When is behavior an illness?

Posted on 14/10/2010 | 1 Comments

This sounds like a simple question, yet it is a fundamentally important one. It is a question that I for one have tried to answer to some degree of rational certainty over the many years of my work in the mental health field. It is a question that a recent news article I happened to read once again raised in my mind.
 
Briefly, the article: “Cheaters do prosper, but are they psychologically ill?” from the Globe and Mail: http://www.theglobeandmail.com/life/family-and-relationships/cheaters-do-prosper-but-are-they-psychologically-ill/article1704646/.   The study reported there found that university students who admitted to cheating scored high on personality traits of psychopathy. This suggests that psychopathy which in its most extreme forms can translate to Psychopath may be associated with self-reported cheating. The one obvious question that I would ask is why do we think that cheaters are honest about reporting if they cheat or not – but that is a question for the researchers.
 
Cheating clearly has adaptive value and in evolutionary terms probably has an evolutionary advantage. It happens in every society that I know of and I would not be surprised if it is common behavior in animals, particularly primates. So what does this say about how we think about “normal” behavior and “illness”?
 
Obviously this is very complex and one blog can not address this issue. But we can start. So here is one thought to help us think more. Most if not all behaviors that we exhibit, occur on a continuum or spectrum. The point at which a particular behavior “crosses” from “normal” to pathological depends on many things. Think of it as “carving nature at the joints”. How we decide where to carve is very complicated and lots of different perspectives come into play, including; statistics; probability theory; social and cultural frameworks; emotion; history; personal bias; etc.  One of the cutting points commonly considered, is: does it create harm to self or others, does it lead to impairment in functioning? Does stopping or diminishing the behavior lead to better outcomes for all concerned?
 
What do you think about this as a “cutting point”. What other “cutting points” do you think are useful?

What people are saying?

On November 04th, 2010 Kelly S said...

“Words, like the chisel of the carver, can create what never existed before rather than simply describe what already exists. As a man speaks, not only is the thing which he is declaring coming into existence, but also the man himself.” -Martin Heidegger

The problem with “carving points” in terms of determining if somebody is “mentally ill” or “mentally well” is that it gets right at the heart of a person’s identity. When a person is diagnosed with a “mental illness”, she not only gets the diagnosis but the dominant discourses that go with it (the “mentally ill” are manipulative, weak, don’t have insight, will never be cured, must comply with treatment etc.). One’s identity is being constructed in a disempowering fashion. And for the rest of that individual’s life, the person labelled “mentally ill” might feel like they belong to an exclusive club that they don’t want to belong to.

I’m not saying that people don’t have problems and that professionals can’t provide tools to help cope with them. But putting people into powerless identity categories (with all the stories that go with them, like it or not) is often not helpful and may create self-fulfilling prophecies.

I am wondering if professionals can use language in such a way that addresses people’s problems with living AND empowers people.

This deficit-based and pathologizing language is only serving the needs of professionals, not clients. By changing the language, we might help to change the discourses surrounding persons who have been diagnosed with mental illnesses.

What do you think?