Impediments to Voluntary Action in Disease

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Most of us think we have free will, and most of us realize that there are limits to free will. If someone has, for example, a lesion in the brain, he or she might behave differently than normal without realizing what is happening. Aristotle discusses the case of a drunk person who commits a crime while drunk without realizing at the time what he was doing. He says that the wrong action itself is not voluntary; however, since the decision to drink too much was voluntary, the drunk person is responsible for his action.

Nature and nurture both cooperate in limiting our practical range of choices. Our heredity can set basic personality traits, environment can modify them, and we have learned that environment can modify a person’s genetics. A person’s own decision can modify his genetics as well–this discovery and others is the reason why epigenetics is a hot field in current biology.

Someone with schizophrenia who behaves in a destructive way due to the disease process in his body is making choices based on the fantasy world view characteristic of schizophrenics. The choice is voluntary in a way, but since it is based on an illusion caused by the illness, the choice is ultimately so constrained as to be involuntary. The same is true of other psychoses as well as most of the Class B personality disorders. Voluntary choice is constrained due to traits that sometimes result in the disintegration of the personality. A person does not have to reach the extreme of dissociative identity disorder to suffer from a fragmented personality. Overwhelming emotions characteristic of the Class Bs can interfere with voluntary action; the impulses can cause an adrenaline rush that can interfere with judgment, and in extreme cases a temporary dissociation can occur. I have struggled with my views on this matter over time. I have met psychologists who say that these persons have free will and have decided to focus on the self, and that such focus is characteristic of egotism and is evil. I once believed this was the case; however, on reading accounts of recovery from some of these conditions, including recovery from the notorious borderline personality disorder, I have reconsidered. J. R. R. Tolkien considered the Rin to be too great a temptation for anyone to bear–a temptation that a person could not resist. Perhaps overwhelming waves of emotion can temporarily limit the scope of voluntary action. The situation would be similar to those who are drunk or on drugs and have impulses they often cannot control. The difference is that in the case of mental illness, environment (and in some cases heredity) have molded a person into unhealthy patterns of behavior that may be too difficult to voluntarily resist. What are the options for such individuals?

It seems to me that the option is to seek treatment, just as alcoholics who are not forced to do so by the criminal justice system must voluntarily decide to be treated if they have any chance to be helped. I am not sure that a schizophrenic recognizes the need for help. If someone with one of the Class B personality disorders avoids denial and seeks treatment, it is possible, with a patient therapist and a long-term therapeutic relationship, for that person to be successfully treated. Dialectical behavior therapy, for example, has been useful in treating borderline personality disorder. The alternative, at least for this condition, is grim. BPD individuals do not intend to hurt others–not for sheer “meanness.” It stems from splitting (which I call “individualized Manicheanism” that puts a person into the “all good” category one moment and the “Satanic evil” category the next moment. Much of the behavior is the attempt of the fragmented personality to survive. Jesus said that “A house divided against itself cannot stand.” Could it be that a personality divided against itself can cause the body to be divided against itself? Some people with various mental conditions are in poor physical health. While that may be due to poor eating and exercise habits, I wonder if a mental disorder can be in a one-to-one correspondence with a physical disorder. Is it possible, for example, for a divided personality to cause the body to be divided against itself? If so, would the physical disease be eased or reversed if the disparate patches of personality could once again join into one? I suppose that is possible. Such a task would involve a skilled therapist with top-notch skills and the wisdom, as well as the knowledge, to help a person become whole again. My hope and prayer is that, with God’s help, all those who suffer from actions that are, at least in part, beyond their control due to illness, physical and/or mental, will heal.

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Chess and Mental Illness

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Morphy

Morphy (Photo credit: Wikipedia)

I love the game of chess. Over the years I have enjoyed playing in tournaments and in informal games at chess clubs and other venues. Now I do not believe there is any necessary relationship between any particular game and mental illness. It does happen to be the case that in studying the history of the game, one finds a number of cases of brilliant players who became mentally ill. Paul Morphy, the great nineteenth century American player and unofficial world champion, is one classic example. Wilhelm Steinitz, the first official world champion and, since he became a United States citizen in 1888, the first U.S. world champion, sadly, became mentally ill in old age, allegedly offering God odds of pawn and move in a game. Akiba Rubenstein, a great player from the early twentieth century, also became mentally ill in his old age. The most famous contemporary example of mental illness in a chess player is Bobby Fischer, the first U.S.-born world champion. After he won his championship match with Boris Spassky, Fischer’s behavior became increasingly unstable, and his rabid antisemitism seemed to be a strange form of self-hatred given that his mother was Jewish, and recent evidence indicates his father may have been Jewish as well. Shortly before he died in 2008, I looked at Bobby Fischer’s personal website–it was clearly the work of a sick man–paranoid, raving, and incoherent. I disagreed with the U.S. Chess Federation’s throwing Mr. Fischer out after he supported the 9-11 attacks because those were not the statements of someone who was mentally “all there”. Why is the case that many chess geniuses suffer from mental illness?

Such problems are not unique to chessplayers–mathematical and musical geniuses sometimes have similar problems with mental illness. It is as if the brain is wired for one type of thinking and does that thing at a genius-level, but other forms of thinking are truncated. I am reminded of the extreme of savants, who can do one thing well, but are profoundly mentally handicapped in other areas.

I would venture a guess that more geniuses have high-functioning autism (which I do not consider to be a mental illness) than other people. It is well known that people on the autistic spectrum tend to focus on one (or only a few) special interests, and they tend to excel at those. In other areas of life, such as social ability, they do not do as well. I am not chess genius, but only an average tournament player of around the 1500-level, but I have been diagnosed with Asperger’s Syndrome (now called high-functioning autistic spectrum disorder). When I go to chess tournaments, many of the players seem more socially inept than I am–that’s saying a lot. I have also noticed some players having interests upon which they focused almost exclusively–chess, of course, but also collecting fantasy action figures, Dungeons & Dragons, war games (board games), science fiction, science, and mathematics. This is not a bad thing–society needs people with talent in many areas who can channel their interests in a positive direction. If that tendency to be antisocial goes too far, however, to the point of debilitating autism or true mental illnesses such as schizophrenia or bipolar disorder, as well as personality disorders, then that results in players such as Mr. Morphy or Mr. Fischer.  These serious cases are sad, and such individuals require treatment which is all too hard to come by these days. Plus, the person or person’s family must take the initiative for the individual to get treatment. I do not believe chess itself will do them harm–it may do them much good in channeling their energies into one of the great strategy games of history and an intellectual contest par excellence.

I will continue to enjoy chess, and continue to enjoy playing over the games of the great players of history regardless of their mental difficulties. Morphy’s and Fischer’s games are masterpieces and are a great joy to go over. I believe that the contributions and beautiful games of chess these men offered more than make up for anything they may have said due to their illnesses. In the end, they have made the world a richer and more joyful place by creating objects of beauty.

The Unpredictability of Human Behavior

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When you think of mental illness, is this what...

When you think of mental illness, is this what you see? (Photo credit: JenXer)

Some of the comments on Internet discussion boards suggest that mental health professionals should have been able to tell that Adam Lanza was dangerous and that they should have had him detained at a mental health facility. Such statements reflect a fundamental ignorance about the nature of mental illness and the predictability of human behavior. There are a few–and only a few–cases in which mental health professionals can be reasonably certain that a person will break the law and/or harm another person. Pedophiles are notoriously difficult to treat–it is well known that their recidivism rate is high. Psychopaths, who lack empathy, often hurt people, although most do not become murderers. A person known to have a violent temper who has behaved violently all his life is likely to engage in violent behavior again. However, in most cases of mental illness, no one can predict with any degree of accuracy whether or not a person will engage in violent behavior. The vast majority of mentally ill individuals, even those with psychotic conditions such as schizophrenia or bipolar disorder, never engage in violent behavior. Even a paranoid schizophrenic who is aware of his condition and realizes that any hallucinations he has are not real may not be at serious risk for violent behavior. Sometimes “normal” people engage in terrible acts of violence, such as a North Carolina man a few years ago who, without warning, beheaded his eight-year-old son. To say that psychologists and psychiatrists and others around Mr. Lanza should have predicted that he would become violent is both unrealistic and ignorant. Mental health professionals cannot read people’s minds. There are many unusual or quiet individuals who do not fit into society’s pigeon holes of normality, and almost all of them will lead peaceful lives. On the other hand, someone who robs and murders multiple people over a period of time may do so without any sign of mental illness per se.

Eccentrics often are the most creative people in a society–Beethoven, Einstein, Thelonious Monk–all were eccentric people who made incredible contributions to science and to music. To say that people who are different or who have certain “mental disorders” should be locked up because of an alleged potential for violence is a view that is not based on facts. Americans want predictability, want order–they want reality to fit into a pigeonhole. Evil actions are often what philosophers call a “surd,” something that cannot be explained. How can someone, without getting into Mr. Lanza’s mind, have possibly known he was going to commit such an act. If his mother had heard him brag about specific violent acts, then there would a problem, but thus far, there is little evidence of that occurring. These murders point out the limits of human knowledge, limits that people do not want to acknowledge–and such a failure to acknowledge limits is used to justify stereotyping the mentally ill (including, as I noted in my previous post, people with Asperger’s Syndrome) as violent. People should do good research before expression opinions that are both wrong and potentially subversive to the rights of entire classes of people.