Each person has different ways of perceiving, interpreting and responding to environmental stimuli. While for some, activities like riding a roller coaster or traveling may be a natural remedy for depression, for others, these same experiences could trigger a panic attack. There are individuals who seem to have a lot to say about their own opinions and experiences, but show little interest in listening to the perspectives of others. These differences, explains psychiatrist José Luis Carrasco, are a reflection of the different traits that make up personality.
In his new book, Personality and its Disorders (Arpa), Carrasco develops a guide to identify the pillars that support “the temple of personality” of each individual, as well as the disorders that can arise when there is an imbalance between them. Understanding these traits is essential for social interactions. According to the psychiatrist, this allows us to better understand ourselves while “helping us understand and cope with others, both to love them and to be able to separate ourselves from them.” “We are not slaves to our personality,” José Luis Carrasco clarifies, “we can let ourselves be carried away by trends or we can try to control them.”
Is personality unalterable or is there the possibility of changing it?
Personality is not a sentence. We are not condemned to be one way forever. It is a tendency to act in certain ways in certain situations. We can't change it completely, but we can improve it. It's like when your car goes a little to the right, you can correct it with the steering wheel. We are not slaves to it: it is modified, reorganized and some features are mitigated. It is not a condemnation that says 'this is how I am and this is how I will always act'. In addition, the environment and friction with others also come into play.
Are personality traits more innately constituted, as part of our biology, or are they acquired from experiences and environment?
People are like flowers: we have common characteristics that make us human, but each one has its own colors and shapes. There are people who are more introverted and others who are more extroverted, and people who are more or less sensitive to fear. This is very biological, it comes from birth and develops, to a large extent, during the first year of life, when we form the most basic connections of personality. None of these particularities are bad, they are all good if they are allowed to grow well and naturally. It is only bad when there is an overly accentuated trait that makes your life difficult.
Many people take refuge in 'that's how I am and I'm not going to change'.
This is quite self-centered and narcissistic. What we also cannot do is try to turn a person into something they are not, because that is where the problems begin. If one has been paired with a person who is very restless and likes to always be doing new things, then one cannot expect the other to be more stable, to really like being at home and spending time in the garden. It won't be possible because those are his personality traits.
Is there a specific stage of life during which certain personality traits are more likely to be mitigated?
One mitigates traits when one needs to adapt to the environment. The traits are neither good nor bad, but if one needs to overcome his introversion or impulsivity a little to win over someone he loves very much, he can mitigate it a little. It is possible to make an effort to change things such as being a little more communicative than you are, not taking things so personally or being a little more sensitive. It's not worth saying 'that's how I am'.
Is it very difficult to achieve these changes?
Much of what we say we cannot change, we can change. We will always tend to be more extroverted or introverted, or we will be more fearful or less fearful, but we can always try a little harder to be better. To make ourselves and the people around us happier. On the contrary, in cases of depression or anxiety, even if you try, you cannot get rid of it alone. You have to use therapeutic means.
How does borderline personality disorder (BPD) develop?
You are not born with BPD. No one is born with the disorder, it develops. Yes, one is born with certain traits that are then combined with things that happen during development, where one acquires identity, the sense of being valid, attachment, building trust with close people... Although BPD is not inherited, There are certain personality characteristics that are more related to its development, such as emotional sensitivity, fear of danger and impulsivity.
Is it the environment, then, that makes it more likely to develop?
Things have to happen that make the personality not grow well. Everything that happens in the first years of life, especially between the second and sixth year of life, is tremendously important for personality. Another influencing factor is trauma. Having experienced situations of humiliation, physical or sexual abuse causes serious damage to the development of self-image and self-esteem. When sensitivity is mixed with impulsivity, with attachment deficits and a low self-image, that is where the storm that is BPD begins to develop. Great emotional instability occurs, lack of regulation of impulses...
As you state in your book, “unhinged is not the same as unpleasant,” right?
Exact. They can be unpleasant on the outside at times: they can be annoying, impulsive, hostile, but that is not their whole person. They are parts that react as a consequence of something they carry inside, more hidden; fear, insecurity, terror of being abandoned, terror of being diluted in their identity. That is the real disease. Anger, aggression and rejecting others before feeling rejected are defense mechanisms.
Do those who suffer from these disorders usually go to therapy on their own initiative or are they motivated by their environment?
The most common thing is that they are brought. They give their signs: they express their pain, for example by self-harm, through suicide attempts or by having angry attacks. Sometimes those around them interpret it as "Wow... what problems they are causing", but that is their way of communicating that they are suffering. With treatment, we try to move them from that body language of impulsive expression to the identification and then expression of feelings. Take it to a more verbal level so you can control it.
Can the patient identify that their discomfort comes from an internal imbalance?
That happens in the therapy process. The patient, at first, only feels discomfort and does not understand why. He feels that it is his parents' fault and that the bad environment that he is doing is not allowing him to develop. But the patient begins to understand that those he blames are not bad and harmful. The people he blames are the ones he is emotionally dependent on. The patient with BPD has a hurt, fragile and scared core inside. If this core of fragility is not entered, the patient continues to defend himself, hitting or self-harming and the family continues to acquire a greater sense of boredom and anger.
Although mental health is an increasingly present topic today, borderline personality disorders are still not so internalized.
They are not internalized and that is a great lack, because it is very important to understand this when starting to live life and have relationships. There are people who have a bad character or somewhat unpleasant reactions for a time, but they are not like that. They can change and that depends a lot on analyzing internal feelings and how we respond to that bad character. However, there are other people who have a bad character, are self-centered and narcissistic, and they are structurally so, not because they are suffering inside. Which makes them less treatable. When you are with a person of that nature, it is very important to know if with better treatment, with greater understanding and if with a certain psychotherapeutic treatment that will change or if there is nothing to do, because that person will continue to be always unpleasant.
Psychopaths, he explains in the book, represent a special case. Why?
The psychopath cannot be treated from a medical or psychological point of view with techniques, because his way of being is already like that. He will never go to therapy because he has no capacity for self-criticism and, in any case, if one day he goes to treatment, it will be to manipulate or make the therapist suffer. That is why it is a separate case, because there is no possibility of treatment nor can a change be expected.
Psychopathy is sometimes equated with some disorders. You explain that this is a problem.
If we call it a disorder, then when they commit crimes - because psychopaths often commit crimes - their lawyers often argue that because it is a disorder, the person is not acting completely of their own free will. They equate it to borderline personality disorder or even histrionic personality disorder, and it is not the same. There is no treatment, that is, there is no medical excuse. Yes, there should be social treatment to see what is done with these people, but they should not have a medical excuse.
Are there people with multiple personalities?
The concept is a little bit fanciful, it's very movie-like. This thing about them transforming into totally different personalities is quite strange. There have been very few cases of people who have different personalities who do not know each other, which would be true multiple personalities. Nowadays what is seen more is dissociative identity disorder, where a person can have different personalities with different names and characters. One more adult and one more child; one more aggressive and the other uninhibited; and they call it different names. But it is not so clear that they do not know each other, there is usually a kind of 'central self' that knows them all.
What characterizes this dissociative identity disorder?
He is a person who has different facets. Maybe he changes his hairstyle, his dress, or has a masculine and feminine side. The parts of his personality are not integrated. We all have our aggressive, childish or traumatized parts, some more and others less, but what constitutes personality development is the integration of all these parts. In this disorder, what happens is that each part of the personality is very fragmented. Each of them is very poorly integrated with the others and it is as if the individual were divided into several individuals.
In your book you mention that some erroneous beliefs that are deeply rooted in today's society occur because of “so much circus organized around mental health.” What are you referring to?
I'm referring to all the noise that has been around mental health in recent years, especially after the pandemic. There are many opinions that come from people who are not health professionals, in addition to many uses of mental health for political or demagogic purposes. This circus confuses people a lot.
Do you think that a certain stigma still prevails around mental health problems?
Some manage themselves with rational (half-rational) thinking, as if mental illnesses did not exist. So, when someone has depression, they say: "What you have to do is cheer up, go to the movies or find friends." But that is precisely what a person with depression cannot do, if he could do it he would have already done it. He doesn't do it because he can't. We must accept that the mind, like all the organs of the body, can get sick and that does not make us less human.
