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.

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.

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.

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.

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.

Image credit: OpenClipart-Vectors on Pixabay

Originally published at mentalhealthathome.wordpress.com on June 28, 2018.

Mental health blogger | Former MH nurse | Living with depression | Author of 3 books, latest is Managing the Depression Puzzle | mentalhealthathome.org