Behavior
Taking It Personally - Depression, Introversion, and Isolation
Isolation may be our worst enemy.
It started out as a whim, but turned into an eye-opener. In May 2003, I asked my Newsletter readers to take an online Myers-Briggs personality test and email the results, along with their diagnosis. Although this was strictly a readers' poll and not a scientific study, and bearing in mind the risks inherent in pigeonholing personalities, the findings were striking enough to indicate I might be on to something.
The Myers-Briggs
The Myers-Briggs type indicator (MBTI) begins with eight personality functions in contrasting pairs - Introvert (I) or Extrovert (E), Intuitive (N) or Sensing (S), Thinking (T) or Feeling (F), and Judging (J) or Perceiving (P). The Introvert/Extrovert dichotomy relates to people drawing their energy from being alone or with people rather than simply being either shy or outgoing. Thinking and Feeling are self-explanatory. Sensors tend to focus on the here and now while Intuitives look for meaning and possibilities. Judgers prefer structure in their lives over the messy flexibility of Perceivers.
Combining six of the functions yields four temperaments: Guardians (SJ), who value tradition and seek security; Artisans (SP), who are sensation-seekers and hands-on people, Idealists (NF), abstract and conceptual, and Rationals (NT), born scientists and engineers.
Falling within these four temperaments are 16 distinct personality types, defined according to the eight paired personality functions, thus INFP, ESTJ, etc.
Very Introverted, Very Idealistic
Approximately 150 responses were received, and of these the first 100 were analyzed (a nice even number for this maths-challenged individual). Most readers also sent in their diagnosis, nearly all with depression or bipolar disorder. Since most people with bipolar disorder are depressed more than manic, it is safe to conclude that this poll was dealing with a mostly-depressed population, without further breaking down the figures. Approximately three-quarters of the respondents were women, which about matched the Newsletter's readership.
The first eye-popping result was 83 percent of those who replied were introverts, which sharply contrasts with the 25 percent to be found in the general population. According to one reader, who had a strong extrovert score four years ago and a much weaker one when responding to this poll: "Over the last four years I've sunk into a very isolated existence. The mania has worsened despite changes in medication/dosages and I spend most of my time sleeping and avoiding large social functions. I do slightly better in small social gatherings, but up until just a couple of months ago I didn't go anywhere or see anyone other than my immediate family within our house."
Guardians and artisans make up 40-45 and 35-40 percent of the general population, respectively, yet accounted for just 15 and 11 percent of this one. Instead, we had 41 percent idealists, who comprise but eight percent of the general population, and 23 percent rationals, who can be found in seven percent of the population.
The best is yet to come: Among the idealists were 17 INFJs and 14 INFPs, the largest populations in this study, the "mystics" and "dreamers," respectively, who only account for one percent each of the general population. Idealists have turned up in higher than expected numbers in at least two online MBTI tests, which may explain the large turnout here. Another confounding variable could be that loners who are drawn to the internet are not representative of the wider population of those who have depression or bipolar.
Nevertheless, it is fair to conclude that the nature of depression and the isolation that derives from any type of mental illness strongly influences our tendency to seek comfort in our own inner world. Whether the reverse may be true, that our personalities may place us at higher risk of an episode or may exacerbate symptoms, remains to be seen.
Other Findings
In addition to the 83 introverts and 17 extroverts, the poll turned up 64 intuitives, 36 sensors; 36 thinkers, 64 feelers, 59 judgers, and 41 perceivers. Among the general population, 60 percent of women are feelers and the same percentage of men thinkers, which might account for the preponderance of feelers in this poll, but the real surprise may be the respectable showing by the thinkers. Although our moods tend to define us, those of us with bipolar disorder even when symptom-free tend to have racing thoughts that can turn us into Platos on Starbucks. On the depressive end of the scale are the brooding and ruminating Hamlets.
The either-or nature of these choices strongly suggests that the MBTI fails to adequately accommodate those of us who both think and feel intensely, where a more reliable measure would probably find us doing a lot of both. This is not a fatal flaw of the MBTI, but is one that clearly needs addressing if ever the test were to be used on a large scale among those with mood disorders.
More personality types: Among the introverts - Add to the 17 INFJs and 14 INFPs, 13 ISFJs (found in six percent of the general population), nine ISFPs, eight ISTJs, four INTPs, and two ISTPs. To sum it up in one sentence, if these were the only people (and this includes me) at an all-night open bar celebration, everyone would be home by nine.
As for the extroverts: Possibly because it was just one letter off INFP, there were seven ENFPs, “visionaries” who would fit right in with the mystics and dreamers, the only category of extrovert over-represented in this poll. The other intuitive extroverts in this poll nearly jibed with the five percent general population at four ENTJs, four ENTPs, and two ENFJs. Among sensing extroverts, however, only two ESFJs and two ESTJs turned up to party, with no ESTPs or ESFPs, in sharp contrast to the 13 percent found among the general population. Since the sensing extroverts have descriptions such as “enforcers,” “adventurers,” “helpers,” and “jokers,” you can see what we are missing.
One of the few psychiatric studies using the MBTI, by David Janowsky MD of the University of North Carolina et al appearing the World Journal of Biological Psychiatry in 2002, also found a preponderance of introverts and feelers among a depressed population (74 percent introverts and 84 percent feelers). ISFPs, INFPs, ISFJs, and ESFJs were over-represented while INTPs, ESTPs, ENTPs were under-represented.
Another study by Dr Janowsky et al, in 1999 Bipolar Disorders, found bipolar patients to be more extroverted and perceiving than those with unipolar depression
Reader Insights
Several readers commented that their results varied on circumstances and phase of illness. Stephanie wrote that "when manic I'm as sociable as Bette Midler on cocaine and when I'm depressed, seriously come not near me." Steven reported that in 1995 when he took the test at work, in a stimulating environment, he was an extrovert, but at home where he could relax away from people he was an introvert. Another reader, who rapid-cycles, reported different results on the same day.
Cindy, a family doctor who has bipolar, commented that the information she receives on personality is pathology-oriented and not very helpful. She treats the adolescents in her practice with the Kiersey temperament scale, a version of the MBTI, which she finds useful in counseling with their families. According to Cindy:
"I have found a general trend that my bipolar adolescents are very frequently INFPs or ENFPs. I'm not sure why except that I attribute spontaneity and risk taking behaviors to somehow be related to a tendency to be bipolar as well as the tendency to experience strong emotion. I also find that adolescents who are artistic or temperamental and have ISTJ or ESTJ parents are often more likely to be brought in by their parents for mental illness issues."
She adds: "I would love to see more of this kind of work done ... I think that more info on personality might help me predict which patients might do well with which medications."
This begs the question of whether psychiatry or psychology is addressing itself to what may be a patient's most pressing need, once the more severe symptoms are resolved. Stephanie, who works with children who stammer, has observed how the condition, if untreated, can have a profound effect on how personality is expressed. In regard to her own bipolar, over 18 months "I started to lose myself big time. I couldn't trust myself to do anything and I increasingly noticed that other people lost their faith too. My perception of my personality altered significantly."
Carol, who came up ENTJ back in college and again a couple of years ago when working for a mutual fund company, observed that "if I may draw a conclusion, those of us who can break through isolation and make contact with others, could be better able to keep the depression at bay."
Conclusion
In the meantime, we are left with the disquieting knowledge that our illness can isolate ourselves to the point of virtual no-return. Another study by Dr Janowsky MD et al, appearing in 2000 in the Journal of Psychiatric Research, found that 84 percent of the 64 suicidal patients examined were introverts, leading the authors to observe:
"The issue of social isolation has been mentioned as a potential risk factor for suicidality. The introverted individual almost certainly has trouble reaching out to others, especially in times of stress and need. Thus the social isolation of introversion may set the scene for suicidality."
In a 2001 article appearing in Current Psychiatry Reports, Dr Janowsky cites various studies to support the proposition that "increased introversion predicts the persistence of depressive symptoms and a lack of remission" (and conversely that extroversion can improve outcomes).
The obvious antidote is to do whatever it takes to get out of the house and into the company of others. This is generally easier said than done, given the nature of our illness, but the stakes are enormous in what could very well be the most important aspect of our treatment.
Updated June 27, 2003, reviewed Feb 10, 2008
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