Personality Theory:
A Biosocial Approach

C. George Boeree, PhD
Psychology Department
Shippensburg University

© Copyright C. George Boeree 2009

Specific disorders

This page has been translated into Swedish by Eric Karlsson

In this section, we will review the major disorders and look as well as some comments from the existential psychologist Viktor Frankl.

Anxiety disorders

The anxiety disorders are the most common disorders.  Nearly all of us know someone, or have suffered ourselves, from a panic attack or a phobia.  At very least, most of us get pretty nervous when we are standing in front of a crowd of people who expect us to say something intelligent or, if nothing else, amusing.

Anxiety is at the root of many, if not all, of our psychological disorders.  It is, physically, a kind of fear response, involving the activation of the sympathetic nervous system, in response to a dangerous situation.  More specifically, anxiety is the anticipation of danger, learned through repeated stress or trauma.  Some people are innately more sensitive to stress, and so are more likely to experience anxiety and develop anxiety disorders.  But everyone becomes sensitized to stress and trauma with repeated experiences:  Each experience "tunes" the nervous system to respond more quickly and more profoundly to perceived danger.

We often talk about anxiety as some sort of genetic issue, and also as something based on traumas in childhood.  But long term stress is probably more often the root of anxiety disorders.  The constant demands of living in poverty, discrimination, war, and abuse are a part of daily life for millions of people around the world.

There are basically five ways in which people respond to unrelenting stress and trauma and the anxiety that comes with them:

  1. Anxiety disorders - the subject of this section.
  2. Self-medication - often leading to alcoholism and other drug-dependencies.
  3. Depression - shutting down (a common western response).
  4. Somatization - bodily aches and pains (a common non-western response).
  5. Dissociation - various "trance" states, and ultimately, psychosis.
Which way a person goes depends on many things, such as their personality, their culture, specific circumstances and so on.  But these responses are in no way exclusive!

Viktor Frankl views the anxiety neuroses as rooted in existential anxiety - "the sting of conscience."  (1973, p. 179)  The individual, not understanding that his anxiety is due to his sense of unfulfilled responsibility and a lack of meaning, takes that anxiety and focuses it upon some problematic detail of life.  The hypochondriac, for example, focuses his anxiety on some horrible disease; the phobic focuses on some object that has caused him concern in the past; the agoraphobic sees her anxiety as coming from the world outside her door; the patient with stage fright or speech anxiety focuses on the stage or the podium.  The anxiety neurotic thus makes sense of his or her discomfort with life.

Panic attacks and panic disorder

Panic attacks are pretty intense.  You know if you have one.  You begin to sweat, tremble, get dry mouth or sick to your stomach. You may start breathing heavily or feeling palpitations or even chest pain.  You feel like you are going to go crazy, lose control, or even die.  Some of you may have experienced a bit of this when you first had to give a speech or be in a play.

Panic disorder is what we call a fairly regular history of panic attacks.  This can be quite debilitating and lead to other problems, including agoraphobia, below.  People who develop panic disorder tend to do so early, in adolescence or young adulthood, and it is about twice as common among women.

Panic attacks are themselves traumatic, and so lead to increased anxiety, which makes the person more vigilant and more likely to misinterpret situations as well as bodily symptoms, and so have more panic attacks.  They are the classic example of anticipatory anxiety:  Being afraid of having a panic attack is the very thing that causes the panic attack!


Agoraphobia is literally Greek for "fear of the marketplace," but is now understood as an anxiety disorder that prevents people from leaving some area that they feel secure in.  A common form is the inability to leave one's home.  Some people are even restricted to a couple of rooms within their homes.  Others can leave their homes but are restricted to some real or imaginary boundaries, such as their home town or a border two miles from home.  Less severe versions involve a fear of travel or of being in a crowded place (that marketplace).

It occurs about twice as often among women than among men. Since 95% of agoraphobics also have panic disorder, perhaps the two categories are really only one.

Specific phobias

When most people think about anxiety disorders, they think about specific phobias.  A phobia is a strong but essentially irrational fear of something.  Common examples include snakes, rats, mice, dogs, birds, spiders, bees, insects in general, heights, enclosed spaces, flying in airplanes, driving cars, storms, open water, injections, blood, and clowns.  (Personally, I think if you aren't afraid of clowns, you are crazy.)  But there are literally hundreds more.  Phobias often start in childhood, but also often start in one's twenties.

Phobias can be understood in part as a matter of conditioned fear:  Strong anxiety or a panic attack is experienced at the same time as the phobic object, and so becomes associated with that object.  More often than not, the panic is not a response to the phobic object (snake, mouse, or spider), but rather to the loss of security experienced when someone (such as your mom or dad) responds dramatically to that object.  If mom or dad is scared, I should be really scared!

It also seems that many phobias have a strong built-in component.  Many people are at least uncomfortable, if not phobic, around snakes, mice, spiders, reptiles, dogs, heights, tight spaces, and swooping birds.  These things make us fearful even before we learn their potential danger.  These fears do make some sense, if you consider the dangers these could have posed for our ancient ancestors.  Of course, it is not the figure of a bird, a snake, a spider, or a dog that directly leads to the fear response.  It is rather the swooping motion, the slithering, the unpredictable presence, the low growling noises, and so on.

Social phobia

Social phobia usually starts in childhood or adolescence and often begins with an experience of embarrassment or shame.  Many of the same characteristics mentioned with the panic attack are a part of social phobia.  What differentiates social phobia from other phobias is that it revolves around - wait for it - social situations, such as public speaking and performance.  It is also associated with a shy or introverted personality.  It isn't easy to get rid of social phobia and many people live with it their whole lives.  On the other hand, many people simply avoid the situations that bring it on and do quite well.

Social phobia is another example of anticipatory anxiety:  The expectation of social embarrassment causes the anxiety that leads to social embarrassment...  In the U.S., social phobia often begins in early adolescence, when peers often humiliate shy children.  This is common in any highly competitive society like ours.  Also, people in lower social positions in a very hierarchical society (and yes, ours is one) often find themselves victimized this way, and developing social phobia.

In Japan, there is an interesting variation on social phobia called taijin kyofusho.  This involves great anxiety that other people find your appearance, your face, and even your odor offensive.

Generalized anxiety disorder

Generalized anxiety disorder is - yes - the most general form of the anxiety disorders.  It is characterized by a long period (technically, more than six months) of excessive worryings which interferes with work and relationships.  It often involves other, more physical, symptoms such as fatigue, tension, irritability, and insomnia.  It occurs about twice as often in women as in men.

In Latin America, some people suffer from something called nervios ("nerves").  They feel a great deal of anxiety, insomnia, headaches, dizziness, even palpitations.  It usually begins with a loss of someone close, or with family conflicts.  Since family is everything in many cultures, family problems are often at the root of psychological problems.

Post-traumatic stress disorder

Post-traumatic stress disorder occurs when people are faced with stress beyond their ability to handle.  Being mugged or raped, be witness to an accident or murder, or experiencing war or refugee camps, are examples.  Rape victims and war veterans will sometimes try to get back to their ordinary lives, only to find that they are constantly vigilant, experiencing flashbacks and nightmares, and unable to deal with the ordinary demands of life.  Work suffers, relationships crumble.  Unfortunately, the person with PTSD may resort to what we call self-medication, i.e. alcohol or drugs, to deal with the pain.  Of course, these only add to the problem.

Many are severely depressed.  There is also a degree of dissociation involved, meaning that victims become numb, detached, showing little emotion.  They no longer feel real.  Perhaps this is actually an adaptive response to traumatic stress.  We find this kind of dissociation commonly in refugee populations, who can sometimes seem like zombies.  They may simply be protecting themselves from further psychological pain.

PTSD appears to involve a number of problems with the hippocampus which, if you recall, is devoted to moving short-term memories into long-term storage.  First, intensely emotional events lead to intense memories called flashbulb memories.  It seems that these memories may actually be partially stored in the amygdala, which accounts for the fearfulness involved.  In addition, the prolonged stress of experiences such as war or childhood abuse actually begins to destroy tissue in the hippocampus, making it more difficult to create new long term memories.  Studies show that people who have suffered long-term trauma have anywhere from 8 to 12% less hippocampus.  The net result could be that they are, in a sense, stuck in their traumatic past.

About half of people with PTSD remit (get better) within 6 months.  The rest may suffer with it for years, sometimes for life.  Again, it is women who suffer most from this disorder.  In addition to possible genetic predispositions to anxiety, women are more likely victims of trauma.

Obsessive-compulsive disorder

Obsessive-compulsive disorder is a combination of - you guessed it - obsessions and compulsions.  An obsession is a thought that you can't seem to get out of your mind, sort of like a song or jingle, but with more sinister effects.  For example, a person may obsess about the idea that they may harm themselves or someone else, or that a disaster is about to occur.  A common obsession is a concern with germs or toxins.  A compulsion is an act, usually repetitive, that the person finds themselves unable to resist, sort of like checking your alarm clock more than once, or turning around to make sure the door you just locked is truly locked.  Again, the obsessions are more sinister:  Some people need to perform acts over and over, checking doors not once or twice, but dozens of times; they may feel the need to touch each parking meter they pass; they may need to put things in order of size or alphabet.  The most common compulsions relate to cleanliness.  Some people will wash their hands many times, even to the point of skin damage and bleeding.  Others will need to do the laundry repeatedly.  Others still will be unable to shake hands because of their fear of germs.

The disorder is found in equal proportions in men and women, and tends to start in adolescence and young adulthood.  It is associated to some degree with tics and Tourette's disorder (multiple, sometimes large, tics, and occasionally vocal grunts and barks or even swear words).

We are beginning to understand some of the brain activities associated with OCD .  The caudate nucleus (a part of the basal ganglia near the limbic system) is responsible, among other things, for urges, including things like reminding you to lock doors, brush your teeth, wash your hands, and so on.  It sends messages to the orbital area (above the eyes) of the prefrontal area, which tells us that something is not right.  It also sends messages to the cingulate gyrus (just under the frontal lobe), which keeps attention focused, in this case on the feeling of something not being right and needing to be done.  It is believed that, in people with OCD, this system is stuck on "high alert."

It should be noted that OCD responds fairly well to the same medications (such as Prozac) that help people who are depressed, which suggests that the seratonin pathways of the frontal lobe and limbic system are involved, just as they are with depression.  More recently, scientists have discovered several genes that appear to be strongly tied to OCD.

But don't think OCD is a purely physiological disorder!  It varies a great deal from culture to culture.  In some cultures, the behaviors are even seen as positive.  Remember that there are still all kinds of superstitious behaviors that people engage in today, which are no different from compulsions.  And, while being obsessed with, say, germs is considered odd, being obsessed with, say, football is considered perfectly okay in our culture!

Viktor Frankl views  the obsessive-compulsive person as lacking the sense of completion that most people have.  Most of us are satisfied with near certainty about, for example, a simple task like locking one's door at night; the obsessive-compulsive requires a perfect certainty that is, ultimately, unattainable.  Because perfection in all things is, even for the obsessive-compusive, an impossibility, he or she focusses attention on some domain in life that has caused difficulties in the past.

The therapist should attempt to help the patient to relax and not fight the tendencies to repeat thoughts and actions.  Further, the patient needs to come to recognize his temperamental inclinations towards perfection as fate and learn to accept at least a small degree of uncertainty.  But ultimately, the obsessive-compulsive, and the anxiety neurotic as well, must find meaning.  "As soon as life's fullness of meaning is rediscovered, the neurotic anxiety... no longer has anything to fasten on." (1973, p. 182)


Hoarding can also be seen as a compulsion. People who collect objects, often of no value, to the point where their house or apartment is no longer a healthy place to live are the ones we worry about. A high risk of piles of paper catching fire, of falling over mounds of stuff, developing diseases from living with the feces of mice or rats, problems with insects such as bed bugs, allergic reactions to mold and mildew... the list of potential problems is endless.

Characteristic of hoarding is a degree of anxiety or even panic when one tries to rid themselves of something they've been "saving", or when others attempt to clean your place. Depression is another common associated problem, and contributes to a lethargy that makes any attempt at cleaning even more difficult. After all, it is likely to feel like an impossible task, once it is too far gone.

There are several other disorders that may initiate or contribute to hoarding. Obsessive-compulsive disorder is common, even though on the surface, a hoarding seems the very opposite of the hyper-orderly or super-clean person with OCD. Attention deficit may also contribute, as can psychosis and alcohol or drug dependency.

The other side of hoarding is the act of gathering things in the first place. Hyperactivity and the manic state of bipolar may contribute to buying sprees that get out of hand. Even a hobby, intended to be a calm diversion from the stresses of day-to-day life, can lead to, for example, a collection of tchotchkes that fills your house.

A related problem is the excessive collection of pets, sometimes to the point that you can no longer care for them or for yourself, and maintaining the cleanliness of your home becomes impossible. Pets are, not uncommonly, things that many people become obsessed with, perhaps as a need for affection. Our culture of separate, parallel lives can lead to a deep sense of isolation, which a dog or cat or a dozen or two of them seems to lessen.

As with all the psychological problems here discussed, these are not people to ridicule or shame. They can't help it - that's why we call it a disease!

Similar disorders

We might also include hypochondriasis here (even though it is "officially" classified as a somatoform disorder).  People with hypochondriasis (called hypochondriacs) are preoccupied with fears of having or getting a serious disease.  Even after being told that they do not have the disease they are concerned about, they continue to worry.  They often exaggerate minor abnormalities, go from doctor to doctor, and ask for repeated examinations and medical tests.  A guess at prevalence of hypochondriacs is that it involves between 4% and 9% of the population.

A curious version of hypochondriasis is found in India, called dhat.  People with dhat suffer from anxiety, fatigue, aches, weakness, depression, and so on - all revolving around an obsessive concern with having lost too much semen!  We may laugh, but 100 years ago, westerners also believed that a man has only so much semen to use in his life-time, and 50 years ago, coaches would warn their players not to have sex the night before a big game because it would drain them of energy.  In the U.S. today, people are obsessed with aging to such a degree that they are willing to undergo surgery and injections of poisons to appear younger - even though these activities may actually decrease their life-span!

Three other disorders are similar to obsessive-compulsive disorder (although officially categorized as impulse-control disorders):

Trichotillomania is the “recurrent pulling out of one’s hair for pleasure, gratification, or relief of tension that results in noticeable hair loss.” (DSM IV)   It is not restricted to hair on head, and may even involve pulling out eyelashes.  Trichotillomania is often associated with stress, but sometimes occurs while the person is relaxed as well.  It usually starts in childhood or adolescence.  1 to 2% of college students report having had trichotillomania at some time.

Kleptomania is the “recurrent failure to resist impulses to steal objects not needed for personal use or monetary value.”  (DSM IV) The person knows it is wrong, fears being caught, and feels guilty about it, but can’t seem to resist the impulse.  It is rare, but much more common among women than among men.  It is, as you can imagine, difficult to differentiate from intentional stealing!

Pathological gambling is “recurrent and persistent maladaptive gambling behavior.”  (DSM IV)  We often call it compulsive gambling.  A lot of distorted thinking goes with it - superstition, overconfidence, denial.  Pathological gamblers tend to be people with a lot of energy who are easily bored, and the urge to gamble increases when they are under stress.  It may involve 1 to 3% of the population, and two thirds are men.

Mood disorders

As the name implies, mood disorders are defined by pathological extremes of certain moods - specifically, sadness and elation.  While sadness and elation are normal and natural, they may become pervasive and debilitating, and may even result in death, either in the form of suicide or as the result of reckless behavior.  In any one year, roughly 7% of Americans suffer from mood disorders.


The most common mood disorder is major depression.  Besides pervasive sadness, depression involves a loss of interest in anything that the person once considered important.  Nothing seems to give them pleasure anymore.  As for physical symptoms, many depressed people suffer from insomnia and a loss of appetite.  However, others (myself included) wind up overeating and sleeping a great deal.

The nastiest part of depression is the tendency to dwell on death, and depressed people make up somewhere in the range of 20 to 35 percent of suicides.  Many turn to drugs and alcohol in an effort to find relief.

Depression tends to last between 6 and 12 months, and some fortunate folks never suffer from it again.  More commonly, depressed people suffer a recurrence after a period of a few more months, and many will continue to cycle through depressive periods for the rest of their lives.

Depression is often an accompaniment of anxiety disorders, and like the anxiety disorders, women are about twice as likely to suffer from depression as men.  Women tend to attempt suicide about four times as often as men, but men succeed about four times as often as women.  This is due to the choice of means:  Women prefer overdoses, which often go "wrong" (i.e. they survive), while men prefer guns, which tend to go "right."

Depression is related, of course, to sadness.  Sadness is a natural response to difficult circumstances that cannot be resolved by running away (that would be fear) or attacking the problem (that would be anger).  Instead, there is the sense that one must wait for the problem to resolve by itself.  In grief, for example, we ultimately realize that only time will lessen the pain.

We consider sadness to have passed over into pathology when we lose the sense that the pain will lessen.  We continue to suffer, we have guilt feelings, we dwell on the problem, we even try to shut down our feelings altogether.  Traumatic events such as the sickness or death of a loved one are common causes of depression.

But continual stress is also a common cause of depression.  Living with stress causes the depletion of the body's resources, including changes in the availability of the neurotransmitters associated with energy, happiness, and calm.  With repeated stress, the nervous system becomes increasingly sensitive to additional stress, until it no longer seems to be able to cope.  A simple way to say this is that you become emotionally exhausted from life's difficulties.

We find depression more commonly in people who live in the face of poverty, discrimination, and exploitation.  It is not a complete surprise that 70% of depressed people are women, as living in a male-dominated society adds to the stresses women must deal with.  It is also more common among people in stigmatized populations.  Cultural psychologist Richard Castillo even suggests that treating depression as a "brain disease" is a way society avoids facing the significant social problems that lead to depression.

One well-known explanation of depression considers it a matter of learned helplessness.  If we see ourselves as helpless in the face of stress and trauma, if we see our suffering as hopeless, we develop depression.  This leaves a dilemma for psychologists:  It often helps people to see depression as a "brain disease" involving low seratonin levels, since they can stop seeing themselves as somehow responsible for their condition.  But that also means they now see depression as something that can only be helped by external medical intervention.

Like most existential psychologists, Frankl acknowledges the importance of genetic and physiological factors on psychopathology.  He sees depression, for example, as founded in a "vital low," i.e. a diminishment of physical energy.  On the psychological level, he relates depression to the feelings of inadequacy we feel when we are confronted by tasks that are beyond our capacities, physical or mental.

On the spiritual level, Frankl views depression as "tension between what the person is and what he ought to be." (1973, p. 202)  The person's goals seem unreachable to him, and he loses a sense of his own future.  Over time, he becomes disgusted at himself and projects that disgust onto others or even humanity in general.  The ever-present gap between what is and what should be becomes a "gaping abyss."  (1973, p. 202)

Depression is not as common in nonwestern and premodern cultures.  In those cultures, it is more likely that emotional exhaustion is expressed via somatization, i.e. in the form of physical complaints.  Castillo suggests that the prevalence of depression in modern western societies such as the U.S. is due to our emphasis on financial success, material values, and the idea that we each have individual responsibility for our own happiness.  In other societies, people rely more on defined status, tradition, and the social support of extended family.  Also in other societies, people don't see happiness as a right.  In the U.S., if you are not happy, we assume that there is something terribly wrong!

Bipolar disorder

Bipolar disorder used to be called manic-depression, which was a good word for it.  Instead of cycling between depression and an ordinary state, they cycle between depression and mania.  It is the mania that differentiates it from regular depression.

Mania is a state of mind which involves excitement, irritation, often a sense of strong well being, and a sense that one can do pretty much anything.  Manics may believe that they are incredibly talented, are unusually creative, and are immune to danger.  They may go on spending sprees, gambling escapades, sexual adventures, and high-risk activities.  They tend to feel full of energy and their minds race.  While they may in fact get a great deal done, they are also very near to something more psychotic, with paranoia and irrational thoughts.

It is likely that mania involves a certain amount of dissociation - that is, a refocussing of attention away from painful situations (especially social ones) and onto a powerful, grandiose fantasy.  So bipolar disorder may be a matter of an energetic fantasy phase followed by emotional exhaustion followed by another energetic fantasy phase, and so on.

Mania is sometimes associated with creativity, and a number of famous writers, artists, musicians, and others are believed to have been bipolar.  They would be depressed for months, and then have bursts of energetic creative activity, only to fall back into depression.  People believed to have been bipolar include Ludwig von Beethoven, Abraham Lincoln, Winston Churchill, Isaac Newton, Charles Dickens, Edgar Allen Poe, Mark Twain, Virginia Woolf, Kurt Vonnegut Jr., Edvard Munch, Vincent van Gogh, Marilyn Monroe, Jimmy Hendrix, Sting, Ozzie Osbourne, Adam Ant, and Kurt Cobain.

Trance disorders

There are a number of dissorders that involve an altered state of consciousness called trance.  Trance disorders is not an official name, but it is particularly appropriate.  First, the somatoform disorders.

Somatoform disorders

Somatoform disorders are characterized by a concern with the body.  Stress and trauma lead to anxiety, but instead of developing one of the anxiety disorders or depression, some people somaticize:  They experience the anxiety as fatigue, loss of appetite, body aches, headaches, gastrointestinal problems, and so on.  Somatization is actually the most common manifestation of anxiety, especially in non-western countries.

It has been noted, since the 1800s, that people with these disorders are uncommonly easy to hypnotize.  This suggests that they may also find it easy to convince themselves of physical ailments that don't really exist.  This can be understood as a matter of dissociation (which we discuss under dissociative disorders, below).  Some people (usually nervous extraverts) are able to focus their attention on some aspects of their bodies (such as aches and pains) and focus attention away from other aspects (such as the ability to feel their hands or use their legs).  This accounts for the way hypnosis and folk remedies are able to help people with somatoform disorders.

There are several variations:

People with somatization disorder have a history of complaints concerning their physical health, yet show little or no signs of actually having the problems they think they have.  It is a rare disorder in western societies, affecting .2 to 2% of women and less than .2% of men.  These people seem to have a very broad variety of problems, including pain in different parts of the body, gastrointestinal problems, sexual and menstrual symptoms and neurological problems.  It has been a concern, however, that this diagnosis has been misused in the past, especially in regards to women who may very well have had real medical conditions beyond the abilities of their doctors to diagnose!

In China, somatization disorder is a relatively common problem, and is labelled neurasthenia.  Neurasthenia combines somatization with feelings of anxiety, depression, irritability, and distraction.  In Korea, there is a version called hwa-byung.  It is most commonly found in less educated, middle aged women who are trapped in bad marriages.

Conversion disorder was formerly known as hysteria, and became famous as the disorder that inspired Sigmund Freud to develop psychoanalysis.  It is similar to somatization, but is more focused on neurological problems such as paralysis of limbs, muscle weakness, balance problems, inability to speak, loss of sense of touch, deafness, vision problems, even blindness, and yet involve no underlying neurological problems!  It is very rare, but is considerably more common in women.  It is often seen in context of accidents or military activity, and is more common among rural and other people who are medically naive.  As Freud and other early psychiatrists noted, the symptoms disappear with hypnosis - but other symptoms usually arise to fill in the gap.

People with pain disorder have a history of complaints specifically concerning pain.  These people are not lying, and are not malingering - they really feel pain, even though the cause is not found.  It is relatively common, but many are concerned with using this diagnosis:  There have been real medical problems discovered that had previously been "dismissed" as psychological, such as fibromyalgia.  Nevertheless, we have to be careful not to underestimate our ability to intensify or even create suffering in ourselves.  Simply focussing attention on small aches and pains can intensify them.

Dissociative disorders

In dissociative disorders, one aspect of a person’s psychological makeup is dissociated (separated) from others.  A commonality among most people diagnosed with these disorders is their susceptibility to trance states, hypnosis, and suggestibility.  Hans Eysenck's research suggests as well that these are more likely to be nervous extraverts.

Dissocative amnesia is the “inability to recall important personal information, usually of a traumatic or stressful nature,” (DSM IV) but more than what we would characterize as ordinary forgetfulness.  It is not due, of course, to a physical trauma, drug use, or a medical condition.  Instead, it is due to the ability that these people have to focus away from certain memories that disturb them.

It has been increasingly common for people to report having forgotten childhood traumas, especially sexual abuse, while in the care of certain therapists.  Recent researchers now believe that the “recovered memories” that these patients report are actually implanted in the minds of these very suggestable people by their over-enthusiastic therapists.  It is still not known whether all recovered memories should be suspect or not, although memory research suggests that trauma is more typically remembered well, not poorly.

Fugue is amnesia accompanied by sudden travel away from a person’s usual haunts.  Time away can range from a few hours to months.  When these people return to normal, they often don’t remember what happened while they were away.  A few adopt an entirely new identity while “on the road.”

Dissociative identity disorder - formerly known as multiple personality - involves someone developing two or more seperate “identities” that take over the person’s behavior from time to time.  The "usual" personality doesn't remember what happens when an alternate personality takes over.  Dissociative identity disorder is not the same as schizophrenia, but does have some similarities.  In schizophrenia, voices and impulses are seen as coming from outside oneself, while in dissociative identity disorder, they are seen as coming from within, in the form of these alternate personalities.

One of the first cases to reach the public was the story of Eve White.  Eve White (a pseudonym, of course), was a mild mannered woman with a domineering husband.  She found herself waking up with garish makeup, hangovers, and other signs that she had been out carousing during the night.  This alternate personality that took over occasionally was called Eve Black.  Eventually, the two personalities were brought together, and Eve's story was made into a movie with actress Joanne Woodward called "The Three Faces of Eve."  A second movie was much more popular:  "Sybil."  This was the true story of a woman who had been severely abused by her schizophrenic mother, and developed (supposedly) 26 personalities.

People with multiple personalities are usually easily hypnotized, making it likely that this disorder may be caused or at least aggravated by therapists, intentionally or unintentionally, much like recovered memories.  It is looked upon with skepticism by many psychologists.

On the other hand, it may also be understood as a modern version of a fairly common occurance in the nonwestern, premodern world:  Spirit possession.  In cultures where the powers of gods, ghosts, and demons are taken for granted, people sometimes feel possessed by these outside personalities.  In more modern societies, lacking the possession explanation, people assume that the alternate personality is internal.

Depersonalization is the “persistent or recurrent feeling of being detached from one’s mental processes or body....”  (DSM IV)  Often the world seems odd as well, which is called derealization.  Physical objects may seem distorted and other people may seem mechanical.  Again, these people may be particularly easy to hypnotize, and the feeling can be induced even in normal people under hypnosis.  Half of all adults may have experienced a brief episode of depersonalization or derealization in their lifetime, but it is most common in people who have suffered from abuse, the loss of a loved one, or have seen combat.  It is also common under the influence of hallucinogens like LSD.

Dissociative trance disorder is an unofficial category often referred to by psychologists and psychiatrists working in premodern, nonwestern societies.  Trance is a narrowing of one's attention so that some things (such as sight, movement, or even outer reality) are placed outside awareness.  Cross-cultural therapist Richard Castillo, in his book Culture and Mental Illness, says that trance is "an adaptation with great individual and species survival value."  It is not far from such non-pathological states as hypnosis and meditation.

Castillo gives numerous examples:

Amok is found in Malaysia and Indonesia.  The word comes from the Sanskrit for "no freedom."  It involves a person losing their sense of self, grabbing a weapon such as a machete, and running through the village slashing at people.  Afterwards, they have no memory of what they have done and are typically excused from any damage, even if their actions resulted in someone's death!

Grisi siknis is found among teenage girls and yound women of the Miskito indians in Nicaragua.  They also run wild with machetes, occasionally assaulting people or mutilating themselves.  They have no memory of their actions.

Pibloktoq or arctic hysteria is found among polar eskimos.  For anywhere from a few minutes to an hour, a person takes off their clothing and runs screaming through the snow and ice, as a response to a sudden fright.

Latah (in Malaysia) involves violent body movements, taking unusual postures, trance dancing, mimicking other people, throwing things, and so on.

"Falling out" (in the Bahamas) involves falling to the ground, apparently comatose, but hearing and understanding what is going on around you.

"Indisposition" (in Haiti) is a possession trance understood as a response to fear.

"Fits" (in India) is a seizure-like response by some women to family stress, curable by exorcism or by simply telling her husband to protect her from her inlaws!

In the west, these kinds of behaviors are often classified as impulse control disorders, along with trichotillomania, compulsive gambling, pyromania, and kleptomania.  One of these - intermittent explosive disorder - is basically the same as running amok, and is commonly known as "going postal."


Mania, conversion disorders, and somatization disorders lead us into a category distinct from the neuroses

As you recall, we construct a "social reality" for ourselves based on our experiences of others in our society. This social reality is no where near as solid as our experiential reality, and we are troubled when it is threatened. During war or economic depression, immigration or cultural revolutions, some people become severely depressed or develop neurotic symptoms in a vain effort to hold on to the stability that our social reality provides.

And some people go through experiences that “break” their social reality altogether.  For someone with great resources - intelligence, nurturant upbringing, self-confidence, whatever - this experience could be an enlightenment.  For people with few resources - people who don’t have a well-developed understanding of the world - this experience can destroy their psychological integrity.  They are reduced to grabbing whatever flotsam they can to fashion a life-raft:  bits and pieces of personal experience, social reality, and fantasy are patched together and used as a substitute for understanding.  This is psychosis: to live in a second kind of constructed reality which I call idiosyncratic reality.

The psychotic lives in a world of words and ideas that, like that of the conventional person and the neurotic, does not match well with experience.  Unlike the conventional person or neurotic, however, the psychotic does not have a community of like thinkers to encourage him or her when the fictions are threatened.  He or she is alone and is kept alone by fear of emptiness.

Understand that we all have our idiosyncratic realities:  Each of us has a slightly different version of the social reality.  Each of us has serendipitous experiences that are not true guides to reality, but have had such an impact on us that we cannot easily discard them, as in the case of childhood traumas.  Most of us, however, have some degree of awareness of how it is we differ from others, and label those differences as either our psychological faults or as special virtues, while we retain essential communication with others who share most of our social reality.  The psychotic has given that up.


When people think about "crazy" people and people in mental institutions, they are often thinking of people with schizophrenia.  Schizophrenia is the primary example of what psychologists and psychiatrists used to call a psychosis.  The general characteristic of people with a psychosis is that they seem to be out of touch with reality.  Mood disorders, especially mania, used to be considered psychoses as well.

Someone with a neurosis appears to be more emotionally troubled, perhaps even excesssively responsive to reality rather than out of touch with reality.  The anxiety disorders are the primary examples.  Although we don't use these terms as much today, psychology students should keep them in mind!

The key feature of schizophrenia is a loss of connection to reality.  Perception in particular is disrupted, including the classic auditory hallucinations - hearing voices.  But thinking and feeling are disrupted as well, all leading to occasionally bizarre behaviors.  Traditionally, we divide the symptom of schizophrenia into positive ones and negative ones.  Positive symptoms are things you "have," negative ones are things you "lack."

Positive symptoms:

Delusions are irrational beliefs.  Common ones include delusions of paranoia (everyone is after me) and delusions of reference (everything is talking about me).  Of course, if everyone is talking about you and looking for you, you must be pretty important.  Hence we sometimes see delusions of grandeur, even to the point (in extreme cases) of believing one is Christ.

Hallucinations are inaccurate perceptions.  As I mentioned, auditory hallucinations - voices - are common, and may be accompanied by  visual hallucinations.  A hallmark of the voices is that they seem to the schizophrenic to clearly come from the outside, and not from within their own minds.

We also see disorganized speech, which in turn implies disorganized thinking.  They go from one topic to another, sometimes in midsentence, and often do not relate their speech to anything around them or to other people's conversations.

Catatonic behavior is found in certain schizophrenics (called, appropriately, catatonic schizophrenics).  It involves a detachment from one's environment, staring blankly into space, and may involve unusual postures that would seem to be very uncomfortable.  Fortunately, these postures are "waxy," meaning that caretakers can gently reform the postures into something less tiring.

Negative symptoms:

Flat affect means that the variety and intensity of emotional expression of emotion is reduced.  Many schizophrenics have a bland expression, flat voices, and avoid eye contact.

Poverty of speech is self-explanatory.  Many schizophrenics speak slowly with little content.

Avolition is a lack of goal directed behavior.  They may seem not to care about anything.

Schizophrenia usually begins in a person's twenties.  It sometimes starts earlier, which is why they originally called it dementia praecox - the dementia of the immature.  It usually begins with social withdrawal and loss of interest, and will eventually move on to unusual behaviors.  This is when the person's family begins to worry.  The disorder can come and go, with periods of lucidity between the bouts of psychosis, but roughly 50 to 70 percent of people with schizophrenia do get better.

Viktor Frankl considers schizophrenia as rooted in a physiological dysfunction, in this case one which leads to the person experiencing himself as an object rather than a subject.

Most of us, when we have thoughts, recognize them as coming from within our own minds.  We "own" them, as modern jargon puts it.  The schizophrenic, for reasons still not understood, is forced to  take a passive perspective on those thoughts, and perceives them as voices.  And he may watch himself and distrust himself - which he experiences passively, as being watched and persecuted.

Frankl believes that this passivity is rooted in an exaggerated tendency to self-observation.  It is as if there were a separation of the self as viewer and the self as viewed.  The viewing self, devoid of content, seems barely real, while the viewed self seems alien.

Although Frankl's logotherapy was not designed to deal with severe psychoses, Frankl nevertheless feels that it can help:  By teaching the schizophrenic to ignore the voices and stop the constant self-observation, while simultaneously leading him or her towards meaningful activity, the therapist may be able to short-circuit the vicious cycle.

Cultural Variation

Schizophrenia is more common in egocentric, as opposed to sociocentric, cultures.  In egocentric societies, each person is seen as more or less responsible for him- or herself, and others may withdraw from the sufferer and allow him or her to fall into isolation.  Families may feel free to express criticism and even hostility when a member does not live up to expectations.  Sociocentric societies, even when they have other, very negative, qualities, nevertheless provide support in the form of extended families.  And, since individual success is not as important as the family's welfare, individuals are not judged as harshly.

Cultural psychologist Richard Castillo suggests that city living, wage labor, and capitalist society places a lot of demands on people, some of whom are not up to the task.  Independence is expected, so people who are not capable of independence are seen as inadequate.  You are expected to be productive, unless you are disabled.  So if you can't work, you must therefore be disabled, and so again inadequate.

Here's another interesting observation about less developed countries and some non-western societies:  Recovery from schizophrenia is common.  In some of these societies, the voices are interpreted as the voices of the ancestors.  Sometimes, the voices are positive, and they give the hearer and his or her family needed advice.  When the advice is acted upon, the ancestor withdraws.  Even if the voices and impulses are negative, they are seen as the effects of demons or witchcraft, and appropriate rituals will bring that person back to him- or herself.  In western society, on the other hand, schizophrenia is defined as an incurable brain disease.  No wonder people don't usually get better!

People want lives in folk societies, wherein everyone is a friendly relative, and no act or object is without holiness.  Chemicals make them want that.  Chemicals make us furious when we are treated as things rather than as persons.  When anything happens to us which would not happen to us in a folk society, our chemicals make us feel like fish out of water.
Kurt Vonnegut Jr. was talking about alienation.   The word comes from the Latin "to be made into a stranger," and it once refered to being deprived of your birthright.  But feeling like a fish out of water expresses the feeling quite well.

The sociologist Seeman analyzed alienation into six aspects that still have meaning:

  1. Powerlessness:  "Nothing I do makes a difference."  "You can't fight city hall."
  2. Normlessness:  "Being 'good' just won't cut it anymore."  "Nice guys finish last."
  3. Meaninglessness:  "I can't make sense of it all anymore."  "What's it all about?"
  4. Cultural estrangement:  "My culture's values aren't mine."  "What is 'success,' anyway?"
  5. Self-estrangement:  "My work doesn't mean much to me."  "What I learn in school isn't relevant."
  6. Social isolation:  "I'm alone."  "I don't fit in."  "No one visits me anymore."

Who hasn't felt at least one of these?  Or know others who feel them?  Some psychologists and sociologists have suggested that alienation is a sign of our times.


Psychological distress is the feeling we experience when we face problems;  psychological delight is the feeling we experience as we solve these problems.  So delight depends on distress, because solving problems means first having problems.  Now, although we spend a lot of time running away from problems - through defensiveness, or aggression, or mindless conformity - occasionally we take on problems.  This requires will.

Will is putting aside present distress in order to reach future delight.  Or staying hopeful, even eager, in the face of anxiety.  Or taking on problems with the intention of solving them.  I'm sure you can think of many things that require will:  dieting, for example - ignoring the cheesecake and attending to the image of a future god or goddess.  Or going to work or to class....  You can see why, in the research literature, will is often refered to as delay of gratification.

When we talk about will, we usually think immediately of what I shall call instrumental will.  This is where the means and the ends are artificially connected:  The distressful things you have to go through are not "naturally" connected to the delightful goals you are attempting to achieve.

Instrumental production  - working for money and such - is the most obvious example:  You put up with boredom, fatigue, anxiety, and all sorts of crap at work, so you can experience a little delight at other times (due almost exclusively to your paycheck!).  Also qualifying as instrumental production for many people is school:  You go to class and read books, not for the joy of learning, but for the almighty grade, followed by the glorious diploma, and hopefully ending with the financially-rewarding job.

In much of research, the motivation behind instrumental production is called extrinsic motivation.

Another example is instrumental association.   You find this a lot at work, too.  Think of all the people you have to be friendly to, even if you don't want to be.  Think of the last time you had to talk to someone you didn't like - perhaps you recall how much your face hurt from smiling at this person all day!  But this is a big part of business:  You have chickens; Joe has chicken coops; You can't stand him, but for the sake of business, you put up with him.

Another name for instrumental association is Gesellschaft.  Instrumental production and association together make up the central concern of economics-style social theories such as exchange theory.

It should be obvious at this point that I have another form of will in mind as well.  I call it natural will, and it involves means and ends that are "naturally," even intimately, tied together.  With natural will, the distress you put up with is due to the same problem which, when you solve it, provides the delight.  Like instrumental will, it comes in two flavors:

Natural production  includes much of what we call craftsmanship, art, and even science.  The artist "sees" the end result of his efforts in the uncut marble, "sees" the final brush strokes on the blank canvas, "hears" how his unwritten song should sound.  The artist knows what he wants, but must struggle to arrive.  You sweat, you curse, but in the end you feel much like the child who proudly presents his clay ashtray to his parents.

The motivation behind natural production is often called intrinsic motivation.

There is, of course, also natural association.  Lovers, families, friendships, clans, neighborhoods....  You sweat with them, too, and curse.  But you "hang around" anyway, even if you don't have to.  Although it takes will, we are supported by that totally irrational feeling that makes us want to "hang around" - love, or a sense of belonging at least.  Your well-being is tied to another's well-being.

This is also called Gemeinschaft.

It is this natural production and association that does not operate by the economic rules of exchange theory, is not directed towards "outcomes," is done, in fact, for no economic reasons at all.  It operates, rather, by non-mathematical principles having to do with increasing complexity in the service of life.  Mystical stuff.

Examples abound:  The bond between parent and child is often highly unrewarding, considered economically, yet it is a hard bond to break;  the loyalty among soldiers will occasionally lead one to sacrifice his very life for the others; there's unrequited love...; the starving artist....  If you consider what we value most in life - honesty, generosity, caring, bravery - you will notice that these things require a lack of concern with costs and benefits!  Running into a burning building to save a child only after being promised a million dollars isn't considered brave - just greedy.

It is true that the instrumental side of life has always been with us.  It seems, for example, that we invented tools before we were who we are (homo sapiens), and tools are the very symbol of instrumentality.  Nevertheless, I feel comfortable calling the natural natural because it seems likely that it was far more common in our early history than it is today.  The anthropologist Robert Redfield called the hypothetical situation of our earliest ancestors the folk society, and described it so:

[It is] small, isolated, nonliterate, and homogeneous, with a strong sense of group solidarity.  The ways of living are conventionalized into that coherent system we call a "culture."  Behavior is traditional, spontaneous, uncritical, and personal; there is no legislation or habit of experiment and reflection for intellectual ends.  Kinship, its relationships and institutions, are the type categories of experience and the familial group is the unit of action.  The sacred prevails over the secular; the economy is one of status rather than the market.

That is, it is a society marked by predominantly natural associations and natural production.  Our society, I think you would agree, is highly instrumental in comparison.


When, in our highly instrumental society, we find ourselves without natural association and production, we feel alienation.

Normally, living instrumentally doesn't lead to alienation.  After a hard day of instrumental association, I can go home and relax with family and friends - my natural associations.  I may even have some friends at work.  And, at the end of the week, after all my hard instrumental work, I get my paycheck, which (after taking care of the necessities) brings me some natural pleasures - movies, books, restaurants, hobbies, sports....  And I may even get some natural satisfaction in my work itself.

Unfortunately, in a largely instrumental society, these things are easily undermined.  First, we may discover that we lack natural associations - that we are rather lonely people.  There may be a fundamental scarcity of natural associations:  Our families are very small, we move around a lot, friends and lovers come and go.  One death in a modern day "subnuclear" family, for example, can be far more devastating than many deaths in a tribal community.

We can also lose faith in people.  We teach our kids "never judge a book by its cover,"  "all that glitters is not gold,"  "never take candy from a stranger...."  We teach them to take people not as they appear to be, but to look for hidden motives, to look for what they are really after - to look at them instrumentally.  But what happens, then, when the child decides to put Daddy in the same category he has been taught to use with the used-car salesman?  The natural is undermined by the instrumental.

We also discover our lack of natural production - our boredom.  Again, the scarcity of natural production is a problem:  How many "creative" jobs are there, really?  How much of even a good job is actually interesting? How much time and money can we spend on our rather contrived (i.e. instrumental) hobbies and sports?

Further, as with association, instrumental production tends to drive out natural production.  Remember Deci's research?  Give kids gold stars for what they enjoy doing and, before you know it, they no longer do it unless the gold star is waiting!  Paying an artist for creativity or a thinker for inventiveness is like paying someone for sex... the thrill soon evaporates.

But even with little in the way of natural association and production, we can get along quite well.  The instrumental life still has its rewards.  There has to be something that triggers alienation, that makes us aware of it:  This happens when instrumental association and production fail, that is, when we are faced with the fact that all that work actually does not lead to happiness.

The failure of instrumental association and production can happen in two ways.  First, it can be a matter of means:  If we lose our jobs, to use the obvious example, we can't pay our bills - and our pleasures are the first things we have to sacrifice.  If you flunk out of college, there is no degree, and no fine career, waiting for us.

The failure of the instrumental can also be a matter of ends:  Money can provide an opportunity for natural enjoyments, but it can't buy them.  Our inclination, when life begins to bore us, is to throw more money into "entertainment."  But when the entertainment fails to entertain, we ask ourselves "is this all there is?"

Back to the beginning

We can go back and review Seeman's six aspects of alienation using the preceding analysis:  In regards to production, we too often find ourselves facing an absence of the natural or intrinsically rewarding (meaninglessness).  Further, we face the failure of instrumental means (powerlessness) and the ultimately unsatisfying nature of instrumental ends (self-estrangement).

Likewise, in regards to association, we find ourselves facing an absence of the natural (social isolation), the failure of instrumental means (normlessness), and the ultimately unsatisfying nature of instrumental ends (cultural estrangement).

The solution to alienation is now clear:  Correct or reverse the courses described above.  First, the alienated person needs to find work that does in fact lead to rewards that are in fact rewarding!  This, more often than not, is a social and political issue: Where does one find such work and how does one train for it?

But beyond this, the alienated person needs to find and maintain sources of natural production and association - meaningful activities and loving relationships.  A part of this, too, is social and political, and often even a matter of luck.  But it may also require changes in a person's ways of perceiving and thinking about work and people and themselves.