When it's not OK not to be OK #MentalhealthAwareness

It's a great thing, the openness around mental health issues and all the initiatives out there to make it 'OK not to be OK'.

It's beneficial to understand more about depression and what may or may not be useful in finding a way through it, about dopamine, serotonin, endorphins, CBT and all the rest of it, and many people are being helped with the symptoms of their deep pain. People want to make people better. Of course, it means improved in wellbeing, physical or mental, but maybe getting better is loaded with being better. Which is what we should be. Feeling better, better at coping, better at being, better at living. Better in every way. To get or be better is not to accept where you are, which is laudable, if you can change. But there are some people for whom at sometimes, 'I can't' is very real. However much as it would be great for them, for the people who know them, and for society as a whole, it could be that they are not giving up, giving in, copping out or whatever but, for the time being at least, really, truly, just 'can't'. In the film 'Richard Jewell', about the security guard falsely accused of the Centennial Olympic Park bombing in Atlanta in 1996, there's a scene where the FBI is turning over his and his mother's home in the search for evidence. His lawyer tells him repeatedly how and how not to behave in front of them. Richard says,'You can do that because you are that sort of man. But I am not' or words to that effect. It struck a chord. However much others might wish to help us, offering solutions and telling us that we can do whatever it is that would make us better, normalise us, if we feel we can't, are temporarily imprisoned by that can't, like it or not, we can't. Maybe, for the time being, acceptance is as good as it's going to get. But people that 'can't', and on some level maybe never could in any 'normal' sense, may try to make it look as if they 'can', using whatever tools they have. Like a seedling in the dark, they might shoot up towards a crack of light, too far, too fast — no time to make a sound root system or side shoots. When the reality of drought or dark days come along, they collapse, suddenly realising they had adapted, yes, but it was a maladaptation, a mutation. No blame, it's just life trying to survive however it can.

A friend told me she'd seen a programme about chimps. A group of youngsters were given an iPad set to selfie mode. Most of them had a look, pushed some other buttons, played with the thing for a while then went off to do something else, maybe something that seemed more relevant, more real, more fun, who knows. But one little chimp didn't; he just sat and stared at himself, stared and stared. Was this an abandoned or orphaned baby chimp? I have no idea, but the image seemed so sad. A little baby chimp, the selfie setting the reflective techno-pond of the modern Narcissus. Not vain, self-centred, selfish Narcissus, but a poor, lonely one, so desperate to prove his existence to himself, so fascinated by what this could mean that he couldn't look away, or run off with the others, join in and play. 'So busy looking in the bathroom mirror he wasn't there when souls were given out', I read somewhere online describing the traits of a narcissist, the psycho bête noire of bête noires.

'It's OK not to be OK' up to and probably including bipolar disorder, which was my diagnosis when I was 22. But when you venture on along the spectrum of mental health issues into the murkier waters of 'personality disorders', I think that perhaps it feels less OK not to be OK for the sufferer and the people who love them. Depression is hard enough. When your friend is suddenly a blank-faced, monosyllabic, unreachable shadow of the person you knew, for months on end, it would test the patience of a saint. But, whatever depression is telling the sufferer about its everlasting nature, it is, hopefully, temporary. It is, like bipolar, classified as a 'mood disorder' and therefore it will pass, presumably. It is not 'you' any more than any other physical complaint. It is to do with chemistry, that dopamine-serotonin thing and it can be put right. Especially if you get on board with your psychiatrist and medication and run, dance, meditate, sleep, volunteer, and do all the things you love (although as anyone with severe depression knows, there just aren't anything of those things as far as the eye can see, and beyond).

After so many months of depression and numerous different anti-depressants, I began to believe that there was more to my state of mind than could be 'explained' or fall under the definition of bipolar depression. Surely I should have bounced up into a high by now as had happened in the past? Why hadn't I? I turned in my despair to the internet to find something that seemed to chime with my experience. I didn't know very much about personality disorders; I still don't, but the name suggests something worse than mental illness (although they are listed as such in the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders 5th Revision). Instead, they are intractable and entrenched, something about you — about your personality— something which you can't medicate away because it is you. It runs right through you like lettering on a stick of rock. That's very scary. That just doesn't feel OK on any level. But what I was feeling didn't fit any definition. My God! Not one of these bundles of awful symptoms fits me, in the whole megastore of malfunction. What sort of a freak does that make me?

Labels have their uses. When well, you might not want one. When unwell, it's nice to know that someone, somewhere has experienced something akin to what you are going through. Some labels are easier to wear than others, ill or well. It's a double-edged sword along the lines of, thank God I'm not the only one/oh please God, I do not want to be this — this just cannot be what my life is. But how else to explain such a long depression? And how else to describe these behaviours? I'm sure it's very well-intentioned. It seems like an impossible task, unravelling all these symptoms and traits and rounding them up into 'disorders' and then clusters. Clusters? WTF? Haven't we all felt some of this stuff, sometimes, if we're honest? I completed an online test and scored an average of 90% for every single 'PD'. I was suicidal at the time which might not have helped. Whatever, that's self-diagnosis for you. Below is an article from Psychology Today's website to help you get your head round the clusterfuck (dictionary definition:a disastrously mishandled situation or undertaking). My thoughts as I read it in black — both ink and mood.

'The study of human personality or "character" (from the Greek charaktêr, the mark impressed upon a coin) dates back at least to antiquity. In his Characters, Tyrtamus (371-287 B.C.) — nicknamed Theophrastus or "divinely speaking" by his contemporary Aristotle — divided the people of 4th century B.C. Athens into 30 different personality types, including "arrogance," "irony," and "boastfulness." Characters exerted a strong influence on subsequent studies of human personality, such as those of Thomas Overbury (1581-1613) in England and Jean de la Bruyère (1645-1696) in France.

The concept of personality disorder itself is much more recent and tentatively dates back to psychiatrist Philippe Pinel’s 1801 description of "manie" sans "délire", a condition which he characterised as outbursts of rage and violence (manie) in the absence of any symptoms of psychosis, such as delusions and hallucinations (délires).

Across the English Channel, physician JC Prichard (1786-1848) coined the term "moral insanity" in 1835 to refer to a larger group of people who were characterised by "morbid perversion of the natural feelings, affections, inclinations, temper, habits, moral dispositions and natural impulses," but the term, probably considered too broad and non-specific, soon fell into disuse.

Some 60 years later, in 1896, psychiatrist Emil Kraepelin (1856-1926) described seven forms of antisocial behaviour under the umbrella of "psychopathic personality," a term later broadened by Kraepelin’s younger colleague Kurt Schneider (1887-1967) to include those who "suffer from their abnormality."

Schneider’s seminal volume of 1923, "Die psychopathischen Persönlichkeiten" (Psychopathic Personalities), still forms the basis of current classifications of personality disorders, such as those contained in the influential American classification of mental disorders, the Diagnostic and Statistical Manual of Mental Disorders 5th Revision (DSM-5). That's it! I'm a frickin' psychopath! I knew it! God, my poor neighbours. I can see the News report now after being found dead, there being 'no suspicious circumstances': 'Our neighbour from hell — we always knew there was something odd about her etc, etc.'

According to DSM-5, a personality disorder can be diagnosed if there are significant impairments in self and interpersonal functioning together with one or more pathological personality traits. Yup. In addition, these features must be (1) relatively stable across time and consistent across situations, Ditto (2) not understood as normative for the individual’s developmental stage or socio-cultural environment, For sure and (3) not solely due to the direct effects of a substance or general medical condition. Unfortunately not.

The DSM-5 lists 10 personality disorders and allocates each to one of three groups or "clusters": A, B, or C.

Cluster A (Odd, bizarre, eccentric)

Paranoid PD

Schizoid PD

Schizotypal PD

Cluster B (Dramatic, erratic)

Antisocial PD

Borderline PD

Histrionic PD

Narcissistic PD

Cluster C (Anxious, fearful)

Avoidant PD

Dependent PD

Obsessive-compulsive PD

Before going on to characterise these 10 personality disorders, it should be emphasised that they are more the product of historical observation than of scientific study, and thus that they are rather vague and imprecise constructs. As a result, they rarely present in their classic "textbook" form, but instead tend to blur into one another. You're not kidding. Their division into three clusters in DSM-5 is intended to reflect this tendency, with any given personality disorder most likely to blur with other personality disorders within its (nut)cluster. For instance, in cluster A, paranoid personality is most likely to blur with schizoid personality disorder and schizotypal personality disorder. Leaving the person where exactly?

The majority of people with a personality disorder never come into contact with mental health services (result), and those who do usually do so in the context of another mental disorder or at a time of crisis, commonly after self-harming or breaking the law. Nevertheless, personality disorders are important to health professionals, because they predispose to mental disorder