We would be remiss in our presentation if we failed to recognize that personality pathology may be shaped by the institutions, traditions, and values that comprise the cultural context of societal living; these cultural forces serve as a common framework of formative influences that set limits and establish guidelines for members of a social group. However, we must be careful to view "society" and "culture" not as entities but as convenient abstractions that characterize the pattern of relationships and responsibilities shared among group members.
The continuity and stability of cultural groups depend largely on the success with which their young are imbued with common beliefs and customs. To retain what has been wrought through history, each group must devise ways of molding its children to "fit in," that is, to accept and perpetuate the system of prohibitions and sanctions that earlier group members have developed to meet the persistent tasks of life. All infants undergo a process of "socialization" by which they learn to progressively surrender their impulsive and naive behaviors and to regulate or supplant them with the rules and practices of their group. Despite the coerciveness of this process and the loss of personal freedom that it entails, children learn, albeit gradually, that there are many rewards for cooperative and sharing behaviors. Societal rules enable them to survive, to predict the behaviors of others, to obtain warmth and security, and to learn acceptable strategies for achieving the rich and diverse rewards of life. It is important to recognize, then, that the traditions of a culture provide its members with a shared way of living by which basic needs are fulfilled for the greater majority with minimal conflict and maximal return.
In previous sections, we noted that for many children the process of cultural training and inculcation is far from ideal; methods by which societal rules and regulations are transmitted by parents often are highly charged and erratic, entailing affection, persuasion, seduction, coercion, deception, and threat. Feelings of stress, anxiety, and resentment may be generated within the young, leaving pathological residues that are perpetuated and serve to distort their future relationships; several of these pathogenic experiences were dealt with earlier.
Attention in this sociocultural section focuses not on the more private experiences of particular children in particular families, but on those more public experiences that are shared in common among members of a societal group. In a sense, we speak of forces that characterize "society as the patient," a phrase that Lawrence K. Frank (1936) suggested close to 70 years ago. He wrote:
Instead of thinking in terms of a multiplicity of so-called social problems, each demanding special attention and a different remedy, we can view all of them as different symptoms of the same disease. That would be a real gain even if we cannot entirely agree upon the exact nature of the disease. If, for example, we could regard crime, mental disorders, family disorganization, juvenile delinquency, prostitution and sex offenses, and much that now passes as the result of pathological processes (e.g., gastric ulcer) as evidence, not of individual wickedness, incompetence, perversity or pathology, but as human reactions to cultural disintegration, a forward step would be taken.
The notion that many of the pathological patterns observed today can best be ascribed to the perverse, chaotic, or frayed conditions of our cultural life has been voiced by many commentators of the social scene (Fromm, 1955; Millon, 1987; Millon & Davis, 1996; Riesman, 1950; Wachtel, 1983; Yankelovich, 1981); these conditions have been characterized in phrases such as "the age of anxiety," "growing up absurd," and "the lonely crowd." It is not within the scope of this book to elaborate the themes implied in these slogans; a brief description of three conditions of contemporary life suffices to provide some idea of what these writers are saying. First, we note the operation of forces that compel individuals to surpass the standards to which they were exposed in early life; second, we point up the effects of changing, ambiguous, and contradictory social values; and third, we describe the consequences of the disintegration of social beliefs and goals.
Few characterizations of American life are more apt than those that portray our society as upwardly mobile. Ours has been a culture that has maximized the opportunity of its members to progress, to succeed, and to achieve material rewards once considered the province only of the aristocracy and well-to-do. With certain notable and distressing exceptions, the young of our society have been free to rise, by dint of their wits and their talents, above the socioeconomic status of their parents. Implicit in this well-publicized option to succeed, however, is the expectancy that each person will pursue opportunities and will be measured by the extent to which he or she fulfills them. Thus, our society not only promotes ambition but also expects each of its members to meet the challenge successfully. Each aspiring individual is confronted, then, with a precarious choice; along with the promising rewards of success are the devastating consequences of failure, as may be seen in the developmental background of certain narcissistic personality subtypes.
Upwardly mobile opportunities are shared by most members of our society; this can only bring forth intense competition. The struggle for achievement is geared, therefore, not only to transcend an individual's past but also to surpass the attainments of others. No better illustration can be seen of the consequences of competitive failure and inadequacy than in the constant testing and grading that children experience throughout their school years; this early form of teaching competitiveness persists and pervades every fabric of societal life. It is evident in athletics, in the desire to be accepted by prestigious colleges, in the search for pretty dates, for getting a job with a title, having the highest income, buying up to a status car, belonging to the right country club, and so on.
The competitive success struggle is insatiable and fruitless since few can reach the top, and there are no spheres of life in which invidious comparisons cannot be made. Thus, a depressed man of 47, who had risen from a poor immigrant family background to a respected and financially rewarding career as a lawyer, became despondent and considered himself a failure following his unsuccessful bid for the elective office of county judge.
Guilt for having let others down, self-devaluation for your limitations, and self-recrimination for failures—all of these pathogenic feelings well up within many members of our society. We have been well trained to compete and to seek public achievements without examining their aims, their inevitable frustrations, and their limited rewards.
Achievement strivings refer to the need to surpass one's past attainments; competition describes the struggle among individuals to surpass one another in these achievements. What happens, however, if the standards by which people gauge their achievements keep changing or are ambiguous? What happens if people cannot find dependable and unequivocal standards to guide their aspirations?
It has been the historical function of cultural traditions to give meaning and order to social life, to define the tasks and responsibilities of existence, and to guide group members with a system of shared beliefs, values, and goals. These traditions, transmitted from parents to child, provide the young with a blueprint for organizing their thoughts, behaviors, and aspirations.
One of the problems we face today is the pace of social change and the increasingly contradictory standards to which members of our society are expected to subscribe (Millon, 1987). Under the cumulative impact of rapid industrialization, immigration, urbanization, mobility, technology, and mass communication, there has been a steady erosion of traditional values and standards. Instead of a simple and coherent body of customs and beliefs, we find ourselves confronted with constantly shifting and increasingly questioned standards whose durability is uncertain and precarious. No longer can we find the certainties and absolutes that guided earlier generations. The complexity and diversity of everyday experience play havoc with simple archaic beliefs and render them useless as instruments to deal with contemporary realities. Lacking a coherent view of life, we find ourselves groping and bewildered, swinging from one set of standards to another, unable to find stability and order in the flux of changing events. There have been few times in the history of man when so many have faced the tasks of life without the aid of accepted and durable traditions. As is elaborated in our discussion of the borderline personality disorder's experiential background, the factors described previously are likely to be central influences in giving shape to their internal psychic dissonance.
This profusion of divergent standards is compounded by intrinsic contradictions among the beliefs to which people are exposed; we are sermonized to "turn the other cheek" but exhorted to "compete and win" as well. The strain of making choices among conflicting values and loyalties besets us at every turn. Competing claims on our time and divergent demands to behave one way here and another there keep us in constant turmoil and prevent us from finding a stable anchor or from settling on a fixed course.
For example, an anxious and dejected 36-year-old mother of three could not resolve the problem of whether to follow her former career as a lawyer, which she had interrupted at the time of her first child's birth, or whether to remain a housewife; when first seen, she was torn between the desire to accept a position as legal counsel for a public agency engaged in humanitarian social programs and feelings of guilt that, by so doing, she would fail to fulfill her responsibilities to her husband and children. With no system of consistent values, we drift erratically from one action to another; countervailing pressures only lead us into uncertainty, confusion, conflict, and hypocrisy.
Large segments of our society find themselves out of the mainstream of American life; isolated by the unfortunate circumstance of social prejudice or economic deprivation, they struggle less with the problem of achieving in a changing society than with managing the bare necessities of survival. To them, the question is not which of the changing social values they should pursue but whether there are any social values that are worthy of pursuit.
Youngsters exposed to poverty and destitution, provided with inadequate schools, living in poor housing set in decaying communities, raised in chaotic and broken homes, deprived of parental models of success and attainment, and immersed in a pervasive atmosphere of hopelessness, futility, and apathy cannot help but question the validity of the "good society." Reared in these settings, individuals quickly learn that there are few worthy standards to which they can aspire successfully. Whatever efforts are made to raise themselves from these bleak surroundings run hard against the painful restrictions of poverty, the sense of a meaningless and empty existence, and an indifferent, if not hostile, world.
As is discussed in our presentation of the so-called antisocial personality disorder, many young Black people today reject outright the idea of finding a niche in contemporary society; they question whether a country that has preached equality, but has degraded their parents and deprived them of their rights and opportunities, is worth saving at all. Why make a pretense of accepting patently "false" values or seeking the unattainable goals of the larger society when reality undermines every hope and social existence is so evidently and pervasively painful and harsh?
Deteriorating and alienated communities feed on themselves; they not only perpetuate their decay by destroying the initiative and promise of their young but also attract the outcast and unstable who drift into their midst. Caught in this web of disintegration, the young and the downwardly mobile join those who already have retreated from the values of the larger society. Delinquency, prostitution, broken homes, crime, violence, and addiction increasingly characterize these communities, and the vicious circle of decay and disintegration not only persists but also is intensified.
We must remember, however, that harsh cultural and social conditions rarely cause personality pathology; rather, they serve as a context within which the more direct and immediate experiences of interpersonal life take place. They color and degrade personal relationships and establish maladaptive and pathogenic models for imitation.
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