While personality disorders may lead to ‘severe impairment’, they may also lead to extraordinary achievement. A 2005 study by Board and Fritzon found that histrionic, narcissistic, and anankastic personality disorders are more common in high-level executives than in mentally disordered criminal offenders at the high security Broadmoor Hospital.

This suggests that people often benefit from non-normative and potentially maladaptive personality traits. For instance, people with histrionic personality disorder may be more adept at charming and cajoling others, and therefore at building and exercising professional relationships. People with narcissistic personality disorder may be highly ambitious, confident, and self-motivated, and able to employ people and situations to maximum advantage. And people with anankastic personality disorder may get quite far up their career ladder simply by being so devoted to work and productivity. Even people with borderline personality disorder may at times be bright, witty, and the life and soul of the party.

In their study, Board and Fritzon described the executives with a personality disorder as ‘successful psychopaths’ and the criminal offenders as ‘unsuccessful psychopaths’, and it may be that highly successful people and disturbed psychopaths have more in common than first meets the eye. As psychologist and philosopher William James put it, ‘When a superior intellect and a psychopathic temperament coalesce… in the same individual, we have the best possible condition for the kind of effective genius that gets into the biographical dictionaries.’

More recently, in 2010, Mullins-Sweatt and her colleagues carried out a study to uncover how successful psychopaths differ from unsuccessful ones. They asked a number of members of Division 41 (psychology and law) of the American Psychological Association, professors of clinical psychology, and criminal attorneys to first identify, and then to rate and describe, one of their acquaintances (if any) who could be counted as successful and who also conformed to psychologist Robert Hare’s definition of a psychopath:

…social predators who charm, manipulate and ruthlessly plow their way through life … Completely lacking in conscience and feeling for others, they selfishly take what they want and do as they please, violating social norms and expectations without the slightest sense of guilt or regret.

From the responses they collated, Mullins-Sweatt and her team found that successful psychopaths matched unsuccessful ones in all respects but one, namely, conscientiousness. So it seems that the key difference between unsuccessful and successful psychopaths is that the former behave impulsively and irresponsibly, whereas the latter are able to inhibit or restrain those destructive tendencies and build for the future.

Intelligence and conscientiousness are not enough to guarantee success, which also requires traits such as ambition, motivation, and people skills—traits that may be particularly pronounced when rooted in a personality disorder.

Personality disorders are generally thought to arise from a combination genetic factors and traumatic early life experiences such as parental loss and emotional, physical, and sexual abuse. People who have suffered childhood trauma may be left with intense feelings of despair, helplessness, and worthlessness. Later in life, they may seek out achievement and success to help compensate for these feelings. For instance, they may wish to be recognized by strangers because they were not recognized by their own parents, or they may wish to have control over others because they had none when they needed it most. The drive for achievement and success combined with the character traits and resilience that arise from loss and trauma may in later life propel them to the highest echelons of society.

This is borne out by a large study that looked at almost 700 eminent personalities, and found that 45 per cent had lost a parent before the age of 21. This ‘orphanhood effect’ seems particularly marked in creative people. One study looking specifically at a sample of authors found that 55 per cent had lost a parent before the age of 15. This suggests that disturbed psychopaths and creative visionaries do indeed share many features. While the former suffer from them, the latter are (also) able to put them to good use.

Broadly speaking, anyone’s personality can be said to lead to distress and impairment. For instance, a gregarious student is unable to isolate himself in the library and ends up failing his exams. A zealous company director loses his temper and regrets the damage that he has done to himself, others, and his company. An upstanding whistleblower ends up losing his job.

Everyone suffers for who he is, and, very often, our greatest strength is also the germ of our deepest suffering. While it is impossible to avoid such suffering, it is at least possible to value it for the personal growth that it can bring.

Like many blind figures in classical mythology, the prophet Teiresias could ‘see’ into himself. This self-knowledge enabled him not only to understand himself, but also to understand others and so to ‘see into the future’. Similarly, our suffering prompts us to look into ourselves. The self-knowledge this brings enables us not only to better regulate ourselves, but also to better appreciate others, the world, and our place within it. Thus, our suffering transforms our lives into a journey, a journey without an end, perhaps, but one that can also be seen as an end-in-itself. It is in this way that our suffering, or ‘impairment’, can bring deep meaning to our lives.

Adapted from the new edition of The Meaning of Madness.


Board BJ and Fritzon KF (2005): Disordered personalities at work. Psychology, Crime and Law 11:17-23.

James W (1902): The Varieties of Religious Experience, Lecture 1 ‘Religion and Neurology’, Footnote 6.

Mullins-Sweat S et al. (2010): The Search for the Successful Psychopath. Journal of Research in Personality 44:554-558.

Hare RD (1998): Without Conscience: The disturbing world of the psychopaths among us, opening lines. Guilford Press.

Is the medical model still helping?

In the UK, mental ill healthis recognized as the single largest cause of disability, contributing almost 23 per cent of the disease burden and costing over £100 billion ($157 billion) a year in services, lost productivity, and reduced quality of life. Every year in the EU, about 27 per cent of adults are affected by mental disorder of some kind. In the US, almost one in two people will meet the criteria for a mental disorder in the course of their lifetime. Data from the US National Health Interview Survey indicate that, in 2012, 13.5% of boys aged 3-17 had been diagnosed with attention deficit hyperactivity disorder (ADHD), up from just 8.3% in 1997.

There is no denying that a lot of people are suffering. But are they all really suffering from a mental disorder, that is, a medical illness, a biological disorder of the brain? And if not, are doctors, diagnoses, and drugs necessarily the best response to their problems?

Since 1952, the number of diagnosable mental disorders has burgeoned from 106 to over 300, and now includes such constructs as ‘gambling disorder’, ‘minor neurocognitive disorder’, ‘disruptive mood dysregulation disorder’, ‘premenstrual dysphoric disorder’, and ‘binge-eating disorder’.

According to a recent report, antidepressant prescriptions in England rose from 15 million items in 1998 to 40 million in 2012, this despite the mounting evidence for their ineffectiveness. Selective serotonin reuptake inhibitors (SSRIs) in particular have become something of a panacea, used not only to treat depression, but also to treat anxiety disorders, obsessive-compulsive disorder, and bulimia nervosa, and even some physical disorders such as premature ejaculation in young men and hot flushes in menopausal women. In the UK, the SSRI fluoxetine is so commonly prescribed that trace quantities have been detected in the water supply.

But despite all this apparent progress in diagnosis and treatment, people who meet the diagnostic criteria for such a paradigmatic mental disorder as schizophrenia tend to fare better in resource-poor countries, where human distress can take on very different forms and interpretations to those outlined in our scientifical classifications.

Psychiatry is in a crisis precipitated by its own success, and, assuming that it once did, the medical or biological model is no longer helping. The specialty of the heart is cardiology, the specialty of the digestive tract is gastroenterology, and the specialty of the brain is neurology and psychiatry. But neurology is not psychiatry, which literally means ‘healing of the soul’.

Some mental disorders undeniably have a strong biological basis, but even these have many more aspects and dimensions than ‘mere’ physical disorders.

It is high time to fundamentally rethink our approach to mental disorders and mental ‘dis-ease’.

The Second Edition of The Meaning of Madness, due out in September, is available for pre-order.

MoM 2e Cover