Thanks to Gardner Campbell for leading me to this article: The destructiveness of perfectionism: Implications for the treatment of depression.
Through the lens of three suicides by “remarkably” talented individuals, Sidney Blatt differentiates productive treatment of depression for “anaclitic” patients, who are “preoccupied with the quality of their interpersonal relationships,” from effective treatment for patients with an “introjective form of psychopathology,” or the self-critics who are high-level perfectionists. The former respond relatively well to “brief treatments” while the latter (that’s me) do not…but they/we do respond to long-term, intensive treatment.
It’s a dense article and I’m still connecting all the dots, but the closing paragraph recaps the most important point:
“…perfectionistic, highly self-critical individuals who have intense investment in issues of self-definition, self-control, and self-worth, although relatively unresponsive to a number of different forms of short-term treatment including medication, appear to be quite responsive to long-term, intensive, psychodynamiocally oriented therapy in both inpatient and outpatient settings.”
The longer description of “introjective psychopathologies” is important too because, while the article is also concerned with how society can support those individuals so they can “continue their important contributions,” I’m not in that group of “remarkable” people for whom society should feel some collective obligation…but I am absolutely in the same clinical class, to wit:
“…a second group or configuration of disorders can be identified as introjective psychopathologies that include disorders in which primary concerns with establishing and maintaining a viable sense of self range from establishing a basic sense of separateness, to a preoccupation with autonomy and control, to more complex internalized issues of self-worth. These patients primarily use counteractive defenses (e.g., projection, rationalization, intellectualization, doing and undoing, reaction formation, and overcompensation). Introjective patients are more ideational and concerned with establishing, protecting and maintaining a viable self-concept than they are about the quality of their interpersonal relations or about achieving feelings of trust, warmth, and affection. Issues of anger and aggression, directed toward the self and/or others, are usually central to their difficulties.”
This so exactly describes me that if I were only a little more paranoid I’d think they’d looked through my records.
The question for me is: what do I do? I suspect that, almost by definition and supported by my own experimental evidence using myself as subject, being my own therapist isn’t going to work. But there’s nowhere for me to get the intense treatment the article recommends, particularly when I consider Blatt’s findings regarding the difficulty this group has establishing a positive therapeutic relationship.