Touchstone Terms: Personality Disorders and Ego-Syntony

I find the distinction between psychological disorders and personality disorders fascinating.

Consider obsession and compulsion. Someone suffering from the anxiety disorder OCD will often engage in ritualistic actions: locking and unlocking a door a set number of times, carefully arranging furniture, repetitive washing, or hoarding. A person with the personality disorder OCPD may do some or all of these things, but the key difference is that the anxiety disorder feels invasive and unwanted by the sufferer, while the sufferer of a personality disorder will endorse his maladaptive behaviors, finding them appropriate, suitable, or correct. He’ll even judge others for failing to behave likewise.

This makes personality disorders particularly difficult to treat; they may be heavily maladaptive, but the sufferer doesn’t experience the personality disorder as an illness. Someone with OCPD instead experiences the world’s failure to live up to their standards or accommodate their behaviors as the major source of their suffering. Personality disorders are thus ego-syntonic: closely tied to the person’s sense of self and their view of the nature of existence. This is different from ego-dystonic disorders, which the sufferer experiences as alien or other: a set of invasive thoughts, reactions, and compulsions at odds with the life and goals she wants.

So far, so good; this is textbook psychology, the normal science hammered out in the last few Diagnostic and Statistical Manuals (DSMs), since the revised third edition in 1988. But there’s a lot to think through here.

Sigmund Freud coined the term “ego syntonic” in his book On Narcissism, where he tried to show that what makes many disorders untreatable is our ability to find support in a partner or a group. This “cure by love” crystallizes a maladaption in what he calls “happy love,” but is supposedly anything but happy. It is merely self-assured “intact narcissism,” because it has intimate social recognition.

Is this the first account of group polarization? Anthony Greenwald thought so. In his essay, “The Totalitarian Ego,”  Greenwald argued that there was a clear connection between the narcissistic ego’s tendency to find self-supporting information and ignore self-critical information and the totalitarian state’s tendency to suppress dissent:

Interestingly, characteristics that seem undesirable in a political system can nonetheless serve adaptively in a personal organization of knowledge.

Conceiving of the ego as a self-protective organization of knowledge strikes me as a useful metaphor for some elements of our thinking. But as always with analyses of bias, especially those like Greenwald’s or Freud’s that take it as a given that everyone is biased in her own way, it raises interesting questions about where to identify disorders and illnesses: the individual ego or the community.

Like Freud, the first DSM classified things like homosexuality as “sociopathic” personality disorders. From one perspective, this makes sense: gays and lesbians don’t experience their sexuality as invasive, but rather experience the world’s hatred as the main impediment to their flourishing. But as we learned then, sometimes it is the world, and not the deviant individual, that must change.

The same thing could be said for a perfectionist with OCPD; perhaps the real problem is that the rest of us are too sloppy or not conscientious enough. Am I wrong to give so little to charity, or is Peter Singer wrong to demand I give so much? Certainly, the personality disorder carries with it a maladaption, a kind of ill-fit between self and world. What empowers the medical establishment to decide where the blame for that misfittedness lies?

It took gays and lesbians activists, sympathetic researchers, and philosophers several decades to remove homosexuality from the DSM. But perhaps other such errors are still present. Some things, like anxiety, depression, or the word salad that schizophrenia produces can be safely recognized as disorders because sufferers experience them as such. But many mental illnesses aren’t precisely ego-dystonic; they merely create a mismatch between self and world: it is the sufferers who decide that it is they who must change and not the world. In their treatments, psychologists put their finger on the scale of that decision, placing the burden on the sufferer and not the world.

That’s why philosophers who have tried to make psychological disorders contained in the DSM into viable worldviews. Activists and sympathetic researchers have embraced depression, anorexia, schizophrenia, multiple personalities, and borderline personality disorder as healthy adaptations rather than maladaptive disorders.

“We are not so inclusivist as to tolerate intolerance such as yours … I don’t see anything herrschaftsfrei [domination free] about my handling of my fundamentalist students. Rather, I think those students are lucky to find themselves under the benevolent Herrschaft [domination] of people like me, and to have escaped the grip of their frightening, vicious, dangerous parents … I am just as provincial and contextualist as the Nazi teachers who made their students read Der Stürmer; the only difference is that I serve a better cause. I come from a better province.” (Richard Rorty, “Universality and Truth,” in Richard Rorty and His Critics, edited by Robert Brandom, 2000.)

Now, if you take someone like Richard Rorty as your guide, this is the particular mission of philosophy: to supply a justification for our pre-philosophical worldviews. It’s not hard to see that what many philosophers are doing is engaging in a defense of their own lives. Bourgeois liberals defend bourgeois liberalism; excluded groups challenge their exclusions; conservatives and theists defend these perspectives. What if this is all just the process of coming to terms with our misfit with the world; all just a kind of narcissism, rooting out ego-dystonic feelings and becoming more fully ego-syntonic?

My sense is that many philosophers understand themselves to be “merely” engaged in this kind of justification and activism on behalf of excluded lifeworlds. And I think that “merely” is a product of their own disillusionment, sometimes quite legitimately. They believe that any greater project of reconciliation or unification is really destined to failure or is propaganda for permanent domination, and so we should settle for this “good enough” work.

But I’d like to believe that we’re doing something more than that: that we’re engaged in a kind of discovery, that we’re working towards some telos in that scholarship, rather than mapping incommensurables. Philosophical justification is not merely a conflict between mutually exclusive personalities, cultures, and ideologies, but the expansion of our shared horizons to find a frame of reference that is inclusive. Rorty’s deflationist account opens us up to the nonsense of Jonathan Haidt (previously here, here, and here.)

In this I find the imagery of Kant’s “kingdom of ends” (at least as interpreted by Christine Korsgaard) evocative: a world where each person finds her own connection with a rule–and a metaphysics–we make together. This necessarily involves some movement back and forth between the diversity of human personalities and the rule that allows us all to flourish. This, it seems to me, involves accepting Korsgaard’s gloss on Kant:

“If you view yourself as having a value-conferring status in virtue of of your power of rational choice, you must view anyone who has the power of rational choice as having, in virtue of that power, a value conferring status.” (Christine Korsgaard, Creating the Kingdom of Ends, 123)

All that is left is to determine how to make each act of value-conferral harmonious with all the others. It’s a difficult practical and philosophical problem that will involve regular digressions into difficult metaphysical and meta-ethical matters, and it can no longer be accomplished while embracing Rorty’s deflationism.

(This post is a part of a series on some ideas that I find particularly useful or interesting.)

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