It seems to me that theproblem is how WELL Otto's approch to life works combined with our repugnance for that approach. This is personality disorder type thinking on our part. Only in a few cases did Otto seem out of control. What's missing is a passion for human interaction that invites trying and failing in that sphere. A value of being connected that produces a willingness to be hurt seeking the connection. My question, and I've seen it often, is this: If Otto's life "works" according to Otto, do we have the right as therapists to impose our own value of "a life worth living" on Otto? We see him missing the passion, delight, joy etc. of life but since he is highly functional, so what? It invites the diagnosis question. Is diagnosis and treatment to cure that our only ethical job? Does anything else put us in the role of spiritual guru or cult leader? I am haveing real difficulty with this question in my practice and invite comments.
Sould add that I'm Adlerian and so have a grounded definition of of a "healthy" life style.