Sunday, November 8, 2009

The Dis-Ordered Self

Character disorders, they used to be called and sometimes still are, if you're talking to those experience-wizened women and men who received their psychiatric training in 1940s. Later on, the name became personality disorders, as we began to realize how deep the rabbit hole goes. Language changes and its appropriate to change with it. Feelin' groovy was fine in the 60s, but unless you want your peers looking at you as though they had cartoon balloons filled with question marks floating over their heads, you need to find a better way to say it in 2009.

Now, it seems, we're taking another step in the way we label the kinds of disorders that suffuse through a person like Bell's Seasoning in Thanksgiving stuffing (more about Bell's in a couple of weeks -- stay tuned), and calling them self disorders or disorders of the self. Actually, I like that term because it describes what seems to take place: a dis-ordering of the self as an integrated unit. This is more than a temporal phenomenon such as might be seen with depression or anxiety. And it extends beyond personality: we're not referring to being an introvert in an extroverted world and feeling like a stranger in a strange land. It's like a breakdown in the development of many of the essential functions that enable effective coping, appropriate emotional expression, and

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reality-oriented thinking and problem-solving.

In essence, it's a disruption that influences a person from the inside
out. From the basic neurochemical level, where electrical impulses trigger chemical signals resulting in cell to cell communication, to the production of the amorphous and ambiguous thing we call mind -- true mind-body interactions -- to interpersonal relations. It's that pervasive. When you think of it in these terms, the classification of dis-ease becomes terribly artificial. Nevertheless, we do it in order to make sense of what we see and in the attempt to develop treatments that may genuinely do some good.

So, you take another look at the fragile/vulnerable individual I described yesterday, and ask how can these things be? In the absence of a well-ordered interior life that is capable of expressing itself meaningfully or establishing relationships with mutual give and take, one resorts to using their environment to compensate. My close friend and coauthor, Dr. Lynn Smith, was very fond of saying in regard to psychosomatic illness, "What the mind cannot express, the body will." If we take that a step further, we might say when the self is unable to express itself functionally, it turns to external factors and virtually insists they perform on its behalf.

And that helps explain why these conditions are so disabling. When you don't have your own intrinsic resources to draw upon to help manage stress, form reliable and consistently satisfying relationships, or cope with uncertainty, you're inhibited in some very critical ways. Navigating your way through life becomes a catch-as-catch-can proposition and you experience considerable pain en route. It's not an enviable position to be in. Ironically, dealing with such a thing means you've got to be able to recognize where you are to begin with. For many with self disorders, that prospect is so disturbing as to seem nearly impossible.

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