Dr. Deb made some comments about the finale of The Sopranos. I never watched Sopranos, I don't watch much TV. So I won't comment about the show. But I was struck by one of Dr. Deb's comments.

Personality disorders are resistant to cure - so Tony's antisocial and narcissistic personality issues were not changeable. That is true. But treatment was successful in reducing panic attacks and his depression - and the insight gained helped Tony find an greater understanding to his life experiences. A total failure, I think not.

Sometimes the whole process of diagnosis is misleading to everyone, the client, and the professional. People who qualify for a personality disorder have learned maladaptive patterns to cope with life. Most often, those experiences occurred in childhood, too often in the form of emotional or physical neglect or abuse. The child who eventually develops a personality disorder becomes impaired in his ability to learn more effective coping. That impairment usually shows up in peer and authority relationships. The child is prone to conflict and rejection by peers and adult figures in his life. The problem in his ability to cope spreads throughout his relationships with others, with himself, and his ability to educate and support himself. He becomes prone to chemical dependency and problems with anxiety and depression.

"Cure" is a loaded word when applied to mental health. That is largely because the disease-based medical model doesn't work very well in explaining mental illness. No one is really cured of mental illness. No one really "catches" a disease. It is much more complex than that. So to say persons with a personality disorder is resistant to change, that is certainly true. The problem develops in a person who has had a chronic difficulty learning how to cope with change. So changing even deliberately is very difficult, more so than for most people.

However, it is NOT true that change is impossible. The pain of living a dysfunctional life is torturous. But the most creative force in all of our lives is our misery. While persons with a personality disorder have many obstacles to overcome, if they chose to make a change, they have all the creative energy they need.

I've had the pleasure of working with hundreds of people with personality disorders over the past thirty years. Many are able to make major changes largely because their pain is so great. Persons who understand that level of pain, can learn effective empathy, mutuality and communication. And when they do, they are capable of incredible tenderness, sensitivity, generosity, and effective living.