A couple of years ago, I put up this post about overcoming my own mental illness. In particular, I wrote in response to this post by the Happy Feminist about her relationship with her narcissistic father.
In my years in and around the mental health system, I was consistently diagnosed not with depression but with a personality disorder. More precisely, I was regularly described (by several psychiatrists) as having “cluster b” personality disorders: Narcissistic, Antisocial, and everyone’s favorite, Borderline. Based on the traditional criteria, I hit each and every one of the criteria for the last of these, and many of the crucial ones for the first two. From late adolescence until the cusp of thirty, as I cycled in and out of doctors’ offices and hospitals, these diagnoses were offered again and again. And in my 2006 post, I talked in general terms about my recovery, conversion, and transformation. But I didn’t get much into specifics.
I’ve corresponded a bit with Jan at Planetjan, who has written quite a bit about dealing with folks with Narcissistic Personality Disorder. (See her first, second, and third excellent pieces.) She wrote something that stirred me up a bit, for understandable reasons:
How is a personality disorder different from mental illness? I had a hard time initially wrapping my head around this one. A mental illness (schizophrenia being the most widely known) can be treated, with varying degrees of success, with medications or cognitive therapy. Most mental illnesses are caused by brain cell synaptic disruptions, most of which are believed to be genetic in origin. I have friends who are bipolar and as long as they take their meds, any symptoms subside and they feel and act relatively “normal.†Mental illnesses typically present themselves in late adolescence or early adulthood. The onset of the mental illness is often sudden and profound. A mental illness descends over a person’s personality like a heavy wool blanket feels on an already warm summer night.
A personality disorder, on the other hand, is all pervasive. The DSM-IV describes a personality disorder as “an enduring pattern of inner experience and behavior that deviates markedly from the expectation 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.â€
With mental illness, a person’s personality is blanketed, or suffocated, by the onset of the mental illness. But the personality of someone with a personality disorder is virtually interwoven into every fiber of that blanket. Unravel the blanket and you unravel their personality.
So someone doesn’t have a personality disorder; they ARE the personality disorder. These personality traits are so deeply ingrained that they defy change.
Bold emphasis mine.
I’ve heard this distinction between mental illness and personality disorders before, of course, though rarely so succinctly expressed. And of course, it brings me up short. Looking at my life narrative, three possibilities suggest themselves as a response to her position (widely but not universally held by the psychiatric profession) that personality disorders “defy change”:
1. Despite being diagnosed with cluster B disorders again and again over more than a decade by a number of doctors, perhaps I never really had a personality disorder — the shrinks were wrong. I just met a whole bunch of the diagnostic criteria, but not the disorders themselves.
2. The diagnoses were correct in the first place, and I’m fooling myself — and a lot of other people — when I claim that I have “overcome” the pernicious influence of these disorders on my psyche and my life. I may have gotten better at disguising the NPD and the Borderline characteristics of my identity, but they still dominate my identity at its very foundation.
3. Jan, and a great many doctors, are wrong. Personality disorders, as powerful as they are, can be overcome.
I want to believe #3, and most of the time, I do believe #3. I seldom give much credence to #1, largely because of the preponderance of evidence over a fairly significant period of time. I do worry, less and less as I grow older, about #2. The fear that I am broken, “maimed from the start” by an aspect of my identity that can be hidden but never erased, comes up occasionally. I know that I have aspects of my personality which continue to meet the diagnostic criteria for at least some of the named disorders, even if I do what I imagine is a very credible job of keeping them from becoming manifest and obvious to others. Continue reading →