When Do Personality Traits Become Mental Illness?

Depression may be adaptive in some regards, and there may even be an evolutionary basis for the attractiveness of moodiness (more on that in “The Sexiness of Sadness.”) But this doesn’t mean that we accept these traits as a society. Instead, what Philip Fischer labels “passionate traits” like melancholy, irritability or even exuberance are frowned upon, especially if you don’t have a particularly theatrical job.

“Hey, Bob! Stop dancing on the copy machine and finish your TPS reports!”

But there is a problem inherent in the way the general population defines “illness.” Numerous traits influence personality, and at any given time, most people will exhibit at least some traits that indicate depression, hyperthymia or anxiety. Unfortunately, we have a tendency to label such traits as disorder as opposed to normal differences between people.

No longer are we passionate dancers, melancholic writers or exuberant salespeople; we are ill. And the more visible those emotions are to others, the more they are seen as an uncivilized throwback to our neanderthal days, a mark of pathology.

• “He’s out of control. I heard he refused to go to work on Friday because they fired his best friend.”

• “She’s crazy. I hear she screamed at the school superintendent for refusing to give her kid admission to the special program.”

• “He’s so loud. He might need anger management.”

• “She’s codependent.”

• “He’s always moody. I think he must be disturbed.”

• “She cries at the drop of a hat. She must be depressed.”

But do we have it all wrong? Is our normal state closer to the extremes than the muted existence we have become accustomed to? And if so, why are we hiding it?

The Link Between Instinct and Emotion (And Reasons To Change It)

According to Charles Darwin in The Expression of Man and Animals, rage, joy, terror and physical pain are the strongest emotions. This is likely due to the action required to respond to whatever caused them. These strong emotions function as the root of our experience, providing a driving force for action, as opposed to just “moods.”

And those emotions used to be more widely accepted.

Philip Fischer, author of The Vehement Passions, also sees passionate expression of emotions as a part of an instinctual drive that is expressed based on the confines of society. Fischer cites the work of Aristotle as a classic example of the difference between how we currently define “good-natured,” and how cultures of the past identified it.

In Aristotle’s Nicomachean Ethics, anger is desirable:

“The man who is angry at the right things and with the right people, and, further, as he ought, when he ought, and as long as he ought, is praised…. This will be the good-tempered man.”

Fisher notes that individuals who were “good-natured” in Aristotle’s time were those who were just the right amount of angry, who responded with justified aggression at slights. To respond passively—in the way that is currently encouraged in our society—meant you had less worth to protect, either in yourself or in those around you. Walking away meant low self-esteem.

Say what now?

This is clearly a contradiction to how we currently see strong expression of feelings, but Fischer has an explanation. He believes that the evolution of how we currently see “emotion” may have been at least partly triggered by the calm following the post war era. After periods where heightened emotion and instinct were linked on a battlefield, the subsequent period of less imminent danger came to reflect the muted state of newfound calm not present in times of war. Instead of seeing feelings in the context of extremes, where emotion was required to fight and kill, those feelings should now be a reflection of relative safety.

Yesterday’s moderate was the one with high anxiety and grief after losing friends on the battlefield, which fueled adaptive anger and necessary aggression. Today’s moderate is neutral because he no longer has to fight daily to live.

Regardless of how much this truly influenced our current system is still under debate, but Fisher is right about one thing: today’s society perceives some expressions of emotion as pathological or threatening no matter which end of the spectrum you are on. Passivity is just as pathologized as strong emotions. The doting matriarchs who showed more submission and lowered mood in earlier generations were not considered ill: they were good wives. Now we call it codependency regardless of the happiness of individuals within relationships.

This is clearly not to encourage the return of submission. I’d fail in .03 seconds (I, like my mouthy characters, have never been a great listener). Instead, it is merely an example of how the perception of certain traits changes over time.

But it is not just a function of time. How we see ourselves is also a function of where we find ourselves. What we diagnose in our society as ill may be seen as a completely normal occurrence in other cultures.

How Does Society Influence Personality Tolerance?

Certain cultures are more comfortable with certain personality traits, and will tolerate a great deal more before they are seen as pathological. Some societies allow for more melancholy and depressive traits, some are more accepting of overall loudness or exuberance. Grief is one concrete example of this difference.

Peter Kramer, author of Listening to Prozac, cites the expected five year grieving cycle in Greece, a place where they may be more socially accepting of lower moods. There, depression after a loss past the five-year mark would be considered maladaptive or pathological. Here we medicate it at a year, and often much sooner.

That’s a four year difference.

While it might be argued that other countries simply don’t medicate these things in the same way, it still speaks to the wider issue of tolerance. Some other cultures accept longer grieving periods and normal expressions of human existence with less stigma. Americans tend to have an intolerance of lower moods and a tendency to pathologize those who experience them.

It is also possible that if you happen to live in a culture that is more accepting of your particular brand of personality, you may not experience the same shifts in self-esteem or furthered lowered mood that comes about when you don’t fit the mold. Culture may make us more depressed not simply as a matter of environment, but also because it defines pathology sooner and makes us feel “less than” for still feeling certain ways. Likewise, those with certain personality traits may actually be happier, or at least feel less shameful, in a culture that accepts those traits as normal.

“So, if I run a little sad by nature I should move to… Greece?”

Don’t leap on a plane just yet, because tolerance is one thing, success is another. Even in other cultures where some personalities are more accepted, this doesn’t mean that they translate into financial well-being. And financial woes are in and of themselves a surefire trigger to depression.

It’s a tricky web.

Hyperthymia Versus Dysthymia: What We Reward (and What We Don’t)

What qualifies as pathology is dictated by our current value systems. We value strong independence, extroversion and social prowess specifically because of the ability of those traits to increase our capacity for financial success.

Dysthymia—or chronic low mood that is less severe than major depression—is one area where there is a fine line between disorder and temperament. Mentioned by Kramer in Listening to Prozac and discussed at length in Darwinian Psychiatry, there is evidence that those with dysthymic personalities may be suffering from a mismatch of ingrained personality style and current social environment. While dysthymia is a viable reproductive strategy which allowed early humans to take less chances and settle for fewer social contacts, today we see some of the traits associated with it—such as introversion or less risk-taking—as signs of weakness, or as an indicator of one who is less successful.

And this is sometimes true. Dysthymic traits are rarely rewarded in any tangible sense (though I’d argue that I was far happier during the pandemic because of my tendency towards “fewer social contacts”).

But whether they reliably lead to financial or social “success,” (which I’d argue has no single definition) do such traits really equal disorder?

It is possible that some of our diagnosis of who is ill and who is not is the construct of a society which does not reward melancholic personalities (even in his younger years, Detective Petrosky wasn’t all about sunshine and rainbows, which never made things easier for him). Instead, hyperthymia is encouraged. The hyperdrive to succeed, the extra friendly predispositions, flexibility, strong motivation, high energy levels and overconfidence can be equally indicative of psychiatric diagnoses. The difference is that we reward certain categories because of how we function within our nation, our society, and our social circles.

Even malignant narcissism tends to be financially rewarded, otherwise, we wouldn’t have any idea who Donald Trump is. Regardless of your political leanings (there are certainly Democrats who have exhibited pro-social narcissism), he is the poster child for unhealthy psychological traits that are rewarded with media exposure and which translate into financial gain. Some of the very elements that indicate disorder were the ones that made him so attractive to a subset of the population.

This difference in reward structure makes identical symptoms look different too. Someone with a hyperthymic personality who cannot sleep is a highly driven go-getter, a workaholic at worst. Someone who edges dysthymic who can’t sleep is too sensitive–they just need to let it go. Surely they’ll be able to work harder and feel better if they just rest.

It is easy to avoid shaming responses associated with traits that are helpful. No matter how anxious the hyperthymic may be, they can put that energy to good use, rationalize it as a good thing and avoid feeling bad about it. Those who are more depressed have no way to justify traits in a society that condemns them, regardless of whether enhanced creativity or deep thinking are a reliable byproduct.

For these reasons, dysthymia and depression are more likely to be diagnosed as an issue than pathologies of the wide-eyed and bushy-tailed variety. Hyperthymia is what we are all aiming for. And because most people aren’t seeking help for traits that lead to success, dysthymia may be more diagnosed purely because we have become intent on “curing” it.

The Link Between Medication and Diagnosis

While the issue of overmedication requires its own post, there is evidence that under treatment may be a bigger issue, particularly when diagnosis and treatment planning is done by general practitioners in ten minutes as opposed to hour-long sessions with a psychiatrist.

These issues aside, diagnostic criteria can reliably affect the way we diagnose mental illness and what threshold we put on treatable suffering, because it dictates what we can do about them. Diagnosing someone with an illness is only useful if it helps you to determine a way to help them.

Kramer argues that diagnosis is often a tool that predicts response to medications. In other words, if someone is depressed, they should respond a certain way to a certain pill.

“Not sure if you’re depressed? Take three of these and call me in a week.”

But according to Kramer, it was the ease and relative safety of Prozac that triggered a cycle where more people ended up diagnosed with depression, because the threshold for treatment was lower.

It went kind of like this:

Step One: Prozac was approved for major depression, despite not being remarkably effective for this purpose in clinical trials (though later research has shown protective effects for the depressed brain).

Step Two: Physicians began prescribing it for less depressed patients, for whom it ended up being remarkably more effective.

Step Three: Those with less marked cases of depression—or those who would not have been diagnosed before—came to be diagnosed as depressed because antidepressant medication made them feel better.

So, physicians felt comfortable giving Prozac to patients with fewer clinical symptoms due to a low side effect profile, even though many of these patients did not meet the official criteria for clinical depression. This subsequently expanded the number of people who were labeled “depressed.”

But if it helped, surely they must have been depressed, right? What would Prozac actually be treating if not diagnosable mental illness?

Unacceptable Personalities

It’s not that personalities and what we consider diagnosable mental illness aren’t connected, but Prozac is especially good at altering mood and temperament, particularly those associated with dysthymia and introversion.

Research shows that Prozac has the ability to significantly alter moods and personality traits outside of simply decreasing depression. And additional research indicates that these effects are common among those taking SSRIs, as opposed to being rare side effects as previously thought.

Kramer notes that Prozac reliably alters boundaries as well, making those who take Prozac more outgoing and social. Whether or not it was deemed a “problem behavior” before, this newfound lease on life often causes people to see their previous disposition as a problem after the fact.

This may mean that some—but certainly not all—of the “depression” that Prozac treats might not be clinical depression at all, but underlying personality traits that are less desirable in our society.

Perhaps you can’t really know what you are missing until you experience it. Or perhaps seeing how much easier life is for those with such traits makes people less tolerant of their own personality styles.

Some might argue that this is a positive: that once you fit in a little bit better, it is a hell of a lot easier to feel better about yourself. This is true. But, as Kramer posits, if the medication worked for you what does that mean? Does it mean that you’ve been depressed your whole life and never realized it? Do you now need the medication because there is actually something wrong with you?

Nothing makes you feel awesome like labels and stigma, particularly because of the ability of social shaming to trigger additional depression all by itself.

The Sometimes Ambiguous Border of Suffering

So where is the line between mental illness and personality traits? It depends, primarily on how the one experiencing it feels about it.

All of us have some depressive or anxious traits from time to time. If I happen to be moody, brooding over this post at three a.m., am I ill? I’d say not, but I am necessarily biased. I’m also not disturbed by my brooding or my state of mood. Deep thinkers write good blog posts and even better books. #fact

It matters whether or not you feel badly in your brooding, your moodiness, your passivity or your exuberance. Your individual definition of happiness matters, as does how often you find yourself there.

But, if you do feel badly more often then not, yet don’t meet criteria for clinical depression, should you be able to alter your personality in order to meet societal expectations? Where is the line be for self-alteration?

There are arguments on both side of this equation. While we tell people to accept who they are, we encourage alteration of these traits at every turn, from schooling practices, to corporate mandates, to overall social acceptance. Society sometimes makes being someone else easier.

One could also argue that by using medications like Prozac, we have an opportunity save people from their pasts by reversing damage done to the brain during a less than ideal history. Kramer notes that we might also save people from negative social and financial experiences by changing the traits that don’t fit a cultural ideal (though he doesn’t argue that this is always wise).

But, if we can save people from their pasts or their futures, where is the threshold of suffering at which we should?

This is not a question any one person can answer, and I don’t believe we have the right to do so for others. Personal freedoms matter for those choosing to exercise them. Just because I wouldn’t alter something doesn’t mean that another should not.

That said, it is a concern when our “normal” is so far removed from actual normal as to skew the way we see ourselves and all of those around us. When normal is not normal, there is the potential for abuse, and it behooves us to seek out what may be contributing to our own experiences, our own mental health or illness, our own happiness or distress.

The question of “Who am I?” is in a large way defined by where we find ourselves, particularly when culture dictates where the line between “good enough” and “less than” is. And that line contributes to more issues than we really should allow.

So where does that leave us? In the absence of clinically diagnosable suffering, where do we draw the line for pharmacological treatment? Do you believe it to be an individual choice, or a societal responsibility to regulate how far individuals go to alter who they are? And can the world really survive if everyone suddenly finds themselves in a hormonally induced position of “top dog” despite environmental cues to the contrary?

True compassion means more than tolerance; it means acceptance. If we simply cannot accept others in a way that leads to better outcomes for all, we have an interesting ethical dilemma on our hands.