In nowhere here does anyone use the word “Ego-syntonic”, what is otherwise standardly used to differentiate personality disorders (PD) from non-PDs. This heuristic has remained unchanged for over a century.
Step 1. Does the individual in question have a recurring series of “pathological traits”, or more bluntly, “traits” that can be characterized as “negative” according to the researcher in the ivory tower?
(We can replace the word “processes” or “states” in place of “traits” so long as they’re measurable).
Step 2: Do these same “traits” highly reliably precede all of their distress or dysfunction? Is there a robust causal link between these so-called pathological traits and so-called pathological events or dynamics involving other individuals, regardless of context?
If yes, this unambiguously points us toward the self. Because such outcomes are a-contextual across space and time (e.g., other people), and only selves can persist across time (so claim most enactivists), then the so-called “problem” must be the self itself. And unless skeptics are seriously prepared to defend metaphysical idealism or a “Universal Self” instead, we mean the self that organizes that particular body: Bob. That is, what others have called the personality, the soul, the psyche, and so on, also means the self. And what the psychoanalysts in the Appendix of Aftab’s post here have called “organization”. I will just collapse all these words as form, since form and organization are literally the same word anyways (see: Aristotle). Even if one demands a neurological definition of a self, such as Dan Zahavi’s “minimal self” or Georg Northoff’s “model of the self”, both emphasizing the “higher level” default and salience networks, those too are emergent forms of matter.
Step 3: Are these same “pathological traits” ego-syntonic to the individual?
Step 4: if such “traits” (or processes or states or dynamics) are ego-syntonic to the extent we can charitably say the individual has intentionally used them to actualize their (“problematic”) values across time, then the necessary criteria for personality disorder is met. If no, then no personality disorder may not be diagnosed at all. Not even in future taxonomies or models of personality disorders, unless they also provide a comprehensive and eternal theory of the psyche, self, soul, personality, ego, and so on that’s also compatible with systems biology (Aristotle’s hylomorphism already does this). The Big 5 does not qualify as it is not a comprehensive mind-body theory in the first place. It's explicitly "a-theoretical" instead.
I agree with Zavlis & Fonagy’s suspicion of defining personality disorders as “lists of traits”.
At best, traits are properties of emerging processes (rather than stand-alone substances or objects). For example, “Bob’s neuroticism” is not a distinct object with mass, charge, or spin that occupies space and time, atleast not “independent of Bob”. No one has ever “found where neuroticism is located” outside of a dataset because it is emergent in causal terms (Zachar & Krueger, 2013, p. 904). And so-called neural correlates “of neuroticism” are not actually “of neuroticism” in the first place, they are correlates of particular brains that are organized in particular ways in particular bodies. Aka, Bob's current form. Re-naming neurons to some “thing” other than neurons, nonetheless independent of it’s organ-ization (aka: form), is a category error. Likewise, shoe-horning a population-specific emergent property, such as neuroticism “inside of the brain” is also a fallacy, so complains Denny Borsboom (again, in Zachar & Krueger, 2013, p. 905).
Since this very logic came out of the book called “The Oxford Handbook of Philosophy and Psychiatry”, then the same can be said of “borderline personality disorder”. PD researchers might “find” neural correlates of particular brains whose’ organizing host has been labeled with BPD. However, such researchers are not actually describing BPD. They are describing an ensouled body to Aristotileans, a “personality” to a PD researcher, a “psyche” to “Psyche-ologists” and “Psyche-iatrists”, or an “organization” to a “psyche-analyst”, and so on. Neither psychiatrists, psychologists, counselors, or researchers have conversations with mental disorders. They instead have conversations with psyches. Indeed, it is because souls, psyches, egos, selves, personalities, and hence forms (all functionally the same word) are substantial given it is they (and nothing else) that organ-izes matter into orga-nelles and org-ans and organ-systems, and so on, and thereby enables and constrains (top-down), the strong emergence of mental processes.
Perhaps if they focused on the correct Greek and Latin roots of the words, rather than decade-specific statistical fads or “purely data driven” nonsense, we might avoid these issues. As it turns out, when you throw away all theory and basic assumptions, just as these PD researchers have done by appealing to the staunchly a-theoretical Big 5 paradigm, you then throw away interpretation and millennia's of insights that we killed kings over.
Zachar, P., & Krueger, R.F. (2013). Personality disorder and validity: a history of controversy (p. 889-910). In (Eds) Fulford, K.W.M., Davies, M, Graham, G., Sadler, J.Z., Stanghellini, G., & T., Thorton. (2013). The Oxford handbook of philosophy and psychiatry. Oxford: Oxford University Press.
Thank you Scott! Btw, are you aware of any empirical literature that has used some operational measure of ego-syntonicity to show that this differentiates the conditions we currently characterize as personality disorders from other mental disorders?
If I'm to be honest, i'm on the side of the analysts suggesting all disorders are self-related or personality-related. The self (psyche, personality, soul, etc), whether we take a phenomenological, substantial, or "narrative identity" perspective is the only thing that can be called "persistent". I mean this in the Ship of Theseus sense of the word. Properties, such as neuroticism, dissociation, perfectionism, inhibition, disinhibition, absorption, wide temporal lobe dynamics, whatever (pick your 'poison'), are not things in themselves. Properties imply a self is causing them, whether they consciously endorse them or not (see Michelle Maiese' claims that non-reflective actions in the world, rather than manipulations of re-presentations, indeed cause persistent properties; she has defined them "desiradive habits"). And I'm saying that mental disorders cannot be "independent" of such a psyche. It would be like trying to isolate "pain" from psyche after observing a broken bone under an xray. If there is no psyche here, then what entity is "having pain"? Is the somatic disease or mental disease (take your pick in either example) having pain instead? Are mental disorders now all the sudden conscious entities? Do they too have selves? That sounds prima-facie absurd because it IS absurd. Given this, I'm suggesting your question loads more on first assumptions. Re-stated: I do not need to provide empirical evidence when the rest of psychology and psychiatry is too lazy to clarify these distinctions. It would be like demanding empirical evidence for whether kidnapping or rape is a-priori "other than healthy" for the brain/nervous system. Do we really need to gather empirical data for this? How about detonating a nuke on the moon. Is it bad? Well gee, i guess we cannot possibly know anything at all about astrodynamics without pure empiricism, independent of first assumptions. So maybe we need to nuke the moon to find out, because screw first-assumptions, right?
Excellent post! It introduced me to the whole debate. I am saving it for further study and will assign my resident to read it.
(About Las Meninas… Of all things I concluded my last Substack post with commentary about this unbelievable painting, and a reproduction of it as well! ) Thanks
Very interesting. The ensuing discussion too. I hope that it will help flesh out my longstanding pondering on these matters. Good stuff to fuel the mind. Thank you. I’m pretty sure I will be exploring the area of personality and its conceptual stability across time and recent generations for the next few days - good to get some time to think out of sheer interest now I’m no longer in practice and can indulge myself.
Very helpful! One question though. Clearly, interpersonal dysfunction captures much or most of what we would be inclined to associate with "personality disorders," given that we are social creatures. But I noticed that you repeatedly lump the self-related difficulties (identity, motivation etc.) representing one piece of Criterion A under the "interpersonal" umbrella by default. I am no expert on Criterion A. And of course, problems with self could be expected to lead to interpersonal difficulties down the line as a general rule. But do you really view self-dysfunction as fundamentally interpersonal in a way that merits such equivalency? What is the point of distinguishing the "self" part of Criterion A if we are just going to label everything as interpersonal? Or was there an asymmetry deliberately built in, designed to emphasize the primacy of the interpersonal over the self? (Perhaps this also relates to Scott's long comment above, which I just noticed).
We have to get along with ourselves as much as with others, and I can think of many pathological features of "personality" that need not be defined primarily in terms of the latter - inability to tolerate oneself, difficulty pursuing goals or experiencing agency, incoherent narrative, etc. - so this apparent asymmetry is curious to me.
That’s a great point Chris. “Self and interpersonal disorders” would be a more accurate characterization (not to be confused with the phenomenological characterization of schizophrenia as a self-disorder). My impression is that the interpersonal part is emphasized because that seems more specific to so-called “personality disorders.” People with PDs often have dysfunctional ways of relating to themselves, but I suspect (this is speculation) that a dysfunctional self-relationship WITHOUT interpersonal dysfunction would probably present more like an internalizing disorder.
Thanks for thinking this through. I don't necessarily mind if there's an emphasis on the interpersonal side, if this had a deliberate rationale, and efforts made in the official criteria to explain this rationale. But it comes across as implicitly smuggled in, as though self were less relevant to personality.
And that's interesting about internalizing vs PD - I guess I was envisioning internalizing forms of PD!
In nowhere here does anyone use the word “Ego-syntonic”, what is otherwise standardly used to differentiate personality disorders (PD) from non-PDs. This heuristic has remained unchanged for over a century.
Step 1. Does the individual in question have a recurring series of “pathological traits”, or more bluntly, “traits” that can be characterized as “negative” according to the researcher in the ivory tower?
(We can replace the word “processes” or “states” in place of “traits” so long as they’re measurable).
Step 2: Do these same “traits” highly reliably precede all of their distress or dysfunction? Is there a robust causal link between these so-called pathological traits and so-called pathological events or dynamics involving other individuals, regardless of context?
If yes, this unambiguously points us toward the self. Because such outcomes are a-contextual across space and time (e.g., other people), and only selves can persist across time (so claim most enactivists), then the so-called “problem” must be the self itself. And unless skeptics are seriously prepared to defend metaphysical idealism or a “Universal Self” instead, we mean the self that organizes that particular body: Bob. That is, what others have called the personality, the soul, the psyche, and so on, also means the self. And what the psychoanalysts in the Appendix of Aftab’s post here have called “organization”. I will just collapse all these words as form, since form and organization are literally the same word anyways (see: Aristotle). Even if one demands a neurological definition of a self, such as Dan Zahavi’s “minimal self” or Georg Northoff’s “model of the self”, both emphasizing the “higher level” default and salience networks, those too are emergent forms of matter.
Step 3: Are these same “pathological traits” ego-syntonic to the individual?
Step 4: if such “traits” (or processes or states or dynamics) are ego-syntonic to the extent we can charitably say the individual has intentionally used them to actualize their (“problematic”) values across time, then the necessary criteria for personality disorder is met. If no, then no personality disorder may not be diagnosed at all. Not even in future taxonomies or models of personality disorders, unless they also provide a comprehensive and eternal theory of the psyche, self, soul, personality, ego, and so on that’s also compatible with systems biology (Aristotle’s hylomorphism already does this). The Big 5 does not qualify as it is not a comprehensive mind-body theory in the first place. It's explicitly "a-theoretical" instead.
I agree with Zavlis & Fonagy’s suspicion of defining personality disorders as “lists of traits”.
At best, traits are properties of emerging processes (rather than stand-alone substances or objects). For example, “Bob’s neuroticism” is not a distinct object with mass, charge, or spin that occupies space and time, atleast not “independent of Bob”. No one has ever “found where neuroticism is located” outside of a dataset because it is emergent in causal terms (Zachar & Krueger, 2013, p. 904). And so-called neural correlates “of neuroticism” are not actually “of neuroticism” in the first place, they are correlates of particular brains that are organized in particular ways in particular bodies. Aka, Bob's current form. Re-naming neurons to some “thing” other than neurons, nonetheless independent of it’s organ-ization (aka: form), is a category error. Likewise, shoe-horning a population-specific emergent property, such as neuroticism “inside of the brain” is also a fallacy, so complains Denny Borsboom (again, in Zachar & Krueger, 2013, p. 905).
Since this very logic came out of the book called “The Oxford Handbook of Philosophy and Psychiatry”, then the same can be said of “borderline personality disorder”. PD researchers might “find” neural correlates of particular brains whose’ organizing host has been labeled with BPD. However, such researchers are not actually describing BPD. They are describing an ensouled body to Aristotileans, a “personality” to a PD researcher, a “psyche” to “Psyche-ologists” and “Psyche-iatrists”, or an “organization” to a “psyche-analyst”, and so on. Neither psychiatrists, psychologists, counselors, or researchers have conversations with mental disorders. They instead have conversations with psyches. Indeed, it is because souls, psyches, egos, selves, personalities, and hence forms (all functionally the same word) are substantial given it is they (and nothing else) that organ-izes matter into orga-nelles and org-ans and organ-systems, and so on, and thereby enables and constrains (top-down), the strong emergence of mental processes.
Perhaps if they focused on the correct Greek and Latin roots of the words, rather than decade-specific statistical fads or “purely data driven” nonsense, we might avoid these issues. As it turns out, when you throw away all theory and basic assumptions, just as these PD researchers have done by appealing to the staunchly a-theoretical Big 5 paradigm, you then throw away interpretation and millennia's of insights that we killed kings over.
Zachar, P., & Krueger, R.F. (2013). Personality disorder and validity: a history of controversy (p. 889-910). In (Eds) Fulford, K.W.M., Davies, M, Graham, G., Sadler, J.Z., Stanghellini, G., & T., Thorton. (2013). The Oxford handbook of philosophy and psychiatry. Oxford: Oxford University Press.
Thank you Scott! Btw, are you aware of any empirical literature that has used some operational measure of ego-syntonicity to show that this differentiates the conditions we currently characterize as personality disorders from other mental disorders?
If I'm to be honest, i'm on the side of the analysts suggesting all disorders are self-related or personality-related. The self (psyche, personality, soul, etc), whether we take a phenomenological, substantial, or "narrative identity" perspective is the only thing that can be called "persistent". I mean this in the Ship of Theseus sense of the word. Properties, such as neuroticism, dissociation, perfectionism, inhibition, disinhibition, absorption, wide temporal lobe dynamics, whatever (pick your 'poison'), are not things in themselves. Properties imply a self is causing them, whether they consciously endorse them or not (see Michelle Maiese' claims that non-reflective actions in the world, rather than manipulations of re-presentations, indeed cause persistent properties; she has defined them "desiradive habits"). And I'm saying that mental disorders cannot be "independent" of such a psyche. It would be like trying to isolate "pain" from psyche after observing a broken bone under an xray. If there is no psyche here, then what entity is "having pain"? Is the somatic disease or mental disease (take your pick in either example) having pain instead? Are mental disorders now all the sudden conscious entities? Do they too have selves? That sounds prima-facie absurd because it IS absurd. Given this, I'm suggesting your question loads more on first assumptions. Re-stated: I do not need to provide empirical evidence when the rest of psychology and psychiatry is too lazy to clarify these distinctions. It would be like demanding empirical evidence for whether kidnapping or rape is a-priori "other than healthy" for the brain/nervous system. Do we really need to gather empirical data for this? How about detonating a nuke on the moon. Is it bad? Well gee, i guess we cannot possibly know anything at all about astrodynamics without pure empiricism, independent of first assumptions. So maybe we need to nuke the moon to find out, because screw first-assumptions, right?
Excellent post! It introduced me to the whole debate. I am saving it for further study and will assign my resident to read it.
(About Las Meninas… Of all things I concluded my last Substack post with commentary about this unbelievable painting, and a reproduction of it as well! ) Thanks
Thank you Julio! Funny coincidence that we both gravitated towards this painting around the same time 😃
Very interesting and helpful post! (I've put some questions / disagreements on X.)
Very interesting. The ensuing discussion too. I hope that it will help flesh out my longstanding pondering on these matters. Good stuff to fuel the mind. Thank you. I’m pretty sure I will be exploring the area of personality and its conceptual stability across time and recent generations for the next few days - good to get some time to think out of sheer interest now I’m no longer in practice and can indulge myself.
I’m glad to hear that!
Very helpful! One question though. Clearly, interpersonal dysfunction captures much or most of what we would be inclined to associate with "personality disorders," given that we are social creatures. But I noticed that you repeatedly lump the self-related difficulties (identity, motivation etc.) representing one piece of Criterion A under the "interpersonal" umbrella by default. I am no expert on Criterion A. And of course, problems with self could be expected to lead to interpersonal difficulties down the line as a general rule. But do you really view self-dysfunction as fundamentally interpersonal in a way that merits such equivalency? What is the point of distinguishing the "self" part of Criterion A if we are just going to label everything as interpersonal? Or was there an asymmetry deliberately built in, designed to emphasize the primacy of the interpersonal over the self? (Perhaps this also relates to Scott's long comment above, which I just noticed).
We have to get along with ourselves as much as with others, and I can think of many pathological features of "personality" that need not be defined primarily in terms of the latter - inability to tolerate oneself, difficulty pursuing goals or experiencing agency, incoherent narrative, etc. - so this apparent asymmetry is curious to me.
That’s a great point Chris. “Self and interpersonal disorders” would be a more accurate characterization (not to be confused with the phenomenological characterization of schizophrenia as a self-disorder). My impression is that the interpersonal part is emphasized because that seems more specific to so-called “personality disorders.” People with PDs often have dysfunctional ways of relating to themselves, but I suspect (this is speculation) that a dysfunctional self-relationship WITHOUT interpersonal dysfunction would probably present more like an internalizing disorder.
Thanks for thinking this through. I don't necessarily mind if there's an emphasis on the interpersonal side, if this had a deliberate rationale, and efforts made in the official criteria to explain this rationale. But it comes across as implicitly smuggled in, as though self were less relevant to personality.
And that's interesting about internalizing vs PD - I guess I was envisioning internalizing forms of PD!