Manipulation & ‘Personality Disorder’ – Dig Deeper

Keir is a Lead Therapist in an NHS Specialist Service and provides training, consultation and therapy around complex mental health problems through beamconsultancy.co.uk

Every now and then people are kind enough to respond to some of the things I’ve written with really thoughtful stories, ideas and comments.  I’m sharing this one.  (And feel free to let me know if you’d like me to share what you think, whether it’s complimentary or not).  It’s inspired by my most read post which is also about manipulation.  If you enjoy reading it do let @sarahjaynepalgr know.

“We all manipulate. People who tend to be diagnosed with personality disorder are just particularly bad at it”. Keir Harding (2016)

Manipulation in the context of those diagnosed with personality disorder has negative connotations. Selfish, egotistical, devious, difficult; but those assumptions refer to the intent behind the behaviour. Manipulation is essentially used for survival in whatever form is required. Our children manipulate us all the time if they feel this is necessary to get what they want and depending on how we respond some may learn that this is an effective means of survival. Forming attachments becomes a risky business when a child lacks nurturing and emotional stability. Toxic parenting, neglect, abuse or indifference (intentional or otherwise) teaches a child that human relationships are untrustworthy, painful and disappointing so the negative experience of this will be carried forward into adult life and form the basis for expectations.

Something people diagnosed with PD have in common is a lack of validation of their feelings from an early age. Many have abuse in their history, sustained trauma, complex PTSD. Receiving little or no validation of thoughts and feelings creates insecurity, fear and lack of trust as a child’s personality is forming. When emotional needs are left unmet the message is ‘you are not worthy’. Layered on top of this, any further dysfunction or trauma re-enforces the belief of unworthiness until trust is an unknown feeling. Anyone who lives in fear and cannot trust will continually test any relationship to prove their belief that no-one can be trusted. When we refer to Personality Disorder we are referring to a personality that has ‘disordered’ itself in an attempt to cope with a traumatic reality. A person has an inability to manage emotions as they have learnt their lessons in life through pain and fear not love. When a person is fearful over a sustained period of time (raw fear in a child, anxiety in an adult), the fear internalises and the chemicals in the brain remain in a permanent ‘fight or flight’ response. This heightened state of anxiety causes automatic and extreme responses to stress as any situation can trigger the fear response with no conscious control, hence creating ‘unreasonable’ behaviour which others find difficult.

Very few can empathise without having walked in a person’s shoes, however we can show human compassion and understanding and refrain from judgement. We are all unique in our ability to cope and heal and if a client is triggering you, ask yourself why and what this tells you about yourself; are you are working from your ego or your heart? To label people dismissively as manipulative, difficult or with terms such as ‘it’s behavioural’, is to ignore the core issues where the answers lie. To dismiss the cause of the condition isn’t really treating it at all but does represent the way in which we approach dis-ease in general in our culture.

It’s worth pointing out also that individuals who have had to read the moods and energy of another to stay safe from a young age are very good at sensing when they are being misunderstood or patronised. Staff should be given access to regular training sessions and examine how they manage their own health and emotions to make a positive impact in the life of another. By the time service users get the diagnosis, care plan and treatment they so desperately need it may be at the end of a very long road of confusion and suffering. To engage with staff and form a relationship takes a lot of energy and effort for someone who is crippled with anxiety and afraid of forming attachments. Whilst lack of funding and adequate resources for training can always be an issue, compassion and empathy come from the heart. If we can share this we will improve service and outcomes and enjoy better relationships with those who we have a duty of care towards.

Sarah J Palgrave @sarahjaynepalgr

Views are based on my own experiences
Professional & personal experience in mental health
Reiki & Theta Healing Practitioner

Keir is a Lead Therapist in an NHS Specialist Service and provides training, consultation and therapy around complex mental health problems through beamconsultancy.co.uk

 

 

5 thoughts on “Manipulation & ‘Personality Disorder’ – Dig Deeper

  1. When I tried to access help at university, I had some psychiatric nurses and two doctors start taking the piss out of me, sharing a joke about dripping blood everywhere in an assessment I experienced as degrading.
    Having been a seriously introverted person who wouldn’t answer the phone, I could feel my blood and urges start surging, yet outwardly I was quite facially blank.
    Actually, some people used to make fun of me saying I should be lobotomized or posting on the notice board that I was a non entity. I was quite withdrawn because I had seen my uncle dead and my sister’s baby died of a haemorrhage at birth, and here I had two laddish doctors who probably joined the rugby team at uni and were playing shag a slag or stripping their peers at a private school and sexually assaulting them. After all, what’s life without a bit of sport? I guess with such enticing company it is hard to refuse the offer to be more outgoing. Not.

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  2. Thank you for sharing this. As a client, I have often wished more mental health professionals would take the time to do their own inner work and to look beyond the “behavior” to what may be driving it. Compassion is sorely lacking in my experience. Most interactions are retraumatising.

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  3. I am reading the Radically Open DBT skills manual for self help at the moment. It says we communicate through facial expressions and body posture, and that this forms the most truthful and main way of expressing our emotions.
    IF self harm is experienced by others as a disguised form of communication, what has been the client’s experience of communication with their faces and body language? IF you experience it as manipulative, are you a bully?

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  4. If you experience an Emergency Shutdown response, linked to a neural substrate in RODBT, you become expressionless and unresponsive. This will not elicit care or worry, but will likely get you ridiculed or/and assaulted.
    Going back to basics, therapists should be able to recognize this state and the dissociation (trance like state) that may accompany it. In fact, any human should be able to recognize it, but then not all humans are humans.

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  5. As I have said, I am reading ro-dbt skills at the moment, and I wonder whether these observations about expressions of overcontrolled individuals could be used to gain insight into the reactions and beliefs in the health professional-self harming individual nexus.
    When I have self harmed, it is a challenge to the inhibition-moralizing system of the person attending to the wounds. Reactions vary from schadenfreude (pleasure in misfortune), fusion with a belief of fecklessness or irresponsibility, anger at feeling manipulated, which might be suppressed and expressed indirectly, for example saying in a voice intended to be overheard ‘anything interesting’ from a colleague to the person applying the dressing to my wound.
    Whatever the reactions, which I often note with heightened awareness, they tend to be way off the mark, because the role of healthcare profession excludes people with the problems I have, and anyway I am already completely aware of how they think, more so than they are themselves (and it doesn’t contain any solutions.)
    People can be very self conscious around an act of self harm, worried that their expressions may be reinforcing it somehow, and also bewildered and mystified in a profound way that someone could behave in such a perverse manner.
    However much navel gazing might go on, I think a good question to ask yourself if you are a professional is whether it is planned or impulsive, whether there is ongoing domestic abuse, because the abused can act very differently and convincingly when the abuser comes to the hospital. I have seen someone put under duress to leave with undressed wounds by a partner. Someone quick might notice tension in the expression of the facial muscles, but professionals tend to invalidate their own thoughts in favour of acting on what people say, because that can go on their notes. ‘X reassured me that they will be safe at home with Y’. Because notes seem to have taken a life of their own, partly because of an entrenched defensiveness, there is a lack of flexibility and responsiveness.
    Written notes are quite different from video, and I also wonder whether there is also a trend to be influenced by patterns and opinions of other people. Should I write what I think or should I be safe and conform to previous opinions? If there is a sustained pattern of negativity, is it not possible to present facial threat and could this influence the patients emotions negatively?

    If someone instead conveyed non-dominance and social safety using RODBT could this avoid the kind of negative and hostile expressions which spiral downwards?

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