If you had the opportunity to live a “golden life” and achieve your dream of success and fame, would you do it? What lengths would you take to pursue this image or pathway to success? Would you too fall into the traps that both star athletes Lance Armstrong and Manti Te’o now find themselves? And, lastly, would you be willing to let go of years of hard work and future dreams in the name of truth?

The recent exposures of Armstrong and Te’o’s dishonesties, deceit and deception have been the topic around the water cooler: “How could Lance lie about doping for so long?” “How could Manti confidently and publicly mourn the death of a fake person?”

Consider the last time you told a “white lie.”  You had to leave your best friend’s party early because you “felt sick,” or you could not run an errand for a loved one because you were “too busy.” After a while, once you had repeated this explanation to yourself, you began to believe that you indeed did have a headache and that you did not have enough time at lunch to run by the pharmacy for a loved on. In order to preserve our image of ourselves as good people, or, even as superhuman figures, we block out the memory of our initial self-serving motives.

Across cultures, “superhuman” and larger-than-life individuals are valued in society. Olympic athletes, pop stars, actors, and national leaders are idolized as legendary characters by many of us and have been so in the history of our countries. These individuals feed our own regressed desires for perfect heroes and heroines to emulate and, one day, possibly become.  But when we publicly or personally witness someone’s fall from grace, it reminds us of the messier, flawed side of humanity and of ourselves. Clients often speak of the difficulty of admitting their own faults and limitations to themselves.  And they are right; to admit to oneself that a mistake has been made or that a change needs to occur can be excruciatingly scary and painful.

This process of honesty towards the self can be immensely humbling. I think that’s the silver lining of any lie or fabrication – the potential for humility. Once we are able to grieve the loss of the “ideal image” or that “perfect self,” we then can explore our actual strengths and limitations, and begin a plan to move forward.

On a more selfish note, I find it reassuring that people like Lance Armstrong and  Manti Te’o are human, just like me (okay, a lot more athletic, but still). If only society would no longer push for worship of superlative human beings, then maybe our public figures would not feel the pressure to live lies, and, personally, we could be more honest with ourselves. Until then, I am not sure that we are ready to handle the truth about humanity – that each and everyone one of us is flawed.

In “Can’t or Won’t?” I wrote about the challenge of making judgments about whether persons struggling with psychiatric disorders are best regarded as being unable to do better (can’t) or unwilling to do better (won’t). Should we think of the alcoholic as being unable to stop drinking or unwilling to do so—can’t or won’t stop drinking? Regarding the depressed person: can’t or won’t get out of bed? We should be wary of such either-or dichotomies; we need to make room for can’t and won’t.

In framing this dilemma, I am putting us therapists and patients in the territory of the problem of free will. Beware: As philosopher John Searle¹ wrote,

“The problem of free will is unusual among contemporary philosophical issues in that we are nowhere remotely near to having a solution.”

But we have a way forward that is helpful for us mental health professionals, owing to the work of another philosopher, Peter Strawson, who made what I consider something of an end run around the problem of free will.

Juggling causes and choices

Strawson’s seminal paper, “Freedom and Resentment,” was first published in 1962² and remains a subject of continuing discussion.³ As I will explain, when responding to problematic behavior—associated with mental illness, for example—we must juggle two perspectives, scientific and moral. In short, we must juggle causes and choices, pitting determinism against free will. Strawson helpfully distinguished two contrasting attitudes toward behavior: emotionally detached (i.e., scientific, objective, based on causes) and emotionally reactive (i.e., moral, subjective, based on choices). We must accommodate both attitudes in the field of mental health and elsewhere.

Science deals with causes and laws. To take the extreme determinist position, owing to the laws of physics, the course of the universe—including all our behavior—was set in stone with the Big Bang: all causes, no choices. The deterministic idea that, in principle, the future is entirely predictable from the past has been undermined by quantum indeterminacy and chaos theory, but randomness and unpredictability in our behavior hardly gives us free will (genuine choice).

Strawson⁴ summarizes the detached, scientific-deterministic view as follows:

“To see human beings and human actions in this light is to see them simply as objects and events in nature, natural objects and natural events, to be described, analyzed, and causally explained in terms in which moral evaluation has no place.”

From this perspective, treatments for psychiatric disorders, based on scientific research, constitute an additional set of causes, changing patients’ thoughts, feelings and behavior in the grand causal chain of determinism. As Strawson² put it, from the standpoint of treatment, the person is to be “managed or handled or cured or trained.” This emotionally detached approach has the advantage of avoiding condemnation of patients with psychiatric disorders and stigmatizing them in the process. With alcoholism in mind, consider Strawson’s point:

“What from one [reactive] point of view is rightly seen as a piece of disgraceful turpitude, an appropriate object of a reaction of moral disgust, is, from the other [detached] point of view, rightly seen as merely the natural outcome of a complex collocation of factors, an appropriate object of scientific, psychological and sociological analysis and study.”

Not so fast! Strawson² made the compelling argument that we naturally respond to others as persons with intentions who are free agents, make choices and are responsible for their behavior. Indeed, he proposed that we cannot altogether avoid the emotionally reactive attitude. Of course, as Strawson made clear, in our judgments and feelings, we take into account the possibility of accidents and unwitting actions—it makes a big difference if someone steps on your foot on purpose or not. And he also allowed for factors that limit the capacity for freedom of action, including compulsions and psychiatric disorders; in such situations, we might “suspend our ordinary reactive attitudes toward the agent, either at the time of his action or all the time.” And he allowed for degrees of mitigation; in suspending the ordinary reactive attitudes, we might feel less perturbed rather than not at all perturbed.

In contrast with our scientific detachment, our reactive attitudes are embedded in our engagement with each other. Such engagement is based on our natural proclivity to mentalize, that is, to interpret others’ actions as based on intentions, desires, feelings, and beliefs—with the implicit assumption that their actions reflect at least some degree of free agency and choice. Freedom of choice always comes in degrees; our choices always take place in the context of constraints⁵—we are constrained by external circumstances and by personal limitations, for example, in capacities or vision. I like philosopher Daniel Dennett’s⁶ view of freedom as our remaining elbow room in the face of constraints; plainly, psychiatric disorders such as alcoholism and depression limit the individual’s elbow room, but I believe that these disorders do not entirely eliminate elbow room—certainly not at every moment.

No either/or

To return to the starting point, we must not be caught in a forced-choice way of thinking about can’t and won’t; as Strawson² maintained, we must be able to straddle the detached and reactive attitudes. Strawson took the psychoanalyst as an example of such straddling; he pointed out, ironically, that the aim of adopting the detached attitude and suspending the morally reactive attitude is to “make such suspension necessary or less necessary” by virtue of “restoring the agent’s freedom.” Wisely, he made the same observation regarding parents, who must straddle the two perspectives to support the “progressive emergence of the child as a responsible being.”

In sum, as we use our scientific knowledge to better understand the constraints associated with psychiatric disorders (the “can’t”), we must find the arenas of elbow room and use our psychotherapeutic influence to help transform “can and won’t” into “will.” I find that when patients know that we fully appreciate their limitations—the extent of “can’t” and the sheer difficulty of “can”—they are less resentful and oppositional and thus more willing to use their elbow room to do what they can.

References

 1. Searle JR. Freedom and neurobiology. New York: Columbia University Press; 2007.

2. Strawson PF. “Freedom and resentment.” In: Watson G, ed. Free will. New York: Oxford University Press; 1982:59-80.

3. Russell P. “Moral sense and the foundations of responsibility.” In: Kane R, ed. The Oxford handbook of free will. Second ed. New York: Oxford University Press; 2011:199-220.

4. Strawson PF. Skepticism and naturalism: Some varieties. New York: Columbia University Press; 1985.

5. Ayer AJ. “Freedom and necessity.” In: Watson G, ed. Free will. New York: Oxford; 1982:15-23.

6. Dennett DC. Elbow room: The varieties of free will worth wanting. Cambridge, Mass: MIT Press; 1984.

Rep. Anthony Weiner at a press conference where he admitted sending lewd photos over the Internet.

In 1973, Karl Menninger, MD, the great psychiatrist and one of the founders of The Menninger Clinic, wrote Whatever Became of Sin? That title is a great question when discussing the texting scandal that involves Anthony Weiner, the Queens, N.Y.-based Representative, who has said he will enter a treatment center of some sort for rehabilitation.

I have personal expertise in two compelling areas that ought to give me absolute credibility as I present my opinions on this matter. First, part of my growing up took place in Maspeth, Queens, one of the neighborhoods in the congressman’s district. Second, I am a first-rate sinner.

Tough questions

The question Dr. Karl posed in his book was this: Why is  “bad behavior” often excused as a consequence of mental illness instead of being considered immoral or bad human conduct wrought by free will? Does Col. Moammar Gadhafi kill civilians because he is a psychopath or because he is evil? Are all wrongdoers simply acting out the manifestation of a mental illness or is bad behavior simply bad behavior? Where does free will belong in the universe of human conduct?

Growing up Catholic in Queens

This is a difficult question that I can only answer for myself. Growing up Catholic, I was surrounded by sin. I went to Catholic school where my perception was that most everything was sinful, from a summer full of reading the hotter excerpts of Henry Miller’s church-condemned Tropic of Cancer with my boys on the steps of a city stoop, to Manuel Giz actually sneaking a copy of Playboy into third grade and flashing the centerfold to his enormously grateful and stuttering classmates just as Mrs. Slattery turned back from the chalkboard.

Manuel was in hot water, no doubt, but I immediately thought, “Thank God the class wasn’t being taught by one of the nuns,” any one of whom might have killed him with a ninja nun blow. As it was, Manuel got the ruler across his knuckles and was sent off to see Brother Thomas, the enforcer of Incarnation School. I knew then that Manuel was going to be dead or in hell or both by the end of the day.

This was during a time growing up in which a sense of morality was being formed under the strictest of rules— rules that were pretty clear. We were taught a list of things and behaviors that were wrong, and if you indulge in them, you will be condemned to a fiery afterlife. I have always appreciated that clarity.

I have sinned since, although now it is no longer a question of whether my conduct is sinful. Nowadays, it’s either right or it’s not. Even as I have grown distant from church rules, I know I retain the basic principles with which I grew up and which provided me the moral compass that guides me every day. Do right. Be good. Don’t read dirty books.

Let’s be clear

I would agree with Dr. Karl’s premise that we often define human failing as illness of the mind as opposed to simple bad behavior. I know the difference as I conduct my own life, which means my personal bad behavior is not inspired so much by illness as it is by my own urges. I also know that individuals with mental illness are not always aware of behavior that can be injurious to themselves or others.

Yet all of our conduct cannot be held blameless, especially when it may be the result of willful greed or lust.

As for Rep. Weiner, whom I have always admired for his bombastic Queens style, I know in my heart I would never emulate him and send images of yours truly to anyone over the Internet. The worst thing I have ever considered sending is Barry White’s entire canon of lyrics, which can be boiled down to read something like, “Oh, baby, baby, oh baby, I love you, baby,” out of my huge respect for that disco maestro and because his lyrics are the easiest ones to remember.

Rehabilitation for the congressman may uncover an uncontrollable addiction or obsession that can be overcome with treatment. Or maybe his trip to rehab is the same cover many celebs seek to escape the limelight with the hope that someone else’s failings will fill the TV images that come at us 24/7. It is up to the mental health professionals from whom he seeks help to make those judgments.

In any case, I hope these professionals keep Dr. Karl’s premise in mind: Don’t let misbehavior or willful behavior give mental illness a bad name. Sometimes our bad behavior is simply that, a personal decision that deserves a comeuppance equal to the crime—like poor Manuel Giz, whom I still imagine burning in hell after all these years.

Did you see the news stories about 17-year-old Rachel Hachero, the apparently Ivy League-bound Florida student who allegedly pistol whipped her mother and threatened to kill her if she didn’t buy her a car?

Oh, she got her car. She also got arrested.

What makes this situation even more disconcerting is the fact that the mother didn’t want to press charges. It seems she feared an arrest could jeopardize her daughter’s future. (I’m not a clinician, but I wonder if that child’s future weren’t in jeopardy long before she picked up what turns out to have been a stolen gun.)

To help make sense of this story, I turned to Elizabeth Conaway, LCSW, and Joyce Davidson, MD, both of whom work with young adults, many of whom are having a rocky time transitioning to adulthood, at The Menninger Clinic.

I know it’s natural for parents to want to protect their children, but this mom seems to have taken that desire to a whole new level.

Dr Davidson:  We see similar situations a lot in our work, with parents protecting children from consequences no matter what the behavior. Parents provide all kinds of rationalizations for why they’re not being firm with their children or for why they are forever excusing behaviors. The danger, of course, is that in long run, kids can escalate their behaviors, which often become more and more self-destructive. In the extreme, the kids’ behaviors can become destructive not just to themselves, but to others as well.

Elizabeth: One common result of this type of overprotective parenting is that the children never get to feel the consequences; instead, the parents feel them because they’re the ones who have to post bond, pay for a lawyer, replace a phone or computer that was damaged in a tantrum, etc., not the kids. And because the kids don’t feel any discomfort as a result of their action, their behaviors don’t change.

Why do you think parents are often reluctant to let their children experience consequences?

Dr. Davidson: Parents today often seem to want to be their children’s friends, which makes it difficult for them to risk making their kids angry by setting limits or giving consequences. Unfortunately, it’s not an effective way to parent.

Elizabeth: I also think that technology is making it easier for parents to be more involved in their children’s lives via social networking. With cell phones, especially smartphones, it’s so easy to stay in touch and to know what everyone is up to. It may very well help give the illusion of being friends. Plus, it’s simply easier to act like a friend rather than a parent.

Do you think there’s been a generational shift in parenting styles?

Elizabeth: Well, we certainly do hear more about “helicopter” parents, who maintain extreme involvement in the lives of their children, even after they’ve left home to go to college. These parents are known for doing things like calling their kids to make sure they get up and go to class or arguing with professors about a particular grade on the child’s behalf.

It’s almost as if the parents want to delay the end of a child’s adolescence. Whether that’s because they don’t want to face an empty nest or because they’re afraid their child isn’t ready for adulthood, I don’t know. But this kind of behavior definitely retards a child’s ability to make a successful psychological transition to adulthood.

Dr. Davidson: One factor in all this may be the change in family size. A generation or so ago, it was common to have larger families than we often see today; so parents may have been able to risk making them angry by giving consequences to negative behaviors. Plus, having rules and consequences helps keep order, which would have been more important with larger households.

Is it possible that this mother was simply in denial about what in hindsight appears to be some warning signs about trouble ahead for her daughter?

Elizabeth: It’s certainly possible, though we sometimes find that parents think, “If they can just finish college, everything will be OK,” but just graduating from college doesn’t mean issues won’t escalate in the future.

Dr. Davidson: One question I think is important to ask: What’s the value system here? Apparently the mom thought it was more important for her daughter to achieve academically than to obey the law.

So was it a good thing she was arrested, even if her mother refused to press charges?

Dr. Davidson: Yes. This teenager engaged in serious anti-social behavior. While I don’t know what the juvenile system is like in Florida, I do know there are enlightened judges and prosecutors out there who can see that some teens need psychological assessment and treatment, not just jail time, and often they will require that such help be part of the teen’s sentence. I hope that’s the case here.

Let’s say there are parents reading this who may have realized they’re doing their children a disservice by not setting limits or giving them consequences for bad behaviors. Is it ever too late to start setting limits?

Elizabeth: The earlier parents start setting limits, the better it is for everyone involved, but no, it’s never too late. While it can be difficult to alter entrenched patterns, it is possible to shift a family’s paradigm. We work with families all the time to help the family unit change, not just the patient.

Do you have any recommendations for parents, especially those with young children, who might want to learn more about the importance of consequences?

Elizabeth: One book we often recommend to families is The Blessing of a Skinned Knee: Using Jewish Teachings to Raise Self-Reliant Children by Wendy Mogel, PhD. It’s a great resource that outlines the importance of teaching kids how to pick themselves up and fix their own problems. When they learn those skills, they have the power to take action and find solutions, and their self-esteem is enhanced. It’s understandable that parents want to rush in when a child is hurting or struggling, but they really do need to let their kids learn how to take care of themselves.

Let’s begin with a little humor. OK, here goes:

A cancer patient, a rape victim, and a Holocaust survivor walk into a bar….

Are you amused yet? Probably not. In fact, I’m lucky you’re even still reading this. Why? Because the people in question all have suffered in some terrible way. We know that it’s common decency not to laugh at the expense of other peoples’ suffering.

Why are we laughing?

Yet somehow talk show hosts and others in the entertainment industry never seem to tire of ridiculing Charlie Sheen. And, God help us, we the public can’t seem to resist taking a peek, clicking on the occasional web link, just to keep up with the hoopla, we tell ourselves. Of course, we often feel uneasy afterwards, like when we laugh out loud at the latest Saturday Night Live characterization. We know a man is being kicked while he’s down, and we perhaps know on some level that we all are diminished when we participate. Yet the urge to chuckle along sometimes seems irresistible.

How can we understand this? Perhaps, we tell ourselves, we’re allowed to laugh at someone who’s being such a bonehead: He’s simply behaving badly! After all, we laughed at him in Two and a Half Men when his character behaved in much the same way. Anyone who is this obnoxious, self-aggrandizing and irresponsible deserves to be laughed at. Um, right?

Charlie Sheen, actor and "bi-winner"

Suppose we look a little more closely: Here is a public figure who is not merely making a mistake or two, but saying peculiar things and behaving strangely over an extended period of time. (This thought experiment could be applied to a variety of individuals, whether it be Sheen, a young and wealthy starlet who inexplicably shoplifts or a Congressman whose own staff quits after he refuses their pleas to get psychiatric help.) To “explain” these extreme and perplexing behaviors as simply “stupid” or “asinine” or even “crazy” is to satisfy ourselves with words as substitutes for comprehension.

In our defense, we should acknowledge that an alternative explanation isn’t readily available. Certainly, it would be more charitable to suggest that people like these aren’t fully in control of their behavior. Perhaps they are ill, but we don’t know that. To be sure, some signs of illnesses such as bipolar disorder and substance dependence are apparent, but that’s hardly the basis for diagnosing someone (although that doesn’t seem to stop some commentators, unfortunately).

Two scenarios

However, we can ask ourselves this question: Which scenario is more likely? A) that a bright, attractive and talented individual would – on purpose – do things that cause untold suffering and damage to himself and everyone who cares about him, or b) that he is being affected by a bio-behavioral disorder that is distorting his perceptions, damaging his judgment and compromising his impulse control? If you favor option a), please bring data, because there’s quite a bit of evidence to the contrary that supports option b).

Sorry I can’t close with the humor promised above, but I would like to share a Huffington Post quote from a fellow psychologist, Dr. Robert Leahy, who (without “diagnosing” Sheen), came down on the side of option b), summarizing as follows:

“Laughing at mental illness is a sad reflection of our lack of understanding of its devastating effects. People crash from manias and they and their families and those who love them may feel left alone to pick up the pieces…. Laughing at Mr. Sheen is like laughing at someone who has been badly mangled in an accident. This is serious business. Illness is not a matter of entertainment.”

Suddenly, that irresistible urge to chuckle seems just a little more resistible.

Editor’s note: Just to be transparent, Dr. Ellis has never treated nor is he currently treating Mr. Sheen. Also, if you enjoyed this post, please check out these recent posts by Dr. Ellis:

• It’s a bird, it’s a plane, it’s … my therapist?
• It’s a funny thing about suicide

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 21^st 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.