We are all, I hope, conscious of how much mental health has recently entered the national conversation. We are now more aware than ever of the prevalence of mental illness among the population. Issues of suicide, self-harm, declines into illness-induced drug and alcohol dependency, working days lost, friendships, families and educations blighted – these have all been ventilated in the press, online and in documentary, biographical and fictional representations everywhere. Schools, human resource departments and government agencies are more alive than ever to the need for destigmatization, understanding and help with the enormous burden that mental health places on the public purse and on public happiness and well-being.
It is an urgent crisis and, while the fire-fighting aspects of diagnosis and treatment remain supremely important, we cannot forget the need continually to parse, construe and comprehend the language and meaning of mental illness. In the USA the Diagnostic and Statistical Manual of Mental Disorders (DSM) has attempted to categorize the subject into a kind of taxonomy, much as we categorize plants and animals, dividing extreme and distressing mood swings, for example, into the diagnoses of cyclothymia or bipolar 1 and 2, and famously attributing to autism a ‘spectrum’. The DSM stands as much as a kind of bible and manual for law courts, industrial tribunals and the insurance business as a genuine revelation about the meaning of illness. All well and good, but labelling reveals more about the state of society than the state of the human mind: a butterfly will flutter by just the same whether you call it a pretty creature, a Monarch or Danaus plexippus. Naming is important but can sometimes block rather than aid comprehension.
One division of mental health conditions that the general population has picked up on is the apparent distinction be-tween mood disorders and personality disorders. Those of us who, like me, have suffered from the effects of bipolar disorder like to congratulate ourselves on the purity and constancy at least of our personalities. The illness, we say to ourselves, is like the weather. It comes from outside of who we are. We might be made alarmingly enthusiastic, exuberant, grandiose and overconfident when in the grip of elevated moods, or grumpy, silent, morose and pessimistic when depression descends on us like a leaden cloud, but inside we are ourselves, all right and tight. Personality disorders – that is, what the boogeyman suffers from – they are dark and dangerous territory. To be told we suffer from such threatens our sense of self and the very ownership of who we are.
We know too much, alas, about how character, disposition and behaviour can be apparently turned upside down by trauma or infection to the brain to be confident that there really is some stable enthroned entity called a personality, which, unlike the liver or skin, for example, stands gloriously immune from degradation and disintegration. But what is it? What marks out a personality disorder? Is it what might have been called a character flaw or moral degeneracy generations ago? The term personality disorder (accompanied by such ascriptions as ‘passive-aggressive‘ or ‘narcissistic‘) can be hurled as an insulting grenade at people whose ideas and behaviour threaten or annoy us – look at how President Trump at the time of writing is characterized. Are such distinctions and classifications useful or meaningful? If so, how do they help us towards treatment?
So many questions are raised by this subject and yet the fear raised by the greater stigma and apparently sinister aspects of personality disorders has meant that they are much less readily discussed and demystified than other forms of mental illness. Now at last comes this exceedingly helpful and instructive book. Professor Peter Tyrer has really let in the air and the light and discusses the many aspects of personality with just the kind of clarity and authority that will be most useful to the general public and health professionals alike. The language he uses is clear and comprehensible; the ideas he raises will live with you for a long time.
Stephen Fry