Tuesday, January 30, 2007

Food for Thought on Mental Illness

I want to make sure you catch the interesting comments on The Prevalence of Predators Among Us.

They point up what a complex issue this is.

Here are a few things Pam said that I want to highlight:

If you really get into studying the history of mental illness and how those who have mental illnesses have been and are treated, you will probably come away with the right assessment of the 'normal' persons handing out the treatment are far more dangerous than those who are truly mentally ill.

So you can understand the attitude that combats viewing mental illness as a moral failing, for these people rightly want to do away with the stigma attached.

But then we get to cases where it is clearly, at least in action, a moral failing - in the case of predators like narcissists and sociopaths. These aren't mere mental disorders; they are personality/character disorders. These two PDs especially are people who typically evoke murderous rage in the most gentle and slow-to-anger normal folks. That means something.

God forbid that they should ever start locking people up based upon a psychiatrists diagnosis, as those diagnosis stand now. If that were to happen,then any of us could be locked up at any time because all of it is so highly subjective.

The more we talk about personality disorder the less I can think of it as illness but only learned behaviors that can be unlearned and choices that can be corrected by the will to make better choices. In the case of psychopaths and MNPD's the question remains as to how to make a person who desires and relishes in the practice of evil desire to be good? The answer is we can't. There is no help for them from without if they don't have the desire for help within. To me, having respect for the boundaries of another says that I can punish evil persons when they commit evil but I can't force them to become well. I think our responsibility toward them is only in punishing the evil.

Here's some stuff in support of that view. A mental illness is defined as something that impairs a person's functioning in society. Does narcissism do that? Here is a new article on the Main Site that can make you rethink that: Narcissism in High Places. I got these ideas from reading that some in the debate argue that narcissism and psychopathy are ADAPTATIONS, not diseases.

I know narcissists who think we're fools for playing by the rules in a game fixed for cheaters to win because it has UNENFORCED rules. (Heaven or Hell in an afterlife doesn't count, because it's like buying property in Florida, sight unseen.) In law, theory holds that an unenforced law is illegitimate for that very reason: suckers follow it, making them easy prey for the bad guys smart enough not to.

So, these personality/character disorders only hurt predators in their personal relationships with those close to them. But the disorder is actually an advantage to their life in society as a whole.

I have also read that some are advocating a whole new approach to therapy for predators, one based purely on good old positive and negative reinforcement. This is essentially what Pam is saying, though she didn't mention using positive reinforcement too.

I must say that this idea strikes me as a good one. I explained here how current treatment, aimed at getting the patient to explore his feelings and trying to talk them into seeing the error of their ways is backfiring.

Maybe every therapist should keep a picture of a little child on their desk and stare at it the whole time to keep reminded of the fact that they are dealing with a child.

It reminds me of treatment I did see once, in a patient for eating disorders. She was a 17-year-old acting like a child, so her psychiatrist put her in pediatrics. Oooh, she did not like that. It was kinda like the Marines: Everything she did right, she was rewarded for; everything she did wrong, she got punished for. Like you train a puppy.

Now, I'm not sure that was the right way to go about it in this case, but it could be a good idea with narcissists and psychopaths. I say that because that's the level they operate at. That's how they train us, by pure positive and negative reinforcement. So, it stands to reason that it will make an impression on them.

The only limit on their behavior is what they think they can get away with. Let them get away with nothing. And make sure you're punishing them with something they don't like. Don't assume that they don't enjoy some things that a normal person would regard as punishment.

They may discover some worthwhile advantages in behaving. That may give them the desire to change. But I agree with Pam: our only responsibility lies in punishing the wrong they do. The rest is up to them.

One mistake in this area I have seen is giving a narcissist the silent treatment for days on end. That isn't negative reinforcement - not any more than yelling at your puppy every time you see him for the next three days after he piddles inside.

Negative reinforcement must be immediate and brief - to associate it with the bad behavior you are punishing. Otherwise the narcissist just goes off and glories in his suffering at mean old you's hands. He doesn't see it as the result of something HE did.

Now, if the bad behavior was serious abuse, you can't, and shouldn't, act like it didn't happen tomorrow. But you can respond politely to anything he does that relates to you in an appropriate manner.

More on this later, but one thing I want to mention now. Chemical imbalances and brain differences can be the RESULT of a personality disorder, not the cause. This would be simply due to them using different parts of the brain to process information, and those parts then develop more and secrete more of their chemicals. The process could be reversible if the thinking patterns changed. Especially if these people were helped before their mid-twenties.

So, don't assume a biological cause or that their brains are malfunctioning in some way. It is actually more likely that they aren't. But no one can say either way for sure yet.
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