Introversion: Why Does Psychiatry Think This is a Bad Thing?

Patient Expert

"I can't wait to get diagnosed with a personality disorder because I'm introverted," writes LadyBehindtheMask. "If  I weren't introverted," she goes on to say, "I couldn't spend so much time sitting by myself. Which means I wouldn't have a ghost of a chance of getting any serious writing done. ... I just hope no one decides to cure all of us who are introverted enough to think."

LadyBehindtheMask was responding to a post of mine last week here at BipolarConnect, Personality or Bipolar: Who is Really Doing the Talking? The illness vs personality distinction has been a very common theme on these pages, and the topic is likely to heat up in light of substantial revisions to personality disorders in the next DSM (due out in 2013). The question we need to ask ourselves is this:

When are our thoughts and feelings and behavior attributable to our illness and when are they attributable to our personality?

Inevitably the two are related rather than completely distinct, and nowhere does this come into sharper focus (or, rather, blurry unfocus) than when we raise the issue of introversion. An introvert's natural element is his or her own private space. An extravert, by contrast, draws satisfaction outside the self. An introvert will feel drained out in the company of others. An extravert is only just getting warmed up. Conversely, an introvert comes to life in his or her solitary pursuits. An extravert dies a thousand deaths.

Neither trait is all good or all bad, but it seems psychiatry has a different view. "What's concerning me,"   says LadyBehindtheMask in reaction to the sweeping changes in the draft DSM-5, "is that it suggests the pdocs of the world have decided we need to be a nation of Rotarians. And if we try to make introverts into extraverts, then we WILL exhaust and depress all the introverts, which WILL require medication -and probably eventually also require long stays in the psych hospitals that are ceasing to exist."

I hear you, LadyBehindtheMask. I am a card-carrying introvert, myself, and I pity all those gregarious glad-handing chatterboxes out there who seem to have no insight into the rich inner world that I experience every day. Here's the way I look at it: Without deep thinking and personal insight, there is nothing worth talking about. Nothing. Absolutely nothing. Yet these people talk. And talk. About nothing.

I know. All my life, I've suffered through their loud and meaningless conversations. Give me a nice quiet cave on a mountain top in the most remote region of Tibet for the next ten years, any day of the week. But it's not like I can get away from them. Three out of four individuals on this planet are extraverts. By contrast, according to a poll I conduced seven or eight years ago, eight of ten people with mood disorders are introverts.

So, the ex's have it. Extraversion IS the norm. Introverts are the outsiders, struggling to fit into a world set up for the numerical majority. Maybe that's why we're so depressed. Make no mistake - there is a lot of good about introversion, but the trait does need to come with a black box warning. Introverts tend to isolate, and isolation invites in depression. Likewise, those in a state of depression isolate, further worsening the depression.

Introversion meets isolation meets depression is not where we want to be.

The DSM-5 has introduced a new dimensional schema based on the well-established "five-factor" model (FFM) of measuring personality. One of the traits the FFM measures for is extraversion. In a dimensional construct (as opposed to categorical) we ask "how much?" rather than "which one?"   "Too much" introversion (or conversely "not enough" extraversion) is not a personality disorder unto itself. In a dimensional context, introversion-extraversion needs to be weighed in with our other factors, such as conscientiousness and openness to experience.

The FFM looks toward our ideal - and well-adjusted - selves. By contrast, the DSM looks through a glass darkly at our fallen - and maladaptive - selves. Thus, in the DSM, extraversion - part of the FFM's model for success - is turned into introversion, a component of the DSM's model for failure. LadyBehindtheMask has every reason to take issue with this.

"What's next?" she rightly asks. "'Excessive athleticism?' (Let's put the young Michael Jordan on something so he won't be at the edge of the bell curve.) 'Hyper-servile syndrome?' ('Sister Teresa, I understand you think God wants you to care for lepers in Calcutta, but you need to pay more attention to your own needs. Why don't you borrow a nice novel from the convent library?')"

You're coming in loud and clear, LadyBehindtheMask. This conversation is only just starting. Please, let's hear from all of you. Comments below ...