The value of flexibility
Normality versus Pathology
Normality and abnormality cannot be differentiated objectively. All such distinctions, including the diagnostic categories, are in part social constructions and cultural artifacts. Although persons may be segregated into groups according to explicit criteria, ostensibly lending such classifications the respectability of science, the desire to segregate and the act of segregating persons into diagnostic groups are uniquely social.
All definitions of pathology, ailment, malady, sickness, illness, or disorder are ultimately value-laden. Disorders are what doctors treat, and what doctors treat is defined by implicit
social standards. Given its social basis, normality is probably best defined as conformity to the behaviors and customs typical for an individual’s reference group or culture. Pathology would then be defined by behaviors that are uncommon, irrelevant, or alien to the individual’s reference group.
Normality and pathology reside on a continuum. One slowly fades into the other. Because personality disorders are composed of maladaptive traits, there are two ways that personality pathology becomes more severe when moving along the continuum from health to pathology. First, single traits can become more intense in their expression; assertiveness can give way to aggression, for example, or deference can give way to masochism. Second, the number of maladaptive traits attributed to the given subject may increase.
Personality disorders may best be characterized by three pathological characteristics. The first follows directly from the conception that personality is the psychological analogue of the body’s immune system – personality disorders tend to exhibit a tenuous stability, or lack of resilience, under conditions of stress.
The coping strategies of most individuals are diverse and flexible. When one strategy or behaviour isn’t working, normal persons shift to something else. Personality disorder subjects, however, tend to practice the same strategies repeatedly with only minor variations. As a result, they always seem to make matters worse. Consequently, the level of stress keeps increasing, amplifying their vulnerability, creating crisis situations, and producing increasingly distorted perceptions of social reality.
A second characteristic overlaps somewhat with the first: Personality-disordered subjects are adaptively inflexible. Normal personality functioning entails role flexibility; knowing when to
take the initiative and change the environment, and knowing when to adapt to what the environment offers.
Normal persons exhibit flexibility in their interactions, such that their initiatives or reactions are proportional and appropriate to circumstances. When constraints on behaviour come from the situation, the behaviour of normal individuals tends to converge, regardless of personality. If the boss wants something done a particular way, most people will follow directions. Such situations are highly scripted. Almost everyone knows what to do and behaves in nearly the same way.
By contrast, the alternative strategies and behaviours of personality-disordered subjects are few in number and rigidly imposed on conditions for which they are poorly suited. Personality-disordered subjects implicitly drive or control interpersonal situations through the intensity and rigidity of their traits.
In effect, the personality disordered person provides the most powerful constraints on the course of the interaction.Because they cannot be flexible, the environment must become even more so.
When the environment cannot be arranged to suit the person, a crisis ensues. Opportunities for learning new and more adaptive strategies are thereby even further reduced, and life becomes that much less enjoyable.
The third characteristic of personality-disordered subjects is a consequence of the second. Because the subjects fail to change, the pathological themes that dominate their lives tend to repeat as vicious circles. Pathological personalities are themselves pathogenic. In effect, life becomes a bad one-act play that repeats again and again.
They waste opportunities for improvement, provoke new problems, and constantly create situations that replay their failures, often with only minor variations on a few related, self-defeating themes.
Personality Disorders in Modern Life. Theodore Millon, 2004