Tag Archives: VPCH

Staff Personality Disorder

I am reprinting this here because it is so true, and because it cannot be located elsewhere on the net, at least not via Google…The author was brilliant but, alas, I can find no name for attribution. A BIG Thank you to Anonymous!

 

 Criteria for Staff Personality Disorder

Personality Disorders

Staff Personality Disorder 601.83

A pervasive pattern of condescension, degradation of others, and controlling behavior beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Condescending or degrading use of body language, vocal inflection, and behavior.

2. Presentation of two or more markedly different personality styles based entirely on context.

3. Persistent protection of people in positions of power even if such people have done something unethical or illegal.

4. Employment in one of the “helping professions”, or other situations in which a person has or can secure power over others.

5. Rigidity in application of rules and explanations to other people

6. Persistent or stereotyped use of euphemisms, jargon, deceptive language, and double standards in language

7. Persistent use of degradation, ridicule, and violence, either gratuitously or grossly out of proportion to the situation

Diagnostic Features

The essential feature of Staff Personality Disorder is a pervasive pattern of condescension, degradation of others, and controlling behavior that begins by early adulthood and is present in a variety of contexts.

Individuals with Staff Personality Disorder display condescending or degrading body language, vocal inflection, and behavior (Criterion 1). They may use a patronizing “contaminated” smile, a sing-song voice, or the forms of language use described in Criterion 6. This behavior would be considered patronizing when directed at the average individual.

Individuals with Staff Personality Disorder present two or more markedly different personality styles based entirely on context (Criterion 2). For instance, while dealing with “clients”, while alone, they may be vicious, punitive, and controlling. When dealing with the general public, they may adopt a saintlike persona. It is not at all uncommon for the antisocial behavior of people with Staff Personality Disorder to go unnoticed, even when that behavior extends to torture or murder.

Individuals with Staff Personality Disorder will persistently protect people in positions of power, even if those people have done something unethical or illegal (Criterion 3). This may consist of putting up a “united front” to clients or to the public. People with this disorder will hide or excuse antisocial behavior in others with the disorder. Hiding may take the form of altering logs and failing to report abuse. Excusing may involve character assassination directed toward victims of mistreatment or abuse, or diminishing their credibility in some other way, while making it seem as if the behavior is the only logical response to certain sorts of people. They will also use these techniques of hiding and making excuses, to justify and rationalize their own behavior.

Individuals with Staff Personality Disorder are often employed in one of the “helping professions”, or other situations in which a person has or can secure power over others (Criterion 4). People with this disorder are disproportionately represented among psychiatric technicians, group home workers, home health care aides, social workers, special education teachers, counselors, nurses (especially psychiatric nurses), direct care staff, and institution staff. People with this disorder may also be grammar-school teachers, prison guards, and other professionals in positions of direct power over others. These positions may be either the cause or the result of the disorder.

Individuals with Staff Personality Disorder are rigid when applying rules and explanations to other people (Criterion 5). This, curiously but characteristically, may not extend to others with this disorder. Individuals with this disorder are likely to use a narrow set of rules to understand the behavior of others, particularly clients. They will see most ordinary behavior as manipulative, attention-seeking, or non-compliant. When confronted with something like violence on the part of clients, they will fail to differentiate between malice, self-defense, and frustration at being trapped. This may result in across-the-board application of punishments such as are described in Criterion 7.

Individuals with Staff Personality Disorder may display persistent or stereotyped use of euphemisms, jargon, deceptive language, and double standards in language (Criterion 6). They euphemistically refer to others as special needs, challenged, or consumers. They prefer jargon to ordinary language, and describe the behavior of others using clinical and psychiatric jargon, often loosely adding such jargon into everyday conversation, e.g. saying that someone they dislike has a Borderline Personality Disorder. They use deceptive language, for instance referring to prisons as hospitals and violence as treatment. They use double standards in language, e.g. referring to themselves as getting bored but to clients as going off task. They may apply certain words in a stereotyped fashion, repeating over and over that others are non-compliant, attention-seeking, manipulative, or playing games, without apparent regard to context or motivation.

Individuals with Staff Personality Disorder display persistent use of degradation, ridicule, and violence, either gratuitously or out of proportion to the situation (Criterion 7). Degradation may take the form of degrading language such as “retard” or “psycho”, denial or pathologization of the existing identity or roles of others (for instance telling someone that thinking he is a writer is a delusion of grandeur), treating people like children, or assigning humiliating tasks. More advanced forms of degradation involve using elaborate methods to thoroughly confuse a person’s sense of reality or self on all levels. Ridicule might include laughing at the aspirations or humiliation of clients, or laughingly dismissing their communication or behavior. Violence includes physical or sexual assault, mechanical restraints, chemical restraints, and solitary confinement. These things may be undertaken gratuitously, on a whim, as a result of boredom or frustration. They may be out of proportion to the situation, such as restraining someone for making eye contact with staff. These things are often justified using the means described in Criterion 3.

Associated Features and Disorders

Individuals with Staff Personality Disorder may have a tendency to take care of people who don’t need taking care of, or imposing their idea of care onto other people regardless of context or other people’s wishes. They may have a tendency to rationalize their own behavior in terms of helping others and be apparently unable to see their victims as fully human. They can be highly manipulative, especially to those they regard as inferior. Staff Personality Disorder may be associated with Stockholm syndrome and complex post-traumatic stress disorder in individuals who have been subjected to abuse by people with the disorder. Thus, a significant minority of people who are in institutional situations may develop features of this disorder or the full-blown disorder. Staff Personality Disorder is sometimes seen in the prodromal stages of developing full-fledged Psychiatry Disorder. Non-disabled children who participate in “Circle of Friends” and other helping-based friendship programs are more likely than other children to develop Staff Personality Disorder by adulthood, as are children who have been raised to be caretakers to disabled siblings or parents. People who go into the “helping professions” or who work in institutions are at high risk of developing Staff Personality Disorder, even if they have shown no signs of it in the past.

Specific Culture, Age, and Gender Features

The pattern of behavior seen in Staff Personality Disorder has been identified in many settings around the world, but is especially common on the top end of unequal power situations. Children imitating adults may transiently show signs that seem to point to Staff Personality Disorder where none is present. In the past, it seemed that Staff Personality Disorder was more prevalent in females, but it is now accepted that due to cultural pressures, it can present differently in males and females.

Prevalence

The prevalence of Staff Personality Disorder is estimated to be about 5% of the general population, about 80% among individuals who work in outpatient settings, about 95% among individuals who work in inpatient settings and other total institutions, and about 20% among inpatients and other people who experience prolonged abuse at the hands of people with Staff Personality Disorder.

Course

While there is considerable variability in the onset of Staff Personality Disorder, there is almost no variability once it becomes entrenched in a person’s identity. The most common pattern is that a person seeks a job in any of a number of “helping professions” and is gradually molded into the behavior patterns that typify Staff Personality Disorder. There is a window of opportunity in acclimation to these behavior patterns, in which a person may still have the insight to quit their job or resist further indoctrination. Once these behaviors become entrenched, they are self-justifying and rarely respond to reason or therapy. This is enhanced by the fact that many people with Staff Personality Disorder spend a lot of time socializing with other people with Staff Personality Disorder. A minority of individuals, when presented with the evidence of the harm they have caused to others with their behavior, truly become cured of Staff Personality Disorder, although literature indicates this requires constant vigilance to avoid falling into their old behavior patterns. Some people with Staff Personality Disorder acquire a disabling condition or another mental disorder and recover after learning what it is like to be subjected to the behavior of people with Staff Personality Disorder, but others will maintain their staff identity even within the inmate role.

Familial Pattern

Staff Personality Disorder is about five times more common among first-degree biological relatives of those with the disorder than in the general population. There is also an increased familial risk for Psychiatry Disorder.

Differential Diagnosis

Staff Personality Disorder often co-occurs with Psychiatry Disorder, and when criteria for both are met, both should be diagnosed. In instances where it is related to the development of post-traumatic stress disorder or other trauma-related disorders, it should be diagnosed in addition to those disorders with a notation that they are connected.

Other Personality Disorders may be confused with Staff Personality Disorder because they have certain features in common. It is, therefore, important to distinguish among these disorders based on differences in their characteristic features. However, if an individual has personality features that meet criteria for one or more Personality Disorders in addition to Staff Personality Disorder, all can be diagnosed. Although Histrionic Personality Disorder can also be characterized by manipulative behavior, Staff Personality Disorder is distinguished by condescension. Paranoid ideas or illusions may be present in both Staff Personality Disorder and Schizotypal Personality Disorder, but in Staff Personality Disorder these ideas are limited to concerns about the behavior of those under the person’s control (often inmates). Although Paranoid Personality Disorder and Narcissistic Personality Disorder may also be characterized by an angry reaction to minor stimuli, the reactions in Staff Personality Disorder have to do with specific situations related to the staff role and distinguish these disorders from Staff Personality Disorder. Although Antisocial Personality Disorder, Borderline Personality Disorder and Staff Personality Disorder are all characterized by manipulative behavior, individuals with Antisocial Personality Disorder are manipulative to gain profit, power, or some other material gratification, the goal in Borderline Personality Disorder is directed more toward gaining the concern of caretakers, and the goal in Staff Personality Disorder is to maintain control over a specific person or group of people. Also, while individuals with Antisocial Personality Disorder rarely show remorse for their antisocial behavior, individuals with Staff Personality Disorder make heavy use of specific rationalizations to justify their behavior to their conscience. However, some people with Antisocial Personality Disorder may have co-morbid Staff Personality Disorder and both should be diagnosed in that case. Personality Disorder can further be distinguished from other personality disorders by the typical pattern of protecting others with the disorder and persistent use of euphemisms and jargon to describe one’s actions.

Staff Personality Disorder must be distinguished from Personality Change Due to a General Institutionalized Condition, in which traits emerge solely in the institutional environment due to the direct effects of people with Staff Personality Disorder on an inmate’s behavior.

It also must be distinguished from Factitious Staff Syndrome, in which a person without Staff Personality Disorder masquerades as a person with Staff Personality Disorder in order to assume the staff role and effect change for the better for those under the power of people with Staff Personality Disorder. Factitious Staff Syndrome does not qualify as a mental disorder, but individuals practising it unwarily may develop Staff Personality Disorder.

Portrait: Three Greenlanders- Art from Vermont Psychiatric Care Hospital

Three Greenlanders:A Portrait
Three Greenlanders:A Portrait

 

 

 

 

 

 

 

 

 

 

 

 

i started this portrait, derived from photographs seen in a National Geographic magazine lying around on Unit D, with the detested Crayola pencils that had to be a requisite 4 inches long or shorter…but eventually i was permitted to use ( and try to repair the portraits) with my Caran D’ache pencils, though it is very hard to try to layer anything over crayolas, especially on paper that is too thin to accept multiple layers…

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In 5-Point Restraints For Six Hours At Vermont’s State Hospital VPCH

 

Fist Protesting Restraints
Fist Protesting Restraints

I admit i had been slamming the doors at 2 o’clock in the morning but this never triggered anything before from the unbelievably patient and forbearing staff at Vermont’s Psychiatric Care Hospital, Unit D, except some bemused bewilderment at what had set me off and offers of PRNs to help calm me. After all, with only two other patients on the floor and those two either stll awake or dead to the world, it really did not matter if I raised a ruckus. But this time, because Hannette was the nurse on duty, my nemesis, it mattered a great deal more than it ought to have.

 

Instead of letting me slam my door a few times and cool off, as i had so often before. or if not, then opening the safety door so when I slammed it it closed only on air, thwarting my attempts to make noise….instead of any of these non-personal interventions, Hannette decided to take another route no one else had ever done. She came right into my personal space and inner sanctum almost no one ever violated without asking me first. Not only did she enter my bed room, but she came right to the door way of my bathroom where I had pulled my mattress and situated my small bedroom stall inside there underneath the shower head.

 

I stood on the mattress, by the toilet, higher by a couple of inches, boosted by the mattress. But Hannette pushed up close and yelled at me, “You will not slam any more doors tonight, do you understand?! You WILL CALM YOURSELF right this instant!”

 

That was like yelling at me, BE spontaneous! Yeah, right. I had gone to the med window at this state hospital I had been committed to weeks before, asking for a second tiny dose of Ativan for severe anxiety and because I had been unable to speak for a few days. The next day the people from my recovery residence were coming and I needed to be able to sleep to meet with them in good form and i had to have a voice to speak with them…

for years catatonia and mutism have intermittently plagued me, and it was only in 2003 that we discovered how effective Ativan was for catatonia…later on, when mutism was the bigger problem, Dr C decided to try it, seeing it as as a feature of catatonia, with good results.

 

However, here at VPCH the on-call doctor,Lasix,  knew nothing about my relapsing mutism, nor my need for Ativan. He only knew about my complaints of sleeplessness and anxiety. So called around 1:30 AM he refused me a second .5mg dose and ordered me to try to relax on my own and sleep for another hour, before he would consider a second dose.

 

This is what occasioned, at 2:00 AM my panicked outburst of door slamming. But I did not start the melee that ensued. Properly the trigger was Hanette’s grabbing my wrists. She restrained me in such a fashion for some reason, but now I dunno why exactly. Maybe she saw my mute shaking my fists at her as threatening. Even so, she ought to have just backed away from me, having cornered me in the bathroom, where I felt threatened by her!

 

As it was, however, she approached closer and grabbed my wrists, another mental health specialist nearby saying at the same time, “we dont want to go hands on here at VPCH.”

 

“Then don’t grab my wrists!” I screamed silently. But reflexively and in terror, I bent to nip her fingers with my teeth in order to get her to release me.

 

Well, that of course was where all hell broke loose… and much more to say but the library hours end now so I have to leave this for tomorrow when I can spend more time at the hospital computer.

 

 

———

So, what happened next you can guess.  She yelled for help and help arrived in seconds in the form of staff prepared to go “hands on” not only to stop me from biting her but to actually restrain me completely.

 

As they  bodily hoisted me off the floor, screaming wordlessly, one man asked, “What now? And HAnnette answered promptly, “Seclude her!”

 

This horrified me. Not again, not a third time in weeks. not in Vermont where they were trying so they assured me everywhere to reduce these events to zero…This was ridiculous.

 

But Hannette had had it in for me ever since the episodes early on in my stay — when there had been forced medication, something my Advanced Directive had explicitly advised against for good reason, and which the “good doctor ” had for some reason seen fit to decide to go for anyway…with predictable consequences. So for several days as a result I had been a version of the Exorcist’s  Linda Blair over that first week or two and that is only a small exaggeration. The foul language spewing from my mouth in hourlong torrents was utterly uncharacteristic of me, both in kind and sheer amount.

 

But it was now nearly week three and after I had filed a grievance, the forced meds had been stopped and so too my involuntary Linda Blair imitations. Only Hannette it seemed still held those horrors against me. Everyone else had been both forbearing during those horrendous days and extremely forgiving afterwards. What is more, during my outbursts, even when I tossed chairs and overturned tables, no one had over reacted or punished me for the extreme and extremely disruptive behaviors i had exhibited at the time, no one.

Only once, when I became apparently dangerous, did the charge nurse put me briefly in five point restraints. and that was when I literally splashed urine all over him and other nurses and urinated on the rug in public and then hit him and two other people…But at no other time did they even come close to suggesting involuntary procedure such as meds or seclusion or restraints. Or at least not that I knew of.

 

Now here i was being dumped in seclusion largely because Hannette had grabbed my wrists, standing too close to me in my own bathroom!

 

Worse was to come. After the panoply of staff dashed from the room,  I ran after them in anger but they closed the door and locked it, locking me in alone.

Hopeless, I sat back down on the mattress dazed and sad but not moving. I heard them talking  but scarcely listened, trying to calm myself and wondering how long they planned to keep me in this god forsaken room. Then I heard someone say, “She has her glasses and watch. We have to get them!”

 

Soon they piled in again, all of them on top of me at once, peeling off my two pairs of glasses and watch and my medical band. And then they searched me for pockets of which I had none. All this time I was screaming, wihout verbalizing a word…and fighting them in protest at the intense violation of my person. Then as they tried to dash off I followed closely and almost escaped the room with them. This time they did not succeed in closing or locking the door, no, because I was wedged in-between. So someone said. “Back inside!” and we all moved as one back towards the mattress.

 

I thought they were going to use the maneuver Scott , that charge nurse. had used the other time, to twist my arms and legs in such a way as to make it difficutl for me to untangle myself and give them time to get out before I could follow. Not pleasant for me but not painful either and rather clever nonetheless.

 

But no, instead, to my dismay I heard Hannette call, “Get the Bed.”  The  BED??? For what? What had I done to deserve The Bed????

 

But the bed was gotten and within minutes I was trussed up in FIVE POINT RESTRAINTS for nothing more dangerous that holding up my fists at Annette and nipping at her fingers when she herself had grabbed my wrists!!!!

 

The worst is yet to be related alas. much worse. But I do not have enough time tonight in the library to explain it all and I need to post it tonight or it will be lost. I go home to MRR on Monday , which may be news to many who have been wondering where I am or have been.

 

It has been a long long journey and it is not over yet. More tomorrow on this story and perhaps I can also catch you up on other parts of it as well. In the meantime  know that VPCH is by and large a good place all told, just not a place to call home, not if you have any life of your own left to live.

 

Tata for now.

 

Pam