Wednesday, March 12, 2008
Manie Sans Delire
Making a diagnosis of PERSONALITY DISORDER is difficult. The validity of such diagnosis is controversial lately. It was claimed by some that a diagnosis of personality disorder is ready to be given by a psychiatrist to all those whom he/she dislike. Me myself and one of my dear colleagues, at the beginning of our first year of residency in psychiatry, used this diagnosis against each other while we have problems with each other. We used this diagnosis as a type of hurting. As a type of revenge. And believe me it was very annoying and really hurting and have long lasting effects. Till one of the older residents in psychiatry told us to stop this childish behavior which, as he said, IS DANGEROUS AND UNETHICAL. But some personality disorders are less controversial than others. It is estimated that 10-14 % of the general population meet the diagnostic criteria for at least one personality disorder.
The antisocial personality disorder is an old concept in psychiatry. In 1812, Benjamin Rush introduced the concept of MORAL DERANGEMENT. In 1835, Prichard introduced the term MORAL INSANITY. It was Pinel (1801/1962) who coined a term that I like, it was MANIE SANS DELIRE, which means MADNESS WITHOUT CONFUSION OF MIND. I like the term, first, because it is in French, and when you use it the other will think that you are a highly cultured person. And Second, because it defines itself.
Nowadays, the DSM IV criteria of antisocial personality disorder can be easily remembered using the mnemonic CORRUPT:
1. Conformity to law lacking,
2. Obligations ignored,
3. Reckless disregard for safety of self and others,
4. Remorse lacking,
5. Underhanded (deceitful, lies, cons others),
6. Planning insufficient (impulsive), and
(3 of these seven are required to be a trait of the personality for life so that the diagnosis is made, and it cannot be made under 18 years of age).
Psychopathy was related early in the formulation of the concept to criminality. Not all psychopaths are criminals. Henderson (1939) described CREATIVE, INADEQUATE, AND AGGGRESSIVE PSYCHOPATH, citing Lawrence of Arabia as an example of creative psychopath.
What am up to is to state that I think that Silvador Dali was having an antisocial personality disorder. As a child he used a sharp instrument to wound the cheek of a goat and, used its blood to write his name on its face. He also pushed a friend of him for a bridge after he made sure that no body is watching, and he confess in his memo that he did not felt any remorse. He also kicked his sister on her head while she was crawling. At school he jumped from above the stairs to cause alarm and apprehension in pupils faces, and to seek attention. He repeated his jumps, from higher and higher points and he got many wounds and bruises, but he said that it was ok because he aimed to seek their attention and fright and he succeeded.
During his life as an adult you can find many evidences for his impulsivity and temper, for his break of social norms, and recklessness.
His indulgence in painting can be explained by this statement from Fish’s psychopathology when describing the antisocial personality disorder:
“As the boredom threshold is low, these individuals resort to thrill-seeking
behaviours such as substance misuse, gambling and promiscuity”.
And I will add to those thrill-seeking behaviors: Art. Especially the unusual art. Artist are highly imitated by many. From here comes the danger of imitating a person with mental illness.