Saturday, May 27, 2017

The world of personality disorders

There’s an area where very few want to go in mental health and that’s the world of personality disorders.  As with everything in this life, there’s a spectrum and we’re all on it in some shape or form. Stress can be defined in many ways, but one of my favourites is that stress is caused by unmet needs. And one of our most important needs is for our caregiver(s) to be present with us. This translates to someone being attuned to us and our needs, we then conclude that our needs and therefore we, matter.

There’s some research that shows that some people who have personality disorders were born that way. They didn’t suffer any childhood trauma that would explain why they are the way they are. But that’s assuming that any trauma was measured properly, based on experience not just events. Besides the more obvious physical and sexual abuse, more insidious and hidden forms of trauma often go undetected or minimised, like neglect. And let’s not forget about accidents and medical procedures. There is also the often overlooked area of trauma in utero which research has shown explains a lot of subsequent “unexplained” behaviour. We’d like to believe that all babies are born a blank slate but that is not the case at all, unfortunately.  And then there is the field of epigenetics which helps to explain the phenomenon of intergenerational trauma which is hypothesised to last for at least 7 generations. So even if we haven’t suffered any trauma in this life, which is extremely rare, our life in the womb and the life of our ancestors can explain a lot about our current behaviours.

In his book, Born for Love, Bruce Perry writes about interviewing a teenage boy called Ryan who had raped a 15 year old developmentally disabled girl and showed no remorse, in fact he said “I don’t know what the problem is really, she never would have gotten laid by anyone as good as us”. Perry said he was as cold, perhaps even colder, than any sociopath he had ever interviewed, including some killers. It turned out that by the time Ryan had turned 3, he had had 18 nannies. He would scream if his mother (who spent at most one hour a day with him) picked him up but at age 3, this had stopped. Perry says this is consistent with children who have disrupted attachments, they stop crying and give up trying to get their emotional needs met. He believed that Ryan had attached to 18 different “moms” and each one abandoned him in his eyes, in fact it was his mother who thought the nannies were getting too close to her son who then fired them. Before he started school, the relational part of his brain had become stunted and functioned abnormally according to Perry.

In a course on family trauma I did by Robert Rhoton, he lists a series of behaviours of sympathetic (angry, aggressive, reactive, hostile, self-centred, coercive, bossy, tantrums, impulsive) and parasympathetic (reactive, emotional and psychological distancing, self-centred) dominance (branches of the nervous system), that are consistent with many of the behaviours that we see in personality disorders. When a person is healthy, these two branches are switched on as needed, neither one is permanently on. A dysregulated nervous system is the basis for a lot of our ills, both mental and physical. One of the most defining and despised characteristics of anyone with a personality disorder is that of being self-centred, the extreme end being a complete lack of empathy for others. It’s like their mantra is “what about me?” and I say that as an observation, not a criticism.

I remember hearing Sebern Fisher saying of people with Borderline Personality Disorder that “they don’t have much sense of themselves beyond those feeling states”. Just imagine how that might feel? You’re stuck in sympathetic or parasympathetic dominance, or alternating between the two, and that’s basically your only sense of self. It must be hell on earth. We hear all the time that we should separate the behaviour from the person, especially when it comes to children. But we have very little compassion for that same child who, as an adult, has a mental health problem for whatever reason. How do we ever hope to help anyone rehabilitate if we don’t show them some compassion and understanding for what’s really going on with them?

There are many strong opinions on people with personality disorders, some believing that they are essentially unhelpable. I don’t believe that they are unhelpable or unreachable, maybe some are unreachable because they just can’t, or won’t, open themselves up to any outside input, it’s just too dangerous and risky. I can’t remember who said that children who have suffered developmental trauma usually become either overly responsible or under responsible and in my experience that is very true. I think many who fit into the category of personality disorders are usually under responsible. Very little is their responsibility, it’s like as if they feel they will be annihilated if they own up to anything. As adults, we need to take responsibility for the direction our life is taking, particularly if we don’t like where it’s going. Not taking responsibility is the bane of most people’s lives and the lives of those they touch.

We can’t make others be willing to take responsibility. Our responsibility to ourself is to take care of us first. We do no one any favours by rewarding bad behaviour, least of all ourself. We have a choice as adults to stay or go if we are being abused, though it’s not always an easy choice, but children don’t have any choice. That’s why developmental trauma at the hands of caregivers in particular, is so detrimental. The betrayal and wounds run deep and it takes time and care to repair them, but they can be repaired. As Peter Levine says, trauma is a fact of life but it doesn’t have to be a life sentence.

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