By Benjamin Andrews
Last week, I suggested that contemporary diagnostic and therapeutic models are self-limiting in that they approach personality disorders through the lens of functional impairment without articulating implicit assumptions about personality health. Generally, this is grounded in well-intentioned desires to be scientifically descriptive and to avoid imposing cultural norms or oppressing minority perspectives. Accordingly, contemporary Psychology’s discourse on personality purposefully neglects its own beliefs about the moral and spiritual teleology of personhood. However, this is problematic on two accounts: first, it is somewhat disingenuous, as Psychology’s values for personhood are often thinly veiled; and second, Psychology’s personality theories are deprived of a vision for flourishing, purpose, and health. A full exploration of this problem is well beyond the scope of today’s discussion, which is focused on a specific tool — a litmus test — for working with personality disorders. However, to understand the tool, we first have to consider what Christians in mental health have to learn from secular clinicians; only then can we understand what we have to offer them.
To begin, we may benefit from considering some questions to stimulate our thinking. Though abstract, these are also profoundly practical, both for mental health professionals in our work and for the everyday person in daily decisions (like who to be friends with, who to date or marry, who to hire, how to respond to a difficult interaction, etc.). So consider, if you will, these questions, and notice how you would answer them for yourself (or, better yet, for someone else who asked you):
(1) How do you differentiate between appropriate, healthy behavior and unhealthy behaviors that reflect personality problems (for example, is this confidence or narcissism, good boundaries or avoidance, a need for autonomy or a demand for control/power, etc.)?
(2) How do you know when you have encountered someone with a disordered personality?
(3) What even is a disordered personality?
Though they have evolved substantially over time, secular models of psychology’s answers to these questions are quite robust. The two models proposed in the DSM-5-TR describe broad, lasting problems in cognition, emotion, interpersonal relationships, and impulse control (the common model) or lasting, pathological difficulties in identity, self-direction, empathy, and intimacy (the alternative model). Those described in the Psychoanalytic Diagnostic Manual (PDM-3) are more detailed, utilizing classification that makes greater inferences about the inner workings of people’s motivations and inner conflicts, perceptions of reality, defenses, and experience of reality. Regardless of model, personalities have to be patterned (occur in multiple parts of life), protracted (showing up relatively early in life and persisting throughout it), and cause distress and impairment.
The observant reader will notice that these definitions only provide a full answer to the third question (what is a personality disorder?), a partial answer to the second (how do I know?), and no answer to the first at all (is this particular instance/behavior healthy or a problem?). The key psychological insight for the first two questions lies in the concept of “function,” from which we also infer a purpose (e.g., What is this behavior’s “function”?). A person’s way of operating (or “functioning”) — their way of thinking, their relational dynamics, their ability to regulate and manner of communicating, etc. — is motivated by a need and intended to satisfy it. A key distinctive of personality disorders, then, is that there is either a problem with the intensity of a need or a problem with patterned, ineffective ways of meeting it. Hence, we could provide a non-exhaustive list of personality disorder stereotypes:
- the borderline personality’s ineffective attempts to create intimacy and prevent abandonment actually push people away;
- the avoidant personality creates safety from rejection by avoiding risk and intimacy but then ends up exactly as it feared — truly alone;
- the obsessive-compulsive personality that is so driven to control and perfect that it drowns in its own guilt, becoming either unable to accomplish anything or unbearable to all around it;
- the narcissistic personality, so demanding of admiration and love from others to compensate for its own insecurity, yet its self-pity and outbursts at any insult inspire neither love nor admiration but only fear, resentment, and contempt;
- and so on
In this regard, Psychology’s perspective is enormously helpful. Behaviors (and the underlying personality constellations of needs and patterned ways to meet those needs) can be assessed not by content but by function. Any clinicians who neglect this simply will not be able to treat personality disorders effectively. Inexperienced therapists are much too likely to attend to content in session (She told me everything in the first session and broke down in tears right away… I must be a great therapist!) Instead of function (She immediately let down all her boundaries to create closeness and then required me to regulate her emotions).
The most common distinctive in personality disordered behavior is inconsistency in communication and function. Words say one thing, but behavior says another. As an example, we’ve probably all heard someone say, “Oh, I’m good, I’m totally over it now” — but they are so “over it” that they have to spend the next hour telling you passionately about it. Or the spouse who says, “I’m fine,” by which they mean they absolutely will not talk with you at all about what is wrong until you figure it out for yourself. Or the person who says, “Oh, I’m not angry at all, I just think…” and proceeds to show you just exactly how angry they are. Or the person who says, “Tell me all about it,” but proceeds to interrupt you at the first chance to share their own experience with no room for yours. Of course, none of these alone is indicative of a personality disorder — but when the discrepancy between communication and function is persistent for much of the lifespan, extends across multiple domains of life, and starts causing serious problems, a personality disorder is likely present.
Christians are uniquely prone to missing the importance of function when they are concerned with moral expectations, and for this reason, we need secular psychology models to help. We can be too busy asking, “Was that the right thing to do?” Instead of, “Why did they do it?” For example, a client’s display of anger is interpreted as sin but not evaluated for its purpose. Another’s decision not to lose their temper is considered laudable without noticing the ways it was driven not by healthy self-control but by fear and need for others’ approval. Another’s risqué encounter is identified as sexually immoral but not considered for its proximity to intimacy. Still another’s mastery of Scripture and moral theology are admired, but the smug superiority and quiet craving for admiration are lost behind a pretense of humility. And yet another’s guilt is identified either as a healthy awareness of sin or a problematic inability to appreciate grace, but neither considers its function in the context of rigidity. I do not intend to frown on Christian morality or even Biblical counseling for that matter; rather, I am trying to highlight the ways in which moral judgments can be used as permission to ignore the psychological function of a behavior — a mistake that Christian mental health professionals simply cannot afford when dealing with personality disorders.
Yet, it is here that Christians also have something profound to offer. In their emphasis on function, secular models have either abandoned their moral convictions or hidden them like contraband, only acceptable as undiscovered goods smuggled quietly into the science of personality. Perhaps most embarrassing, there is almost no defining way of understanding what it means to be healthy. In this, therapeutic approaches to psychology have been essentially apophatic, so by inference, the definition of personality health becomes whatever is “not disordered”: neither overreactive nor under-reactive, not desiring too much intimacy but not too afraid of it, not having too high or too low an opinion of self, neither being domineering nor under-assertive, not needing too much attention but not isolating oneself either, etc. Put differently, if personality disorders result from extremes of intensity and extremes of traits that lead to ineffective behavior, then the basis of personality health would involve finding the relative middle of the continuum for expressing relevant personality traits. This is unfortunate, as it implies that human thriving involves, at least in part, becoming the world’s most medium person.
Christianity has a better view of flourishing. Personality is nestled within the deeper concept of personhood, and personhood has a teleological purpose: participation in the divine nature and mediation of God’s presence and rule in the world. Jesus sums this up very succinctly and in far less abstract terms:
“You shall love the Lord your God with all your heart and with all your soul and with all your mind. This is the first and greatest commandment. And the second is like it. You shall love your neighbor as yourself. All the law and the prophets hang on these two commandments” (Matt 22:37-40).
Rather than rejecting it, Jesus takes morality as expressed in the Law and Prophets (this morality, which previously proved a stumbling block to identifying psychological function) and drops it right into the context its true purpose: love of God, others, and self.
Consider, then, which is the more satisfying view of a healthy person: (1) someone who has the capacity to actively express and receive love in relationship with God, others, and self, or (2) someone with averagely intense needs and exhibits relatively averagely traits while being reasonably good at meeting their own needs. In one, the purpose of personhood is transcendent and beautiful; in the other, the telos is the self purposed on itself in pursuit of self-actualization and self-satisfaction. Christianity, then, has much to offer the rugged individualism of contemporary psychology. Admittedly, some secular Psychologists would disagree with my depiction of their view of personality health (and could do so fairly) — but to say so, they would have to be willing to unpack their bags and disclose those values that have been smuggled into their descriptive science. And that is a second gift we have to offer secular Psychology: an opportunity to get honest about its own religious values and beliefs.
The implications of all that I’ve written so far can be summed up simply: A Christian perspective of personality requires a unity of teleology and function. To misappropriate Christ’s words for a psychospiritual therapeutic purpose, we might say: “By their fruit you will recognize them… Do people pick grapes from thornbushes, or figs from thistles? Likewise, every good tree bears good fruit, but a bad tree bears bad fruit” (cf. Matt 7:15-20). Teleology tells us about health, and function tells us whether the behaviors are motivated by love or are likely to bear the fruit of love. From this vantage, we can see through the mask of narcissism, avoidance, dependence, or other behaviors; attending to “function” lets us see what is beneath the behavior, and teleology shows us whether what is beneath is truly healthy.
At last, with all this as context, we can now turn to a simple tool. For those who are still reading, thank you — I hope it is worth your time. These questions are intended to aid as a litmus test, discerning between that which is disordered and that which is healthy. Most often, since our behaviors come from mixed motives and our hearts, minds, and souls are easily divided, the discernment occurs within a single experience rather than between two different experiences (although the latter can be done as well). For example, if a client loses their temper, it is likely that discernment will identify loving and unloving motives within that moment. Conveniently, this discernment also maps nicely onto DBT’s preference for both dialectical thinking and Wise Mind, both of which are mainstays in treatment for many personality disorders.
Relationship with self: a healthy person can give and receive love in relationship with themself.
What would I do in this situation if I was going to truly love myself well?
Does this decision/behavior help me express love to myself more, or make it harder to do so?
An exercise: imaginative exercises (similar to IFS) for self-compassion
Relationship with others: a healthy person can give and receive love in relationship with others. This implies that in a healthy relationship, both people matter to both people.
What would I do in this situation/conflict if I truly valued myself? What would I do in this situation/conflict if I truly valued this other person?
What do I like about how I responded in this situation, and what do I dislike about how I responded? How do these reflect or fail to reflect what is truly loving for both of us?
Exercises: Role-plays, empty chair, and interpersonal feedback and use of the therapeutic relationship
Exercises
1. Does this prayer help me express love for God?
2. How would I be praying if I were to receive God’s love for me?
3. Exercises
a. To build and receive love from God: Looking at Jesus Looking at Me (see Christian Psychology Weekly, February); God-image and God-attachment exercises
b. To grow in love for God: reflection and imaginative prayer on Christ, practice of gratitudes, use of music and worship, use of visual media (art, The Chosen, etc.).
Ben is a licensed psychologist who works with adults encountering a variety of challenges in their lives, including anxiety, depression, relationship difficulties, OCD, history of trauma, addiction, and bipolar disorder. He is particularly interested in faith and spirituality as they arise during the course of therapy, and he also enjoys supporting others in the helping professions (therapists/counselors, social workers, doctors, nurses, pastors and priests, etc.).
