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Transient Situational Personality Disorder

A diagnosis of transient situation personality disorder is applied to a patient who seems to be reacting to some overwhelming environmental stress. “Classified under this heading are certain personality responses of a more or less acute nature which occur in a relatively well-integrated individual under situations of acute stress or strain. In order to qualify in this category the patient must have a reasonably well-developed personality with a good adaptive capacity and revert to his original normal adjustment with the passage of the stressful situation” (English 1964).

There probably is a high incidence of this type of disorder in outpatient practice never gaining admission to a mental hospital. In this study of Filipino patients, frequency of this disorder may be reflective of the great role of culture in the genesis of the emotional conflict. Many of these patients were unable to derive enough cultural support in their attempts to solve personal difficulties. The patient’s personality structure and idiosyncratic psychological resources were evaluated as reasonably adequate. He was able to accurately and realistically appraise the problematical situation, but perceived and planned solutions found little or no room for implementation in the cultural environment.

It may be argued that a healthy personality should be able to avoid, cope with, or remove oneself from the situations of continuing frustrations. The psychiatrist leaning towards this diagnosis may be accused of over-empathizing with the patient, “taking their side,” as it were, against the noxious people or factors in the environment. In the Philippines especially, where interpersonal transactions are highly emphasized and where “to blame” is an all-important issue, giving the patient the verdict that he or she is “normal” but that the environment is causing the illness, will only confound the issue and not move it any closer to solution. Therapy is quickly transformed into a hearing court where it becomes more important to label and localize blame. For this reason the psychiatrist has to be even more careful as he puts on the scales the patients’ ego- strengths, the inflexibility of the noxious situation, and more importantly the extent to which all of these has crippled the patient’s psychological functioning.

As the pattern of communication in different societies and cultures becomes more scripted, and the meanings of a person’s emotional reactions more accurately evaluated, this kind of diagnosis may become even more frequent than it is now.

Example of a case in this study diagnosed as “Transient Situational Personality Disorder”:

A 34-year-old housewife came for a marital problem which was giving her severe headaches. Over the past two years, her husband had become extremely controlling, critical, verbally abusive and suspicious of her, without her doing anything to warrant this kind of treatment from him. She was not sure what is making him act this way but mentioned that for three years now, he had been working for her father, by mutual agreement and to their mutual economic advantage. Her mother-in-law died from cancer about one and a half years before; her husband was very devoted to her then. For whatever causes, he seemed to have changed rather drastically. However, she admitted that he had always been on the jealous side. He did not allow her to go out of the house without a companion. He interrogated the maids to her activities while he was in the office. He called her four letter words if she as much as showed her knees when seated even if there were just the two of them in their own living room.


His brothers and sisters did not support her in her protests against his behavior. They felt he had a perfect right to treat his wife as he saw fit. Her family sympathized with her but thought they should not interfere. She tried reasoning with her husband, helping him, ignoring him, asking a priest to mediate, going on a trip with him-but to no avail. To distract her mind, she tried opening a dress shop, but he would not let her do this. She had offered to go to work with him and hold office near him but he refused.

He refused to get any help, whether it be from a psychiatrist, priest, or family friend. Divorce had crossed her mind, but she know it was impossible to obtain this resource this recourse in the Philippines. She had tried occasional separations but their families and her children always talked her into returning. If she resisted them, they resented her and blame her “because it did not look good for a woman to leave home.” What was she do?

The woman in this particular case found herself hemmed in by culture which demanded conformance to existing norms, but at the same time failed to point out ways of helping her cope with her problem.

 

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