HD 3700 1st Edition Lecture 21Outline of Last LectureI. What is “healthy” functioning?II. Varieties of JanIII. Approaching the idea of “personality disorders”Outline of Current LectureI. Play within the playII. More on personality disordersIII. Object relations model of self developmentCurrent LectureI. Play within the play- Opening night in Elsinore- Being able to know someone else as well as the struggle to know oneself—the degree to which you know others is dependent on the degree to which you can know yourself- Theater is a formalized role play—pretending to be someone else, play within theplay- Speaking to queen—lines are slightly old fashioned, more formal- Hamlet is now completely manic- Shakespeare gave us a way of thinking psychologically II. Personality Disorders- Diagnostic criteria: an enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.- These disorders have been a part of human history forever, in every culture, although they may be described differently – whenever human beings are together they create an idiosyncratic culture- Psychiatry and clinical psychology have come to the point where we’re naming and categorizing symptoms, and trying to understand childhood experiences, cultural influences, and neurobiological influences shape disorders, as well as treatments- After WWII when soldiers come back with PTSD, there is a cultural shift in which psychotherapy becomes more common (someone else’s mind observes yours) - Personality disorders come out in the 1960s—culture with enough clinicians that a common vocabulary arises- “Some like it hot”—Marilyn Monroe, was the sex symbol of her day, she had Borderline Personality Disorder (she cut herself, did drugs, drank, public love affair with JFK, killed herself with drug overdose)- Therapists become aware of patients that would come in, seem to improve, then drop out and see another therapist (people who consumed psychotherapy without improving), very sensitive, vigilant, became attached very easily, very impulsive, promiscuous, drug use – this cluster of symptoms became known as borderline – on border between psychosis and neurosis, personality was so infantile, even though they were adults- How to treat them—provide structure, become predictable, ask them to stop acting out behaviorally (don’t cut, don’t drink etc.), “reparenting” these patients, providing a basis of attachment, so much expected rejection, betrayal and abuse,often had major depression and suicide attempts- Three clusters of PDs: these are suggestive categories, there is a spectrum!o Cluster A: spectrum disorders of SCZ, have 1st degree relatives with SCZ, these are schizotypes Schizoid Personality Disorder- Negative symptoms, flat affect Schizotypal Personality Disorder- Has a few positive symptoms, i.e. magical thinking, might have odd beliefs, overvalued ideas, computer geek who plays dungeons and dragons and you get the feeling that they might actually believe it Paranoid Personality Disorder- Richard Nixon, mild paranoid beliefs All of these people are functioning, but just differento Cluster B: Borderline Personality Disorder- Very impulsive, often experiences feelings of emptiness, has attachment hunger, makes best friends in a day but then next month diff friends, spend money without thinking about it, drug use etc.- Fragmented self Narcissistic Personality Disorder- Organized around maintaining his or her self esteem, feel like they’re not being recognized for being the brilliant person they are, preoccupation is their greatness, surround themselves by people who worship them, may actually hate themselves or think themselves are great Antisocial Personality Disorder- Criminals, take pleasure in humiliating/dominating others, have no remorse, absent in morals Histrionic Personality Disorder- Seem to be dramatizing everything in their life constantlyo Cluster C: Dependent Personality Disorder- Comorbid with anxiety, doesn’t believe he/she can survive without advice 24/7, frantic when alone Avoidant Personality Disorder- Like Schizoid  Obsessive Compulsive Personality Disorder- Ignore this  Personality Disorder NOS (Not Otherwise Specified)III. Object relations model of self development: separation and individuation- We’re all born with a temperament – impulsive, emotions, anxious, how intelligent we are, how reactive we are –at 9 months you see the whole range of temperaments- The self: the capacity to regulate one’s feelings, behaviors, the capacity to reflect on one’s experience, to be in touch with wants and fears, negotiate relationships where you get some and give some, the self will develop in part depending on the experiences one has- Borderline personality disorder: a lot of these people came from disrupted/turbulent households, often had a history of sexual abuseo Led therapists to think trauma caused BPD, but then there were the “resilient” children - Women are overdiagnosed as BPD- Stages of development o Autism: 0-2 months An unfortunately chosen term, “Autism” implies that the infant is immersed in sensory-motor experience which will lead to attachment and awareness of others. Mainstream developmentalists argue that the processes of awareness and engagement begins immediately.o Symbiosis: 2-6 months In these first two months, parents and babies “mirror” each other,and it is thought that babies are in symbiotic relationship with their caregivers … they don’t yet have ideas about self and other …parents are an “experience” which seems to occur ofteno Separation-Individuation: 6-24 monthso Hatching Subphase: 6-10 months When infants begin to crawl, explore, tolerate momentary separation from caregivers, they have begun to experience themselves as separate from their caregivers in some basic ways. Peek-a-Boo games appear, and babies “check back” visually when their crawling off away from their parents. o Practicing Subphase: 10-16 months The child is now walking and exploring, ventures out to play then rushes back to be held by parents for emotional “refueling.” Some theorists refer to this phase as the toddler’s “love affair with the world.” Play is often about running away and coming back.