Friday, December 28, 2012

Compassionate Personality Disorder

This is about compassionate personality disorder. I invented this diagnosis years ago as I kept finding myself in the DSM IV but in many places but I wasn't happy with any of the diagnoses. For more about my beliefs about the DSM classification system, see what William Glasser has to say (  As Michael White used to say "every day's a field day for a psychopathologist".

I seriously believe that the centralised, patriarchal and disempowering model of so-called "mental illness" health care delivery is ineffective at best and at worst, the current model canbe very damaging to people's self esteem and even abusive by 

a) removing people's self faith inadvertently by application of a diagnosis and hidden strong biases towards pharmaceutical treatment processes, and 

b)inadvertently shifting their faith in recovery  from their own community to expensive, scarce and less readily available specialists, and by shifting their focus of help-seeking in the same direction- away from available friends, family and community towards professionals. 

Here I agree with Vikram Patel and his model of "SUNDAR" with us all empowered to help.

I am not saying this disempowerment is deliberate- the hidden memes (eg "you can't do this without chemicals, or a professional", "you are deficient in something that only they can provide, be it strategies, or serotonin") can be the cause of the harm, not the intentions of the carers.  But the system is here to stay....

.. if you can't beat-'em, join-'em.....


People with compassionate personality disorder have a heightened sense of responsibility for what they do. They have a heightened awareness of the effects they have on others.

The criteria for this disorder are as follows...

The valuing of compassion. People with cpd value compassion highly. They are committed to improving experience for people with whom they come into contact. They are commmitted to trying to relieve other people's suffering. They are more interested in connectedness than in individuation, more interested in experience than in facts, more interested in finding common ground with people than differences and more interested in finding the good in people than the bad. They don't believe in blaming others, labelling them, and are more likely to do this to themselves.

(Warning...If you aren't finding this helpful I suggest you stop here.. This is MY definition of cpd, as the entity has not really been described. A few people who see me have found it really helpful, as previously they have not been able to relate to the labels that people have given them... depression, inadequate etc. This, for some people provides a label that gives acknowledgement to their experience while valuing them as people rather than devaluing them. If you are happier with a more conventional "diagnosis" there are plenty of other places to go on the internet.. this blog might not be for you!)

The feelings of compassion....

People with cpd feel other peoples pain and anguish. They are readily able to identify with people. Because the world has so much abuse, hardship and suffering, people with cpd feel lots of pain. When joy occurs, people with cpd feel elated and high. They SHARE experience with others, rather than isolate their emotions, thoughts and feelings from others.

Guilt is a common experience for people with cpd. (see the thoughts of compassion).

Anger is extremely common. People with cpd feel anger and outrage about the injustices in the world. They cannot believe how badly some people treat others. Because they are in tune with other peoples’ pain, they often experience outrage and anger.  

Because they are so in touch with their experience, they often express their feelings to others. This attracts others to give them advice to “toughen up”, or “don’t feel so angry”. They get told “that’s just how the world is.. get used to it”. They find this difficult because they are ethically opposed to “just getting used to it” because to do so would allow others to continue to abuse people.

People with cpd are often misdiagnosed with “depression” or “anxiety”. They often get told they need medication. They see doctors. Doctors have been trained to judge people, but, although they are familiar with the feelings of compassion, have been trained by their superiors to think of these feelings (when they have them themselves) as signs of becoming “over-involved”. To be in tune with them would have them overwhelmed by the numbers game that society has imposed on them. So they encourage people with cpd to do what they themselves HAVE to do.. “Switch off”, “toughen up”, “learn to be cruel to be kind”, “be rational, not so emotional”. They diagnose depression or anxiety, and often prescribe tablets. (Don’t get me wrong... the tablets are good for some people, and for some people they are extremely good. They do help, but they aren’t the only answer.. see more below in “some advice”). 

People with cpd feel like they don't fit in with our society. They think that the world could be a better place and can't understand how harsh and cruel cold and remote others can be.

The thoughts of compassion. People with cpd are more likely to think.."I could have done better" or "I can do better". This is what makes them put in 100% for others. They think this rather than "I've done my best, there is nothing more than I can do" .. that thought which allows people to back off from a situation and then blame others for any problems occurring.

Because they feel guilty, they are likely to think "Because I feel guilty I must be bad" (or "there must be something wrong with me" or some other negative variation on a theme.) Other people are likely to reinforce this belief by labelling people with cpd as having something wrong with them, or treating them as if they are weak or deficient. 

CPD sufferers devalue this guilt as something wrong with themselves. Without guilt would not one act more irresponsibly, and create more suffering for others? For CPD sufferers, "guilt" is their conscience which for the moment has happened to stumble upon a megaphone. The problem here is not the guilt, it is the megaphone. We all need a strong conscience.

CPD sufferers are more likely to think "I must not have a negative impact". This is at odds with the belief which is becoming more prevalent in our society which is “I have the right to influence others (and the environment)”. CPD sufferers, when they are suffering, have repeated thoughts which echo "Lack of entitlement", guilt, self-blame, anxiety and shame. Society reinforces these strongly; in fact I argue that society can only force people to do things in the workforce they wouldn't normally do if they have a healthy dose of these entities- call me a conspiracist if you like!.

The actions of compassion
People with compassionate personality disorder often find themselves doing things for others or because of a sense of duty or obligation. They are ethically opposed to letting people down {as compared with people with individualistic personality disorder, or economic-rationalist personality disorder who believe that people fall into two categories.. those who don’t deserve to be let down (their friends) and those who aren’t entitled (the weak, pathetic, those “below” themselves, or the "unwell". Unfortunately the industrialised model of health care makes such discrimination necessary to prevent burn out. Practitioners must divide people into those "deserving" of help and those where the effort might be less rewarding, relying on ideas of professionalism, sustainability, objectivity and pragmatism}

When people with compassionate personality disorder are doing things for others, they often feel bad, put out, or cross with themselves for putting themselves out, BUT THEY KEEP DOING IT. That is because they are very committed to the service of others. When they are regaining energy to go back into service (resting), they feel guilty and selfish. They keep on DOING COMPASSION, RATHER THAN JUST TALKING ABOUT IT. It is this doing that makes them often feel tired. They often strive for “balance” in their lives, and they think that this will provide comfort. It is when they start thinking “life should be comfortable” that they start to feel depressed, because they find that by seeking comfort, they often have to take themselves “out of service” to others.

Why is this a “disorder”?
CPD is a disorder because it is not consistent with the dominant beliefs of modern society. People with CPD are sometimes not valued as employees because they put in extra effort trying to get to know people, which is not "efficient". Because they don't believe in "having an impact" they can be seen as indecisive. People with "realistic personality disorder" are more likely to blame them for not being strong, decisive and "in action". People with cpd will only be in action if they are confident that they have done their utmost to minimise the negative consequences of their action on others. This is in contrast to people with "realistic personality disorder", "decisive personality disorder", "remote personality disorder" and "economic-rationalist personality disorder". The latter groups use this difference to judge people with cpd, so they are continuously being judged by others. They ethically refuse to do the same back, so others see this as a sign of weakness. These others are into strength, which they see in terms of "standing by your decisions", "defending yourself", "not taking any shit", and "knowing your boundaries" etc. These people are into having an impact or influence, moving on, etc. People with cpd are more into conserving, peace, stillness, rest, appreciation rather than modification of the world.

People with cpd don't climb hierarchies because the practices that are necessary to do so are not consistent with their values.

Treatment. It is not a good idea to try to treat people with cpd, because the world is worse off if their disorder is treated. People who need compassion and support will be denied refuge from the harshness of the world. It is helpful to explain to people with cpd that they have a disorder that was once a desirable condition, but is no longer consistent with modern Western ideas of progress, efficiency and the pursuit and worship of information rather than appreciation of life. It is very important to give people with cpd permission to shout, yell, scream, and do crazy things because the burden of being compassionate all the time is extreme. It is only when they become aware that compassion is their choice that they start to feel more comfortable with the thoughts and feelings and experience of compassion, much of which is negative. When they start thinking... "I'm glad I'm feeling bad... it shows I am in tune with my compassion and love for others" that paradoxically they start feeling better. That is WHEN THEY BECOME COMFORTABLE WITH THEIR DISCOMFORT, RATHER THAN FIGHTING IT. When they become comfortable resting, and see it as a necessary break to replenish themselves before returning to service, rather than selfishness, then they become less distressed.

One risk for people with cpd is to see themselves as compassionate people. For me Compassion is a practice, as is love. I believe that one way of knowing that I am practising love or compassion for others is when I am feeling guilty, or doing something for someone which I really do not feel like doing. But this is my choice. Sometimes I choose to have a different idea of compassion. If I have exhausted all other avenues, it might be compassionate to distance myself from others. But this I see as a last resort.. a temporary way of nourishing myself so that I can continue to serve others...when I feel better. I am not prepared to go down the physical gurgler because of my beliefs about compassion. While I am feeling fit and well, I believe in selflessness. When I am feeling overwhelmed and cornered and sick, I believe in selfishness. When I get back my energy, I believe in selflessness. Like a battery, sometimes I need to be run right down before I will recharge, other times I keep on going, with little top-ups in between.

Some advice (which I am not really entitled to give, as to do so is to participate in inviting people to feel bad about what they have done already.. so please see it only as a sharing of what SOME  other people have found helpful SOME of the time, in SOME circumstances.

About doctors and counsellors.
Find the doctor who will not only prescribe, but who will also help you think about your thinking in a way that feels collaborative to you. If your doctor gives you the impression that they are pretty much only interested in diagnosing you and prescribing for you, see someone else as well. Any counsellor who checks on how their style is working for you, and seems happy to adjust it if it is not working is fine.

Don’t be fooled into thinking that your thinking is wrong or deficient. It isn’t. It is simply compassionate thinking. That anger is “ a passion for justice”. That guilt is your conscience.. your moral values system. If you lose them you would be more inclined to let the world self destruct, and you would start contributing more to that destruction. You don’t want to lose them.. just stop feeling bad about anger and guilt. And if you do feel bad about them... Don’t feel bad about feeling bad. Feel good that you can feel bad about feeling bad. Being able to feel bad is the only thing that makes you a good person. Without that ability you would start to do more bad things to people. And you wouldn’t give a stuff. You know the people who do that.. do you want to be like them?

That doesn’t mean that you shouldn’t want to change your thinking or your experience of your thinking. “Treatment” can help to create a different “space” to step into and out of when you choose. In this space you can ask yourself “Am I ready to re-enter the compassionate (uncomfortable) way of being, or do I need a rest?” You already know that resting space.. it’s the space where you feel selfish. One thing that may help is to change the “aren’t I selfish?” into “isn’t it great to be selfish like this, so that I can regain the energy to continue to be selfless?”