In editing process…… maybe back later!!
This is a serious mental health problem that has recently been identified and studied by mental health professionals and other interested parties. This leaflet is intended to give you a basic grounding in understanding the condition in order that you can identify it in your family and friends and thereby empower yourself to offer them support. As always with any serious medical problem it is best to consult a doctor in order to get the best medical advice.
What is obsessive posting Disorder (OPD)?
Obsessive Posting Disorder is very common, although it is only recently that the extent of its occurrence has been recognised and individuals successfully diagnosed. OPD is a condition that effects many middle class professionals, but it has been recognised amongst all social classes and groups. Young and middle aged persons are particularly affected. It seems to be particularly prevalent amongst activists and other persons who have passionate belief systems. The major characteristic of OPD is an excessive desire to communicate your thoughts, feelings and acts to relative strangers despite major contra–indications to the appropriateness of such communications. However there is still great controversy about what OPD is, what causes it, and how it can be treated.
What are the signs of OPD?
Every person with OPD is unique, however it is useful to know what common symptoms to look for which may indicate the presence of OPD.
A. Characteristic symptoms: Three or more of the following, each present for a significant portion of time during a one month period.
1 Bizarre communication: Such as with people they have no known relationship with, about issues of an idiosyncratic or personal nature which would not normally be suitable for public disclosure. Communication will be incessant and obsessive, and the sufferer will engage in it throughout the day and night.
2 Inappropriate communication: Insisting on carrying on communicating despite clear evidence of disinterest by the recipients of such information. In particular the fundamental ground of human discourse, the acknowledgement of the other is frequently lacking. This often manifests itself in lack of common courtesy and impaired understanding of the other communications.
3 Disordered cognition and Intellectual rigidity: Suffers often display bizarre thought patterns. This can manifest in rigidly held beliefs (which are held to be facts). Holding on to the validity of such ideas when presented with clear evidence to the contrary, from the real world.
4 Delusions of grandeur: Suffers sometimes see themselves as important, gifted and perceptive. Sufferers believe that their facebook ’friends’ are people they have a close personal relationship with, despite never having met. A frequent delusion is that suffers deserve to be trusted and believed by others, prior to expressing any insight which would make such trust appropriate. This can frequently lead to pointless arguments and having your account deleted.
5 Grossly disorganised behaviour: As the desire to communicate comes to dominate the sufferers’ everyday duties, patterns of behaviour and structure come to suffer.
6 Formal sleep disorder: The sufferer may lose sleep staying up late or rising early in order to keep up with the latest post.
7 Dependency: An excessive need to be confirmed in their sense of self regard by the other.
8 Negative transference and projection: A common feature is that the sufferer is unable to distinguish their own beliefs from those of the people they are attempting to relate to. This is assumed to be the reason why they sometimes ‘act out’ this confusion by behaving in ways which provoke anger in other people and then punitively label this anger as a sign of pathology in that other.
B. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset.
C. Duration: continuous signs of the disturbance for at least six months. This six-month period must include at least one month of symptoms that meet criterion A.
D. Mood disorder exclusion: A differential diagnosis has ruled out mood disorder because no depressive or manic or mixed episodes have occurred with active phase symptoms or their duration has been brief.
E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance or a general medical condition.
F. Relationship or a pervasive development disorder: If there is a history of autistic disorder or another pervasive developmental disorder, the additional diagnosis of obsessive posting disorder is made only if prominent delusions of grandeur or grossly disorganised behaviour are also present for a least a month.
What causes OPD?
This is a question which is causing debate, especially amongst mental health service users and survivors who were the first to notice this condition. They as usual struggled to be heard amidst the usual stigma and discrimination they suffer, but lately mental health professionals have listened and are now taking the condition seriously. Undoubtedly much of its symptomatology becomes deeply ingrained in sufferers’ behaviour patterns as a result of negative socialisation. Sufferers tend to isolate themselves from regular human relations thus leading to an increased tendency to show signs of the disorder.
Others however believe that these environmental factors merely mask a severe underlying disorder which is almost certainly genetically determined (although the precise mechanism of this organic fault has not yet been fully determined). Most researchers today would work from a stress/vulnerability model recognising environmental triggers but concentrating on how to treat the underlying disorder.
Today it’s most prominent manifestation is thru internet forums but this should not confuse us, this is just the post-modern manifestation of the disorder. In previous era it has, and to some extent still does take the form of serial letter writing, graffiti, pamphleteering and postering to name just some.
It has been noted that many venerable persons from history have shown signs of the disorder and are believed to have been sufferers. This should be a great solace to sufferers, as, if medical science can identify protective factors there is no need to think that sufferers cannot go on to live productive lives.
Some noted sufferers where Henry James, the novelist, Ronald Reagan, former US president, Jane Austen, Napoleon Bonaparte, Jackie Kennedy Onassis, JFKs wife and Albert Einstein the noted physicist. All these manifested the disorder thru writing large amounts of correspondence. Jean Michel Basquiat, the artist is also thought to have been a sufferer manifesting thru graffiti, he was famous in the 1980’s for his ‘graffiti art’.
It is not known as yet if Ronald Reagans OPD influenced his politics but it alerts us to the fact that some sufferers may rise to positions of public prominence or power. This should alert us to the need for a vigorous public information campaign in order that the public are fully informed.
How can OPD be treated?
There are several barriers to treatment identified.
- Most suffers do not, or are unable to recognise that they have a problem. This lack of insight is a major stumbling block to treatment.
- Much of the sufferer’s disturbed behaviour is positively reinforced by the surroundings they develop for themselves. They tend eventually to come to restrict their relations to other suffers.
- The main harm caused by OPD is not experienced by the actual sufferer but by those around them. This limits the motivation to change.
In spite of the above, treatment is being tried. At present the core of therapy is seeking to find the right balance between support and challenge to try to bring the above problems to the sufferer’s consciousness.
Results to date are mixed. There have been some successes; however, the people administering the therapy (largely other posters) are becoming frustrated at the painfully slow rate of progress achieved thru this approach.
Unfortunately the prevalence of the disorder is also reinforcing it. As more and more individuals develop the full blown disorder and don’t answer their phones or socialise in regular ways others become vulnerable. This isolation leads them to depend on communication thru irregular means thus making them vulnerable to develop positive symptomology.
Ultimately it may be that OPD only responds to a limited degree on individual therapy and that an approach based on structural change will need to be tried. It may be tempting to just ask them out for a pint but while this may distract them for a while, because of the widespread use of smartphones it won’t dissuade them, and in fact the disinhibitory effects of alcohol may provoke a crisis of all night posting.
Although only recently identified it is in testament to the vigorous intellect discourse within the psychiatric community that dispute has arisen about how to classify OPD. Most psychiatrists would readily place the disorder within the anxiety spectrum. However a growing number of mental health professionals think that not enough alarm is being raised about this serious condition. They feel that it is most likely one manifestation of psychosis, most likely bi-polar depression. They point to the decline in social functioning, the loss of sleep and sleep hygiene, as well as the notable irritability of sufferers. The presence of delusions in many cases also indicates psychosis as a more appropriate diagnostic category. In addition a number of practising psychiatrists argue it should be included amongst the personality disorders. They point to the poor prognosis and the poor results from current treatment modalities. And recently it has been postulated recently that excessive internet use may in fact be an addiction.
This at first glance may look like a pretty reasonable depiction for public education about a ‘mental illness’ which may concern people. However it has been entirely concocted (by me informed by some of the sources below). This may seem a rather trite if somewhat ironic take upon the literature ‘advertising’ and ‘marketing’ ‘mental health’ awareness. However it may actually be handy to distinguish the literary rhetoric for an understanding of more ‘real’ experiences. That this claims to educate us about an imagined ‘mental disorder’ should alert us of the need to be more circumspect when informing ourselves about the troubles which afflict a loved one. They no doubt are enormously distressed which is distressing to us and this document (constructed to ‘amuse’ the service users who have learnt not to take their diagnosis so seriously but rather to concentrate upon their lives) can be taken as a call not to take our labels so seriously, either in identifying with them (it can seem very helpful to have a name to understand our problems) or in totally rejecting the label as totally pointless or meaningless. It might be viewed as yet another ‘metaphorical illness’ to be treated with ‘metaphorical medicine’s by ‘metaphorical therapists’?
Bibliography, sources and resources.
American Psychiatric Association; Diagnostic and Statistical Manual of Mental Disorders DSM-III (1980); DSM-III-R (1987); DSM-IV (1994); DSM-IV-TR (2000)
Bentall, Richard; Doctoring the mind
Boyle, Mary; Schizophrenia: A scientific delusion
Kutchins, Herb and Kirk, Stuart A.; Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders
Lowson, Dave; Professional thought disorder
On being sane in insane places
Rowe, Dorothy; Beyond Fear
Life is full of interruptions and complications![i]
When we succumb to despair, our non-criminal conduct is upsetting to others or when our relationship with reality seems fractured, it might be suggested that we are placed before a psychiatrist’s attention for assessment. This is usually a time filled with fear and apprehension. We may be dragged to the mental hospital kicking and screaming against our fate. Or we may go more or less willing, but ignorant and unaware of what lies in store for us. Our mental state may make us peculiarly sensitive and vulnerable. But the benign and humane charms of the psychiatrist soon disarm our natural fears of the psychiatric process. We learn to trust in the special knowledge and special responsibility that psychiatrists profess to have. We may then start to hand over power and responsibility for our happiness to the legions of ‘mental health experts.’ Indeed Doctors, Psychiatrists and other medical professionals are seen by our society, politicians and media as the recognized experts on ‘mental health’ so it is no surprise that we share this view too.
Yet the suicide rate keeps escalating – recovery rates from depression, ‘schizophrenia’, ‘manic depression’ and other ‘mental illnesses’ have not improved since the doctors took over the ‘care’ of the insane during the 19th century, in fact they appear to have got worse. Indeed the data seems to show that the ‘prognosis’ for recovery has got worse during the era in which we are medicating distress[ii]. The W.H.O. sees depression as being one of the most serious ‘medical’ issues of modern times. Governments have seen fit to pass legislation granting psychiatrists full powers to detain, diagnose, label and treat (more or less any way they choose, with the minimum of safeguards) people they see as suffering from ‘mental illness’. This is like putting the roles and powers of judge, jury, defence and prosecution in one person’s hands and expecting a balanced assessment of the facts. Impossible!! Aren’t we making a big mistake in continuing to give such unregulated power to the psychiatrists in ‘caring’ for the ‘mentally ill’? I don’t know if we are, because I don’t know what more can be done than is being done. This is not solely because of any lack of knowledge or understanding of the nature of the distress involved in ‘mental illness’ but rather is it our collective unwillingness to learn from and apply this knowledge and understanding[iii].
All of the most profound understanding of mental distress has been bypassed, dismissed, discredited or simply ignored. Important work remains unreferenced by psychiatrists in their headlong rush to control mental distress with the latest medication. [iv] The Psychiatrist’s answer is to treat the symptom rather than focusing on the person’s predicament. They only address effect’s not causes and seem frequently to confuse the two. They have no ‘cures’ to offer only dependence on medication and behavioural control. And to be fair until the advent of the current ‘recovery’ ideas did not profess to have any cures, and their enthusiasm for these interventions maybe more as a means of encouraging self-management, whereas in a crisis the psychiatrist reasserting their control. Of course they cannot ‘cure’ these diseases for they do not exist.
Many people have had reason to be grateful for the vast array of medications on offer. But Psychiatry is not part of the solution – Psychiatry is part of the problem. With its own manifest obsession with correcting bio-chemical imbalances (which have never been identified), it fails to deal with peoples’ stresses and adds to them by colluding with the suffering persons fear and despair, proffering easy answers and therapeutic despair, thereby avoiding a root and branch look at their circumstances and listening to their story . Society by refusing to take notice adds dependence on psychiatry for an answer. An answer that is not forthcoming: and is least likely to come from psychiatry. In its headlong rush for medico-scientific respectability psychiatry has created the myth of its own special place as the ‘mental health experts’. So long as we believe in the myth of ‘mental illness’ we will fail to cure the profound suffering of the ‘mentally ill’ persons. We need to look not just at them but to consider our own flawed humanity also. ‘No man is an island’, but the Psychiatrists and many psychologists tend to see the person, as suffering, in splendid isolation from their life experience, as if they were. But they can do no other when the others refuse to participate it the recovery process. After all it is not the others who have the problem now, is it, they are concerned and upset, they are not ‘mentally ill’.
“No man is an island, entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friend’s or of thine own were. Any man’s death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee.” [v]
One must begin to see the psychiatric admission, diagnosis and treatment process for what it is. It is one play in a complex social drama aimed at invalidating the legitimacy of one person’s suffering as a ‘mental Illness’. [vi] The branding of a person as depressive, schizophrenic, obsessive, etc is to deny the symbolic resonances and meanings their ‘symptoms’ are trying to convey. We should desist from succumbing to this ideology of despair. It suffers from the same alienation that it seeks to treat. Madness is a message aimed at making sense of our shared reality. The mad are its carriers and the mercenaries of psychic diplomacy are then sent by society to relieve us of the burden of truth and its mystery.
- The psychiatrists’ perception of confusion and fear as an illness which is the end result of a line of physical causation harms people because it denies their experience. Whenever other people deny our experience we feel pain, anger and fear. If we can argue back we can protect ourselves from the threat of being devalued, ignored, turned into an object of no importance, annihilated as a person. However, once you become a psychiatric patient (that is mad) renders the account you give of your experience incorrect. The account of your experience as given by the psychiatrist, assisted by his team, is the true one. If you argue with the psychiatrist’s account you are, at best, ungrateful and, at worst, ‘lacking insight’, something psychiatrists consider to be a characteristic of the very mad.
- What we need when the events of our life have plunged us into confusion and fear is people around us who do not deny our experience and who constantly reassure us of our value. This is precisely what psychiatric patients are not given. The stone-floored dormitories and locked cells of the old mental hospitals may have been replaced by less fearsome wards and clinics, and the lone autocratic consultant psychiatrist may now be heading a ‘mutidisciplinary team’, but the hierarchical structure where the patient occupies the lowest rung remains, and on that rung what the patient needs most is denied.[vii]
However the mad do not always end up in psychiatric hospitals. It is one’s relative ability (or maybe one’s relatives) at exercising power that determines this. In relation to the other’s involved in our social drama of course. If one is good at keeping things to oneself (even from oneself), at manipulating the guilt and shame of our peers we may suffer on in silence. If indeed we can learn to keep a wall of charm and decorum up against society we may even prosper and learn to madden others, while remaining deeply alienated from the meaning of our own experience. For example, paranoid conspiracy theories about the ‘liberal establishment’, the ‘armies of political correctness’, the ‘liberal media’ and ‘femi-nazi’s’ are all paraded out regularly as having some malign, criminal, decaying influence on our culture, by socio-political pundits. But none of these constructs of paranoid propaganda actually exist. People who parade these views assert that the hurts of the past built their characters and had no malign influence on their present; while all the time, being walking testament to the malignancy of a cruel and insensitive childhood. Or indeed the hurt they have felt at the hands of those who deny their experience by a cruel and insensitive person who uses the shibboleths of PC liberalism to put another person down, more interested in playing parlour game’s than compassion.
Of course some mental patients can be equally maddening. Some are under the persecutory delusion that psychiatry is out to get them. Psychiatrists don’t care that much; they are just doing their job. They are of course out to get you to behave in a reasonable and sane fashion. If only we could be so good as to agree what sane and reasonable behaviour entailed. In their madness and torment mental patients can seem to attempt to suck all around them into the maelstrom of chaos. In such circumstances it seems more than reasonable to label one person as ‘mentally ill’, in order to save the others around them from being sucked into the chaos of such confusion. It is legitimate to save oneself from madness’s worst corrosion. But the traditional medico-chemical approach, while appearing too, does not in fact achieve this aim, it only appears to. There is a certain callous collusion between the actors in the psychiatric sub-culture. But no great conspiracy designed to undermine the lives of individual mental patients; Just a mutual dependence of psychiatrist, pharmaceutical companies and patients. The shrinks connect the patients and the pharmaceutical companies and prescribe the medication for which we are eternally grateful. The pharmaceutical companies provide the research grants and meaning for shrinks to justify their existence… and the patients meanwhile, grateful for the medication and the attentions of the shrinks are waiting patiently for a cure and the treatment to start.
In alleviating deep emotional distress (sometimes unfelt and registered as psychosomatic illness, delusions or hallucinations) we need to rid ourselves of the illusion that it is something that is just happening within one person ‘the mental patient’. To carry this view and diagnose, label and treat as such is to further humiliate and dis-empower an already dis-empowered group and in addition to hand them the power ‘as mentally sick’ to absolve themselves of social responsibility. We must first recognize the social drama in the context of which many if not all the individuals may be more or less severely disturbed or disturbing, although unrecognised as such. It is in a desperate attempt to keep up appearances when the truth rears its ugly head that we reach for the concept of ‘mental illness’. We do this not to help explain what is happening but rather to explain it away.
There is much life, humanity and receptiveness in the hospitalised patient. There is more truth and honesty in the acuteness of their distress. But when released and properly ‘managed’, however, they may frequently resent any further intrusion, any memory of their distress and frequently deny the insight gained from their experience. The hospital can thus become the carrier of the distress and all efforts are made in avoiding the hospital; rather than in recovery, which may involve a confrontation with the self, needing the necessity of acute care. Many patients may be terrified even to visit the location of their despair as it may evoke horrifying memories.
It usually goes unsaid and there is no harm in pointing it out; the people receiving psychiatric ‘care’ can be the sweetest, most innocent, sensitive and insightful and wise of individuals (even if, maybe, a certain ignorance is at the root of some of their major difficulties). As can staff, when not overwhelmed or bothered and pissed off by their own incomprehension and fear of madness or the occasional crudity, ignorance and bad mannered behaviour of the patients. Unfortunately the patient cannot always validate the legitimacy of others hostility and can then become quite stubborn and unapologetic. They make a mountain out of a molehill- but we must realise that this is because of the basic existential insecurity that beggars the patient and goes un-comprehended by the professional- “everyone is much more simply human than otherwise.”[viii] Most of the time, there are good relations between client and practitioner but for a regrettable tendency to treat people like objects when beset by madness. If anything patients give too much gratitude for the services they receive from the psychiatrist.
As a society we seem to be witnessing an escalation in the diagnosis of human suffering. We justify our indifference by training ourselves in the ignorance called psychiatry. But the suicides rates, reports of public disorder, our fears of violence against the person and drug abuse seem to be rising. Although it would seem that (in the western world at least) that life is generally more benign and your risks of experiencing actual harm (as opposed to fearing such) are declining, ie. People are safer in many respects than in previous times. More and more people are reported to be stressed out or depressed and fed up with medicines inability or refusal to help, are turning to alternative practitioners. The truth will out. But will we as a society leave it too late.
What psychiatrists should learn is to stop saying you shouldn’t: shouldn’t be feeling this, thinking these thoughts, hearing unpresent voices, seeing unpresent sights. They should study the many reports of recovery from over the centuries. They will learn that the problem they call ‘mental illness’ that they seek to obliterate are in fact part of the solution- the depressed feeling’s, paranoid thoughts, etc., are the minds way of alerting us to the problems we have in our lives. The person has problems- (the symptoms when properly decoded,) the message when understood can give us the solution. The mental patient wants most of all to be heard. Can you listen, with empathy, with sympathy?
- Psychiatry could be, and some psychiatrists are, on the side of transcendence, of genuine freedom, and of true human growth. But psychiatry can so easily be a technique of brainwashing, of inducing behaviour that is adjusted, by (preferably) non-injurious torture. In the best places, where straitjackets are abolished, doors are unlocked, leucotomies largely forgone, these can be replaced by more subtle lobotomies and tranquillizers that place the bars of Bedlam and the locked doors inside the patient.[ix]
By all means we can take our medications, improve our diet, exercise, learn self-advocacy and practice mindfullness; consult psychiatrists, psychotherapists or counsellors who will listen, not just lecture, who will talk to you as an equal suffering human being. But we must also listen to what our bodies and our minds are telling us. It is possible to find someone who will listen but harder to encounter someone who knows what to listen for. We cannot expect life to always threat us kind.
Madness is not always breakdown it is also breakthrough. What is called psychosis is not a disease, but should sometimes even be encouraged and always validated. However, one should never underestimate how preferable madness is to society (and the families affected in particular) than the ugly truth underlying it. A psychotic’s fate is determined as much on what society makes of and for them as on their own efforts. It is not always possible for us to prosper on our own; I should know I have tried. Society needs to find the places where madness can work its way out and where people in these predicaments can grow back their confidence as equal human beings.
If you are coming here to help me, you are wasting your time. But if you come because your liberation is bound up with mine then let us work together. [x]
It is not like anyone is to blame for this situation. The most tragic experiences can occur in the midst of love. We must assume loved ones would be only too happy to know the truth, if this would ease a loved one’s pain. The pain of truth however can be a major stumbling block to its realisation. Our own social pressures, obligations and flaws beset us all. We could just start by taking responsibility for the consequences of our actions. Maybe then we could open the doors in our minds, letting a healthy creativity, a benign reality flow in. We might not find solutions, we might not succeed but we might as well try.
There are many wonderful people doing wonderful work in the mental health services. This is not meant to be an attack on them. I am against the idea that madness is a meaningless biological event. When people cannot make themselves understood, it is too easy, lazy and damaging to dismiss their experience as the result of some as yet undiscovered genetic disease. Largely our disturbed, distressing abused selves are the logical consequences of how we were/are treated how we treat others and how we treat ourselves. “Human suffering arises from our embodied interaction with a world whose reality, though it cannot be known, cannot be wished away.”[xi] And that society considers it otherwise is the result of the greatest amount of medico-socio-political spin. It may be diplomatic but results in the destruction of much worthy life experience and expense for the sake of a little short-term peace.
If we could only organize psychiatric delivery such that the first thing that people learned was that psychological work to encourage people think well of themselves and get on with others while developing a sense of meaning and finding purpose was the main aim of the therapy, it would be so much better, so much more effective. But this is not what mental hospitals teach you; they just reconfirm your maladjustment and teach you to think of yourself as a sub-human defective, genetically flawed, too stubborn and unreasonable. From the first you are filled with medications, sometimes against your will; subtlety, charmingly and seductively led down the path of thinking of yourself as medically ill. Many can lose their way because of these pressures to conform to psychiatric thinking.
[i] Love Actually
[ii] See the work of Robert Whitaker in compiling data from many research projects in the long-term outcomes of psychiatric intervention in The Anatomy of an epidemic.
[iii] Dorothy Rowe, Beyond Fear
[iv] For instance the work of Harry Stack Sullivan; Gregory Bateson; Michel Foucault; R.D. Laing; Mara Selvine-Palazzoli; and Alice Miller; David Smail; Dorothy Rowe; Lucy Johnson; Mary Boyle; Richard P. Bentall; Sami Timimi or our own Ivor Browne, Terry Lynch, Michael Corry or Pat Bracken. And more recently Jaakko Seikkula’s Open Dialogue approach in Finland has proved remarkably successful at facilitating the return of people with experience of psychosis to education, training and work. with minimal need of medication.
[v] John Donne
[vi] Goffman, Irving; the degradation ceremony in Asylums
[vii] Dorothy Rowe, Wanting Everything: the art of happiness.
[viii] Harry Stack Sullivan quoted in Madness explained by Richard P. Bentall
[ix] R.D. Laing, preface to The Divided Self
[x] Unknown Australian quoted by Ben Bassman
[xi] David Smail, Taking Care