“What are you looking at?” On the link between traditional masculinity and paranoid personality disorder.

In the mental health field there is probably no more controversial set of diagnoses than those that live on “Axis II” – the so-called “personality disorders.” Unlike the Axis I disorders – which are more likely to be illnesses in the more classic sense of the term (i.e. schizophrenia, bipolar disorder, major depression) – the personality disorders can be thought of as being more like deep character flaws. They are less about what someone has, and more about what someone is.

The whole construct of personality disorders can be contentious. Adding to the controversy is the way in which people are diagnosed with these conditions. Personality disorders are very much in the eye of the beholder. (A highly unpleasant acquaintance, neighbor, coworker, or family member who is a colossal pain in the ass might well be perceived by a specialist as someone who is suffering from a personality disorder.) Researcher Joel Paris noted in 2004 that “personality disorders are dysfunctional exaggerations of normal personality traits. There is no sharp boundary, but a continuum between traits and disorders.” http://www.springerlink.com/content/a61rj580756up787/

So personality disorders are a matter of degree. The question is where on the continuum one falls. And that’s a subjective judgment.

Gender bias or gender difference? Another strong concern about diagnosing of people with personality disorders is that each disorder has a gender skew. Unlike the Axis I disorders such as schizophrenia or bipolar disorder (which afflict equal numbers of women and men), each Axis II disorder is more likely to be found either in men or in women. “Borderline personality disorder,” for example, is overwhelmingly diagnosed in women. Some writers and theorists cite this fact as evidence that the conceptualization of that disorder is inherently sexist. That is possible. However, other personality disorders (such as antisocial personality disorder) are overwhelmingly diagnosed in men.

Addressing the question about the gender difference in these disorders, Joel Paris writes that since personality disorders are just dysfunctional exaggerations of normal traits, “it is logical to assume that gender differences in disorders should reflect gender differences in traits.” Personality disorders, he argues, are extremes of normal behaviors, and these extremes will often coincide with strongly gendered behaviors.

So it would tend to follow that women – who are generally more relational than men – would more often be diagnosed with the personality disorders that tend to involve very intense interpersonal dynamics – like borderline personality disorder and dependent personality disorder. Men, for their part, are generally less relational than women, and tend to be diagnosed with the less relational disorders, including avoidant personality disorder and antisocial personality disorder.

But why are men more paranoid? A fair amount has been written about men being much more likely to be diagnosed with antisocial personality disorder. Our prisons are full of males who act in extremely antisocial ways. Less consideration, however, has been given to the fact that males are far more likely than females to be diagnosed with paranoid personality disorder.

Paranoid personality disorder described. It is critical to distinguish between paranoid schizophrenia and paranoid personality disorder. Individuals who have paranoid schizophrenia typically have persecutory delusions and/or hallucinations that are the result of psychosis. Paranoid personality disorder, on the other hand, is more like having a distorted view of the world and one’s place in it. People with this disorder are otherwise “sane,” but their way of understanding interactions with others is inaccurate. Everyday interactions are misinterpreted as attempts to persecute them.

According to The Cleveland Clinic, people who have paranoid personality disorder “suffer from paranoia, an unrelenting mistrust and suspicion of others, even when there is no reason to be suspicious… People with PPD are always on guard, believing that others are constantly trying to demean, harm, or threaten them. These generally unfounded beliefs, as well as their habits of blame and distrust, might interfere with their ability to form close relationships. People with this disorder:

• Doubt the commitment, loyalty, or trustworthiness of others, believing others are using or deceiving them
• Are reluctant to confide in others or reveal personal information due to a fear that the information will be used against them
• Are unforgiving and hold grudges
• Are hypersensitive and take criticism poorly
• Read hidden meanings in the innocent remarks or casual looks of others
• Perceive attacks on their character that are not apparent to others; they generally react with anger and are quick to retaliate
• Have recurrent suspicions, without reason, that their spouses or lovers are being unfaithful
• Are generally cold and distant in their relationships with others, and might become controlling and jealous
• Cannot see their role in problems or conflicts, believing they are always right
• Have difficulty relaxing
• Are hostile, stubborn, and argumentative.”

(As I read this list I am struck by how well it describes many of the abusive men I have known over the years. It does not describe all of them, but it could fit a large share of them.)

Masculinity as a recipe for PPD. Why would men experience this disorder so much more often than women do? I would argue that the roots of male paranoia are deeply embedded in our societal beliefs about what it means to be a man. Robert Brannon’s famous essay on the four pillars of masculinity provides some clues to this link between male socialization and paranoia in relationships.

The big wheel. One of the dictates of masculinity that Brannon identified is that a man has to be “the big wheel.” He has to be more successful and more powerful than all the other guys. Men who attempt to live up to this model cannot help but be fearful of others. If you are determined to be the king of the hill, then every other man (or woman) you encounter is a threat – a rival. In a world characterized by dog-eat-dog competition, there are no friends, only foes. Anyone you encounter might want what you have and try to take it away. Leave you with nothing… and in a world where masculine identity is equated with what you manage to amass, someone who leaves you with nothing also leaves you as nothing. A man with nothing is nothing.

The sturdy oak. According to Brannon, traditional masculinity requires that a man must also be “a sturdy oak.” He must be independent and inexpressive. He must be willing to go it alone. He is not supposed to connect with or rely upon others. And every person he encounters is a threat to his individuality and his independence.

No sissy stuff. A man must also reject everything feminine. He must engage in “no sissy stuff.” This stance too requires constant vigilance to ensure that one is at all times and in all places behaving in a sufficiently manly fashion. One’s masculinity is always on display, and is up for appraisal and critique. At any minute another man (or a woman) can declare that you are simply not masculine enough. Do something – anything – that the American actor and politician Arnold Schwarzenegger disapproves of, and he will quickly denounce you as a “girly man.” And because being called “girly” is to be avoided at all costs, men who buy into this model of masculinity must run scared. They are hyper-vigilant in defending their masculinity – and the line between hyper-vigilance and paranoia is a very thin one indeed.

Give ‘em hell. Finally, Brannon identified that men are expected to be adventurous and aggressive. They are supposed to be ready to step up and respond aggressively to any threat (real or imagined) that they see coming over the horizon. And many people believe that “the best defense is a good offense.” And nothing works better to briefly allay one’s fears and anxieties than a good preemptive strike! Look at me wrong, and I may attack you. I’ll shoot first, and ask questions later.

No wonder so many men are paranoid! Taken together, these messages represent a powerful juggernaut that many men feel that they must negotiate. The pressures to be rich enough, to be strong enough, to be “manly” enough, and to be aggressive enough are all immense. The message is: you have to fight for what you get, and then you have to fight to defend it. Everyone you encounter is a potential foe – someone who might want to take it all away. Take away your fortune. Take away your strength. Take away your masculinity.

So what choice do a lot of men feel they have – other than to treat the world (and the people in their lives) as the enemy? This is a tragic outcome – and it is yet another way that men lose when we try to uphold antiquated, patriarchal notions of what a man is supposed to be. We lose – and so do the women and children in our lives.

Traditional masculinity, it would seem, just isn’t very healthy for anybody.