Personality Disorders Are Not Illnesses

by Phil on May 5, 2010

The central theme of this blog is that there are no mental illnesses. The concept of mental illness is a spurious invention of psychiatrists and other mental health professionals for the purpose of medicalizing normal human problems and selling drugs.

The central tenet of the mental health system is that unusual, bizarre, and disturbing behaviors are caused by mental disorders (or illnesses). But their definition of a mental disorder is: a serious behavioral problem. So problem behavior is caused by problem behavior. This is the facile logic behind the widespread peddling of drugs in which psychiatry and the mental health system engage.

Within the mental health system a personality disorder is conceptualized as a specific kind of mental illness and is defined as follows:

“an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.” (DSM-IV-TR, p. 685)

DSM lists eleven different kinds of personality disorder. These are: paranoid; schizoid; schizotypal; antisocial; borderline; histrionic; narcissistic; avoidant; dependent; obsessive-compulsive; and of course, personality disorder not otherwise specified.

Let us examine schizoid personality disorder. The APA lists the following criteria:

A. A pervasive pattern of detachment from social relationships and a restricted range of
expression of emotions in interpersonal settings, beginning by early adulthood and
present in a variety of contexts, as indicated by four (or more) of the following:

(1) neither desires nor enjoys close relationships, including being part of a family
(2) almost always chooses solitary activities
(3) has little if any, interest in having sexual experiences with another person
(4) takes pleasure in few, if any, activities
(5) lacks close friends or confidants other than first-degree relatives
(6) appears indifferent to the praise or criticism of others
(7) shows emotional coldness, detachment, or flattened affectivity

B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder
With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental
Disorder and is not due to the direct physiological effects of a general medical
condition. (DSM-IV-TR, p 697)

It is clear from even a cursory examination of these criteria that what’s involved here are the qualities of solitariness, introspection, and stoicism. Note in particular that the criteria do not require that the individual be troubled by these qualities. Even if a person is perfectly contented with his habitual state of quiet isolation, he nevertheless has a mental illness and swells the ranks of the “untreated sufferers.” The so-called schizoid personality disorder is one of the more blatant examples of the APA’s pathologizing of normal human differences. Even their selection of the word “schizoid” serves to impart connotations of danger and hidden pathology.

The fact is that each of the criterion qualities listed above is present in the human population to a varied degree. And it is indeed the case that some individuals are introspective and isolative to an extreme degree. Assuming, however, that this necessarily constitutes a problem is unwarranted and dangerous. Most of the introspective individuals I have known are contented productive people who would be truly appalled to learn that in reality they are suffering from a mental illness and that they need treatment (i.e. drugs). The drugs, of course, will be prescribed by a psychiatrist and manufactured by a pharmaceutical company. It is little wonder that a former surgeon general could state that one fifth of the US population is suffering from a mental disorder in any given year. As has been stressed many times in this blog, the primary purpose of DSM is not to advance our knowledge of ourselves as a species, or help us become more resilient and adaptive, but rather to generate income for psychiatrists and pharmaceutical companies.

The reader who is not particularly isolative or introspective might be thinking “Oh, well – but it doesn’t apply to me.” Read on.

Here are the DSM criteria for dependent personality disorder:

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) has difficulty making everyday decisions without an excessive amount of advice and reassurance from others
(2) needs others to assume responsibility for most major areas of his or her life
(3) has difficulty expressing disagreement with others because of fear of loss of support or approval. Note: Do not include realistic fears of retribution.
(4) has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy)
(5) goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant
(6) feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself
(7) urgently seeks another relationship as a source of care and support when a close relationship ends
(8) is unrealistically preoccupied with fears of being left to take care of himself or herself

Two generations ago probably half the women in our culture would have met these criteria. (Note that only five of the items have to be met.) Even today a substantial percentage of the women in our society are raised to think of themselves as essentially dependent and as having little or no personal identity until they have become “hitched” to a man. By calling this a mental disorder, the APA is pathologizing what for many individuals is a normal state. It is also critical to note that the only reason that this particular lifestyle is a mental disorder is that the APA say so. The APA attempts to promote the idea that their so-called diagnoses are based on science. This is simply not the case, and is certainly not true of the so-called personality disorders. The APA and its various committees have simply decided that certain lifestyles and mindsets are to be considered pathological. They pretend that this reflects some kind of reality, i.e. that in fact these individuals are truly damaged in some way. But in fact the determination that certain mindsets constitute disorders while others do not is entirely arbitrary.

Why, for instance, is there not an independent personality disorder? After all, if people who are extremely dependent are to be considered pathologized, why not the individuals at the other end of the continuum? Individuals who never ask for help; who conceptualize asking for help as shameful; who are driven to succeed by their own efforts; who never see themselves as part of a team, etc., etc.. One could easily draft eight or ten criteria, arbitrarily require that 3 or 4 or 5 of these be met, and voila! A new diagnosis. Frighteningly, there are probably individuals within the APA who would take this suggestion seriously. The APA’s objective is to pathologize as much normal behavior as possible, and this has been demonstrated clearly by each successive revision of the DSM.

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  • Andras Gregorik

    Hi Philip,
    this post is a true eye opener!
    You speak the heart of many of us. The DSM is long considered such an authority that few dare to question its criteria. Yet in reality, it’s an arrogant, narrow-minded and judgmental excuse for a manual. To put it bluntly, it’s some of the DSM authors that should be probably pathologized.
    Cheers!

  • http://behaviorismandmentalhealth.com Phil

    Andras,

    Thanks for the comment and for the kind words. The DSM treatment of personality is indeed facile nonsense.

    Best wishes.

  • Alfy

    There are no recommended drugs to treat personality disorders. If a clients come to treatment they have “pathologized” themselves. I prefer to say that they feel they have a problem; then that is specified. But I agree that these diagnoses should not be used to categorize people just to standardize the

  • Alfy

    There are no recommended drugs to treat personality disorders. If a clients come to treatment they have “pathologized” themselves. I prefer to say that they feel they have a problem; then that is specified. But I agree that these diagnoses should not be used to categorize people just to standardize the psychological presentation of clients, especially among mental health professionals in case of referral or consultation. That’s what is taught to trainee therapists and that’s how these conceptualizations should be used. That is also the problem with misunderstanding the work of trained professionals. Psychology is funny because people think they know people better than experts. No ever says that they can build a bridge better than an engineer.

  • Andras Gregorik

    “I prefer to say that they feel they have a problem”

    Even if they do, it’s clear that it’s basically a cultural problem that they are having: they do not feel up to current sociocultural expectations, which can actually be a good thing; psychiatrists will never agree on this, but most theologians, philosophers and sociologists would agree that Western culture is “ill”, corrupted, shallow, whatever. A “personality disorder” within the framework of this culture may well indicate a valid (if primitive) criticism of this culture, along with a subconscious wish to get out of it. At this point, psychiatry adds insult to injury by pathologizing this valid criticism by the “patient”.

  • http://behaviorismandmentalhealth.com Phil

    Alfy,

    Thanks for coming in. You make some interesting points. Of course you are correct in that some clients do indeed “pathologize themselves.” However, I think that the direction of therapy should be encouraging people not to do this, rather than crystallizing the process with a so-called diagnosis.

    Best wishes.

  • http://behaviorismandmentalhealth.com Phil

    Andras,

    Thanks for coming in.

    This is a very good point about incongruence with cultural expectations, and in a more general sense is a problem with all the DSM “diagnoses,” not just the personality disorders.

    Take oppositional defiance disorder, for example. This problem is almost always more a matter of parenting behavior than anything intrinsic to the child. But the APA insists on labeling the child as mentally ill and in need of “treatment” (i.e. drugs). The real problem is never addressed.

    Best wishes.

  • Andras Gregorik

    Phil,
    thanks. ODD is a good example, and so is schizoid PD, which is simply not a “disorder” but a peculiar way of experiencing life that used to be well accepted for centuries: take mystics, monks, nuns, hermits, poets, novelists and so forth. Many of these so-called “schizoids” were among the greatest minds of their generation (Beethoven, Michelangelo, Emily Dickinson etc.).

    Enter the APA and suddenly these gifted artists are “in need of medication”. The APA tolerates nothing else but herd mentality and colorless cultural conformism.

  • http://behaviorismandmentalhealth.com Phil

    Andras,

    Thanks for coming back. Karl Marx once wrote: “The ideas of the ruling class are in every epoch the ruling ideas.” Pharmaceutical companies with their enormous wealth are a part of the ruling class. The APA are willing pawns whose self-interest happens to coincide with that of the pharmaceutical companies. Individual psychiatrists follow like sheep in the wake of easy money.

    The problem, of course, is that people like to take drugs, and even more tragically, like to feed drugs to their children. It makes for an easy life.

    I agree that schizoid personality disorder is a particularly noxious piece of medical stigmatizing. It is noteworthy that the criteria do not require that the individual is experiencing any distress. He is simply a loner – someone who prefers to be alone, do things alone, etc..

    There is literally no behavior or collection of behaviors that the APA is not willing to target for the sake of business.

    Best wishes

  • Andras Gregorik

    Phil,
    again, very insightful. We can add to this the fact that the ruling ideas (of the ruling class) constitute a “a social setting with a given set of expectations” (to quote Erving Goffman), with built-in stigmatization of those unwilling or incapable of fulfilling these expectations.

    In the APA’s case this is further aggravated by the apparent financial aspect, i.e. that they wish to profit from their stigmatizating process.

    I don’t know what else conscientious psychologists/psychiatrists can do other than completely ignore the APA’s directives and help their patients realize that they are dealing with a cultural stigma that requires a “holistic” approach; meaning that once the “patient” gains a certain degree of psychological, sociological and philosophical knowledge, their perspective grows to a point where they no longer view themselves through the skewed lens of their given society, resulting in their stopping of being “sufferers of personality disorders” and becoming sovereign, uncontrolled human beings.

  • http://behaviorismandmentalhealth.com Phil

    Andras,

    Thanks for coming back.

    I agree that social expectation is an important concept. All of the behaviors listed as “symptoms” in DSM are behaviors that are unusual or disturbing to others, i.e. outside expectations.

    Ignoring APA’s system is, of course, the right thing to do. However, here in the U.S. at least, this is very difficult, as third party payers won’t reimburse without a billable “diagnosis.” And economics makes cowards of us all. I have heard of psychologists who simply say to the client: “I will help you work on whatever it is you want to work on. You will have to pay me directly, as I don’t get involved with third party billing, and I don’t use the DSM system.” The problem is that people who see psychologists aren’t usually awash with cash, so it’s hard for psychologists who work outside the system to make a living.

    With regards to psychiatrists – I have never met one who had even the slightest qualms about the DSM. I believe that medical training stresses acceptance of status quo doctrine from the “great men.” Psychology training, in contrast, traditionally stresses questioning and challenging, but in recent decades courses in DSM have become standard fare in psychology degrees. In fact, many (30 or 40%) of the questions on the psychology licensing exam are based on DSM! It’s a bit like learning how to identify a witch.

    You mention the acquisition of knowledge on the client’s part, and to this I would add what would commonly be called skills. I realize that the two terms overlap considerably, but both need to be emphasized. For instance, over-eating and consequent obesity are problems that beset large numbers of people. Now, one can know that over-eating is a counterproductive behavior, but until one has acquired the skill of eating appropriately-sized portions, and the habit of moving around more, the problem will persist. And it is these kinds of problems that, in my view, cumulatively undermine the personal sovereignty which you mention. I don’t think the mental health system, at least here in the U.S., does much to promote personal autonomy. The emphasis is on: do what you’re told, eat your pills, and come back in three months.

    Anyway, thanks for coming back. These are deep issues. Best wishes.

  • http://twitter.com/Bamftiger Bamftiger

    A psychologist is an Arts graduate, ie an Arts student who successfully graduates. To suggest people with the level of intellect required to enter into an Arts degree are capable of rising to the level of true expertise is beyond bizarre.

    Psychiatry at least has the rigour of medical training behind it, and that in itself bears other problems not the least of which is the catastrophic lack of affect so many “practitioners” of the medical profession manifest.

    In short, there is a reason why so many people are turning to magical thinking and outright shamanism- it does no more harm and enjoys no less success than psychology (Arts degree) or psychiatry (professional but of questionable origin).

  • Anonymous

    Bamftiger,

    Thanks for your interesting comment to Alfy. I’m sure you are correct. We psychologists are probably not as bright as we should be.

  • George

    It is not just a peculiar way of experiencing reality, it  is a real disorder because their distorted view of reality is not consistent with reality itself. I can attest it is a real disorder from personal experience because i had it. DSM criteria does not describe “qualities”, of stoicism, solitude, and introspection but an individulals who is dysfuctional, imature, and completely isolated from reality and external world. Also, cognitive disorganization is not a prerequisite for diagnosis of SPD in DSM criteria, so one can be highly intelligent and schizoid at same time. Also did you consider the possibility that some that mystics, monks, hermits, poets, novelists actually were Schizoid because not many people can  tolerate complete isolation, but many of them became isolated they are capable of doing just that. There are several ways for people to cope with isolation; sensory distortion, cognitive distortion, and obsession with fantasy. Isolated individuals who have high capacity for imagination do not develop formal thought disorder because their rich fantasy prevents from distorting their cognition.  Schizoid as described may be creative and intelligent but they have no social life and are detached from reality and as such they are dysfuctional. I also had Dependent personality disorder, analogy with women is just a Straw man fallacy because despite cultural expectations most women are capable of taking care of themselves. And in familial setting women are only partially dependent on man, while women who have DPD are incapable of performing traditional gender roles such as cooking, cleaning sewing, etc. And for anyone who believes that mental disorders do not exist, I would strongly suggest you to take visit to psychiatric hospital.

  • George

     Since schizoid spend a lot of time fantasizing they have highly developed imagination, this would explain why some historical schizoids were creative geniuses. But developed imagination is all they have, in other areas of life they are dysfunctional.

  • Anonymous

    George,

    Thanks for an interesting comment.  I’m not sure if Andras will be responding to you, but here are my thoughts on the matter.

    Nobody is disputing that the behaviors listed in the DSM categories exist.  Of course they exist, in that people do, in fact, sometimes behave in these fashions.  The issue is whether these behaviors (or clusters of behaviors) can legitimately be considered illnesses.  That’s the fundamental issue in this blog.  My contention is that the so-called diagnoses listed in DSM are not illnesses, but are simply ordinary problems of living.  Furthermore, it is my contention that shoe-horning these behavioral problems into an illness model is counterproductive, and much of the so-called treatment provided by the mental health system does more harm than good.

    With specific regard to the so-called personality disorders, there is an additional issue, in that many of the behaviors listed are not actually problems for the individuals concerned.  Now I’m not saying that none of these behaviors are problems – some are, some are not.  The example mentioned was schizoid personality disorder, which is a complicated pseudo-medical way of saying “loner.”  Now I have come across loners who were perfectly content to be loners.  Pathologizing these people by called them schizoid personality disorders is, in my view, destructive and unhelpful.

    The fact is that each individual is different to begin with, and then each of us grows and develops in a unique environment.  As we mature, some behaviors are routinely reinforced more than others, and these behaviors tend to become habitual.   In general loners are people for whom social contact was not strongly reinforced during their formative years.  That’s basically it!  It’s not an illness or a disease – it’s just a question of what learning experiences people have been exposed to.

    As I’m sure you realize, the only ‘treatment” offered by psychiatrists today is drugs.  A learning theory approach, by contrast, provides a great deal of real help for people who – for whatever reason – want to change a deep-rooted habit.  A loner, for instance, who wants to become more outgoing, needs to take steps to ensure that his social encounters are reinforced (artificially if necessary) until they become self-reinforcing.

    The other criticism I make of the illness theory is that although it purports to be an explanation of the behavior in question, in fact is has no explanatory value.  To say that a person has schizoid personality disorder is no more informative than saying he is a loner.  It is simply another example of psychiatric turf expansion, the primary result of which is the pushing of drugs towards another segment of the population.

    You suggest a visit to a psychiatric hospital.  Well, of course I have visited many psychiatric hospitals, and what I have seen there is not inspiring.  Indeed, it is because of my conviction that psychiatry is doing so much damage to people in and out of hospitals that I started writing this blog in the first place.George, it is clear from your comment that you have a great deal to say in this area.  I hope you will come back.  Also, if you would like to tell your story in more detail, you can do so at the tab above labeled “Tell Your Story.”Best wishes.

  • Anonymous

    George,

    Thanks for coming back.  I can’t agree that “developed imagination is all they have.”  Human existence is always more complicated than that.

    Dysfunctional is a value-laden word.  A person may seem “dysfunctional” to others yet be perfectly happy in himself.  We tend to use the word “dysfunctional” to stigmatize things that we don’t like in others.  I guess I would limit the word to behaviors that are truly injurious to self or others.  In the mental health system, of course, the word is used much more freely.

  • Anonymous

    George,

    Thanks for an interesting comment.  I’m not sure if Andras will be responding to you, but here are my thoughts on the matter.

    Nobody is disputing that the behaviors listed in the DSM categories exist.  Of course they exist, in that people do, in fact, sometimes behave in these fashions.  The issue is whether these behaviors (or clusters of behaviors) can legitimately be considered illnesses.  That’s the fundamental issue in this blog.  My contention is that the so-called diagnoses listed in DSM are not illnesses, but are simply ordinary problems of living.  Furthermore, it is my contention that shoe-horning these behavioral problems into an illness model is counterproductive, and much of the so-called treatment provided by the mental health system does more harm than good.

    With specific regard to the so-called personality disorders, there is an additional issue, in that many of the behaviors listed are not actually problems for the individuals concerned.  Now I’m not saying that none of these behaviors are problems – some are, some are not.  The example mentioned was schizoid personality disorder, which is a complicated pseudo-medical way of saying “loner.”  Now I have come across loners who were perfectly content to be loners.  Pathologizing these people by called them schizoid personality disorders is, in my view, destructive and unhelpful.

    The fact is that each individual is different to begin with, and then each of us grows and develops in a unique environment.  As we mature, some behaviors are routinely reinforced more than others, and these behaviors tend to become habitual.   In general loners are people for whom social contact was not strongly reinforced during their formative years.  That’s basically it!  It’s not an illness or a disease – it’s just a question of what learning experiences people have been exposed to.

    As I’m sure you realize, the only ‘treatment” offered by psychiatrists today is drugs.  A learning theory approach, by contrast, provides a great deal of real help for people who – for whatever reason – want to change a deep-rooted habit.  A loner, for instance, who wants to become more outgoing, needs to take steps to ensure that his social encounters are reinforced (artificially if necessary) until they become self-reinforcing.

    The other criticism I make of the illness theory is that although it purports to be an explanation of the behavior in question, in fact is has no explanatory value.  To say that a person has schizoid personality disorder is no more informative than saying he is a loner.  It is simply another example of psychiatric turf expansion, the primary result of which is the pushing of drugs towards another segment of the population.

    You suggest a visit to a psychiatric hospital.  Well, of course I have visited many psychiatric hospitals, and what I have seen there is not inspiring.  Indeed, it is because of my conviction that psychiatry is doing so much damage to people in and out of hospitals that I started writing this blog in the first place.George, it is clear from your comment that you have a great deal to say in this area.  I hope you will come back.  Also, if you would like to tell your story in more detail, you can do so at the tab above labeled “Tell Your Story.”

    Best wishes.

  • mike

    Maybe we should go back to the old Greek Tragedy: human behaviors that cause the character to have an unhappy ending (not to be confused with the English Tragedy which just indicates that the main character dies).

    Where the behavior is tied into the character’s unhappy ending as opposed to simply being difficult behavior for the parents.

  • Phil_Hickey

    Mike,

     

    Interesting thought.  There
    is also a Greek flavor to the perennial struggle between parent and child:
    child fighting to retain his self-centered, hedonistic qualities; parent trying
    to instill qualities like altruism, gratification delay, etc..  What’s particularly interesting is that if
    the child wins the battle, he loses the war.

     

    Thanks for coming in..

     

     

  • HPJM

    It is probably no surprise that personality disorders are among the most frequently diagnosed mental ‘illness’ while also seeming the most ridiculous. Once you analyse people enough and then minus all the people who are diagnosed with personality disorders from the population, I would bet you are left with a fairly narrow range of people, similar in emotional expression, expected reaction etc. The broad spectrum of human personality seems to be pathologised by the psychiatrists, like they do for nearly all behaviour that does not fit a preconceived notion of normal.

  • Phil_Hickey

    HPJM,

    Thanks for coming in. What you say is very true. And just in case one of the standard “personality disorders” doesn’t work, there’s always personal disorder not otherwise specified: a catch-me-all category that can be used to pathologize almost anybody.

    I agree that there is a strong drive to pathologize people who are different, and this process is being applied to children as young as one or two years. (See my post on Childhood Bipolar Disorder.)

    Again, thanks for coming in. Keep beating the drum.

  • Anon

    Most people, if not all, do have traits in the personality disorder criteria. Some may have traits in all of the criteria of a personality disorder, this does not mean that they have a personality disorder. It’s only when it goes to the extreme that it becomes a personality disorder, when it inhibits a person to function on a normal level.
    Medication is not especially advised in treating a personality disorder, it is sometimes advised to not use medication. Rather you try to make the patient learn how to cope with their irrational fears or thoughts, by psychotherapy, and indeed sometimes medication.

    You seem to think that it’s a way of living, that these people are content with. It is not…
    I love to read about people, read their blogs, forums and so on. I am interested in people and wish I could interact with them, in person or at least less anonymously, I even fantasize about having normal social interaction. I failed school, by skipping it and instead going elsewhere or not leaving my room, because I feared my teachers and classmates and everyone else, irrationally. Since then I’ve moved out and now live on disability. I leave my apartment about 2-3 times a week, when there are few or no people outside, to buy food and meds (physical) and also occasionally going to psych. I avoid people, even though I wish to be with them, I fear them for no real reason. I do fully well understand that I’m being irrational, this does not change my behavior and cognition. My fear of rejection, humiliation, criticism is somewhat extreme and not completely rational, it does inhibit me from doing the things I want. I don’t have friends and I avoid everyone, including therapist and family, because of it.
    My case of AvPD is not exactly the worst there is, others suffer far more than I. They, just like me, do not they wish to live life this way.

    I really think you should look into these things more, maybe visit some sectioned patients, before you write the things you do. These illnesses and disorders aren’t made up to make money, they’re real and ruin lives.

  • Phil_Hickey

    Anon,

    Thanks for coming in. But you’re missing the point. The behaviors you describe are indeed real. The problems are real, and can pose considerable difficulty. But – and this is the critical point – they are not illnesses. And they have been medicalized with the specific purpose of expanding psychiatric turf and selling drugs.

    Can you provide me with one piece of hard evidence that the problems you describe are, in fact, an illness?

    And for the record, I spent most of my career working with people who had been labeled as “mentally ill.”

    Best wishes.

  • Anon

    That is not what you wrote in your article. You said that almost everyone could be diagnosed with a personality disorder, and that it is only natural behavior, that they shouldn’t be treated. That “independent personality disorder” is actually not too far away from narcissistic personality disorder, also has characteristics from schizoid. You can have more than one personality disorder, or strong traits from several, which I guess would put you in PDNOS.
    Cancer and all diseases are natural, that does not mean that they’re good human experiences, they’re not healthy and may lead to death. That’s why they’re treated treated, same with mental disorders.

    From wikipedia:
    Illness
    Illness and sickness are generally used as synonyms for disease. However, this term is occasionally used to refer specifically to the patient’s personal experience of their disease.
    In this model, it is possible for a person have a disease without being ill (to have an objectively definable, but asymptomatic, medical condition), and to be ill without being diseased (such as when a person perceives a normal experience as a medical condition, or medicalizes a non-disease situation their life). Illness is often not due to infection, but to a collection of evolved responses—sickness behavior by the body—that helps clear infection. Such aspects of illness can include lethargy, depression, anorexia, sleepiness, hyperalgesia, and inability to concentrate.

    Personality disorders are disorders, and not described as illnesses, though sometimes mental disorders are replaced with mental illness. I’m not sure that’s what you’re arguing about. I think that paste from wikipedia does make it possible to call it an illness. I have taken medication for other mental disorders, which have been more or less caused by my AvPD, so I think that would be evidence that I’ve been ill, had a mental illness.
    There are also neurological mental disorders, which I think could be called an illness more freely, because they might be possible to classify as a disease.

    What you’re seemingly talking about is a definition of words issue, and not if mental disorders need medical treatment or not. You would not have to bring in, and criticizes, mental disorders to do this.
    I would think that the medical professionals, while writing their books, were guided by language professionals. Which thought it was accurate to use illness in specific circumstances. You’re arguing the language, which might not be very simple, especially if you’ve not specifically studied it.
    I’m not educated in english, it’s not even my first language, so I can’t really debate this. Though, I think you should make it clearer that you’re arguing about a words definition, and not bring in mental disorders into it.

  • Phil_Hickey

    Anon,

    I don’t know how I can make my views any clearer. The APA lists a wide range of human problems. They then call these problems “mental disorders.” They never use the term “mental illness,” but psychiatrists in the field do use the term. The APA presents these “mental disorders” as the causes of the problems. So if one were to say to a psychiatrist: why am I so fearful, why am I afraid to go outdoors, or whatever, the likely explanation one will be given is: because you have a mental disorder/illness called avoidant personality disorder.

    But if one were to ask this psychiatrist how does he know that one has this mental disorder/illness, the only possible response is: because you are so fearful; afraid to go outdoors. The only evidence for the “diagnosis” is the very behavior it purports to explain. What the psychiatrist is saying is: you’re fearful because you’re fearful! Nothing more. It just sounds like more.

    Now if you’re happy with this “explanation,” then that’s fine. It’s no part of my agenda to deflect you from your chosen position.

    All I will say is this: there are much better ways to understand, and deal with, one’s fears than by labeling them in this way. But – and this is a critical point – as long as one conceptualizes his fears as being caused by this invented disorder/illness, it is unlikely that they will ever be conquered.

    With regards to the term “illness,” my definition is very simple and non-contentious: something wrong with the organism.

    I am very emphatically not arguing about the meaning of words. My position is that the DSM is a spurious and destructive way to conceptualize human problems. I have written 143 posts on this topic over the past four years. If you have an interest in these matters, browse around. There are better ways to conceptualize human problems.

  • Anon

    A personality disorder is part of ones personality, it is not seen as a physical illness, it is just extreme and inhibits a person to function normally. It is also the cause of why a person is behaving a certain way, it’s diagnosed trough the persons disordered behavior, which is caused by the disorder.
    AvPD is a personality disorder, describing the symptoms somebody with said personality disorder will experience. Both the patient and psychiatrist will know the basics of the problem, and can then work on treating it, from having that label. It won’t just be left without treatment, just like any physical disease or disorder wouldn’t.
    Without a diagnosis it wouldn’t be possible to treat it medically/psychologically, because nothing would be wrong with the patient. If it was treated without a diagnosis, they’d create a new diagnosis for it.

    Everyone has a tummy ache, or other stomach problems, every now and then, that does not mean that everyone has a digestive disease. Reading your comments, it seems that you think that everyone could be diagnosed with a mental/personality disorder, which is far from the truth.

    “My contention is that the so-called diagnoses listed in DSM are not illnesses, but are simply ordinary problems of living.”
    I guess having cancer, being paralyzed, being very physically sick etc are also ordinary living problems.

    “Furthermore, it is my contention that shoe-horning these behavioral problems into an illness model is counterproductive, and much of the so-called treatment provided by the mental health system does more harm than good.”
    Psychotherapy isn’t good enough? How does that do more harm than good?
    The treatment plan is not the issue here. Rather it’s that people can’t afford psychotherapy (if it’s causing you a lot of problems you won’t be able to hold a job), or any other effective way to treat their disorder. Instead they use a cheaper method, medications, which for some might be useless or cause worse problems, but for others it might lessen their problems.

    “With specific regard to the so-called personality disorders, there is an additional issue, in that many of the behaviors listed are not actually problems for the individuals concerned.”
    You’ve also already said that the person affected by a personality disorder isn’t causing problems for the individual.
    Then later you wrote this to me: “The behaviors you describe are indeed real. The problems are real, and can pose considerable difficulty.”

  • Phil_Hickey

    Anon,

    Thanks for coming back. Let’s just agree to differ.

    Best wishes.

  • Bella

    They need a lot of understanding and patience. Just try and
    put yourself in their shoes and see how it feels like. This world would have
    been a much better place if we could all be fair and just.

    Bella Goggins

  • Steve

    DSM and ICD are too one-sided. These are more like “social norms” than “real” science. Being an “authority figure” makes it easy to convince someone that her or she has a particular “disorder” and take thair money via therapies and stuff. Some things may be true, some are not always.

  • Phil_Hickey

    Steve,

    Thanks for coming in. What you say is very true, and actually is at the very heart of psychiatry: “these conditions are illnesses because we say to!” And this is the underpinning to a multi-billion dollar industry.

    Again, thanks for coming in, and best wishes.

  • Lucho Velez

    LOL!

  • http://www.EcoReality.org/ Jan Steinman

    Dysfunctional: not operating normally or properly.

    Of course, “normal” and “proper” are social constructs, and therein lies the crux of it.

    If you suffer or cause others to suffer, are you not “dysfunctional?”

  • ssenerch

    I have to beg to differ. Your generalization about psychology students and their intellect is simply that – a silly generalization. It is quite possible to rise to the level of expert in human psychology/development, and one PsyD whom I think has done just that is Dr. Faye Snyder, who has written “The Manual: The Definitive Book on Parenting and The Causal Theory,” among other books. Dr. Faye has done absolutely brilliant work in laying out a true “science of character” and personality. Psychiatry being a (faux-) medical discipline may be more rigorous, unfortunately it’s also completely irrelevant to the matter of psychology/mental health, so it seems really pretty pointless as a profession.

    A real rigorous study of and understanding of human psychology/development concepts is not out of reach – on the contrary, it is greatly and urgently needed. We just have to clean up the field and make sure that the solid, evidence-based information is getting taught and the junk is thrown out. If you would like to see what expertise in human psychology/development looks like, please do acquaint yourself with Dr. Faye Snyder’s work.

  • Gerard Scott

    Thank you. Thank you.

    I am campaigning against this stigmatization of normal human variations in
    personality, intellect, and consciousness itself. It has taken me 3/4ths
    of my life but I finally figured out why I am relatively imaginative, insightful,
    intuitive, and intelligent—according to the DSM (Dumb Sheets Manual) I am
    schizotypal. No doubt about it. https://www.youtube.com/watch?v=D-ZkoSvvR3c I think it is safe to say that most introverted deep thinkers are schizotypal too. Maybe deep
    thinking introvert should be added to the Dumb Sheets Manual list of diagnostic
    criteria for SPD. Can’t believe their so dumb as to describe me as
    lacking in empathy and affect. Me? LMAO

    But wait, there is hope. Now they are saying schizotypy is a “SPECTRUM” order (no dis-ing by me). A spectrum is a condition that is not limited to a specific set of values but can vary infinitely within a continuum. Hmmmm? Doesn’t that account for all of humanity? So why have all my friends and family gotten upset about my recent outing of myself as a homo . . . . sapien with schizotypy? They had no idea I was crazy, but now they are convinced that I am either a drugee or crazy and in need of serious help? WTF? I thought “normal” people were a bit dumb to begin with but now they have convinced me. LOL

    But guess what you normal knuckleheaded friends and family, being schizotypy simply means I have the genetic evolutionary advantage. In my ever humble INFJ personality type opinion, I’m simply smarter than you. So there, take that! Yes, sometimes my thought processes are too complex for you to keep up with but that does not make them delusional. Maybe you’re too much of a simpleton. Yes I do believe in
    Jungian mythology, the collective unconscious, parallel universes, synchronicity,
    and lots of other “crazy stuff,” but those beliefs are based upon considerable
    thought, intuition, and lots of reading. Maybe you should get some further education.

    Thank you Dr. Hickey for assisting me in with this rebuttal with your comments and this great opportunity to provide my friends and family a link which includes my comments. They say social isolation is another symptom of schizotypy. Well, I’m sure it will only be temporary and at the moment I feel a small price to pay for having my say. LOL

  • Phil_Hickey

    Gerard,

    Thanks for coming in, and for your interesting perspective on these matters.

  • T.A. Anderson

    Hope all understand the hyperbole was mostly for comic effect. I’m certainly with you 100% regarding big pharma $$$. Interesting that when talking about this “spectrum” condition, the DSM 5 still has to hang onto the prefix “schizo.” Gerard Scott

  • T.A. Anderson

    One last attempt at humor. I don’t have a copy of the Dopey book but surely they were wise enough to not overlook you Dr. Hickey. Surely excessive belief and dedication to a cause by a retiree living in a mountainous state as demonstrated by his/her urge to speak, write, blogg, etc., in support of his/her very strongly held beliefs ought to sua sponte equate with the DSM definition of OCD.

  • Phil_Hickey

    TA Anderson,

    Yes I got it..

  • Phil_Hickey

    TA Anderson,

    Too true. I also suffer from paranoid personality disorder, in that I routinely distrust psychiatrists, and misinterpret their obviously benign motives a malevolent.

    Best wishes.

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