Search

The prevalence of personality disorders seems to be increasing in the last decades. Many sociologists and historians believe that since the end of World War II, we have seen important changes, social, cultural and economic, which could indicate that we are entering a new age. The Postmodern Age, after nearly 500 years of Modern Age. Postmodernits is characterized by an increase of the speed in all realms of life, permanent changes, materialism, dominance of capitalism as economic model, changes of roles, etc. We speculate about the posibility that the characteristics of postmodern society may be contributing to the increase of prevalence of personality disorders in general and some of them in particular.

The authors make available in this paper the text of a previously unpublished letter by Freud, probably addressed to the founder of British ecology and his former patient, Sir Arthur Tansley, F.R.S., dating from 1932, concerning the treatment and later life of 'Anna O.', the first psychoanalytic patient. They give the full text of Freud's letter as discovered, and offer a brief commentary on its significance as evidence of Freud's view or views of Anna O.'s treatment, case-history and later life. The authors compare the view of Anna O.'s treatment and later life with other sources, in particular Freud's roughly contemporaneous letter to Stefan Zweig. The letter's principal novel formulation is to be found in the phrase 'a cure with a defect', with which Freud characterised Anna O.'s experience of her treatment with Breuer.

This year, the centennial of Ernest Miller Hemingway's (1899-1961) birth is being celebrated. He committed suicide on July 2 1961, thus ending a crowded and turbulent life. He published seven novels and a number of short stories during his lifetime; four novels were published after his death. Millions of copies of his works have been sold and he is still one of the world most read authors. His simple, matter-of-fact and compressed style has had great influence on other authors. There has been enormous interest in the life and works of Hemingway. This paper addresses this interest and various aspects of Hemingway's life and tries to offer some explanations by looking at Hemingway's medical history, using some psychoanalytical approaches to his life and work.

It has been proved that Adolf Hitler suffered from idiopathic Parkinson's disease. No indication for postencephalitic parkinsonism was found in the clinical symptoms or the case history. Professor Max de Crinis established his diagnosis of Parkinson's disease in Hitler early in 1945 and informed the SS leadership, who decided to initiate treatment with a specially prepared 'antiparkinsonian mixture' to be administered by a physician. However, Hitler never received the mixture, this implies that the SS intended to remove the severely diseased 'Leader'. Two different character traits can be analysed in Hitler's personality: on the one hand the typical premorbid personality of parkinsonian patients with uncorrectable mental rigidity, extreme inflexibility and insupportable pedantry. On the other an antisocial personality disorder with lack of ethical and social values, a deeply rooted tendency to betray others and to deceive himself and uncontrollable emotional reactions. This special combination in Hitler's personality resulted in the uncritical conviction of his mission and an enormous driving for recognition. The neuropsychiatric analysis of Hitler's personality could lead to a better explanation of the pathological traits of one of the most conspicuous historical personalities., (Copyright 1999 Lippincott Williams & Wilkins.)

This article reviews the history and evolution of the diagnosis of personality disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) from its first edition in 1952 through its fourth edition in 1994. The article also traces the earliest origins of personality disorders (e.g., Hippocrates) through the modern foundational works of Pritchard, Schneider, and Horney. Analysis of the changes across the editions of the DSM suggest slow but steady progress in the clarification and classification of personality disorders, although formidable challenges remain. A call for future research as to reliability and validity of personality disorders is made, and suggestions for research are offered.

From 1992 to 1995 the Republic of Bosnia-Herzegovina experienced a war of genocidal proportions between the Bosnian Serbs, the Bosnian Croats, and the Bosnian Muslims. The international Criminal Tribunal for the Former Yugoslavia has indicted Dr. Radovan Karadzic--former President of the Bosnian Serb Republic, psychiatrist, and poet--as a suspected war criminal for his role in war crimes, crimes against humanity, and genocide. Karadzic remains enigmatic and poorly understood. Psychological profiling highlights in Karadzic's case the complex coalescence of the psychology of a genocide perpetrator with that of a charismatic narcissistic political leader. Such a profile may possess usefulness in forensic psychiatric investigations and legal proceedings.

The empirical research in premorbid personality of psychiatric patients has markedly advanced in German speaking countries since adequate research methods were introduced in the middle of the sixties. Among the various results are the following: Kretschmer's typological conception of human constitution were largely refuted and replaced by other conceptions on a methodologically more solid ground; Tellenbach's concept of the "melancholic type" as the premorbid structure of the majority of patients suffering from a unipolar affective disorder with melancholic features could be convincingly validated; this concept was supplemented by that of the "manic type" of personality as the premorbid correlate of the amount of a predisposition to manic episodes within the course of an affective disorder; the premorbid deviations of personality in schizophrenics and neurotics were shown to possess little nosological specificity; furthermore, similar deviations could be demonstrated in the personality of (still healthy) relatives of patients with severe mental disorders; the complex relationships of (premorbid) personality, personality disorders and mental disorders were partly clarified.

This article discusses the historical underpinnings of psychiatric classification and examines empirical evidence relevant to (a) whether personality disorders are distinct from each other and from normal personality and (b) whether personality disorders should be classified separately from other mental disorders. At the phenotypic level, research evidence strongly supports the use of a dimensional model to delineate personality disorders; evidence about their genotypic representation is less conclusive though still supportive. Neither empirical nor rational arguments indicate strong justification for separating personality disorders from other mental disorders, as has been done in both the third and fourth editions of the Diagnostic and Statistical Manual of Mental Disorders. Distinctions between abnormal and disordered personality are considered, and suggestions are made for more satisfactory diagnostic classificatory schemes.

A historical account is offered of the European origins of the DSM-III-R category, personality disorder, and a differentiation is made between the history of terms, patterns of behaviors, and concepts. The concept of "disorder of character (personality)" developed in the nineteenth century, and was possible after notions such as character, constitution, temperament, and self received a psychological definition, and after the insanities became transformed into "psychoses." Terms such as "type" and "trait" were in turn ushered into the nineteenth century by faculty psychology and the phrenological tradition. Until the end of that century, "personality" referred to the subjective aspects of the self, and "personality disorder" meant alteration of consciousness (e.g., hysterical dissociation); the behavioral patterns dealt with by DSM-III-R as personality disorders were then called disorders of character and explained as states of volitional failure, or loss of coherence between cognitive, emotional, and conative functions, or of "automatism," i.e., the manifestation of lower (more primitive or animal) forms of behavior escaping the control of higher (human) ones. Character types and disorders were first considered as forms of attenuated insanity, and later on were made into a separate group whose membership could be attained via the visitation of a degeneration taint, neurological disease (e.g., encephalitis), or plain ill-breeding. The relevance of the intellectual background of the nineteenth century to these diagnostic changes is also discussed.

This article presents a contextualized treatment of the current configuration of self, some of the pathologies that plague it, and the technologies that attempt to heal it. Of particular interest is the historical shift from the Victorian, sexually restricted self to the post-World War II empty self. The empty self is soothed and made cohesive by becoming "filled up" with food, consumer products, and celebrities. Its historical antecedents, economic constituents, and political consequences are the focus of this article. The two professions most responsible for healing the empty self, advertising and psychotherapy, find themselves in a bind: They must treat a psychological symptom without being able to address its historical causes. Both circumvent the bind by employing the life-style solution, a strategy that attempts to heal by covertly filling the empty self with the accoutrements, values, and mannerisms of idealized figures. This strategy solves an old problem but creates new ones, including an opportunity for abuse by exploitive therapists, cult leaders, and politicians. Psychology's role in constructing the empty self, and thus reproducing the current hierarchy of power and privilege, is examined.

Courts, administrative agencies and doctors are occasionally but stubbornly confronted with reproaches and viciously hostile attacks by habitual litigious grouchers and fault finders to whom court judgements or counsels are purposeful personal insults. Such querulous, opinionated persons are obstinate "bellyachers" who "stick to their guns" and imaginary legal positions to the extent of being a general nuisance. Many of them are unable to appreciate the difference between law and their entirely subjective (often perverted) sense of justice; they feel constantly wronged or even persecuted. Basing on semantics and history, the psychological, psychiatric and expert problems are exhaustively discussed, including the problems of causing public annoyance and of the risks inherent in litigious paranoia.

There was conducted a retrospective study of a remarkable personality in history of two millennia ago: Cleopatra, the Great. Though there was a paucity of hard facts about her early years, yet considerable pertinent information could be gleaned from scholarly writings about this versatile queen to render a diagnosis. Cleopatra was a complex, dynamic woman who rose to power in the Mediterranean world, but eliminated herself dramatically when she could not bear defeat in her narcissistic personality.

As an exercise in the use of the current diagnostic manual of psychiatric disorders, the life story of Joan of Arc is summarized from birth until her execution at age 19. Then various psychiatric diagnoses are considered in the light of published criteria, including types of psychoses, psychosexual disorders, and personality disorders.

The author discussed the life and work of Yukio Mishima from the object relational point of view. First, he described his brief life history, pointing out the four big identity crises in his life as his fierce struggles against the suicidal wishes were likely to enlarge within himself. Then, he suggested that Mishima had been in the state of part object relationship throughout his life. Thirdly, the important role of the body or bodies in his fantastic and real life was discussed as a manifestation of not merely autoerotic activities but also disturbances of the core of identity. Finally, the fragility of the intermediate area of experience which was thought to have eventually led him to the last action, the seppuku, was examined.

Any theoretical direction in psychiatry takes into account a definition of the illness, and of the state of health and their limits, as well as the relationships between these two different states in their psychobehavioral expressiveness and within the relational system of personality. The states which are taken as deviations from what is generally considered and accepted as normal state, have always been identified and form the so-called major mental pathology, but one cannot ascertain the same thing about the so-called borderline states, and the representation of normality. It is also true that within the two international systems of classification, WHO and DSM-III one can find the difficulty and even the hesitation of using the term "mental illnesses" instead to use "mental disorders". These are the reasons that made the author consider useful the illustration of the diagnostic criterion through the classification of the concepts on mental illness--an evolution illustrated by the contribution of syndrome concepts, i.e. an anatomoclinical state according to the evolution of the symptoms, psychopathological criteria and generally the dimensional and categorical criteria. Thus, the criteriological investigation remains a theoretical actual approach and at the same time applicable for the psychiatric care.

Considerable confusion and disagreement remains in the psychiatric literature over the meaning of the term borderline. Over the last ten years a veritable explosion of books and articles on the subject have espoused overlapping and at times contradictory ideas on entirely different levels of discourse: biological, genetic, pharmacological, objective-descriptive, ego psychology theory, object relations theory, separation-individuation theory, and so on. Together, they seem both bewildering and irreconcilable. Despite DSM III's efforts to impose conceptual clarity, the situation remains a semantic mess. "Borderline" still means different things to different people and still tends to be a wastebasket diagnosis. No definition has been entirely satisfactory. This article is a preliminary effort at synthesis and explication of how and why psychiatry has arrived at this state of affairs.