Psychiatric illness... deliberately controlling your behaviour

[tieslafen]

If you have a psychiatric illness ... child or adult .. and it is unmedicated ,
Regardless of what illness it is.... Is it possible to control your behaviours?

For example: If you or child is normally destructive, busy, antagonistic and doing things deliberately when you are not happy for whatever reason , can you override those impulses and behave impeccably when you need to eg in front of a Doctor/ Mass etc and if so ,can you identify a psychiatric illness that has that ability to do this, thanks .

I have a diagnosis of a serious mental illness (Bipolar Disorder), in an episode of being seriously unwell it would be almost impossible for me to control those impulses or behaviours eg pressurised speech, very “active” behaviours etc. I also have some professional experience of working with people who have serious mental health conditions and I’ve never known anyone who was seriously unwell to be able to hide it. Depression - yes, many people can and do mask, but serious depression where someone presents with flat affect, robotic/slow speech or movements etc is almost impossible to hide or control.

Well many depressed people are able to do so. Depression is a psychiatric illness.
Alcoholics, narcissists, people with childhood trauma.
i’d venture to say more people have a psychiatric illness and are not on medication than are and do fine in several settings.

Thank you for sharing.
I'm asking from a professional point of view as my experience is limited.
If a teenager/ adult is normally violent, aggressive, oppositional and destructive, why would they behave absolutely perfectly when in the presence of a group of healthcare professionals ...even if the teenage/ adult wasn't aware that said professionals are there to observe .

@tieslafen because they are aware.

Ware of their illness or aware that they are being observed ? And if aware that they are being observed, how

Can they know this and how can they switch their behaviour on and off.

It was like watching two entirely different people at work , to an unsettling degree.

Some people are manipulative and can behave this way without mental health conditions.
Some disorders, like personality disorders, can make a person manipulative - some also cause identity issues where a person will act a role and be a different person in different situations. When really, really unwell with emotional intensity personality disorder I couldn't act rationally at all, but could otherwise, to the point that a psychiatrist didn't believe I'd tried to commit suicide because I was so calm and collected a short time later.
I always recommend requesting the Millon test, a series of multiple choice questions designed to catch out acting. Also, using thought/mood journals helped with my diagnosis. It can be really hard to get diagnoses for complex mental health conditions, especially in children/young people. Good luck.

If they have experienced developmental trauma then their dysregulation may be interpersonal- only when triggered by something in relation to others - often feeling shame or fear will be a reason. Behaviour still needs addressing but understanding why helps to know what will help. It’s very complex though and that’s just an oversimplified explanation. In order to fully understand you’d need;

• a very good chronology of their history (pregnancy too as alcohol, drug use and stress can impact temperament).
• detailed descriptions of incidents where they’ve kicked off that include unpicking everyone’s perspective if the antecedents, triggers and what everyone does.
• what’s the parents history? Psychiatric and in terms of their childhood and what they experienced as children. Attachment histories and attachment styles.
• Current context: stressors, drug use, adolescent development etc.

People can be very good at masking to protect themselves. It can’t normal last for a sustained time period but certainly can be done.

Also, from years of experience- the worst behaviour often manifests within the closest relationships. Kid doing great at school and with other adults but the ‘mum gets it in the neck’. Often due to abuse and neglect histories - lack of trust and pushing away to test.

My guess is this kid has experienced some developmental trauma of some kind (could be neglect or abuse, could be parental mental health issues, could be other stuff).

Yeah it's called masking and it's very common but MH workers are stunningly bad at identifying it and the more incompetent put it down to "fluctuating mood".

I have bipolar disorder and can pull myself together often for short bursts of time like a meeting. It's a bit weird - sometimes I'm sitting in a meeting with all these weird thoughts going through my brain and it seems surreal that no one else notices. Like, I remember sitting in a meeting with my psych and he was telling me that it wasn't likely I could [do something impossible] and I nodded politely while internally thinking "well, I fooled you".

Having said that, I've done the opposite and seemed calm all day (although my mind was buzzing), then walked into a doctor's office and he's pressed the wrong button with me and I've totally freaked out and had to be removed because I was literally ripping chunks of my hair out and screaming.

For me, it isn't that I can never fake being same when I'm in an episode. I just can't do it consistently or for long. I don't necessarily think it's fair to call that "manipulative" behaviour - surely everyone has variable abilities to pull themselves together? And no one can spend all their time, 24/7, screaming or self harming? I mean, your throat gets sore if nothing else!

Yes. A relative was able to act normally enough to be deemed no risk to his family. The same afternoon he committed a violent assault on a family member as a result of his condition. He was hospitalised directly afterwards (sectioned) for 6 months.

He was subsequently diagnosed as a schizophrenic. I know not all a violent but he is/was.

Does this person have a diagnosis of some kind? It is entirely possible to display those behaviours without having an illness or disorder of any kind, in which case then they absolutely can control it. If their illness is severe enough that they exhibit these behaviours regularly then they’re unlikely to be able to exert the level of control you’re describing over them,

I’m dysregulated only around the people who have traumatised me - my family. In every other sphere I’m a perfectly normal and functioning person. The people who traumatised me think I am nuts (very narcissistic people) and they are actually correct in that their narcissistic abuse triggers very strong internal get the fuck away from them internal responses which dysregulate me. So in that regard my mental health condition only presents in very specific circumstances.

Allytheapple

Thats amazing that you can recognise that. Sorry you had such a hard time. What strength you must have to have got through it and have such insight. Impressive!

Most people don't think of severe and enduring mental.illness ,when they think.of mental illness ,in the cases of somebody who is in the grips of an acute psychotic episode ,or hypomanic episode than I doubt somebody would be able to control their behaviour as they can quite literally not be in reality .

Not quite the same but DS can be very violent and aggressive in the midst of a meltdown. But this only ever happens at home, he keeps himself “controlled” at school/in social situations and when he comes home hell breaks loose. But that’s because home is where he feels safe and where he can erupt, he genuinely doesn’t seem able to control it at home. It’s lead to me being physically injured a couple of times but as he never presents as anything other than lovely, caring and sweet in front of HCP I’m not taken seriously over the extent of his behaviour.

Sorry meant to add, DS has ASD.

Well, do you actually know if this person has been diagnosed with a mental illness? Plenty of people who are violent and aggressive aren’t mentally ill.

Even if they are definitely are mentally ill, some behaviours might be triggered by specific people or situations. Family friends of ours have a son who has had some serious mental health problems (and has a diagnosis) and in his 20s he was frequently violent and aggressive in the company of his mother but rarely around anyone else.

The person on question is consistently violent, aggressive , oppositional and refuses point blank to accept consequences for actions. There is no diagnosis as yet.

When a HCP comes into the school to observe, the behaviour is impeccable.
Engaging, does as is asked and is lovely to other pupils. When they leave, the kickback is enormous.

Home behaviours are consistent with school behaviours in that violence and aggression are the norm.

I'm at a loss to understand this.

The only consistent trigger is not doing exactly as they want.

Well with some, you can. It's called masking. It can manipulative but more often than not its protection for the person suffering. I do it all the time but it's so draining.

So in what you've described it certainly sounds manipulative.

My late dh had a psychotic episode and his behaviour was increasingly extreme over several days. In an urgent assessment session he behaved so calmly and rationally that the assessors wrote 'no risk of self harm' (not that that is possible, they probably meant low risk). He was dead less than 3 hours later.

I don't think his behaviour control was exactly 'deliberate'. But it was part of an interaction. Assessors being present are not a neutral factor, they influence behaviour.

OP< I think you're overlooking the fact that in psychiatric disorders , the patient's symptoms can fluctuate quite widely . He can't control the frequency or intensity of chemical messages in his brain. That's why his behaviour fluctuates so unpredictably.