My name is Sam Vaknin. I am the author of Malignant Self-Love, Narcissism Revisited.
We keep using the phrase personality disorder, but what is a personality and what is a disorder?
In their Opus Magnum, Personality Disorders in Modern Life, Theodore Millon and Roger Davies define personality as a complex pattern of deeply embedded psychological characteristics that are expressed automatically in almost every area of psychological function.
The Diagnostic and Statistical Manual, text revision 4, published in the year 2000 by the American Psychiatric Association, defines personality traits as enduring patterns of perceiving, relating toand thinking about the environment in oneself that are exhibited in a wide variety of social and personal contexts.
Laymen often confuse and compute personality and character and temperament. These three are distinct entities.
Our temperament is the biological genetic template that interacts with our environment. Our temperament is a set of in-built dispositions we are born with, our temperament. It is mostly unalterable.
Though recent studies demonstrate that the brain is far more plastic and elastic than we thought, still temperament is fairly much built in.
In other words, our temperament is what the ancients used to call our nature.
Our character is largely the outcome of the process of socialization, the acts and imprints and edicts of our environment and nurture, and how they work on our psyche during the formative years, 0 to 6 and in other lists.
Our character is the set of all acquired characteristics we possess, often judged within a cultural, societal context.
Sometimes the interplay of all these factors results in an abnormal personality.
Here we come to the question of what is a personality disorder?
Personality disorders are dysfunctions of our entire identity, tears in the fabric of who we are. They are all pervasive because our personality is ubiquitous and permeates each and every one of our mental cells.
So when we talk about personality disorder, in the background lurks the question, what constitutes normal behavior? Who is normal and what is normal?
We have to compare a disorder to order an abnormality to normality or normalcy.
Well first there is what may be called the statistical response. Statistical response is that normal is what is average and what is common, but this is unsatisfactory and incomplete.
Conforming to social edicts and mores does not guarantee normality.
Think about anomic societies and periods in history such as Nazi Germany or Stalin's Russia. Model citizens in these hellish environments were the criminals and the sadists. They were the cream of society. They were the elite. So were they normal?
Well within the context of Nazi Germany and Stalin's Russia they were normal.
But I don't think any of us would think that SS guards in concentration camps and butchers in Stalin's Gulag were normal people.
Rather than look to the outside for a clear definition of what is normal, many mental health professionals ask, is the patient functioning? Is the patient happy? Or in professional terms is the patient egosyntonic? If he or she is both functioning and happy then all is well and all is normal.
Abnormal traits, behaviors and personalities are therefore defined as traits, behaviors and personalities that cause dysfunction and cause subjective distress or unhappiness.
But of course this falls flat on its face at the slightest scrutiny.
Many evidently mentally ill people are rather happy and they are reasonably functional. Even psychotic schizophrenic, paranoid have long stretches of time where they are completely functional and many of them are happy.
Some scholars reject the concept of normalcy altogether. The anti-psychiatry movement objects to the medicalization and pathologization of whole swaths of human conduct.
Others prefer to study the disorders themselves or rather to go metaphysical by trying to distinguish them from an imaginary and ideal state of being mentally healthy.
Even though it is a highly fictionalized account of what it means to be normal, I subscribe to the letter construct.
I believe that we should compare all modes of functioning and all modes to a completely ideal non-existent definition, sort of a construct, an invention of a normal person, a normal psyche, mentally healthy.
I much prefer to delve into the phenomenology of mental health disorders, traits, characteristics, impact on others, functions, dysfunctions, distress, happiness.
I prefer to observe than to analyze or build theories.
I think the role of psychiatry in psychology is to heal, not to make psychiatrists and psychologists famous for the grandiose theories and ideas.