Are You Crazy?

is micronationalismexplained by mental disorder?

Eric Lis MD,CM

Why me?

MD.,CM 2010

Residency

ResearchMcGill University Psychiatry Perceptions

of Emerging Technologies Labs

Disclosures

Relevant biases

Conflicts of interest

Financial incentives

CaseMr. L.

30 yo MAshkenazi Jewish originSingle, longest relationship 5 yearsWorks full timeGood 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…

micronationalistsGrandiosity

Odd or uncommon beliefs

Argumentativeness

Depression?

Substance dependence?

Alzheimer’s Disease?

Anxiety?

SchizophreniaSchizophrenia vs psychosis

schizoaffective disorder

delusional disorder

brief psychotic episode

What it is

What it isn’t

Bipolar DisorderMania 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

interaction2. failure to develop peer relationships appropriate to developmental level3. 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 conversation3. stereotyped and repetitive use of language or idiosyncratic language4. 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 focus2. apparently inflexible adherence to specific, nonfunctional routines or rituals3. 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 PersonalityImpulsivity

Sense of emptiness or “identity disturbance”

Emotions are unstable and “too big”

Terror of being abandoned

Chronic suicidal ideation, non-suicidal self-harm

Antisocial PersonalityDisregard for the rights of others

Impulsivity/irresponsibility

Aggressiveness, criminality

Lack of empathy and remorse

Histrionic personalityExcessive, rapid shifting, “shallow” emotions

Attention-seeking

Self-dramatizing and theatrical

Overly familiar and intimate

Not “culturally appropriate”

Narcissistic personalityGrandiose sense of self-importance

Preoccupied by fantasies of own success

Belief in own uniqueness, “specialness”

Exploitative, lacking in empathy

Sense of entitlement

So…

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