Can You Be Just a Little 'Psychopathic?'

Click here to read an original op-ed from the TED speaker who inspired this post and watch the TEDTalk below.

Watching Jon Ronson's TEDTalk, "Strange Answers to the Psychopath Test," made me think of the following quote by C.H. Waddington: "There is a congruity between our apparatus for acquiring knowledge and the nature of the things known."

What I have come to think this means is that we are often blinded by our own cultural "maps" that we acquire as well as the limits of our brains and sensory systems. This idea also refers to what society has imprinted on our biology as well as what our professional cultures have given or even imposed on us. The artist's soul will intuit something is missing in a purely mechanical view of defining humans, which is psychiatry's DSM system. In fact, many will fiercely resist this quantification.

The western worldview is exemplified by science, inductive logic, and a more linear reductionist reality). This worldview seeks to analyze, categorize, objectify. We narrow our version -- believing the parts are the whole story. How psychiatry or psychological science assesses human behavior is often no different. Developing a diagnostic system (the DSM) only based on a purely scientific (and pathological) worldview tells a distorted and partially informed story. It suggests we should fit people in group boxes, (diagnosis) as opposed to seeing the whole picture or a "wide lens view." Of course, when we put people in boxes -- we will literally put people in boxes -- as Ronson demonstrates in his talk.

I think of this in the context of the publication of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May 2013 by the American Psychiatric Association. The association stands to make millions from this product (as does the pharmaceutical industry indirectly).

"The artist's soul will intuit something is missing in a purely mechanical view of defining humans" -- Jonathan Appel

There has been a supposed attempt in the soon to be published DSM-5 to move beyond the system of putting people into categorical boxes (e.g. psychopathic or not). If the fact the APA has stated:

In the earlier versions of DSM, as with the current DSM-IV, disorders were described and arranged by category, with a specific list of symptoms for each mental illness. In this categorical system, a person either had a symptom or they didn't, and having a certain number of symptoms was required to receive a diagnosis. If this number was not met, the disorder could not be diagnosed. The categorical syndromes do not always fit with the reality of the range of symptoms that individuals' experience. The DSM-5 Work Groups are now considering an additional way to help the clinician capture the symptoms and severity of mental illnesses, by using dimensional assessments. These would allow clinicians to systematically evaluate patients on the full range of symptoms they may be experiencing. Dimensional assessments would allow clinicians to rate both the presence and the severity of symptoms, such as "very severe," "severe," "moderate" or "mild."

(So in the latest edition you may be able to be just "a little psychopathic").

The concern is that they have just stretched the box -- because just a small amount will now qualify as a "diagnosable disorder." This suggests being trapped in a linear and medical conceptual model of human behavior. But would be not expect that from a manual that was for the most part designed by American M.D.s?

As one trained in systems theory, I was taught one would also need to view the individual --particularly children or adolescents -- as only the "symptom bearer" of the series of embedded systems. A system has multiple levels and sub-systems including the family, the community, peers, and society in general -- all which may initiate, hold, and contribute to the dysfunction. Children become the symptom barriers of the ills of the culture. So what do we see? ADHD and Autism, which perhaps represent two extreme expressions of biopsychological (mal) adaptation through the forms of (1) the rewiring/reorienting our brain-mind to keep up with the increasing frantic pace of our information culture (and lost ability to focus and contemplate) -- or (2) turn it off and go completely inward and/or go numb to screen the distress of an oversensitive biology. With the DSM, we can recognize a problem, but only as a piece or a manifestation of something larger. If the culture becomes more psychopathic -- won't we see this in increasing numbers? But, we must avoid merely "pathologizing" and over-labeling people, especially children. There are higher capacities to all of us. If you dwell in the problem, you will see it everywhere. There are many professional mental health voices rebelling, like Ronson, against putting people merely into boxes. My recent attendance and exchanges at DSM 5 workshops at the most recent American Counseling Association Conference attest to this. Additional choices and viewpoints are clearly needed.

Ronson's talk renews the voices and those raging in the night against the desire merely to quantify the qualities of human experience, especially its frailties. Diagnostic systems can be helpful -- as it gives a wide range of professionals a common language to communicate across related disciples. We must also recognize such tools are also a product of the same human frailty and underdeveloped vision, and take them with a huge grain of salt -- learning to use them in the least harmful ways. The intentions are good, but partially blinded by professional apparatus. We should not mistake the map for the territory -- and most of all we must listen with our hearts as well as our brains. Rage on.

Dr. Jonathan Appel has worked in the field of behavioral health for over two decades. He has worked with individuals, groups, families, and organizations as a counselor, psychotherapist, clinical supervisor, program director, consultant, researcher and educator. He is currently an associate professor of psychology and criminal justice at Tiffin University in Tiffin, Ohio.

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