A Prescription, Disorders, Conformity and Culture

Sauk Centre, Minnesota. Wednesday afternoon. (May 17, 2023)
Looking out my front door on a slightly smoky Wednesday afternoon. (May 17, 2023)

First, the good news. I am not experiencing withdrawal (or, more politely, “discontinuation syndrome”). The not-so-good news is that I’m putting off what I was getting ready for today until next week.

This ‘journal’ post is, in part, an explanation:

About smoke in the air, here in central Minnesota: we’re downwind of Canadian wildfires. Sometimes it’s overhead, sometimes it’s at ground level too.

Google air quality map ca 22:30 Central time May 17, 2023; 3:30 UTC May 18, 2023.
Google’s Air quality map Wednesday evening, showing overhead smoke. (May 17, 2023)

Decisions — or — Ducks in a Row and Other Alternatives

Photo: Brian H. Gill, at his desk. (March 2021)This has been another interesting week.

That’s partly because I learned about a newly-confirmed exoplanet, TOI-244 b. What scientists said about this super-Earth ties in with what I’d hoped to have ready this week.

That’s the good news. For me, at any rate.

But it’s also mildly frustrating news. Getting my facts straight, my ducks in a row and ideas organized would take more time than I have.

Since I’ve got free will, I could forego ferreting out facts, let my ducks wander into traffic, and trust my freewheeling mind to churn out something worth reading.

Since I want what I write to make sense, that strikes me as a really bad idea. So instead I’ll spend time on this journal entry, and keep working on that ‘super-Earths and the search for life’ post.

Smoke in the Air, Health Issues and a Needed Prescription

My methylphenidate prescription, with one day left. (June 10, 2021)My wife and I, and the two now-grown kids who live here in Sauk Centre, could feel better: partly due to smoke that’s blowing over from Canada.

Our granddaughter’s surgery went well, and she’s been home for several days. I talked about that last week.

She’s still what my oldest daughter and I call “subdued”: which makes sense.

A broken arm does not feel good. This is the first time she’s experienced that outcome of the interaction between a swing and gravity. I figure she’s on a learning curve, and that’s another topic.

Meanwhile, I spent part of last week and the first few days of this hoping that authorization for a sincerely-needed medication would get processed before I run out.

I put myself on half-doses last week. That would have kept me going through Wednesday of this week. Doing so is not a particularly good idea. But maintaining full daily doses until my supply runs out is a worse one.

I’d better explain that.

Responsibility and Requirements, Reasonable or Otherwise

Rurik's photo: The maze of Longleat House. (Autumn 2005) via Wikipedia, used w/o permission
The Longleat hedge maze in southern England. Labyrinths like this are fun.

① Remembering to request an authorization each month is my responsibility.

② I’ve been told, and believe, that the regional health authority must have five business days to do whatever it is they do after my monthly request for an authorization disappears into their labyrinthine departments.

Whether or not I think this is reasonable is irrelevant. It is the reality I deal with.

I don’t like having to get permission each month to keep using my brain

But again: this is the reality I deal with.

Clarifying something: “using my brain” isn’t quite accurate. Make that “using my brain without metaphorically fighting the machinery”.

Happily, I’ve had decades of practice, staying moderately functional while dividing attention between what’s happening ‘outside’ and maintaining control ‘inside’.

Benefit/Risk and Labels

Vincent van Gogh's Sorrowing Old Man' or 'At Eternity's Gate.' (1890)The prescribed medication that needs authorization every month is methylphenidate. It’s marketed under the brand names Ritalin and Concerta, and is occasionally used as fodder for headlines.

It’s also a Schedule II controlled substance. American citizens have been protected from controlled substances since 1971, so I must ask for a new authorization each month.

Schedule II controlled substances have medical uses “with severe restrictions”, and have “a high potential for abuse.” (21 U.S. Code § 812 – Schedules of controlled substances)

Folks who made the controlled substances list had a point. Like so much else in this world, methylphenidate can be be misused.

For that matter, folks can misuse caffeine; although research that could make it a controlled substance is still controversial. I’m just glad I don’t need authorization each time I buy instant coffee, and that’s yet another topic.

Back to methylphenidate. It’s a central nervous system stimulant. I’m taking the maximum safe daily dose.

I could see what happens when I take more, but I won’t. Results of taking too much can start with agitation — hallucinations and toxic psychosis optional — and end with circulatory collapse.1 Risking that would be a very bad idea.

So I use methylphenidate as-prescribed: when that’s possible. That has made my life better, and significantly improved the lives of my family, too.

Learning Experiences

AP photo via BBC News, used w/o permissionI don’t like the monthly descent into bureaucratic protocol. I certainly haven’t enjoyed times when the authorization SNAFU took weeks to untangle. But again, it’s a reality which I must deal with.

Besides, experiencing withdrawal a few times has given me opportunities for understanding what others have endured, so I’ll see that as an ‘up’ side.

I also learned that what I experienced was “discontinuation syndrome”, not “withdrawal”.

I did a little checking and learned that the symptoms and causes of both were identical. That strongly suggested that I was looking at two labels for one phenomenon.

I verified my conclusion with a doctor: “discontinuation syndrome” is withdrawal from a prescribed medication.2

That’s probably a comfort to folks who’d get upset if their experience shared a label with something junkies sometimes experience.

I think labels, and words in general, matter. I also think reality matters. And prefer using labels which more descriptive than euphemistic.

Oh, wait. I haven’t said why I started taking methylphenidate.


An image from Brian H. Gill's brain scans in 2018.A dozen or so years back, my wife said I should consider seeing a psychiatrist.

I agreed. Partly because I’d long since learned that listening to my wife is a good idea, partly because something was obviously amiss.

Long story short, it didn’t take long to establish that I was experiencing depression, and had been for decades.

Depression, in this context, is a mental disorder with measurable physical effects. Or maybe, some researchers say, a person’s biochemistry causes depression.

Either way, now I had a name for how I’ve felt since I was 12, back in the early 1960s.

Depression wasn’t my only problem. ADHD-PI, also known as ADHD-I or attention deficit hyperactivity disorder predominantly inattentive, is at or near the top. Which sounds odd, since being hyperactive, physically, is profoundly not an issue with me.

Today, folks with ADHD-whatever generally get diagnosed early: as infants or children. Since I was born during the Truman administration, that didn’t happen.

I gather that getting an ADHD diagnosis for kids was fashionable at one point.3 I think that would be not good for the kid, or the parents, and I’m wandering off-topic.

An Informed Decision, Unforeseen Results

National Institutes of Health's illustration: regions of the brain affected by PTSD and stress. (ca. 2018)At any rate, ADHD etc. is one of my disorders that can be treated.

Not cured, I gather: but I’ve got options other than resignation to my fate.

Methylphenidate was not the first drug the psychiatrist and I tried.

When it became an option, I wasn’t overly keen on using it.

I knew that methylphenidate was addictive. Still is, for that matter. If I started taking it, my body would rapidly become dependent on it.4

But at the time I thought the benefit/risk balance was in my favor. I still do, although I hadn’t realized how frustrating the monthly request could be.

Or how often I’d wonder whether this month’s authorization would get lost, and I’d experience withdrawal. Again.

This time around, I had one day’s half-dose supply left when the authorization finally cleared. And, thankfully, the pharmacy had a supply of methylphenidate on hand. And that’s yet again another topic.

“Reefer Madness”, “Frankenfish” and Me

'Reefer Madness' (1936, released 1938-1939) theatrical release poster. (1972)Methylphenidate doesn’t cure what I’ve got, and apparently isn’t even a treatment for some of my disorders.

“What I’ve got”, officially, varies over time. Possibly because definitions in the DSM keep getting revised. Anyway, this is a sampling from my diagnosis sheet:

  • ADHD: Attention deficit hyperactivity disorder, inattentive type
  • ASD: Autism spectrum disorder
  • Cluster A personality disorder
  • GAD: Generalized anxiety disorder
  • PDD: Persistent depressive disorder
  • PTSD: Post traumatic stress disorder

I could let ‘there is no cure’ bother me, but prefer doing what I can — and accept that I cannot do everything.

A distinct ‘up’ side to living in the current era is that methylphenidate and medications like it exist. Taking my meds makes my life much less difficult that it might have been.

A not-so-up-side to living in early 21st century America is that we’re still dealing with responses to an earlier generation’s concerns and paranoia: which gave us the Controlled Substances Act, or CSA. The CSA took effect in May of 1971.

I remember the 1960s. I think pill-popping, prescribed and otherwise, was a problem, and that drug abuse is still is a problem.

But it wasn’t and isn’t the only issue we’ve been dealing with, and I do not think that either “Reefer Madness” or “Frankenfish” represent reasonable responses to real concerns.5

“…Odd or Eccentric”?…. I Can See That

Illustration of 'icepick' lobotomy, from Dr. Walter Freenan II's 'Psychosurgery in the Treatment of Mental Disorders and Intractable Pain.' (1950)I’m not sure what I think of “Cluster A personality disorder”: or the idea of personality disorders in general.

That may be partly due to my memories of the ‘good old days’ when conforming to a particular group’s social norms mattered.

Time passed. The Establishment of my youth ripped whatever remained of their reputation to shreds. Now we’ve got a new Establishment, with new social norms, and that’s still another topic.

The point is that I’m not entirely comfortable with the folks in charge defining some behaviors and ways of thinking as “disorders”. The good news is that lobotomies aren’t nearly as fashionable as they were in my salad days.

And that brings me to Cluster A personality disorder.6 Although bits and pieces of Cluster B’s definitions that sort of fit me, I’ll admit that Cluster A may be a somewhat closer match. Particularly the schizotypal part.

“…Cluster A (odd or eccentric disorders)
Cluster A personality disorders are often associated with schizophrenia: in particular, schizotypal personality disorder shares some of its hallmark symptoms with schizophrenia, e.g., acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior. However, people diagnosed with odd-eccentric personality disorders tend to have a greater grasp on reality than those with schizophrenia….”
(Personality disorder, Wikipedia)

Schizotypal Personality Disorder: Two Lists

William Hogarth's 'A Rake's Progress' Plate 8 ' In The Madhouse'. (1735 (original engraving), 1763 (retouched by Hogarth, adding Britannia on wall))Insanity happens. What the word means depends on whether it’s used in an informal, legal or political context. As a medical term, it’s apparently been replaced by mental disorder.

Folks have tried to understand mental disorders for a long time. As a field of study, psychology started a couple dozen centuries or 17 decades back, with Thales or Gustav Fechner.

We’ve been learning a lot lately: redefining categories and making new ones, like schizotypal personality disorder. It showed up in the DSM-III. We’re up to DSM-5-TR now, and that’s — you guessed it — more topics.

Nine years back, fitting five of these nine criteria warranted a ‘schizotypal personality disorder’ diagnosis.7 Bear in mind that this isn’t expert advice.

  1. Ideas of reference
    (the notion that ‘it’s all about me’, that events are aimed at oneself)
  2. Odd beliefs or magical thinking
  3. Unusual perceptual experiences and bodily illusions
  4. Odd thinking and speech
  5. Suspiciousness or paranoid ideation
  6. Inappropriate or constricted affect
  7. Behavior or appearance that is odd, eccentric, or peculiar
  8. Lack of close friends or confidants, other than first-degree relatives
  9. Excessive social anxiety that doesn’t diminish with familiarity, tends to be associated with paranoid fears
    (Source: “Schizotypal Personality Disorder: A Current Review“, Current Psychiatry Reports (CPR) (July 2014))

Mayo Clinic’s list is shorter, or compressed.

  • Peculiar dress, thinking, beliefs, speech or behavior
  • Odd perceptual experiences, such as hearing a voice whisper your name
  • Flat emotions or inappropriate emotional responses
  • Social anxiety and a lack of or discomfort with close relationships
  • Indifferent, inappropriate or suspicious response to others
  • “Magical thinking” — believing you can influence people and events with your thoughts
  • Belief that certain casual incidents or events have hidden messages meant only for you
    (Source: Personality disorders, Diseases & Conditions, Patient Care & Health Information, Mayo Clinic)

Next, I’ll do an informal and very unscientific self-analysis.

Navel-Gazing — or — The Paranoids are After Me! 😉

Fred Barnard's 'Discussing the War in a Paris Cafe,' Illustrated London News. (September 17, 1870) via Wikipedia, used w/o permission.Going through the CPR list in reverse order, starting with numbers nine and eight: excessive social anxiety with a dash of paranoia, and no close friends other than first-degree relatives.

“First-degree relatives” doesn’t include spouses,8 and I enjoy interacting socially, so I don’t quite qualify.

On the other hand, I’m not someone who must get together with a few hundred close personal friends several times each week.

Maybe I do qualify, after all.

Odd, eccentric or peculiar appearance or behavior? Inappropriate affect? Yes, on both counts: since “affect” in this context probably means facial expressions and body language.

I’ve got a beard and long hair, which isn’t customary in these parts. My “affect” could be a great deal less on the 50th percentile than it is, but it’s something I’ve learned to monitor.

Suspiciousness or paranoid ideation? I don’t think so. I’ve learned to avoid being gullible, but that’s probably not “paranoid ideation”. I hope not, at any rate.

Odd thinking and speech? I talk like a professor. I subscribe to Sky and Telescope, and occasionally read papers on PubMed Central. None of that’s normal, so yes: I exhibit odd thinking and speech.

Unusual perceptual experiences and bodily illusions? I don’t think so. Hallucinations aren’t part of my daily life. Except a stress-related auditory hallucination, decades back, and that’s long since gone.

Magical thinking? No: like everyone else, my thoughts don’t affect others unless I turn them into words or actions.

“Odd beliefs”: I’m an American who grew up in a Protestant family and became a Catholic. That is odd.

Finally, “ideas of reference”? Definitely not. I realize that the universe isn’t all about me.

My score is maybe three or four out of nine. I almost qualify; and might, from another person’s viewpoint.

Disorders, Cultural Expectations and Making Sense

Joseph Keppler's 'The Bosses of the Senate' cartoon, first published in Puck Magazine. (January 13, 1889) This version by the by the J. Ottmann Lithographing Company, via Wikimedia Commons, used w/o permission.
Joseph Keppler’s “The Bosses of the Senate”. (1889)

As I said earlier, I’m not entirely comfortable when the folks in charge define some behaviors and ways of thinking as “disorders”.

That’s partly, I suspect, because I wasn’t The Establishment’s page my youth. And, although The Establishment’s got new preferences and slogans, I’m still not dancing to their tune. Mixed metaphors there, but never mind.

I think personality disorders, as defined by the American Psychiatric Association, are real.

“…To be classified as a personality disorder, one’s way of thinking, feeling and behaving deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time…..”
(What are Personality Disorders?, Personality Disorders, Patients and Families, American Psychiatric Association)

But with my background, “…deviates from the expectations of the culture…” encourages a degree of caution.

I’d better explain that.

Living Up, or Down, to Expectations

Screenshot from a 20th Century Fox trailer for 'Gentlemen_Prefer_Blondes.' Marilyn Monroe and men in formal suits and vests. (1953) via Wikipedia, used w/o permission.In my ‘good old days’, “she’s smart as a man” was supposed to be a compliment.

Men would avoid being seen in public, holding their baby. Some women would cross the street, rather than pass by a pregnant woman.

I do not miss those ‘good old days’.

Back then, seeing most women as bubble-headed, while grudgingly admitting that the rare boring bookworm might achieve male intelligence, was the culture’s expectation. I’m oversimplifying, but not by much.

Living up, or down, to cultural expectations wasn’t much better for boys. My opinion. Although reading was taught to both boys and girls, being bookish outside the classroom wasn’t encouraged. Certainly not for my half of humanity.

Granted, my lack of obsession with sports may connect with being born a cripple. If I do something, I want to be at least adequate in my performance.

Back to cultural expectations of my salad days.

Some girls defied convention by admitting competence in academic skills. I was in my early teens before I realized that boys could, on average, be as smart as girls.

Treating personality disorders was different in those days. I don’t know how many boys were encouraged to ‘man up’ and stop exhibiting reading skills and creativity.

That changed, as did overt efforts to force girls into the household-appliance role. Disconnects between claims that women are people and commercial/media objectification remained and remains an issue. Again, my opinion.

Being Out of Step

Eugenics law historical marker, Indiana.That last bit about cultural expectations reminded me of another point.

On the rare occasions when someone identifies me in political terms, I’m generally ‘some conservative guy’. I figure that’s because I’m not on the same page as today’s Establishment.

Compared to the red-white-and-blue-blooded stalwart American patriots of my youth, I’d probably look liberal. And comparatively sane, but this isn’t the time for me to go off on that tangent.

Since I don’t fit The Establishment’s approved model for beliefs and behavior, I could seek treatment for my personality disorder. Which I have, actually, with mixed results, but never mind.

Happily, I haven’t been and may not be forced into a re-education program. Even under McCarthyism and more recent enthusiasms, that hasn’t become a national policy.9

A Few Good Ideas

Postcard: Willowbrook State School. Staten Island post cards collection, Scanned by New York Public Library, via Wikipedia, used w/o permission.I’d be a great deal more upset about my country’s current situation, if I didn’t realize that it’s temporary.

It also helps that I see many periods, from the Gilded Age and Progressive Era, on up to the present, as a mix of horrific policies and a few good ideas.10

The trick, as I see it, is to help preserve what’s right, fix what’s not, and keep seeing other people as people.

It’s not easy, and at the nuts and bolts level it’s not always simple.

But I think it’s a good idea. I’ve talked about this sort of thing before:

1 Controlled substances, mostly:

2 Terms and conditions:

3 Disorders:

4 A controlled substance:

5 Background:

6 Why I’m not missing the ‘good old days’:

7 Terminology:

8 Another term:

9 Culture, control and conformity:

10 Miscellanea, mostly United states 1870s-2010s:

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About Brian H. Gill

I was born in 1951. I'm a husband, father and grandfather. One of the kids graduated from college in December, 2008, and is helping her husband run businesses and raise my granddaughter; another is a cartoonist and artist; #3 daughter is a writer; my son is developing a digital game with #3 and #1 daughters. I'm also a writer and artist.
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2 Responses to A Prescription, Disorders, Conformity and Culture

  1. Even as someone with clinical mental issues myself, I find myself confused as much as I am fascinated about these personality disorder definitions. And stuff like “What I’ve got”, officially, varies over time. Possibly because definitions in the DSM keep getting revised” reminds me of how we can get this stuff wrong. But at the very least, Truth’s always got the truth, even when we fools He guides and challenges mostly fumble our way into figuring that out.

  2. “…can get this stuff wrong…” and do: 😉 frequently. But we keep trying. And as you said: “Truth’s always got the truth”. And, happily, we keep fumbling and stumbling our way forward. With God’s help.

    Thanks for responding – it’s good to hear from you.

Thanks for taking time to comment!