Dave's Progress. Chapter 90: Psychotic vs. Psychopathic- A Common Misunderstanding.

I'm sorry to bang on about this, as it is a point I have probably mentioned in previous posts. It is just that this particular misunderstanding about mental ill health is so prevalent that I think it probably deserves one last, hopefully exhaustive explanation. I am, of course, referring to the seemingly ubiquitous mistake made, particularly in the media and (mostly American) films, where the terms "psychotic" and "psychopathic" become confused.
To make it clear, and as far as I know, "psychosis" or being "psychotic" simply refers to a set of symptoms, such as delusions, hallucinations, illusions, becoming withdrawn and flattening of affect. In psychosis, there is no inherent link to violent or criminal behaviour, but more of a break from "reality". Psychosis can occur in illnesses as wide-ranging as schizophrenia, bipolar disorder and depression. "Psychopathic", however, refers to a particular type of personality disorder, I believe also referred to as "sociopathic" or "anti-social" in which there is no break with reality and, although it pains me to say this, there is a link to violence. Despite this massive difference, these terms, perhaps because of the prefix "psycho" and its stigmatizing associations, are often used interchangeably.
If I give just a few examples: in "The Observer" newspaper, the habitually violent, criminal character played by Joe Pesci in the film "Goodfellas" was described by the resident film critic as "psychotic". So, this mistake is not confined to the red-tops, but also the apparently liberal, intelligent broadsheets. In the film "Scream", Neve Campbell's character describes the killer, who goes around routinely stabbing innocent teenagers, as "psychotic". And, only the other week, on "Mastermind", of all things, the "psychopathic" character of Thomas Harris' novels and many films, Hannibal Lecter, was similarly described as being "psychotic". Even a piece of junk-mail I received from "Benson's World" video and dvd company described the child killer in Fritz Lang's masterpiece "M" as "psychotic". So, this error seems to be all over the place.
Perhaps the main reason this bothers me (after all, you might think, why be so pedantic, it's only a word?) is because if people like the Campaign for the Abolition of the Schizophrenia label get their way, the name for the illness which has plagued me for some twenty years may be re-named something like "post-traumatic psychosis". So, if this term continues to be misused, the erroneous assumption that there is an inherent link between schizophrenia and violence will continue, despite the re-naming. It is a well researched fact, after all, that misunderstanding leads to a misattribution of anti-social behaviours, and therefore, stigma.
So, I hope, once and for all, I have cleared up this confusion for you and you will all now go about being good anti-stigma campaigners, and point out to people when they are making this mistake. OK, so maybe I'm being optimistic. But, this would have a very real effect, if the research is to be trusted, and make a lot of people's lives easier.
So, it's back to the old subject for now, but rest assured I will return, after the responses I got for my last post, with another, perhaps lighter and different topic. Maybe I could take to infusing the quotidian with comedic flourishes, like my pal klahanie, who gets away with making talking about things like radiators, washing-machines, toasters, and bog-roll entertaining. I guess you'll just have to wait and see.
But, that's all for now from your normal, average, delusional and paranoid man.


bazza said…
All very sad and disturbing David.
There is similar (but less harmfull) conflation between the words 'psychologist' and 'psychiatrist'. It's hard to see these distinctions ever being overcome unless a word with a different root is created from scratch; old words carry conotations which simply cannot be shaken off.
David said…
Dear bazza,
Yes, it is hard to see how these problems will be overcome. I assume most of the public would not even know what "psychosis" really is. As you say, perhaps we need a new word altogether to get rid of these horrible conotations. Unfortunately, psychiatrists (as opposed to psychologists!), in my experience, in their rush to diagnose, rarely think of the social and cultural implications of a diagnosis, only the medical ones. On the other hand, without such diagnoses, how do you get effective treatmnet? It's all a bit of a minefield.
Anyway, thanks for your continued interest, bazza- as I say, I hope to print something a little lighter next time.
Yours with Very Best Wishes,
Smita Tewari said…
your psyco-analysis is really interesting! keep updating us!
thanks for sharing!
and do drop by my blog & post a comment!
MichelleLCSW said…
I just popped over to your blog and started reading your posts - and I have to say you are spot on with the MANY misunderstandings that are present when it comes to "mental health" terms. It drives me bat-shit crazy when people misuse different mental health terms - especially when they're trying to stir up some kind of controversy for "effect." I'm glad that you took the time to distinguish the VASTLY different diagnoses of "psychotic" vs "psychopathic." We have a lot to do to eradicate so many of the stigmas associated with mental health.
David said…
Dear Smita,
Thanks for visiting and taking the time to leave a comment.
I'll be sure to visit your blog soon.
With Vey Best Wishes,
David said…
Dear Michelle,
Thanks so much for commenting.
I'm glad that I seem to be "spot on" with "many" (oh well, can't be right all the time!) of the misunderstandings surrounding mental illness. As you can see, it drives me bat-shit too. In a good way, that is. (By the way, is "bat-shit" a technical term?):)
Also, I loved reading your own blog and will be sure to visit again.
With Very Best Wishes,
klahanie said…
Dear David,
Apologies for arriving so late in regards to this posting.
I'm going to keep this fairly brief. I get somewhat agitated by the misuse of mental health terminology. Your article, as per usual, gives a very informative slant on the whole thing.
I really must echo Michelle's excellent response to this posting. Like you, Michelle does an excellent blog, although a little zany, in a very clever way. Her blog, is most definitely, well worth a read.
Thanks for this, David.
In kindness and respect, your buddy, Gary.

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