Developmental Disorders and Personality
Donna G. Stevenson <dgstevenson@mac.com>: This page is part of a document, titled Brain-Quadrant Integration, which examines whether imbalanced use of four parts of the brain, the left and right neocortex and limbic system, could be the source of focused intelligence, learning and mental disorders, and autism.
This page looks at how this four-part model is just complex enough to explain personality, the positive aspects of disorders, the overlapping nature of diagnoses, and the large number of described disorders with their gradient of symptoms.
In the section on intelligence, I tried to argue that both intelligence and personality would be whole brain activities, and that focused intelligence is created by overdeveloping some parts of the brain while leaving other parts underdeveloped – with a resulting effect on personality. Here I discuss why I believe we should investigate a four-part model.
For centuries people have been attempting to categorize the range of human personalities. I think that activities like handwriting analysis, and the ability of good sales people to read other people quickly, indicates that some of us already use the knowledge that when function X in the brain is strong, so will be functions Y and Z. I believe that what we understand about brain development indicates that it would get sweeping instructions, such as develop this area first, rather than a micromanaged plan of development.
Why hypothesize that there is an underlying four-part development in the brain? One reason is that a four-part categorization has been suggested for centuries. My inspiration came from Ned Herrmann’s (1988, 1996) work on personalities, and his inspiration came from the idea of the brain having differential use of the right and left neocortex and limbic system. Since current knowledge suggests that the limbic system evolved first, and then the neocortex, I believe that it makes sense from an evolutionary standpoint that a person’s development of these parts of the brain wouldn’t have to be locked together.
If the brain does develop in a way in which the functions in the left and right neocortex and left and right limbic system are more likely to develop together in four sections, the resulting personalities would be difficult to anticipate since these sections contain functions, parts of abilities, not whole abilities. From this, though, we could explain the limited success of schemes, such as Herrmann’s, to simplify and begin to categorize human personalities. Since Herrmann’s work suggests that we typically have one quadrant that we don’t use as much, it might also explain a three-part view of individuals such as Freud’s Id, Ego and Superego. Given what we currently know, I believe that the four-part view of development is a viable candidate for greater understanding of this process.
So, if small imbalances in brain capabilities could create more intelligence and some lack of abilities, a greater imbalance would create greater negatives and positives. This view is consistent with two surprising facts about disorders - that we cannot seem to distinguish between the outer edges of normal personality and the beginnings of disorders, and that disorders appear to have positive aspects.
Again and again it seems that we discover disorders in their most extreme form, and then come to realize that there is a spectrum of people that could be described as having varying degrees of the same problem. An example is Tourette’s Syndrome; researchers Cohen, Bruun and Leckman (1988) wrote:
It is now clear that the majority of TS [Tourette’s Syndrome] patients suffer from mild difficulties for which no specific treatment, or perhaps only reassurance and guidance, are needed. The most severely afflicted patients are a minority (p. xii)
I believe that the evidence points to there being a gray area where it is a unclear whether one might call someone quirky or disordered. I have found that the biographies of people with autism often show relatives who I believe fit into this gray area.
- About Luke Jackson’s mother “Mum can spot something moving slightly in the corner of the room and this drives her absolutely mad. No one is allowed to even move their fingers, never mind tap them when she is around.” (Jackson, 2002, p. 69)
- About Erika Hammerschmidt’s parents “Not that they dressed me as a boy; the clothes and hairstyle they chose for me were deliberately gender-neutral. They were afraid of child molesters. A child molester, they said, is usually interested in either males or females, and will leave you alone if there’s uncertainty.” (Hammerschmidt, 2004, p. 9)
- About Morgan Collins' mother: “Jennifer has a system for housework. She has many systems, actually. But the point system is the most important. Every item picked up, every item cleaned or moved: that is a point. (Collins, 2004, p. 79)
If there is a continuum from typical personalities to disorders, then some of us have mild versions of disorders. John Ratey and Catherine Johnson (1997) wrote Shadow Syndromes; the cover calls shadow syndromes “The Mild Forms of Major Mental Disorders That Sabotage Us”. They wrote:
A forme fruste is an incomplete expression of an illness, though the term is little used today. We have chosen to replace it here with the phrase shadow syndrome because the meanings of the word shadow, both literal and metaphorical, capture the nature of a mild mental disorder. (p. 11)
Also from Shadow Syndromes, Ratey and Johnson (1997) wrote ”Where the severely depressed do distort life to the negative, the mildly depressed are quite possibly the most accurate observers of life in our midst. They perceive with crystal clarity the truth that, when the glass is half-full, it is also half-empty.” (p. 68) “Thus, as with all of the shadow syndromes, the mildly depressed personality has its strengths.” (p. 69)
It is often claimed that people with particular disorders share particular strengths, which is what one would expect if the disorders were created through imbalanced development. “It’s often said that dyslexic kids are extraordinarily creative.” (p. 122) wrote Robert Frank and Kathryn Livingston (2002) in The Secret Life of the Dyslexic Child.
About people with Nonverbal Learning Disorder, researcher Byron Rourke (1995) wrote:
Excellent phonemic hearing, segmentation, blending, and repetition and very well-developed receptive language skills and rote verbal capacities are evident, as are a large store of rote verbal material and verbal associations, and a very high volume of speech output. All of these characteristics tend to become more prominent with advancing years. (p. 3)
In the book I Can’t Sit Still by Dorothy Johnson (1992), she wrote about Attention Deficit Hyperactivity Disorder (ADHD):
What’s good about ADHD? Children with ADHD are usually very divergent. They tend to think of and do lots of different things. They make interesting and unexpected connections and tend to be exciting and creative. (p. 11)
It is commonly believed that there is a positive side to mild autism. Even Karyn Seroussi (2000), one of the founders of the Autism Network for Dietary Interventions, who believes that “autism is caused by an abnormality in the immune system” (p. 199), and that “the shadow of the beast has fallen over my home, and my doorway has been darkened by its dreaded countenance” (p. 201) also says that she sees attributes in her husband and son that are “a gift that autism contributes in its mildest form” (p. 192).
Kay Redfield Jamison (1993) wrote the book Touched with Fire: Manic-Depressive Illness and the Artistic Temperament which described the same connections that I have been discussing – personality, gifts, disorder - but makes the argument specifically about Manic-Depressive illness.
Most people find the thought that a destructive, often psychotic, and frequently lethal disease such as manic-depressive illness might convey certain advantages (such as heightened imaginative powers, intensified emotional responses, and increased energy) counterintuitive. (p. 3)
Many are unaware of the milder, temperamental expressions of the disease or do not know that most people who have manic-depressive illness are, in fact, without symptoms (that is, they are psychologically normal) most of the time. (p. 5)
Somewhat related, though as yet still preliminary, research has also found an unusually high incidence of special abilities (for example, outstanding artistic, language, and mathematical abilities) in a sample of children with manic-depressive illness. (p. 82)
Two British studies, one of architecture students and the other of chemistry students, found that higher academic and creative performance was associated with greater psychological disturbance and an increased use of mental health facilities. (p. 82)
The temperaments associated with manic-depressive illness are also part of the affective continuum, forming in turn a natural bridge between a virulently psychotic illness on the one hand and the moody, artistic temperaments on the other. (p. 97)
Aristotle focused more specifically on the relationship between melancholia, madness, and inspiration. “Why is it,” he asked, “that all men who are outstanding in philosophy, poetry or the arts are melancholic?” (p. 51)
If it should turn out that the Brain-Quadrant Integration theory were true, it is likely that those who do the most dramatic good and those who do the most dramatic bad come from the gray area between those with more typical personalities and those who are disordered. Those who are clearly disordered would be more likely to have deficits that diminish their ability to accomplish their goals. Those in the gray area would be more likely to have the maximum amount of imbalance while still being able to move toward their goals. Our most successful individuals and the ones who have done the most harm would probably come from this category.
Bennett Simon (1978) wrote “At what point do we draw the line between innovative and insane, between visionary and psychotic?” If these do turn out to be two sides of the same coin, what then is mental illness? I don’t believe that the atypical use of the brain is itself mental illness. The most important definition, to me, is that mental illness is society’s judgment that someone is so disordered that they are neither responsible for taking care of themselves nor do they have responsibility for their actions. Based on this, I am sympathetic to those who say that mental illness is just a label constructed by society. Still, this labeling can be a compassionate response to a difficult situation. I believe that when we better understand what is happening in these situations then the language will evolve along with our ability to help others.
One might wonder if a four-quadrant model could explain the large number of disorders which have been described. I believe that one part of the answer is that seeing disorders as separate entities is not the only view historically. I think you could call the Brain-Quadrant Integration model a ‘unitary concept’, and it is from Karl Menninger’s (et al.) (1959) article ‘The Unitary Concept of Mental Illness’ that I first read this term. This article gives an historical view of the unitary concept.
Researcher Tim Crow (1998) in his commentary “From Kraepelin to Kretschmer Leavened by Schneider: The Transition From Categories of Psychosis to Dimensions of Variation Intrinsic to Homo sapiens” argues for a more unitary concept because of the widespread nature of psychosis.
I have pointed out that this cross-cultural constancy is inconsistent with the view that there are “psychosis genes” that are confined to subfractions of the population. The variation of which predisposition to psychosis is a part must cross the population as a whole. In that that part is associated with a biological advantage I have argued (because the variation is maintained in the face of selection) that it must be associated with the function that is characteristic of the species, ie, language. (p. 503)
The only change I would make to Crow’s argument is that I think that focused intelligence in general is a better candidate for the characteristic of our species. It would explain why we are so advanced in so many aspects, such as tool making, politics and game playing, which I don’t believe can be explained solely on the basis of advanced language skills.
Another part of the answer is that a four-part model can be the basis for expecting that numerous disorders could be described, though someone might argue that this model clearly anticipates our finding only four disorders, which could now be labeled:
- Weak in Left Neocortex Disorder
- Weak in Left Limbic System Disorder
- Weak in Right Neocortex Disorder
- Weak in Right Limbic System Disorder
I think that the simplest response to the idea that there should be only four disorders is that I don’t think we would be able to group together all the ‘Weak in X’ disorders without understanding the underlying connection. Those with mild deficits would have different symptoms from those with large deficits. That brings us up to eight disorders. Since the environment is an important component, I would suggest that there would be large differences between those who have had lives that suited them well and those who have had traumatic lives. That would double our disorders to sixteen. Add in disorders that describe particular problems, which would include people from those sixteen disorders, and the number of disorders goes up dramatically. I believe that a four-part model can be consistent with our describing numerous disorders.
A more specific reason for why we wouldn’t be able to group all the ‘Weak in X’ disorders into one category is that each quadrant has functions and not complete abilities, and those functions are not unique to each quadrant. Researcher Joseph Hellige (1993) wrote “even simple tasks consist of a number of components or subprocesses” (p. 29) and “it is rarely the case in the intact brain that one hemisphere can perform a task normally whereas the other hemisphere is completely unable to perform the task at all” (p. 29).
In order to try to explain why the way the brain functions makes it difficult to connect all the ‘Weak in X’ disorders, I am going to use an analogy which I believe is helpful, but will fall short of what I believe is the truth. I would make the comparison with having four bins of mechanical parts. These parts can be used to make little machines and then those machines can be put together and transformed into a robot. (I don’t imagine that this is an exact match to humans who, at the very least, I expect can effect the availability of ‘parts’ through nutrition, meditation or other means, but I still find the analogy helpful.) I purposely use parts in the bins instead of something useful like tools because the parts aren’t useful by themselves. Something like being able to feel fear is not helpful unless something triggers it and you can act on that fear.
Let’s imagine that in one case, we have lots and lots of parts in bins A and D, almost no parts in bin B, and some parts in bin C. That means that any machines you can make with the parts in A and D can be made in large quantity. There would be some machines that couldn’t be made at all that depended on parts in B, but there may be parts in the other bins that could take the place of the parts from B, or you might be able to build a different machine with a similar function from parts in the other bins, or you might find that you can get along without that machine most of the time. Building any particular machine may be dependent on exactly how low you are on parts from bin B. A natural redundancy in parts, and being able to achieve goals with different machines, will obscure the lack of parts in B. Also, the strengths and weaknesses of the resulting robot, not made up of many parts from B, will be very dependent on what is available from the other bins, and not defined completely by the lack of B parts.
We might also find that we want to define a disorder by the robot not being able to do a particular task. If that machine is really simple enough that it is dependent only on there being parts in one bin, then a lack in one ability may tell us something about the lack of parts in a particular bin. Most of the machines will be complex enough that they are dependent on more than one bin which means that one disorder can group robots together who have deficiencies in different bins.
Let’s also imagine that there is a very valuable machine that is heavily dependent on parts from bin D. Let’s say it helps a robot to fly. We may find that those robots made with good amounts of D are able to fly into the sky, but that those robots who use lots and lots of small flying machines are susceptible to flying off into space. Sometimes a strength is so strong that it becomes a weakness. If we define a ‘flying off into space’ disorder, we may have to subdivide it into those who build that machine out of parts from A /D and those who build it from C/D, because the resulting robot depends on what other machines are able to be built which is dependent on what parts are available. It also confuses the issue if we believe that we can define all disorders in terms of which bin is low on parts.
If the imbalance between the available parts in the bins were great enough, then it wouldn’t be of great benefit to have unlimited numbers of D parts, because the lack of parts in the other bins means that making machines is so difficult. You might not realize all the machines that you are missing because the lack of some important ones is so obvious. No one might even notice that you have a great supply of D parts because your resulting robot has so many difficulties.
Leaving my bins and parts analogy behind, I believe that the current situation reflects the confusion of not understanding the bigger picture in which the details would fit. A parent of an autistic child, Echo Fling (2000), wrote:
What’s in a name? Plenty! I’ve heard of parents who have taken their child to a psychologist and received a diagnosis of Asperger Syndrome; their neuropsychologist diagnosed NLD [Nonverbal Learning Disorder]; the occupational therapist gave the same child a diagnosis of Sensory Integration Disorder; the Speech Pathologist says it’s Semantic-Pragmatic Disorder; and the pediatrician originally thought it was Attention Deficit Disorder. (p. 202)
We might still ask the question, are there some developmental disorders which are clearly isolated from other problems and therefore would dispute a unitary view? At this time, the evidence weighs heavily towards disorders not coming singly, that disorders overlap and co-exist.
Graves and Bartak (1999) have noted the coexistence of disorders of attention and disorders of the autism spectrum. They state: ‘As a principle of developmental disabilities, multiple impairments are the rule rather than the exception.’ (Lawson, 2001, p. 143)
Researchers have shown connections to Attention Deficit Hyperactivity Disorder (ADHD), “related disorders such as depression, manic-depressive illness, alcoholism or other substance abuse, antisocial behavior, or dyslexia or other learning disabilities” (Hallowell and Ratey, 1994, p. 197) and “a considerable degree of comorbidity with Oppositional Defiant Disorder, Conduct Disorder, Learning Disability, and, in adults, Personality Disorder” (Levy and Hay, 2001, p. xiii) Diane Kennedy (Kennedy & Banks, 2002), a parent of three sons with developmental disorders, wrote The ADHD Autism Connection in which she focuses on the similarities between autistic spectrum disorders and the combined type subtype of ADHD.
About Tourette’s Syndrome, researchers Leckman and Cohen (1988) wrote:
Although the cardinal features of these disorders remain the repetitive motor and/or phonic tics, other behavioral symptoms and mental states frequently co-occur with tics and may be etiologically related. These associated symptoms include premonitory sensory urges, stimulus-bound behaviors, obsessive thought, compulsive behaviors, mood liability, irritability and behavioral disinhibition. Attentional problems, impulsivity, motoric hyperactivity, and specific learning problems also frequently are associated with tic disorders, particularly among children referred from clinical evaluation. (p. 4)
E. Antonio Hernández (2003), a person with Asperger’s Syndrome, Tourette’s Syndrome (TS), and Obsessive Compulsive Disorder (OCD), argues that all three are parts of the same problem. “My guess is that Asperger’s autism is probably much more common than anyone thinks, and I believe it to be one and the same as TS and OCD.” (p. 10)
I am also struck by the issue that people can define themselves by one problem even when it isn’t the only problem that they have. Robert Frank wrote about himself in The Secret Life of the Dyslexic Child (Frank and Livingston, 2002).
As an adult, I still don’t read very well. My handwriting is atrocious, and I have trouble remembering all kinds of things, from names and dates to directions and how to spell words. Yes, today, I’m a psychologist. An author. A college professor. A husband. A dad. No, I’m not dumb or lazy. I’m dyslexic. (p. 1)
Mary Grigar also labeled herself as a dyslexic in her autobiography A Day to Cry (Grigar and Hullinger, 1994), and she also wrote about her other problems. “A word such as “the” was so abstract that I could never memorize it.” (p. 4) “only had the visual memory of a six year old” (p. 76) “My depth perception is way off – the perception I have of my environment is distorted.” (p. 78) and “Even today the buzzing of the fluorescent lights bothers me. The motor of the refrigerator goes off and I notice it.” (p. 86)
It is clear that people will not view all of their deficits the same, some are nuisances and some can be seen as the defining characteristic of the person. It is also clear that the person’s environment can minimize or accentuate any specific problem – or turn a possible problem into an asset. Deficits may be masked by compensations, hidden, or appear to be a choice the person is making such as that they aren’t trying hard enough.
I believe that a quadrant model can explain the level of overlapping disorders and confusion in labeling that we currently see. It isn’t a simple model because each quadrant has only functions that are parts of behaviors. I believe that the Brain-Quadrant Integration idea is consistent with our history of trying to explain these problems that includes both unitary models which acknowledge the connections between disorders and the multitude of descriptions of disorders which show that there are groups of people with similar strengths and weaknesses.
Cohen, D. J., Bruun, R. D., & Leckman, J. F. (1988). Preface. In D. J. Cohen, R. D. Bruun & J. F. Leckman (Eds.), Tourette’s Syndrome and Tic Disorders: Clinical Understanding and Treatment. (pp. ix-xiii). New York: John Wiley & Sons.
Collins, Paul (2004). Not Even Wrong: Adventures in Autism. New York, London: Bloomsbury.
Crow, T. (1998). From Kraepelin to Kretschmer Leavened by Schneider: The Transition From Categories of Psychosis to Dimensions of Variation Intrinsic to Homo Sapiens.” Archives of General Psychiatry, 55(6) 502-504.
Fling, E. R. (2000). Eating an Artichoke: A Mother’s Perspective on Asperger Syndrome. London, Philadelphia: Jessica Kingsley Publishers.
Frank, R. and Livingston, K. E. (2002). The Secret Life of the Dyslexic Child: How She Thinks, How He Feels, How they can Succeed. [Emmaus, Pennsylvania]: Rodale.
Grigar, M. and Hullinger, L. (1994). A Day to Cry. Chicago, Illinois: Grigar Graphics & Publishing.
Hallowell, E. M. and Ratey, J. J. (1994). Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood. New York: Pantheon Books.
Hellige, J. B. (1993). Hemispheric Asymmetry: What’s Right and What’s Left. Harvard University Press: Cambridge Massachusetts.
Hammerschmidt, E. (2004). Born on the Wrong Planet. Palo Alto, California: Tyborne Hill Publishers.
Hernández, E. A. (2003). No Duty to Retreat: The Stories of Tourette’s Disease and Asperger’s Autism. Baltimore, Maryland: PublishAmerica.
Herrmann, N. (1988). The Creative Brain. Lake Lure, North Carolina: Brain Books.
Herrmann, N. (1996). The Whole Brain Business Book. New York: McGraw-Hill.
Jackson, Luke (2002). Freaks, Geeks and Asperger Syndrome: A User Guide to Adolescence. London and Philadelphia: Jessica Kingsley Publishers.
Jamison, K. R. (1993). Touched with Fire: Manic-Depressive Illness and the Artistic Temperament. New York: Simon & Schuster.
Johnson, D. D. (1992) I Can’t Sit Still: Educating and Affirming Inattentive and Hyperactive Children: Suggestions for Teachers, Parents and Other Care Providers of Children to Age 10. Santa Cruz, California: ETR Associates.
Kennedy, D. M. and Banks, R. S. (2002). The ADHD Autism Connection: A Step Toward More Accurate Diagnosis and Effective Treatment. Colorado Springs, Colorado: Waterbrook Press.
Lawson, Wendy (2001). Understanding and Working with the Spectrum of Autism: An Insider’s View. London and Philadelphia: Jessica Kingsley Publishers.
Leckman, J. F. & Cohen, D. J. (1988). Descriptive and Diagnostic classification of Tic Disorders. In D. J. Cohen, R. D. Bruun & J. F. Leckman (Eds.), Tourette’s Syndrome and Tic Disorders: Clinical Understanding and Treatment. (pp. 3-19). New York: John Wiley & Sons.
Levy, F. and Hay, D. A. (2001). Preface. In F. Levy & D. A. Hay (Eds.), Attention, Genes and ADHD. (pp. xiii-xiv). Philadelphia, Pennsylvania: Taylor & Francis.
Menninger, K., Ellenberger, H., Pruyser, P. & Mayman, M. (1959). The Unitary Concept of Mental Illness. Pastoral Psychology, 10(94) 13-19.
Ratey, J. J. and Johnson, C. (1997). Shadow Syndromes. New York: Bantam Books.
Rourke, B. P. (1995). Introduction: The NLD Syndrome and the White Matter Model. In B. Rourke (Ed.), Syndrome of Nonverbal Learning Disabilities (pp. 1 -26). New York and London: The Guilford Press.
Seroussi, K. (2000). Unraveling the Mystery of Autism and Pervasive Developmental Disorder: A Mother’s Story of Research and Recovery. New York: Broadway Books.
Simon, B. (1978). Mind and Madness in Ancient Greece: The Classical Roots of Modern Psychiatry. Ithaca, New York: Cornell University Press.
Brain-Quadrant Integration
