ego syntonic vs. dystonic

[icebreakers]

a lot of times it appears as if half or more of the 'dis-ease' in certain mental illnesses is due to the fact that the illness itself is ego-dystonic. it seems like in those cases, there is interference in the patient's functioning (on many levels) only because of the fact that the patient feels that what he/she is doing/thinking/feeling, is not 'right' or is not 'healthy' based on his'/her own perspective

paraphilias (sp?). the necrophiliacs...who are sexually aroused by fecal matter (this is probalby a blatant oversimplification)... and its labeled as a mental illness. people who do it, 'know' its wrong and weird or whatever(subjectively)...
but what about the individual who doesn't think there is anything wrong with it (and lets say he's found a safe way to do it to), and he doesnt at all think his behavior is weird....and, he has absolutely no deterioration in his functioning whatsoever. i think its a pretty feasible hypothetical..

so, how do you treat the necrophiliac? tell him/her, its okay, its not weird, its perfectaly normal and see if theyare capable of accepting their own behavior as 'normal' to them? or help them with a strategy to stop? assuming that we can figure out a way to make the activity safe.

this goes to my next question, ....how much of disease is based in our in ability to accept our own behaviors/tendencies? when we dont accept something, we cause a huge amount of misalignment in our personalities, and a cure would then be found in acceptance. right? how far can we milk this concept? how far do we milk it already in psychiatry?

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[Psyclops]

Well, scatophiles and necrophiliacs are two very different things, and it seems that you have confused them. Scatophiles are aroused by feces, necrophiliacs by the dead. Pretty much everyone has a problem with necrophiliacs even if they don't themselves.

Other than that though it is a great topic and some great questions, bu I don't have time to contribute much more right now.

 

[MBK2003]

In my mind this question also taps into an ongoing discussion about whether severe racism should be a DSM-V diagnosis. While we as a society consider the behavior/thought process "wrong" is it "diagnosable?"

Do others have thoughts on the topic?

 

[icebreakers]

oh, yeah. thanks for the clarification.

Well, scatophiles and necrophiliacs are two very different things, and it seems that you have confused them. Scatophiles are aroused by feces, necrophiliacs by the dead. Pretty much everyone has a problem with necrophiliacs even if they don't themselves.

Other than that though it is a great topic and some great questions, bu I don't have time to contribute much more right now.

 

[Triathlon]

Some things are just wrong! There is no making the patient "feel" a certain way about it or accepting it. There is an inherent part of humans that protects them form being ousted from the social groups, disgust. If the disgust mechanism is bypassed by "therapy" then you set up the patient for social failure. Of course there is the hyper active disgust with ones behavior that needs to be help when the problem is actually benign. Who draws the line? Me. In my own treatments I guess. I will have to jugde what i can treat and what I will not treat in a therapy type direction.
If you understand all that great. If not, ignore it.

 

[Poety]

Please, there is nothing "ok" with pedophilia, or necrophilia, or beastiality, etc etc - its not a matter of whether the patient accepts it as being ok - its a matter of fact.

Just because people engage in behaviors that may be ok to other cultures, doesn't make them any more right. For instance, what they did to little girls in the African tribe, the practice of circumcision (ie cutting off the female clitoris so that they can never enjoy sex) may have been accepted by the society - but it was still WRONG.

 

[Psyclops]

Tri, in reference to your post please look up Mark Leary's Sociometer Theory of Self Esteem, it talks about what you were saying.

In response to other poster's certain things might be a result of psychiatric conditions, such as the paranoid patient being racist vs. a CEO of a fortune 500 being racist. Of course that doesn't get at the heart of the matter.

I think there are certain things that one would expect a person to feel bad about, and that wouldn't be abnrmal. Others, people feel bad about, when they shouldn't, that's usually when we step in.

 

[Psyclops]

I think it's always important to take context into account.

 

[Triathlon]

Tri, in reference to your post please look up Mark Leary's Sociometer Theory of Self Esteem, it talks about what you were saying.

I like the way he depicts his idea, and I would guess that the polar opposites on this sociometer, for illustrative purposes, would be the narcissist and the schizoid PDs. This, as far as DSM is concerned, not including Axis IV stuff.
My point earlier is along these lines for particular behaviors, but overall psychological states is applicable also.
Evolutionary ethology always seems to have a role. 😎

 

[icebreakers]

Triathalon, well, scratch my example about the necrophiliacs and others....
i understand your point about being in alignment with social norms...

but what I was trying to probe was...it seems like there is something intrinsically worse in ego-dystonic disorders, vs syntonic ones. Obsessive compulsive disorder vs. obsessive compulsive personality.

What is it about having acceptance about a part of yourself and your actions and behaviors, that is clearly healthier than rejecting a part of yourself.

Is acceptance, frequently used as a goal of therapy?

I like the way he depicts his idea, and I would guess that the polar opposites on this sociometer, for illustrative purposes, would be the narcissist and the schizoid PDs. This, as far as DSM is concerned, not including Axis IV stuff.
My point earlier is along these lines for particular behaviors, but overall psychological states is applicable also.
Evolutionary ethology always seems to have a role. 😎

 

[Poety]

In my mind this question also taps into an ongoing discussion about whether severe racism should be a DSM-V diagnosis. While we as a society consider the behavior/thought process "wrong" is it "diagnosable?"

Do others have thoughts on the topic?

this is an excellent topic, we discussed it at length during my sub-I, I'm glad you brought this up. Things we thought would need to be considered are the acts that come out of racism and what can be used as a diagnosable "excuse' for reprehensible behavior. If it became a diagnoses, wouldn't we essentially be taking any blame and punishment away from the person?

Also, where would the limits be drawn if we started diagnosing any inexcusable behavior/action/belief? Would homophobia be a dsm disorder? What about the crimes that are related to homophobia? Would the person that beats the participants in a gay parade be allowed to get off for having a "disorder"?

I'm very interested to hear others thoughts on this topic too... Psy? OPD? DS?

 

[Psyclops]

Ah, another line conversation. Where should we draw it? This is so tough. I was thinking abou this the other day, kind of in response to why are we not solely behaviorist beings, a la Skinner. Ultimately I see it that we don't start diagnosing everything because of our capability to consider multiple options when behaving. For example, you choose between turkey on rye, and tuna salad on white, presumably neither is predetermined, you have chosen both in the past, and you will choose both in the future. This is a simplistic anser I know. But I think it gets at the heart of the matter.

Now there are cases where people suffer from what we have termed "compulsions" and we generally consider this to be a psychiatric condition. But how are bigotry, impulsive acts of violence, etc not compulsive? I'm not sure, but I know they aren't.

 

[Triathlon]

To add yet another angle to the above post, can some disorders be a product of choices or are these choices a product of disorders? Depression can come from drug use and the opposite. Can bigotry come from a choice to disagree then be fueled by further choices to read about it talk with others "find" examples to support your original thought to where an obsession of sorts is created. I am sure there are theories out there that can pin a biological rewiring process to these sorts of situations. Of course this goes into the nature nuture arguement and that isn't really what I want to get into, I am just wondering if this is a common idea.

 

[Triathlon]

Triathalon, well, scratch my example about the necrophiliacs and others....
i understand your point about being in alignment with social norms...

but what I was trying to probe was...it seems like there is something intrinsically worse in ego-dystonic disorders, vs syntonic ones. Obsessive compulsive disorder vs. obsessive compulsive personality.

What is it about having acceptance about a part of yourself and your actions and behaviors, that is clearly healthier than rejecting a part of yourself.

Is acceptance, frequently used as a goal of therapy?

Luke 16:13
No servant can serve two masters: for either he will hate the one, and love the other; or else he will hold to the one, and despise the other. Ye cannot serve God and mammon. 😉

 

[Psyclops]

If I serve mammon will I hate god?

 

[Triathlon]

If I serve mammon will I hate god?

The Christian God, yes. Within that system there is no other way as I understand it. If you believe contrary then you remove yourself from the system and where there is no law there is no sin. Of course this is in the eyes of the beholder, just hope that you're right. Otherwise it won't really matter what your eyes behold when God's see you serving mammon.

 

[Psyclops]

? I was once asked by a man who had converted to islam why, since I didn't beleive in a god, I didn't go around raping and pillaging, since by default I shouldn't have morals along with a fear of punishment in the afterlife. This man was obviously at a high stage of moral development.

 

[Triathlon]

? I was once asked by a man who had converted to islam why, since I didn't beleive in a god, I didn't go around raping and pillaging, since by default I shouldn't have morals along with a fear of punishment in the afterlife. This man was obviously at a high stage of moral development.

That is a funny question. Obviously one can have morals and values not tied to any recognition of a higher being. This can also be attributed to a self-esteem social acceptance theory. Raping and pillaging will jeopardize your position in a community. Self preservation. But of course there is the power of love for others that is just plain hard to put into psychological context, other than observation. Religion has a great impact on many a persons life, and at the same time some abuse religion and use it to manipulate. Still others cannot strike a balance within their chosen system, they will feel inadequate and blame the system, the same thing is evident in education systems though too, or any organization where perfection is the goal. 4.0 top of the class, best at everything is impossible, as is living fully the commandments of any particular religion. We all have ego-dystonic potential. It all depends on our own sensitivity of self-acceptence.

 

[Poety]

Now the question leads to.... are we born with morals? Is it something we are taught? Is it innate... hmmm.

 

[Psyclops]

I tried to explain something to that effect, but wasn't very good at articulating it. I was young at the time (17). I think you put it quite nicely.

 

[Anasazi23]

a lot of times it appears as if half or more of the 'dis-ease' in certain mental illnesses is due to the fact that the illness itself is ego-dystonic. it seems like in those cases, there is interference in the patient's functioning (on many levels) only because of the fact that the patient feels that what he/she is doing/thinking/feeling, is not 'right' or is not 'healthy' based on his'/her own perspective

The concept of a 'disorder' or process being either ego-syntonic or dystonic is critical from a treatment perspective, and the most valuable in prognosis.

This is especially true in assessing delusional vs. psychotic vs. bipolar disorders, and helps tremendously in assigning diagnosis.

To address your paraphilias, some would argue that the ability of the clinician to creat an ego-dystonic situation should be the basis of therapy.

 

[50960]

Racism is not and should not be diagnosable. It is not a state of disorder or disease, but an acquired set of beliefs that are ego-syntonic for whatever reason. Axis V maybe, but not if the feelings are truly syntonic. I cannot imagine racism being an axis 1 dx, as we would be barred from using it for anyone but white males thanks to PC edicts.

 

[Poety]

Racism is not and should not be diagnosable. It is not a state of disorder or disease, but an acquired set of beliefs that are ego-syntonic for whatever reason. Axis V maybe, but not if the feelings are truly syntonic. I cannot imagine racism being an axis 1 dx, as we would be barred from using it for anyone but white males thanks to PC edicts.

COuld be used for reverse racism or so its called - nonetheless, its a bad idea all the way around.