5 ms·

There is also a healthy debate over the degree to which personality disorders represent a true disorder, or just an extreme personality on the edges of normal d

There is also a healthy debate over the degree to which personality disorders represent a true disorder, or just an extreme personality on the edges of normal distribution. If you consider it in those terms, then “treatment” amounts to having someone voluntarily attempt to change their personality at a fundamental level. Even if they wanted to, how likely is that to succeed? All too often treatment for personality disorders, especially in Cluster B just train people how to better fake “normalcy” and to speak the language of therapy.

da_chicken 8y ago
> There is also a healthy debate over the degree to which personality disorders represent a true disorder, or just an extreme personality on the edges of normal distribution. I'm not sure that's a meaningful distinction. That is to say, a "disorder" should be something that interferes with your ability to function and flourish in a normal environment. I'm not sure it's meaningful to draw a distinction between people who absolutely cannot function and people who merely effectively cannot function. Just because your ankle is sprained and not broken doesn't mean you don't need medical care or that you should be walking.
- kofejnik 8y ago
  Homosexuality was considered a disorder until fairly recently
  - DyslexicAtheist 8y ago
    I always wonders who benefits from these treatments other then the doctors and scientist lining their pockets, along with academics circle-jerking their way to juicy funding. Labels like narcissism are just a way to tell a whole group of people that they're ill. In fact it's a personality trait that according to "research" is rampant in management professions. There are so many crappy online tests that measure your tendency to "narcissism" (and any extroverted high-achiever might fall into their trap) ... but if you look at the research it gets flimsy very quickly. They quickly talk about a "spectrum" indicating they have no fucking idea what they're doing. A bit like the current tendency to over diagnose kids on the autistic spectrum. Flimsy jargon like "spectrum" is excellent precondition for whole industries to emerge that can line their pockets. imvho psychology / psychiatry must be one of the most fraudulent sciences of our times (check out all the research that was done by these crooks to devise better methods of interrogation and soft torture) ... something, something "medical industrial complex". EDIT: what @zamalek describes above "My therapist has explained the biggest issue about PDs: the disorders make a person extremely unlikely to seek out help," sounds like the perfect cover for a fraudulent practice. Such language IMO is outright dangerous to anyone who may be diagnosed without their consent (e.g. by SJW's or society in general).
  - da_chicken 8y ago
    Yes, so was gender identity disorder (i.e., transgender) which was often classified with pedophillia or body integrity disorder. There is no frame of reference for psychology to use except society and general assessments of normality and expected behavior. That mean the only method to determine whether or not something is a disorder at all is a) determine the impact of the condition on the individual's ability to function, and b) determine whether or not the condition results in harm to the individual or others. These are both very subjective measures. The fact that we think we're more right today than we were yesterday is really pretty immaterial.
- drb91 8y ago
  Well, if functioning and fluorishing is defined by conformity, this doesn’t seem very meaningful. Some personality disorders allow a high functioning career and social life. To be clear I am trying to illustrate the idea that a disorder seems inherently devilish to define.
  - DanBC 8y ago
    > Some personality disorders allow a high functioning career and social life. No, they don't, because built into the definition of disorder is the impact it has one someone's life.
    - toufiqbarhamov 8y ago
      Which is a bit of an issue isn’t it. Is Shkreli in Cluster B? Probably, and now he has the impact on his life to prove it. So before that, when he was just incredibly successful, had no criminal record, and seemed able to function at a high level did he have the same disorder? If outcomes represent a diagnostic criteria then it reveals a weakness in understanding or even defining the disorder in question. It’s important to distinguish between diagnostic criteria, and the disorder itself, if they are actually disorders.
    - drb91 8y ago
      Ok... so most mental “disorders” with high functioning people aren’t actually disorders? The definition seems useless without meaning simply “nonconforming”.
  - jacobolus 8y ago
    Years ago I dated a woman with a “high functioning” career and from outside apparently normal social life who in retrospect was clearly BPD. She was very good at hiding her feelings during most casual interactions, and was clever and generous and fun to talk to when calm, but had almost a second personality which would come out when she became even slightly stressed which was bitter and entirely self-centered and extremely manipulative. She was at that stage of her life completely incapable of maintaining a close personal relationship, and she was frequently (on a daily basis) under extreme stress about perceived grievous slights from everyone around her that were to an outside observer inconsequential mistakes or misunderstandings, and she was harboring numerous long-term grudges. It seemed like she knew she had a problem, and during times where she wasn’t stressed out would regret her outbursts and seemed to wish she generally had better emotional control. She seemed generally pretty miserable about it, but maybe I was projecting based on the way her problems made me feel.
philwelch 8y ago
There's a more nuanced debate about the degree to which many personality disorders (particularly Cluster B disorders) don't qualify as a mental illness for another reason. You are considered mentally ill if you have cognitive and behavioral patterns that harm yourself. If your cognitive and behavioral patterns harm other people but leave you relatively unscathed, that's arguably not mental illness.
- Brakenshire 8y ago
  Have we just defined conscience as a mental disorder?
  - philwelch 8y ago
    Excessive conscience probably constitutes an anxiety disorder.
  - DyslexicAtheist 8y ago
    that wouldn't be profitable to the current industries so I guess not. There was talk of "An Ancient Virus May Be Responsible for Human Consciousness" not long ago so that at least is some acknowledgement in that direction: https://www.livescience.com/61627-ancient-virus-brain.html https://www.livescience.com/61627-ancient-virus-brain.html
- DanBC 8y ago
  Where are you getting that definition from please, because it's not one I recognise.
  - philwelch 8y ago
    While I can't find a source, it's a relatively common standard that I've seen used in multiple places, including in the psychology classes that I took (or sometimes dropped in on) in college. The distinction is most useful because many mental illnesses aren't necessarily qualitatively different than "normal" or "healthy" human behavior and cognition; they're just more extreme versions. For example, normal people regularly engage in compulsive rituals, and engaging in these rituals is sometimes beneficial to them--consider a baseball player's ritual at stepping up to the plate, or a basketball player's ritual when stepping up to the free throw line. But if you start engaging in rituals that are a little too compulsive and too disruptive to "living a normal life", that's when it crosses the line into obsessive-compulsive disorder. However, even if you can life a "normal" and successful life, that doesn't mean you aren't harming the people around you, unless you harm them enough that the long-term social consequences end up hurting you. Most cluster B personality disorders end up with the disordered person alienating people and suffering the consequences of their antisocial behavior. But if you're a high-functioning narcissist or whatever and you get away with everything...? Here's a rather snarky example of this standard being applied to a certain alleged narcissist (whose name I'll redact in my quote, below, since this person's identity is a bit of a distraction from the more general point): https://www.nytimes.com/2017/02/14/opinion/an-eminent-psychiatrist-demurs-on-trumps-mental-state.html https://www.nytimes.com/2017/02/14/opinion/an-eminent-psychi... > Most amateur diagnosticians have mislabeled <<a prominent individual>> with the diagnosis of narcissistic personality disorder. I wrote the criteria that define this disorder, and <<this person>> doesn’t meet them. He may be a world-class narcissist, but this doesn’t make him mentally ill, because he does not suffer from the distress and impairment required to diagnose mental disorder. <<this person>> causes severe distress rather than experiencing it and has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy.
WalterSear 8y ago
There is not. Anyone takes care of a person with a PD would tell you that. And the high functioning people with PDs would explain to you the all the very specific deficits they have to overcome in order to function. And the clinical researchers would explain to you as much as we know regarding regarding the developmental and environmental causes of specific PDs.
- toufiqbarhamov 8y ago
  There is not. Anyone takes care of a person with a PD would tell you that. And the high functioning people with PDs would explain to you the all the very specific deficits they have to overcome in order to function. Interviewing people in Cluster B is often an exercise in being lied to. It also requires them to have insight which is generally lacking as a clinical feature. Their caretakers are in a tough position, since they’re often the target of many manipulations gauges to engender sympathy and continued care. All in all it reveals a weakness in diagnosis and formulation of disorders by anecdote. And the clinical researchers would explain to you as much as we know regarding regarding the developmental and environmental causes of specific PDs. When they can accurately predict such outcomes from first principles even as well as they do for something like major depressive episode, schizophrenia, etc, I’ll take those claims seriously.
phkahler 8y ago
>> especially in Cluster B just train people how to better fake “normalcy” and to speak the language of therapy. Really effective, non-superficial therapy is very hard. You may have to dig deep. Really deep. And when you do reach the roots there's still the issue of how to deal with what you find. It's not like surgery where you take out an infected appendix and say "you're cured". >> If you consider it in those terms, then “treatment” amounts to having someone voluntarily attempt to change their personality at a fundamental level. Even if they wanted to, how likely is that to succeed? That's exactly why it's hard. The fundamental drivers are often hidden and can be scattered (my term). You don't really change until you change the core. Most therapy seems to try to work from the outside in - probably because it's easier to do but less effective.
clairity 8y ago
in general i'm skeptical that the medicalization of these kinds of idiosyncrasies is helpful. implicit to that process is normalization (defining the normal and the abnormal), and that by itself causes psychological and social pain for the so-called abnormal. we each have our crosses to bear (in all kinds of abilities, including mental and physical) and medicalization can give a false sense of understanding, treatability, and absolution of personal responsibility. tangentially, on a population level evolution happens on the margins and medicalization can only dampen that process (not that this is important on a personal level).

da_chicken 8y ago

> There is also a healthy debate over the degree to which personality disorders represent a true disorder, or just an extreme personality on the edges of normal distribution. I'm not sure that's a meaningful distinction. That is to say, a "disorder" should be something that interferes with your ability to function and flourish in a normal environment. I'm not sure it's meaningful to draw a distinction between people who absolutely cannot function and people who merely effectively cannot function. Just because your ankle is sprained and not broken doesn't mean you don't need medical care or that you should be walking.

kofejnik 8y ago
Homosexuality was considered a disorder until fairly recently
- DyslexicAtheist 8y ago
  I always wonders who benefits from these treatments other then the doctors and scientist lining their pockets, along with academics circle-jerking their way to juicy funding. Labels like narcissism are just a way to tell a whole group of people that they're ill. In fact it's a personality trait that according to "research" is rampant in management professions. There are so many crappy online tests that measure your tendency to "narcissism" (and any extroverted high-achiever might fall into their trap) ... but if you look at the research it gets flimsy very quickly. They quickly talk about a "spectrum" indicating they have no fucking idea what they're doing. A bit like the current tendency to over diagnose kids on the autistic spectrum. Flimsy jargon like "spectrum" is excellent precondition for whole industries to emerge that can line their pockets. imvho psychology / psychiatry must be one of the most fraudulent sciences of our times (check out all the research that was done by these crooks to devise better methods of interrogation and soft torture) ... something, something "medical industrial complex". EDIT: what @zamalek describes above "My therapist has explained the biggest issue about PDs: the disorders make a person extremely unlikely to seek out help," sounds like the perfect cover for a fraudulent practice. Such language IMO is outright dangerous to anyone who may be diagnosed without their consent (e.g. by SJW's or society in general).
- da_chicken 8y ago
  Yes, so was gender identity disorder (i.e., transgender) which was often classified with pedophillia or body integrity disorder. There is no frame of reference for psychology to use except society and general assessments of normality and expected behavior. That mean the only method to determine whether or not something is a disorder at all is a) determine the impact of the condition on the individual's ability to function, and b) determine whether or not the condition results in harm to the individual or others. These are both very subjective measures. The fact that we think we're more right today than we were yesterday is really pretty immaterial.
drb91 8y ago
Well, if functioning and fluorishing is defined by conformity, this doesn’t seem very meaningful. Some personality disorders allow a high functioning career and social life. To be clear I am trying to illustrate the idea that a disorder seems inherently devilish to define.
- DanBC 8y ago
  > Some personality disorders allow a high functioning career and social life. No, they don't, because built into the definition of disorder is the impact it has one someone's life.
  - toufiqbarhamov 8y ago
    Which is a bit of an issue isn’t it. Is Shkreli in Cluster B? Probably, and now he has the impact on his life to prove it. So before that, when he was just incredibly successful, had no criminal record, and seemed able to function at a high level did he have the same disorder? If outcomes represent a diagnostic criteria then it reveals a weakness in understanding or even defining the disorder in question. It’s important to distinguish between diagnostic criteria, and the disorder itself, if they are actually disorders.
  - drb91 8y ago
    Ok... so most mental “disorders” with high functioning people aren’t actually disorders? The definition seems useless without meaning simply “nonconforming”.
- jacobolus 8y ago
  Years ago I dated a woman with a “high functioning” career and from outside apparently normal social life who in retrospect was clearly BPD. She was very good at hiding her feelings during most casual interactions, and was clever and generous and fun to talk to when calm, but had almost a second personality which would come out when she became even slightly stressed which was bitter and entirely self-centered and extremely manipulative. She was at that stage of her life completely incapable of maintaining a close personal relationship, and she was frequently (on a daily basis) under extreme stress about perceived grievous slights from everyone around her that were to an outside observer inconsequential mistakes or misunderstandings, and she was harboring numerous long-term grudges. It seemed like she knew she had a problem, and during times where she wasn’t stressed out would regret her outbursts and seemed to wish she generally had better emotional control. She seemed generally pretty miserable about it, but maybe I was projecting based on the way her problems made me feel.

philwelch 8y ago

There's a more nuanced debate about the degree to which many personality disorders (particularly Cluster B disorders) don't qualify as a mental illness for another reason. You are considered mentally ill if you have cognitive and behavioral patterns that harm yourself. If your cognitive and behavioral patterns harm other people but leave you relatively unscathed, that's arguably not mental illness.

Brakenshire 8y ago
Have we just defined conscience as a mental disorder?
- philwelch 8y ago
  Excessive conscience probably constitutes an anxiety disorder.
- DyslexicAtheist 8y ago
  that wouldn't be profitable to the current industries so I guess not. There was talk of "An Ancient Virus May Be Responsible for Human Consciousness" not long ago so that at least is some acknowledgement in that direction: https://www.livescience.com/61627-ancient-virus-brain.html https://www.livescience.com/61627-ancient-virus-brain.html
DanBC 8y ago
Where are you getting that definition from please, because it's not one I recognise.
- philwelch 8y ago
  While I can't find a source, it's a relatively common standard that I've seen used in multiple places, including in the psychology classes that I took (or sometimes dropped in on) in college. The distinction is most useful because many mental illnesses aren't necessarily qualitatively different than "normal" or "healthy" human behavior and cognition; they're just more extreme versions. For example, normal people regularly engage in compulsive rituals, and engaging in these rituals is sometimes beneficial to them--consider a baseball player's ritual at stepping up to the plate, or a basketball player's ritual when stepping up to the free throw line. But if you start engaging in rituals that are a little too compulsive and too disruptive to "living a normal life", that's when it crosses the line into obsessive-compulsive disorder. However, even if you can life a "normal" and successful life, that doesn't mean you aren't harming the people around you, unless you harm them enough that the long-term social consequences end up hurting you. Most cluster B personality disorders end up with the disordered person alienating people and suffering the consequences of their antisocial behavior. But if you're a high-functioning narcissist or whatever and you get away with everything...? Here's a rather snarky example of this standard being applied to a certain alleged narcissist (whose name I'll redact in my quote, below, since this person's identity is a bit of a distraction from the more general point): https://www.nytimes.com/2017/02/14/opinion/an-eminent-psychiatrist-demurs-on-trumps-mental-state.html https://www.nytimes.com/2017/02/14/opinion/an-eminent-psychi... > Most amateur diagnosticians have mislabeled <<a prominent individual>> with the diagnosis of narcissistic personality disorder. I wrote the criteria that define this disorder, and <<this person>> doesn’t meet them. He may be a world-class narcissist, but this doesn’t make him mentally ill, because he does not suffer from the distress and impairment required to diagnose mental disorder. <<this person>> causes severe distress rather than experiencing it and has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy.

WalterSear 8y ago

There is not. Anyone takes care of a person with a PD would tell you that. And the high functioning people with PDs would explain to you the all the very specific deficits they have to overcome in order to function. And the clinical researchers would explain to you as much as we know regarding regarding the developmental and environmental causes of specific PDs.

toufiqbarhamov 8y ago
There is not. Anyone takes care of a person with a PD would tell you that. And the high functioning people with PDs would explain to you the all the very specific deficits they have to overcome in order to function. Interviewing people in Cluster B is often an exercise in being lied to. It also requires them to have insight which is generally lacking as a clinical feature. Their caretakers are in a tough position, since they’re often the target of many manipulations gauges to engender sympathy and continued care. All in all it reveals a weakness in diagnosis and formulation of disorders by anecdote. And the clinical researchers would explain to you as much as we know regarding regarding the developmental and environmental causes of specific PDs. When they can accurately predict such outcomes from first principles even as well as they do for something like major depressive episode, schizophrenia, etc, I’ll take those claims seriously.

phkahler 8y ago

>> especially in Cluster B just train people how to better fake “normalcy” and to speak the language of therapy. Really effective, non-superficial therapy is very hard. You may have to dig deep. Really deep. And when you do reach the roots there's still the issue of how to deal with what you find. It's not like surgery where you take out an infected appendix and say "you're cured". >> If you consider it in those terms, then “treatment” amounts to having someone voluntarily attempt to change their personality at a fundamental level. Even if they wanted to, how likely is that to succeed? That's exactly why it's hard. The fundamental drivers are often hidden and can be scattered (my term). You don't really change until you change the core. Most therapy seems to try to work from the outside in - probably because it's easier to do but less effective.

clairity 8y ago

in general i'm skeptical that the medicalization of these kinds of idiosyncrasies is helpful. implicit to that process is normalization (defining the normal and the abnormal), and that by itself causes psychological and social pain for the so-called abnormal. we each have our crosses to bear (in all kinds of abilities, including mental and physical) and medicalization can give a false sense of understanding, treatability, and absolution of personal responsibility. tangentially, on a population level evolution happens on the margins and medicalization can only dampen that process (not that this is important on a personal level).