On a Sunday morning in 1963 Theodore Millon woke up in a Pennsylvania hospital. He was in bed at a psychiatric ward shared by 30 patients. One of them thought he was Jesus Christ, another believed he was the pope, and a third claimed he was a corporate CEO who had been hospitalized by mistake. Millon began to fret. “I am wearing a hospital gown like all the other patients,” he thought. “Am I really a professor of psychology? Or did I just imagine that?” Apprehensive, he went to the nurses station and called the head of the hospital. His anxiety finally eased when the director confirmed that he was, in fact, a clinical psychology professor at Lehigh University and chair of the board of trustees at Allentown State Hospital who was voluntarily spending the weekend in the psychiatric ward. “That experience shocked me, and I never spent another night there,” Millon remembers, although he would still occasionally walk incognito among the patients. Experiencing the world from the patients’ vantage point gave Millon a uniquely powerful window into their needs and had a lasting impact on him. “It became clear to me how primitive our understanding of psychological disorders and our methods of treating them still were,” he recalls. It especially bothered him that doctors typically saw the mentally ill only as collections of symptoms. “I wanted to understand the patient behind the illness,” says Millon, who now heads the Institute for Advanced Studies in Personology and Psychopathology in Florida and is an emeritus professor at Harvard Medical School. These perspectives informed Millon’s first major book, Modern Psychopathology (Saunders, 1969), which became a standard text for American psychologists and psychiatrists. His so-called biosocial-learning theory of personality and the Millon Clinical Inventories constructed around it are still influential in clinical research and practice. Millon’s “personalized psychotherapy” promoted goals and methods tailored to the individual, and his work is one of the major reasons why research into personality and personality disorders has gained so much importance in psychology over the past 25 years. His latest book, Resolving Difficult Clinical Syndromes: A Personalized Psychotherapy Approach (John Wiley & Sons, 2007)–co-authored with psychiatrist Seth Grossman of the Institute for Advanced Studies in Personology and Psychopathology–offers a revised and comprehensive manual for the treatment of such disorders. Millon had his first exposure to mental pathology at home. He describes his mother, Molly Gorkowitz Millon, who was quite gifted musically, as emotionally labile. Today she probably would be diagnosed as having bipolar disorder, or manic depression. “As a child, he wanted to learn why she was that way. I never completely succeeded,” he says. But the desire to understand people became compelling. Many years passed, however, before he found his professional path. The son of immigrants from Poland and Lithuania, young Millon loved the theater and wanted to make that his career. But his father, Abraham, who ran a textile factory in Brooklyn, N.Y., forbade him. And when his mathematically gifted son said he instead wanted to pursue math or music, Abraham nixed those ideas as well. Millons father believed that those were not decent professions for “a nice Jewish boy,” who should study something useful, such as business. Millon bowed to his father’s wishes and became an accounting major at the City College of New York, where he would also meet his future wife, Renee. Millon was unable to get interested in accounting so he switched majors (briefly to economics, then to philosophy and physics). He fared well in an introductory psychology course and attended a series of psychology lectures–a key event that awakened his interest in personality research. The professor conducting the lectures, psychologist Gardner Murphy, had just published Personality (Harper and Brothers, 1947). “That became my bible,” Millon says. Murphy’s theory about personality development immediately appealed to Millon. The theory presented dispositions and the environment–meaning biological and social factors–as contributing to development in combination, instead of regarding them as competing explanatory models. It was in this tradition that Millon himself later created his biosocial-learning theory, which explains how both inherited predispositions and social learning shape personality [see box above]. The significance of a person’s environment–whether it is family or culture–for personality runs through Millons career. In the 1970s he worked in the psychiatric ward of a VA hospital in Chicago with colleagues from Romania and Thailand and patients who were mostly African- American. During that time, he was also a member of the committee that prepared the Diagnostic and Statistical Manual of Mental Disorders-III (DSM)–which is the standard American reference work for diagnosing mental illnesses. It presented, for the first time, explicitly formulated diagnostic criteria for personality disorders. These experiences prepared Millon for his role as a mediator when he served from 1988 to 1992 as president of the International Society for the Study of Personality Disorders–and gave him insights into how cultures can clash. At the society’s conferences around the globe, a speaker from the U.S. might, for example, discuss a patients extreme perfectionism as a sign of an obsessive personality. Japanese researchers would not understand the presentation. “In Japan, no one would talk about such things as pathological behavior, because perfectionism is part of societal expectations,” Millon explains. What people perceive as normal or not normal strongly depends on their cultural background. According to Millon, borderline personality disorder, for example, is typical of modern Western societies. Victims are unsure about who they are, what they want to be and what makes their life meaningful. This type of unstable personality reflects its surrounding societal conditions: vague role models and changing ideals, lifestyles and conditions mark the cultural environment. If a person in this culture also grows up amid chaotic family circumstances, it could have detrimental effects on his or her personality. For similar reasons, Millon promotes personalized psychotherapy and accuses therapists who ascribe to traditional schools of taking too narrow a view of their patients. “They distance themselves from human reality in the process,” he warns. Millon believes that therapists must consider their patients’ entire life and every aspect of their personality. His strategy is guided by the patients individual characteristics and combines various treatment methods, so that a therapist can deal with several problems simultaneously. For example, a shy person should first overcome his or her anxieties, which would ease mastery of the subsequent steps, such as gaining self-confidence and learning competence. Personality at the Root Even when a therapist is dealing with a client’s depression or another chronic mental illness, rather than a less severe personality disorder, Millon recommends tailoring treatment to the patients character. Similar symptoms can be caused by different problems, depending on the individual. After a divorce, for example, a person with a dependent personality may develop depression because he feels helpless without his partner. A narcissist, in contrast, seeks to maintain a self-image as a perfect person and may be depressed after a divorce because she feels so damaged that her self-image has collapsed. In addition, patients’ inclinations to follow their doctors’ advice depend on their personality. A patient with a dependent personality or an obsessive one would probably follow prescriptions to the letter, whereas a mistrustful person would not. Millon is critical of excessive use of psychopharmacology. “Almost any person suffering from depression can probably profit from antidepressants,” he says. “But there is the danger that they will not help in the long run.” Therapy should help patients to change root problems in their life and uncover new possibilities. Millon compares today’s psychiatric practices with the state of medicine when physicians concentrated on treating the effects of disease, such as smallpox lesions and the inflamed lungs of tuberculosis victims, rather than their causes–viruses and bacteria. “We are beginning, now, to understand that a dependent personality gets depressed for different reasons than someone with a narcissistic personality,” Millon says. For both therapists and physicians, he recommends studying a patient’s personality before beginning treatment of the underlying illness–a step Millon took himself as a young man, when he traded his white coat for a hospital gown.
Apprehensive, he went to the nurses station and called the head of the hospital. His anxiety finally eased when the director confirmed that he was, in fact, a clinical psychology professor at Lehigh University and chair of the board of trustees at Allentown State Hospital who was voluntarily spending the weekend in the psychiatric ward. “That experience shocked me, and I never spent another night there,” Millon remembers, although he would still occasionally walk incognito among the patients.
Experiencing the world from the patients’ vantage point gave Millon a uniquely powerful window into their needs and had a lasting impact on him. “It became clear to me how primitive our understanding of psychological disorders and our methods of treating them still were,” he recalls. It especially bothered him that doctors typically saw the mentally ill only as collections of symptoms. “I wanted to understand the patient behind the illness,” says Millon, who now heads the Institute for Advanced Studies in Personology and Psychopathology in Florida and is an emeritus professor at Harvard Medical School.
These perspectives informed Millon’s first major book, Modern Psychopathology (Saunders, 1969), which became a standard text for American psychologists and psychiatrists. His so-called biosocial-learning theory of personality and the Millon Clinical Inventories constructed around it are still influential in clinical research and practice.
Millon’s “personalized psychotherapy” promoted goals and methods tailored to the individual, and his work is one of the major reasons why research into personality and personality disorders has gained so much importance in psychology over the past 25 years. His latest book, Resolving Difficult Clinical Syndromes: A Personalized Psychotherapy Approach (John Wiley & Sons, 2007)–co-authored with psychiatrist Seth Grossman of the Institute for Advanced Studies in Personology and Psychopathology–offers a revised and comprehensive manual for the treatment of such disorders.
Millon had his first exposure to mental pathology at home. He describes his mother, Molly Gorkowitz Millon, who was quite gifted musically, as emotionally labile. Today she probably would be diagnosed as having bipolar disorder, or manic depression. “As a child, he wanted to learn why she was that way. I never completely succeeded,” he says. But the desire to understand people became compelling.
Many years passed, however, before he found his professional path. The son of immigrants from Poland and Lithuania, young Millon loved the theater and wanted to make that his career. But his father, Abraham, who ran a textile factory in Brooklyn, N.Y., forbade him. And when his mathematically gifted son said he instead wanted to pursue math or music, Abraham nixed those ideas as well. Millons father believed that those were not decent professions for “a nice Jewish boy,” who should study something useful, such as business. Millon bowed to his father’s wishes and became an accounting major at the City College of New York, where he would also meet his future wife, Renee.
Millon was unable to get interested in accounting so he switched majors (briefly to economics, then to philosophy and physics). He fared well in an introductory psychology course and attended a series of psychology lectures–a key event that awakened his interest in personality research. The professor conducting the lectures, psychologist Gardner Murphy, had just published Personality (Harper and Brothers, 1947). “That became my bible,” Millon says.
Murphy’s theory about personality development immediately appealed to Millon. The theory presented dispositions and the environment–meaning biological and social factors–as contributing to development in combination, instead of regarding them as competing explanatory models. It was in this tradition that Millon himself later created his biosocial-learning theory, which explains how both inherited predispositions and social learning shape personality [see box above].
The significance of a person’s environment–whether it is family or culture–for personality runs through Millons career. In the 1970s he worked in the psychiatric ward of a VA hospital in Chicago with colleagues from Romania and Thailand and patients who were mostly African- American. During that time, he was also a member of the committee that prepared the Diagnostic and Statistical Manual of Mental Disorders-III (DSM)–which is the standard American reference work for diagnosing mental illnesses. It presented, for the first time, explicitly formulated diagnostic criteria for personality disorders.
These experiences prepared Millon for his role as a mediator when he served from 1988 to 1992 as president of the International Society for the Study of Personality Disorders–and gave him insights into how cultures can clash.
At the society’s conferences around the globe, a speaker from the U.S. might, for example, discuss a patients extreme perfectionism as a sign of an obsessive personality. Japanese researchers would not understand the presentation. “In Japan, no one would talk about such things as pathological behavior, because perfectionism is part of societal expectations,” Millon explains. What people perceive as normal or not normal strongly depends on their cultural background.
According to Millon, borderline personality disorder, for example, is typical of modern Western societies. Victims are unsure about who they are, what they want to be and what makes their life meaningful. This type of unstable personality reflects its surrounding societal conditions: vague role models and changing ideals, lifestyles and conditions mark the cultural environment. If a person in this culture also grows up amid chaotic family circumstances, it could have detrimental effects on his or her personality.
For similar reasons, Millon promotes personalized psychotherapy and accuses therapists who ascribe to traditional schools of taking too narrow a view of their patients. “They distance themselves from human reality in the process,” he warns. Millon believes that therapists must consider their patients’ entire life and every aspect of their personality. His strategy is guided by the patients individual characteristics and combines various treatment methods, so that a therapist can deal with several problems simultaneously. For example, a shy person should first overcome his or her anxieties, which would ease mastery of the subsequent steps, such as gaining self-confidence and learning competence.
Personality at the Root Even when a therapist is dealing with a client’s depression or another chronic mental illness, rather than a less severe personality disorder, Millon recommends tailoring treatment to the patients character. Similar symptoms can be caused by different problems, depending on the individual. After a divorce, for example, a person with a dependent personality may develop depression because he feels helpless without his partner. A narcissist, in contrast, seeks to maintain a self-image as a perfect person and may be depressed after a divorce because she feels so damaged that her self-image has collapsed. In addition, patients’ inclinations to follow their doctors’ advice depend on their personality. A patient with a dependent personality or an obsessive one would probably follow prescriptions to the letter, whereas a mistrustful person would not.
Millon is critical of excessive use of psychopharmacology. “Almost any person suffering from depression can probably profit from antidepressants,” he says. “But there is the danger that they will not help in the long run.” Therapy should help patients to change root problems in their life and uncover new possibilities.
Millon compares today’s psychiatric practices with the state of medicine when physicians concentrated on treating the effects of disease, such as smallpox lesions and the inflamed lungs of tuberculosis victims, rather than their causes–viruses and bacteria.
“We are beginning, now, to understand that a dependent personality gets depressed for different reasons than someone with a narcissistic personality,” Millon says. For both therapists and physicians, he recommends studying a patient’s personality before beginning treatment of the underlying illness–a step Millon took himself as a young man, when he traded his white coat for a hospital gown.
