‘Show me a normal man and I will cure him’

I was reminded of this aphorism, which has been attributed to Freud, by an article on ‘Personality Disorder’ in The British Medical Journal of 16 September 2023.

If such an entity exists, this means there must be a standard for personality that is not disordered – a normal personality, as one might say. And what, pray, is that?

Rather than attempting to answer this question, orthodox psychiatrists have taken it upon themselves to define a species of man, or in these days of inclusiveness I had better say of human being, whose personality is not normal. And the nearest they get to doing this is to say it ‘may represent a significant deviation from what is expected for the individual’s developmental stage and culture.’ However, they hasten to add that ‘no consensus exists on a single definition,’ and then admit that ‘some clinicians question the use of the term “personality disorder” altogether.’

This pejorative ascription, whereby one human being, a psychiatrist, labels another human being, a person in distress who is seeking help, as having a personality disorder is almost an insult. No wonder the article starts by saying, ‘Personality disorders describe a set of longstanding complex emotional difficulties, which are common, highly stigmatised, and potentially disabling.’ (My emphasis.)

Of course the label of personality disorder is stigmatised (the qualifier ‘highly’ is redundant). It’s like calling someone paranoid, but anyone would feel paranoid if they were being attacked all the time!

In spite of this, the article repeatedly mentions ‘people with personality disorder’, ‘people who have a personality disorder’, and similar phrases, implying that this diagnosis is an objectively recognisable condition. But what causes this so-called disorder? The article’s five authors, of whom three happen to have Greek names, have an answer, sort of: ‘Genetic and environmental factors contribute to the development of personality disorders.’ That covers just about everything but, disappointingly, we are informed, ‘the genetic link is still not well understood.’ What are we left with then?

Adverse childhood experiences, including physical, emotional, and sexual abuse, neglect, and parental mental illness, are associated with an increased risk of a diagnosis of personality disorder in adulthood.

This is the trouble with orthodox psychiatry. Obviously, if you have had a terrible childhood with neglect and physical, emotional, or sexual abuse, it would not be surprising if you experience problems in later life. But the psychiatrists turn this situation into one where such an unfortunate person has an increased risk of being diagnosed with a disorder! They assume the diagnosis exists in the first place and then proceed to put people with certain difficulties into this pre-defined pigeonhole.

Now we get onto the approach to treating someone who might have a personality disorder. No, this won’t do. Let’s drop the disorder and ask: How should doctors approach a patient in emotional distress? There is a whole section on this important matter where we are patronisingly told:

General principles include an open, empathetic, and non-judgemental attitude, attentive listening, active and genuine interest, and validation of the patient’s experience.  

Well of course a doctor should approach a distressed patient in this way. Would any doctor worthy of the name use a closed, unempathetic, judgemental, inattentive, passive and pretended interest, non-validating approach?

The authors then defer to classification systems such as that of the highly esteemed DSM-4 (fourth edition of the Diagnostic and Statistical Manual of Mental Disorders created by the American Psychiatric Association), similar to DSM-5, which ‘attempts a “hybrid” approach between categorical and dimensional models,’ whatever that means, where we find a list of the following types of so-called personality disorder:

Paranoid, Schizoid, Schizotypal, Antisocial, Borderline, Histrionic, Narcissistic, Avoidant, Dependent, and Obsessive-compulsive.

I promise I am not making this up. On the contrary, I seem to have discovered a new mental condition to which American psychiatrists are prone: Invention of Psychiatric Disorders Disorder (IPDD).

And where does all this categorising get us with regard to treatment? At last, some common sense!

The goal is to engage in a curious and compassionate way with the person experiencing distress in their attempt to understand and manage their painful experience.

This approach was recognised as long ago as 1937 when it was explained in a lecture by the great Swiss psychiatrist, C. G. Jung:

Experience has taught me to keep away from therapeutic ‘methods’ as much as from diagnoses. The enormous variation among individuals and their neuroses has set before me the idea of approaching each case with a minimum of prior assumptions. (C. G. Jung, The Practice of Psychotherapy, Routledge & Kegan Paul, 1961, para 543.)

My impression from talking with psychiatrists is that they don’t read Jung these days. Maybe they should.

Text © Gabriel Symonds

Picture credit: Jené Stephaniuk on Unsplash