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.

Borderline Personality Disorder

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Borderline Personality Disorder Awareness

Borderline Personality Disorder is a disorder I have been blessed not to have, though I’ve known individuals, some close to me, who were borderline. BPD is essentially a problem of emotional control. Borderline people have wild mood swings, though they are not usually bipolar. They can love you and think you are the most wonderful person in the world one moment, then turn on you, demonize you, and hate you. Those shifts can be unpredictable and can happen quickly, leaving family members hurt and wondering how to react. Borderline individuals tend to put people they know into lose-lose situations. If the borderline person is angry with you, whatever you say will be the wrong thing. You will, as one bestselling book on BPD alludes to, be “walking on eggshells.”

Borderline people can be manipulative, just like narcissists, but unlike sociopaths or psychopaths, they do have a conscience and are capable of love. Often, however, their love is twisted, oriented more to feeding their egos (like narcissists receiving “supply”) than truly focusing on the other person. They are good at making themselves look “too good to be true,” seeming to be interesting in everything you are. Some borderline individuals will lie about their accomplishments in order to impress others; other borderline individuals find it difficult to tell the difference between appearance and reality. The latter group can go into a dissociative state and not remember what they did during that state. If you quote the borderline’s statements to you to his family and friends, often they will stare at you as if you are crazy–because the BPD person told you that something happened that, in truth, did not happen.

BPD individuals, like narcissists, psychopaths, and sociopaths, often have a great deal of charm, which they use to their advantage. But the advantage is only temporary as people pick up on the fact that the BPD person “ain’t quite right” as we say in the South. Instability in jobs and instability in relationships may lead to the BPD going through multiple jobs quickly, moving many times, and going through multiple marriages. All relationships are unstable. The borderline person is afraid to lose anyone in his life, yet does not realize that his behavior drives people away. Sadly, the BPD individual is usually miserable inside and lonely, desperately wanting a friend. Most BPD persons do not recognize that their behaviors drive away other people; others may recognize that fact, but believe that their traits are essential for their emotional survival. That points to the greatest problem borderline individuals have in overcoming their disorder: a failure to take responsibility.

So many mental problems are due, in part, to someone believing they are the slave of fate, that given one’s background, one cannot help the way he is. For that reason, he refuses to take responsibility for his actions and blames others for bad things that happen to him. The most difficult obstacle psychologists and psychiatrists have dealing with borderline people is the borderline’s refusal to take responsibility. The borderline often tries to manipulate the therapist. Sadly, many affairs with therapists occur that way. One psychologist told me that of his fellow therapists who fell into affairs, probably over 95% of the lovers were borderline individuals. Since flirtation gains the borderline attention and helps with low self esteem (which only masquerades as high self esteem), many borderlines are extremely flirtatious. Not all will go to the point of a full-fledged affair, but many do.

BPD usually has its origins in childhood. Oftentimes, childhood sexual abuse by a parent or stepparent is the cause–though this is not the only cause. BPD usually manifests in a person’s teens. Some borderline individuals spontaneously recover in their forties; others never recover. Therapy is notoriously ineffective, although newer cognitive methods work better than previous therapies. It is a joke among psychologists that the way to harm an enemy psychologist is to refer a borderline patient to him. If the psychologist can get the borderline person to admit that he is not the slave of forces beyond his control and that he is able to change, the major step toward recovery has occurred.

Are borderline individuals sick or evil? Some borderline behavior seems to be evil: the lying, the manipulation, the willingness to say or do almost anything to get what one wants, the sudden turns toward absolute hatred. I know of one therapist (not my therapist) and one person who works in the criminal justice system who consider borderline people to be evil. In my opinion, most of them do not begin as evil, though, like any human being, they may become evil due to habituation. They are trying to survive something that hurt them so much as a child that they believe that their behaviors are the only way they can survive in the world. They may believe that if they did not behave the way they do that they would fall apart–indeed, their personalities seem to be fragmented. These sad, frightened people need to be guided toward healing–but they must be willing to get help and be serious about it. To anyone who may have this disorder: I pray for them to get help, to engage in positive behaviors that support solid relationships with others, and to find peace in their lives.

Is Asperger Syndrome a Real Condition?

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Hans Asperger

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In 2006 I was diagnosed with Asperger Syndrome, a condition, first identified by Hans Asperger, on the autism spectrum in which social awkwardness, a focus on particular interests to the exclusion of others, and physical clumsiness are combined. But does the term “Asperger Syndrome” refer to a real phenomenon in humans or is it a product of the modern tendency to attach labels to normal variations in personality?

My short answer is “Yes, Asperger Syndrome” is a real set of behavior patterns in some individuals”–but there is more to be said. It is true that Americans, especially, love to label. They love to medicalize. Although Attention Deficit Hyperactivity Disorder is a real condition that truly handicaps some children, there is a temptation to apply the label to children being children, especially by tired teachers or by parents looking for an excuse for their child’s poor behavior. But misdiagnosis does not imply that ADHD is a myth; it means that diagnosis must be done with care and conditions such as ADHD must be carefully defined. Otherwise, some children may be placed on Ritalin or some other drug of which we know very little about long-term effects.

Now Asperger Syndrome can be socially damaging since individuals with Asperger’s do not read other people well. Thus there are some negative effects of the condition that have practical consequences, especially for social relationships, friendships, marriage, and job interviews. There is some evidence that, like full-blown Autism, Asperger Syndrome is correlated with changes in the brain–but one must take care about such correlation. Correlation is not causation. In addition, there is the “chicken-egg” problem of whether changes in the brain affect behavior patters or whether behavior patterns remold the brain. The truth may be a combination of both. Parents with Autism or Asperger’s are more likely to have children with these conditions, so there seems to be a genetic link. A critic, however, may point out that if parents who model behavior for their children have Asperger’s, then the child may model his behavior after the parents and engage in Asperger-like behaviors. Science may not be able to answer every question about Asperger’s and heritability, but from my own experience, watching my maternal grandfather’s behavior, I believe that a tendency to Asperger Syndrome can be inherited, but whether science confirms this conclusively will depend on future research.

Asperger Syndrome is not a disease. In part, I think of the term as a pragmatic label that helps people “wrap their minds around” a certain combination of behavior patterns. Placing those patterns under the Asperger’s label helps both scientists and individuals with Asperger’s and their families to place past, present, and future behaviors into a meaningful “pigeonhole.” Pigeonholes are not always bad things as long as people are not overly legalistic about them. If a pigeonhole helps someone make sense of his life or his loved one’s life, and if it points to an actual pattern of natural human behavior, then the pigeonhole is pragmatically useful.

But is the label “Asperger’s” true? Does it refer to a “natural kind” with stable properties? I lean toward that position. I realize the dangers of over-medicalization of normal variations (and I think Asperger’s is an extreme of normal personality) and of labeling. From my own experience and from the experience of others, Asperger Syndrome does refer to a pattern that is ontologically real–“really real,” so to speak. Now whether Asperger’s is overdiagnosed is an empirical question that can, in principle, be resolved by careful study. More rigorous tests can make diagnosis more accurate. But for those who are accurately diagnosed, they should take comfort that their condition is not just a label–and accept the strengths that arise from having Asperger’s–and work on the weaknesses.