frequency  – How often a person is angry – infrequent or frequent

Level of anger – How angry does the person get? Minor irritable or explosive aggression?

Circumstances – Does it take a significant event to provoke anger, or is the anger waiting for any trivial excuse to be let out? Anger tied to circumstances can lead to predictability or unpredictable aggression.

These three aspects are the larger part of establishing the impact of another’s anger to others. For example, a person may be infrequently angry, but it is extremely explosively aggressive and seems to be at triggered by random occurrence. This makes the impact seem random and scary. This can leave people wondering what is going to trigger the anger and how bad it is going to be.

If someone’s anger impact is low to moderate, there is little call for an intervention. However if their impact is medium to high, then there may be.

Insight and Responsibility

Insight

The fact that you have recognised someone else has an anger problem is only a small fraction of the issue. They need to recognise it too.

Being aware of your own behaviour and traits is an important first step to actively doing something about it. Another key component of anger is recognising that it is an issue to other people – that is, their anger affects others, and that this is a problem.

We call this awareness Insight. If angry person is unaware that they are angry, then they can’t do something about being angry.

Responsibility

Once a person is aware of their actions and recognised that their actions are affecting others, they also need to acknowledge that they are responsible for what they do and that effect on others. Dodging responsibility often goes hand in hand with statements like “look what you made me do”, or “if you hadn’t done X I wouldn’t have to do Y”, or “Why are you so upset?”

A person who has insight and takes responsibility is primed and ready to do something about their anger and how their aggressive response is impacting other people. The best solution is for the person to go to therapy and get some anger management counselling. Remember, feeling angry isn’t the problem – it is how that anger is managed that is failing.

Managing Angry People

When the angry person doesn’t recognise that they are having anger issues, or that they are responsible for managing this and the effect is has on other people, then they are not going to manage themselves. You have two options: avoid them, or manage them.

Avoiding sounds easy in principle – just leave. Get out. Get a divorce. Get a restraining order if needed. Cut the heart strings to them and get on with your life.

In practice, though, it is much harder than that.

For a start, you care about them, you care about the consequences to leaving or are scared of what will happen once you are gone. Often you love the person who isn’t angry and aren’t sure of what to do with the person who is. You keep hoping that if you wait a little bit longer, plea a little harder, try a bit more, then they will change and become that person you knew.

The reality is that if the person has no insight awareness of their anger and its consequences, then the angry person is not likely to change. If you can safely leave, it really is the best option. Call the domestic help lines, either Men’s if you are male, or women’s if you are are not. Clearly identify that you are scared of your angry partner to get put to the right channel. Each country will have their own variant of this. This opens the door for your leaving.

Sometimes it really isn’t possible to leave. When that happens, you have to manage your angry other – we will deal with those options in the next post.

The Five Love Languages

“The Five Love Languages: How to Express Heartfelt Commitment to Your Mate” is a book written by Gary Chapman in 1995. It talks about how we want to give and want to receive love (not necessarily the same thing) and how those we love also want to receive and give love.

The awkward part comes in when these are not the same, or worse, not really compatible.

Below is a generic chart of some of the dos and don’ts of these languages.

Figuring out the languages of those we love means we can consciously shift our expression and expectations to match theirs.

While it is difficult to scientifically test these and there may be cultural differences, it is still a useful concept to consider.

https://en.wikipedia.org/wiki/The_Five_Love_Languages

5 Love Languages
5 Love Languages

Neuroplasticity

When I was growing up it was believed that the adult brain was done learning and only inevitable death from neuronal pruning would result. This was how we understood Alzheimer’s Disease worked – the decaying brain. It was thought that what you knew as you entered adulthood was all that you could know.

Clearly this is wrong. However it was the human biological model that was taught for a few hundred years – pretty much since it was recognised that the seat of consciousness was the brain and not the heart.

Research as early as 1923 by Karl Lashley was starting to buck the trend (his research was on rhesus monkeys showing changes in the brain pathways), however the momentum of assumptions took almost 60 years to shift. By the late 1980’s the idea of neuroplasticity was becoming real. With the advent of fMRI and direct brain observation via direct electrodes to the brain, the idea of the  adult brain actually changing because of experience was receiving recognition.

So what does this mean to us?

The first bit seems kind of obvious. We can continue to learn as adults. We instinctively know this because if you can remember yesterday, then you have learned things. Learning involves creating memories and using those memories to solve problems.

The next bit is a bit let obvious. Changing the brain’s software changes the brain’s hardware. That is, if we change our behaviour we change our brain pathways and chemicals. If we can change our brain pathways, then we can learn to be less anxious, learn to not be psychopathic and we can learn to recover from many brain injuries.

There are limits though. We can only go forwards, we cannot go backwards. What this means is if we have lost a memory, it is gone. We can’t go back to how we were. This may seem sad and not what we want, but really, growing means going forwards, not backwards. We grow up, not down. So go forwards to a new you.

Not all things can be learned new, some things just need to be compensated for. For example, one of the spectra for autism is not being able to pick up the social cues of others very well. Some people with autism do this quite well, some do it very poorly. An person with autism can learn to do this better with good coaching, but will generally not learn it well enough for reading social cues to be effortless.

What neuroplasticity tells us is that you can change the way your brain works. Change the software, you change the hardware. To do this well takes a good therapist, a good rehab worker or some dedicated research and effort on your own behalf.

There is no locked in stone and hopeless case. If you want to change – you can.

Neuroplasticity
Neuroplasticity is the brains ability to change itself

More can be learned at WikiPedia

Common presentations for help

As a mental health social worker, counselling people for the last 10 years, I have worked with a diverse group of people trying to recover their lives from, mostly, mental health issues. Not surprising when you look at the work I do…

However what I find fascinating in a statistical sense, is the reasons why people come to me.

The 3 most stand out reasons why people come to me for help are:

1) Someone is hurting them, but they think it is their own fault.

2) They have troubles regulating their own moods and reactions.

3) They are struggling against a real life situation – commonly unemployment/Centrelink or something like job loss / death.

The next category of things I tend to come across

1) Neuroatypical people trying to figure out what the heck is going on

2) Non-mood regulation types of mental heatlh disorder

3) Someone very concerned at another person’s struggles and trying to figure out what they can legally, resource, morally or ethically do.

Anxiety – Not something to get worked up about

Anxiety is a the fear that something is about to go wrong without a thing actually going wrong.

When we are in immediate danger – about to be hit by a truck, an attacker is aggressively moving towards you, you’ve just been caught doing something wrong – we have an internal button to get all systems on line. That includes focusing the attention to the immediate problem, suping up the body for immediate action and forcing that action into happening now. Because of the immediacy of the threat, we don’t have time to think about what to do – we act on instinct. Usually that is run, but sometimes that is attack – or in more common words, flight or fight.

When the threat is clear and present, you are not having an anxiety attack, you are having a justified fear response.

When there is no clear and present threat (such as worry about what comes next, the feeling of dread with no thing causing it, the feeling that everyone is watching you or the fear that someone is going to break into your house), and your brain presses the internal button to get all systems on line, you are having a panic attack.

Often a panic attack is mistaken for a heart attack, breathing problems or going crazy. It usually follows being very anxious – fearful – of what might be going on.

Anxiety is a feeling of powerlessness about something that is either prompting fear or anger, whether it is present or just anticipated.

Anxiety sucks.

To manage this requires retraining your brain to not be anxious. First assess – is there actually danger here? If there is, then deal with it or run. If there isn’t, then slow down – you’ve got time. If danger suddenly appears, go back to that first step. Now that you’ve slowed down, calm down. This is achieved through controlling your breath. It is the only part of “all systems on line” that we can take manual control of and mess up the automatic system that has erroneously been triggered. Grounding exercises come next. Once we are calmer, we can think more clearly. Now assess the problem – if it is a false alarm, stick around for a few minutes while continuing your calming exercise. This teaches the brain that this, here, is not a fear situation. If there is something to address but your brain over reacted to it, calmly plan a solution that addresses the actual problem rather than fighting it or fleeing from it. Do the plan. Afterwards congratulate yourself on not panicking and managing to remain in control. The rewards is very important.

If you want to know more about this, let me know.

Social Anxiety

Imagine, if you will, a time before cities, a time before agriculture, a time when it was human versus the untamed world, alone and unsupported. Imagine this is around 50,000 years ago.

 

Imagine you are alone in this part of the world. You are sitting by a river, sorting the plants you have gathered. Some of these plants are edible, some are useful for making tools, some are poisons/medicines and some are just useless to you. You have a few tools, a thumping stick, a spear and a bowl you have carved out of a slab of tree with some stones. You don’t carry the stones, because they are heavy.

 

There are dangers around you. A crocodile in the water, if you get too close, a venomous snake in the tree, and over there on the horizon is a thylacoleo, a nightmare cross of a tiger and marsupial, like a thylacine (Tasmanian Tiger) on steroids. These things could all kill humans and would frequently do so given half a chance. However if you keep on your toes and are ready go hoof it if one gets too interested, you stand a chance.

 

Sooner or later you need to sleep. Different predators come out at different times of the day and night. The average person can stay awake for about 72 hours if necessary, however functional effectiveness usually begins to decline around hour 19. Basically, sleep at your own risk.

 

Time to get an ally. Someone who will watch over you while you sleep in exchange for you watching over them. This won’t work if you don’t actually honour your bargain. If you steal their stuff and leave, or kill them, then you’ve got no one. If they do the same, they have the same problem. Trust is very important. However what choice do you have? You need them and they need you.

 

Having an ally is great. When the Thylacoleo comes a stalking, you can work together to overcome it. Two are more likely to defeat this beast than one is. However if one of you gets seriously hurt during the combat, you are back to being alone. You need a spare.

 

Forming a trusted group of allies is even better than having just one ally. With one ally, someone has to be awake while someone sleeps. The average human needs 8 hours of sleep per 24 hours. This means that 16 hours in the day is spent sleeping for the two of you to remain optimal. With three people this drops down to 12 hours wasted on sleep, which is around the same number of hours as night time. With 5 of you, some people don’t need to interrupt their sleep – that is, every few days everyone gets a full nights un-interrupted sleep.

 

Other benefits of having a group is that you can exchange knowledge. “When I stick my spear in the fire and let it get slightly crispy, the end is harder and penetrates my prey easier”, “oh – that is how you start a fire, that seems really efficient” and so on. Another great advantage is keeping each other awake during wake shifts, collaborating in hunts, working together to build things and so on.

 

There is risk that comes with having a group. I like you, you like Jo, Jo likes Sasha, Sasha likes Alex, Alex likes Lee. But I hate Lee. If I have too much conflict with Lee then the rest of you might think you are better off without me. If a divide happens, and I am split off from the group, I am on my own while there are four of you to watch each others backs. I need the group more than the group needs me. When there were just two of us I had to put up with the irritating things about you and vice versa because we needed each other and we had a lack of choice. As the group expands, the need to put up with someone decreases. They either comply to the group rules or they suffer for it by being kicked out.

 

Often group rules are not explicitly stated. There are a few of them that are – we don’t kill each other, falling asleep during your wake shift is bad, don’t steal and so on. The ones that are really dangerous are less well stated rules, the unspoken rules, the implicit rules, the rules everyone else assumes but no one has told you about. The things you thought were fun but they think are taboo. Each group has them, and no one talks about them. Most people unconsciously adopt these rules and don’t really think about them until one is transgressed. At this point people look to the group to see if they all, or enough of them, agree with you. With support, you will look at the transgressor with disgust and they will either conform or get out. If I think an action should be taboo but no one else agrees, then I will either change my stance, or more likely begin a campaign to get everyone else to agree with me.

 

There are people that don’t pick up on social rules very well, and or miss social cues to say “you crossed a line” or “enough”. When the group recognises this, but sees value in the individual despite the difficulty they have with conformity, allowances can be made for that person. Some transgressions are frownable offenses (they get frowned upon, but tolerated) and some are zero tolerance, leading that person to be exited from the group. It is a sliding scale and not all group members will agree on what that scale is – either specific order or what behaviour crosses this part of the scale from acceptable to not acceptable.

 

Once you are fairly secure in your group, one tends to boundary test a bit. What can I get away with? Sometimes this is a power game – I wonder if I can get away with this… Sometimes it is a side effect of relaxing and being lazy – it’s a lot of effort to conform to that rule, so I’ll let it slide a bit. A consequence to this is risking being kicked out.

 

Once you are out, you need to quickly find another group to join. Humans don’t do well on their own. Once you find a group, you now need to learn their rules, because each group is different, has different goals and grows organically in different ways. Organic growth can look similar, but each is unique. When I hang out with the mercenaries, a certain kind of humour is not only tolerated but is welcomed. When I hang around religious people, that kind of humour is taboo. However there is no list of social rules, I am just supposed to know what these rules are.

 

Often it is easier for me to conform to the group than it is to get the group to conform to me. This works well when the new group is, for the most part, right. Or at least not blatantly wrong. They are a compatible level of right. 6 + 3 = 9 for my old group. This group prefers 3 + 6 = 9. Meh, close enough. However if they insist that 5 + 5 = 9, well that is just wrong. Now I need to work out – do I try to correct the group, put up with the wrong thing, or leave the group? If I try to correct the group, I may get kicked out of the group. If I put up with the wrong, I may become complicit with the wrong. If I leave the group, I’m on my own again – will the next group be equally wrong?

 

Conformity is a big thing in humans. We are biologically driven to conform or leave. Often, though, we aren’t conforming to the group per se. We are conforming to the leader of the group, who through strength of charisma, defines the explicit and implicit rules of the group. If they are good enough, they stay the leader. If they underperform, either the group suffers or the leader is replaced. If you cross the leader, you place yourself in quite a bit of danger. Non-conforming behaviour automatically brings you into conflict with that leader.

 

In this modern time, I live in a city with millions of people. Most of them are strangers. I have a few small groups that work with me, or perhaps, allow me to work with them, to survive. I have my family group, most of whom are allies, and some are Lee. I have my work, most of whom are friends of Lee – that is, associated and acquaintances – not friends, but not enemies either. I have social groups, the people I prefer to hang around with, but it is with a purpose.

 

For each of these I am expected to behave in a certain way to conform to their explicit and implicit rules. Behind these behaviours I need to hold on to who I am – me. If that “me” conflicts with a group, or where a group is going, I need to either decide to correct that group, correct me, or leave the group.

 

The thing I fear is discovering that I have transgressed a groups rules too late to correct and stay. That isn’t me choosing to leave a group, that is me being kicked out of a group. That lack of choice is a real kicker. Often I will feel like an imposter in the group while I try to figure out what enough of the rules are to survive.

 

Once I seem a bit more comfortable with the group, I can start to express my true nature a bit more. This has risk, but it also helps me to become a unique part of that group, where the good that I bring outweighs the odd that I bring, where odd is pushing that rule boundary a bit in non-conformity. After all, if there are multiple wood carvers and food is scarce, get rid of a surplus carver. However if I am the only one that makes high quality spears, then they don’t dare get rid of me. I need to find my niche in the group and make my “me” needed, yet at the same time, don’t cross enough rules that it is cheaper for the group to lose that niche than to keep me.

 

Social is complex. Social anxiety is the fear that we will be judged as not worthy of the group and we will be kicked out and end up on our own. We would often rather take on the isolated role through our own choice than risk being excommunicated by the group for transgressing some rule we didn’t know about, or some rule that doesn’t make sense. The danger of being rejected is real and the consequences can be devastating to the ego. Each rejection indicates that you failed to find a niche that was valued, and by simple logic it seems that there is nothing about you that is valued, that is, you think you are worthless. It is very hard to balance that role of being a conformed part of the group and being unique enough to be a niche filler. After all, if you are yet another woodcarver, what value are you? If your niche is rejected, again, what value are you?

 

The person working through social anxiety is hypervigilant to any signs of transgression – one’s own or that of others. Suggestions of rejection by group members will be klaxxon clarion bells warning you to comply, comply, comply, or run, run, run. Other people’s transgressions are used to try to understand the implicit rules better, or to work out which explicit rules are not as rigid as one was led to believe. It becomes baffling when Lee can transgress a rule and you get punished, and that is because part of the implicit rules is a scale of acceptance based on your perceived value to the group – a placement in hierarchy.

 

Hierarchy is often mistaken as a linear scale from least important to most important, when really it is more like a branching tree. The leader may be at the top of the hierarchy, but often they are actually the second top and the true power lies in the person behind the scenes. Or there isn’t so much a second in charge as there are several second in charges. Or George provides unique X so we allow them to get away with various Y, and since you don’t, you can’t.

 

I’ve covered here the basic biological establishment of groups and built up to some of the complexity of group engagement. This is just an introduction to some of the issues faced by people with social anxiety – the fear of people in groups and your place in them. It is distinct in many aspect to agoraphobia, which is the fear of being in a crowd [of strangers] and/or open space. I might cover that one in the future at some point.

Schizophrenia

All people have behavioural and psychological traits, such as being happy, being sad, being angry, having belief in a thing, being talkative, flinching from danger, being self centred and so on. The list is very long and changes subtly from culture to culture. When one of these becomes dominant they can progress into a disorder and then into a mental illness.

 

Frequently these disorders and mental illnesses can be managed by treatment, which can  include therapy, lifestyle changes and possibly medication. Most of these disorders are where there is an over expression or under expression of a normal human trait, possibly due to a chemical/hormone imbalance or a behavioural trait that is learned and can be unlearned.

 

Then there is schizophrenia. Schizophrenia is defined by positive and negative traits. Positive traits are behaviours and experiences that most people don’t have while negative traits are an absence of traits most people do have. An example of a positive trait is the soft drink dispenser asking you about your day where no one else hears it or experiences it (this excludes pranks or “smart dispensers” that talk to everyone), while an example of a negative trait is an absence of joy.

 

Along with positive and negative traits there is frequently a cognitive dysfunction. To a mainstream person, a person with schizophrenia will use chains of logic that almost make sense, but don’t. Dysfunction can also be lost memories, lost skill sets (I use to be able to do this, but now I can’t) and strange beliefs.

 

As with all conditions, schizophrenia presents on a spectrum. Simplistically we can look at a simple linear functionality spectrum, from managing fine in the community without medication, managing with medication and treatment, to not managing. However the reality is that the spectrum is multi-axial. That is based on how much of each of the above signs and symptoms are present and how capable is the person experiencing this is able to compensate and manage.

 

Schizoaffective disorder is a combination of Schizophrenia and Affective (mood) Disorder, where both symptoms of schizophrenia and mood disorder are present, but not quite enough of either to diagnose the person in either category. Often people will receive this diagnosis before being upgrade, if necessary, to the schizophrenia diagnosis later.

 

Please note that this is all a simplified version of what schizophrenia is and is not a diagnostic guideline.

 

Often people diagnosed with schizophrenia will be referred to, or refer to themselves, as schizophrenic. This is very common in mental illnesses and some other illnesses – to mistake oneself for the diagnosis. I am schizophrenic, I am autistic, I am diabetic, I am broken armian, I am chronic pain, I am momentary headache. The fact is, you are a person first, diagnosed with one or more of these issues as a description – not an identity.

 

Highly creative people are able to look at disparate information and make sense out of it. Examples of some of these creative people are artists and scientists. This ability is all about making unusual links and then testing to see if it is feasible and doable. Uncreative people are not able to make these links and follow more traditional means of connecting information together. People diagnosed with schizophrenia are thought to lack the second part of this ability – testing. That is, reality testing to check if it is feasible and doable. The hypothesis is that people with schizophrenia lack the important reality testing part that rejects ideas, thoughts and visions that shouldn’t work and/or exist and instead assume that these ideas are real and accurate.

 

Another angle on this hypothesis is that the brain misfires certain inputs (stimuli from outside the body, such as sight, touch, smell etc) or the processing of internal inputs (memories, thoughts) and ends up with a bizarre result. This bizarre result is then accepted as accurate rather than rejected before the conscious mind is aware of it. All brains misfire and come up with unusual result, but generally these ideas are rejected before much attention is given to them. A hypothesis about schizophrenia is that either this rejection isn’t very good, or that there are so many misfires that the brain assumes it must be true. Any lie told often enough takes on a hint of truth, so enough repeats of the wrong idea will start to seem right.

 

Schizophrenia seems to have a genetic component. If you have a family member with schizophrenia traits, then it is more likely that you will inherit it. This isn’t much of an increase though. Instead of it being about 1 in 200 people, you are now 1 in 100 people – which is not much of a shift. It can also be spontaneous, with no family history of schizophrenia. Most often it is developed during the early to mid teens. Some mind altering substances are thought to cause schizophrenia in some people, but the evidence for this is weak. Did the drug cause schizophrenia, or was the person already experiencing some symptoms that they were trying to treat with illicit drugs? Which was first? Or even if there were no preceding symptoms of schizophrenia, was the person going to develop them anyway, and drugs were a correlation rather than a causation? What has been evidenced is that some illicit drugs have a higher correlation with schizophrenia diagnosis than others.

 

Not all people with schizophrenia need treatment. It is estimated that roughly 1 in 3 people who experience these symptoms manage themselves without input from mental health teams and or medication. They experience full and generally happy lives. Another 1 in 3 of these people respond well to treatment, where they find the skills learned through therapy and or antipsychotic medication mean they can lead a fairly high quality community life. Unfortunately it is estimated that roughly 1 in 3 people don’t respond well to medication or therapeutic input, struggling to find meaning and quality in their life. The exact statistics are difficult to get as not all people who experience symptoms are diagnosed or have any interaction with mental health.

 

If you are in the last of these 3 subcategories, take heart. Many people who didn’t respond well to the medical model of treatment found good support from peers (those with similar experiences) via the Hearing Voices Network – a worldwide organisation. Even those in the first two categories have frequently found positive value in connecting to others. It isn’t for everyone, but it does exist and can help.

 

Another thing to look into is the recovery model. The idea here is that you have a thing, and it is big and somewhat disruptive. How can you manage that big and disruptive thing, minimising its impact? And wherever that big thing doesn’t disrupt your life, how much comfort and meaning can you get? Recovery is about recognising that this diagnosis is about a thing you have, it isn’t defining you. I have an arm – does that make me an arm? No. I am a person who is more than my arm. You have schizophrenia, that doesn’t make you schizophrenia.

Little Dog Syndrome

This is an analogy that I have thought up – it isn’t a clinical disorder. However it is an interesting perspective that can be useful.

Cats are gods. They know they are gods. They know that other cats are also gods. When they meet each other, sometimes they have a fight, but mostly they nod their head and basically say “sup”, as in “what’s up?” Cats don’t growl at humans or creatures passing by the fence, flying in the trees and so on. They know they are gods. They don’t have to prove it. If you can’t see their godhood, that is your loss.

Chihuahuas, on the other hand, wish they were rottweilers. They like to prance about, bark loudly and growl at everything to prove that they are rottweilers, despite their physical appearance. If you look at them, you see their posturing and say to yourself “wow – a powerful dog”. Really, though, despite their bluster, they only harm they can give you is a small nip, unless they trip you up and manage to get you in the jugular or something.

Generally they are all noise and no really threat.

They hate it when you know that. They must prove to you, impress upon you, that they are big and powerful and worthy of respect, which they only see in the form of fear.

Rottweilers fear that you look at them and think they are a chihuahua. So they have to defend their territory and be the biggest, scariest dog on the block. Go past their designated space? Barking ensues. Meet another dog, they must prove they are the dominant beast. Because when two dogs meet, only one can be the rottweiler, so the others must be the chihuahua.

When dogs look in the mirror, they see a chihuahua, regardless of what others see, regardless of their breed. “I could be bigger, more ferocious, more feared” they think, “that little dog – it is pathetic. That is nothing to be feared. That’s what others see. I have to be more ferocious”.

For a dog, there is nothing more terrifying than someone else seeing that you are weak. Even with the best of intentions, any reassurance that they are not weak, small and insignificant highlights that you can see that they think they are, and you will be seen as the enemy. Trying to help these people is a good way of getting your fingers nipped. Praising them for how big and fearful they are is a way to appeal to their delusion. It can keep you safe for a while, but it is time limited.

Mostly little dogs don’t get help with their fear, because first they have to acknowledge that they are, indeed, little dogs. And that is terrifying for them.

Domestic cats mass about the same as a little dog. Big cats, like tigers and lions, massively outweigh the biggest dogs. Yet domestic cats know they are gods, so don’t care, while little dogs only see themselves as inadequate big dogs.

So when you see one of these dog people yapping at you, realise that their yapping is telling you what they see in the mirror – a little dog wishing they were big and ferocious. Do what cats do. Get out of the way, see them for the dog they are and mostly ignore it. Be a god.

== please note, I have met some really nice chihuahuas, rottweilers and some very insecure cats. This is a thought idea rather than a statement that all chihuahuas have issues.

 

Narcissistic Personality Disorder

Narcissus was a mythical character from ancient Greek times who was the son of the river god Cephissus and nymph Liriope. He was physically beautiful, but disdained those who loved him. The goddess Nemesis learned of him and drew him to a pool of water, where Narcissus saw his own reflection, fell in love with his own image and starved to death rather than leave the picture of perfection.

This myth gave rise to the term Narcissism – an exaggerated opinion of self and self worth, which lead to Narcissistic Personality Disorder (NPD), previously called megalomania. NPD should only be diagnosed by specialists, and while it is easy to see someone acting egotistical and self centred and label them as NPD, the odds are you are just dealing with a selfish person.

People often mix up the meanings of NPD and psychopathy (sometimes referred to as sociopathy). While they are both personality disorders, they are polar opposites. Both can be devastatingly harmful to others. Psychopaths don’t get empathetic feedback from others and so don’t really care what you think, just don’t get in their way too much. Narcissists need you to have positive feelings for them. There is far more to psychopathy, but that isn’t the scope of this entry.

Narcissists fear being exposed as frauds, being seen as weak, incapable or vulnerable. This fear requires them to create an image of perfection for everyone to admire. Narcissists need admiration of others. This fear of exposure makes it very hard for them to get help as they first have to admit to someone else that they need help and expose their vulnerabilities to a therapist to work on the core fear of exposure.

It is thought that roughly 1 in 100 people have NPD to some pathological level, although it is hard to truly gauge as people who could be given an NPD diagnosis don’t tend to come forward to be assessed. While the prevalence could be as low as 50% male vs 50% female, it is thought to be as high as 75% male vs 25% female. Mostly it is considered to be more likely a male trait, but certainly not exclusive.

The American Diagnostics and Statistics Manual version 5 (DSM V) states the following:

[TLDR – To have NPD, the condition must hinder the individual and others in specific ways and be characterised by some antagonism, grandiosity (feelings of entitlement) and attention seeking, but not be a recent or brief thing or explained by some other condition or circumstance.]

“The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose narcissistic personality disorder, the following criteria must be met:

Significant impairments in personality functioning manifest by:

  1. Impairments in self functioning (a or b):
  2. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.
  3. Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.

AND

Impairments in interpersonal functioning (a or b):

  1. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.
  2. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality  constrained by little genuine interest in others‟ experiences and predominance of a need for personal gain

Pathological personality traits in the following domain:

  1. Antagonism, characterized by:
  2. Grandiosity: Feelings of entitlement, either overt or covert;  self-centeredness; firmly holding to the belief that one is better than others; condescending toward others.
  3. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.
  4. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.
  5. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.
  6. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).”

While the exact mechanism for why the disorder occurs is unclear (could be a genetic component, environmental component, developmental delay etc), the traits often begin in adolescence and get stronger. Many teens show some of the traits – being self centred and reactive is often what it means to be a teen, the traits in most teens are not overrepresented and will diminish in time. When the traits get stronger and don’t resolve the NPD diagnosis may become relevant.

It is easy to over pathologise being confident and assertive as NPD. Being sure of yourself and your capabilities is not a hallmark of NPD. What is a better tell is what happens if you are told you are wrong. If you check to see if you are, or take on board suggestions from others, then you do not have NPD. If you feel threatened and retaliate to reclaim your feeling of comfort, then perhaps you should speak to a professional therapist.

The core of the disorder appears to be the fear of the self being weak, and the need to prove that isn’t true. That very need to prove capability and brilliance proves the weakness. A person who knows they have ability just goes quietly along and does what they need to do. They don’t need others to congratulate them, admire them or reassure them. They just do it. The occasional thanks is nice, but not required.

It is tempting to pathologise the human need to be recognised as worthwhile, and have your actions validated. The difference between this human need and NPD is in two parts: the first is that when most people are validated, it assures them they are on track – it is a confirmation rather than a requirement; the second is how the person seeks that validation and what they do if the person is told they are doing the thing wrong – NPD people will attack if they are not validated and will seek the validation using negative manipulation or cajoling, while other people will check to see if they need to change what they are doing to better match reasonable societal expectations.

If you have read this and think … oh dear, perhaps I have NPD, then by all means go and talk to a therapist and get yourself checked out. In Australia, go to your doctor, express your concerns and get a referral to a suitable therapist. You can learn to decrease your fear and empathically connect better to others.

If you have read this and think … oh dear, my family member / close friend / boss may have NPD, then there are a few things that are a good idea to do. First of all, assess the damage that person is doing to others (including yourself). If there is no significant emotional harm, social harm or financial harm, then they probably don’t have NPD. NPD requires both the person to have a fragile ego and be causing problems with other people because of it. By all means, go see a therapist to discuss your concerns and get some specific help in working out if this person who is affecting you fits the profile – going through all the possibilities is beyond the scope of this article.

If your conclusion is that this person does fit the NPD profile, then you need to ensure you protect yourself first. These people are often incredibly charismatic and have a reality distortion field. If you see through these, they feel exposed and threatened by you and will act against you.

The charisma is the narcissists learned ability to manipulate the affection and awe of those around them to validate their need to be loved and respected despite their fear that they are inadequate. Unfortunately most people are prone to fall for these as the manipulation methods rely on hijacking normal social interactions and tuning them for their own exaggerated benefit. The reality distortion field (named after the Steve Jobs effect) is where reality seems to be different around these people. They can convince people that black is white, giraffes are short and that things that you thought happened didn’t, oh and by the way, you are responsible for that thing that went bad. This can leave you very confused about what is right and proper, wondering if you are really the one who needs help because there is clearly something wrong with you.

When a person with NPD fails to charm you, or you fail to admire them, or you seem immune to their reality distortion field, they will feel threatened by you. The fear they have is that you can see through to their true self, whom they feel is pathetic and worthless. While it is tempting to try to convince them that you can see their true self and want to nurture it, to help them grow to not be what they fear, the majority of people diagnosed with NPD will see you as a threat and will take steps to protect themselves from the perceived threat. This will take the form of crass social manipulation, threats, erratic mood swings, childish tantrums and possibly direct attack. In effect, they will try to bully you into submission, demonise you, and try to convince others that you are some kind of evil. The charismatic nature of the condition means that people will begin to believe the person with NPD, or keep giving them the benefit of the doubt. In short, you can’t nurture them back to a healthy balance.

Sometimes it is best to walk away. Only if the person with NPD recognises themselves for what they are and seek help on their own (by all means encourage, but don’t push), will they have a chance to work through the diagnosis and recover their sense of inherent self worth rather than fabricating a facade of competence.