Changes in Personality
The idea that a disease could cause even modest changes in who we are makes many of us uncomfortable. However, there is no question that the brain is changing because of Parkinson’s.
There has been a lot of discussion about a “Parkinson’s Personality” over the years. Although controversial, some researchers have attempted to go back into the past to search for a common set of personality traits among people who later develop PD. There are a number of problems here, not the least of which is the bias that is bound to occur when anyone looks to the past with knowledge of what the present looks like. It is more reasonable to assume that the neurological effects of Parkinson’s Disease cause a great deal of similarity in personality among people with the disease. Therefore, I think it is more important to consider the likelihood of personality change with PD.
Talk with any family member of a person who has Parkinson’s Disease and you will frequently hear them say, “Parkinson’s has made my spouse/partner/parent/sibling different.” They are reporting that there is something discernibly altered in who their loved one is as a person. It might be subtle or it might be quite blatant, but the person is no longer the same as he or she once was. I recently presented a talk on Parkinson’s Disease and personality change to a group of family members and was astonished at the number of people with whom this idea resonated.
We are not really used to talking about Parkinson’s as an agent of personality change because we focus on the disease as a movement disorder in most of our discussions. This allows us to talk about brain change in terms of dementia or executive dysfunction. But both of these conditions manifest as a fundamental change in who the person is. The idea that a disease could cause even modest changes in who we are makes many of us uncomfortable. However, there is no question that the brain is changing because of PD. Because a substantial part of our personality relies on our brain function, it is not a stretch of logic to ask if a changing brain produces a changing personality.
One of the most difficult neurological disorder symptoms of Parkinson’s
Why might this be important to families challenged by PD? Because the biggest source of conflict in families occurs when loved ones fail to recognize that a person with brain changes is not the same person who existed at an earlier time in life. Human beings greatly value continuity in personality but by expecting the person to be the same as they once were, loved ones are unfair to the person with brain insult. This person could no more return to an earlier personality state than he or she can will away tremors or rigidity. Energy expended in any way other than coming to terms with this “new” person is fruitless. There is actually some fascinating research in this area and it is likely to be a topic for a great deal more discussion in future blogs.
The American Psychological Association (APA) defines personality as “the organization of an individual’s distinguishing, traits or habits.” According to the APA Encyclopedia of Psychology, this individualized organization comprises four domains: thinking, feeling, behaving, experiencing the environment. Words such as traits and habits imply that personality is an enduring function of the person. Based on our perceptions of what one’s personality is like, we are able to make reasonable predictions about how a person functions across those four domains. We do so with folk terms that have been in our language for ages because these provide not only a common understanding but also allow us to make predictions about how a person is likely to act under given circumstance. It is important to remember that this might sometimes mean a more/less energized form of characteristics that were already present (e.g. controlled vs volatile for how a person responds when angry).
Because of the greater likelihood for executive dysfunction and dementia, personality change is easier to see among individuals with more advanced PD. Motivation (a personality characteristic we might call engagement) is frequently affected, resulting in apathy (introversion) that diminishes how actively an individual interacts with other people (aloofness) and with the world (withdrawn). Thinking or cognition changes can cause the person to process information more slowly and with less focus and concentration (inattentive, absent minded). A previously methodical, consistent (conscientious) individual often becomes increasingly chaotic (disorganized) in their response to their environment (undisciplined). One easily becomes less interested (bored) and hopeful about the future (pessimistic).
Even among individuals with young onset PD, there can be subtle changes in personality. Thus, a person may begin to experience more negative emotions (neuroticism), becoming more anxious (fearful) or depressed (withdrawn or moody). They may have difficulty letting go of ideas/beliefs (stubbornness) or become overly drawn to detail (obsessive). They may exhibit difficulty completing work assignments (unproductive) because they have difficulty organizing (careless). They might try previously unsuccessful methods over and over (uncreative).
Many readers might ask why it is necessary to complicate an already complicated disease by talking about it in terms of personality. The simple answer is that our families use personality terms when describing behaviors to professionals (“He is very compulsive about getting his meals on time”) and when trying to articulate their feelings that a person has changed (“She was never this stubborn before PD”). Medically-untrained individuals typically use personality terms as kind of shorthand to communicate what they are seeing or experiencing because there is some degree of cultural agreement about what the terms mean. Finally, physicians who try to treat stable states occurring with Parkinson’s Disease (such as apathy) medically may be less inclined to do so if they recognize these concerns as expressions of personality, resistant to change. There are after all, no FDA-approved treatments to make a person care about what they are constitutionally disinclined to care about.
It is important to recognize that our personality is relatively stable over time, although aging, life experience, and other factors (including disease) can lead to at least some modest changes. Given the chronic and progressive nature of PD, it makes no sense to believe that personality changes will magically disappear. They are likely to become increasingly more prominent and new traits may arise. Although we may be uncomfortable looking at Parkinson’s Disease as a condition that changes who we are, it makes sense to do so. We already recognize the disease to be a life-changer but may wish to consider that part of the reason is because it can change who we are.