Tag Archives: CBT

Can a personality be disordered?

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…

Be mindful of your thoughts

Mindfulness comes up a lot in Buddhism. Druids who take inspiration from Buddhism seem to mention this one a lot. It’s also absolutely central in Cognitive Behavioural Therapy. The more I contemplate it, the more convinced I am that mindfulness is a thing we should all be striving to achieve, regardless of path.

Self awareness means knowing what you are doing and why. Knowing what you want, how you feel about things – no repressed ideas and desires, no being driven by motives you won’t consciously acknowledge. CBT mindfulness goes further, and as part of a therapeutic process, requires us to minutely examine our thoughts. We all have habits of thought, and they influence our emotions and actions, but how conscious of those thoughts are we?

For example, I just had some really disappointing and frustrating news. My immediate thoughts are that other people will assume what happened is all my fault, that I will seem less credible, that no one will believe it was just bad luck and not some failure on my part. It takes me seconds to think this, and all the optimism of the last few days is wiped away. Seconds I could easily fail to notice. But I’ve caught it, and am trying to fight it.

Now, CBT, being  a therapy, is something people pick up after the event. It’s something you do when depression has already taken you down, when anxiety is sitting on your chest like a lead weight or low self esteem has you thinking the world might be a better place without you. Aided and abetted by circumstances, we think our way into holes. The person who has some belief in themselves and some capacity for hope, and the energy to keep going can and will prevail. The person who has taken inside every setback and criticism, who has bought into the bully’s story, or a family myth about their own uselessness, won’t fight what’s happening externally, but will instead use it as a stick to beat themselves with. I do it. Partly I do it because I sort of believe that if I can show I’m repentant and recognising my failures, I will not be beaten up quite so much by external reality. And no, I wasn’t brought up Catholic. As defensive measures go, it’s not even slightly clever or helpful. But I know it’s there. I don’t have to be the mediaeval mystic who starts hitting myself with a flail as soon as the plague comes to town.

What we think about life experience shapes how we understand what happens to us. It’s very easy to let those thoughts occur and not to think about what we are thinking. All those people who act and speak in the spur of the moment. I didn’t mean it. It just came out. I don’t know why I said that. I don’t know why I did that. Without self awareness, we cannot hope to be in control of our actions and choices. Someone else, something else, can pull our strings. We’re easy to manipulate, or running on habit, not properly engaged with what is really happening and not making rational decisions about our lives from one moment to the next.

What are you thinking?

Whose voice is inside your head? (See the blog post on hearing voices).

What are you telling yourself about the meaning of experiences?

What are you telling yourself you are entitled to do, justified in doing? Are you working up a rage, a reason to hit out, an indignant response, a ‘justified’ attack on someone else?

Are you saying ‘well done me’ at all? Or are you just bombarding yourself with criticism?

A lack of self consciousness and self awareness may seem like the easy way to drift through life. Cheerful obliviousness. Ignorance is bliss. I think this is deluded, at best. It might protect us from having to look at the aspects of self and behaviour that we don’t really like, but those who do not look, cannot change.

I’m not aware of any particularly Druid tradition of mindfulness. There are lots ways. I’m not sure that we need one. I would recommend paying some attention to what you think, step back now and then if you can, contemplate your own responses and the implications of what happens between your ears. It is entirely possible to change how you think, but to do so, you need to be aware of what you think. If you’re in a spiritual tradition looking for some kind of personal growth, I would ask what kind of growth there can ever be without proper self awareness?  Knowing how you think, and what that thinking means, is key to this. Thinking about thinking is inevitably self referential and all about the navel gazing, but ultimately, it is liberating.