Early Perspectives on the Personality Disorders

The history of every science may be said to include a prescientific "natural history" phase, where the main questions are, "What are the essential phenomena of the field?" and "How can we know them?" Ideally, as more and more data are gathered through increasingly sophisticated methodologies, common sense begins to give way to theoretical accounts that not only integrate and unify disparate observations, but also actively suggest directions for future research. The existence of black holes, for example, is predicted by the theory of relativity, and the accumulated evidence of several decades now suggests that one or more black holes exist at the center of every galaxy. No one will ever smell, taste, touch, hear, or see an actual black hole. Because even light cannot escape their gravitational power, they must remain forever hidden from observation. Instead, scientists must infer the existence of black holes from the predictions of relativity and from their observable effects on surrounding space-time. Technological advances have since allowed many other predictions of relativity to be tested.

With this brief example, the function of theory in science becomes clear. Theories represent the world to us in some way that accounts for existing observations, but nevertheless also goes beyond direct experience, a characteristic known as surplus meaning. Theories embrace the available evidence, but allow us to make novel predictions precisely because they exceed the evidence. Thus, the mathematics of relativity may be used to predict exactly what would happen if you fell into a black hole, though you would never return to report about it.

Theory and experimentation are given equal weight in the natural sciences. Sometimes in the history of science, as with the theory of relativity, theory outpaces the capacity of science to make observations. Black holes, for example, were a known mathematical consequence of relativity long before scientists began to figure out ways to observe their effects. Alternatively, new technologies may make possible observations that are more detailed, more precise, and more abundant than ever before, challenging existing theories to the point that entire fields are sent into chaos. The ready availability of new observations allows testing to progress unfettered, quickening the pace of theory formation in turn. Thus, the science matures. The yield of the Hubble space telescope, for example, is so vast that cosmologists cannot yet assimilate everything their new tool allows. Because there are usually multiple competing theories for any given phenomenon, determining which account is correct depends on the construction of a paradigm experiment, one designed to produce results consistent with one theory but inconsistent with the other. In this way, research tends to close in on the truth, whittling down the number of possible theories through experimentation over time.

The social sciences, however, are fundamentally different. Whereas investigation in the natural sciences eventually comes to closure through the interplay of theory and research, the social sciences are fundamentally open. Here, advancement occurs when some new and interesting point of view suddenly surges to the center of scientific interest. Far from overturning established paradigms, the new perspective now exists alongside its predecessors, allowing the subject matter of the field to be studied from an additional angle. A perspective is, by definition, just one way of looking at things. Accordingly, paradigm experiments are either not possible or not necessary, because it is understood that no single perspective is able to contain the whole field. Tolerance thus becomes a scientific value, and eclecticism a scientific norm. In personality, the dominant perspectives are psychodynamic, biological, interpersonal, and cognitive. Other, more marginal conceptions could also be included, perhaps existential or cultural. Some offer only a particular set of concepts or principles, and others generate entire systems of personality constructs, often far different from those of the DSM. Hopefully, the most important ways of looking at the field are already known, though it is always possible that alternative conceptions remain undiscovered. The chapters in this text that discuss the specific personality disorders address these different perspectives: the cognitive, the psychodynamic, the biological, and the interpersonal views of the antisocial personality, for example.

The open nature of the social sciences has further important consequences for how they are presented for study. The history of physics as a science is interesting, but only incidental to the study of its subject matter. Universal laws are universal laws. If Einstein had never been born, the equations that describe the relationship between energy and matter, space and time, would still be the same. We may disagree about politics and religion, but we all live in the same physical universe, and the mathematics describing that universe constitute one truth about its nature.

In the social sciences, however, different perspectives on the field are discovered in no necessary order. Later perspectives tend to be put forth as reactions to preceding ones. The social sciences have what philosophers might call a contingent structure: Had Freud never been born, the history and content of psychology would be very different. In fact, primacy is perhaps the single most important reason that Freud has been so influential. Freud was simply first. When psychoanalysis was becoming established, the only truly competing perspective was biological. In time, psychoanalysis became so dominant it was synonymous with the study of abnormal behavior. Because the cognitive and interpersonal perspectives had not yet been founded, it took some time to discover that psychoanalysis is really just one part of psychopathology, rather than the whole science. Later thinkers studied Freud's work to draw important contrasts with their own points of view so that today, the father of psychoanalysis is one of the most famous and most refuted figures in history. And naturally, in studying Freud, these important thinkers were also influenced by him, in effect becoming psychoanalysts, at least somewhat, in order to become something more.

In any field, perspectives seldom emerge fully formed. Instead, novel ideas coalesce slowly, so that only after a period of time does their presence as a new point of view become apparent. When this occurs, many individuals formerly seen as belonging to the old school are now seen as transitional figures, difficult to classify. Harry Stack Sullivan, about whom you will read more later, reacted so strongly against psychoanalysis that he is regarded as the father of the interpersonal perspective. Nevertheless, many of Sullivan's notions were anticipated by Alfred Adler, who also reacted against Freud. Yet, Adler is regarded as psychodynamic, and Sullivan is regarded as interpersonal. Even so, contemporary interpersonal theory has advanced so far that Sullivan sometimes looks analytic in contrast.

Understanding the open nature of social sciences and how they evolve may seem tangential, but in fact, it is fundamental to understanding personality and its disorders. Each perspective contributes different parts to personality, but personality is not just about parts. Instead, personality is the patterning of characteristics across the entire matrix of the individual. Whatever the parts may be, personality is about how they intermesh and work together. Occasionally, you may hear someone say that personality is really just biological, or really just cognitive, or really just psychodynamic. Do not believe them. The explicit purpose of a perspective is to expose different aspects of a single phenomenon for study and understanding. A single element cannot be made to stand for the whole. By definition, each perspective is but a partial view of an intrinsic totality, and personality is the integration of these perspectives, the overall pattern or gestalt. Each point of view belongs to the study of personality, but personality itself is more than the sum of its parts. In the next two sections, we trace the history and importance of two competing approaches to personality, the biological and the psychodynamic. Among other things, these perspectives have given the field important units of analysis—temperament and character, respectively—that have sometimes sought to replace personality itself as the proper focus of clinical study.

The Biological Perspective

Axis III of the DSM recognizes an important truth about human nature: We are all biological creatures, the result of five billion years of chemical evolution here on planet Earth. In the course of everyday life, we do not ordinarily think about the link between mind and body. Especially when we are young, our physical matrix usually hums along so smoothly that its functions are completely transparent. Subjectively, our existence seems more like that of a soul captured or held within a body, not that of a self that emerges from a complex physical organization of neurons communicating chemically across synapses. So strong is the illusion that philosophers have debated for centuries whether the universe is ultimately composed of mind or matter or both. To us, our minds seem self-contained, and our will free. Because our choices always seem to be our own, we cannot imagine that our bodies are anything more than vessels. No wonder, then, that many religions maintain that each of us has an immortal soul that escapes upon the body's demise. From the standpoint of science, however, humans are social, psychological, and biological beings. As such, our will is neither totally determined nor totally free, but constrained by influences that cut across every level of organization in nature.

Biological influences on personality may be thought of as being either proximal (nearby) or distal (far away). Distal influences originate within our genetic code and often concern inherited characteristics transmitted as part of the evolutionary history of our species. Many such characteristics are sociobiological. These exist because genetic recombination could not exist in the absence of sexuality. As a prerequisite for evolution, we are gendered beings who seek to maximize the representation of our own genes in the gene pool. For the most part, the influence is subtle, but even among human beings, males tend to be more aggressive, dominant, and territorial, and females tend to be more caring, nurturant, and social. Such tendencies are only weakly expressed among normals, but some personality disorders do caricature their sex-role stereotype, notably the antisocial and narcissistic personalities among males and the dependent and histrionic personalities among females.

Other biological influences in personality focus on proximal causes, influences that exist because we are complex biological systems. When the structures that underlie behavior differ, behavior itself is affected. Two such concepts important to personality are temperament and constitution.

Temperament

Just as everyone has a personality, everyone has characteristic patterns of living and behaving that to a great extent are imposed by biology. Each child enters the world with a distinctive pattern of dispositions and sensitivities. Mothers know that infants differ from the moment they are born, and perceptive parents notice differences between successive children. Some infants have a regular cycle of hunger, elimination, and sleep, whereas others vary unpredictably. Some twist fitfully in their sleep; others lie peacefully awake in hectic surroundings. Many of these differences persist into adulthood. Some people wake up slowly, and others are wide awake almost as soon as their eyes open.

The word temperament came into the English language in the Middle Ages to reflect the biological soil from which personality develops. Temperament is thus an underlying biological potential for behavior, seen most clearly in the predominant mood

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