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WHEN ALARM BELLS SHOULD RING:
Recognizing Personality Disorders
By
Susan Schwartz Senstad, M.A., M.F.T., M.F.A.
What is ‘abnormal’
Pathology does exist, however. Not everybody who at first seems
normal actually is. Some people are wounded, physiologically, psychologically
or both, so profoundly and at so early a stage of their development,
that genuine deficits occur. (Killingmo) According to the National
Institute of Mental Health, many people with one kind of Personality
Disorder (Borderline) have experienced abuse, neglect, or separation
as young children; 40-71 percent report having been sexually abused.
(NIH Publication No. 01-4928) It is no wonder that many people,
after such experiences, grow up with holes in their psychological
development that leave them impaired. (Be aware that ‘Borderline
Personality Disorder’ seems at times to be used in the literature
as an umbrella concept covering various forms of Personality Disorders.)
What most of us think of as mental illness is sometimes easy to
recognize. When someone is psychotic – hearing voices, being
disoriented as to time and place, speaking in incoherent, disjointed
sentences – their view of reality is so different from ours
that we get the signal loud and clear that something is wrong. It
isn’t difficult for a Voice Dialogue practitioner without
training in psychopathology to know she ought not to facilitate
a person in that condition. People with more severe forms of the
mental illnesses called Personality Disorders (so-called ‘low-functioning’),
as they are described in the psychiatric diagnostic manual, DSM
IV (see Appendix 2), may be law-breakers and thus in prison, or
so destructive and/or self-destructive that they are hospitalized.
These too are easier for non-professionals to recognize.
The people with milder forms of Personality Disorders (so-called
‘high-functioning’), meanwhile, present symptoms that
are far more subtle and hard to spot. When these people are in circumstances
which don’t trigger their vulnerable points, they may look
and behave as if they were quite healthy. In fact, people with some
forms of Personality Disorders – such as three of the types
of Personality Disorders which VD facilitators are most likely to
encounter: Narcissistic, Histrionic and Borderline – may even
be outstandingly charming and engaging, brilliant and creative.
Some appear retiring, shy, even insular, but others may have quite
a high profile as prominent citizens and accomplished members of
society. Some are Voice Dialogue practitioners. Consequently, they
often go undiagnosed or misdiagnosed, even by experienced professionals.
For those of us whose psychological development proceeded normally,
VD is an exquisite tool for developing the Aware Ego. For those
with major deficits, however, Voice Dialogue alone will do no lasting
good and could do harm. It would need to be offered, for example,
within the context of a deep, on-going, long-term therapeutic relationship,
one which provides a ‘corrective experience over time’
in order to help construct the missing structures where the deficits
lie.
Ignorance about Personality Disorders creates crucial difficulties
for the ‘normal’ VD practitioner. We can, for example,
make an important contribution by using VD to help a basically healthy
person balance her narcissist-like behavior by “facilitating
her more caring inner selves,” those capable of understanding
and meeting other people’s needs. But to ask a person suffering
from a Narcissistic Personality Disorder to do that is to hurl him
into the void of his most isolating deficit, his incapacity for
empathy. We do people no kindness when we ask them to perform beyond
their psychological capacity.
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Table of Contents
Aims of this article
What is ‘normal’?
What is ‘abnormal’
Warning signs that a potential client/student
may suffer from a Personality Disorder
What to do – but first, what NOT to do
Working with a client/student whose parent
and/or partner suffers from a Personality Disorder
Doing Bonding Pattern work with a client/student
with a Personality Disordered parent and/or partner
About the author
Appendix 1: References and Useful Books
& Websites
Appendix 2: DSM IV – Personality
Disorders
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