Behaving badly: not all bad behavior is rooted in mental illness

by Roger Verdon on September 21, 2010 · 11 comments

in behavior

I see a lot of poor behavior that I can explain, yet I am less and less tolerant of it. This is a real change. For many years, I would spend days upon days wondering why it was that so-and-so treated people around them with such contempt or hatred, or why someone expected their obvious misbehavior to be tolerated, which always seemed the rule and not the exception.

Brazil - it's big.

I had an aunt whom I realize only now had a personality flaw the size of Brazil. Every interaction I ever had with her left me feeling terribly guilty about the flaws I perceived in myself. It never occurred to me growing up that maybe the problem was not me, but her. My sister recently told me she felt the same way, blaming herself for ticking Auntie off all the time. My aunt was a middle child and a single mom who had a rough time of things. Still, that’s no excuse to make everyone around her as miserable as she was.

Misbehavior or idiosyncrasy is not necessarily constructed on a foundation of mental illness. Some people are simply rude with unkempt personalities, sort of like some people who live in New Jersey.

No bad children?

As a layperson, I no longer feel compelled to practice empathy around bad behavior, despite Peter Fonagy, PhD, the prominent psychoanalyst and clinical psychologist, once telling me “there are no bad children.” He said this without blinking.

I blinked a lot hearing such a thing. (And I tried, I really, really tried, Peter, to adopt your thinking. I was, and remain, unsuccessful.)

Over and over we hear that there is a human or psychological reason or explanation—not badness—for every action. Every serial killer, every thief, every failed politician, every dictator has a compelling back story that explains their poor behavior; therefore, we can and we should understand that behavior within the context of a diagnosis frosted with empathy and forgiveness. My deductive, Sherlockian response for this is “fuggedaboutit!”

Self forgiveness

Karl Menninger said the primary cause of mental illness was the inability of people to forgive themselves for being imperfect. How forgiving need we be of others whose rude, nasty behaviors raise our hackles? Forgiving ourselves is difficult enough; forgiving others is even harder. What we need not do is enable bad behavior by tolerating it. If a person requires clinical help, they should get it, and we are obligated to point them in that direction. But even a great psychiatrist like Stuart Yudofsky, MD, author of Fatal Flaws, a book about personality disorders, has said if you come across someone with borderline personally disorder, run the other way.

Mean people

For example, there’s Mary Ellen (not her real name), an overly critical woman whose father died when she was a child. He slipped off an icy apartment roof during a storm as he was adjusting a TV antenna. Nowadays, as soon as MaryEllen gets too close to someone, or admires someone, or finds someone like her father, she acts to scuttle the relationship through meanness, before the relationship is scuttled for her. She apparently believes all relationships will end as her father ended, in surprise, horror and misery, and therefore she needs to be in charge of her relationships.

What is bad?

Is this person bad? I don’t know. Whatever you call her behavior, it is certainly not good. It is destructive and hurtful. If I can’t change this person and she won’t respond to suggestions for change, what am I to do but abandon hope that anything will change? The least I can do is not blame myself for her bad behavior. This isn’t about me, it’s about her, although troubled folks have a great ability to transmit blame anywhere but themselves. That doesn’t mean they are mentally ill. It may mean they are merely uncaring and rude. There is a difference.

Toxic children

Richard Friedman, MD, a professor of psychiatry at Weill Cornell Medical College in New York, recently wrote about a child who was mean, unkind and unsympathetic. The kid’s parents felt horrible that they had raised such a monster and blamed themselves, while overlooking the other two perfectly adapted children they had raised in the same environment.

Dr. Friedman found nothing untoward clinically with this boy. That was no surprise to him.

“The fact remains,” he said, “that perfectly decent parents can produce toxic children.”

Bad parents?

That thought has evolved into a new maxim for the 21st century. “The era,” he said, “of ‘there are no bad children, only bad parents’ is gone.”

Is Dr. Fonagy wrong? No. But human evolution has yet to catch up with his observation, so while we wait, let’s give ourselves a break. Sometimes people are exactly who they seem to be: mean-spirited, out of sorts, rude and unmannerly. Forgiving them by attributing their behavior to a clinical diagnosis gives truly ill people a bad name.

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{ 11 comments… read them below or add one }

Esperansa March 31, 2013 at 11:28 pm

I’m about 3 years late into this conversation but I couldn’t resist replying to “Stephani,” you evidently have never lived with anyone like that. Therefore you don’t know what you’re talking about. “Give them the benefit of the doubt and then…move on?” Really? It’s HELL to pay whether it is or not mental illness and…you do not move on!!

Bruce MacIntyre February 5, 2013 at 2:30 pm

I get what the author is trying to say, although perhaps not always clearly written or explained –it’s a blog not an indepth dissertation. Anything that gets us talkin and gaining or searching for insights that leads us to look for more understanding with much misunderstood disorders is a good thing. I felt his frustrations dribble out in the article with the medical, social, psychologoial communities and professionals and government. You can see sometimes more harm that be done if even well meaning medical and mental health providers do not diagnose and treat properly. It then ‘seems’ like a loosing battle that professionals give up on, the families who are torn, and the individual suffering let down as we the public see the manipulative, acting out those closer see the effects of sometimes also acting in of the personal who is caught in their own living hell, but to us seems like just a few simple rational changes if it was us could easily overcome, but to them its like trying to cross a ranging river with a broken bridge. It takes the right experienced trained individual to get them to understand the bridge is not broken or you can simply walk down a few blocks to then one thats open and working just fine. While we know some disorders are caused or at least not helped by ‘ bad parenting’, it is wrong to assume that but yes the stigma is always there and some highly educated healthcare workers still jump to and hangon to that wrongful conclusion. We need to get some of these disorders categorized properly to get proper recognition, proper funding and so not be canoodled to fit the proper medical billing code so the case is not seen for what it really is.

Iben December 30, 2012 at 1:59 am

You stigmatize a large group!
You talk about running fast if they meet a person with borderline personalty disorder.

It is unbelievable how persons lacking in knowledge and skills love to stigmatize and destroy other persons life’s .

I am appalled that anyone can write anything like that under a website about not to stigmatize!

What on earth are you thinking ?

Carl September 18, 2012 at 2:03 pm

My youngest son, and I have five children, has no empathy for anyone. he doesn’t feel remorse. If he cries it is a learned response, not an emotional one. He is 11 and is considered a sociopath in all but diagnosis. He also has a host of other diagnosis, including a traumatic brain injury due to his birth mom’s drug use. We can’t teach him to be nice to other people. Believe me we have tried. It is scary to look at your child and say to yourself “I am afraid of you.” He will likely spend most of his life in some kind of institution. It wasn’t lack of trying on our part.
My latest conversation: http://whynotfathers.com/2012/09/master-of-deception.html

Janet Hutcheson March 3, 2012 at 4:50 pm

I believe my loved one is just mean and selfish, not “mentally ill”.

lili dauphin August 24, 2011 at 11:27 pm

Great article! Sometimes a person’s behavior can be so injurious to others that we would much rather contribute it to mental illness. It’s our unique way of denying the bad behaviour. It’s much easier to acknowledge goodness than meanness. I tend to offer love, empathy and forgiveness even though they can never be acknowledged or appreciated. Some of us do not know how to handle negative behaviors. We tend to accept them as normal because we’re so accustomed to them. When such behaviors become too detrimental to our own wellbeing, we must gather enough courage to move on.

sunny October 24, 2010 at 1:24 am

Stigma & unethical unprofessional practice in DBT programs:

After 7 months in a DBT treatment program I got kicked out. I have never in all my experienced of therapy been treated with such stigma& judgment and knee jerk reaction. The rigid scrutiny was almost like a cruel punishment of control freakism.

When u are with an outside one on one therapist for 10yrs what ever you trust in confidence(verbally or in writing or e-mail) in the other remains private between 2 and is kept in context.With any ambiguities at least asked & questions clarified rather than acted hastily on.Doesn’t matter if its the inevitable topics of hate or rage or suicide or murderous thoughts come up -its kept in perspective as passing phases.

No not in the case where the program is attached to a government public health system. Its like a nazi security boot camp everything that gets said is vetted and u even get sent to a disciplinary board if you seem to be too verbally abusive.

They would ostracize me by comments like ‘we’ve never had a person like you in this program we usually refer them on’. Or in all our 3 yrs running this DBT program we’ve never had any trouble till now why do u think that is?’

Never mind that my seemingly shocking upset reactions were often been triggered by counter transferences & counter over reactions to my expressive vocal ways.

Time again my trauma was re-triggered,my voice & consent was waivered, I was ridiculed humiliated& violated by all my thoughts/feelings,private e-mails& letters, aired to peer review team.-most of the time never warning me or omitting irrelevant personal feelings/material.there is an ethical guideline for electronic record keeping other wise it so against a therapeutic nature of trust to be degrading a clients most inner struggles & vulnerabilities.

Despite being a team its still the therapist job to advocate,protect therapeutic relations and vocalize issues on behalf of client.But in this instance the therapist acted like a sheep and never stood up to decisions they were opposed of. So shocked at the implications of her own unhinged erratic misconduct time again until it was pointed out to her.

There was no flyer or manual of rules laid down about how the peer team work or nothing said at any of the assessment interviews to indicate what we do or say will go under review.There was nothing saying that while under a goverment health program you would be treated like an involuntary criminal.

Every time i kicked up a stink about privacy & asking/checking with me first to consult with me on decisions.When i pointed out this constant disrespect that kept puncturing out trust by their irrash actions. The therapist in this program was over literal,too unstable,naive and surprised at my reaction then changed nothing of the detrimental way she & the peer team were unethically treating me.

At the end of it all I was spat out back on my own with no support or follow up by a cowardly good bye good luck message left on my answering machine.

talk about non-judgmental or no- mindful or forgetting to use skills & over reacting in crisis situations. something they were teaching us.

This experience leaves me cold & angry. Once again the health system get away with so much these so called skilled specialists.

Kristin Ulland September 25, 2010 at 11:38 am

The stigma is attached the first time that you use the language that the psychiatric community wishes us to use in reference to people in mental distress. The DSM outlines all the labeling and descriptions of “illness” and keeps people in mental distress right where they are and unable to move into any kind of healing. With the label firmly attached, there is no wiggle room.

I think that this especially applies to personality “disorders” like BPD – the “untreatable” problem. When my daughter was handed down this diagnosis, it was in hushed tones and with resignation. What I didn’t understand then was that the doctors were frustrated and my “treatment resistant” daughter was beyond their control. None of their potions worked. Hundreds of pharmaceuticals later, they admitted defeat and sent her on her way.

Along with the pronouncement of why they could not help my daughter, she was told that she would never live outside of a residential facility and that she would be required to take a truckload of drugs to maintain some semblance of “normalcy”.

But, then I learned that there doesn’t exist a “chemical imbalance in the brain”. We had been chasing the “equalizer” for years. My daughter moved to New York City and began to build a life – without the numbing, debilitating drugs and without the support of a psychiatric community and most importantly, without the labels that she had been carrying around for years.

The psychiatric industry was built shaky scientific evidence.

The DSM was created by the American Psychiatric Association who perpetrated the notion that mental health issues are “diseases”.

Because I think that most physicians who enter the psychiatric industry know that a “chemical imbalance” in the brain prior to adding psychiatric drugs doesn’t exist, I am always amazed at their complicity.

As Robert Whitaker writes in the chapter entitled The Hunt for Chemical Imbalances in his recent book, Anatomy of an Epidemic, “From a scientific point of view, it is apparent today that the chemical imbalance hypothesis was always wobbly in kind, and many scientists who watched its rise and fall have looked back on it with a bit of embarrassment.”

Psychiatrists wanted the magic bullet that would set them up as “real” doctors. Doctors in internal medicine had their antibiotics and psychiatrists wanted to have their “anti-disease” pills, too.

With a blind eye to science and clever marketing, they succeeded.

With the DSM, you have a reference of all the behaviors that the industry has turned into pathological problems. You have the language set and the stigma ready-made. The mouthpieces of the industry – psychiatrists, therapists, and NAMI keep the “illness” theory alive and unsuspecting families are at their mercy when they first experience a mental health issue.

Roger Verdon September 23, 2010 at 2:33 pm

Let me clarify my blog post and my reference to running away from individuals with borderline personality disorder (BPD). Dr. Yudofsky made his comment not in his book but at a luncheon and was counseling people who are amateurs not to attempt to “treat” individuals with BPD. He suggested leaving treatment up to professionals. I apologize for not making that clearer. Perhaps my own frustration is showing and I understand the writer’s criticism of me. Yet, I reserve the right to have my own moments of pique. After all, I’m one of those amateurs who has tried and failed to help relatives and friends whose problems were well beyond my meager skills. Yet, I am evolving. As Karl Menninger suggested, I continue to work on forgiving myself for my own deficits.

Sarah September 22, 2010 at 8:07 pm

This (from the post) is exactly what contributes to stigma:

“What we need not do is enable bad behavior by tolerating it. If a person requires clinical help, they should get it, and we are obligated to point them in that direction. But even a great psychiatrist like Stuart Yudofsky, MD, author of Fatal Flaws, a book about personality disorders, has said if you come across someone with borderline personally disorder, run the other way.” I’m referring to “…if you come across…” This is exactly what my first year assessment professor said to the eight of us on the first day of class in my Clinical Psychology Doctoral programs. No wonder there is so much stigma about BPD. I am hoping that this quote from Dr. Yudofsky’s book was taken out of context. I’d be interested in what some of the experts at Menninger on BPD (Drs Allen and Bleiberg) have to say about this quote being included in a blog aiming toward stopping stigma. I’m appalled.

Stephanie September 21, 2010 at 8:43 pm

The difficulty lies in knowing how to tell the difference between those with a true mental illness and those who simply behave badly. So I tend to be forgiving for the most part. That is not to say I will subject myself to their behavior but rather give them the benefit of the doubt and move on.

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