Should mental illness be used to explain bad behaviour?

When people see and hear statements or actions by others that seem to make no sense or are morally abhorrent, all too often mental illness is tossed around as a possible explanation.  Take mass shootings, for example.  For someone to do something like that, they must have something wrong in their heads, they must be disconnected from reality, they must have mental illness, right?  Yeah not so much.  Yet far too many people don’t understand this.  I even remember speaking to a fellow mental health nurse several years ago who thought mass killers must be psychotic to do something so unimaginable.  If even someone that works in mental health is that misinformed, is it any surprise that the average idiot out there in the world doesn’t get it?  I’ll warn you right now, this post is perhaps not the most cohesive; instead it touches on a variety of unpalatable subsets of the population that have crossed my mind recently.

Incels

It seems as though there are a lot of angry white men making themselves visible these days.  They come in a variety of flavours, including neo-Nazis, but it was only after a recent mass killing in Toronto that I became aware of the term “incel”, or involuntary celibate. This particular breed of asshole blames women who won’t sleep with them for all of the problems in their lives.  Men who have expressed such sentiments have engaged in mass killings in the past, but the incel term was new to me.  Apparently in November 2017 Reddit banned an incel subreddit due to violent content.  Some of this lot believes that women who are having sex but aren’t willing to have sex with them (Stacys) should be punished, and deserve to be raped.  Men (Chads) who are getting laid are another target of their violent ideation.  The incel mindset is repulsive and abhorrent, but that doesn’t mean that there needs to be a “thinking too much with your penis” mental illness whipped up to describe these characters.

Psychopaths

Pyschopathy isn’t a diagnosis in the DSM, although its closest equivalent would be antisocial personality disorder.  Much of our understanding of psychopathy comes from Dr. Robert Hare, who developed the Hare Psychopathy Checklist (more info here).  A psychopath knows exactly what they’re doing.  They know that things they do are considered “wrong” by society, but they just don’t care; it’s not their problem.  While many psychopaths are criminals and end up in prison, there are also psychopaths leading apparently successful lives.  In my nursing career I’ve only encountered one patient who was quite clearly a psychopath.  He was a master puppeteer, and it was chilling to see how he smoothly manipulated the world around him, using violence whenever it suited his needs.  There is some debate as to whether psychopathy is a form of mental illness, but unlike mental illnesses which tend to impair one’s control, psychopaths have the control of a finely tuned orchestra.  The psychopath is very much in touch with (and in control of) reality.

Pedophiles

Pedophilic disorder is listed in the DSM, and my personal prejudice is to call BS on that. To me it’s along the lines of homophilia, which was previously included in and then removed from the DSM.  Haven’t we established that sexual preference is not a mental illness?  People can fantasize about whatever they want in their heads, but I strongly believe that the monsters who act on pedophiliac fantasies do not deserve the excuse of getting a mental illness diagnosis.

Narcissists

There’s lots of talk on the internet about narcissists and narcissistic abuse.  This has always concerned me a bit.  First, let me say that my issue is not with those who talk about being victims of narcissistic abuse; I don’t in any way doubt that these people have experienced serious psychological and emotional abuse.  What I question is whether it’s useful or appropriate to attribute the abuser’s behaviour to a personality disorder, particularly when it would seem that in many cases a diagnosis of narcissistic personality disorder is not something that’s been made by someone qualified to do so.  I feel like it’s a slippery slope that seems to take responsibility for one’s actions away from the abusive individual’s conscious intentionality.  I’m guessing that it’s a way for those who have been victimized to understand and contextualize their experience, but I would worry that focusing on the abuser’s mental health (or lack thereof) shifts focus away from the abuse victim’s own mental and emotional wellbeing and the attention it deserves.

Unfortunately the world we live in includes some pretty despicable human beings.  When mental illness is implicated in their horrible acts, this is likely to only further promotes stigma.  Sometimes an awful person is just an awful person, end of story; no need to drag mental illness into it.

 

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30 thoughts on “Should mental illness be used to explain bad behaviour?

  1. myloudbipolarwhispers says:

    This is excellent. So informative and so well-written. You are a fabulous writer. I was fascinated with this entire article. I agree with so many of your points and I learned a lot as well. Thank you for writing and sharing this. I totally agree with you. I’m so sick and tired of anything bad or negative (people) being labeled with a mental illness especially President Trump. I don’t think that he even deserves to have a diagnosis of mental illness. I’m sorry if you’re a Trump supporter. I usually don’t write about politics. Sorry if I offended you with the Trump response. Thanks again for the wonderful post. Loved it. Hugs, Sue ❤🌻👍😊

  2. Michelle Polacinski says:

    I never thought about pedophilia as something other than a mental illness, but I have had the discussion with others about how it’s not a problem if you fantasize about it, but it is if you act on it. Once you compared it to homosexuality, and how it used to be listed in the DSM, you have totally opened my mind to that idea. I didn’t know pedophilia was in the DSM. I agree it doesn’t belong there and I also think it is mostly incomparable to homosexuality minus those two things (preference and do not belong in the DSM). It seems like most people just think of it as a crime, within the criminal justice system, but it’s true that others just blame it on “insanity,” which bothers me so much. It bothers me when there is *another* mass shooting and people automatically jump to mental illness, because those people never talk about mental illness/live with it. They always ignore it and they don’t understand it. If they did, they would realize that most of the depressed/schizophrenic/anxious/bipolar/etc people in this world are not picking up and would never pick up a gun to do harm to other people. It seems mostly a separate issue. Thanks for your writing on this. I think a lot of it is valid and relevant. Thanks for opening my mind, too. 🙂

  3. easetheride says:

    I think that so often, when shootings and other violent acts are considered, mental illness is used as a smokescreen to avoid the real conversations that need to happen. Because while maybe mental health is a piece of it, it’s not the whole of the problem. And even if it were, I don’t see the government shelling out any money to actually fix that problem. The misinformed, insufficient conversations we have about mental illness just further stigmatizes mental illness, like you said, by framing those people with it as evil or psychotic, when really there is a separation between the two.

  4. BeckiesMentalMess.wordpress.com says:

    I found your view very interesting, and intriguing. I lived with a narcissistic asshole for close to eight years that did nothing but lift me up, just to bring me down with no conscious of his actions. He was controlling and manipulating to the highest degree. He caused an awful lot of damage to me, that I will never forgive him for. Hell, when I was suicidal, he flat out said he didn’t care if I died and kept supplying the wine and pills to assist me in accomplishing my attempts.

  5. Meg says:

    Great post!!

    You make a million good points that I don’t even know where to begin to tackle. So informative! I completely agree.

    I too feel deep sympathy for anyone who feels sexual attraction to children. Cross that line, though, and my sympathy flies out the window. If that’s what I was struggling with, I’d make sure I was never near any kids, no matter to what extent I had to go.

    I had heard about Stacys and Chads but didn’t know who they were referring to. Thanks for the enlightenment! This is repugnant. Yeah, those people who are… what’s the term?… incels? aren’t mentally ill–they’re just grossly immature. And there needs to be a distinction between being mentally ill and being grossly immature.

    If a mentally ill (yet mature) person gets in a bad mood, they’ll probably apologize later or thank someone for cheering them up. On the other end of the spectrum, you have incels.

    I don’t view psychopaths or narcissists as being mentally ill, since they’re personality disorders. (Axis 2, right?) But I know exactly what you mean. It’s hard to not want to make excuses for them based on their uber-flawed personalities. [Shakes head and rolls eyes at myself while thinking of Mother.] I’m grateful not to have any personality disorders myself, but it leaves me wondering how much power personality-disordered people really have to overcome it and do better. (I’ve heard it takes a lifetime of therapy to treat them. Yikes, is all I can say.)

    It really irritates me when people make that illogical leap: “For that person to act that way, he/she must be mentally ill,” when I’m thinking, “No, they’re being IMMATURE. Not the same, people, not the same!!” Mental illness and immaturity are separate and disparate happenings. AAAAARRRRGH.

  6. utahan15 says:

    there was
    a man here
    who went outside
    naked
    and killed two persons
    for no apparent reasons
    the fact
    that you suffer
    so much
    makes
    you a better
    nurse

  7. Casey Elizabeth Dennis says:

    This! I had to explain to this people because I get sick of hearing mass shootings are due to mental illness. Very few actually had mental illnesses. Very, very few. I said the same thing about the distinct difference between mental illness & psychopathy… psychopaths know exactly what they’re doing & why it’s wrong.

  8. glitterfluff says:

    If only psychiatric diagnosis was a precise science, then what you have written makes perfect sense. And I certainly agree with you when you talk about how peoples’ nasty actions are written off as ‘they can’t be right in the head/there must be something mentally wrong with them’. However: being gay was once listed in the DSM as a psychiatric disorder. Agreement between psychiatrists on diagnosis of a particular patient is not much better than chance. There are no clinical indicators of any particular mental illness and the DSM categories change and develpp according to ‘expert opinion’ rather than new discoveries.

    I have worked with genuinely mentally ill people who have suffered serious disconnects from reality and done some terrible things. They without fail have expressed remorse when they have ‘come back to themselves’. That is mental illness. It is something you can recover from, something other than your normal way of being. Whether such people should be held responsible for their behaviour whilst in the grip of their illness is an interesting discussion, and a great basis for it is the work of Thomas Szasz – I do not agree with all he says by any means, but he poses some really mind-boggling questions that it is worthwhile pondering.

    But are personality disorders mental illnesses at all? They cannot be cured – and I believe those that can (e.g. borderline PD) only can be because they are a misdiagnosis – people who have been abused often develop symptoms that perfectly fit BPD but can be resolved because they are ill as a result of abuse, not personality disordered.

    With the likes of Trump, when psychiatric diagnosis basically comes down to a matter of opinion, why not diagnose someone with such a high media profile at a distance? There is so much footage of Trump that a psychiatrist would have way more information available to him than he would have from your average client after several sessions.

    People with personality disorder do not change. So unless we are going to say that they cannot be allowed to have mental capacity, then they have to be held responsible for their actions. In general, they are the ones hurting other people, whereas people with severe mental health problems overwhelmingly harm themselves more often than they harm others.

    Great article, though, lots of interesting points to ponder

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