Do Those with Behavioral Disorders Act the Way They Do Because of Personal Defects?

 

"Dance" by Eugenio Barba Theater. Public domain.

Many mental health providers treat all suffering as if it’s all due to some personal defects that need to be fixed. To be  fair, major psychiatric disorders like schizophrenia are almost certainly due to brain defects (despite what you may hear). So those do indeed need to be “fixed.´

But what about patients who have repetitive self-destructive or depressogenic behavior or repetitive self-initiated relational issues? Why do they act the way they do?

When we watch someone else react in their own typical way to a certain environment, we all have a tendency to attribute their behavior more to their own internal predispositions and to discount the environmental factors that they are reacting to. This is called the Fundamental Attribution Error as described in a previous post, and it is rife in the psychology and psychotherapy literature. You’d think most psychologists would be aware of that, but few of them are. My biggest beef with most psychotherapy schools is that they think these issues are all in the head, as if the surrounding social environment has nothing to do it, or at the very most, does no longer.

So what are these defects said to be? Mostly one of three things: The person is said to be either mad, bad, or stupid. Crazy, evil, or has an IQ lower than that of a lizard. We might add a fourth one: the person is a masochist who enjoys suffering,.  From an evolutionary perspective, that would be bizarre. The whole point of pain from the that perspective is to get the organism to NOT do something. Maybe these folks only say they enjoy pain in order to accomplish some social objective  - and leave out a lot of other important information.   (One exception to this may be the self mutilation done by people with borderline personality [BPD]. That seems to lead to the release of endorphins – an opiate-like substance - in the brain, which might relieve pain. I find they often do that to create for themselves a distraction from another, worse type of pain – the helpless feeling of not knowing how to solve a highly threatening and pressing problem)

Most people who do seemingly stupid things repeatedly have a ulterior motive for doing them which they keep hidden .They are almost never crazy, evil, or too stupid to know what’s obviously going to happen when they act that way. They can even tell you that they are well aware of what’s going to happen if you politely tell them you can see how bright they are.

Readers of this blog can probably predict what I think is motivating to act in these ways. They are sacrificing their own well being in order to solve an even bigger family problem. And it does work, at least over the short run. So they keep mindlessly repeating it over and over.

Even the therapy schools that acknowledge that a troublesome environment is a big part of problem seem to focus on helping patients suffer through them more easily, without working on changing the problematic family behavior itself. A good example of this is Dialectical Behavioral Therapy from Marsha Linehan, the most prominent and often-used treatment designed for people who have BPD. It seems to mostly ignore what she herself says is one of the two big factors that cause BPD: The invalidating environment.  The one they grew up with and to which they are still subjected. She doesn’t even seem to specify the context of the invalidating environment, why people do that, or even who is doing the invalidating.

Some therapists believe that, in many cases, helping a client to work on changing another family member's behavior is impossible, so they focus instead on self soothing. They are wrong about that.

A Family Cut-off as a Gift of Love

 

In my second book for psychotherapists, Deciphering Motivation in Psychotherapy, I discussed how therapists can uncover the hidden motives for dysfunctional behavior patterns by looking critically at what patients say about them as well as by looking at how the patient behaves while saying it. Ambiguity is inherent in all languages; any sentence and most words can mean two or more different things. Sometimes they can mean seemingly opposite things. To get an idea of how this can mislead you, take a look at clues in crossword puzzles. In one New York Times Sunday crossword, the clue was “unlocked.” The answer was “bald.” With patients discussing family issues, I usually found that the seemingly less obvious answer to the question of what something means turns out to be the right one. Thinking about that possibility then shaped my further questions.

I came across a good example where such might be the case in a recent column by advice columnist Dear Abby.

DEAR ABBY: As a young mother, I endured a difficult marriage filled with domestic abuse. In the midst of that turmoil, I struggled to be the parent my children needed. They are adults now, and I find myself distanced from them. It pains me deeply to know they want nothing to do with me. I can't help but feel I ruined their lives, and the weight of that thought is unbearable. I miss them dearly and long for the chance to reconnect and heal our relationship. I'm at a crossroads and unsure of how to move forward and mend the bonds that have been strained. I deeply regret my past mistakes and want to make things right, but I'm uncertain where to start. Thank you for your guidance. -- LOST

DEAR LOST: … I wish you had mentioned why you think you "ruined your children's lives." Were you physically or emotionally abusive? Did you abandon them? If that's what happened, reach out. Apologize and offer to join them in family counseling if they are willing. It might be a healthy first step toward reconciliation.

Of course we have no way of knowing for certain the reasons behind the cutoff between the writer and her adult children just from this letter. Most people, if they had to guess, would guess that they are angry at her for not protecting them from their abusive father.  I’m sure those kids would be somewhat angry if that were the case, but if I had to guess, I would say that it is not the main reason for the cutoff.  I would suspect that instead there’s a little “pathological altruism” going on here.

Mom’s letter practically reeks with references to the mother’s guilt over her parenting failures (“I can't help but feel I ruined their lives, and the weight of that thought is unbearable”). Usually in cases like this, I would strongly suspect that the mother flagellates herself for her failings in front of them quite a bit whenever she sees them, just like she does in a letter that might be published. They may feel that Mom's misery is their fault. They may avoid seeing and communicating with her to avoid making her feel even worse than she already does. Staying away from her would then seemingly protect her from some of these “unbearable” guilt trip she puts herself through.  They might think they are doing her a favor with what is called “A gift of love.”

Unfortunately, the children avoiding her like this does her more harm than good. She’s already feeling a ton of guilt anyway, and now she’s now cut off from her children to boot! And as much as the kids dislike Mom,s overwhelming guilt, they really would like a better relationship with their mother. As a therapists, I worked with patients on strategies for empathically addressing such interactions and putting a stop to them.