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Theodore Millon’s Disorders of Personality: Introducing a DSM/ICD Spectrum from Normal to Abnormal presents a comprehensive personological taxonomy, building on his earlier theory in Toward a New Personology. This newer work expands upon the taxonomy previously offered and sheds light on clinical personality disorders, extending the understanding toward normalcy. Additionally, it introduces new personality types and disorders not currently covered by the DSM or ICD.

 Millon begins the Preface with a justification of the guiding principles of the book:

“Guiding the principles and content of this book is Darwin’s concept of natural selection. In line with this ‘‘law’’, personology and personality disorder are conceived as varieties of successful and failed natural selection efforts by humans as they attempt to achieve an optimal balance among the three essential elements comprising life:
(1) existential survival (avoiding death/pain and enhancing life/pleasure);
(2) ecological adaptation (environmental accommodation/passive and environmental modification/active); and
(3) species replication (maximizing reproduction/ self and nurturing progeny/others).” (Millon 2011 ix)

The interplay of these three elements, as described in the preceding sections, will serve as the foundations of this model. Our first task then is to clarify and justify these three elements. 

The reason for basing the model on Darwinian theory is that the field of personology has lacked a cohesive and shared understanding, as well as a unifying framework to guide its different aspects. Therefore, it requires a comprehensive framework to bring all its parts together. An evolutionary-based system can fulfill this role, as it offers a substantive framework that can unify the field. (x)

Millon has been proposing personality categories for a considerable time, as noted in Millon (2011, p. xi). He initially developed a “biosocial framework” before moving on to create an “evolutionary model.” Despite their apparent differences, these two conceptual frameworks are consistent and complementary. The former draws heavily from learning theory and informs developmental ontogenesis, while the latter utilizes constructs from evolutionary theory that apply to both phylogenesis and human adaptive styles. (xi)

The DSM-5 and Millon’s model use some key concepts in a similar way. The DSM-5 emphasizes positive and negative emotionality, which correspond to Millon’s theory of pleasure and pain. The DSM-5’s externalizing and internalizing concepts align with Millon’s active and passive adaptation. The DSM-5’s self- and interpersonal functioning dimension is consistent with Millon’s self and other replication. However, while the DSM-5 presents these ideas separately, Millon’s Darwinian-based theory shows how they relate and generate not only the traditional DSM personality disorders but also new normal styles and previously overlooked ones. (xii)

Millon quip, “That the incidence of both mild and severe mental disorders is strikingly high in contemporary society cannot be denied.” (3)

What does the term “mental disorder” mean? At its core, a mental disorder is a mismatch between normal mental processes and those that are dysfunctional, either personally or socially. Because normalcy and functionality are subjective, the concept of mental disorder is also subjective. Once we establish what is considered normal and functional, we can determine whether mental processes fall within or outside of those boundaries. Mental disorder is a crucial concept because it affects our daily lives. While there are different ways to understand it, most people in the contemporary United States believe in the medical model, which views mental disorder as an illness that should be treated with Western medicine. This belief is not necessarily based on theoretical understanding, but rather on acceptance of medical institutions as authorities. Therefore, many readers may simply view the medical model as the obvious and necessary way to approach mental disorder. It’s important to note that this is not a criticism of the public, but a warning about the potential limitations of this model. (Adapted from Luhrmann, 2012)

The practical importance of the concept is clear, as it influences both research and treatment within our institutions. Despite my own reservations about its adequacy, particularly within psychiatry, it is necessary to acknowledge and understand the medical model in order to engage with the existing audience and literature. Therefore, I will use existing language and terminology, even if it may not always align with my personal views. I want to make it clear from the outset that my use of language is based on the conceptual and lexical framework available to us at each point in this text.

Gregory Zilboorg (1941) described detachment as a lack of feeling, where one reviews past events as an uninterested observer. However, Millon argues that this approach fails to capture the vitality of a subject’s history, reducing it to a series of statistical points on a table.

Millon presents his model as the foundation for a Kuhnian paradigm shift. Kuhn’s concept acknowledges that theorists and investigators have certain fundamental assumptions about the components of a subject, and it identifies questions that can be asked about those entities as well as the methods for finding answers to those questions. Once a paradigm is established, it serves as the foundation for “puzzle-solving,” which refers to the rules and techniques that scientists and clinicians use to further develop their subject.

I do not mean to imply that other models are incorrect or insignificant when utilizing Millon’s model. In fact, Millon’s theory is a synthesis of these other models. However, the mental health sciences are primarily the product of an evolutionary process characterized by random variation and natural selection, according to Millon. (Millon 2011, p.4)

There are several competing schools of Psychology and Personality, including Kretschmer (1925), who considered body morphology as a significant variable in conceptualizing pathological types; Cattell (1957, 1965), who gave preeminence to statistically derived trait dimensions; and Horney (1950), who emphasized the interpersonal orientation developed to resolve unconscious conflicts (Millon 2011, p.5).

Millon’s project offers reason for optimism because theorists and classifiers now believe that the complexities and intricacies of personality can be studied systematically and understood scientifically (Millon 2011, p.5).

In summary:

• A personality is a set of styles of adaptive functioning. 
• Being requires distinction (from non-being).
• Millon’s justification for the model uses the relatively high level of unity and evidentiary support in Biology to justify its use in priority over psychological, sociological, and other possibilities that are not yet in a state of theoretical unity.