Are You Crazy? is micronationalism explained by mental disorder? Eric Lis MD,CM

Why me? MD.,CM 2010 Residency Research McGill University Psychiatry Perceptions of Emerging Technologies Labs

Disclosures Relevant biases Conflicts of interest Financial incentives

Case Mr. L. 30 yo M Ashkenazi Jewish origin Single, longest relationship 5 years Works full time Good social supports (family, friends, etc) O/E, Mr. L insists he rules a small country as its “emperor” and to have hundreds of “citizens.” Otherwise, no grandiosity, paranoia, homicidality, suicidality. Thoughts logical, goal-directed.

What is mental disorder? “illness” vs “disorder” “sick” vs “crazy” subjective vs objective function vs dysfunction “normal” as per the DSM, ICD, CCMD…

micronationalists Grandiosity Odd or uncommon beliefs Argumentativeness Depression? Substance dependence? Alzheimer’s Disease? Anxiety?

Schizophrenia Schizophrenia vs psychosis schizoaffective disorder delusional disorder brief psychotic episode What it is What it isn’t

Bipolar Disorder Mania and depression Psychosis and “mood congruency” “Happy manics” and “angry manics” elevated, expansive, and irritable Time course: >1 week Hypomania: when cheerfulness is bad for you

Autism (A) A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3) (1) qualitative impairment in social interaction, as manifested by at least two of the following: 1. impairments in use of nonverbal behaviors (eye-to-eye gaze, facial expression) in social interaction 2. failure to develop peer relationships appropriate to developmental level 3. lack of spontaneous seeking to share enjoyment, interests, or achievements with other people 4. lack of social or emotional reciprocity (not participating in simple social play or games) (2) qualitative impairments in communication as manifested by at least one of the following: 1. delay in, or total lack of, the development of spoken language (without attempt to compensate) 2. in individuals with adequate speech, impairment in the ability to initiate or sustain a conversation 3. stereotyped and repetitive use of language or idiosyncratic language 4. lack of varied, make-believe play or social imitative play appropriate to developmental level (3) restricted repetitive and stereotyped patterns of behavior and interests as manifested by at least two of: 1. preoccupation with restricted patterns of interest that is abnormal either in intensity or focus 2. apparently inflexible adherence to specific, nonfunctional routines or rituals 3. stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting) 4. persistent preoccupation with parts of objects (B) Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction (2) language as used in social communication (3) symbolic or imaginative play (C) The disturbance is not better accounted for by (other diagnoses) Asperger’s Disorder Diagnosable via Microwiki?

Personality disorders “a pervasive pattern of maladaptive behaviours” When does “who are you” become pathological?

Schizotypal personality “Cognitive or perceptual distortions” “Eccentricities” outside the “norms of subculture” Social deficits, lack of confidants/close friends social anxiety vs paranoia

Borderline Personality Impulsivity Sense of emptiness or “identity disturbance” Emotions are unstable and “too big” Terror of being abandoned Chronic suicidal ideation, non-suicidal self-harm

Antisocial Personality Disregard for the rights of others Impulsivity/irresponsibility Aggressiveness, criminality Lack of empathy and remorse

Histrionic personality Excessive, rapid shifting, “shallow” emotions Attention-seeking Self-dramatizing and theatrical Overly familiar and intimate Not “culturally appropriate”

Narcissistic personality Grandiose sense of self-importance Preoccupied by fantasies of own success Belief in own uniqueness, “specialness” Exploitative, lacking in empathy Sense of entitlement

So…

does that mean everybody’s crazy? or just you?

But are you sick? “The symptoms cause a clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

The bottom line Is micronationalism explained by mental disorder? Do you: have friends and family? a job and/or scholastic success? hobbies you share with others? money/organization to make it to Polination?

The bottom line Congratulations! You might be weird, but you aren’t crazy

Questions and discussion