Solitary “disorders”

Medicine, like science in general, attempts to classify behaviors into patterns, and patterns into syndromes, disorders, and ultimately into diseases. Thus the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) has at one time or another in a person’s life, everybody’s number — literally. Presumably the exception is all those who are normal and all-wise from birth, with ideal parents, environment, and world, to the point of perfection as average and having no outstanding behavioral characteristics. Which is impossible.

The solitary personality has been nicely defined by Oldham, who rightly stresses that every so-called personality is a cluster of behaviors that we cite for convenience sake but that they are all normal behaviors, simply within the range of how people are.

Only with dysfunctional behavior do we look back and see how dysfunction is itself an exaggeration or abuse of originally normal behaviors. Thus the solitary, at the extreme of dysfunction or mental disorder, is schizoid. The ideal solitary (if such exists) is an ideal set of traits. The real solitary is checkered with presumed disorders from childhood that linger. What the real solitary needs to do is embrace their self, work honestly with their characteristics, and find the transcendent dimension that transfers their insights into values. That is another dimension to personality that, however, does not fall within the capacity of medicine as diagnosis and prescription.

(My favorite fact usefully described in Oldham is this: contrary to the popular view of the solitary personality as depressive, due to introversion, reticence or preferences for being alone, it is the extrovert who is more prone to depression due to dependence on feedback from the external world of people and things.)

Medicine has the tendency to aggregate symptoms and label them a disease, when, in fact, the symptoms may have entirely separate etiologies, and may be treated separately. This is especially the case with bodily disorders, where part of the tendency of modern medicine is to fit a pharmaceutical to a disease — which it cannot do if treating symptoms alone. Ironically, the cure or prescription is usually treating only a cluster of symptoms, not a disease, at least not until the outstanding characteristic of the disease establishes itself irrefutably.

Two “disorders” associated with the solitary personality (at least in the DSM-IV, not in Oldham) are “Social Phobia or Social Anxiety Disorder” and “Avoidant Personality Disorder.” The DSM has our number, literally: Social Anxiety Disorder is 300.23 and Avoidant Personality Disorder is 301.82 in its classification of mental disorders. The first is a phobia, and the second is a personality disorder.

The diagnostic features of social anxiety disorder are intended for physicians but are certainly of interest to the lay person in seeing how authorities judge behaviors. For example, it is cautioned that the fear of social or performance situations must be dysfunction for the individual, incapacitating them from regular functions. A preference for not eating in public, or being judged and criticized, or worrying in advance of a social event are features.

Individuals with Social Phobia … may manifest poor social skills (e.g., poor eye contact) or observable signs of anxiety (e.g., cold clammy hands, tremors, shaky voice). [They] … often have decreased social support networks and are less likely to marry. [They may] have no friends, … completely refrain from dating, or remain with their family of origin.

There are warnings about suicide and associated disorders like Anxiety Disorders, Mood Disorders, and Substance-Related Disorders.

At least the manual notes that

Fears of being embarrassed in social situations are common, but usually the degree of distress or impairment is insufficient to warrant a diagnosis of Social Phobia.

That, coming from authorities, is intended to the inadvertent layperson-reader as a solace.

Allusion is made to Korea and Japan for cultural context, but nowhere else. The term hikimoro does not occur (it not being clinical, presumably). The range of 3% to 13% of the general population are sufferers of Social Phobia. The conclusion is made that there are no laboratory tests to demonstrate the condition, and that without the presence of other mental disorders, there is not much to be done.

Another characteristic disorder of the solitary is Avoidant Personality Disorder, defined as

a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation …

Usually this disorder is identifiable from early in life with schooling, right on through work. Such people bristle at disapproval, criticism, or suggestion. Says DSM-IV:

They tend to be shy, quiet, inhibited, and “invisible” because of the fear that any attention would be degrading or rejecting.

In contrast to social phobics, the avoidant persons “often vigilantly appraise the movements and expressions of those with whom they come into contact,” essentially out of fear. They have low self-esteem, and like the social phobics, no social network. Again, like social phobia, there are related disorders usually present to warrant the diagnosis of dysfunction.

About .5% to 1% of the general population can be labeled as having Avoidant Personality Disorder. Only in the last lines of this section of the DSM-IV do the authors acknowledge that

Many individuals display avoidant personality traits. Only when these traits are inflexible, maladaptive, and persisting and causing significant functional impairment or subjective distress do they constitute Avoidant Personality Disorder.

Reading the DSM-IV can engender hypochondria, paranoia, or fear that one is losing one’s mind. There are enough problems in life that demand our coping. But, further, we can be aware that the behaviors we inherit from childhood are being vigilantly classified by medical authorities. Of course, such awareness on our part is necessary, and on the part of science if science is to attain its goal of complete knowledge of all empirical phenomena, with dubious probability of attaining this. But psychiatry and pharmaceuticals are, after all, industries. They require clients and consumers. We should purchase only what we need, enough to feed ourselves, correct ourselves, become more conscious of ourselves.

And for that we can find psychiatric research useful. But no more than philosophical or psychological or spiritual work, which can take us as far or further, rightly understood. We need to go the distance with both, but no further in the case of allopathic medicine and the perilous divide between a self as bundle of behaviors and a self as fully realized.