Meeting-The-Challenge-Making-a-Difference-Practitioner-Guide

Is the culture of a second
generation immigrant that of
the family he or she grew up in,
or the culture of the wider
community in which he or she
went to school?
This is why the phrase in the
DSM IV definition is very
important: that the
problematic pattern of
behaviour ‘leads to distress or
impairment’. Sometimes being
extreme or unusual within a
particular culture is adaptive
and functional: it enables
people to challenge the status
quo, and to achieve extreme or
exceptional things like the
early feminists or civil rights
activists. When this is the case,
if they do not harm others or
feel distress themselves in the
process, we may think of them
as eccentric maybe, but ‘high
functioning’ and not suffering
from a mental disorder.
Distinguishing personality disorder
and mental illness
Within a psychiatric framework for understanding mental health
problems a clear distinction is made between personality difficulties and
‘mental illness’such as severe depression,psychotic disorder and bipolar
disorder. However, this distinction rarely reflects individual experience; it is
common for people to have a range of difficulties,which this model would
see as mental illness and personality problems; health professionals call
this ‘co-morbidity’. Some people are now questioning whether it is helpful
to see someone as having two or more disorders,rather than viewing
them as a person whose problems have different aspects. For example,
many people with personality disorders use drugs and alcohol to help
them manage their feelings. If they become dependent on substances
some people would regard it as an additional disorder (a ‘co-morbid’
disorder) rather than part of the same underlying problem. Service users
generally want to be treated as individuals,seeking supportive,empathic
staff to help them navigate through the difficulties they experience in
life,rather than being seen to have a number of disorders.
As discussed earlier, there is controversy about using a psychiatric
approach to understanding emotional distress. However, it is
widely used, and a distinction is often made between ‘mental
illness’ and ‘personality disorder’ based on the following:
• Unlike personality disorders, mental illnesses are thought to
have an identifiable onset, in which a period of ‘illness’ interferes
with the individual’s usual way of functioning. In contrast,
personality disorder is more developmental, so there is no
identifiable point in time when someone becomes unwell.
• Severe mental illnesses are traditionally treated with medication with
the aim of returning someone to a state of wellness,although
fluctuations can occur. In contrast, the difficulties associated with
personality disorder form part of the personality system; medication
may have a part to play but will not be the main component of the help
required. People with personality disorder have long term problems,and
do not have a healthy self to return to,but rather need to build one.
• Despite these distinctions, some people diagnosed with
personality disorders also meet the criteria for ‘mental illnesses’
such as depression, psychotic disorder or bipolar disorder. It is
also suggested that having a personality disorder may increase
one’s risk for developing mental illness.
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