She’s lost control

An article in Slate claims to have detectected a ‘logic hole’ in how much sympathy we feel for people with mental illness as both psychopathy and autism are ‘biological disorders’ that people ‘can’t help’ but we feel quite differently about people affected by them.

The ‘logic hole’, however, doesn’t exist because it is based on misunderstanding of the role of neuroscience in understanding behaviour and a caricature of what it means to have ‘no control’ over a condition.

Here’s what the article claims:

In the piece [recently published in The New York Times], Kahn compares psychopathy to autism, not because the two disorders are similar in their manifestation, but because psychologists believe they’re both neurological disorders, i.e. based in the brain and really something that the sufferer can’t help.

This caused me to note on Twitter that even though the conditions are similar in this way, autism garners sympathy and psychopathy doesn’t. In fact, most social discourse around psychopathy is still demonizing and utterly unsympathetic to the parents, who are often blamed for the condition. It struck me as an interesting logic hole in our cultural narrative around mental illness, since the usual assumption is that sympathy for mental illness is directly correlated with inability to control your problems.

Clearly the author has good intentions and aims to reduce the stigma associated with mental illness but in terms of behavioural problems, everything is a ‘biological disorder’ because all your behaviour originates in the brain.

The idea that because a disorder is ‘based in the brain’ it therefore follows that ‘really something that the sufferer can’t help’ is a complete fallacy.

Psychopathy, autism, depression, over-eating, persistently losing your keys and constantly getting annoyed at X Factor are all ‘based in the brain’ and this fact has nothing to do with how much control you have over the behaviour.

Putting this misunderstanding aside, however, there is also the unhelpful implication that someone ‘has’ or ‘has not’ control over their thoughts, behaviour, emotions and propensities, especially if they have a psychiatric diagnosis.

Conscious control varies between individuals, is affected by genetics, is amenable to change and training, and depends on the specific task, situation or action.

This does not mean that everyone with autism, psychopathy or any other diagnosis can just decide not to react in a certain way, but it would be equally stigmatising and simply wrong to assume that current difficulties are forever ‘fixed’.

The article finishes “I was just interested in the fact that there’s no relationship between how much we care about those with a mental disorder and how much those with it can help having it.”

In reality, sympathy for people with disorders is a complex phenomenon and the perception of ‘how much control the person has’ over the condition is only one of the factors. The (often equally bogus) moral associations also play a part as does the seriousness of the condition and the medical speciality that treats it.

Nevertheless, we need to get away from the idea that ‘biology means poor control’ because it is both a fallacy, and, ironically, known to be particularly stigmatising in itself.
 

Link to somewhat confused Slate article (via @ejwillingham)

21 Comments

  1. Marty Oakley
    Posted May 15, 2012 at 2:29 pm | Permalink

    As someone who as dealt with depression and suicidal thoughts my entire life, I could strangle people who say “Just smile and be happy”. Really????? Why didn’t I think of that! My husband suffers from a mild form of Aspergers. We take each other as we are. Perhaps someday I’ll find the right combination of medications that actually works. ECT didn’t help me. All I got was short term memory loss.

  2. Posted May 15, 2012 at 4:27 pm | Permalink

    Pet peeve of mine that most “news” articles I read nowadays, even the ones focused on a single study, have zero links to the actual published material. I see more bloggers reference the actual study than so-called news websites.

    Question: Is the “poor control” attitude mostly an American phenomenon? Maybe due to a lack of good science education? I hear these ridiculous arguments about free will as though the brain is somewhere seperate from the body.

  3. Sasha
    Posted May 15, 2012 at 5:43 pm | Permalink

    As someone that suffers from bipolar disorder with a healthy dose of anxiety and ADHD it makes me sad that people think I am ‘crazy’ or not in control of myself. Everyone is different and everyone goes through moments of lapse in self control in their lives. Awareness can help, but there are times there is no out and no quick fix, you just have to be in your mood until you can get out. I have dealt with a lifetime of being judged and been labeled an outcast or crazy many different times. As I have grown I have been lucky to develop a level of self awareness to assist me in my feelings and how I outwardly share them. I work hard to bring new light to the disorder I share with many other individuals. I thought for years something was wrong with me only to realize later this is who I am and there is something wrong with people that can not recognize that. I hope people begin to understand pain and sadness exist for everyone-therefore everyone should have some level of understanding of how it feels to be there. I hope one day we can all be cool to each other, because it is hard being one of the few that tries to make it cool for everyone.

    • Posted May 17, 2012 at 5:16 am | Permalink

      Very well said. Especially want to call out again your Call to Action…”I hope one day we can all be cool to each other, because it is hard being one of the few that tries to make it cool for everyone.”

      Just last week my sister reminded me that people take medication for their families…out of love and to take care of their discomfort as much as anything.

  4. hacker00740
    Posted May 15, 2012 at 6:06 pm | Permalink

    Mindhacks misunderstands Slate. Slate’s point was that sufferers of both autism and psychopathy cannot avoid, ie can’t help but to contract/manifest, their biologically rooted diseases. Consequently, Slate suggests, the difference in public attitudes of sympathy between sufferers of autism vs sufferers of psychopathy is unwarranted, since they are both disease sufferers of conditions that no one chose and that no one would choose. The sense of ‘control’ used by Mindhacks misses the point. Slate is just pointing out that the biological basis of psychopathy means that it is not simply a fancy term for ‘bad character.’ To Slate, I would point out that the public attitudes are different because psychopaths are feared while autistics are pitied. Pity enhances sympathy, but fear inhibits it. Thus, autistics get sympathy while psychopaths get the fear/anger response. Given the media’s obsession with and sensationalism of psychopaths as all being homicidal maniacs, the different public attitudes are predictable. And since there is more risk in a social field full of psychopaths, there is a logic operating.

    • Eben Hero
      Posted May 16, 2012 at 6:04 am | Permalink

      The point is that character itself can be viewed as biologically mediated, including ‘bad character’. From there, the idea of moral action ceases to have meaning, and the defence ‘it wasn’t me, it was my brain’ can be made for every act.

  5. Angela
    Posted May 15, 2012 at 9:30 pm | Permalink

    Psychologists admit that self-control is finite. That is, a person only has so much of it. When thoughts or feelings overwhelm the ability to self-regulate, you will see behavior which our society considers inappropriate. Even in the throes of a complete psychotic break from reality, I knew that my behavior was “crazy,” but I just didn’t have the wherewithal to control it. Having suffered most of my life with major depression as well, I was completely unable to function until I found the right medication. While I cannot always control my thoughts, I can always make decisions about my behavior. I don’t believe in giving anyone a free pass to act badly, but I realize that telling people that they can control their illness if they really wanted to is unfair. It is the worst kind of finger-pointing. While practice does make dealing with life easier, and the power of the right medications changes the chemical imbalances which are organic in nature, you cannot ask a person to control something they are not causing. Psychopaths have been categorized as having personality disorders, which implies that they are choosing not to control their thoughts and behaviors, and the upcoming DSM-V will do away with the ‘personality disorder’ category altogether.

  6. Posted May 16, 2012 at 4:09 am | Permalink

    I also have a peeve with so many articles that are outright garbage. I mean, seriously, did he really expect a relationship between a psychiatric designation and average people that have little knowledge of the causes of behavior?

    Get real: “since the usual assumption is that sympathy for mental illness is directly correlated with inability to control your problems.” Give me a break. Usual assumption? I’ve never heard that in but the very most general way that loosely applies. People with lucidity are rarely given understanding for their behaviors, the correlation is to apparent disabling the condition causes physically and intellectually.

    Addictions, emotional disorders, aloofness, narcissism, anti-social behavior and violence/intimidation are given way less compassion even though, as I can attest with addiction and depression/anxiety, these are just as debilitating for social functioning.

    It has more to do with physically recognizable disabilities and impairment than emotional.

    amelie, I really don’t know what you are talking about. There is no mention of free will, and before you get carried away, the vast majority of people think free will is compatible with brain function located in the head. Careful what you call ridiculous; no one thinks their brain is ‘somewhere separate from their body.’

    • Posted May 16, 2012 at 2:04 pm | Permalink

      M, maybe you should read comments more carefully instead of scanning over them. What I said is that Americans, due to lack of science education, may be more likely to display the attitude that mental illness = poor self control.

      How about you define free will before making such a blithe statement?

  7. Robert
    Posted May 16, 2012 at 12:09 pm | Permalink

    If society was accepting of any and all behaviour then there wouldn’t be a DSM in the first place. I.e. The DSM and the treatment for the “illnesses” defined in it are a product of the stigma associated with behaviours that society consider need to be stopped or modified to be closer to the norm, which history has shown to be a moving target.

    Mental illnesses are those behaviours you engage in that others convince you are maladaptive and/or unacceptable, or are unwilling to tolerate. The amount of tolerance people have for your behaviour is influenced by how inconvenient and unpleasant it is.

  8. Posted May 16, 2012 at 1:23 pm | Permalink

    Loved this piece.

    Several reasons, in random order:

    1. lovely gratuitous Joy Division reference
    2. clarity
    3. debunkiness
    4. wit
    5. wisdom

    I was driven to write a longer piece on ‘Pundit Sermonising Disorder’ which you can find here:

    http://plexity.wordpress.com/2012/05/16/pundit-sermonising-disorder-or-psd/

    You have only yourselves to blame (or is it the fault of your brain?) if you choose to read it.

    BTW, I’d like to ‘share’ that I am some sort of bipolar myself, because I’m anxious to avoid being dumped in the ‘people unsympathetic to real disorder sufferers’ category by any potential reader.

    I also liked what Sasha said.

    (Vaughan – I would love to write a guest blog for you on the topic of ‘delusional management advice’.)

  9. Pia Marjukka Laasonen
    Posted May 16, 2012 at 7:13 pm | Permalink

    Dear Scientist,All about what we are is coming us parents,Dad and Mamas Genes and the genes. So on.All we have to reed and create,our way.Brains whatever relationship,healty body. so on.mental
    on the brains way is the best way.Why someone have to be ill.Genesis,genetics,generation to greate thats all good.Deine Vege.

  10. Pia Marjukka Laasonen
    Posted May 16, 2012 at 7:28 pm | Permalink

    Dear Doctors,The First child,genetics,brains.All need to reed notice no notice what we have reeded.All must do some sport and be free.The Toots are free,creation prosers no Gravity,only a Graveyard)

  11. Pia Marjukka Laasonen
    Posted May 16, 2012 at 8:08 pm | Permalink

    Dear English People.The Oueen
    Elisabeth what never lost controll.What a way to live this planet.Are you 2 parties all God safe The Oueen.Yes, Pope too.Think.Take care alive of your own lifes,free.Yours Finnland P.M.L.Amen.p.s.not nessessary.

  12. Pia Marjukka Laasonen
    Posted May 16, 2012 at 8:16 pm | Permalink

    Dear Society.The Oueen.As well as we know,Pope as well as we know.

  13. Posted May 17, 2012 at 12:26 am | Permalink

    Can’t say that I agree with you Pia, but I am enjoying the Bridge on BBC4.

  14. Posted May 17, 2012 at 12:37 pm | Permalink

    I am autistic, and the only thing I suffer from are the annoying and bigoted people I encounter in my day to day life.

    Agency is complicated, just as much for us autistics as you allistic types.

    Also, let’s not forget the refrigerator mother theory, which blamed mothers for their autistic children’s non-normative behavior.

    Sympathy is not something I or any other autistic person I have encountered in my life actively aspires for. Not being systematically oppressed by society, now there’s something I could deal with.

    And autism is not a disease, for Christ’s sake. Clueless people are annoying.

  15. Joanne
    Posted May 22, 2012 at 5:14 pm | Permalink

    As with any good discourse, good questions come to the fore.

  16. Pia Marjukka Laasonen
    Posted May 22, 2012 at 11:56 pm | Permalink

    Dears,Reed Self-identificition of personality in social enviroment 1991.department of Dducation University Of Helsinki SF-00120finnland.-P.s.My Fathers Better than First.sorry so late eat Schwaldenkirchentorte.Auf Wiederhören nix sehen.

  17. Pia Marjukka Laasonen
    Posted May 23, 2012 at 12:30 am | Permalink

    Deine.Human nature it is Nature itselfs.


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