Recently, someone asked GoodTherapy.org to include Personality Disorders within our list of Concerns Addressed (this is the list of concerns that people can select when searching for therapists and the list that all members select from when creating their listing). Our decision was a unanimous “no” and we thought it would be fair to explain why and to give our members the chance to make an argument for the use of the “Personality Disorder” diagnosis. I should say that we do support the inclusion of “personality disorder” symptoms in our list of concerns and we are currently working on translating these to fit into our list…. Please feel free to add your comments to this discussion below by clicking on the comments link directly below this post.
The following is our reasoning: We believe that by labeling a person as personality disordered or, in its more gentle form, stating that a person has a personality disorder, we are essentially claiming one’s personality, their person-hood, their essence, is fundamentally flawed. What else are we, other than our personality? Such a diagnosis is very likely, if not absolutely, to produce more shame, worthlessness, and rejection in a person who probably has enough of it already. I don’t care how it is framed, normalized, or expressed: having a diagnosis called “Personality Disorder” says one thing: you are fundamentally flawed.
Please don’t get me wrong, I’m not saying I’ve never worked with people who’s inner systems fit the criteria for the DSM categories of Borderline, Narcissism, and others. The difference is that I don’t use the categorical and shaming word “Personality Disorder” to describe a person’s experience and I don’t view people as fundamentally flawed. Deeply wounded, yes, powerfully protected, yes, but fundamentally and irreparably flawed, no.
It’s at this stage in the debate that some people will say to me, “well what about sociopaths like Ted Bundy, Charles Manson, and others?” My reply to this is to say a few things: 1) I don’t have evidence to conclude that “sociopaths” are born without the capacity for remorse and empathy or that sociopaths are the result of their environment – such as lack of attachment, etc. I think the jury is still out on this and until I have evidence sociopaths are a product of nature, I’m going to give them the benefit of the doubt and assume most sociopaths are a product of their early childhood relationships, one without a healthy emotional attachment to a primary caregiver, among other things. 2) The odds of an adult without remorse and empathy ever developing the capacity to attach is probably very low. But, I think it’s better to stay open to the possibility that adults can develop attachment. The latest research from the field of interpersonal neurobiology demonstrates that the adult brain can develop new neural connections and can even grow new neurons; this offers tremendous hope. 3) We’re talking about people in the context of psychotherapy and “sociopaths” generally don’t go to therapy, unless they’re mandated by the law or their significant other. So, humbly, my experience and beliefs about the nature and etiology of personality wounds comes from my clinical experience, however limited, and leads me to believe that most people classified as “personality disordered” are just deeply wounded, but not irreparably flawed… Sure, many folks with personality wounds may not heal in this lifetime. But this should not preclude us from treating such folks with dignity; recognizing that they too were born as lovable, vulnerable, and helpless babies, rather than evil and irreparably damaged.
My experience teaches me that people are not fundamentally nor irreparably flawed:We are all born loving, lovable little babies. As far as I can tell, all of us come into the world fully equipped to experience peace, self-acceptance, forgiveness, calm, compassion, confidence, satisfaction, and other positive qualities. Sure, we have many temperamental differences based on genetics, but no child is born prewounded, predefended, closed-hearted, nor do we have evidence that people are born sociopathic. If the caregivers and peers of our youth can nurture us adequately, we flourish; we experience joy, satisfaction, and connection to others. But because there is suffering and danger in life, because things happen to us and around us which burden us with extreme body-feelings and extreme beliefs, few of us mature into adulthood without some wounds and/ or protection. So, nearly all of us, to some degree, are part of the walking wounded. Each of us has developed different strategies, depending on how we suffered, to survive, to cope, to self soothe, to numb the pain, to escape, and to never be hurt again. For those of us, who have experienced a lot of hurt, our protective parts have a big job to do and work very hard to help us survive. For those of us fortunate enough to not have suffered too many wounds, our protectors work less intensely or frequently. Regardless of whether our protectors come in the form of addiction, self-criticism, anger, depression, anxiety, avoidance, or others, these strategies or protectors are just parts of us with survival strategies, not the true Self. The true Self is the indelible core that lies unharmed behind all of our defenses and wounds. And yes, this true Self exists within all of us, even folks labeled as “Personality Disordered.”
A person labeled as Borderline, for example, does not start out with such a polarized and fragile inner system, he or she was born a loving and lovable person, equipped to develop healthy self-esteem, confidence, self-soothing, and other positive qualities. But significant things happened (abuse, trauma, neglect) or did not happen (attachment, connection, love, soothing) to or in proximity of such a person. The results of this are extreme feelings and beliefs which cover over and hinder access to the qualities of the true Self.
Richard Schwartz, a pioneer in the field of psychotherapy and the developer of Internal Family Systems®, a model of therapy I practice and a model of therapy which teaches therapists how to heal trauma safely, describes the Self as the “I” within the storm. I love this analogy. Imagine a hurricane. In a hurricane the outer winds reach over a hundred miles per hour and cause great destruction. This is analogous to how people feel when overtaken by their protective parts (such as anger, self criticism, addictions) or their wounds (rejection, shame, fear, abandonment, worthlessness). It’s how any of us can feel at the end of a long and stressful day when there are too many things to do and not enough time to do them all. However, just as a hurricane has a calm center where the sun shines and the winds are calm, so to do all people. Richard Schwartz and other IFS therapists have demonstrated that even the most heavily traumatized, burdened, abused, and wounded folks, with all kinds of protective and destructive behaviors, can with a bit of guidance, access the calm, curious, reflective, and compassionate core Self. When someone, even someone diagnosed with the label “personality disorder,” can shift into the state of Self, he or she has the potential to heal their wounds and in turn the defenses, which are attempting to keep the person from ever experiencing the overwhelming, awful, trauma they once did.
More curiosity and compassion helps us to see the pain beneath the protection.
Let me be more specific about how some of the protective parts of a person labeled with a “personality disorder” try to help the person to survive and avoid their exiled feelings. So for example, imagine a person named Mary who’s been diagnosed with borderline personality disorder by her mental health provider. Mary tends to “split” people in a way that people with a “borderline” constellation experience, she shifts between states of idealizing and devaluing. The devaluing part of Mary, when activated, views others as “all bad.” So, if Mary’s boyfriend does something which triggers her vulnerability, say by choosing to spend time with someone else or perhaps by expressing a criticism of her, Mary’s devaluing part, in an effort to protect her from feeling rejected, worthless, shameful, or unloved, hijacks her and manifests as anger, criticism, and perhaps even hatred toward her boyfriend. The act of lashing out at the external trigger of the suffering serves the purpose of automatically and powerfully numbing Mary to those vulnerable exiled feelings, which are the real source of her suffering.
This devaluing part of Mary which vilifies her boyfriend and other “people/love objects” in her life has an enormous and important job to do, it’s trying to help her from feeling old feelings she’s exiled. If Mary’s devaluing part were to fail to vilify and blame others who trigger her, there would be a risk of being overwhelmed with worthlessness, shame, and other vulnerable feelings. This is why people with this sort of internal constellation have a reputation for self-harm and suicide, they’re not always successful at keeping the overwhelming and hopeless feelings out of consciousness. If you or I were burdened with as much shame and worthlessness as someone like Mary, it’s likely we’d feel suicidal too.
The second protective ego state that forms the other end of the splitting polarization is a part which idealizes her boyfriend or other “people/love objects” as “all good.” The idealizing part helps Mary’s young exiled ego states, the ones that are harboring the shame & worthlessness, to have hope for redemption. If Mary’s idealizing part can worship her boyfriend and view him as the manifestation of perfection, her young parts which carry the wounds and burdens can maintain hope that someone exists who will finally love them and care for them in away they’ve always wanted; essentially redeeming the young parts inside which have felt so rejected and worthless.
What we see in the example above are protective ego states/parts in existence because there are vulnerable ego states/parts harboring and experiencing, consciously or unconsciously, some kind of old suffering, danger, or hurt. Mary is so livid and hateful toward her boyfriend at times because the power and intensity of a person’s protection is equal to the power and intensity of their hurt. She has deeply wounded parts which harbor intolerable amounts of pain which occasionally get re-triggered by events.
I’ve used one symptom of the “Borderline” constellation, splitting, to demonstrate this, but I believe it’s the same with most constellations which include protection: there is not fundamental and irreparable flaw, there are deep wounds. The whole reason someone with a personality disorder is so protective and dysfunctional is because they harbor parts that are so wounded.
Original sin? I know this term may trigger my Catholic friends, but my answer is “Absolutely not.”
If you’ve worked long enough helping people to grow and heal, you see that these wounds are not something one is born with, as I explained above, they are wounds suffered and experienced in the course of development. So, if it is true that “flaws” are the result of protective and wounded parts; true that protective parts arise in response to our wounded parts; true that wounds are not inborn but a result of experience, then we can only conclude that people are not fundamentally and irreparably flawed, but rather deeply impacted by the thing that happen. Furthermore, if you have witnessed the healing process in someone so deeply wounded you realize that, the wounds and defenses are not destined to be permanent. With the sufficient amount of time, attention, and enough Self in the room, anyone is capable of healing. Developmental psychology, as Richard Schwartz points out, was wrong to ever hold that if a person didn’t get what they needed (love, attention, etc.) from a caregiver by a certain age they were destined to suffer incomplete and deficient. Advances in modern psychotherapy have proven this once strongly held belief to be false. Because people are generally whole from birth and have what they need inside for optimal health and happiness, healing is not about giving someone something they don’t have: be it wisdom, social skills, self soothing skills. It’s about releasing the constraints that inhibit access to the true Self. This is what good psychotherapy helps people to do.~
Stay Tuned for the upcoming posts:
“Why do we use ‘personality disorder’ diagnoses anyway?”
“What’s an alternative to the current diagnostic & classification system?”
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