… Man hands on misery to man …
Are you a hungry person, sometimes greedily addictive, prone to bingeing on work or sex or drugs or food? Are you a good mimic, a charmer, a lover of artifice? Are you mistrustful, even of closest intimates? Are you a control freak? Do you tend to extremes of good and bad, to dividing the world into the wonderful few versus the rest? Do you have to be the centre of attention? Do you lurch between grandiose views of yourself and black depressions? Are you prone to antisocial, hostile, impulsive, selfish behaviour? Are you a novelty-seeking risk-taker?
If your answer to any of these questions is yes, you probably have a weak sense of self and suffer from what is known as a personality disorder. You are in good company, for, even if 80 per cent of criminals and about 13 per cent of the general population do so, so do the majority of high achievers, be they in politics, business, the arts or showbusiness. Your weak self can lead to astonishing feats of imagination and dominance, albeit often accompanied by terrible anguish. But your symptoms are not unknown to everyone else. Far more than 13 per cent of people have some of them – all of us do, to some extent, in some situations.
Although no one can directly remember their earliest experiences in infancy, it is back in this forgotten time that the origins of personality disorder and the weak self are found. The psychoanalyst Donald Winnicott claimed that it results from the care you receive in the first few months of life. Early care that lacks empathy creates an immature adult with arrested development, prone to the reckless and amoral acts of a young child, to the ‘me, me, me’ selfishness and inflated grandiosity found in the fantasy life of the toddler. But the cause of personality disorder is not wholly care in infancy. Subsequent experiences, especially sexual and physical abuse, can also play critical roles. In most cases, genes play little or none.
Winnicott wrote that ‘There is no such thing as a baby’, meaning that babies are as nothing without the thoughts and feelings attributed to them thousands of times every day by their carers. Indeed, if a baby has solely her physical needs met but receives no personal attention to her emotional and social demands, studies of children in orphanages show that she is more at risk of death and certain not to flourish. Just as we anthropomorphize the behaviour of our cats and dogs, so with babies; but with the important difference that if our mother keeps on attributing human meanings to our babyish gestures, we eventually come to share them. During the first six months our experience is largely physical and primitive – sensations of hunger and satiety, of warmth and cold, of fear and security. Our sense of time is limited to physical changes, like from being fed to not being fed. We cannot label these sensations with words so we cannot represent them as conscious thoughts with which we could predict and ultimately control our world. We have weak boundaries between what is Me (what is inside our body and mind) and what is Not-Me (outside), the two often being blurred. When we suck on the breast or bottle it could be a part of us. When the milk goes into our mouth, we do not know what it is or where it came from. This blurring is still evident in our later vivid fantasy life as a three- or four-year-old, which is filled with such confusions. Only half jokingly we may say, ‘I am you’ to an admired parent or, when naughty, imagine that our wickedness can be read in our mind long before it could have been detected. By having our needs met reliably we accrue a memory bank of bodily sensations which are the foundation of the sense of where Me begins and Not-Me ends – the sense of self.
If our mother was an empathic carer, she quickly learnt to adjust her behaviour to fit our natural rhythms of looking towards and turning away. We became partners in a dance which could be frenzied and peaceful by turns, constantly switching types of behaviour. Perhaps we let out three cries of increasing length: ‘Eh, Eeh, Eaarg!’ Our mother may have responded through a different mode, by waving an arm to the precise beat of the cry, imitating its cadences: small wave, big one, even bigger one, with a slight change in direction to express the ‘arg’ element of our last utterance. A wave responded to with an equivalent sound, a look with a pat or stroke – such exchanges, known to psychologists as ‘cross-modal matching’, were going on all the time between us.
In the vast majority of mother–baby couples, it is the mother and not the infant who determines whether this dance takes place at all; and, if it does, how it is patterned. The emotional empathy of Winnicott’s ‘ordinary, devoted, good-enough mother’ is as critical to the infant’s wellbeing as food is to his physical health. If our care does not start from where we are, emotionally, then if we look away the unempathic mother is liable to misintepret this action as rejecting or controlling. She will talk at or grab hold of us, acting intrusively and out of keeping with our desires. If we are only fed or picked up when it suits her, she hijacks our capacity to experience our own needs and we grow looking outwards for definition. Winnicott maintained that in this situation we develop a ‘false self’, feeling unvalued and powerless. In later life that weak self shows up in the symptoms of personality disorder or even, if it is extremely weak, as the mental illness schizophrenia. In a thousand ways, every day and through innumerable tiny interactions during the first few months, the lack of empathy communicates itself. The result is a chronic loss of the capacity for pleasure, for which we compensate in one of two main ways.
The first is to become frenetic. In this hyper mode, as an infant you are locked in a state of vigilant consciousness and wakefulness, regardless of how fatigued we are. Our activities may be speeded up, with exaggerated sensitivity to sounds or other stimuli. We may indulge in repetitive, rhythmic behaviour such as rocking or sucking. There may be muscular tension, stiffness, rigidity of the back and body, and exaggerated intensity and muscular force when we make movements. Breathing may be rapid, with our pulse rate racing and our food gulped in a frenzy. These indicate our desperation at our lack of pleasure and may prefigure a host of severe problems in later childhood and adulthood, from addictive behaviour to eating disorders.
It may be the precursor of hyperactivity, for example. Although the illness officially known as Attention Deficit and Hyperactivity Disorder or ADHD is widely touted as being of largely genetic origin, and although 3 million American children are being treated with drugs at any one time on the assumption that it is a disease of the brain with a physical cause, there are a lot of good scientific reasons to question this approach. Even during pregnancy, the mother’s state of mind significantly affects whether her child is likely to be hyperactive. In one survey of seven thousand cases, twice as many children suffered the problem if their mothers had been anxious in late pregnancy. Raised cortisol levels or stress in the mother during pregnancy predict subsequent behavioural and emotional problems in the child at ages 4, 7 and 9. Postnatally, several studies have shown that when unempathic early care takes the form of intrusiveness it leads to hyper states. Intrusive and overstimulating care measured at six months was strongly associated with hyperactivity a long time afterwards, both at three and at eleven years old. The infant’s temperament, measured a few days after birth, did not predict hyperactivity at all, suggesting little role for genes. Another study compared children of maltreating parents who had been placed in group care in an institution with those who had more personal care in a foster home. The ones who had the more depriving group care were much more likely to be hyperactive, again suggesting that genes were not playing much of a part. The importance of care is strongly suggested by the fact that children whose mothers are often overstretched, such as those who are single parents, are three times as likely to be afflicted as children who have both parents at hand. Whilst twin studies show that genes may none the less be significant in as much as half of cases, it seems very likely that the seeds for the illness are often planted by intrusive, unempathic care which fosters the habit of being hyper as a way of dealing with lack of pleasure. (Subsequent progress of the illness is probably the result of erratic or coercive punishment in later childhood, determining whether the infant’s potential for hyperactivity is fulfilled and, subsequently, whether this evolves into a weak conscience and criminal delinquency.)
The deprived infant’s lack of pleasure may equally be compensated for by the opposite of hyperactivity – a depressive turning in upon the self, passive hopelessness. Faced with extremely unempathic care, as infants we fall back on our body as a last-ditch source of gratification: rocking, head-turning or, to create sensation, scratching our skin or masturbating. Finally, still unpleasured, we withdraw from the world altogether, becoming somnolent, lethargic, unreactive to stimuli, floppy and weak; we have shallow, slow breathing and are a reluctant, unenthusiastic eater. Dried tears sit upon a rigid, expressionless, averted face. We evade repetition of the pain of insensitive, unempathic relating from the carer by becoming totally unresponsive.
These hyper and depressive ways of coping with lack of pleasure become established as electrical and chemical patterns in the infant brain: levels of hormones and patterns of brainwave and heart rate differ between babies who have had empathic and unempathic care. This lays down the potential for disorder in later life, like a computer program, although, just as that can be modified by being rewritten, so can the infant’s neurology. The right set of subsequent experiences can change for the better the instructions for what to expect from life, because the brain is an organ which is highly sensitive to its environment throughout life.
However, such compensation is the exception rather than the rule, and in most cases the effects of unempathic early care are still visible decades later. It tends to result in an adult with a weak self whose personality is disordered. Our integrity is fragile and in order to stay intact we use ‘primitive’ mental mechanisms, so-called because they are evident in very small children. Faced with adult reality, we regress to childlike modes. Although we may appear normally adult in most respects, in others that are more or less well concealed we have never grown up.
A core stratagem in people who are Personality Disordered is omnipotence, an infantile conviction that we can achieve anything we wish because we are magically all-powerful. Having felt powerless to affect our carers as a baby, we simply reverse the truth and tell ourselves that we can change the world merely by thinking it different. This is visible in normal three-year-olds when they close their eyes and wish something different by casting a spell. So keenly do they feel their fantasy world of play that they believe anything can happen. But in adults, such ‘magical’ thinking can appear as symptoms of mental illness. At its most extreme, it takes the form of delusions where sounds or sights that conform with the fantasy are hallucinated. The many severely deluded people who are attracted to the belief that they are Jesus Christ may be suffering from omnipotence. Not only did he have the status of Son of God, he was so omnipotent that he could cheat death itself. All of us had grandiose fantasies as children and there can be few adults who have permanently left them behind, particularly at times of severe stress. But the Personality Disordered continue to have them more of the time, into adulthood; sometimes these fantasies are highly creative and unusual, but more usually they just lack realism.
Exactly the same dynamic of reversing the truth fuels narcissism; however, instead of powerlessness being reversed, in Narcissism it is the feeling of being worthless which is compensated for by a grandiose fantasy of inflated status in the eyes of others. We are constantly attention-seeking and only happy when we, or something about which we feel authoritative, are the topic of conversation. The abiding injury we suffered as a baby at being deemed unimportant because our needs were subordinated to those of the carer is temporarily healed by saying to anyone who will hear (or just secretly to yourself), ‘I am the most wonderful/beautiful/intelligent/special person’ – the precise opposite of how we really feel. We have great difficulty in relating to people realistically and honestly unless we incorporate them as part of ourselves, something easily done because of weak boundaries between Me and Not-Me. We love to create social or professional cliques, elites based on the unconscious dictum: ‘I am perfect. You are perfect too, but you are part of me.’
Narcissism and omnipotence are usually present if we suffer from one of the commonest kinds of Personality Disorder, the borderline. We have a pervasive instability and ambivalence in the stream of our everyday life. Emotionally erratic, capricious, impulsive and often explosive, we make a very awkward, manipulative companion. Relatives and acquaintances are put on edge by sullen displays and hurt looks or by obstinate nastiness, eliciting rejection rather than the nurture that is desperately needed. Ever since we learned depressive and hyper modes in earliest infancy, our mood has shifted between extended periods of dejection and apathy and frantic spells of anger, anxiety or excitement. Our despair is genuine but it is also a means of expressing hostility, a covert way of frustrating and retaliating. Angered by the failure of others to nurture us, we use moods and threats to ‘get back’ and ‘teach a lesson’. By exaggerating our plight and acting in a miserable fashion we avoid responsibilities and place added burdens on others. Cold and stubborn silences are punitive blackmail, a threat of trouble to come. Easily offended by trifling matters, we are readily provoked to contrariness if things do not go our way.
We often have rapidly changing and self-contradictory thoughts about ourselves and about odds and ends of passing events. We voice dismay at the sorry state of our life, and articulate our sadness and our resentments: we feel discontented, cheated, unappreciated, misunderstood and disillusioned, and that all our efforts have been for nothing. The obstructiveness, pessimism and immaturity which others attribute to us are dealt with by believing that these are a reflection of our greater sensitivity or of some other special attribute – a narcissistic distortion. Yet, confusingly, at other times we may lurch from this sense of superiority to saying it is our own unworthiness, our failures and bad temper, which are causing misery to ourselves and pain to others. In a state of permanent flux, our thoughts and emotions are precarious.
Not surprisingly, sustaining stable personal relationships is difficult. A study comparing borderline women seen in a marriage guidance clinic with non-borderlines found the borderlines to be filled with self-deceit. They had greater sexual dissatisfaction and depression about their sex lives, yet thought of themselves as highly desirable. They reported more problems in their relationships, greater sexual boredom, difficulties in achieving orgasm and proneness to affairs, yet they invariably identified their partner as the one with the sexual problem. The borderlines also were more likely to report lesbian desires, and half had suffered sexual or physical abuse as children. Borderlines in particular, and Personality Disordered people in general, are more likely to have what is called a ludic love style, in which love is seen as a game – something done to, rather than with, another person. We tend to believe that what our lover does not know about cannot hurt them, and to be unfaithful. Deceiving partners in this way, we gain more pleasure from the playing of roles than from intimacy or sexual intercourse itself.
Intimate contact with others leaves us feeling battered because our omnipotent and narcissistic fantasies are constantly banging against the ceiling of reality. It also leaves us feeling drained and depleted, increasing our loneliness, dependence on others and need for company. We seek contact and set off on the cycle again. We are at grave risk of filling the emptiness with manic addiction to drugs, alcohol, sex, gambling or work, just as we responded with hyperactivity when pleasure-starved by unempathic care in infancy.
A sad example of a borderline personality was the television presenter Paula Yates, with whom I worked on a television series for six months in 1986 and who died from a heroin overdose in 2000. In her autobiography she described herself as ‘a mass of contradictions’ and she was someone who could change her ideas freely, apparently with no sense of self-contradiction. An ambitious careerist who worked throughout her own children’s early years, she said of working mothers, apparently without a hint of awareness that she was referring to what she had done herself, ‘If they do not stay at home the emotional well-being of the next generation is in jeopardy ...if you think you can give birth and skip back to work in a matter of weeks you are being at best irresponsible and at worst, selfish.’ On several other occasions she flatly contradicted herself in print, for example writing, ‘I never said that mothers should not work.’
Regarding her public image, she stated that, ‘My image in the media as a Mata Hari is nothing to do with reality’ and complained that she had been misrepresented. Yet those closest to her knew she was sexually promiscuous to an unusual degree, and prone to eroticizing all relationships with men. ‘Paula flirts with everyone,’ said her friend Sue Godley, and in practice she was eccentrically sexual in her dealings, especially with complete strangers. At our first meeting she walked up to the table and sat on my lap. I saw her do this to other men, too. Part of the intention was to create embarrassment and draw attention to herself. In my case she did it because I was a close friend of someone upon whom she relied for her living; she wanted me to like her in order to advance her career.
As a colleague, Paula was liable to be as egomaniacal as a toddler. Indeed, in many ways she never grew up and this may have been partly because, according to her account, her childhood was traumatic. She described herself as having been a ‘whining, whingeing, clinging child’ in a home ‘permeated with the scent of melodrama every morning’. The man who she thought was her father, Jess Yates, was a manic depressive TV presenter whom she loathed. Shortly before she died it emerged that her biological father was, in fact, another TV presenter, Hughie Green. Her exceptionally selfish and whimsical actress mother was rarely there, but the young Paula still missed her terribly. Her parents separated when she was nine. When her mother subsequently made a rare sign of acknowledging her existence by sending some presents, her deranged father threw them on the fire. Paula recalled that ‘Because of incidents such as these I hated being a child. I couldn’t wait to be grown up. No one should ever have to feel as powerless as I did as a child.’ According to her autobiography, she escaped into fantasy from this intolerable reality: ‘I had my own parallel world where the future was everything and the present meant nothing. I withdrew into my own internal world.’ The adult Paula still had a tendency to convert fact into fantasy, which on occasion spiralled to such a degree that she had to be admitted for treatment in a mental hospital.
Throughout her marriage to Bob Geldof she gave many interviews stressing how deeply in love they were. Yet those close to her knew that she was having affairs. Paula may partly have been just lying rather than fantasizing. She made extensive use of a public relations consultant whose job was to massage the truth for the media.
Her lack of consistency was typical of the borderline personality. Paula was engaged in a minute-by-minute struggle to make her life seem meaningful, for, instead of a stable, secure self, she had an insecure, shifting void. She tried to create meaning through melodramatizing her life, liable to feel she did not exist unless she was at the centre of a crisis which – despite protestations to the contrary – she liked the tabloids to chronicle because they made her feel significant. She tried to bolster her poor self-regard by associating with the famous.
Although Paula seemed to be aware of some of the ways in which her childhood affected her, she was powerless to avoid repeating the past. She saw parallels between the events that led to the end of her father’s TV career and her own. In both cases they were exposed by the tabloids as having had affairs, and because they worked on family programmes were cast out. She glimpsed other similarities to her father, yet none of this knowledge helped her to avoid his mistakes.
This was partly because she persistently dressed her childhood in flippant humour. By converting it into a ‘hilarious’ tale she distanced herself from it. Patients in therapy sometimes recount childhood events without recalling the accompanying feelings. Paula’s shallow glibness, evident in her autobiography, kept her at one remove from the emotions. As a result, despite all her awareness and vows not to do so, she did to her own daughters much of what had been done to her. ‘I’d always thought that people should stay married forever no matter what it was like for them,’ she wrote. Yet she was able to persuade herself it would be all right for her to leave her husband for another rock star, Michael Hutchence. She was probably blaming her external circumstances for an internal problem.
Sustaining any sense of coherence is a problem for all Disordered people, and a fundamental tactic for keeping reality at bay is called ‘splitting’. The world is divided into good and bad, black and white, expressing a crude psychology in which there is only us and them, for and against. Knowledge of different aspects of our experience is kept in separate compartments to avoid incoherence and provide certainties. For example, a wife-beater may seem to his colleagues at work to be a mild, charming, generous fellow. Through splitting, the ‘him’ at work may be totally unaware of the ‘him’ that beats his wife.
Deep down in many Disordered people lies a paranoid conviction that others are hostile and malicious. Yet this can be reversed at a moment’s notice by engaging in ‘idealization’, a conviction that others are benign and wonderful regardless of the evidence. Such processes are found in all three-year-olds, living as they do in a passionate world of extremes, but in adults they are perplexing.
‘Denial’ aids these mental operations, enabling the world to be cut up to suit inner reality. It is illustrated by the opening scene of the movie Big Deal at Dodge City. A woman is sitting on a bed doing a jigsaw when her husband comes in and notices that she has a pair of scissors. He asks what she is doing with them, and she replies that she is cutting the jigsaw pieces to make them fit. The Personality Disordered are constantly chopping up the noncompliant, complex and intolerably independent jigsaw of reality. It can be adapted to fit the needs of the moment but, like the woman using the scissors as a childish solution to her problem, in the end they are confronted with the incomplete puzzle of their lives.
Another way of getting rid of unwanted experience is ‘projection’ – attributing our own feelings to others. This is easily done by a person who has weak boundaries between Me and Not-Me. Instead of experiencing our own depression or anger, we simply attribute it to someone else and say, ‘Why are you so unhappy?’ or ‘What are you so angry about?’
Equally, we can remove ourselves from the situation through ‘dissociation’. At its most extreme, this is the strange sensation of being outside ourselves, looking in. It is often found in Wobblers, a pattern of insecurity very common in Personality Disordered people.
For such a fluid psyche or mind, the adoption of multiple personalities is easy. If reality is unbearable, a fine way to evade it is to be someone else. We often feel unreal and ‘unable to be myself’, uncertain as we are of who that is. Paradoxically, we may feel most real when pretending to be someone else, and even if we don’t gravitate towards acting as an actual profession we still make a good actor. We live our lives as if playing ourselves, rather than really feeling that is who we are. We recognize our passport photograph or face in a mirror as belonging to the person named on our birth certificate or passport, but for much of the time that person is someone we are pretending to be. This can make us a very adept mimic, able to switch identities with remarkable fluidity, just as small children can flit between one fantasy game and another. Often witty and charming when we first meet someone, afterwards we leave an indefinable sense of something being not quite right. We are an impostor impersonating ourselves, expecting someone to tap us on the shoulder and expose us as the fraud we feel ourselves to be.
I have interviewed dozens of politicians, TV presenters and business entrepreneurs with these As If personalities. For example, the disc jockey Tony Blackburn told me in a television interview that ‘I only feel myself when I am pretending to be Tony Blackburn, the disc jockey. I live for the daily two hours of broadcasting – you can forget the rest. I wish my whole life could be a live radio show.’ A more recent example is the TV presenter Michael Barrymore, at the time of writing hoping to make a comeback after a scandal involving the death of a man at his home. Speaking of his difficulty in living a life without regular TV appearances and unadulterated by heavy drug abuse, he states that ‘the only time I ever found true contentment or happiness is in front of an audience. The minute I came away from that environment and had to be me, that’s what I couldn’t live with.’
Jeffrey Archer, the novelist and former politician, whom I interviewed on TV in 1987, is another example . The interview took place shortly after he had won a libel case which, although exonerating him from consorting with a prostitute, had cost him his vice-chairmanship of the Conservative party. This was the second time that he had snatched disaster from the jaws of success, the first having been when he was declared bankrupt as a Member of Parliament and had to resign. I asked him why his career had been so full of boom or bust moments and, although he displayed little insight, one reply was revealing. He told me about a play in which all the characters had lost everything they cared about. ‘The duchess faints,’ he recounted, ‘the prostitute swears, the soldier shoots himself and the one who’s lost more than anyone else sits in the chair, looks straight at the audience and says, “Wonderful. Now I can start again.” And I think there is a little bit of that in me. When I reach a certain point I need to be driven – I need a challenge.’
Perhaps he does need challenges, but this could also suggest that Archer has a need to be found out: his feeling of fraudulence becomes so overwhelming that he longs to be exposed. For living a pretend life is lonely and unsatisfying. There is no real (a word which Archer used again and again in my interview with him) contact between you and others because all you are offering is a false self, a carapace. You feel a desperate longing for something real to happen, of which being unmasked is an example. That may explain the huge pleasure Archer took in the wealthy man’s ‘Wonderful. Now I can start all over again.’ It may have meant, ‘At last I can give up all this pretence and be someone authentic, if only for a brief moment.’
At the same time, there is often a huge desire in the As If personality to play games and to sustain the fraud – to get away with it, as so many of Archer’s characters do in his novels. This ploy, called ‘imposture’, can encompass revenge on people who live first-person lives and joy at having suckered them. Not far beneath Archer’s exuberant, Roy of the Rovers exterior is an infantile rage. It briefly exploded during my interview with him when, upset by my repeated attempts to find out why he was so self-destructive, he embarked on a peculiar rant: ‘I am by nature an enthusiast, I am by nature someone who wants to change things and do real things with my life, and when the petty, and the little belittlers go on decrying my feeble achievements – and many of them are feeble – I feel sorry for them because they’re not getting up and achieving something themselves. And I won’t become a cynic myself or become a belittler myself, running everyone else down to prove that I was really in the right. I was wrong [in his relationship with the prostitute Monica Coghlan], I made a mistake, I’m trying by hard work to get back and none of your psychological discussions on Channel 4 will change that – that is the way I am.’ In a more recent television documentary, his rage was even more evident. When the interviewer asked him a difficult question he completely lost his temper.
Archer may pretend to be the Great Novelist or Politician or Playwright, rather than actually feeling himself to be that person. For the As If, proving to the world that their fantastical version of reality is true, even when they know it is not, may become crucial for their mental health. Alongside their desire to be exposed, the As If often also want to force the rest of us to accept their fraudulence as real, because otherwise they will be conscious of how fake they feel.
In bringing a libel court case against the tabloid newspaper which exposed his relationship with the prostitute Monica Coghlan, Archer was taking an extraordinary risk, since we now know that he was lying. What he may really have been doing was trying to prove to us that our world is a sham and that his is real. By all accounts, the air of unreality at the trial was striking. A ‘fragrant’ wife (as the judge famously described Mary Archer in his infatuated summing up) with a loving, dutiful husband were portrayed, yet most of the press knew perfectly well that Archer had had at least one mistress and that it was all too probable that he had used the services of a prostitute. That made it all the more satisfying to Archer to turn reality on its head by getting a verdict which supported his Walter Mitty existence.
Of course, all of us are playful and engage in As If pretence – it is a vital sign of emotional richness. Children love to make believe that they are someone else, and as adults we often feel at our most alive when telling stories and putting on funny voices. By identifying with fictional characters in films and novels we can experience our emotions more intensely than in reality. Once, when I split up with a girlfriend, I shed no tears until months later when watching the Humphrey Bogart and Ingrid Bergman characters part at the end of the film Casablanca – a piece of fiction was more real to me than what had actually happened in my life. Escape into fiction and a regaining of power over otherwise inescapable reality is a prime motivation of creative artists. In all the arts there is an element of controlling other humans by engaging their emotions and forcing them to feel those that are difficult or moving – most often, the ones that artists cannot cope with themselves.
In Archer’s case, his novels and plays, with their cast of liars, conmen and charmers, are transparent attempts to live out in fiction what he would (or actually did) enjoy in real life; they are wish-fulfilments. He began scripting a play immediately after the Monica Coghlan story broke, and did the same as soon as his ambitions to become Mayor of London collapsed in 1999. In the play he even acted on stage the role of the accused, breaking down even further the barriers between his fantasy and his reality. Indeed, some of his words contain barely veiled accounts of his actual deceits, allowing him to sit back and enjoy the feeling that he has taken us in: not only did his lies remain uncovered in reality, but the reader has paid him money by buying the book that catalogues them.
One variant of the impostor type earns their living through criminal deception. This is the Machiavellian, ‘false self’ type – the psychopathic conman who assumes identities in order, for instance, to sell old ladies false insurance policies. Psychopaths are impulsive, greedy for sensation, prone to criminality and breaking norms of decent behaviour, and have a weak conscience. If we are psychopathic our emotions are not deeply felt. We do not experience guilt, remorse or empathy. Towards others we are promiscuous, manipulative, grandiose, egocentric, forceful and cold. In the popular imagination all psychopaths are drooling maniacs or cold killers, but in reality this is just the tiny minority who become serial killers or sexual criminals, some of whom are masters of disguise and take great pleasure in a game of evading detection. The great majority of the 2–4 per cent of Britons who are full psychopaths are not behind bars, and some of them occupy the most powerful positions in our society. For, although most Personality Disordered people have severe conflicts with authority figures at school and work, and personally unsatisfying professional and personal lives, the peculiar mix of traits involved means that a proportion are extremely successful.
The false self’s tendency to define itself externally can make people-pleasing, especially towards authority figures such as teachers, examiners and employers, a central principle. That can make for excellent exam results and accelerated promotion. Such people may also go to fantastic lengths to try to make their fantasies come true, to confirm their narcissism or omnipotence in reality, using actual success to gain the adoration and power they were deprived of as infants. The performing arts – popular music, stage, screen and TV – are choc-a-bloc with narcissists desperate for the next fix of public approbation to over-ride their rock-bottom self-esteem. Their infantile sense of worthlessness is matched precisely by their surface need to be recognized as the opposite. Being acknowledged as Who They Are by a stranger in the street confers identity and temporarily compensates for the sense of invisibility to carers that they had in infancy.
The ones who are more omnipotent than narcissistic may become power- and wealth-crazed politicians and businessmen, endlessly concerned to prove themselves, always restless and in need of further proof of their efficacy in succeeding over others or of a material wealth that disproves their inner poverty. No wonder we talk about promising, competitive individuals as ‘hungry’; a great many literally hungered to be fed as babies. A particularly telling example is the Formula One racing team owner, Frank Williams.
Very unusually for a living famous man, an intimate and reliable portrait exists of him by the woman who shared his life, his ex-wife Virginia. In the preface, she claims that her purpose in writing the biography was not to make money or to settle scores. She wrote it ‘as an exorcism’ and in the hope that he would read it: publishing was the length to which she had to go in order to communicate with him. Whilst Williams has never told his side of the story, and hers inevitably cannot be wholly objective, it seems to have been done in a spirit of love rather than one of revenge.
The picture that emerges is of a man unfeeling to the point of sadism. Here was a husband who loved to drive her home late at night through country lanes with the headlights off. Virginia writes, ‘I would shout at him to put the headlights back on. “I can go faster this way. I can see the lights of oncoming cars”, he would reply, unmoved by my shrieks.’ During their long courtship, she recalls, ‘I knew I must behave as if I regarded our affair as lightly as he did, if I were to avoid him haring off in fright.’ At first he refused to spend extended periods of time with her, but she gradually weaned him on to regular stays at her flat by doing his washing and cooking. However, she writes, ‘he would seldom warn me that he was due to leave for a trip until the morning and would make endless excuses as to why he couldn’t leave a phone number, so I was very far from feeling secure. I always hated him going away and often burst into tears, which he found hugely funny.’ Typically, after a few nights ‘suddenly, he would disappear for three weeks … [he] liked the company of women but he also seemed terrified of the power they wielded’. He confirmed this himself in a rare confession of emotion after their marriage, saying to her that ‘I’ve never been as scared of anything in my life as marriage.’
In accord with this, Williams found it as hard to give love as to receive it. Fifteen years passed before he gave Virginia a present. When it happened, she ‘was astounded. Frank had never given me anything in my life before. Present-giving was not a habit he had ever acquired.’
On the day of their wedding he rang the restaurant where they were supposed to meet first for lunch, to say he was detained by work and would see her at the registry office. As soon as the ceremony was over he said, ‘Okay, I’m off back to the office. See you later.’ When she had a son she asked what he thought. ‘Oh, I’ve seen him. I feel sick,’ was his only comment. Regarding the prospect of a daughter his observation was that ‘I can’t imagine anyone wanting a girl.’
Virginia learnt early on to expect sexual infidelity. ‘I discovered something unwelcome – Frank was a terrible flirt’, and before long she ‘had no illusions that I was the only woman in his life’. When Williams’s huge success came, ‘Frank had become enormously attractive to women.’ She believes that, for famous men, the lust of attractive women is ‘a spoil of victory’ to which they succumb and that ‘alas, I knew that Frank was unlikely to be an exception’.
The psychoanalyst Anthony Storr gives a brilliant account of the mind of such men in his book Human Aggression. Storr writes that ‘although they passionately long for love, they have so deep a mistrust that any really intimate relationship appears to them dangerous. Receiving love is humiliating or actually dangerous.’ They may seek to insulate themselves through high achievement but, writes Storr, ‘however successful he may be in the external world, love from another seems to threaten his independence and masculinity’. As a result, such men live in a perpetual dilemma. On the one hand, writes Storr, ‘to deny the need for love is to enclose himself in a prison of isolation and sterile futility’; on the other, ‘to accept love is to place himself in a position of dependence so humiliating that he feels himself to be despicably weak’. These observations are borne out in Williams’s case. At their final parting Virginia asked him, ‘Don’t you care, Frank?’ His reply was ‘Ginny, emotion is weak.’ She comments that ‘he never discussed his emotions or feelings at all’, so that as she left ‘he just looked at me without expression’.
The explanation for Frank Williams’s remote, cold personality is found in his earliest experiences. His parents separated shortly after his birth and he only saw his father a few times afterwards. He was never close to his mother, who was so out of touch with him, literally as well as emotionally, that, as young as three, he regularly wandered away from home, on one occasion being found by the police several miles away. Three was also the age at which his mother sent him to the first of a series of Catholic boarding schools. As if that were not sufficient maternal deprivation, many of his holidays were also spent away from her, farmed out to monks at a monastery. In effect he was like a child who had been taken into local authority care, and this is exactly the kind of childhood that creates the sort of person Anthony Storr describes. ‘Human babies are, for a protracted period, peculiarly helpless and unable to fend for themselves,’ he writes. If no one person meets their needs they end up desperately insecure and ‘however competent or powerful a man may be in fact, he still feels at the mercy of anyone whom he allows to become emotionally important to him’.
Above all, Williams used cars to protect him from such dependence and to turn the lead of his pathology into the gold of success. Virginia records that they, much more than any woman (including her), were his true love. According to his mother, ‘from his earliest days his heroes were drivers – people who could make wheeled machines do as they wanted’. He could not control the people in his chaotic childhood world, so he employed the controllable inanimate to replace the unpredictable intimate.
This account, of Frank Williams in particular and of Personality Disordered people in general, should not mislead us into believing that they are beings of a wholly different order from everyone else. All of us sometimes use the mental equipment described above and, when we are young adults or teenagers, more than half of us have Disorder either severely or mildly. Jokingly, but perhaps less so than we would care to admit, we may boast of our sexual or sporting prowess (grandiosity, narcissism). We may daydream about gaining total power at work or in bed (omnipotence). In intimate relationships we may confuse our own feelings with those of partners (projection) and initially blank out the truth when faced with intolerable realities (denial). All of us put on different faces to meet the faces that we encounter at work and play (false selves), and we enjoy adopting personae when telling jokes or stories (imposture). Nobody could survive without keeping numerous facts about themselves secret from other parts of themselves (splitting). Truly, ‘Humankind cannot bear very much reality’, and normal, mentally healthy people use these mechanisms to bolster and embellish their illusions.
It is interesting that, as we get older, our tendency to be Disordered decreases. An American survey showed that one third of young people had severe signs of the illness and one fifth had it mildly. Yet between the ages of 25 and 59 the proportions dropped dramatically, and by the age of 60 only 11 per cent had the full illness (with a further 17 per cent having it mildly).
Whilst there are clear differences in the degree and amount of Disordered psychic defences employed by Personality Disordered people compared with those who are mentally healthy, we can see signs of infant deprivation and specific weaknesses of sense of self all around us. Watch people waiting for a long-delayed bus or for their supper when it is an hour late and you will witness hyper and depressive reactions, albeit concealed beneath an adult carapace. Whenever we are in a high state of expectation about something we long for – hearing an exam result, going on a date or day one of a new job – the strength of our sense of self and capacity to tolerate uncertainty, with its attendant risk of feeling deprived, are put to the test. Carefully observe the normal dances of dominance and submission to be found in most workplaces and many homes, including a casual cruelty and pleasure at others’ suffering, a self-centredness verging on omnipotence and narcissism. The way we cope with adversities is hugely influenced by our earliest equivalent experiences. A baby waiting to be fed, or crying out to be held, or feeling too hot or too cold is in a state of extreme vulnerability, completely powerless and at the mercy of its carers. This was true of all of us once – and for all of us, too, there were times when the care we received was unempathic. The difference between Disordered people and the rest is only that the lack of empathy was greater for the Disordered and endured for longer, as illustrated by the scientific evidence directly linking early deprivation of empathic care with subsequent Personality Disorder.
Children who received no empathic care at all during their infancies and who survived are rare. There are 39 well-documented cases of children who were either raised by wild animals or given no care from humans beyond the supply of food. Their language development is nonexistent, they have no social skills and their personality is totally Disordered. Where such extreme early deprivation is followed by nurturant care there is some improvement in speech, intelligence and social skills as a result. However, the care does not reverse the damage to the self. Invariably, such cases are severely Personality Disordered with a weak sense of self.
Systematic study of the impact of infant deprivation began after it was first noticed that orphans in impersonal institutions suffered physical and mental harm. Even in sanitary and hygienic orphanages, the mortality rates were far higher than among children raised by their parents. Institutionalized infants suffered from ‘hospitalism’, comprising lethargy, failure to develop the most basic social and mental skills, and extreme susceptibility to infections and disease. No infants thrived under these circumstances and all were damaged permanently, suggesting that if there is such a thing as genetic resilience it cannot withstand the absence of care. However, infants in orphanages where relationships with individual carers were encouraged did far better. It was not the sensory deprivation of the cribs with no toys or stimulation that damaged the neglected babies, nor was it simply the absence of their mother. What was critical was having someone who knew the child intimately and understood his or her specific needs, capacities, idiosyncrasies and vulnerabilities. Babies who had this experience could survive a lack of sensory stimulation or could cope without their mother. So long as someone was empathic, the infant could always develop to some extent.
That these early experiences are linked to later Personality Disorder is strongly supported by the fact that at least half of men and one third of women raised in children’s homes suffer from it. Most revealing of all, the younger the child when poor parenting was experienced, the greater the likelihood of subsequent Personality Disorder. In one study, children were examined when in care and then interviewed years later in adult life. Many bad things had happened on the way to adulthood, from poor education via lack of supervision to being bullied, but one environmental experience above all others predicted whether they would be Personality Disordered: disrupted parenting before the age of two.
What is true of institutionalized children is also true of those raised by their own unempathic parents. John Ogawa and his American colleagues followed 168 children from birth to the age of nineteen, measuring the quality of the care they received throughout childhood. The sample, all of whose parents were at high risk of being depriving or abusive, had been selected to test whether early maltreatment correlated with problems in later life. In particular, the impact of early parental care on dissociation was measured. A distinctive sign of Personality Disorder, dissociation entails a variety of amnesiac mental tactics for evading painful realities, like not noticing or disallowing or forgetting or refusing to acknowledge. Dissociated people also escape from the present by becoming distantly absorbed in a single aspect of the inner or outer world, for instance gazing hypnotically at a pattern in the wallpaper or disappearing into a fantasy in the company of others. There may in addition be depersonalization, in which events are experienced as if by a third party disconnected from one’s own body or feelings. At its most extreme, the dissociated person may develop different sub-personae into which they escape – in some cases this is the precursor of schizophrenia.
For the first time, Ogawa demonstrated that the degree to which care was neglectful or abusive or disharmonious before the age of two predicted whether a person would be suffering from dissociation seventeen years later. Genetic factors appeared to play no part: the baby’s temperament after birth or at three months did not predict how he or she turned out. An accompanying report from the same study also proved that having a Wobbler pattern of attachment at two years old predicted later dissociation, and that it was the quality of early care which predicted both Wobbling and later dissociation. Despite the fact that an enormous number of influences intervened between the experience in infancy and the measurement of the nineteen-year-old personality, its substantial impact was proven. Those in the sample who were only maltreated after infancy, whether between the ages of two and four or in middle or later childhood, were significantly less likely to suffer dissociation at nineteen than those who suffered maltreatment in infancy: the earlier the maltreatment, the greater the likelihood of a symptom of Personality Disorder.
Ogawa was also able to explain why some of his sample were more likely than others to develop dissociation when faced with traumatic environments after infancy. A strong sense of self was crucial. If a child had developed a strong one early on, through empathic care, he was far less likely to become dissociated when faced by traumas in later life. Children who first suffered maltreatment after the age of five were much less likely to be dissociated at nineteen if they had an early strong self rather than a weak one. Being uncertain of who they are, the weak-selfed require less severe and less frequent trauma to make them doubt their reality, and, because their psychic boundaries are fragile, it is easier for them to make a dissociative escape from intolerable realities. The stronger-selfed can manage to remain themselves. This is suggested by another study which showed that twenty-two-year-old adults had a better quality of relationship with partners at that age – they had more insights about themselves and were more respectful of the other’s autonomy – if their mothers had been sensitive in caring for them during the first year of their lives. Whether sensitive or insensitive, the impact of care is laid down as electro-chemical brain patterns, evident in either a strong self or Disorders of it.
Ogawa also checked to see if genes could be responsible for dissociation: inherited, temperamental traits were measured soon after birth and again at three months of age. These traits were found not to predict dissociation at age nineteen at all, suggesting that genes played little or no part in causing it. Studies of identical twins also suggest this is true of many Personality Disorders – no genetic influence was found in one study of borderline personality, for example. By contrast, strong evidence (from over twenty studies) exists to show that, compared with adults suffering other kinds of Personality Disorder or other mental illnesses, Borderlines are more likely to have suffered childhood maltreatment – in particular, loss or separation from parents, being unwanted, and abuse and neglect from both parents. In one large study, 84 per cent of Borderlines had been subjected to some form of maltreatment from both parents, compared with 61 per cent of patients with other Personality Disorders. None the less, at least in theory, the cause of Personality Disorder could lie in the child’s inherited temperament. An infant could be born with difficult traits that would cause her parents to become unempathic. If she was born with a great reluctance to make eye contact, or was constantly irritable, or forever crying and never sleeping, a parent might give up the struggle to make contact and to understand life from that baby’s point of view. It is true that a baby has no physical power over her parent and cannot deliberately use her mind to influence the parent. But because most parents are highly motivated to do their best to keep the baby happy, a difficult baby is particularly distressing because the parents feel they are failing her. On top of this, it is also perfectly possible that babies with genes that make them difficult are more likely to have the sort of parents who themselves have a genetic tendency to be unempathic, a double whammy. Not only is the child born disinclined to connect with her parents, the parents are also that way inclined themselves: poor relating could be heritable from both sides.
These ideas have been investigated by measuring the difficultness of infants soon after birth and relating this to the way the mother subsequently behaves and the infant turns out. As noted in Chapter 4, the main finding of such studies has been that it is usually the degree of maternal empathy, not the difficultness of the infant, that determines what happens.
In writing these words, I am acutely aware of how upsetting, enraging or depressing they could be to the reader who is a mother and feels she has failed her infant. Yet I bow to no one in my appreciation of how difficult it is to care for small babies, and stirring up guilt or anxiety is the very last thing I hope to do. In fact, one of my objects is to make more people aware that most women are unlikely to experience a greater threat to their mental health than the first few months of the life of their firstborn. Between 10 and 15 per cent develop a full-blown major depression soon after the birth and about 25 per cent have done so by the end of the first year. For the remaining women who do not become actually mentally ill, caring for the infant in the earliest months normally produces dysphoria, a state of low grade, depressed mood allied to total exhaustion. In a recent survey of 1,000 British mothers, over half said their exhaustion left them in ‘a state of despair’ and highly irritated by their babies, four hours’ sleep a night being the average for those with small ones. Four-fifths of mothers of under-twos said the infant had placed their relationship with partners or husbands under ‘immense strain’, with rows commonplace; and two-thirds of the women had been ‘completely put off sex’. Whilst at times they doubtless also feel an unprecedented sense of fulfilment and achievement, until the infant has settled into stable patterns of sleeping and eating on a daily (and especially nightly) basis they will be liable to terrifying feelings of loss of control, periodically violent impulses towards their baby and chronic desperation.
Most people imagine that postnatal depression is a largely or purely biological misfortune, the flipping of a hormonal switch, but there is no evidence whatever that it has a primarily physical cause. Whilst all women’s hormonal levels alter during pregnancy and for a few weeks after the birth, no difference has ever been demonstrated between the hormones of mothers who become depressed and those of mothers who do not. By contrast, it is possible to predict with a fair degree of accuracy which mothers are most likely to become postnatally depressed by asking them about their psychological histories: it is the kind of childhood they had and their current circumstances, not hormones or genes, which predict postnatal depression. In most cases, it is the combination of these with the sheer hell of trying to meet the needs of the infant which tips them into depression. The fundamental problem is the total dependence of the baby, twenty-four hours a day, resulting in an equally total loss of autonomy in the mother. The great majority of mothers do not have someone else there at all times to help them out when the grinding relentlessness of meeting the infant’s needs becomes too much. Whereas in pre-industrial revolution societies people lived in extended families and there would always be sisters, mothers and other relatives on hand, all too often when the exhausted modern mother of a tiny infant is at the end of her tether there is no one available to share the burden.
Having money certainly reduces the risk of depression because it buys mechanical support (cars, washing machines) and the human equivalent (maternity nurses, nannies). In the definitive study of the subject, whereas nearly one third of the mothers of an under-six-year-old from poor homes suffered from full-scale depression, only 4 per cent of middle-class women did. But it is not only a matter of money. Women who breastfeed are at greater risk, since they get less sleep and producing the milk is tiring; likewise, women who lack strong intimate relationships, putting divorcees and single mothers in particular danger. So are those whose own mother died when they were young; and, if she is still alive, the risk is greater for those who have a bad current relationship with her or who did so when small (and are insecurely attached adults as a result). The sheer number of children is also a factor. Having three or more under fourteen, especially if one of them is under six, increases the risk. Even if the mother has survived the firstborn, trying to cope with a second or third newborn offspring is nightmarish when there is little support. The increased risk of having more than one child to care for is neatly illustrated by the simple fact that significantly more mothers who have twins, rather than singletons, are depressed.
All these factors, mostly predictable from before birth and many of them preventable if our society were better organized, affect whether the mother becomes depressed. But what about the baby – surely his difficultness is important too? Any mother who has had more than one will agree that they are all different, and this could provoke despair. In particular, during the first few weeks and up to three months about one fifth of babies cry more than three hours a day for more than three days a week; it is known as colic. In such cases, crying increases from about two weeks after the birth, reaching a peak in the second month. The infant has prolonged bouts of intense crying that are resistant to soothing, including feeding, and is fretful and fussy in between. Typically, these bouts occur in the early evening, precisely the time when the mother is at her most exhausted. The infant often clenches his fists, flexing his legs over his stomach and arching his back; he has a flushed face and makes grimaces; his stomach may be hard and distended, and he often has wind and vomits. Perplexingly, the crying bouts seem to have no obvious trigger and may end suddenly and spontaneously.
If ever there would seem to be an illness with a physical cause it is colic and yet, despite decades of research, no causal factor has been identified as present in colicky babies and absent in those who don’t have colic. On the contrary, the fact that it seems to be rare or even unknown in some non-Western cultures suggests it is not a medical condition, like a bacterial infection. Nor has the problem been linked to the kind of feeding method used, breast or bottle. The most respected authorities estimate that a physical cause exists in only about 5–10 per cent of the one fifth of babies who get colic. What is more, it is becoming increasingly clear that most, if not all newborns develop some symptoms of colic, and that the only distinguishing feature of babies labelled as having the illness is the severity and frequency of the bouts. Full colic is the extreme end of a universal spectrum. For the newborn it is probably a normal part of adjusting to using their stomach to digest food – having spent nine months using the placenta for nutrition – and to other peculiarities of life beyond the womb, like the need for stomach bacteria. Whilst there may be substantial differences in the degree of sensitivity newborns display to these new conditions, the evidence suggests that it is how the mother reacts to the baby’s inevitable periodic distress that is critical.
The first few weeks are a very delicate period in the mother’s life. She is emotionally fragile, vulnerable, yet the need to fit into the infant’s patterns feels like permanent jet-lag, with her sleep patterns going haywire. Worst of all, she is having to expect the unexpected as regards the baby’s patterns. Until the age of three months, and sometimes beyond, just when the mother thinks she has established a routine of sorts, the baby is liable to break it – no wonder the helplessness and despair of depression are provoked. None the less, if she has adequate support and is able to tolerate the chaos, a virtuous circle can develop, in which the infant senses her overall calmness and has its needs met with a good-enough rapidity and perception, so that by six or eight weeks he has settled into reasonable gaps of two to four hours between feeds and sleeps for much of the night, requiring one or two feeds.
But if the mother is unsupported and at risk of postnatal desperation, a vicious circle can develop – about as horrible an experience as it is possible for a human to have, because the mother’s mental pain is exacerbated by the sense that she is failing her infant. In this situation, when the baby displays colicky signs the mother is either unable to remain calm or simply ignores it, leaving the baby to cry, perhaps encouraged by a childcare manual suggesting she introduce strict sleeping and feeding regimes from birth. (In fact, the imposition of such patterns should not begin before two months and should be done only gradually.) Picking the baby up during the first two months has been proven to reduce crying – babies whose mothers carried them for three hours a day or more cry less at three and six weeks than those who do not. Close contact with mothers also promotes secure attachments, proven experimentally. Starting at birth, one group of mothers, randomly selected, were asked to use a sling regularly to carry their infant around with them, doing so at least 2–3 times a day, whereas another were not. At 13 months, twice as many (80 per cent) of the sling-carried babies were securely attached compared with the sling-less (40 per cent). What is more, babies whose mothers feed on demand and impose no rules before two months cry less at that age than mothers who do impose rules (but by four months the gradual introduction of regulated sleeping and feeding do help). However, once the infant has developed full-blown colic, often absolutely nothing works and the mother has to just ride out the storm. Carrying will not necessarily make any difference to the crying but it probably does give some solace.
The more that the mother can hand the ‘screaming brat’ – as he will seem at such moments – to someone else and grab a much needed nap, the better for all concerned. But if none of this is possible, the infant becomes increasingly distressed, the mother becomes more depressed, making her less empathic, leading to still further infant distress and so on. By two or three weeks into the baby’s life a hellish scenario is developing in which the mother is getting very little sleep and most of the baby’s waking moments seem to be filled with grimaces and screams. The vicious cycle is established and unless it is broken, it predicts problems later: three-year-olds who had infant colic are more liable to suffer from hyperactivity, temper tantrums and sleep disorders.
Given all this, it is little wonder that there is a direct connection between the degree to which a baby has colic and the mother’s mental health. Fully 50 per cent of mothers with extremely colicky babies are liable to have a mental illness. This falls to 25 per cent of mothers of babies with moderate colic and to just 3 per cent of mothers whose infant has minimal signs of colic. But which comes first – the colic or the mother’s mental illness?
Whereas no physical pathogens (germs) have been shown to cause colic, the mother’s history has been proven to play a part. In one study 1200 mothers were interviewed during pregnancy and again when their babies were three months old, at which point one third of them were diagnosed as severely or moderately colicky. Having a good relationship with a partner before the birth protected against colic. Also, if during the pregnancy the mother experienced a lot of stress, felt socially isolated and anticipated needing a lot of help after the baby was born, her child was more likely to have colic. For example, 25 per cent of the women who had no symptoms of stress during pregnancy subsequently had a colicky baby, whereas 70 per cent of babies did so if their mother exhibited five or more symptoms while pregnant. Since mother and baby are connected via the placenta, it is highly probable that the physical effects of this stress on the mother, such as raised levels of the stress hormone cortisol, are directly passed into the baby’s bloodstream, perhaps creating greater vulnerability to colic.
Other studies show that the mother’s relationship with her own mother and the kind of childhood she experienced affect whether the circle of mother–infant relationship is virtuous or vicious, the latter inducing colic. When asked during pregnancy or a few days after the birth, mothers who recall distressing childhood memories of their own, or expect a lack of support or excessive interference from their mothers, are more likely to have colicky infants. There is a real likelihood that some colic is transferred between generations not by genes but by problematic relationships between grandmother and daughter. At its simplest, this may consist of the grandmother teaching her daughter to care for the newborn in ways that exacerbate the colic, such as discouraging her from picking the infant up or from feeding on demand during the early weeks. Other grandmothers may be unable to provide support, reminded of their own grim experience of a colicky baby, leaving their daughters vulnerable to exhaustion and isolation. Alternatively, if the grandmother is still ‘enmeshed’ with her daughter, unable to allow her to function separately as an adult and still treating her as a child, she may interfere so much that her daughter is made anxious or becomes furious, preventing her from riding out the signs of colic that all babies show. All of this may be made worse by the fact that both mother and grandmother suffered unempathic care themselves, leaving them ill-equipped to provide it, reproducing the vicious cycle.
Of course, colic is not the only problem the baby can present to the mother. Immediately after birth, most babies are not difficult eaters or sleepers, not particularly moody, floppy, passive and so forth but they do vary in these respects. The reason has little or nothing to do with genes, as a fascinating Italian study of twins in the womb showed: variations in the prenatal experience are very considerable. Combined with the difficultness of the actual birth, this explains why newborns’ temperaments differ, insofar as they do. But the crucial finding is that, largely regardless of what a baby is like at birth, what determines what they are like at six months or twelve months is how their mother reacts to them. Nearly always, a difficult baby will be made less so if the mother is empathic and the converse also applies: an easy, relaxed baby will be made difficult by unempathic care. When mothers who have a ‘difficult’ infant are given help in learning how to care for them, they soon cease to regard their baby as a problem because its feeding or sleeping soon become better regulated.
Another way of examining the role of maternal care is to see how infants of prenatally disturbed mothers fare. Numerous studies of infants born to parents who are liable to be unempathic because they are depressed, abusive, alcohol abusing or cocaine using show that they are far less likely to thrive. It is estimated that at any one time there are no fewer than two hundred thousand children with heroin-addicted parents. Easy babies of such parents are far more likely to be made difficult, and subsequently to have Disordered patterns of relating, than babies of normal parents. In particular, it is now clear that children of severely maltreating parents are more likely to be Wobblers, and that Wobblers are more liable to become Disordered in adult life.
In the case of infants of depressed mothers, the unempathic care has been shown actually to change the infant’s brainwave patterns from healthy to abnormal. Long-term damage to the right brain occurs regardless of the infant’s initial temperament. When the brainwaves of infants of depressed mothers were measured shortly after birth and again at later ages, the patterns had changed in the offspring whose depressed mothers had been unempathic. This occurred regardless of the pattern with which the infant was born. Interestingly, even if the mother recovered from her depression in the child’s second or third year, the evidence of the damage to the child’s brain was still there. Pathological patterns of brain electro-chemistry are the physical and enduring effect of unempathic care.
Above all, if there are any difficult newborns who drive their mothers to mental illness, it only happens because the mother was already vulnerable. Thus, it has been shown that if a newborn is especially floppy, mothers at high risk of depression are more likely to develop the condition. They are particularly at risk of being pushed from gloom to despair by a difficult baby if they lack the social support provided by a partner or friends. In this very limited sense, infants’ neonatal temperaments can cause parents to become unempathic by triggering depression.
Of course, there may be such a thing as the baby from hell. Perhaps one in two thousand are born with only a minimal capacity to relate to their parents or anyone else. As the years pass it becomes apparent that, whoever had been their parents, these traits would have developed. No amount of empathic care would have changed them fundamentally and, given enough bad luck, almost any mentally healthy parent could be severely emotionally disturbed by such a child. Yet even in these cases, such as the illness autism, how parents respond makes a significant difference. Autistic children whose parents are helped to care for them in ways that are specifically attuned to dealing with their emotional deficits fare far better if the training occurs while the child is still only two or three. Usually the child will finish up being cared for by the state, but where the parents have exceptional commitment, resources and professional help it is possible for an autistic child to lead a relatively normal life.
Overall, there is no doubt that newborn babies pose a serious threat to the mental health of many mothers. As a society we do far too little to counter that threat. None the less, it is worth recalling that the average baby’s emotional state is almost completely dictated by the minute-to-minute, hour-to-hour, month-to-month level of empathy of its carers, whereas the average carer’s capacity for empathy is not controlled by an infant’s character. Two simple facts highlight this power ratio. First, three-quarters of babies have been hit by their parent before the end of the first year. Infants cannot hit parents. Secondly, the infant age group (under two) are four times more likely to be murdered than any other. Infants cannot murder mothers.
It is unempathic care, then, not genes, which creates a weak self biologically anchored in brain electro-chemistry, but subsequent care can alter the brain’s patterns. It can have an effect on whether the potential to become Personality Disordered is fulfilled and what particular form it takes – the degree to which it is narcissistic, addictive, psychopathic and so forth. So, to be precise, deprivation in infancy does not cause Personality Disorder; rather, it creates the vulnerability. The type of later childcare and family script that are experienced affect the extent to which the potential remains dormant or finds expression, and so does the kind of society in which the child grows up.
Of these various experiences after infancy, neglect and physical and sexual abuse in childhood are the greatest predictors of Personality Disorder. When asked in adulthood, about half of Disordered people say they suffered abuse – far more than non-Disordered people and more than people with other kinds of mental illness, like depression. People who suffered childhood maltreatment are four times more likely to have a Personality Disorder than people who did not. Indeed, it is possible that a few Disordered adults emerged from infancy with strong selves, only to have them weakened by atrocious subsequent childhood experiences.
Symptoms of Disorder, like dissociation, are ways of coping with intolerable circumstances. If a child is being beaten or sexually interfered with, dissociation is a good way to distance himself from the experience; so are many of the other defences commonly found in the Disordered. Denial (‘This is not happening’), omnipotence (saying to oneself ‘I can do anything I choose’ when feeling powerless) and narcissism (‘I am perfect’ when feeling worthless) will help the child evade the feelings of physical pain, fury, self-hatred, sadness and humiliation that abuse activates. Sub-personalities, which may develop into full-blown schizophrenia, are the ultimate escape mechanism (‘I am someone else, so this abuse is not happening to me’). Interestingly, among survivors of sexual abuse the age at which it was committed affects the number of sub-personalities that subsequently develop and the extent to which the self is fragmented. Children abused before the age of six have much larger numbers of sub-personalities and more chaotic selves than those abused at later ages. Similarly, the earlier and more severe the abuse suffered, the more likely a boy is to become a violent man. All of this strongly supports the idea that, since our ego is weaker when young and less able to cope with adversity, the impact of early experience is greater.
The life of the film director Woody Allen well illustrates the role of later childhood abuse in fulfilling a potential to become Personality Disordered that was originated in infancy. It is not only the characters that he writes for himself in his films that are Disordered; he exhibits many of the symptoms in real life.
Ordinary contact with ordinary people is painful and disturbing to Allen. Rather than exchange glances or a word in a lift with a stranger, he will turn to the wall or bury himself in a newspaper. He shrinks if he is physically touched by acquaintances. He has known for decades the members of the jazz band with whom he plays every week, yet he eschews all but the most functional social exchanges with them. The performance of comic shows is his ideal form of companionship. ‘I go up on stage, I tell my jokes, they laugh, I go home,’ he relates, for he regards others with mistrust and suspicion.
From as young as he can remember, through to his early forties, he was unable to go to sleep without a night light on and until he had searched through the whole of his home to check that ‘there were not any enemy there out to get me’. He is scared by any form of transport that he cannot directly control, be it an aeroplane, lift or train. He has a terror of being kidnapped and of being poisoned, unable to eat food unless it has been carefully vetted by an elaborate ritual. He will not use a bath – only a shower – for fear of dirty water. When he was married to the actress Mia Farrow and stayed for the first time at her country residence, he returned to New York because there was no shower. A special shower room had to be constructed exclusively for his use, and he always took his own food with him for the visits.
For Allen, relationships with women become painful when the sexual element grows into dependence and intimacy. Women who inspire these feelings in him are soon liable to be treated with malice and condemned as mad, bad or stupid. Stable, enduring love has been elusive to him, both his early marriages foundering within weeks. His comment about the actress Diane Keaton, whom he dubbed ‘the coatcheck girl’, illustrates his need to feel superior towards his wives: ‘When I first met her, her mind was completely blank.’ Of his current marriage to Mia Farrow’s adopted daughter Soon-Yi, he said, ‘The inequality of my relationship is a wonderful thing. The fact that I am with a much less accomplished woman works very well.’ Thus far, this relationship seems to have been the most stable.
His relationship with Farrow was the first in which he felt truly loved. Initially he was able to keep her at arm’s length despite the unprecedented sense of being nurtured, saying that ‘a relationship is always better if you do not actually have to live with the other person’. They continued to live apart, but gradually he was drawn into domestic commitment. Farrow had his first child but he felt far more involved with Dylan, a girl whom they had adopted together. Until then he had been voluble in his dislike of children but, knowing he was most beguiled by blondes, Farrow went to some lengths to find a fair-haired infant to adopt. For the first time in his life Allen showed real passion for a child, a passion which famously became destructive and distorted.
He lavished such massive attention and love on Dylan that the other children felt excluded. Sometimes he would chew her food for her so that it would be easier to eat. He encouraged her to suck his thumb and was witnessed massaging sun cream into the crack of her buttocks. When the authorities were brought in to investigate, seven-year-old Dylan claimed that Allen had touched her genitals on two occasions. The detective responsible for the criminal case declared unequivocally that there was sufficient evidence to prosecute, but would not do so for fear of the damage such a case would do to Dylan. The child psychologist whom Allen himself appointed to assess the relationship labelled it ‘inappropriate’. The conclusion of the Supreme Court examination of his plea for custody of the child was that Allen was a ‘self-absorbed, untrustworthy and insensitive’ father.
It is likely that none of this would have become a matter of public record had Allen not engaged in another questionable relationship – that with Soon-Yi, whom Farrow had adopted whilst married to André Previn. Then a needy nineteen-year-old, it seems that Soon-Yi deliberately sought to seduce him. Allen is genuinely unable to comprehend why succumbing to her advances should be regarded as inappropriate. Whilst not the girl’s father, his role in the household made him an authority figure; yet Allen consistently represents it to this day as a normal sexual liaison. Equally strangely, he was unable to discern the hurt it would cause Farrow, his partner of nearly ten years, for him to have an affair with her daughter.
It might seem surprising that a man who had had thirty years of psychoanalysis could act with such minimal understanding of the impact of his actions. But Allen is highly skilled at keeping others at bay, limiting both his knowledge of their feelings and theirs of his. A friend described him as ‘one of the most insensitive people I know’ and of his several psychoanalyses he said there had ‘not been one emotionally charged moment’. When one analyst persistently pressed him to reveal more and to cease withholding his feelings, Allen abruptly terminated the treatment.
Since the age of five Allen had immersed himself in feature film fiction, enjoying a secondhand life through the characters on the screen of his local cinema. Alternative personae have been the principal way of living his real life as well. Working seven days a week and making a film every year for the last twenty-five, he has devoted most of his existence to the creation and writing of the parts that he plays in his films and the narratives of these characters’ lives. For that small part of his life when he is not engaged in these fictions he keeps a distance from others through living his life As If he is himself, acting parts written by his immediate social environment. In 1996 he permitted a documentary film crew to follow him for sixteen hours a day for six weeks, complete with a radio microphone attached to him to record every utterance. After seeing the film a close friend was amazed that he had managed to act the part of a reasonable, decent, warm man for all this time without a single slip-up. He was acting a self that he wanted to portray, presenting it as his real self.
What it is like to change personae constantly is described in his film Zelig, summarized by his biographer as follows:
Set during the 20s and early 30s, the story purports to be a real documentary about Leonard Zelig, a man who so badly wants to be liked that he tries to fit in everywhere. Insecure and anxious, he can’t help assuming the personality, even the appearance, of people he meets. For example, contact with a black musician makes him change into a black musician; conversation with a psychiatrist transforms him into a learned doctor, and so forth. As a consequence of this miraculous talent, Zelig the human chameleon quickly becomes an international celebrity feted with ticker-tape parades and merchandised with board games and dolls, songs and dance crazes. At the same time, fame takes its toll and ‘the price he paid was being an unhappy, empty human being’, Woody explained.
Allen’s biographer believes this to be a straighforwardly autobiographical film: ‘Like Leonard Zelig, Woody Allen was a famous figure who, forced to battle the beast of celebrity, continued to feel like a poor lost sheep once known as Allan Konigsberg.’
If Allen does have an imposturous personality, there have none the less been some constants. From as young as he can remember he has been ‘pessimistically depressive’. His first visit to a therapist at the age of twenty-three was triggered by ‘a continual awareness of seemingly unmotivated depression’. Aged fifty-one, he was to say that ‘not a day goes past when I do not seriously consider the possibility of suicide’. However much he achieves, he feels such an intense sense of failure that ‘everything dissatisfies me’. When he discovered the technical term for an inability to experience pleasure, anhedonia, he immediately wanted this to be the title of his next film. His lack of pleasure and lurches between workaholism and depression are strongly reminiscent of the hyper and depressive coping strategies of the infant who suffers unempathic care.
Typical of the successful Personality Disordered, as part of their defence against feeling impotent and worthless they charm, bully or manipulate the world into accepting their fantasies of their own power and status. That is not to say that the high-achieving Disordered person does not earn his glory. Allen has been making films full-time, without weekend breaks, for a quarter of a century. But he is the first to say that his workaholism is a defence, saying that he works hard ‘so I don’t get depressed’. Earlier in his life he was motivated more by a simple desire for fame. A childhood friend says that ‘he had this powerful need to be recognized’ and Allen recalls having wanted to be famous at the age of thirteen. At sixteen, he was thrilled to see his name in a national newspaper for the first time when a one-line joke was published by a columnist. It was only in the last two decades of the twentieth century that he came to loathe the attention that fame brings.
The childhood experiences that caused this complex and Disordered personality illustrate the importance of events after, as well as during, infancy in fulfilling the potential for Disorder created during it. Allen was born and raised in lower middle-class New York. His father Marty had a peripatetic career until he finally settled into a job at a nightclub. He was a benign, laid back character, in marked contrast to his wife, Nettie, who was liable to fly into a temper at the slightest provocation. As a result, there was a state of almost perpetual warfare between husband and wife. For most of their son’s childhood they lived in very cramped accommodation, and Allen recalled their daily disharmony being ‘there all the time as soon as I could understand anything’. Although he had a sister eight years his junior Allen was the particular focus of his mother, who was probably depressive as well as aggressive. According to Jack Freed, a boyhood friend, ‘His mother had a hot temper and was always taking a whack at him. Whenever he got her goat, she’d start howling and yelling before taking a good swipe at him. If my mother hit me that hard, I’d have run away crying, but he never cried. He had an amazing ability to restrain his emotions. His mother couldn’t control herself at all.’ Another boyhood friend described her as ‘extremely naggy. Sometimes Woody couldn’t take it and would say very cruel things.’ Years later, in 1986, Allen was to confront his mother about her use of corporal punishment. After a great deal of testy refusal to accept that her care had been in any way inadequate she eventually acknowledged that ‘I wasn’t that good to you because I was very strict, which I regret. I was much sweeter to Letty [his younger sister] than I was to you.’ So in his family script, Allen was the recipient of his mother’s negativity.
Possibly the only way he might have pleased her would have been through conventional achievement. She was incensed by his refusal to take school seriously and impressed upon him the importance of work and success. ‘Don’t waste time!’ she would yell. She sent him to a Hebrew school and from a young age he was indeed immensely industrious – but only in activities he had chosen himself, such as learning magic, playing the clarinet or selling jokes to newspapers.
According to his mother, he had a sweet, happy-go-lucky temperament until about the age of five, only to become sour and antisocial overnight. His sadness made no sense to her. He became obsessed with death, and as young as six years old tried to imagine in minute detail what it would be like to die, which left him desperately depressed.
From this brief account we could make some plausible guesses at linking Allen’s childhood experiences with his adult personality, taking into account the evidence of the role of family scripts and parental aggression in causing childhood depression. But the most important factor may have been his very earliest care. Precisely what it was like during his first six months is not known, but there are some strong clues. His biographer describes his infancy thus:
Shortly after the baby’s first birthday, Nettie found work as a book-keeper for a Manhattan florist and began travelling back and forth to the city every day. Her son was tended by a succession of caretakers, mostly ill-educated young women who desperately needed the money and were not terribly interested in the finer points of early childhood development. As Woody later recollected, they invited friends to the house and sat around gossiping all day while he played by himself … In the evening when his mother returned from work, she had little time for reciting bedtime stories. When he got on her nerves, which was frequently, she wound up spanking him. As a result, he grew up believing that from the cradle he had been unwanted. Nothing would ever convince him otherwise.
Whilst we cannot be certain from this account how good a relationship he had with his mother during the first six months of his life, the likelihood is strong that it was poor. Studies of mothers who share Nettie’s personality – aggressive and abusive to their offspring, as she is known to have been since Allen was one year old – show that they are rarely able to be empathic to their offspring before that age.
Given that a strong potential to develop Personality Disorder was created by this type of infancy, Allen’s subsequent abuse and neglect ensured that the potential was fulfilled. Such a rancorous home may explain his thin-skinned dislike of contact with humanity and his enduring expectation that other people will be hostile. Repeated physical abuse at his mother’s hands would have reinforced this feeling, as well as making him an angry person with the potential for malice and destructiveness that he was later to show to his lovers. Such unhappiness may have driven him to escape into private fantasies and to live much of his life through fictions, not just as a fanatical movie-goer but in his second-by-second experience of himself, dissociating himself from an intolerable present and encouraging As If, imposturous living. His mother’s aggressive–depressive negativity towards him may account for his depressive tendencies. No praise, no unconditional love, no simple warmth and affection are a recipe for low self-esteem. Feeling so unimpressive and worthless could also fuel a desire to be recognized through fame. Her sense that nothing he did was ever good enough could explain his joylessness, his inability to experience pleasure and his impregnable sense that he was a failure, however many Oscars he was awarded. That the only possible means of gaining her approval was achievement could help to explain his drive to succeed and to work hard.
Woody Allen’s life shows the importance of experience after early infancy in fulfilling a potential to become Disordered. It may also illustrate the role of society in fostering or suppressing it. The number of people suffering from Personality Disorder varies from nation to nation and between historical periods. Someone who had experienced Allen’s childcare in France would be less likely to have been so Disordered. New York and Los Angeles probably contain the highest concentration of Disordered people anywhere in the world, and North America is the most Disordered continent. Riddled with crime, it has fully four times more convicted psychopaths per head of population, and they are far more likely to exhibit callousness and lack of empathy and to be glib, and prone to superficial charm and to grandiosity. This is likely to be true of the normal population. Individualist American culture, largely through the effect of television, strongly encourages grandiose and selfish behaviour; cultures in developed nations which prize community and collectivism, however, such as Sweden (which has half as much Disorder as the USA) and Japan, with their lower crime rates, have the lowest proportion of psychopathic people in the general population in the developed world. In the even more collectivist nations of India and China, surveys show that only one in one thousand suffers psychopathy, compared with twenty to forty per thousand in much of the developed world.
Such large variations between nations strongly suggest that genes play little role in causing the illness. Japan is a particularly telling example of the way that infantile experience and social order together, not genes, determine its prevalence. Japan is one of the few developed societies in which empathic infantile care is regarded as indispensable. Until very recently, almost all Japanese infants were raised exclusively by their biological mother, with tremendous attention paid to meeting their every need. If there was ever a society organized to provide the kind of empathic care which should create a strong sense of self, this is it. Given that Japanese children have so much better-quality early experiences than the average American infant, half of whom are given over to often inadequate substitute care before the age of one, they should also have much lower rates of Personality Disorder. And so it seems: certainly, even today, Japan has very low rates of crime and drug abuse amongst its young people compared with America. However, Japanese mothering cannot take all the credit. It is likely that the social system, too, reduces the probability of those relatively few Japanese who suffer infantile deprivation or abuse, and who therefore have the potential to be Disordered, actually expressing it. Japan provides a sense of order and connectedness that is largely absent in American society. As this order has gradually diminished over the last quarter of the twentieth century, with the colonization of Japanese culture and mores by America, so crime and drug abuse among the young have increased. However, their very solid early infancies may mean that they never develop American rates of Disorder, especially psychopathy.
The most fundamental of the numerous destabilizing trends that scar America is the shift from a collectivist to an individualist society. In the collectivist system, identity is ascribed on the basis of family ties preordained by birth. People put the group’s interests before their own, and the erasure of hedonistic and selfish desires is valued. The cardinal virtue is sensitivity to the potential impact of one’s individual actions on others. The collectivist teenager is discouraged from cutting loose from the family, which is often large. Obedience, reliability and approved conventional behaviour are fostered, and rebellion is quickly stifled.
By contrast, in the individualist cultures to be found to a greater or lesser degree today in most developed nations, but epitomized by America, identity is achieved through education and occupation, in open competition in a supposedly meritocratic system regardless of gender, class and race. In such societies, the self is defined by reference to inner feelings and thoughts rather than to external and preordained social roles. The goal of the individualist is to express himself, whether through hedonism, achievement or consumerism. In order to realize the achieved self, he must break away from ascribed family roles. The adolescent must seek out new ties and become part of many networks – school, university, profession – to which he has divided loyalties. Families are small, and parents see their job as being to foster self-reliance, independence and creativity.
For those who had empathic, unabusive childhoods, and therefore have a strong self, the individualist society presents an opportunity for self-expression never previously witnessed throughout history. But for the large numbers of children with a weak sense of self, the cornucopia of choice and constant demands for self-definition are severely destabilizing. As they grow up they are required to face the tasks of life without the aid of accepted, durable traditions. The strain of making choices from discordant standards and goals besets them at every turn. These competing beliefs and demands, inflated by aspirations stimulated by consumerism, reduce what hope there may have been for a weak-selfed person to develop internal stability. In a society where families are increasingly falling apart, schools are constantly being changed as parents move home, and grandparents, teachers and church leaders no longer provide an alternative, children have no stable models. Where once there were powerful social institutions and conventions that could vitiate the effects of Disordering childcare, today there are many fewer. This has been proven in a study which measured increases in anxiety levels among American young adults and children between 1952 and 1993. Anxiety levels rose steadily during that time, to such an extent that the average level of a normal child today is the same as that which was found in children who had been sent for psychiatric treatment in the 1950s. The causes of the rise were shown to be the increase in social disconnectedness, arising from such trends as high divorce rates and more people living alone, and the rise in feelings of being under threat, such as from violent crime. Just as depression has increased up to tenfold since 1950, so it is with anxiety, and the fabled American way of life seems to be playing a big part. What is true of these mental illnesses is almost certainly true of Personality Disorders, such as addictions, as well.
Unfortunately, the disturbed children most in need of structure are precisely the ones most likely to abuse mind-blurring drugs and alcohol. For those with a strong self these explorations are not dangerous, but for a weak-selfed person desperately in need of reliable and exciting sources of satisfaction stimulants seem a godsend. Those who least should be taking drugs which reduce realism and encourage childish fantasizing are those most attracted to it. One study, which followed 101 Americans from the ages of three to eighteen, illustrates this well. Those teenagers who had used drugs, but only moderately, were actually the healthiest at eighteen. Both frequent users and those who had never taken them at all had significantly worse relationships with their peers and higher levels of emotional distress such as depression and anxiety. Right from the beginning of the study, these two groups had both been more disturbed and suffered bad relationships. The way their parents had related to them caused their pattern of drug use, whether they abused them or abstained. Compared with those of occasional users, abusers’ parents were observed to be cold, critical, pressuring and unresponsive to their child’s needs. In the case of the abstainers, their fathers had been autocratic, authoritarian and domineering. The researchers actually concluded that moderate marijuana use was an indicator of mental health.
Nowhere are the risks for the weak-selfed more startlingly evident than in America. Because of its enormous gulf between rich and poor, one quarter of the population live in almost Third World conditions, with minimal health care – the more unequal the state, the greater the health deficit of the citizen. Slightly less than 2 per cent of the 260 million population are imprisoned by the state at any one time, mostly in appalling conditions (as it happens, about the same percentage as were incarcerated in the old USSR; where once that totalitarian regime was the focus of attention from the human rights movement, now it is the US prison system that is being targeted by Amnesty International). Nearly half of American infants under the age of one are placed in some kind of daycare, much of it of a kind liable to induce insecure attachment. These are conditions for creating widespread Disorder (as well as the Wobbler pattern of attachment) and, not surprisingly, the American version of individualism is very different from that found in Europe. The selfishness, greed and shallowness that were healthy adaptations to the tough conditions of much of the world for much of history are also appropriate in modern America, and are valued there. By contrast, European individualism is based far less on historical precedents, and is encouraged within a civic, collectivist context.
If a comprehensive study were carried out following several thousand people from birth to death (as opposed to the 168 in Ogawa’s study, the best that currently exists), I believe it would demonstrate the crucial role of unempathic care in infancy in causing Personality Disorder. Very few of the most severely deprived infants would not develop it. Virtually none of the infants who had very empathic care and strong selves would become Disordered, even in the face of severe subsequent maltreatment. However, if the self was only strongish, the more unempathic the care the more symptoms would arise, and the more that subsequent childhood abuse would trigger them.
Studies would show little or no significant differences between the genes of the Disordered and the non-Disordered. Nor would genetic differences between races or nations be found to influence rates. Above all, in comparisons between developed nations the degree to which a social group has an American style of advanced capitalism would predict the extent to which those who had been made vulnerable to Disorder by their childhoods would fulfil that potential.
The practical implication of such findings would be to focus on creating a more child-friendly society in which mothers and their infants were given every possible assistance and encouragement, especially during the first six months. Unfortunately, a major impediment to such a change may exist: on the basis of meeting many of them, I have come to the conclusion that a disproportionate number of leaders and chief communicators in our society suffer from Personality Disorders, or symptoms of them; they are often unable to acknowledge the dependence of children on parents or increasingly, of citizens on states.
Many of the traits that accompany Disorder are also an advantage in reaching positions of power. Being a chameleon, with the self-monitoring, game playing distance which often accompanies dissociation, has been shown to enhance career success in organizations. If concealed well enough, an omnipotent drive to control others can motivate the industriousness that is so vital to success. Few people are prepared to work in the evenings and weekends, but people such as Woody Allen or Frank Williams who find intimacy painful actively prefer work to domestic life. Ruthlessness is easier if you lack empathy for the emotions of others, as borderline people often do, and being ruthless is usually necessary if you are to reach the very top. These traits are mostly developed in early infancy as ways of coping with unmet emotional needs. The Disordered are the last people to want to acknowledge that they have such needs or that others have them, because it would make them feel lonely, angry and depressed.
There is no obvious solution to this problem. To run a large business or government department requires extremely hard work, and it may even be that the Disordered are the best equipped to make what to others would be a sacrifice of their personal lives. Perhaps the best hope is to persuade leaders that creating a child-focused society is actually the most cost-effective way to manage our affairs. Certainly, there is good evidence that spending money to help parents do their job better saves a great deal in the longer term. One American scheme proved that for every dollar spent in improving the quality of care and education of a group of deprived children in early life, six dollars were saved, in terms of reduced expenditure on crime, mental health services and unemployment benefits, when they grew up.
The link between our infantile care and subsequent sense of self is ghostly: it is there, but we cannot see it. Yet it has played a vital role in the chain of connections that explain us. By the end of childhood, not only do we have a more or less strong sense of self but the security of our relationship patterns varies too, as do the weakness or strength of our conscience and role in our family drama. In theory there are dozens of permutations, but in practice some combinations are more common than others because parents, whether responsive and empathic, or the opposite, tend to stay that way. People with weak selves and Personality Disorders as a result of unempathic care in early infancy are also liable to be insecure Wobblers, and both are liable to have a weak conscience because their parents consistently maltreated them throughout childhood. Conversely, the strong-selfed tend to be secure and to have a benign conscience, the most mentally healthy that it gets, because their parents were always responsive and authoritative.
Of course, there are plenty of exceptions to these rules. Some of us had empathic infancies followed by insecurity-inducing toddler years followed by authoritative subsequent care. Parents can change. They can get depressed, go back to work, fall out with each other – any number of shifts can mean that the care we receive differs from one stage to another. Futhermore, as parents we all vary in the degree to which we find different stages of childhood appealing. Some cannot get enough of tiny infants, endlessly intrigued by the strange psychic place that they inhabit, and find the fascination with facts and the rumbustiousness of middle childhood less congenial. Others are left cold by infancy and adore toddlers, with their vivid fantasy lives. Still others do not really connect with children until adolescence. Many parents are so wrapped up in the adult world that they cannot easily plug into childhood reality, finding it repetitive and unstimulating. Their response is to accelerate the pace at which childishness is replaced by adult capacities – a concern with education, education, education that can diminish creativity.
Having reached the end of this chapter, after completing the audit below (if you have decided to audit chapter by chapter) you will be ready to apply the evidence of this book to yourself: the subject of Chapter 6.
If you do have a weak or weakish sense of self and symptoms of Personality Disorder, one of the symptoms may be a lack of self-knowledge which will make it hard to realize that you have these problems. One way around this may be to think of someone who you suspect does have them.
Picturing this friend or acquaintance or colleague, ask yourself if they are especially prone to any of the psychological defences described in the section on Personality Disorder (p. 193).
• Omnipotence: Are they a ‘control freak’, or someone who likes to feel they are powerful and dominant, or someone who hates being bettered in arguments, or given to fantastical ideas of what they can achieve?
• Narcissism: Do they find it hard to talk about anyone other than themselves, only really relaxed when the subject is them or a matter about which they feel expert? Do they tend to exhibit an inflated sense of their own importance?
• Denial: How do they cope with unpleasant truths or bad news? Do they tend to forget they told you they were going to do something for you, or not to recall awkward facts or acts from their past?
• Projection: Are they liable to attribute feelings to you which you do not have – do they pressurize you to feel things you do not feel? Do you tend to leave their company in the grip of uncomfortable emotions or a sense that you have been emotionally ripped off?
• Dissociation: Do they sometimes feel very ‘out of it’, as if they are not really there, perhaps gazing off into space, not having noticed that several minutes have passed, as if in a dazed, shocked state? Do they seem to find it difficult to concentrate on what you are saying to them? Do they have sub-personalities – are they very different people in different contexts?
• Imposture: Are they skilled at imitating others’ voices or gestures? Do they enjoy acting, perhaps seeing life as a game?
• False self or Machiavellianism: Are they devious, so that you have witnessed them put on an act deliberately to deceive someone? Do they prefer to skate on the surface of life, artificial and superficial in their intimacies?
You can see that the person you are picturing has some of these characteristics, but do you not as well?
Another way of trying to penetrate your possible reluctance to see these things in yourself is to consider how ‘normal’ you are. Psychiatrists have four main criteria for defining Disorder. Try these out on yourself:
• Do my moods often seem at variance with what is generally considered normal. For example, do I feel things more keenly than most? Do I have spectacular, unpredictable rages?
• Are my thoughts often of an unusual kind? For example, do my colleagues think that I am not just a lateral thinker but that my ideas often seem downright weird, likewise my friends?
• Are my relationships unusual? Is my love life distinctly odd by most people’s standards? Do I dip in and out of friendships exceptionally often?
• Am I impulsive, perhaps prone to sudden bingeing on food or shopping, perhaps liable to lash out for no reason that even I can fathom, perhaps given to astonishing U-turns in my decisions?
• Have one or all of these tendencies been present for as long as I can remember?
A way of checking whether any of these apply to you would be to ask the most normal person you know to go through this list. But be aware that you may tend to seek out the company of abnormal people, so don’t simply ask your best friend.
Even more than the causes of your pattern of attachment, identifying what created your sense of self depends on other people’s accounts of your early infancy. How empathic your care was at that time may be hard for your mother to think about accurately, especially if she provided the sort that results in Personality Disorder – for instance, if she was depressive or drank a lot. The best approach will probably be to ask what sort of baby you were – a good sleeper? a good eater? prone to crying? liable to illnesses? If your mother was herself Disordered, she may find it easier to recall what you were like than how she related to you, but in doing so she may convey how much she tuned into your unique needs. If she attributes a lot of negative qualities to you in your infant days, that may be a clue that she was not in a good frame of mind herself. Of course, it could be that you were a Baby from Hell, but this is very rare – it is more likely that she is projecting on to the infantile you the way she was feeling at the time.
Another important clue to what went on in your first six months can be gleaned from refering to the questions in Method 1 of the audit at the end of Chapter 4 (p. 181). For example, if your mother suffered a serious problem shortly before or after your birth, like the death of one of her parents or a divorce, that could have severely diminished her capacity for empathy.
Easier to recall is whether you were abused or severely neglected in later life, although even this can be difficult to admit to if you feel protective of your parents. If you do recall being belittled, ignored, attacked or humiliated, this is a strong clue that you were also maltreated in early infancy. The sort of parent who does this to older children is also more likely to provide unempathic infantile care.
Direct, conscious memory of early experience is inaccessible, for the simple reason that it predates our acquisition of language. Once we can label events with words it is far easier to recall them, but from the time before that we have only a flow of sensations which we are unable to order or control with the thought that language makes possible. For this reason, the search for evidence about your earliest experiences in your present-day life must focus on the nonverbal. Two very basic areas are your attitude to food and to time:
• Food: Would you call yourself a hungry, greedy person, prone to overeating, insatiable? If so, this could be because you were not fed when you needed milk as an infant – your mother was not attuned to what you wanted. Equally, having been cared for like this could have made you someone who denies hunger pains altogether, so that you don’t eat enough or are a very erratic eater.
Another clue is your attitude to being fed by others. Perhaps you are exceptionally uneasy about being kept waiting for food, or always have to be the cook, or are extremely particular about what you will eat, having very strong dislikes of whole categories of food – no meat, say, or no fish or dairy products. Control over food is at the core of anorexia, but to a greater or lesser degree many of us have a strong desire to determine what or when we eat. This dates back to patterns of breast or bottle feeding in our first few months.
• Time: Extreme punctuality or its opposite, or very strong feelings about these in others – passionate dislike of their pattern, be it punctilious or not – may tell you that you were kept waiting a lot in infancy by unempathic care. The infant’s sense of time exists as a sensation of hunger or non-hunger, feeling cold or having that feeling removed by nurture, feeling lonely or the end of that feeling, and so on – it is very basic. But we all continue to experience these things as adults. How you react to being kept waiting, to minor illness or aches and pains, to living alone or not, are all heavily influenced by your earliest experiences.
You may detect signs that you suffered unempathic care if you are intolerant of being kept waiting, either by others or by your body. Extreme impatience at the smallest frustration, like a cold that does not clear up immediately or a delayed train, are the most obvious signs. However, some deprived people deal with it by becoming extraordinarily immune to frustrating events. Through denial or dissociation they ignore their bodies’ signs that they are in discomfort. Yet these same people may amaze you occasionally by infantile bursts of rage at apparently insignificant events.
The strongest single sign that you had unempathic early care is if normal dependence on others, or of them on you, is your worst nightmare. To have to rely on someone else for love or food or sharing of recreation is hell for a person who had unempathic care, because it re-creates that very early experience of being kept waiting.
This completes the emotional audit which this book offers. It is now time to put it to use.