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Handbook of Personality DisordersReview - Handbook of Personality Disorders
Theory and Practice
by Jeffrey J. Magnavita (Editor)
John Wiley, 2003
Review by Peter B. Raabe, Ph.D.
Sep 24th 2004 (Volume 8, Issue 39)

At close to six hundred pages—counting the foreword, preface, and two indexes—this is a very hefty book.  As suggested by the subtitle, "Theory and Practice," this book is aimed primarily at students and practitioners, but most of the essays in it are written in a style that is comprehendible by non-professionals.  The book is divided into five sections.  The first section, titled  "Etiology, Theory, Psychopathology, and Assessment" consists of seven chapters containing discussion on controversial topics such as classification and etiology of personality disorders  (what exactly is meant by a "personality" disorders and what differentiates them from so-called mental illnesses), various assessment approaches, the question of whether a personality disorder has an internal causation or whether it has an inter-personal origin, and sociocultural factors in their treatment.

The second section also contains seven chapters and is titled "Contemporary Psychotherapeutic Treatment Models."  Here the authors deal with just some of the many approaches to treatment which all make basically the same two claims:  that they are substantially and significantly different from each other, and that they are each superior in effectiveness in treating some of the many classified disorders.  I found two chapters in this section particularly interesting:  the first on cognitive therapy since it steers clear of talk of so-called unconscious processes, and the other on a treatment method called "eye movement desensitization and reprocessing" because, while it seems to be effective in some situations, it is still largely a mystery as to exactly how this works. 

Section three is titled "Broadening the Scope of Treatment:  Special population and Settings" and is made up of six chapters. Chapters in this section discuss the very controversial issue  (in my opinion)  of drug therapy, the efficacy of short-term or day treatments, the complexities inherent in the treatment of personality disorders where the patient is also substance dependent, and an examination of how trauma, memory, neurobiology and self-image are affected by and affect personality disorders. 

The fourth section contains only two chapters.  It is titled "Expanding the Range of Treatment:  Child, Adolescent, and Elderly Models."  As the title suggests, this section deals with the treatment of severe or dramatic personality disorders in children and adolescents as well as in older adults.

The final section also contains only two chapters and is titled "Research Findings and Future Challenges."  Here the authors look at some of the most recent empirical research in personality disorders, and an attempt is made at a possible way to approach the formulation of a unified model of treatment. 

My suggestion is that anyone who buys this volume should begin by reading chapter 6 written by Judith V. Jordan and titled "Personality Disorder or Relational Disconnection?"  She starts by cautioning her readers that "a failure to appreciate the power of context to shape people's lives characterizes many of the traditional psychodynamic models where tribute is paid to autonomy, separation, and separate-self status" (120).  I agree with her that, while this book's publication date is 2004, many of the chapters cite references that are more than ten years old.  This makes the claims based on this research questionable at best given academic standards in psychological research data.  And many of the authors promote theories and perspectives, such as a "Eurocentric, limiting model of separate self" (132, italics in original), which are clearly outdated in light of feminist theory and recently published clinical research findings. 

While there is much valuable information in these pages, it would be prudent to read this volume with a critical mindset.  There are some surprisingly old-fashioned arguments in its pages that offer questionable logic as proof of their conclusions.  For example, in the third chapter the author claims that in the 1950's and 60' psychopharmacology (drug therapy) proved to be a success due the fact that when drugs were handed out "mental institutions were virtually emptied of patients" (61).  This is an unfounded and inaccurate conclusion.  My own research into that era shows that the emptying of mental institutions was not so much the result of the effectiveness of medications as it was motivated by economic considerations (either the desire to increase the profit margins of private insurance companies and hospitals, or to reduce the expenditures of government-funded health-care plans).  A second conclusion offered by this same author is that the so-called "palliative" nature of the medications which allowed hospitals to send patients home "demonstrated the biological basis of many psychological disorders"  (61).  In fact the use of medications did no such thing.  The pharmacological agents mentioned by the author, such as lithium and Thorazine, don't target any psychological disorders directly; they merely dull general and overall brain functioning.  They have the same "palliative" effects on normal brains as they do on the brains of individuals diagnosed with personality disorders. 

Interestingly, in chapter fifteen, which deals specifically with pharmacotherapy, the author admits that "there is no medication with a Food and Drug Administration (FDA) indication for treatment of any of the personality disorders, nor are there any medications approved for treatment of any of the personality disorders… Nonetheless, pharmacological treatment of personality-disordered patients is common practice" (331).  I find this to be a rather hair-raising admission.  In what other area of medical treatment would this be allowed?  Look at the recent outcry over non-FDA approved herbal and naturopathic remedies for sale in local health-food stores! 

Some of the chapters in this book also suffer from the common problem of questionable causal claims.  For example, in chapter five the author discusses abnormalities in the adregergic and cholinergic systems and deficits in the dopaminergic systems as though they are the causes of various personality disorders an/or affective dysfunction.  But much of the research into human biology, and especially into the functioning of the brain, clearly shows a reciprocal relationship between biological states and affects.  In other words, the relationship between, for example, the dopaminergic systems and personality is such that the functioning of the dopaminergic systems causes changes in personality and changes in personality affects the dopaminergic system's functioning.  It is simply inaccurate to say the causal relationship is unidirectional from the biology to the psychology.  These sorts of claims warrant that a careful and critical reading of this book is in order.

Despite its shortcomings, this volume is full of useful information about the multitude of perspectives on personality disorders and their treatments held by the psychotherapeutic community.  It offers a commendable attempt to define "normal,' it explains many of the theories concerning personality disorders, it clarifies a variety of treatment models with helpful diagrams and charts, and it concludes with two very good indexes:  one of authors and one of the subjects and topics discussed. 

 

© 2004 Peter B. Raabe

Peter B. Raabe teaches philosophy and has a private practice in philosophical counseling in North Vancouver, Canada. He is the author of the books Philosophical Counseling: Theory and Practice (Praeger, 2001) and Issues in Philosophical Counseling (Praeger, 2002).


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