Book contents
- Frontmatter
- Contents
- List of tables
- List of boxes
- List of figures
- List of contributors
- Foreword
- Part 1 The nature of the problem
- Part 2 Management and general treatment approaches
- 9 Assessment of personality disorder
- 10 Diagnosis and classification of personality disorder: difficulties, their resolution and implications for practice
- 11 Murmurs of discontent: treatment and treatability of personality disorder
- 12 Personality disorder: its impact on staff and the role of supervision
- Part 3 Specific treatment approaches
- Index
11 - Murmurs of discontent: treatment and treatability of personality disorder
from Part 2 - Management and general treatment approaches
Published online by Cambridge University Press: 02 January 2018
- Frontmatter
- Contents
- List of tables
- List of boxes
- List of figures
- List of contributors
- Foreword
- Part 1 The nature of the problem
- Part 2 Management and general treatment approaches
- 9 Assessment of personality disorder
- 10 Diagnosis and classification of personality disorder: difficulties, their resolution and implications for practice
- 11 Murmurs of discontent: treatment and treatability of personality disorder
- 12 Personality disorder: its impact on staff and the role of supervision
- Part 3 Specific treatment approaches
- Index
Summary
Summary In this chapter, I suggest that the term ‘untreatable’ should not ever be used in relation to personality disorder. Instead, mental healthcare professionals can use an approach used in medicine for other heterogeneous disorders. It is possible to assess the severity of a personality disorder in terms of its type, spread and comorbidity with other disorders; and then determine what therapies are appropriate. It is also important that therapies are offered even in palliative cases; and that lack of trained therapists does not lead to lack of treatment.
‘They answered, as they took their Fees,
“There is no Cure for this Disease”.’
From ‘Henry King’, Hilaire BellocSome clinicians still make the global generalisation that personality disorder is not ‘treatable’ by psychiatrists. To some extent, this is a relic of the Mental Health Act 1983 for England and Wales, in which a legal concept of ‘treatability’ limited the involuntary hospital admission of patients with certain types of mental disorder. The aim of the treatability criterion for such detention was to protect citizens from detention simply on the grounds of deviance or social dissent; it perhaps was also a tacit acknowledgement that it may not be sensible to detain a group of patients that psychiatrists do not like (Lewis & Appleby, 1988).
The amended Mental Health Bill for England 2007 removed the treatability criterion for detention; so, instead of a legal concept of ‘treatability’, the amended Mental Health Act requires that ‘appropriate medical treatment’ is available. Medico-legal debates may therefore arise as to whether the treatment being provided is ‘appropriate’ for the patient detained.
However, ‘treatability’ (and its confusing sister, ‘untreatable’) are still words with medical significance. In this chapter, I will look at them in more detail, and examine their strengths and limitations in relation to personality disorder. I will argue that treatability is linked to resources and training, as well as psychopathology, and that different understandings of personality disorder may alter ideas about treatability.
- Type
- Chapter
- Information
- Clinical Topics in Personality Disorder , pp. 172 - 187Publisher: Royal College of PsychiatristsPrint publication year: 2012