Medicine And Books

Social Factors in the Personality Disorders: A Biopsychosocial Approach to Etiology and Treatment

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7074.154 (Published 11 January 1997) Cite this as: BMJ 1997;314:154
  1. Kwame McKenzie
  1. honorary clinical research fellow, Department of Psychological Medicine, Institute of Psychiatry, London

    Joel Paris Cambridge University Press, £35, pp 232. ISBN 0 521 47224 5

    Personality disorders have been accepted by psychiatrists as a category of mental illness for only a few decades, and several problems remain. No universally accepted way exists for defining different types; relatively little research has been done on outcome and treatment; and many doctors do not understand them, do not see them as mental disorders, and think they are untreatable. The better understanding of their aetiology which Professor Paris hopes to foster would go a long way to producing agreed classifications and debunking the myths that surround the subject.

    Society is important in the promotion of personality disorders, and what constitutes a disorder is different in different cultures. For instance, in some societies the narcissism of most of our members of parliament would be thought of as a personality disorder. If a culture values social cohesion then traits which increase this, such as deference to elders, dependability, and reliance on others, are valued. But in a “go get 'em” individualistic society social cohesion is sacrificed for personal gain, so narcissism and autonomy are promoted, and dependent sorts can end up in the psychotherapist's chair.

    Societies all over the world are changing, so the line between normality and pathology continually shifts, hence the need for in depth research into what society does to the personality and the need for Professor Paris's work. But society is not the whole story: parents of a single child may be happy to believe in environment as the major factor in personality development, but have two or more and you will soon believe in genes.

    The strength of Professor Paris's book is its eclecticism. It pulls together psychological, biological, and social theory to produce a biopsychosocial model for the aetiology of personality disorders. About half the variance in personality comes from genes and the rest from social factors-such as childhood environment, peer groups, and societal structure.

    Figure1

    Projection x ray micrograph of spider's knee, from X-rays: The First Hundred Years (Wiley, £34.95, ISBN 0 471 96502 2), a series of essays which demonstrates the way in which x rays have spread from medicine and physics, such as lithography, astronomy, and lasers, and tries to predict the advances of the next century.

    The many genes involved interact with each other and have a variable influence on different personality traits. They also influence the social environment. Social factors interact with each other and influence and are influenced by genetic factors. The sum of all this is your personality-or, given the right circumstances, personality disorder. So even if it were possible to bring up two children in exactly the same way they would still have different personalities.

    Professor Paris readily admits that some parts of his book are speculation based on research and that much more research is needed. But his model leads to important conclusions: unless there is mental illness or family violence, divorce has long lasting negative effects on personality in children no matter how positive it is for their parents; a two parent nuclear family is by and large better than other alternatives; and there is enough evidence for social scientists to support the importance of “family values.”

    But before members of the new right begin to crow too loudly they might consider a tricky international legal problem. What if a person with dissocial personality disorder argues in the European Court of Human Rights that the condition, which has ruined his life, was caused by the individualist policies of a government? And that this government could have known from Professor Paris's work that the social disintegration and rapid social change caused by its policies would undermine the social factors which stop the development of his type of personality disorder?

    Rating: **

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