fered from a severely Parkinsonian condition since the 1920s responded in the 1960s to L-Dopa. In some cases there was an extraordinary restoration of the original personality, which had been totally submerged for decades. It was not always possible to maintain the revived personality, but the fact that it could be revived at all supports the idea that, in these long-term conditions that distort character and personality, the original version of the person may not be totally lost. On the analogy of a television where the picture has been replace by visual chaos, there is the hope that if only could get the neurological or neurochemical tuning right the original picture might be restored.
There is also the thought that, as with dementia, the new personality is obviously caused by the disorder, and that it was not the product of the person’s own previous decisions or self-creative project. It seems unfair that their personality has been distorted by something outside their control, and refusal to see the new personality as really them is a kind of recognition of this.
On the other hand, the refusal to recognize the new personality as reflecting anything other than illness seems to leave the person as they are now in a kind of limbo, possibly for the rest of their lives. It is possible to have a character and personality shaped by a medical condition and still to identify with it. One autistic person protested against parents who wished his autism could be cured, by saying that their real wish was that he had not been born and that they had had a different child instead. The arguments pull both ways.
3. THE MISSHAPEN REAL SELF.
Schizophrenia typically comes on at a much earlier stage in life than dementia. But even schizophrenia’s onset comes on after there has been time for quite a bit of development of the person’s “original” character and personality. Because of this, we can contrast the person and the illness, and may see the latter as eroding or distorting the person’s previous character, But there are conditions with a comparable influence on character and personality that are present at a much earlier developmental stage, in some cases possibly from birth. This category includes the cluster of conditions known as “personality disorders”. Because there is no previously developed alternative personality, it is much harder to get any grip on the contrast implied by the question, “Is it her or is it her psychiatric condition?”
A. The Personality Disorders.
“Personality disorders” are typically said to be “deeply ingrained maladaptive patterns of behaviour”. The personality is “abnormal either in the balance of its components, their quality and expression or in its total aspect. As a result either the patient or society suffers or both.” There are obvious questions about such an account. The word “maladaptive”, with its evolutionary overtones, may disguise a residue of the bad old tendency to medicalize behaviour that deviates from socially accepted norms: the approach that once allowed being gay to count as a psychiatric problem. Or, if a really Darwinian interpretation of the word is intended, so that behaviour is “maladaptive” when it reduces the chances of survival, other problems arise. Did Socrates have a personality disorder? His deeply ingrained pattern of behaviour, his persistent asking of awkward questions, certainly seems to have shortened his life.
But objections to the general definition are too easy. It is worth mentioning some particular “personality disorders”. Although textbook lists vary, several appear on most lists. “Paranoid”, “hysterical” and “narcissistic” personality disorders involve having the kind of personality the names suggest. Another is “Schizoid personality disorder”. Typically it is said to be characterized by a defective capacity for close relationships, by lack of empathy, by withdrawal, solitariness and detachment. There is also “Obsessional personality disorder”. People in this category are characterized by perfectionism and rigidity. They are mean with money and obsessed with cleanl