September 19, 2008

Successful Psychopaths V. Criminals

After a crazy summer I've decided to restart the blog!

I went to a fascinating lecture this morning on treating personality disorders with cognitive therapy (CT). This spurred three questions:

Questions: What is a personality disorder? What is Cognitive Behavioral Therapy? How will knowledge of both these topics give us insight into ourselves and our own coping mechanisms?

Some version of an answer:

Personality Disorders:
A personality disorder is basically when a normal coping mechanism - such as being wary of dangerous situations, paying attention to details, or feeling able to accept help - extended to situations in which it becomes problematic or even dangerous. Some examples include paranoia, dependency, passive-aggressiveness, and obsessive-compulsive personality disorder (not OCD). The American Psychiatric Association (APA) defines a personality disorder as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it".

What's striking about these disorders is that they're so relateable because these behaviors are effective in certain contexts. For example, paranoia can make you safer if you're walking alone at night, obsessive-compulsiveness can be productive when you're packing for a long trip, dependency is positive when you're sick and need to accept care. However, they become a disorder when they're projected into other parts of one's life inappropriately - like getting paranoid at the grocery store or becoming so dependent on a partner that you can't let them out of your sight.

One study surveying executives and criminals in Great Britain (reference: Board, B.J. & Fritzon, Katarina, F. (2005). Disordered personalities at work. Psychology, Crime and Law, 11, 17-32) found that some personality disorders were actually more common among the executives than the criminals. They refer to this as the difference between successful and unsucessful psychopaths. Taken with the cultural component of the APA definition, it speaks to "the importance of social norms in our definition of functioning - and adds to the discussion of interpretation of illness in different cultures (The Sprit Catches You and You Fall Down -style: how epilepsy is a divine gift or a disease depending on which cultural lens).

Cognitive Therapy:
The more I learn about cognitive behavioral therapy or CBT (of which cognitive therapy is a specific type), the more I think everyone should be engaging in at least some of the strategies. One of the clinicians with whom I work says that the real goal of CBT is to train someone to be their own therapist - or more specifically, to ask themselves the "Why am I thinking this?" and "What are the factors affecting this decision/action/response" as it's occurring, instead of only at therapy appointments.

CBT is based on a theory of dividing thoughts into three categories:
Core Beliefs: general beliefs about yourself, the world, and other people (e.g. I am compentant)
Assumptions: the ways in which you apply this to the world around you (e.g. I will do a good job)
Automatic Thoughts: in response to specific situations (e.g. I will do a good job on this paper).

Judith Beck, PhD, the speaker, said that when people have negative core beliefs it's usually because they feel at least one of three things: incompentent/ineffective, worthless/unvaluable, or unloved. Addressing why someone feels these things is not the point of CBT, rather the aim is to revamp ones responses/actions so that they prove these core beliefs wrong.

The speaker's father, Aaron Beck, MD created the most commonly accepted psychological theory of depression which is that people who are depressed feel depressed because their thinking is biased towards negative interpretations. Therefore, all of his theory of CT is focused on adjusting these interpretations to make them 1) more accurate and 2) more positive by evaluating what core beliefs and assumptions are going into them.

I keep trying to challenge myself and my friends to think about the assumptions and core beliefs we're working with as we make all these challenging decisions about navigating through "real life" - are we worried about feeling unloved? are we making sure we're not avoiding because we're worried about feeling ineffective? do we know how valuable we are?

"yet the terrible truth was that the girl who broke your heart would always have more power than you liked" -charles baxter (I'm pretty sure), feast of love

No comments:

Post a Comment