“Re: those personality disorders that you mentioned (pure anti-social disorder, and reactive attachment)... I think those types of labels are pure bullshit.”
I will absolutely and irrevocably stand by what I said. (And there is a HUGE body of literature, from thousands of clinicians and researchers way smarter than you and me, who will back me up on this. “Google’ it and start reading, and choose, if you wish, a irrefutably reliable source such as that from the Mayo Clinic, or the National Institute of Mental Health).
I’ll agree with you that yes, there are no absolutes, that no two people look or think alike, and that everyone has something that another person does not have, and that everyone has the potential to change, and we shouldn’t rank people because who’s to know what anyone’s true purpose in Life really is. No argument there. But, the addition of a character-disorder label is not the end of the story or of the world. It doesn’t allow a clinician to ‘dismiss’ or categorize a patient, but rather is an entirely useful and necessary adjunct in coming to understand how a person got into the mess they’re in, how to help them in an inpatient setting, and how to understand the best and most useful options for them in follow-up outpatient care.
For example, someone comes in for treatment for a recurrent depression, but they also have been recognized to have an Avoidant Personality trait. Sure, they can be helped to feel less depressed, but if they aren’t given the opportunity to recognize one of the major things that is driving that depression to occur over and over, would we truly be doing for them the best that we can? The answer is ‘no’, Rick. We owe it to them to give them their best chance at seeing the ‘big picture’.
I can see how the ‘dropping’ of a label on someone could be an affront. Matter of fact, considering your vehemence at my original post, if I was to make a conjecture, it might possibly lead me to wonder if you, or someone you know, has been stung by having such a label applied to them. If that were the case, I also might guess that the clinician applied/presented it in clumsy fashion. Properly done, it can be a useful insight that will help a person, who is suffering, to understand the full picture of WHY they are suffering, and that is an entirely proper goal. We have a very wise, educated, and experienced psychologist who has mastered this approach of helping people to get a grasp of their personality quirks, stressing how they are rooted in biology and personal history and are NOT the fault of the patient, and they have been universally appreciative. It has never once blown up in her face.
Here’s another example, between two guys facing marital separation, the first reasonably well-adjusted, the second a Narcissistic personality.
The first, a man without character disorder, would be sad, lonely, anxious, discouraged, frightened for his future, but who would be able to talk about his distress, be able to look with some objectivity about how the relationship spiraled downward, would be chagrined at his wife’s distress, would be interested in repairing the damage with his spouse, and would be able to engage in self-examination in therapy.
The second, a Narcissist, would have a different meltdown, and can anyone tell me that they haven’t read about, or personally witnessed, this behavioral trait in action?
At best, the narcissist just doesn't give a shit. The wife is nuts, the proof in that she let him get away. Her loss, not mine.
Or, he's pissed, but he's smart enough not to 'lose' it, but she's going to pay. He screws her at every turn- she can't have any belongings/furniture, he starts frivolous lawsuits that cost the wife in attorney fees she can't afford, he refuses the quick divorce and drags it out so that she can't have any access to a settlement, he starts dating immediately to 'rub it in' about how 'attractive' he is, he uses the kids to goad her, refusing to deliver them in shared-custody, or refusing to help with their expenses, stuff like that.
One degree worse yet, he loses self-control, and pulls the 'grand dramatic gesture', (and this is what gets them to the inpatient unit),- he'll slice his wrists (but not deep enough to put his life at risk, of course), or he'll drive his car into a tree (but keep his seatbelt on), drive off into the woods with a firearm after calling his wife and telling her it's all her fault and leaving suicide notes, but gets talked out of it by other family ("OK, since you begged me...."), or slightly more dramatic, will get the wife on the phone and then discharge a gun (at the ceiling. He likes himself too much to actually damage himself).
One more degree worse in mental disorganization, he is the hostage taker, or who has to have the 'suicide-by-cop', because he doesn't have the heart to do it to himself, and puts no thought to the danger he causes or what emotional trauma the cops have to endure.
And worst, of course, the narcissistic-antisocial combo, the murder spree. They'll murder their kids and leave the wife alive (as the ultimate way to punish), or they'll kill their entire family, (if I can't have you, nobody will).
Anyone can see, based on the differential personality diagnosis, that the treatment of each respective individual has to differ, as does the outpatient care. But there is a wide list of character disorders that cause all types of personal and social disruption, and any clinician worth his salt will have them firmly in his grasp if he is going to pretend to be able to understand or help his client.
And one more thing, I’ll agree with you to the extent that SOME personality-disordered people can change, particularly those such as the Avoidant and Dependent types. In therapy, or even in close self-examination, these folks can recognize themselves and work to change their thinking and their behaviors. But I defy you to convince me or any clinician that those who are schizoid or schizotypal, eg, or those who are narcissistic or antisocial, will ever be able to examine or change themselves or their dysfunctions in any significant way.
I speak from at least a reasonable perch. In November, I will have reached 25 years as a nurse on an acute-care inpatient psychiatric unit. Over those 25 years, I have seen, applied, and used the wisdom of those researchers who describe personality disorders as ‘enduring patterns of dysfunctional behavior, inflexible and pervasive across many situations’. We have a percentage of the local population who have been in and out, in and out, over those full 25 years, consistently unable to manage their stressful situations: new partners but same relationship outcomes, new jobs/homes/friends, but the same interpersonal chaos, it goes on and on. Do I get fatalistic? No. I give them my best effort, each and every time. But do I have diminishing expectations? Yes, because I believe I have a clear picture of some of the root causes of these situations based in their dysfunctional personality styles which, if not addressed, examined, and changed, will find them back on our inpatient unit again, sooner or later.
And you surprise me back, with your history of work in the correctional field, that you have no understanding or conception of an antisocial personality. Prisons are rife with them. Ted Bundy was a pure antisocial, and he was as real as death itself. Some 35, (and perhaps dozens more) young ladies paid the ultimate price for his “label”, and he’s just a single example of that genre. You can absolutely believe, as a father of a pre-adolescent daughter, that discussion has already begun of dysfunctional attitudes and behaviors that are presented on TV and in movies, not to cause alarm or paranoia, or that I have any misconception that she won't fall prey to some young man's manipulations, but rather to have her begin to exercise some critical thinking, that it not come as something that she has never seen when she begins dating, and that she may be least likely to have some douchebag take advantage, or worse, put her in danger.
Anyone who does not accept the premise of this disorder strikes me as goofily naïve. And I stand by my advice to Bikermike. I applied no labels to anyone. But I did make mention of potential pitfalls, and they are real possibilities. Bikermike is free to offer any help he would like, but as a husband, he has first responsibility to his wife and family not to jeopardize their welfare or safety. After that, making efforts to help that young lady, or the ten people he’s going to see on the NEXT block, are completely reasonable. Hell, there's a wide world of noble causes, and people in need. The question is how to choose whom to help, and as I said, how to know that the help one offers, is the help that is needed.
Lastly, I am fully aware, the internet being what it is, and psychiatry being as prey to fraud as any other branch of medicine, that you may have bought into some quack therapy and are going to tell me that your ear-candling and your phrenologist have turned your life around, or that you are likely to dredge up something off the internet to refute what I'm saying, and I will not go down that road. You've said your piece, I've said mine. You believe what you believe, as do I, so this is all I'll have to say about this subject, because I doubt you'll be able to let this drop, (and that is a prediction).
I am accomplished at what I do, I believe what I believe, I work with consummate professionals, and we do a world of good to many hundreds of tragically suffering individuals every year. But I will not let you call our diagnostic process "bullshit" without making reply.
