The Madness Taboo

I have a persistent problem: My 16-year-old daughter is mad. She makes up stories about herself and believes in them. Sometimes she is going to be a professional figure skater. Sometimes a photo model: When she was 15 years old, she broke up with her grandparents because they wouldn't lend her their apartment in Stockholm, where she needed to live to take (non-existent) modelling jobs. She is oblivious to social facts. For example, she holds a persistent idea that she is going to save her younger siblings, especially a toddler brother she adores, from their substandard parents. When she encounters a person of authority, she constantly tries to negotiate with them, wringing out every possible advantage. She almost completely lacks any theory of mind: For example, she does things like meticulously hiding a carefully packaged bunch of notebooks in the ground and then leaving a digging spade next to the hiding place. She runs away and hides from all people she doesn't feel at ease with, including her social worker. In general, although her IQ level is very high, she seems to completely lack imagination of what people might be thinking of her.

I could go on and on and make the list longer. The point is, to the naked eye, Alma is crazy. You just need a little information about her behavior to agree that she most likely is delusional. Everyone who needs to deal with her for extended times finds that obvious: Her parents, the social workers, her foster parents.

Everyone, except her psychologists and psychiatrists. Yes, this is really perplexing. A psychologist I know says that a personality disorder should only be diagnosed if it is obvious enough for a bus driver to see it. But what do we call a case of madness that every bus driver could see, but psychologists fail to detect?

Almost two years ago, when Alma's first psychologist failed to see that she was dealing with an unusually mad patient, I believed I had just encountered an unusually stupid psychologist. When I asked the psychologist to help Alma fight her madness, the psychologist decided that I was the mad one and helped Alma to move into foster care. The foster parents then discovered rather quickly that Alma was actually mad. I did my very best to lobby to get the oblivious psychologist out of the picture. Eventually that succeeded and Alma got ...