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.

The Boundary Between Mental Illness and Evil

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"Satan Sowing Seeds" by Felicien Rop...

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Was Jared Lee Loughner, who allegedly murdered six people in Tuscon and wounded 13 others, including Congressman Gabrielle Giffords, insane or evil or both? Leonard Pitts and other columnists and bloggers have openly wondered whether “evil” is a more appropriate description of Mr. Loughner than “insane.” Psychiatry and psychology tend to medicalize deviances in human behavior, sometimes to the point that they tone down the role of human responsibility. For example, classifying alcoholism as a disease alleviates the moral responsibility a person may have for engaging in the heavy drinking that made him dependent on alcohol.  Classifying mass murderers as “psychopaths” may be accurate as a descriptive label for their condition (no empathy, no conscience), but such classification does not address the issue of whether psychopaths are evil. There are several bad arguments that someone who medicalizes terrible human actions may use. For example:

1. If person x has a mental illness, and that mental illness contributes to x’s destructive behavior, then x is not morally responsible for x’s actions.

2. Person x has a mental illness.

3. That mental illness contributes to x’s destructive behavior.

4. Therefore, x is not morally responsible for x’s actions.

The weakness of this argument is premise 1. Just because a person is mentally ill, and that mental illness causally contributes to his behavior, does not imply that the person is not morally responsible for his actions. The reason is that the mental illness may be a necessary but not sufficient condition for x’s destructive behavior. X’s evil moral character may still play a causal role as well. Or x’s evil moral character may have causally contributed to his mental illness.

Another bad argument goes as follows:

1. Deviations from normal brain structure are correlated with psychopathy and other personality disorders.

2. If deviations from normal brain structure are correlated with psychopathy and other personality disorders, then the individual with such deviations is not morally responsible for his actions.

3. Psychopathic [mass murderer, swindler–take you pick of crime) individual x has deviations from normal brain structure.

4. Therefore psychopathic individual x is not responsible for actions that are due to his psychopathy.

One problem with this argument is that correlation is not causation. Even if a causal relation could be established, this does not answer the question of which direction the causation goes (the “chicken-egg problem”). Do the deviations from normal brain structure cause psychopathy or does psychopathic behavior cause deviations from normal brain structure? Unless one accepts reductive or eliminative materialism, then one cannot automatically claim that a twisted mind and behavior are caused by an abnormal brain. To make such a claim would be to beg the question on the complex metaphysical issues surrounding the mind-body problem.

I do not know where the exact boundary between evil and mental illness. A rough answer that seems reasonable to me is that if a person’s mind is utterly divorced from reality, then he is not as responsible for his actions as someone who has a firm or even partial grip on reality. Where should that line be drawn? This is the difficulty. It seems to me that psychopaths are evil people. Borderline personality disorder is (and I’m not trying to be “facile”) is a borderline case–but if a person suffering from borderline personality disorder destroys another person’s life, emotional health, and/or reputation due to manipulation and lies, then the person seems as much evil as having a medical disorder. The refusal of many borderlines to get help or take responsibility for their actions are basic elements of an evil character. Munchausen’s Syndrome and Munchausen’s by Proxy fall in the same category–the drive for attention is twisted to the point of doing evil and manipulative actions. I know that many professional psychologists and psychiatrists would disagree. But they do not know everything any more than I as a philosopher know everything. I know there is a level of mental illness that totally removes a person’s moral responsibility for heinous actions.  But since evil is by nature a distortion of the personality, there may be some individuals who are considered to be mentally ill but who are actually evil, or some individuals who suffer from mental illness and have an evil character.  Human beings are a mixture of good and evil, and that battle, as Alexander Solzhenitsyn said, is fought in every human heart.

The Tragic Shooting in Tuscon

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Gabrielle Giffords, Democratic nominee and gen...

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Like most people, I was shocked at the shooting spree in Tuscon that killed six people and wounded many others, including Representative Gabrielle Giffords. I pray for the families of those so brutally murdered and for the recovery of Rep. Giffords and the other people wounded. The shooter, Jared Lee Loughner, is clearly mentally ill; it is almost impossible to predict the behavior of someone so deeply disturbed, and we will probably never know what pushed him over the edge into violence and murder. There has been a great deal of concern expressed that extremes of political rhetoric may have led to this tragedy. This claim goes beyond the evidence, but political debate should be conducted in a rational matter using good arguments rather than ad hominem attacks. Both the right and the left have been guilty in this regard. However, I am not sure that in issues involving politics or religion that debate will ever be conducted without some people making personal attacks. Politics deals with the nature of government and what makes up a good society, something that affects us all. Religion deals with one’s overall view of the world. For many people, religion and politics are part of their very identity, and they feel threatened when their religious and/or political views are attacked. In addition, many people in society have been infected with the postmodern disease of not believing that reason can resolve political issues (and by “reason” I primarily mean “practical reason” in Aristotle’s sense). Distrust of reason only leaves room for emotion–and while emotion is necessary for our survival and is probably necessary for good cognition (as the work of Damasio suggests), emotion tends to go to extremes without the balance of reason. Without reason, all that remains in politics is emotional attacks that quickly degenerate into personal attacks and even into violence. Such a view ends up leading to “might makes right.” That is sophism of the kind Thrasymachus accepted as Plato portrays him in The Republic. Thrasymachus wished to attack people personally, even threatening them physically, to push forward his views. The kind of violence seen in the earlier attacks on Rep. Giffords’ office, or the vandalism of the Rutherford County, Tennessee Republican Party Headquarters (twice) is the result of such an ethic.

Concern about political rhetoric should not be used as an excuse to limit freedom of speech or to cut off debate on controversial issues. Even nasty political rhetoric, as long as it does not involve slander or libel or physical threats, is protected speech. Political debate today is nasty, but is nowhere near as nasty as it was in the nineteenth century. Yes, we should be more civil in political debate. But even those who are uncivil have the right to be uncivil. The terrible tragedy in Arizona should not obscure this fact. Sadly, the sheriff in Tuscon and many in the media have tried to politicize this tragedy or blame specific people or movements for the crime. This is the very kind of political rhetoric that is unhealthy. Ultimately, there is only one person who is guilty of the murders and assaults in Tuscon, and that is Jared Lee Loughner.

The Ethics of Psychedelic Research on Human Subjects

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Stanislav Grof, psychologist and psychiatrist

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Is it morally right to do research using psychedelic drugs such as mescaline, LSD, or DMT using human subjects? Much laboratory research has been done using animals already, and someone may argue that there is no need to study these dangerous substances in human beings. I will argue otherwise.

All three of these drugs, as well as other psychedelics, are widely abused–and that is one of the dangers of research–the press will find out about the research, disseminate information about it, and some non-addicts will read about the research and say, “Now that drug seems interesting–I think I’ll try it.” Ergo, we have more addicts than ever. But I would argue that that danger is exaggerated. Knowledge of mescaline and LSD has been public for many years, and DMT has become increasingly known since the 1990s. Mushrooms have been used for centuries, and ketamine has been widely abused since the 1960s. I do not see how human trials could publicize these drugs any more than they already have been–and even if they do, dangerous side effects and bad trips will also be publicized, scaring many people away from trying them.

The main reason I support psychedelic research with select groups of human subjects is that some mental illness is intractable to current treatments. Some cases of schizophrenia, for example, are so severe that current therapy does little or no good. Some researchers, such as Stanislav Grof, have used LSD in the treatment of schizophrenics. Other conditions, such as depression, can be so severe that only electroconvulsive therapy does any good, and the good that is does is only temporary. Plus, ECT carries with it the risk of brain damage. If some psychedelics could be used to treat these intractable cases of schizophrenia and depression more effectively than current treatments, especially if such research is backed up by animal studies, why not try it using select subjects. Now for subjects able to give informed consent, they should be thoroughly warned about the risks of such studies. For subjects who are mentally incompetent, the family member or person with power of attorney should be given sufficient information to give or withhold informed consent based on his interpretation of the patient’s prior wishes. If risks are thoroughly explained, and the patient has not been helped by any other treatment, and informed consent is given, I see no ethical problem with attempting to determine whether a psychedelic drug can help the patient. A critic may reply, “What about the risk of harm, both physical and psychological? What about the risk of future addiction caused by the study?” If current treatments, such as ECT, can harm the patient and only give a temporary reprieve from the illness, a study using psychedlics most likely would not do more harm than prior treatments–and it may help. As far as the risk of addiction, that comes with the territory of any drug that helps a patient feel better. Should we stop research on painkillers because some patients become addicted to them?

The FDA has been very conservative in approving studies with psychedelics. Part of this caution is necessary to prevent harm to human subjects. And no one wants to go back to the days when the U. S. Army and CIA were secretly giving LSD to soldiers–one soldier committed suicide. The FDA has the right to leave no stone unturned–I would not want to be the FDA agent who helped pass a study that ended up harming research subjects. But sometimes regulatory agencies hear the word “psychedelic” and are afraid to support any research involving such drugs, even if they potential to treat intractable mental illness. Hopefully some balance can be found between the absolute necessity of protecting research subjects and the desire to find new drugs to help those who cannot be helped with current therapies.