I’ve been posting on the many misconceptions that exist about various psychological terms and concepts (See, for example: Misunderstood Psychology Terms Pt 2: Personality and Character, Addiction, Codependence, PTSD, Anxiety, and Self-Esteem). The rampant misuse of terms (including many of the more familiar terms) by both lay persons and professionals has helped perpetuate many of the misconceptions about them. But changing definitions over the years has also helped confuse folks about what some terms really mean. This is especially true when it comes to the term “disorder.”
Most of us think of medical “disorders” or illnesses as something we never asked for but came upon us as the result of a bacterial or viral invasion or an unplanned, unpredictable, possibly even genetically-predisposed breakdown of one or more of our body’s systems. We certainly don’t think of such conditions as something we simply choose. We don’t choose to cough, be congested, or run a fever simply because we like to ache, sneeze, have difficulty breathing and hack incessantly. And while there are definitely things all of us voluntarily do that might indeed either increase decrease the chances that certain diseases might afflict us, most of the genuine “disorders” we suffer during our lifetimes are not strictly of our own making or choosing.
Many years ago, the folks in charge of labeling and cataloging mental disorders went to a strictly objective, observable behavior-oriented approach as opposed to one that allowed for hypothesized but almost impossible to prove or demonstrate underlying causes. While this new approach solved the problem of subjectivity on the part of the diagnosing clinician to be sure, it also promoted in the public mindset the idea that all of the various “disorders” listed in official manual (presently, the DSM-V) – including the various behavioral disorders – are illnesses that afflict as opposed to patterns of behavior a person voluntarily chooses or prefers (despite the maladaptive nature of those behaviors). While several of the conditions listed in the manual are indeed illnesses in the traditional sense (especially, for example, schizophrenia, Huntington’s Disease, etc.), the application of the term “disorder” to all the conditions listed, regardless of their underlying character, has led to some serious misconceptions.
Occasionally, misconceptions about the nature of a mental “disorder” and abuse of the term can reach an absurd extreme. I’ve written before about the notorious child rapist Ariel Castro (See: “I Am Not a Monster”: Impression Management Ariel Castro Style) who satisfied his lust for teenage girls by carefully stalking and then abducting three young women, holding them hostage for years, and regularly assaulting them. At the sentencing hearing for his heinous crimes, Castro claimed it was wrong for others to see him as a “monster” or predator. Rather, he asserted folks should view him as “sick,” the victim of a severe pornography “addiction” – someone to be pitied instead of reviled, and someone more in need of understanding and treatment than deserving of punishment. And only a few days after the Castro hearing, defense attorneys for three drug-dealing teenage thugs who were caught on their school bus surveillance camera beating a classmate within an inch of his life pleaded with a judge to see their clients not as hoodlums out to “teach a lesson” to a classmate who “snitched” on them to school authorities but rather as unfortunate young men who had both learning and impulse control “disorders” and who needed “anger management” and other therapies for their conditions as opposed to punishment and correction (even though, as juveniles, the worst punishment they could have received would have paled in comparison to what would be typically meted out to adults committing the same criminal offenses). Events like those just mentioned are all frequent these days. From the congressman caught systematically funneling off hundreds of thousands of dollars in campaign funds for personal use and then claimed Bipolar Disorder made him do it, to the lawmaker turned mayoral candidate who claimed that his ongoing lewd behavior (even after “treatment”) was the result of a “sexual addiction” (see also “The End of Political Sex Scandals — Or Something Else?”), claims that mental “disorders” of some sort are really to blame for someone’s willful misconduct have become so commonplace that some folks have not only lost their outrage about such claims, but also increasingly granted them a fair degree of plausibility and even legitimacy. This begs the question of whether the concepts of personal responsibility and accountability even exist anymore. Is everyone in fact a victim in one way or another? Is all our behavior merely a product of our biochemistry, our upbringing, our environment, etc.? Do we really have as much control over our actions as most of us were taught to believe? Are the concepts of right and wrong, crime and punishment simply outdated? Is everything an illness? And perhaps, most importantly, has the “pathologizing” of almost every behavioral abnormality by labeling it a “disorder” caused us to loose sight of what a mental illness truly is?
I think that by cataloging almost all dysfunctional human behavior patterns and then slapping the label “disorder” on them has had many unintended and decidedly negative consequences. Upon hearing the term “disorder,” many folks infer that a genuine disease process is at work that in some measure relieves a person from full culpability (It’s partly for this reason that I was inspired to write both Character Disturbance and In Sheep’s Clothing). But in fact only a handful of clinical illnesses can potentially render a person not fully responsible for their behavior. For example, individuals suffering from a delusional psychosis can commit acts — even heinous acts — because their brains (most often through no fault of their own) are not functioning normally. And in such cases, the afflicted individual can indeed lack the capacity both to judge right from wrong, and to voluntarily conform their conduct to appropriate social norms. The question of culpability, however, gets quite a bit dicier when a person induces such a state through the voluntary ingestion of powerful mind-altering drugs. Similarly, folks in the throes of a severe manic episode have been known to engage in impulsive, reckless acts — even harmful acts — that are out-of-character for them. Again, however, the question of culpability becomes a lot more cloudy if the hyper-elated state that led to the reckless or injurious behavior was brought on by the voluntary ingestion of “recreational” drugs (e.g., cocaine) known to induce or exacerbate the state.
Things get even murkier when it comes to correctly understanding the various personality disorders and their relationship to personal accountability and culpability. By definition, every personality disorder represents a “preferred” style of relating. And while we’re learning every day about the genetic and other biological predispositions to some of these disorders (and some indeed appear more constitutionally-influenced than others), none of the personality disorders relieves an individual of personal accountability for his or her actions (with the possible exception of a personality disturbance arising solely from brain damage or other neurophysiological anomaly).
There are other “disorders,” such as the developmental delays that can plague an individual that make it really hard to assess accurately how much of a person’s behavior is truly under their ability to control. And I’ll have more to say about some of these conditions and the popular misconceptions surrounding them in next week’s post.
This Sunday’s Character Matters program will not be heard due to a special broadcast marathon on the network. But the program on the Sunday following Christmas will be devoted to discussing this special time of the year and some of the more important themes in my book The Judas Syndrome. I hope you’ll tune in, and, if you have a mind to, to call in and join the conversation.