Two basic false assumptions in psychology, especially clinical psychology, is that mentally ill people have reduced access to reality, they're somehow detached from reality. And the second assumption is that mental illness is about a loss of self-control. These people are ruled by their impulses and drives and energies, and they are like puppets in the hands of the instinctual drive-ridden puppet master of their own mind, diseased as it may be.
So these two assumptions, lack of access to reality and a total disintegration, dissipation and loss of self-control, these two assumptions are manifestly untrue.
So what is the truth?
Sam Vaknin, author of Malignant Self Love: Narcissism Revisited, and professor of clinical psychology.
The truth is exactly the opposite.
And this is the topic of today's video.
Mentally ill people have too much self-control and too much access, unfettered, unmediated, too much access to reality.
Let me try to explain myself. Not easy, I know, but you're long suffering, so you'll get used to it.
Mental illness is not a loss of control. Mental illness is about too much control. This is known in clinical psychology as rigidity.
Mentally ill people exert enormous amounts of effort and energy into controlling themselves and their behaviors. They are terrified of themselves. They're afraid of themselves.
And so there is this all-pervading sense of terror or fear of losing control.
Mentally ill people catastrophize. They anticipate the worst. They're paranoid. They live in a world which they perceive as hostile and they retreat very often into fantasy as a defense.
But throughout all this, mentally ill people hold themselves together rigidly, whole themselves together rigidly, forcefully, inexorably, and they don't let themselves go. They don't trust themselves to do the right thing. They realize that they are self-defeating and self-destructive.
So mental illness is not about a loss of control. It's about the fear of a loss of control, the phobia of losing control.
And the result is too much self-control. Too much self-control to the point of rigidity.
We'll discuss it in a minute.
Mental illness is also not about a lack of access to reality, but exactly the opposite. It is a lack of access to reality, but exactly the opposite.
It is a set of defenses against excessive access to reality. Unmediated, unfirewalled contact with reality.
Mentally ill people have no skin, so to speak. They are directly exposed to the vagaries, the exigencies, and the pain and suffering inflicted by reality.
Mentally ill people are in direct contact with reality because the mechanisms that operate in healthy people and which isolate healthy people from reality, from harsh reality, these mechanisms do not work well in mental illness.
For example, defense mechanisms whose main role is to falsify reality and to render it livable and palatable, defense mechanisms do not operate well in mental illness.
So what happens to the mentally ill person, he or she, they get in touch with reality, unmediated touch, unmitigated contact, not ameliorated or attenuated by any internal or external process.
Reality is harsh, reality is painful, reality is abrasive, reality is dangerous, the friction with reality is devastating and mentally ill people endure this day in and day out. They have no outlet and no escape from this.
And so what they do they resort to fantasy or to delusions or to any other form of escapism. They escape, they flee away from reality.
But they flee from reality. They avoid reality. They withdraw because they have too much reality. They have an access which is unbridled, unfettered, access that causes them agony.
And so that's why they escape from reality.
To summarize this first part, mentally ill people have too much self-control because they're terrified of losing it.
And they escape reality because they have a surface of contact with reality, which is too big and too agonizing.
Shutting out external reality is because mentally ill people confront a situation where they have too much information to process, where there is a dissonance between internal information, internal noise and external noise, where they perceive everything is impossible to control or to understand or to make sense of or to mediate or to manipulate.
Mentally ill people feel helpless and they feel helpless not only because their helplessness is learned but because it's real, it's their perception of themselves as helpless is accurate. They are helpless. They are unable to have any impact on their environment. Their self-efficacy is low.
They don't quite know how to extricate themselves and extract beneficial outcomes from the environment.
So there's too much to process, impossible to control, not beneficial outcomes, things often turn bad and sour, and so mentally ill people decide to disengage, to put distance between them and reality, to shut reality out and shatter themselves in a bubble.
They prefer an internal, rigidly controlled environment to the unpredictable, indeterminate, uncertain and threatening external environment.
Now, this is very reminiscent of some medical conditions. You all heard of tetanus I assume. Tetanus and also situations of extreme fever. Tetanus and extreme fever, in these situations, in these medical conditions, the motoric nerves, the nerves that enervate the muscles, emit a high rate of action potential.
In other words, they fire much more. They emit electro-biochemical signals much more frequently and of a much higher intensity. And this causes rigidity of the muscles. The muscles spasm and the spasm generates rigidity.
If you touch someone in the throes of a tetanus attack or someone with a very high fever, their muscles are like rock, they are like stones under the skin. They are not pliable and they cannot be flexed. They're fixated. We call this situation spasticity in medicine.
But it has another name, hyperreflexia. And it's very interesting because hyperreflexivity is a major element in psychotic disorders.
This rigidity of the muscles is because the stimulation of the muscle is too extreme. The muscle is exposed to external pathogens. And these external pathogens, which represent reality, they cause rigidity in the muscle system, in the muscular system.
So this is very reminiscent of mental illness.
In mental illness, the mentally ill person is exposed to the environment, to reality, and reacts with mental rigidity.
It's as if the psychological muscles go hard, go strong, go rigid. The same way that the physical muscles go rigid when they are exposed to the toxins of tetanus and the resultant high fever.
It seems that body and soul react with rigidity when they are exposed to a toxic environment.
Mental illness is actually a desperate attempt to cope with this resulting rigidity, to cope with the perceived and threatening loss of self-control, and to cope with the reality, with an environment, with circumstances, with other people who are threatening, who are toxic, who are hateful.
And so we could conceive of mental illness as a kind of muscle relaxant, the antidote to tetanus. Mental illness relaxes the mental muscles. Mental illness flexes the psychological musculature.
It is the equivalent of curare, by the way. It's a kind of poison that relaxes muscles. We use curare to counter tetanus tetanic spasms or rigidity.
So this is the sequence.
There is a mentally ill person because of genetics, because of a brain abnormality, because of upbringing in an environment which has been abusive and dysfunctional and traumatic, whatever the reason may be.
The end result is a mentally ill person. This mentally ill person has no skin, has no protections against the environment, human environment and non-human environment, but especially against other people.
So this kind of person, when he or she is exposed to adversity, to conflict, to threats, to unpleasantness, to discomfort, when these kind of people are exposed to all these, what they do, they go rigid. They go rigid, like the muscle, which reacts to tetanus. So they go rigid.
This rigidity disables their ability to adapt. Rigidity means that your internal processes freeze and you're no longer capable of modifying your behaviors, controlling your cognitions and your emotions.
So there's a freeze. This is the first reaction.
The second reaction is to escape reality, to avoid it, to go into fantasy, to develop delusions or psychosis.
And so mental illness is an attempt to create a flexible internal environment in reaction and contradistinction to the rigidity that is brought on by the external environment.
The external environment, other people, toxicity, conflict, aversive stimulus, whatever the reason, the external environment causes rigidity.
The person withdraws, retreats, goes inward, flees the reality, escapes reality into an inner world, a paracosm, an alternative reality.
And within this inner world, the person creates a fantasy or a delusion.
And within this fantasy and delusion, the person is fully functional.
Within the fantastic world, the person is flexible.
Outwardly, the person is rigid. Internally, the person is flexible.
But the flexibility comes at the expense of reality testing.
The person has to sacrifice access to reality, contact with reality, gauging reality appropriately, operating in reality and on reality, obtaining outcomes.
The person has to give up all this, self-efficacy, agency, self-personal autonomy. The person has to give up all this in order to be able to survive in an internal environment that allows for flexibility and adaptation.
The internal environment provides stimuli, generates or engenders responses. It is fully self-contained and self-sufficient.
Within the internal environment, the mental ill person is self-efficacious, is under control, is content, and is happy with himself.
The internal environment is a full substitute to the external environment, which explains why it's very, very, very difficult to successfully treat mental illness, shutting out external reality.
Now, I mentioned that in tetanus, high fever, similar conditions, we have a response called hyperreflexia. Hyperreflexia is another name for the contraction and rigidity of the muscles.
We have a similar condition in psychotic disorders. It is known as hyperreflexivity, which is almost the same word. And it refers to a form of exaggerated self-awareness.
You remember that I said that the mentally ill person finds reality unbearable, intolerable, threatening, menacing.
And so the mentally ill person gives up on reality, renounces it, and withdraws inwards into the fortress, the internal fortress, draws up the drawbridge, the ramparts, and finds himself isolated within this fortress, besieged by reality, but totally self-sufficient.
Within the fortress, within this mental, internal mental space, within this fantasy, within this delusion, the person is highly self-aware.
The self-awareness is exaggerated, caricature, excessive. The person is self-aware of every tiny twitch, every flexing, every cognition, every emotion, every echo, every memory.
The self-awareness is total, immersive, all-consuming, and the person ends up actually developing a symbiotic relationship with his overt self-awareness.
The self-awareness becomes a substitute to the external world and this is a great definition of psychosis when self-awareness or the self is mistaken for the world.
When the sick person, the patient, the client, whatever you want to call it, mistakes the external world for internal reality, when the psychotic person hears a voice, he thinks the voice is coming from the outside.
This internal voice is perceived as external, misperceived, of course. It's not external. It's a voice in the mind of the psychotic person, but he misidentifies it as coming from the outside.
Similarly, when the psychotic person sees something, an image, a vision, a photo, a video in his mind, he thinks it's coming from the outside, he thinks he's watchingmind, he thinks it's coming from the outside, he thinks he's watching it, and this is known as hallucination.
So hyper-reflexivity is when your self-awareness is so acute, so exaggerated, so crazy, so detailed, and you put so much effort and time and mental resources into being self-aware that you begin to confuse yourself with the world. You begin to misidentify what's happening inside you as if it were happening outside you.
It undermines the stability of normal self-experience, or what Nelson and Suss call the center of experiential gravity.
You see that the mentally ill person makes a choice. The choice is this.
I'm going to be in total self-control when it comes to the external environment. Because if I don't, I will lose control and bad things will happen to me.
This is catastrophizing.
But I'm going to let my hair down. I'm going to let loose. I'm going to be much more flexible and adaptive in an alternative universe that I'm going to create within myself, within my mind.
And within this internal universe, the alternative reality in my mind, I'm going to be normal, I'm going to be okay.
This solution is very appealing, very attractive.
There's only one problem with it.
Gradually, the longer you inhabit your internal universe, you begin to confuse it with the external universe.
This is what happens to narcissists. Narcissists confuse external objects with internal objects.
Narcissists confuse other people, for example, intimate partners or friends. They confuse them with internal objects that represent these people in the narcissist's mind.
Similarly, the psychotic person confuses external reality with internal reality.
Psychotic person believes that voices and images in his mind are really out there for everyone to see.
And so this is a disruption of the center of experiential gravity.
If you want to learn more about this, I advise you to read the works, all their articles and so on by Nelson and by Sass.
Apologies for the name.
And we have many examples of this paradigm that I'm proposing.
I'm proposing a new paradigm where actually mental illness is about self-control and about access to reality, only exaggerated.
And so we have an example, for example, obsessive compulsive disorders.
Obsessive compulsive disorders involve rituals which are supposed to have an effect on the environment. It's a form of magical thinking.
If I wash my hands a hundred times, nothing bad will happen to me or to my loved ones.
This is of course the confusion of the internal world with the external world.
We have personality disorders. I mentioned the fantasy of the narcissist.
The borderline has a similar fantasy where she incorporates symbiotically her intimate partner into her mind. She actually outsources her mind. She gives it, hands it over on a silver platter to her intimate partner to regulate and to control.
Again, it's a confusion of external and internal because the borderline's mind is internal. Her belief that her mind can be regulated from the outside is a delusion. It's delusional. It's a fantasy.
And so her contact with the intimate partner is essentially psychotic. This is an observation made by Otto Kernberg and many other scholars of borderline.
Hence the word borderline on the border between neurotic and psychotic.
So I mentioned psychosis.
If you want to witness muscle rigidity in action, all you have to look for is catatonic signs.
In catatonia, which is an extreme stage of psychosis or psychotic disorders, it's very common in schizophrenia. In catatonia, the person sits usually on a chair, not a single muscle moving for days, absolutely, literally for days and not the smallest twitch. There's no winking, there's no the eyes, the eyelids don't move, that nothing moves. All the muscles are in absolute, totally rigid, unalterable condition. And the posture and the position do not change for hours and days on end.
This is Catatonia.
Catatonia is actually the embodiment of the processes that I'm discussing. I'm discussing a process of terror or fear of loss of self-control in an environment which is perceived as potentially dangerous and threatening and risky.
And the solution is to withdraw inward into a fantastic space.
Catatonia is the external visualization of this process.
The body is totally rigid and yet mental life proceeds inside.
There is a cognitive, behavioral, attitudinal rigidity in psychosis and especially in catatonic states. It's an amazing reification of the paradigm.
The catatonic person actually is the end stage of all mental illness.
Supposedly, if a mentally ill person were to fail in controlling herself and if he were to fail in renouncing reality, disengaging from it, the onslaught of reality coupled with a lack of self-control would result in Catatonia.
Similarly in autism spectrum disorders we have something called hyper fixation where the autistic person focuses on a single thing. It could be a blotch on the wall. It could be the color of the chair. It could be a sound. And there is hyperfixation. The person becomes essentially immobile and totally focused on the stimulus.
In autism spectrum disorder, we have stimming self-stimulation. The self-stimulation is repetitive, stereotypical. We have repetitive movements, repetitive behaviors, ad nauseum.
And all these are forms of rigidity, stereotypy, repetition, steaming. They're all forms of hyperfixation. They're all forms of rigidity.
Even concrete thinking is a form of rigidity when the autistic person interprets words lexically as if he had a kind of mental dictionary open in his mind, but does not understand allusions, nuances, other interpretations, historical layers and etymology of the words and so on.
So what is concrete thinking? It's a form of control.
Because if you interpret the words, lexically, you control the words. There's only one agreed upon interpretation it's a rigid structure and concrete thinking excludes reality it's a form of fantasy it's a delusional way of listening to words.
Because each word has a history, a themology, associations with other words. Each word has a history, a themology, associations with other words. Each word evokes memories. Each word can be interpreted in multiple ways, emotionally, etc.
All this is inaccessible to the autistic person.
In other words, the autistic person precludes, erases, eliminates multiple layers of understanding words, multiple layers of semantics and symbiotics. In other words, multiple layers of reality.
Concrete thinking is a form of ignoring reality and adhering to an internal codex, internal index, that has nothing to do with reality, but which gratifies the autistic person, calms the autistic person down, restores inner peace and harmony within the autistic person.
More generally, psychological rigidity is a form of resistance. Resistance to change.
The environment is perceived as unpredictable, mutable, constantly transforming, and not in control. You can't control the external environment.
And some people, the mentally ill people, are terrified of this. They're simply very afraid of this.
So they develop resistance to change. They become fixated on habits, on attitudes, on concepts, on beliefs, on specific emotions, on cognitions, on interpretation of words, on repetitive behaviors, or fixation is a key.
Change is perceived as stressful, as bad, unfair, chaotic, and therefore to be excluded. Rigidity blocks the perceptions of reality, perception of reality.
So it also blocks the perceiving of other people.
The rigid person, the mentally ill person, is unable to accurately perceive, accurately digest, accurately be exposed to other people's emotional states.
Rigidity leads to the misinterpretation and misreading of social cues of body language of other people. It consequently rigidity inhibits empathy and compassion and makes every type of conflict life-threatening and hostile.
And this is common to all forms of mental illness.
The dirty secret is that in the vast majority of mental illness, probably in all of them, empathy is much reduced. Not only in narcissism, not only in psychopathy. That's a common lie.
In borderline, for example, there is a reduction in empathy. In bipolar disorder, in many mood disorders, there's a reduction in empathy.
And one of the reasons is that the rigidity of the mental illness does not allow information pertaining to other people to penetrate the mentally ill person's mind.
And so what the mentally ill person does, he reduces other people to symbols, avatars, icons, internal objects, representations.
The mentally ill person is unable to relate to other people as three-dimensional objects with personal autonomy, a developmental trajectory and agency.
Rigidity is a coping mechanism. It's an autopilot response to environmental and mental over-stimulation.
The overstimulated brain limits the information that it processes.
And so in stressful conditions where information is much more abandoned than in non-stressful conditions, we are much more attuned to information when we are threatened, when we are stressed, when we are in pain, when we are suffering.
So in that situation, the brain shuts off, and we default to automatic behaviors. We resist information, other perspectives, alternative evidence. We develop confirmation bias.
This rigidity isolates us from reality which is a defense against the attack as reality is perceived as attacking, as besieging.
Rigidity therefore is not always problematic. In mentally healthy people, there are moments of rigidity, phases of rigidity, and they pass away.
In mentally ill people, rigidity is built in.
Indeed, if you go to the Diagnostic and Statistical Manual, it describes many disorders, mental health disorders, especially personality disorders, as rigid patterns.
Rigidity becomes problematic when it becomes conscious, deliberate, a strategy.
When we count ignore information, we devalue it, we dismiss it, and we trigger negative reactions from other people. We alter our circumstances in a way which is not conducive to our well-being.
Rigidity is not healthy.
To the mentally ill person, rigidity appears to be an excellent solution. Fantasy even more so. Delusion, perfect.
But in reality, these strategies are counterproductive. They're dysfunctional. They damage the mentally ill person.
Oversimplified solutions, reductionist view of other people, lack of empathy, fantasy, delusions, they make matters worse. They reduce the self-efficacy of the mentally ill person, rendering the mentally ill person unable to operate in and on the environment and extract beneficial outcomes.
Rigidity also breeds intolerance, aggression. Rigidity is closely associated with aggression.
And so consequently, many mentally ill people are aggressive. They're not violent actually.
Mentally ill people, including psychotic people, are not more violent than the general population. That's a myth.
But they are much more aggressive. There's no question about it. They are much more extreme. They're much more reactive.
We have a name for it. It's called reactors.
And so they damage other people and the environment, the human environment. They create situations of suffering and polarization. They project their own disintegration, fragmentation onto the outside.
And so one of the key goals in therapy, for example, is to counter this rigidity by teaching the patient to self-control, for example, regulate impulses in ways which are not socially dysfunctional.
And also to teach the patient that reality is not as hostile, not as dangerous, not as threatening as the patient perceives it to be. It's a misperception.
And sometimes we succeed. And patients become less rigid, more in tune with reality. They develop better reality testing. Their behaviors become more self-efficacious.
And sometimes we fail, for example, with narcissists and psychopaths. We often fail.
And so, ultimately, this paradigm of rigid self-control coupled with alternatives to a reality that is encroaching and painful, this paradigm is very helpful in developing new treatment modalities, a new approach to mental illness.
Right now, the antiquated ideas that mental illness is about a loss of self-control and that mental illness is about a lack of access to reality, these antiquated ideas which are not supported by research of any kind, they led to the development of treatment modalities which don't work and they don't work because they're based on false premises.
It's time to change that.