• Accurate diagnosis:
  
  Correct diagnosis is absolutely essential for successful treatment. However, on the internet, I often read posts from individuals who appear to be misdiagnosed.
  
  For example, in "Personality Disorder" support groups, I read posts from individuals who clearly appear to have Bipolar Disorder. Also, in Bipolar support communities, I read posts from individuals who clearly appear to have schizophrenia.
  
  Thus I believe our communities should focus more on teaching the American Psychiatric Association's rules for correct diagnosis (i.e., the "DSM-IV").



• Correct medication:
  
  There is wide-spread consensus now in psychiatry regarding the correct treatment of severe mental illness. There are excellent, well-researched, treatment guidelines for mood disorders and schizophrenia.
  
  Many of our members have posted their diagnosis and medications in their Profile. I have noticed that some members' treatments deviate significantly from what is suggested by these well-researched, treatment guidelines.
  
  Thus I believe our communities should focus more on teaching what treatments are recommended by these well-researched, treatment guidelines.



• Psychotherapy:
  
  Apart from the universal problems of accepting their diagnosis and cooperating with their treatment; I have noticed that many individuals in support communities have major psychological/social problems that aren't being addressed.
  
  Practically all research has shown that combination treatment with medication and psychotherapy has a better outcome than just treatment with medication alone (for mood disorders and schizophrenia).
  
  Thus I believe our communities should publicly explore personal/social problems that normally would be addressed in individual psychotherapy. Specifically, I believe we should use a modification of cognitive behavioral therapy (that was introduced by Benjamin Franklin in 1726).



• Having A Plan, And Monitoring Progress:
  
  When I visit support communities, I sometimes notice individuals who appear to just go from crisis to crisis, with their history always repeating itself.
  
  These individuals seem to not have a plan for their life. They never seem to set specific goals, or systematically monitor their progress. Yet goal-setting and systematic monitoring of progress are essential for successful therapy.
  
  President Abraham Lincoln said: "To feel good, you must do good." In life, good intentions aren't enough. To accomplish anything, you must take action. Every morning from age 20, Benjamin Franklin specified his goals and, every evening, monitored the success or failure of his actions. Benjamin Franklin was one of the most accomplished, intelligent and famous Americans in history.
  
  Thus I believe our communities should teach our members how to set goals for their therapy, and how to systematically monitor their progress.

Phil Long M.D.
Administrator

• Temperance: Eat not to dullness and drink not to elevation.



• Silence: Speak not but what may benefit others or yourself. Avoid trifling conversation.



• Order: Let all your things have their places. Let each part of your business have its time.



• Resolution: Resolve to perform what you ought. Perform without fail what you resolve.



• Frugality: Make no expense but to do good to others or yourself: i.e. Waste nothing.



• Industry: Lose no time. Be always employed in something useful. Cut off all unnecessary actions.



• Sincerity: Use no hurtful deceit. Think innocently and justly; and, if you speak, speak accordingly.



• Justice: Wrong none, by doing injuries or omitting the benefits that are your duty.



• Moderation: Avoid extremes. Forebear resenting injuries so much as you think they deserve.



• Cleanliness: Tolerate no uncleanness in body, clothes or habitation.



• Chastity: Rarely use venery but for health or offspring; Never to dullness, weakness, or the injury of your own or another's peace or reputation.



• Tranquility: Be not disturbed at trifles, or at accidents common or unavoidable.



• Humility: Imitate Jesus and Socrates.

Individuals With Paranoid Personality Disorder Lack:

• Trust: Trusts friends and close associates.



• Forgiveness: Forgives others' mistakes.



• Gratitude: Often expresses praise and gratitude; is thankful for the good in his/her life.


Individuals With Schizoid Personality Disorder Lack:

• Companionship: Usually is socializing with some.



• Empathy: Understands, and is sensitive to, how others feel.



• Love: Often openly expresses love or affection for others.


Individuals With Avoidant Personality Disorder Lack:

• Courage: Is self-confident; acts on own convictions even if they are unpopular.



• Hope: Is hopeful or optimistic.



• Friendship: Is friendly, out-going and sociable.


Individuals With Dependent Personality Disorder Lack:

• Independence: Doesn't fear being alone or being temporarily separated from a love one.



• Leadership: Is able to act as a leader to encourage a group to get things done.



• Peacemaking: Is able to handle conflict and to preserve harmony within a group.


Individuals With Obsessive-Compulsive Personality Disorder Lack:

• Moderation: Sets realistic, attainable standards; does not demand perfection. (This is identical to Benjamin Franklin's "Moderation".)



• Work Balance: (If working) is able to maintain a proper balance between work, love and play (isn't all work & no play). (This is very similar to Benjamin Franklin's "Order".)



• Compromise: Is flexible and able to compromise without being rigid or stubborn.


Individuals With Narcissistic Personality Disorder Lack:

• Humility: Is humble; not arrogant or excessively proud. (This is identical to Benjamin Franklin's "Humility".)



• Equality: Is not domineering or dictatorial; treats others as equals.



• Generosity: Helps others by unselfishly giving time or money; isn't greedy.


Individuals With Histrionic Personality Disorder Lack:

• Sincerity: Is genuine or natural (not overly dramatic, seductive or attention seeking). (This is very similar to Benjamin Franklin's "Sincerity".)



• Chastity: Has no temporary or casual sex partners. (This is identical to Benjamin Franklin's "Chasity".)



• Caution: Shows caution and discretion; thinks carefully before taking action.


Individuals With Borderline Personality Disorder Lack:

• Emotional Stability: Remains calm without over-reacting to stress. (This is identical to Benjamin Franklin's "Tranquility".)



• Stable Identity: Knows “who-I-am” and “where-I’m-going”; has meaning and purpose to his/her life. (This is very similar to Benjamin Franklin's "Resolution".)



• Social Stability: Lives in harmony with friends, family and spouse without "love-hate" relationships.


Individuals With Antisocial Personality Disorder Lack:

• Tolerance: Is tolerant and open-minded; not judgmental, prejudiced or racist.



• Responsibility: Accepts (age-appropriate) responsibilities (especially for his/her own behavior).



• Ethical Behavior: Is honest; doesn't deceive, manipulate or exploit others; respects the rights of others. (This is identical to Benjamin Franklin's "Justice".)



The underlined "good mental health behaviors":
• Are incompatible with militarism.


• Are lacking in the behavior of most dictators (eg., Mao, Stalin, Hitler).


• Are lacking in the behavior of most sociopaths.


• Are the last behaviors to develop as adolescents become adults.

Phil Long M.D.
Administrator

Phil Long M.D.
Administrator

P.S. A belief in evolution doesn't mean that an individual doesn't believe in God. Just because we see a process of nature unfold (e.g., the birth of a child or a star); it doesn't answer the question: "Who or what is responsible for this?". I believe that something far, far greater than man is perfecting our brains and our destiny.

Let's take a break from this academic topic.

I hope you find this beautiful Celtic song very inspirational and relevant to what we just discussed.

"May It Be: A Promise Lives Within You Now"

May it be an evening star
Shines down upon you
May it be as darkness falls
Your heart will be true
You walk a lonely road
Oh! How far you are from home

Mornie utúlië (darkness has come)
Believe and you will find your way
Mornie alantië (darkness has fallen)
A promise lives within you now

May it be the shadows call
Will fly away
May it be you journey on
To light the day
When the night is overcome
You may rise to find the sun

Mornie utúlië (darkness has come)
Believe and you will find your way
Mornie alantië (darkness has fallen)
A promise lives within you now

A promise lives within you now

• Community members are afraid or do not like to ask others for help. Thus the majority of members don't post; they just benefit from reading other members' posts.



• Community members do not fully trust other community members.



• There are many non-productive discussions, which make some community members impatience with these discussions not helping them.



• It seems as if little is being accomplished in the community. Members feel they are not benefiting.

• Community members argue a lot.



• Community members generate lots of ideas, but other members do not use them because members fail to listen to them and reject them without fully understanding them.



• Most suggestions for community improvement are resisted.



• Many of the community members have their own ideas about how the community should be run and personal agendas are rampant.

• The community administrator ensures that members do not argue.



• Community members try to achieve harmony by avoiding conflict.



• Community members accept each other as trusted members of the community.



• Community members express criticism of others constructively in an understanding and compassionate manner.



• Community members share their personal problems with others without fear of rejection.

• Community members share a deep bond of mutual understanding and caring.



• Community members fully accept each other's strengths and weaknesses.



• Community members enjoy working together; members have fun.



• There is a close attachment to the community.



• Community members are able to work through group problems.



• Community members get a lot of work done (in helping others and being helped).



• The community administrator is democratic and collaborative. Most of the time, the community can function effectively without any administrative intervention.

Phil Long M.D.
Administrator

• Our Full Members actively monitor all new posts, and immediately notify our administrative staff if members are being treated unfairly.



• Our community has adopted a code of ethics to ensure that members are treated with respect, understanding and compassion.



• Disruptive, disrespectful members are removed from our community by the administrator.



• We have set aside “private” areas in our community which can’t be “googled” or indexed by any internet search engine. Only members with 100 or more posts can gain access to these private areas. Members posting in these private areas thus are ensured that their posts can only be accessed by trusted, Full Members of our community (and not by employers or relatives “googling” them, or by disruptive starting members).



• All of a member’s public posts are saved in their personal archive. In that way, we have no secrets. Everything that has ever been posted in our “public” areas is in these archives, and is easily retrievable. In this way, we hold ourselves accountable for what we post.

Phil Long M.D.
Administrator

Some time ago, at the Seattle Paralympics, nine athletes, all mentally or physically challenged, were standing on the starting line for the 100 m race. The gun fired and the race began.

One boy tripped and fell badly, and started crying. The other eight racers heard him crying. They stopped and came back – all of them.

A girl with Down’s Syndrome sat down next to him, hugged him and asked, “Feeling better now?” Then, all nine walked shoulder to shoulder to the finish line.

The whole stadium stood up and applauded. Even today, people still talk about this amazing event.

Trust is the belief that, when we trip and fall in life, others will care enough to come to our aid.

• “There might be negative comments being circulated about me”



• “Strangers and friends look at me critically”



• “Bad things are being said about me behind my back”



• “I need to be on my guard against others”



• “People might be hostile towards me”



• “People are laughing at me”

• “People are trying to make me upset”



• “Someone I know has bad intentions towards me”



• “People deliberately try to irritate me”



• “I might be being observed or followed”



• “People communicate about me in subtle ways”

• “People would harm me if given an opportunity”



• “I am under threat from others”



• “I have a suspicion that someone has it in for me”



• “Someone I don’t know has bad intentions towards me”



• “There is a possibility of a conspiracy against me”



• “My actions and thoughts might be controlled by others”



• “I can detect coded messages about me in the press/TV/radio”

Phil Long M.D.
Administrator

quote:

---

Originally posted by PhilLongMD

Dear Members:

I am trying to define "good social functioning" (at www.mentalhealth.com/qol/IMHQOLScale_2.pdf).

The ordering of the items on this "Social Quality of Life Scale" roughly corresponds to the order in which, while growing up, individuals learn these social skills. Thus "trust" is one of the first social skills a baby learns, and "ethics" is one of the last things an adolescent learns.

I would greatly appreciate your comments concerning this topic, and whether you feel my scale accurately measures "good social functioning".

Phil Long M.D.
Administrator

---

unemployed
thirty-one-year-old Korean-American
married woman
diagnosed bipolar 1993

quote:

---

Originally posted by PhilLongMD

I would greatly appreciate your comments concerning this topic, and whether you feel my scale accurately measures "good social functioning".

---

unemployed
thirty-one-year-old Korean-American
married woman
diagnosed bipolar 1993

Good questions EA,

We recently updated our Social Quality of Life Scale at:
http://www.mentalhealth.com/qol/IMHQOLScale_2.pdf


On the Social Quality of Life Scale, all the healthy social behaviors are scored "0", and all the unhealthy social behaviors are scored "2". Intermediate severity is scored "1".

MY PREMISE:

The "unhealthy" social behaviors are those most commonly seen in individuals with personality disorders. My assumption was that the opposite of these "unhealthy" social behaviors would then define "healthy" social behaviors.

On this Social Quality of Life Scale, if you read the "2" items for each row, you will see the core diagnostic features for that personality disorder.

Thus, the core diagnostic features for Paranoid Personality Disorder are:

* Doesn't trust his/her friends, or doubts that he/she can rely on them.
* Doesn’t forgive others’ mistakes; bears grudges; seeks revenge: seldom apologies.
* Seldom expresses praise or gratitude; feels exploited or victimized.

SCORING:

It appears that family members can more easily diagnose the person's personality disorder than can the patient.

Multiple "2" items do seem to indicate significant pathology.

VALIDITY:

This is a brand new scale; thus it will be some time before we have enough clinical data in my practice to test its validity and reliability. So far, it seems very promising.

COMPUTERIZATION:

This scale is already computerized, and it generates a printed report, for our paid subscription members. The results of our 3 page Quality of Life Scale are automatically inserted into the person's diary. The computerized therapist version of this 3 page scale is available by subscription at www.mytherapy.ca.

LIFE GOALS:

We are starting to computerize "life goals" which would be printed whenever an individual mentions a significant problem on the Social Quality of Life Scale.

For example, if the individual indicated that they had a problem with "Trust", the computer would suggest:

Trust others, and be a loyal and trustworthy friend.

• Don’t assume that other people can’t be trusted unless given ample evidence to the contrary.

Confide in your friends.

• It is very difficult to trust someone you know nothing about. That is why it is so important to confide in your friends so that they know and trust you better.

If the individual indicated that they had a problem with "Forgiveness", the computer would suggest:

Forgive wrongdoing that is honestly regretted and amended.

• Don’t bear grudges or seek revenge. Don’t let minor slights arouse major hostility.

When you have wronged others, apologize and make amends.

• A sincere apology must be honestly regretted and amended.

OUR HOPE:

In this scale, I am attempting to spell out clearly what constitutes "healthy" social behavior. If a person has "unhealthy" social behavior; our computer program will suggest a way to correct this.

In a few days, I will post our proposed remedies for all of the "unhealthy" social behaviors listed in our Social Quality of Life Scale.

I hope this will stimulate debate, and help to improve the wording of this scale.

Thanks for your interest EA.

Phil Long M.D.
Administrator