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.