Theodore Millon

Psychologist

• Born: August 18, 1928
• Birthplace: New York, New York
• Died: January 29, 2014
• Place of death: Greenville Township, New York

Type of psychology: Assessment; Biography; Personality

Theodore Millon, PhD, DSc, was a psychologist who developed a series of widely used personality tests; his theories helped define how scientists think about personality disorders.

Introduction:

Over a very productive career in which he wrote or cowrote thirty books and more than one hundred book chapters and scientific papers, psychologist Theodore Millon synthesized a great deal of descriptive information into a set of standardized types of personality disorders (e.g., borderline, paranoid, antisocial) and, in doing so, helped establish personality disorders as an important area of clinical practice and research. The most famous of his inventories is the Millon Clinical Multiaxial Inventory (MCMI), the fourth edition of which (MCMI-IV) was published in 2015. Millon also developed similar tests for various demographic groups, such as college students, adolescents, and medical patients. All these tests consist of 175 or fewer true-false questions that can be scored either by hand or by computer. They are often included in intake screenings, outcome measurement, or research at community agencies, mental health centers, college counseling programs, general and mental hospitals, courts, and private practice offices.

Born in the Manhattan borough of New York City and raised in Brooklyn, Theodore Millon was the only child of Abner Millon and Mollie Gorkowitz, both emigrants from eastern Europe. His ancestry included many Jewish scholars, and his first language was Yiddish; he did not begin to learn English until the first grade, and he spoke with a Yiddish accent that took over a decade to fade.

Millon's family strongly valued education, and Millon himself did well in school. After starting college as an accounting major, he switched programs and graduated in 1945 with a bachelor's degree in psychology, physics, and philosophy from City College of New York (CUNY), then stayed to earn his master's degree in psychology in 1947. While at CUNY, Millon was highly involved in student activities, met his wife, and had the opportunity to meet regularly with influential scholars such as art historian Meyer Schapiro and anthropologist Margaret Mead. He earned his PhD in personality/social psychology from the University of Connecticut in 1953.

After finishing graduate school, Millon took a position as an assistant professor at Lehigh University in Pennsylvania. In 1954, as part of an abnormal psychology course, he took his students on a field trip to Allentown State Hospital, a 2,200-bed psychiatric hospital that was operating under appalling conditions. That same fall, Pennsylvania gubernatorial candidate George M. Leader criticized previous administrations for providing inadequate care for the state's citizens, especially the mentally ill. Millon wrote Leader a detailed, five-page letter asking him to visit Allentown; Leader did so, accompanied by reporters, photographers, and Millon. When Leader won the election that year, Millon was appointed to a newly created board of trustees for the hospital. The board elected him to be its president, a position he retained for ten years. During his tenure at Allentown, Millon sometimes walked incognito through the halls, slept in the rooms, and talked to patients and staff. What he learned became the motivation for his work on personality disorders and the basis for Modern Psychopathology, his 1969 textbook that introduced his biosocial learning theory.

In 1969, Millon moved to Chicago to be the chief psychologist at the Neuropsychiatric Institute of the University of Illinois Medical Center. While there, he became involved in the task force that developed the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III, 1980), which at the time was the universal standard for establishing psychiatric diagnoses in the United States. As the only expert in the field of personality disorders, and a psychologist on a team composed mostly of psychiatrists, Millon played a central role in the development of the personality disorders section of the manual. He was also on the developmental task force for the fourth edition, the DSM-IV (1994). Although the DSM is now in its fifth edition (DSM-5, 2013), it retains the same ten personality disorders that appeared in earlier versions.

While in Chicago in the 1970s, Millon began to develop a test of personality disorders, the Millon Clinical Multiaxial Inventory (MCMI). Later, he participated in developing similar inventories for adolescents, preadolescents, medical patients, college students, and general populations. Millon thought that normal and abnormal traits lie along a continuum with no sharp dividing line between the two. For example, he believed that the person who is shy has much in common with a person with avoidant personality disorder (AvPD); the difference is that the shy person can adapt to the environment in a healthy way, whereas the person with AvPD is so inflexible that he or she cannot.

The MCMI has been translated into several languages and is used in cross-cultural research. Derived from his taxonomy and personality theory, it assumes that all people have a personality that influences what kind problems they experience, how severe these problems are, how they express symptoms, and what kinds of treatments are most likely to be effective. Thus, the MCMI requires the person completing it to know something about his or her personality, behavior, and symptoms and be willing to report it honestly. The MCMI is one of the most widely used and researched objective measures of assessing personality in history, behind only the Minnesota Multiphasic Personality Inventory in both clinical and research use.

Millon designed the MCMI to be user friendly. Written at an eighth-grade reading level, it usually takes people about twenty to thirty minutes to answer its 195 true-false questions (for example, “As a teenager, I got into lots of trouble because of bad school behavior”). He also was responsive to new research and developed newer versions of the MCMI when he thought that new information warranted revisions. The newest version, the MCMI-IV, was published in 2015, a year after Millon's death.

Although personality disorders are longstanding, originating in childhood, and resistive to treatment, Millon was optimistic that they could be treated. Of the MCMI-IV's twenty-five clinical scales, fifteen (the personality scales) broadly correspond to personality disorders identified in the DSM-5: schizoid, avoidant, melancholic, dependent, histrionic, turbulent, narcissistic, antisocial, sadistic, compulsive, negativistic, masochistic, schizotypal, borderline, and paranoid. The first twelve are classified as clinical personality patterns, while the last three are severe personality pathologies. The MCMI provides a score for each of these patterns or pathologies so as to give a complex picture of personality.

In contrast to personality disorders, clinical syndromes are considered to be responses to life events, so can be treated relatively more easily. Millon included ten clinical syndromes in the MCMI-IV—generalized anxiety, somatic symptom, bipolar disorder, persistent depression, alcohol use, drug use, post-traumatic stress, thought disorder, major depression, and delusional disorder—of which the last three are classified as severe clinical syndromes. The MCMI also includes some scales that indicate the person's response style when taking the test, such as overly reserved or overly disclosing; scores on these scales might influence or even invalidate all other scores.

Millon's focus was on people who have psychiatric disorders, and the MCMI has several uses for them. It can serve as a screening device or as part of a test battery, for example, at a mental health clinic or health department, to identify those with emotional and interpersonal difficulties that may require more intensive evaluation or professional attention. The MCMI profile includes suggestions for therapeutic management. Thus, it can be used by psychologists, counselors, psychiatrists, social workers, or anyone licensed and trained in the use of assessment instruments. However, it is not designed for everyone. Rather, it is specifically for persons in the middle ranges of severity, rather than those whose difficulties are either close to normal (e.g., those in workers' compensation lawsuits, spouses of patients) or markedly clinically severe (e.g., those who are acutely psychotic, or those with chronic schizophrenia).

Millon designed other tests as well. The college students test helps counselors identify, predict, and understand many psychological issues common among college and university students. It might be used at a college counseling center as part of an initial intake, as a way to measure counseling progress, or as an indication of treatment outcome. Millon developed two tests for adolescents, one for adolescents in general and the other for adolescents in a clinical setting; both are at a sixth-grade reading level and written in language that teenagers use. Although usually administered individually, there are no special conditions or instructions beyond those printed on the test booklet itself. Thus, like other versions of Millon's tests, they lend themselves well to group settings.

In 2001, Millon developed a test for medical patients to assess aspects of personality that might be especially relevant to treatment and adjustment to illness. It includes psychiatric indications, coping styles, stress moderators, treatment prognostics, and management guides. Its 165 questions are compute -scored and automatically corrected for response style, such as overreporting or underreporting symptoms.

In 1977, after serious heart surgery and his wife's colon cancer, Millon moved to sunnier climate to become the clinical psychology director at the University of Miami, where he taught and supervised clinical psychology graduate students for more than twenty years. Though initially planning to cut back on work activities, he also accepted a part-time visiting professorship at the psychiatry department of Massachusetts General Hospital, a teaching hospital of Harvard Medical School, and later transferred to its affiliated McLean Hospital, a psychiatric hospital. During this time, he also cofounded the International Society for the Study of Personality Disorders (with Niels Strandbygaard and Erik Simonsen) and the Journal of Personality Disorders (with Allen Frances).

Millon has been described as voluble and gifted in his vocabulary, which at times gave his writing a very imaginative quality and quite expansive perspective. Among many honors, he was professor emeritus at both Harvard Medical School and the University of Miami, and in 2008 he received the American Psychological Association's Gold Medal Award for Lifetime Achievement. He died on January 29, 2014, as a result of complications from heart disease.

Bibliography

"Gold Medal Award for Life Achievement in the Application of Psychology." American Psychologist 63.5 (2008): 345–47. Academic Search Complete. Web. 23 June 2016.

Millon, Theodore. "A Blessed and Charmed Personal Odyssey." Journal of Personality Assessment 79.2 (2002): 171–94. Academic Search Complete. Web. 23 June 2016.

Millon, Theodore. Disorders of Personality: Introducing a DSM/ICD Spectrum from Normal to Abnormal. 3rd ed. Hoboken: Wiley, 2011. Print.

Millon, Theodore. Masters of the Mind: Exploring the Story of Mental Illness from Ancient Times to the New Millennium. Hoboken: Wiley, 2004. Print.

Schubert, Siri. "Seeing the Person in the Patient." Scientific American Mind June–July 2007: 50–53. Academic Search Complete. Web. 23 June 2016.

Simonsen, Erik. "Theodore Millon." Journal of Personality Disorders 28.2 (2014): iii–iv. Academic Search Complete. Web. 23 June 2016.

Tringone, Robert, Theo Jolosky, and Stephen Strack. "Theodore Millon (1928–2014)." American Psychologist 69.5 (2014): 552. Academic Search Complete. Web. 23 June 2016.