Introduction



MAIS 750 – Personality Disorders in History, Literature, Film

and Public Life

Introduction

Welcome to MAIS 750: Studies in Personality Disorder in History, Literature, Film and Public Life. This online reading course is designed as a graduate level introduction to the characteristics which suggest, or in sufficient number define, personality disorder. These are characteristics which all of us have already encountered in greater or lesser number in both our virtual and real relationships with others and perhaps even in ourselves. Our goal in this course will not be to acquire expertise in the diagnosis, assessment and remediation (in so far as that is possible) of personality disorder, a quest to which many specialists have devoted their entire professional lives. Rather, our goal will be to formulate a basic understanding of the nature and function of personality disorders, to recognize their ubiquity in contemporary society, and to acquire an appreciation of the difficult task for the therapist that their remediation poses. We will consider the logic behind DSM, gather a basic understanding of the Clusters A and C disorders and then focus our efforts intensively on Cluster B, particularly on Borderline and Narcissistic Disorders, looking for past and present examples of their manifestation in the Western World.

Course Objectives:

1. Understand the rationale behind the various personality disorders as defined in DSM-IV-TR, why they are arranged in a cluster system, and why they are categorized under Axis 2.

2. Understand what personality is and what makes a personality disordered.

3. Know the history of the development of the DSM and the major criticisms that have been raised against it.

4. Learn about gender bias in the diagnosis of personality disorder.

5. Appreciate the role of culture in personality development.

6. Become aware of the duplication of certain personality traits across Axes 1 and 2, across Clusters A, B and C as well as within the various Clusters.

7. Learn the key characteristics of the DSM-IV designated personality disorders and why they are catalogued under their respective clusters in the way that they are.

8. Survey the historical development of the various personality theories which have led up to our present Western understanding of personality disorders.

9. Apply what you have learned to searching out examples of various personality disorders in historical, fictional or contemporary characters.

10. Complete an in-depth analysis of one or more fictional or real characters to demonstrate why you believe that they manifest key characteristics of one or more personality disorders

Background Section:

The Diagnostic and Statistical Manual (currently DSM-IV-TR) differentiates between Axis 1 and Axis 2 disorders. It places personality disorders under Axis 2, ostensibly so they won’t get overlooked among the more “florid” Axis 1 disorders such as schizophrenia, bipolar disorder and severe depression. Personality Disorders in this classification system are, in turn, grouped into three separate clusters. Cluster A includes individuals often appearing as odd or eccentric; Cluster B includes individuals who frequently present as dramatic, emotional or erratic; Cluster C includes individuals who often appear anxious or fearful. Of note, the validity of this cluster system, and of the entire DSM classification system for that matter, has been repeatedly challenged and it should be recognized as a work in process and not necessarily as the final word on categorizing mental disorders.

For the purposes of this course we will be working within the confines of the current DSM classification system. There, Personality Disorder is defined as “…an enduring pattern of inner experience and behavior that deviates markedly from the expectations 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.” (DSM –IV-TR, 685). Although an examination and exploration of Cluster B Personality Disorders will be our principal concern, it will be necessary to situate them within the larger context of the DSM classification system. That will entail a general recognition of symptom overlap with other Axis 1 and Axis 2 disorders, as well as a particular awareness of the overlaps that occur across the various Cluster B disorders.

Course Requirements:

This online course is designed to provide graduate students with an overview of personality disorders, some understanding of the taxonomies which define them and some ability to recognize striking exemplars of Cluster B disorders in our history and culture.

To understand what comprises a personality disorder in the Western world we need first to contrast it with our usual understanding of personality.

Personality: The sum total of the behavioural and mental characteristics

that are distinctive of an individual.

Personality Disorders:

A category of mental disorders with onset no later than

early childhood, characterized by pervasive, inflexible,

and enduring patterns of cognition, affect, interpersonal

behaviour, or impulse control that deviate markedly from

culturally shared expectations and lead to significant

distress in social, occupational, or other important areas

of functioning.

(Oxford Dictionary of Psychology, 547-48, 2001)

From the above you can gather that personality is to a certain extent a cultural construct

manifesting differently in different societies.

Part One

One criticism that has been made of the general category of

personality disorder is that it is based on Western notions of

individual uniqueness. Its applicability to people from cultures

with different definitions of human personhood is thus open to question. Furthermore, even within a culture, it can be difficult

to define the limits of "normalcy."

(retrieved from the Internet, Health A to Z

Encyclopaedia, “Personality Disorders”, November 12th, 2007)

The readings in this section will provide a brief overview of contemporary personality theory, follow up with a survey of the DSM-IV-TR classification system for personality disorders and then look at the major criticisms which have been raised against it.

Course Objective – to acquire a basic understanding of what personality is, what and why personality disorders are divided up as they are in DSM-IV and what the major weaknesses of DSM system are. .

Readings:

- Millon, Theodore et al. (2004) Personality Disorders and Modern Life, 2nd Edition. New Jersey: John Wiley & Sons, chapter 1, pp. 1-37.

- Clark, L.A., Watson, Dl, & Reynolds, S. (Annual 1995) Diagnosis and classification of psychopathology: challenges to the current system and future directions, Annual Review of Psychology, 46, 121-33. (available through the AU database).

- Livesley, W. John (Ed., 1995) The DSM-IV personality disorders. New

York: Guilford, chapters 1 and 2, pp. 3-42.

- Optional - Mitchell, James E. (2001) Points of View: Stories of

Psychopathology, Philadelphia: Brunner-Rutledge

These readings will explore the following topics:

- Historical perspectives and contemporary views on personality disorders

- Personality disorders as structured by DSM and current concerns with DSM taxonomy, e.g. crossover traits

- Personality, character and defense mechanisms

- Western bias in terms of ‘normal’ personality

Part Two

Personality Disorder is a huge area of study and we can only acquire a limited grasp of it in this course. In order to approach in sufficient depth to satisfy the requirements of a graduate course we will limit our focus in Part II to Cluster B personality disorders as defined and described in DSM-IV-TR: Anti-Social, Borderline, Narcissistic and Histrionic.

1. Antisocial Personality Disorder

Most of us have had ample opportunity to survey the workings of the Antisocial Personality Disorder through TV crime shows and movies. However, like most categories, this one is not monolithic. Common factors underlying Antisocial Personality Disorder (ASPD) can be explored along with its genesis in a particular individual, historical or otherwise. Comparisons of ASPD to Sociopathy and Psychopathy, categories that do not exist in DSM-IV but which are part of our popular lexicon* can be explored in the process of identifying one or more individuals who purportedly fit into this category, exploring the etiology of the development of this Personality Disorder in their case, and demonstrating why they can be said with some certainty to have this disorder.

*See, for example, Hare, Robert D. (1996) “Psychopathy and Antisocial Personality

Disorder: A Case of Diagnostic Confusion”. (February 1, 1996)

Psychiatric Times, Vol. 13 No. 2

2. Borderline traits in literary, historical or public figures

DSM-IV describes Borderline Personality Disorder (BPD) as “A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts….”(DSM-IV-TR, 710). It goes on to list 9 common characteristics of which 5 or more must be present to warrant a formal diagnosis of BPD. Many individuals have several traits associated with this disorder but not sufficient for a full-fledged diagnosis. The most commonly observed traits are: a pattern of unstable and intense interpersonal relationships, fear of abandonment, identity disturbance, impulsivity, and chronic feelings of emptiness.

Western literature is sprinkled with complex characters who reflect some or many of the traits associated with Borderline Personality Disorder as outlined in the current Diagnostic and Statistical Manual (DSM-IV-TR). An internet search linking public or historical figures with Borderline traits turned up 2580 entries. It is a disorder that has been misunderstood and over-diagnosed, and one which conjures up a picture of people impossible to deal with in a rational manner. ‘Walking on eggshells’ is the description often given of what it is like to interact with these individuals and a popular book and workbook of that name are in print. Relationships break down, therapists avoid or dismiss such individuals as unworkable and clients with this diagnosis reel along from one emotional crisis to another.

Despite the negativity of this picture, a genuinely warm and likable personality often co-exists with the frequent anger and emotional instability manifested by clients with BPD. Since the early 1990’s, our theoretical understanding and treatment practice for individuals with this disorder have grown more sophisticated, providing new hope and understanding for people afflicted with BPD or Borderline traits.

The student choosing to complete an essay would identify and explore in depth the Borderline traits of one literary, historical or public figure or compare and contrast at a less in-depth level those of several.

3. Narcissistic Personality: How or Why it Comes About:

We are all painfully aware of the recent shooting spree at Dawson College in Montreal. A university professor interviewed in Toronto described the shooter as “just a bad man”. A journalist commented on “his narcissistic act”. The contrast is between moral and psychological interpretations of a particular behavior. In our current era of political correctness there is little left that one can safely judge but, rightly or wrongly, individuals with Borderline or Narcissistic personality traits are still seen as fair targets.

Narcissistic Personality Disorder was named for the tragic Greek mythological figure, Narcissus. Like him, individuals suffering from this disorder are forever doomed to remain focused on themselves while at the same time being only able to recognize themselves through the eyes of others. Their most striking characteristics include “grandiosity, need for admiration, and lack of empathy” (DSM-IV-TR, p. 714). Depending on other talents and qualities this combination of traits can make them either annoying but pathetic or a menace. In the literature you will now find references to the ‘fragile narcissist’ or the ‘malignant narcissist’. While associating closely with an individual with BPD diagnosis can be very stressful, chaotic and upsetting, associating closely with a narcissist, either in a work, social or intimate setting, can be, at best, draining and debilitating and, at worst, dangerous or even deadly, e.g. Jim Jones of the Jonestown massacre.

Students choosing to focus in this research area would undertake an in-depth analysis of a particular historical, literary or public figure demonstrating strong Narcissistic traits or they could develop a comparison and contrast of several such figures. Alternately, it could be a critical analysis of a particular approach to understanding Narcissism, which demonstrates some in-depth reading in the field in order to place the selected model in a context that would allow for an informed evaluation. Any of these projects would have to be grounded in a full understanding of the nature of Narcissistic Personality Disorder and would therefore require some substantive background reading.

4. Histrionic Personality Disorder

Histrionic Personality Disorder seems, for some reason, to be the least researched of the Cluster B disorders. Blashfield, R.K. and V. Intoccia found that diagnoses of Histrionic Personality Disorder have declined significantly since the mid-1970’s while diagnoses of Borderline Personality Disorder have grown at a high rate ((2000) The American Journal of Psychiatry, 161, 1350-1365). The central characteristics of Histrionic Personality Disorder are “…excessive emotionality and attention-seeking behavior” (DSM-IV-TR, 711), and since these are also two of the core criteria for Borderline Personality Disorder as described since DSM-III, published in 1980, perhaps this is not surprising. As stated previously, there is symptom overlap across all the Cluster B disorders but the degree of overlap between Borderline and Histrionic Personality Disorders is the most extreme.

If students choose to research in the area of Histrionic Personality Disorder they will find some of the most striking instances to be amongst certain movie stars of an earlier generation. This is not so much the case in the current, highly competitive Hollywood environment where actors and actresses do not survive without a reasonable degree of self-discipline and professionalism, despite whatever persona they may wish to project for publicity purposes. An essay in this area would involve scouring the literature in search of characters who might fit into this type and then comparing and contrasting their relevant personality manifestations to determine what they had in common and in what key ways, if any, they could be said to be outside the rubric of Borderline Personality Disorder.

Assignment File:

Assignment One – 25%

Write an essay demonstrating an understanding of the structure and place of Personality Disorders in the DSM context, as described above. Explore what makes each of the 10 Personality Disorders unique and describe the similarities and differences they share with other DSM-IV Axis II disorders and with each other. Embed this description within the larger context of what personality is and consider the likely circumstances under which certain subsets of personality traits coalesce and reach a level of intensity sufficient to be considered a disorder.

Assignment Two – Research Project 60%: 30 – 40 pages plus list of works cited.

Explore a specific Cluster B Personality Disorder in the context of one or more literary, historical or contemporary figures who, in your opinion, fit into this category. Explain and justify your analysis.

Assignment Three – 15% - Annotated Bibliography

Prepare a complete bibliography of the works you have consulted for your research project in proper APA form. Ten of these sources, including the two main texts, should be annotated. You can consult the University of Toronto writing site on-line at the following URL for suggestions on how to do this effectively.



Course Texts:

Millon, Theodore et al. (2004) Personality disorders in modern life: Second edition.

Hoboken, New Jersey: John Wiley and Sons (ISBN 0-471-23734-5) price: $89.98

USD - .

Livesley, W. John (Ed.) (1995) The DSM-IV personality disorders. New York:

Guilford Press. ISBN 0-89862-257-3 price: $27.95 USD used – .

Strongly Recommended:

Ronningstam, Elsa F. (2005) Identifying and understanding the narcissistic personality.

Oxford: Oxford University Press. ISBN – 13-978-0-19-514873-2

A Good and Inexpensive Resource:

Mason, M.S. and Randi Kreger (1998) Stop walking on eggshells: Taking your life

back when someone you care about has borderline personality disorder. Oakland,

CA.: New Harbinger Publications Incorporated

In addition to the above, a number of resources on general and Cluster B-specific personality disorders are available in the AU library and through the databases.

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