Handbook of Personality Disorders: Theory, Research, and Treatment

THEODORE MILLON

SARAH E. MEAGHER

SETH D. GROSSMAN

The complex composition of personality and psychopathological disorders, and the diversity of practical approaches and frames of reference, call for a rigorous task of conceptualizing and organizing clinical data. Behaviorally, such disorders can be conceived and grouped as complex response patterns to environmental stimuli. Biophysically, they can be approached and analyzed as sequences of complex neural and chemical activity. Intrapsychically, they can be inferred and categorized as networks of entrenched unconscious processes that bind anxiety and conflict. Quite evidently, the complexity and intricacy of personological phenomena make it difficult not only to establish clear-cut relationships among phenomena but to find simple ways in which these phenomena can be classified or grouped. Should we artificially narrow our perspective to one data level to obtain at least a coherency of view? Or, should we trudge ahead with formulations which bridge domains but threaten to crumble by virtue of their complexity and potentially low internal consistency?

Psychologists still grapple with this intrinsically complex problem and have yet to manifest a completely satisfying approach to the vinculum of personality to psychopathology. In spite of a long history of brilliant cogitations, psychopathologic nosology still resembles Ptolemy’s astronomy of over 2,000 years ago: Our diagnostic categories describe, but they do not really explain. Like so many crystalline spheres, each lies in its own orbit, for the most part uncoordinated with the others. We do not know why the universe takes its ostensive form. There is no law of gravity which undergirds and binds our psychopathologic cosmos together. In fact, the word “cosmos” implies an intrinsic unity, a laudable ideal, which is not appropriate in its usage: Our “star charts,” our DSMs, remain an aggregation of taxons, not a true taxonomy. Their reliability, but dubious validity, lends our field the illusion of science but not its substance. Such a state of affairs is simply unscientific.

Our most radical (albeit reactional) alternative would be to discard taxonomies altogether. This, of course, would be impossible, as a taxonomy serves indispensable clinical and scientific functions. Clinically, it provides a means of organizing pathological phenomena, the signs and symptoms or manifestations of mental disorder. By abstracting across persons, a taxonomy formalizes certain clinical commonalities and relieves the clinician of the burden of conceptualizing each patient sui generis, as an entity so existentially unique it has never been seen before nor ever will again. For psychopathology to be practiced at all, there cannot be as many groups as individuals. Even if the formal categories that constitute a taxonomy are but convenient fictions of dubious reality, some groups are better than no groups at all.

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