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About Aaron Friedmans Supposedly Incurable PPD Diagnosis Really???

Yet another serious question concerning the integrity of the purported " " and his diagnoses has
arisen. Lets remember that this fellow managed to diagnose Aaron Friedman with Paranoid Personality
Disorder (PPD) . sight unseen. He/She also solemnly declared that the condition is UNTREATABLE.
The old saying goes that where theres smoke, theres fire. After noticing several troubling aspects pertaining to
the diagnosis of Aharons purported mental illness (some of which Ive discussed in earlier posts on this blog), I
figured it might pay to take a closer look at the symptoms of PPD and try to match them to whats widely
known about Aharons character traits.
What I found should be shocking: According to up-to-date research, the diagnosis itself and the assumption that
it untreatable both seem extremely untenable. While I didnt have time to do a thorough review of the literature,
I believe that the facts are more than enough to raise very serious questions regarding this crucial component of
the .
First, the BIG news, concerning treatability: This is from Carroll, A. (2009). Are you looking at me?
Understanding and managing paranoid personality disorder. Advances in psychiatric treatment, 15(1), 40-48.
Its available for download at: http://apt.rcpsych.org/content/aptrcpsych/15/1/40.full.pdf.
TREATMENT OF PARANOID PERSONALITY DISORDER: NONE OF THE POSSIBLE TREATMENTS
FOR PARANOID PERSONALITY DISORDER HAS BEEN SUBJECTED TO RANDOMIZED CONTROL
TRIALS. NOTWITHSTANDING THIS, THE CONDITION SHOULD NOT BE VIEWED AS
UNTREATABLE AND THERE IS A DEGREE OF CONSENSUS WITH RESPECT TO GENERAL
PRINCIPLES WHEN ATTEMPTING TO SAFELY MANAGE THE DISORDER (GABBARD 2000; FAGIN
2004). POSSIBLY THE MOST USEFUL FOR THE GENERAL PSYCHIATRIST IS BECK AND
COLLEAGUES MODEL OF COGNITIVE THERAPY FOR PARANOID PERSONALITY DISORDER
(BECK 2004).
Both Government agencies and insurance companies consider cognitive therapy to be among the therapies with
the very best evidence base and therefore recommend its use, and yet in reality its application is spotty, at best.
Dr. Tom Insel, longtime Director of National Institutes of Mental Health, the US agency in charge of mental
health, often discussed this problem.
Its interesting to note that that the concepts expressed in many major authoritative Hashkafic texts (such as
' ", , , ",) ,also correlate highy
with concepts that are deemed important in Cognitive Therapy.
One reason the might have missed this crucial point is because although the evidence base shows its
efficiency, the problem seems to be that therapists find it much easier to use relationship based therapies, which
are not so demanding of the client. In fact, this is a reportedly why theres often a problem with fidelity,
namely that even those therapists that do attempt cognitive therapy often find it necessary to deviate from
recommended protocols, usually because of issues with motivation or therapist habits of mind the fact that
therapists dont take cognitive seriously, simply because most werent trained in how to apply it and arent
accustomed to using it.

This is extremely troubled ". The facts seem to show that the whole is predicated on the ignorance of
the expert, which is based on his own personal biases. Can we call a mental illness untreatable, simply because
the expert ignores the available research and relies on his own biases? I think the answer is obvious.
All of the above, is assuming Aharon really had PDD. Its extremely unlikely, ". Heres why:
It turns out that PPD symptoms are very hard to miss. From everything detailed Ive read, its not the type of
illness that can easily be hidden, because its the sort of thing that hits you in the face. I cant help but be
puzzled why a professed expert would choose such a diagnoses without even seeing the patient, since it seems
quite easy to spot. Whether the " " in this case really meant the diagnosis he gave or just did it for
some ulterior motive, this specific diagnosis seems to scream SLOPPY WORK!
About Aharon: Many commentators and some of the have pointed out their concerns regarding:
The constantly changing story that was told against Aaron, the fact that he has several law degrees & works in
Congress for many years, Tamars diary entries, the fact that both in Bais Din and Court his mental health never
came up, etc. At the very least, the takeaway is that Aharon is no raging lunatic. I think even Tamars most
ardent backers will have to agree to that.
If we only look at the typical laundry-list of PPD symptoms, someone that doesnt know Aharon can easily say
maybe? However, once we clarify what PPD is really about it becomes quite clear that there is absolutely NO
WAY that such a diagnosis can be give sight unseen, in good consciousness.
First the regular laundry list of symptoms - for which someone that doesnt know Aharon can possibly say
maybe, who knows?
* 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 and believe they are always right. * Have difficulty relaxing. * Are hostile, stubborn, and
argumentative.
Now, lets see what the experts say about someone with Paranoid Personality Disorder (PPD). Are these
symptoms easy to hide, or is it easy to spot someone suffering from PPD? How important is context and past
history? What about differential diagnosis (correctly choosing this diagnosis rather than other possible
explanations?). Heres a little sampling of what the experts say. I didnt change anything except occasionally
add caps for emphasis & add clearly marked notes. I also didnt check the information contained in the bios for
accuracy.
First, something meant for laymen, from Dr George Simon, an internationally-recognized expert on
manipulators and other problem characters and the author of 3 bestselling books: In Sheeps Clothing (which
has been translated into 12 foreign languages), Character Disturbance, and The Judas Syndrome. Hes made
appearances on several major television (Fox News Network, CNN, CBS 48 Hours) and radio programs and is
also the host of a weekly internet program on UCY.TV called Character Matters.

Dr George Simon: Among the more serious personality disturbances, theres a disorder you hardly ever hear
about. Even when it manifests itself, this disorder is often neither recognized for what it is nor properly
diagnosed. But WHEN SOMEONE HAS PARANOID PERSONALITY DISORDER (PPD), BELIEVE ME,
YOU KNOW IT, WHETHER OR NOT YOU KNOW THE RIGHT LABEL TO APPLY TO IT OR YOU
FULLY UNDERSTAND ITS DYNAMICS. YOU KNOW ALWAYS KNOW SOMETHINGS
DREADFULLY WRONG WHEN SOMEBODY HAS PPD BECAUSE OF HOW UNNERVING IT IS TO
HAVE ANY KINDS OF DEALINGS WITH THEM. JUST LIKE WHEN YOU ENCOUNTER
PSYCHOPATHIC PERSONALITIES, YOU CAN SOMETIMES FEEL THE HAIR ON THE BACK OF
YOUR NECK STAND ON END WHEN YOU DEAL WITH SOMEONE WHO HAS THIS DISORDER.
THAT CHILLING FEELING IS YOUR NATURE-GIVEN INTUITIVE WARNING SYSTEM TELLING
YOU SOMETHING IS SERIOUSLY WRONG WITH THE PERSON YOURE DEALING WITH AND
SOMETHING REALLY BAD COULD EASILY HAPPEN, especially if you should do or say anything that
upsets them in some way.
Retrieved from: http://www.manipulative-people.com/a-rare-but-potentially-dangerous-personality-disorder/
Now lets move on to research on PPD.
Dr. Carroll (cited earlier) notes:
A normal response to unusual circumstances should always be considered as part of the differential diagnosis
of a patient with cross-sectional features suggestive of paranoid personality disorder. Features of personality
disorders in general can be considered as extreme, maladaptive variants of normal traits. Dimensional rather
than categorical analysis seems especially applicable to paranoid thinking: one persons paranoia is anothers
due caution, and one persons trust is anothers gullibility normal development entails learning that not
everyone who seems trustworthy is trustworthy
[Note: In other words, normal behavior can easily be confused with PPD. All the more reason to censure a
purported expert who issues a diagnosis based on information obtained from only one side with a vested
interest, as Rav Feldman mentioned].
-=
Diagnosis is dependent on longitudinal evidence that maladaptive features of feeling, thinking and behaving
are enduring over time. Collateral data are thus essential to demonstrate that the features are not confined to
particular situations and that they have been in evidence since adolescence or early adulthood.
[Note: Hes saying that to avoid the problem of confusing normal behavior with PDD, its crucial to follow the
patient since adolescence or early adulthood. In our case it is abundantly clear that no symptoms of PPD where
manifested for so long, unless we cheat by including either normal response to unusual circumstances or we
include what many consider due caution].
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Suspiciousness may be adaptive in certain environments, and determining how much interpersonal trust is
appropriate in a given situation may indeed be a vexing judgmental dilemma (Kramer 1998).
[Note: Ive raised this point before, namely that the environment Aharon was thrust into would make many
perfectly normal people suspicious.Yet, it seems that the expert had no problem with this dilemma.]
-=
An epidemiological study of a community sample in New Zealand found that 12.6% demonstrated at least
some paranoid features (Poulton 2000), and nearly half of American college students report experiences of
paranoid thinking (Ellett 2003). Thus, many people manifest mistrust and suspicion from time to time but

because they are transient, modifiable and not significantly disruptive, such phenomena are not pathological.
[Note; Hard to justify based on a condition thats so widespread at different stages of life, unless the
expert somehow was sure that the paranoia was very extreme and stable. Hard to believe how that could be
ethically done, sight unseen, given what we know about Aharon].
-=
People with high levels of paranoid thinking have an externalizing, personal attributional bias: a tendency to
explain negative events in their life by blaming others rather than reflecting on their own potential contribution
to circumstances (Bentall 2001, 2006). The normal self-serving bias, whereby negative events are attributed to
external circumstances, is exaggerated and distorted (Campbell 1999), being skewed towards other people and
their supposed malevolent intent.
[Note: To this day, NOTHING was ever mentioned about a blaming tendency. Funny]
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(Mirowsky 1983; Haynes 1986) have emphasized that paranoid thinking is likely to emerge in situations
involving: sudden social loss or isolation
acute disruption of usual social networks exposure to
environments in which previous social
skills may not be useful, for example immigration or
imprisonment acute sensory deficits actual powerlessness and victimization. an understanding of how
paranoid thinking can be engendered by such situations not only helps to predict when the features of paranoid
personality disorder are likely to become more apparent, but also assists in the differential diagnosis between
paranoid personality disorder and normal responses to extraordinary circumstances.
[Note: The fact is well known about how Aharon was shunned & denigrated in the media and in person. This
points to the high possibility that the paranoia was a result of what was done to him].
-=-=-=
A final word:
Understanding the misdiagnosis: To be sure, the expert didnt just pick the diagnosis out of a hat. Carroll points
out that impairments that affect social skills have been linked to paranoia, as has failure to understand the
viewpoint of another person. Both of these issues are indeed noted in Tamars diary entry. Still, the fact that so
many typical factors usually present in PPD are missing here should raise a strong red flag. After all, most
people that arent interested in socializing are not paranoid. So too, what a biased party sees as failure to
understand the viewpoint of another person may be a principled stand against that viewpoint, for various
perfectly objective reasons. The clearly failed to investigate, and the results are tragic.