Dr. Thedore Millon, The Pioneer of Personality Science
If Freud was the ‘Father’ of Psychoanalysis, Dr. Theodore Millon is the ‘Grandfather of Personality Theory’. I couldn’t have been more thrilled to interview Freud than I did Dr. Millon (pronounced Milan, like the city)!
Dr. Millon’s biography reads like a clinical and scientific manifesto with his prolific writing of an unusually large number of books and journal articles. His career has not only spanned decades but has changed how the world has come to understand personality and the disorders of it. His contribution to the understanding of personality disorders has earned him the title of one of the ‘Pioneers of Personality Science.’
I wanted to launch the magazine with my talk with Dr. Millon because everything we do at The Institute is related to the issues of personality and personality disorders. So to begin the magazine’s focus on the right foot, it would seem fitting to begin with talking about personality, theory, development, and why this is so important to you–the survivor in a relationship with someone with a personality disorder. This discussion should also be of interest to therapists trying to help a survivor with the aftermath of the relationship. In either case, what has troubled someone enough to seek out The Institute is their relationship with someone else’s personality disorder, pathology, or psychopathy.
But first, a little trot down memory lane for me about Dr. Millon and his importance to me and you!
- My theory books in graduate school for my course in Personality Development were Dr. Millon’s.
- My theory books in graduate school in my psychopathology course included Dr. Millon’s and his work was peppered throughout the other course books and personality disordered trainings that I have taken in over 20 years.
- As a young therapist in a mental health clinic working in only personality disorders, it was HIS testing instruments we used to diagnosis personality disorders.
- It was his information I used to describe the personality formations that make up personality disorders to my interns.
- His charts help us distinguish characteristics between the various 10 personality disorders.
- His ideas on ‘challenges of life’ that personality disordered people face.
- His references about violence associated with psychopathy that warned us.
- And his clinical reference books that lined my book shelves and the pathology library associated with our mental health clinic/
For me, there could have been no one else I would rather talk to than the person who has contributed so much to the understanding of personality disorders and what I have devoted my coaching work to. He has helped you as well–any informational help you have received about narcissism, borderlines, anti-socials, and psychopaths has probably stemmed from the work of Dr. Millon.
At 83 years old, his life time of dedication to the exploration of personality disorders has brought it out of the closet of ‘mystery’ and ‘assumptions’ and under the microscope of diagnostics. So on a personal level I thank this man for his contribution to what we know so far.
So what is it that we should discuss about personality disorders? Why is the issue of personality important to you, your future, and your therapist? You can’t deal with what you don’t know—as a survivor or as a therapist and so the first step in this journey associated with personality disorders is the ‘knowing.’ The difficulty about ‘knowing’ personality disorders is that its theories are still being hashed and rehashed (as it should) and what we are left with are some differing views. While Dr. Millon has clearly helped us understand what he calls ‘personology’ and the developmental aspects of the disorders, we still have a long way to go in understanding things such as,
- Why do these disorders form?
- What can be done if anything?
- Who will be affected or even harmed because of them?
- What societal effect does personality disorders have?
- What cultural and political effect does personality disorder have on others?
- What relational damage is done to others?
- What parenting damage is done through personality disorders?
- What type of parent, partner or prodigy does a personality disordered person make?
- What are personality disorders doing to our systems—legal system, social service system, criminal justice system, mental health system?
- Why are some of the personality disorders more destructive than others?
- What commonalities do personality disorders share at their core?
- Is there a common ‘after math of symptoms’ seen in the survivors of the high destructive Cluster B personality disorders?
- How do survivors heal? What do they need? What do the children need?
- Who doesn’t understand this and how can we teach them—the general public, the court systems, the mental health systems, social service systems, and child welfare systems?
These are existential type questions that survivor’s live with every day. Now our world is starting to live with these questions and the problems of these unanswered questions as pathology and its tyranny rises in the world around us. As our societal systems are being challenged by pathology and hood-winked by the lack of education it’s the survivors and children who feel the most impact of our ‘not knowing enough’ about these existential questions related to these disorders. The bleed-over is a conned legal system, a blinded child welfare system, an untrained mental health system, a tapped-out social service system, and a burgeoning criminal justice system. Education about these disorders has never been more vital to our own existence than it is today.
Sandra: “Dr. Millon, where are we today in understanding this diverse diagnosis of personality disorders? What is on the horizon, for instance, in psychopathy?”
Dr. Millon: “We are still dealing with the changes that happened to the Diagnostic Statistical Manual III when they changed from a psychopathic personality to what they now call Anti-social personality disorder. There are some flaws there because Anti-social is based on illegal activities and criminality when many of these persons don’t get caught to get labeled criminal so diagnostically would be missed.”
Sandra: “So what is being discussed for the next DSM version that will be coming out?”
Dr. Millon: “From what I gather, they are still discussing expanding Anti-social to include combinations of other personality disorders. Many persons with Anti-social also have other personality disorders associated with it which can make their presentation very different from others.”
Sandra “Such as?”
Dr. Millon: “Combinations of Anti-social + Paranoid, Anti-social+ Avoidant, etc. There could be as many as 10 factors or combinations of the disorder if we look at them in these types of configurations.”
Sandra “How will that help?”
Dr. Millon “It’s a clearer picture of the overlap of the disorders combined together and shows some of the diversity that you can see in the disorder when it’s influenced by other personality disorders.”
Sandra “There is a lot of talk about the genetic transmission of some of these personality disorders. What are your thoughts?”
Dr. Millon: “I think we are still trying to understand this. There are some of the personality disorders that are more strongly genetically transmitted than others for instance psychopathy. But for some of the other personality disorders, it is more socially learned.
Sandra “You mean ‘the nurture’ portion?”
Dr. Millon “Yes, sometimes family influences, and sometimes other types of social influences. It was Koch in 1890 that discussed biological aspects of psychopathy. He called it ‘constitutionally psychopathic.’ Then Birnbaun in 1910 discussed it as a ‘sociopath’ because he felt there were more social influences that caused the disorder than biology.’
Sandra “I am sure you are aware of the brain imaging techniques that are being used now to look at some of the possible biological differences in the brains of psychopaths. Do you think there is something this can teach us?”
Dr. Millon “I think it is some years away from being able to help us. While we can look at some of the biology of it, it doesn’t help us ‘yet’ understand personality apart from biology. This is still in a very primitive stage. What we also need to look at are the cognitive processes and how the brain activity affects personality. We aren’t there yet. It’s a course tool but I do see that it holds promise.”
Sandra “What do you believe about the permanence of personality disorders. Your Institute offers treatment to various types of the disorder. What changes do you see in them?”
Dr. Millon “This is difficult now days with insurance companies giving limited amount of sessions. Personality disorders take a long time to effect some change in their behavior.”
Sandra “But how are they down the road? The partners get very frustrated with their inability to sustain positive changes.”
Dr. Million “Yes, that’s a very good way to describe that. Consistency is difficult for them. It would be most helpful if they could come back several times a year for ‘tune ups’ to remind them what they should be doing. This is where treatment effects are often lost. Of course, some of the lesser personality disorders can have more modest changes than some of the difficult Cluster B’s.”
Sandra “So what are we really doing then? It seems we are offering their partners false hope when they enter therapy and the partner believes that the change will be permanent. They are staying because they believe that.”
Dr. Millon “No doubt that their relationships are heavily impacted by their disorders. They don’t always have good outcomes in their relationships. I understand why their partners are concerned if their treatment will be effective over the long haul.”
Sandra “How do you know it IS effective over the long haul? Do you hear back from your client’s years down the road? Is success merely being able to hold a job? Or is there a quality of life issue, even for the partner that needs to be evaluated?”
Dr. Millon “Some do contact me from time to time. It’s not always easy to be able to tell what is happening in their lives by a quick contact. It would be optimal for them to come back several times a year so we can really gauge what is happening.”
Sandra “You aren’t referring to anti-social, psychopaths, etc. when you are discussing this type of treatment, per se?”
Dr. Million “More with the narcissists, histrionics and borderlines.’
Sandra “Are personality disorders, in essence, attachment disorders?
Dr. Millon “In some ways, many of them lack intimate attachments or the ability to have attachments as we know them. Some of the disorders have low emotionality and constitutionally or biologically experience a sort of a-social emotionality. They don’t connect on the same level which effects their attachments.”
Sandra “This seems to me to be what the partners complain about most—the essence of the attachment is marred. This could lead into a whole other conversation about Attachment Theory, couldn’t it?”
Dr. Millon “Yes, yes indeed. Personality and their disorders clearly affect a wide parameter in interpersonal relationships.”
Much of the rest of our conversation was more clinical in nature about theory and cognitive-behavioral approaches.
What I think we can take away from this conversation with Dr. Millon is how far we have come in understanding some of the disorders over the last few decades yet clearly, there is still much to understand when we consider the overlapping nature of the clustered disorders and how each personality disorder can create an almost layered effect when someone has more than one personality disorder. (According to research, 60% of people who have one personality disorder have more than one personality disorder.) Understanding how multiple types of disorders effect the overall personality presentation (and its effect on others and resulting relational health) is important for survivors and therapists to understand. There remains a lot of debate as to the ‘treatable-ness’ of personality disorder largely related to the complexity of these overlapping symptoms.
Our thanks to Dr. Millon for a life time dedicated to understanding personality and its disorders.
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Theodore Millon, PhD, DSc, is a leading personality and developmental theorist. Dr. Millon was the founding editor of the Journal of Personality Disorders and is past president of the International Society for the Study of Personality Disorders. He has been a full professor at Harvard Medical School and the University of Miami. He is the principal author of many clinical inventories and testing instruments related to personality disorder testing. Dr. Millon has also written or edited more than 30 books and has contributed more than 200 chapters and articles to numerous books and journals in the field. Dr. Millon established the Institute for Advanced Studies in Personology and Psychopathology in Coral Gables, Florida, where he serves as dean. In 2008 he received the “Gold Medal Award for Life Achievement in the Application of Psychology” from the American Psychological Foundation. The award recognizes Dr. Millon’s distinguished career and his enduring contribution to psychology through research and the application of techniques to important practical problems in psychology. You may view Dr. Millon’s vita here:
http://www.millon.net/content/tm_vita.htm
All content does not necessarily reflect the opinions of The Institute.
