Should Psychiatry Use the Term: Personality Disorder?

Should We Replace the Collective Term 'Personality Disorder' with Something More Sensitive? 

Years ago, when I was a student mental health nurse, I wrote an article for an NHS magazine called Mental Health Practice. It was an opinion piece, reflecting on how careful we should be when labelling a condition as a personality disorder, because, the meaning carries connotations directed at ones sense of identity. It is counter-intuitive given how invalidation itself significantly impacts on people living with these diagnoses. The name of this condition acts like an ongoing trigger of the condition: We can, for example, argue, that borderline personality disorder, alone, is infact, confining a person to their disorder.

When a trained psychiatrist labels someone, and, someone who (like everyone) will have their own personality, will feel an unkind impact. Immediately, upon diagnosis, their personality is sort of stamped 'out of order,' you could expect a person might feel frazzled or marginalised, because a trusted source delivered such news. In contrast, it's a bit like the clergy saying your soul is evil, your teacher saying that you're thick. Imagination can take the freshly diagnosed individual to a few unkind places; such terms do reject, ignore or reduce a persons lived experience, which I previously identified as invalidation, a significant thorn in the side of people with problems of which they seek help. We could rename the whole personality disorder umbrella term, using something more fitting, like 'Ingrained Behaviour Pattern' for instance. I wrote this magazine article in a time of active stigma against these particular clusters of conditions. I am unsure if much has changed.

From the magazine:

'IT WOULD be awful to be told that you have a personality disorder. Imagine coming home from seeing your psychiatrist and thinking to yourself: ‘Am I disorderly or is my personality out of order?’' Mental Health Practice. 12, 7, 13-13. doi: 10.7748/mhp.12.7.13.s19

Are my views the same now? Have I changed my mind?

To answer this the way I feel I need to, I might have to go off on one! So imagine a sun-touched golden haired surfer, paddling her solid surfboard in the blue cool sea. Without recognition of what water is, nor any grasp of the concept of swimming, a shark could swim through the water and bite hard into the board crushing it with its powerful jaws. Mechanised and cold, not one ethical thought of doubt crossing it's mind, no fear of spiritual consequence; the clockwork dynamics of reality simply playing out. It's the multifactored determinants of our world that drove the genetic evolution of that shark. Modern sharks instinctively swim, hunt and eat as a consequence of evolution. The natural world, has made many creatures like bio-organic robots. Even us, our lives are dominated by biological pullies and cogs and even much of our human conduct is chemically triggered: Grehlin and leptin regulate our desire to eat and to stop eating, melatonin and adenosine make us tired, cortisol makes us more hypervigilant, do you see where I'm going? 

We often describe sharks with vocabulary rich with soulless words, like cold, spiritless monster, we call them the perfect hunters and killing machines. Yet, we cannot for a second see ourselves that way, because, self-evidently, axiomatically, we are alive, and we experience human feelings and human thoughts, which don't exist in a shark. For me, I try to see myself as the awareness of a human and not just the human itself. I am a bit of a mystic, and, I will often slip into the mistake of believing that we are purely our body in the materialistic sense, entirely physical. The human animal, or homo sapien, is just as mechanical as the shark, it hungers, moves, follows desires. Phenomenal consciousness within any form, be it a dog, shark or a chicken, will vary. Going on that, we cannot know subjective sharkness any better than a shark can understand what the human word 'shark' means. 

What's this got to do with Personality Disorders? 

It has everything to do with personality disorders because we humans defied the laws of the natural world by denying our own physical instincts full control over us, we developed reason, logic and most of all discipline. Today, we are liberated, resulting with our awareness of what a 'person,' is, from the word 'persona' meaning mask, to appreciate that social etiquette or conduct has become personality. The etymology and development of personality is social, pertaining to conduct and assimilation. It is a mistake to assume your personality is you, rather than your mask or social presentation. This persona is comprised of aspects of the mind, and ones own physical attributes, (namely genetics). Psychiatry should be looking at concepts surrounding social assimilation and ingrained behaviours not highlighting a faulty personality. 

In all thinking creatures, lots of well organised braincells enable higher processing and performance of certain tasks; copious olfatory neurons give dogs their superior sense of smell, sharks can smell blood from miles away, allegedly. As we humans evolved; developing reason, morals, and our arts and sciences, we suffered for it. Humanity tasted death in the form of mourning, impermanence, existensialist fear and we became addicted pleasure seeking behaviours and comfort. Unlike snakes, sharks and chickens who must be much happier than we are, because there is no evidence of them wrestling with nihilistic trappings of athiest philosophy; our, uniquely human words, and complex and stupid ways such as flat earth actvism, our religious teachings etcetera are testament to the fact that we are a species that will define itself. 

To end this madness, let's have a butcher's at thought and mental discipline considered to be causally not of the body: mathematics is not inspired by grehlin or melatonin, disciplined discussions don't usually require lust or violence, and paradoxically, pious meditations and focused expressive arts are often deemed to originate from the self, because practitioners aim for selflessness and union. Self-focus, embracing egotism, and hedonistic living are not helpful for anyone, short term happiness is not they key. I believe people can defeat these challenges.

That little idea is quite sweet. We are not just crude matter, despite it seeming very much so, but we are the experience of it. It's all one and the same. If you've been told your personality isn't quite orderly enough, or you've had social conduct or assimilation issues, you still have the same opportunity as many others to face your challenges. Hopefully with support. 

Do you think the term needs updating?