Prompted by a friend on facebook, I spent some time at the weekend looking at what Mind (a UK mental health charity) www.mind.org.uk has to say about the subject of personality disorders. It’s not a thing I’d given much thought to before. Just the name suggests that there are things to be uncomfortable with here –what is more personal to any of us than our personalities, and what could be more damning than to be told that there is something wrong with yours? Much of the additional language around specific disorders, is pejorative, and I imagine, demoralising for anyone diagnosed.
One of the things that defines a person as ‘unwell’ in this way, is that other people have a problem with them. I was talking last week about the pathologizing of difference (which is how I came round to this issue via facebook.) To what extent is the idea of personality disorder quite exactly this? To what degree do we need to be inoffensive to others in order to not be labelled as ill? It’s a very interesting question. Social functioning is a useful life skill, we generally do need to be able to deal with other people effectively. But how acceptable do we have to be? And is the bar set in the same place for all of us? I’d be prepared to bet that the more money and power you have, the less antisocial people will find you, be you ever so paranoid and aggressive. Can we pause and think about the kinds of opinions politicians and religious leaders sometimes spout. Disordered, at all?
What really got my attention though, was the discovery that ‘personality disorders’ can be treated with Cognitive Behavioural Therapy. Now, CBT is all about changing how you think. A disorder that can be treated with CBT, is a thinking disorder, pretty much by definition. Not a personality disorder. Not some kind of failure as a human being, but a learned, acquired or induced pattern of thinking that does not work and can be changed.
Would it make a difference if we called them thinking disorders? Paranoid thinking disorder sounds very different from paranoid personality disorder. The former implies hope for change, for a start. Dependant thinking disorder, narcissistic thinking disorder… my feeling is that a change of word there makes a lot of odds and may be more accurate.
Now, if people are getting mental health issues to the kind of degree ‘personality disorder’ implies, with issues that can be treated with CBT… we’re back to how we raise and teach people in the first place. How much suffering could we avoid if we routinely taught thinking skills to young people? If we taught coping mechanisms that won’t render you dysfunctional, if we did more to support self esteem, embrace difference and diversity, to encourage rational thinking, to teach people how not to be eaten alive by fear or to become convinced that they’re the be all and end all. We have the tools. We could not be using CBT restoratively if we did not have the tools. Why are we not using what we know in a more active, preventative way to nurture good mental health?
Of course if people know how to think, they can question the status quo, and that might not suit some people very well at all… call me paranoid…