We rejoice, every so often, that we have eradicated an illness once so widespread and so lethal millions died. Equally some illnesses like TB once thought to be consigned to history have re-appeared to haunt us again.
But mental illnesses are a bit different. The issue is always whether some behaviour pattern should be considered a mental illness worthy of treatment. Critics talk of over-pathologising. They talk of ‘psychiatric political control’ and how repressive regimes have used psychiatry to lock up people in mental hospitals with often worse conditions than prisons. And not so long ago when homosexuality was regarded as a mental illness.
Of late, the critics have lamented the massive growth in mental disorders. So bolshy adolescents have ‘oppositional defiant disorder’ and badly behaved, impulsive people of all ages have ADHD. There has been massive inflation. Over-excited psychiatrists, like zoologist and botanists in a virgin country, seek to find and label new disorders like the latter do species.
However what is less reported are the disorders that disappear over time from the textbooks. They vanish for various reasons. First, when investigated the ‘disorders’ did not seem very debilitating at all. In fact the opposite. Thus ‘hysterical personality disorder’ quietly disappeared and those “affected” were able to carry on happily seeking the attention of others. Second, most common, the “illness” proved too unreliable to diagnose. Faced with the same patient, psychiatrists could not agree. One thought he had X, another Y, a third both X and Y and yet another that he was basically OK. A very serious issue indicating that the diagnostic criteria were too vague or that the essential nature of the problem had yet to be clearly identified.
A third reason is even more bizarre. That is that so many people appeared to have this disorder that it could no longer be considered abnormal. After all, normality is a statistical concept. This has been the fate of a personality disorder: one that people know of, and that has passed into everyday language.
It all started 60 years ago with the American Psychiatric Association’s publication of their first great manual (guidebook, dictionary, encyclopaedia). One of the dozen or so personality disorders listed was the passive-aggressive disorder. Within this framework three related types were identified; passive dependent who were clingy, helpless and constantly indecisive; passive-aggressive who were inefficient, pouty, stubborn, prone to procrastination and very obstructive; aggressive who were destructive, irritable and resentful. Sixteen years later the latter two types were merged.
So we had the passive aggressive individual: You must know the type at work. Those “doing their own thing” with the very conscious “right to be me.” They are “it is not my responsibility”, leisurely types. They snipe rather than confront and mask their opposition to and rebellion against authority. They shirk responsibility and sabotage others. Brilliant at breaking team morale they generate nothing but animosity among their co-workers.
The passive-aggressive person is a p-in-the-a person; marching to the beat of their own drum, supremely confident in their abilities and work ethic and cynical, often undermining the skills and talents of others. At work they do (mostly) what is expected of them but no more. All demands for anything more are seen as exploitative, discriminating and unfair. And they are never cowed by authority.
The list of symptoms grew: apparent forgetfulness, dawdling and intentionally inefficiency. They are a supervisory and managerial nightmare.
But by the third edition of the manual the syndrome was dropped. The reason: it was thought of not as syndrome or disorder but a specific behavioural response to a particular (work) situation. Yes, you got it. It was the bosses’ fault. And so widespread it was no longer an illness. The argumentative, irritable, leisurely sulker was all your fault.Your management style and your unfair and unreasonable demands caused it!
By the fourth edition of the manual (DSM IV) the syndrome was renamed negativistic but was appendicised rather than put in the main text. Many of the behavioural descriptions remained the same such as resistance to routine tasks, complaints about being misunderstood, sullen argumentativeness, scorn of all those in authority, envy and resentment of the relatively fortunate, perpetual and exaggerated complaints of personal misfortune. And of course that alternating between hostility and contrition which was the hallmark and origin of the original term.
And so passive-aggressive disorder was dispensed to the diagnostic graveyard; taken off the books. It was too common to be odd and too much of a reaction to situations. So, it was thought, you might be a p-a at work but not at home; in one job but not another.
There are those eager to resurrect it. All disorders are the result of genetic-environment interaction: the biological predispositions and the abusive environment. But some people do seem to be p-a carriers. These individuals feel at all times and in all circumstances unappreciated; they are moody complainers; they do undermine operations with contempt. And they are irresponsible.
So is the miserable, jobsworth type a result of bad management? Possibly. Are they a massive headache for management? Definitely. Are they treatable by TLC, good performance management systems and the like? Maybe.