In 1979, David Reuben, M.D. wrote a book entitled, Everything You Always Wanted to Know About Nutrition. It is an excellent book, but also clearly memorable for one tag line:
“There are people who sell white powders for a living. These white powders destroy health. If you are a cocaine dealer and you get caught, you go to prison for many years. If you’re a grocer and you sell sugar, you go to Florida in the winter for vacation.”
I bring this up as a context in which to compare maladies that have devastating effects, but which are regarded socially and treated medically with stark differences.
Cancer is a life-threatening (and often fatal) disease that compels medical treatment and elicits sympathy and familial and community care. No one would argue that a cancer diagnosis is anything but devastating. Having cancer requires that people support you and treat your illness skillfully and intensively utilizing the most potent and innovative curative protocols available. No one would dare to suggest that you are responsible for developing cancer. Even those who have persisted in maintaining behaviors and lifestyles known to lead to cancer (such as smoking) are ostensibly “forgiven” for their poor judgment and are vigorously treated medically and sustained emotionally when the disease strikes.
On the other hand, if you have a “mental” condition—such as anxiety, depression, bipolar disorder, schizophrenia, attention deficit disorder, post-traumatic stress disorder, an addiction or chemical dependency—some may have trouble feeling compassion for you. This is because the behavior of those beset with these disorders makes life extremely stressful and miserable for people around them, and the relentless discomfort and turmoil they typically produce often seem to be endless and insoluble.
The mentally and emotionally afflicted may elicit varying degrees of benevolence. However, their behavioral issues usually rise to the forefront of their interactions with others, and frequently overwhelm and supersede the benevolent feelings of their loved ones, caregivers, friends, and associates.
In contrast, cancer prompts a clearly defined series of multi-faceted, systematic, and ever evolving treatment protocols, standards of care, and, in increasing instances, the chance for cure or extended remission. Certainly, there also looms the likelihood of emotional and physical pain, and a terminal diagnosis is possible in the case of specific types of cancer. But, significantly, those interacting with a cancer patient can personally identify with the plight of the patient because they realize that someday they might also be facing the same misfortune. The axiom—there but for the grace of God could go I—intensifies the willingness to render sympathy, empathy, compassion, and support.
Mental disorders, on the other hand, are more likely to be tolerated with ambivalence, and either untreated or addressed partially or ineffectively. Its victims are often overtly or covertly alienated, shunned, and devalued. Yet, both types of afflictions are organic diseases that destroy the quality and substance of life, and both—in their varied forms—are physiologically based. One doesn’t have to scratch far beneath the surface to uncover this underlying glaring, disconcerting, and hypocritical paradox.
I don’t know much about cancer (although I’ve had close family members with cancer, and I wouldn’t wish it on anyone). I know quite a bit about mental illness. I’m comparing the two to highlight paradoxes in the way we treat and regard serious health issues. As a society, we address cancer with the utmost seriousness, and we care for its victims with gentleness, understanding, and the best treatments available. We pour money into cancer research, and insurance companies pay for treatment.
Mental health? Tragically, the way it’s treated is often, disgustingly, a joke—both in the literal and figurative realms. Too often, we make fun of people with odd, quirky, distasteful, and/or inappropriate behaviors, and we dismiss or minimalize their pain and suffering.
Here are two mainstream definitions of mental health:
Mental health is a dynamic state of internal equilibrium that enables individuals to use their abilities in harmony with universal values of society. Basic cognitive and social skills, ability to recognize, express, and modulate one’s own emotions, as well as empathize with others; flexibility and ability to cope with adverse life events and function in social roles; and harmonious relationship between body and mind represent important components of mental health which contribute, to varying degrees, to the state of internal equilibrium.
—World Psychiatry 2016
Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.
—World Health Organization
Here is the bottom line: cancer victims are very unlikely to deny the presence of their disease. Behaviorally afflicted individuals routinely deny that there is anything wrong with them, while concurrently defending themselves and their actions and attributing problems to others.
Although a cancer diagnosis may bring initial shock and attempts to challenge or minimize the situation, victims quickly accept its reality, and they take action to get treatment. They seek and welcome treatment, however onerous or unpleasant it may prove to be. The instinct to survive and prevail is a powerful motivator! In contrast, mentally afflicted individuals—meaning those who are chronically maladjusted according to the social norms in which they live—typically assert their brand of normalcy and “rightness,” avoid treatment or acquiesce to it with great reluctance, misperceive and distort reality, eschew accountability and responsibility for their behavior, and engage in conflict with those who hold them accountable or administer consequences.
In a nutshell, those with cancer know they are sick and appreciate the efforts to make them well. Those with behavior problems think they are healthy, and misconstrue that the ones who are reacting negatively to them are the sick ones.
It seems odd that when viewed as illnesses, the aforementioned biologically based behavior disorders with detectable physiological correlations and associated normative deviations would elicit such discrepancies in attitudes and responses. To further illuminate this dichotomy, the following factors must be considered:
It boils down to the locus of control, accountability and responsibility, and choice.
Thus, an examination of these issues may shed some light.
To be clear: the different responses to and ownership of illnesses or disorders are typically differentiated in the minds of most observers by the phenomenon of cause and effect. People stricken with cancer—which to the person identified as having the dreaded disease appears to occur haphazardly—cannot rationally deny the existence of the illness, once it has been accurately diagnosed. Usually, the patient accepts the proposed treatment protocols and standards of care. Even so, patients do not give up their rights to choice and collaboration in treatment.
On the other hand, those afflicted with mental and behavioral conditions, which those struggling with these disorders (as previously stated) often deny or repudiate, do not necessarily fit into or accept a diagnosis, treatment, standards of care, and professional consensus. The all-too-common repudiation of responsibility by those afflicted cannot help but dishearten and alienate observers, and in many cases it may cause these observers to conclude that their refutation is willful and that the associated negative behaviors simply reflect entrenched personality flaws.
This is a classic example of an erroneous and simplistic cause and effect conclusion based on misconstrued observations and a dismaying (albeit unwitting) rush to judgment on the public’s part. To resort to an apt cliché: the proof is in the pudding. The origins of the organic causal factors are most certainly tangible, identifiable, and neuroscientifically measurable and treatable.
If those who are behaviorally or mentally afflicted could reach cooperative ground with those who want to assist their recovery, better outcomes could be achieved on a large scale. My thoughts about—and hopefully some contribution to—this issue revolve around a frank examination of the determinants of behavior.
I have tackled this issue for most of my life, and I’ve written and expressed my thoughts extensively about this topic for decades. The themes of personal responsibility and choice thread throughout my books and essays and permeate my prayer life and relationships.
In my 2004 book, ADD: The 20-Hour Solution (co-authored with Siegfried Othmer, Ph.D.), Chapter 8, The Cult of the Neurotransmitter, addresses this subject. Let me excerpt and summarize the relevance to behavioral causes and responsibility:
From ADD: The 20-Hour Solution
Steinberg, M. & Othmer, S. (2004) ADD: The 20-Hour Solution, Bandon, OR: Robert J. Reed Publishers.
What ever happened to free will?
Once the province of philosophical and religious inquiry, this question enjoys a resurgence in popularity among the denizens afflicted or affected by dysfunction and maladaptive behavior. The issue of free will and personal responsibility has surfaced with tenacious significance in step with the explosive growth of neuroscience and the increasing understanding within the scientific community about how the brain functions and how it can be modified. Ironically, the mounting discoveries about brain complexity have had a troubling side effect: Behavior is increasingly seen as a function of biochemistry, which can be targeted by designer pharmaceuticals. As personality and behavior are reduced to products of neurotransmitter efficiency, people find it easier to disown responsibility for their actions, often attributing reckless or harmful acts (with the sanction of advocates or the applied biochemistry industry) to biochemical imbalances.
While wrestling with the causes of problems considered as emotional, behavioral, or “mental”, consider the stakes:
People function and dysfunction. Millions muddle through their four score and ten years unhappy, stressed, fearful, depressed, frustrated, and insecure. They are run by powerful negative emotions that jade their perceptions and undermine their mental and physical health. Nonetheless, the majority of these quietly suffering people are somehow able to get through the day. They grow up, get through school, go to work, have relationships, raise children, and more or less go about their business. They may appear functional to outsiders, but they know that they are desperately struggling to hold on. The powerful negative feelings that drive so many people through years of silent suffering often skulk as carefully guarded individual and collective secrets.
The data describing the status of mental health in the United States are startling. A recent report prepared by the Surgeon General of the United States contains some astounding statistics:
Americans spent a staggering $69 billion for treating mental disorders in 1996. (Note: in 2009, the amount spent was over $200 billion). We spent another $12 billion on direct treatment of drug and alcohol abuse (Note: in 2015, the amount spent on addictions was over $276 billion). Despite these astronomical outlays, nearly two-thirds of all people with mental disorders do not seek treatment. Ironically, the probability of satisfaction and success for those who do seek treatment is marginal.
In desperation and with seemingly no other recourse, dysfunctional people often turn to mental health providers for help. The objective of most of these interventions is to free the patient of negative emotions by means of comprehensive self-examination, methodical retraining (operant conditioning) of counterproductive response patterns, or drug therapy.
Once the reluctance to seek help is assuaged, patients face wrenching conflicts between their inner relief from depending upon all-knowing professionals and their opposing yearning for independence and self-direction. Besides the intended alleviation of symptoms, the benefits of dependence include being cared for, feeling understood, yielding to passivity and reduced effort, and the absolution of (at least partial) responsibility for one’s circumstances and actions. The downside is that one bargains away portions of self-sufficiency, autonomy, personal beliefs, and control in submitting to treatment. A price for ascribing dysfunction to being ill is the erosion of one’s free will.
These dynamics apply to a range of mental/behavioral health and medical conditions and cogently to the inscrutable ADD/ADHD.
As the controversies over ADD/ADHD intensify, concerns about who and what is ultimately responsible for its detriments assert center stage. Where should we focus? Parenting? Moral laxity and cultural evils? Family decline? Educational deficits? Genetics? Biochemistry? Diet? In a maddeningly vicious cycle, the cause continues to elude the chase for fitting solutions. All the while, the recriminations and frustrations continue: Why me? Why this? What next?
Our first chapter elucidated a working model of ADD/ADHD characteristics and the effects of disregulation. Chapter 2 highlighted this issue through eyes of Matthew and his parents as they each wrestled with their torments. In Chapter 9, we visit the very personal struggle of the Othmers in ascertaining the “volitional” versus “neurological” determinants of Brian’s troubling behaviors.
Here we confront the issue of personal responsibility, cause, and responses to ADD/ADHD in the current social and medical context.
Our era has seen a proliferation of technological marvels. These have extended into the biological domain to reach sophisticated achievements, such as cloning and genetic engineering. Medical science has brought us “designer” drugs that increasingly pinpoint neurotransmitter functions in the effort to tailor somatic and emotional reactions.
Modern imaging techniques allow us to see how the brain responds to stressors, tasks, and substances, as well as the physiological and structural effects of these things over time. It is said that, after the internet, the explosive growth of the neurosciences will be the most influential scientific frontier in the coming decade. This is heady stuff!
But, what about personal responsibility, free will, and choice? We suggest that any conceptual framework (scientific or otherwise) that wrests control and responsibility from the intention of individuals is seriously misguided and flawed. The wonders of technology (including brain-training technology) must be balanced against the risks of medical “reductionism” so that we don’t excuse or condone bad behavior on the basis of technical explanations for justifying who people are and what they do.
We are not denying the systematic and meticulous discoveries about biochemical and genetic influences. In most cases, we enjoin them in parallel explanations of behavior — parallel in that, for EEG neurofeedback, we use models of neurotransmitter functioning similar to the medical models, only that we propound changing these neurotransmitter patterns through brain training rather than through psychoactive drugs. Indeed, we go so far as to suggest that learning is so basic to brain function that the brain actually learns to respond to psychoactive drugs).
We caution, however, against relying upon these “medical” explanations as the entire determinants of behavior and the implications and effects of such views upon treatment, self identity, human relations, legal jurisdiction, and social behavior. Certainly, people are propelled by biochemical realities. Yet, this is no rationale for the flippant and pervasive “biochemical imbalance” explanation given by doctors and patients alike to settle concerns about untoward behavior. The true “imbalance” would be that of worshipping with the cult of the neurotransmitter: Accepting facile technical explanations as a substitute for combining the wealth of developing knowledge about the brain as a control system with new methods of modifying it and the historical cultural treasures we have cherished about human free will and responsibility.
It seems that theories of biochemical imbalance are both fashionable and scientific. Like other universal truths (e.g., gravity and reinforcement effects upon behavior) biochemical imbalances exist and exert their influences whether or not we believe in them. The practical challenge is to gain enough understanding and control over them so as to predict and modify their desired outcomes.
The real issue, from our perspective, is that biochemical imbalances exist in normal, and even optimal, functioning. To ascribe ADD/ADHD, depression, etc. to a biochemical imbalance is to miss the point — which is the appropriate and functional management of biochemical imbalances on a homeostatic, automatic, internal basis.
Life is a series of imbalances. Hunger, fatigue, ambition, sexual desire, cell reparation… these are all cyclical imbalances that require adjustments and corrections constantly. This is, part and parcel, the fabric of living. The body and mind detect, respond to, assess, and evaluate challenges regularly. These challenges involve routine biochemical functions (even maintaining body temperature), as well as perceptions of, accommodations to, and integrations with the environment. The distinct and persisting difficulties that many people have in regulating these imbalances comprise vulnerabilities, not necessarily diseases.
There are markers, of course, for disease that are not merely categorical. Certainly, disease processes impinge upon and deteriorate our systems’ abilities to regulate internal balances. But the tendencies toward and prevalence of disregulation (lack of consistent and effective management of the shift of balances) far exceeds the occurrence of disease.
We emphasize that the traditional medical model frequently errs in the understanding and treatment of these mismanaged balance shifts by “overpathologizing” disregulatory states into bona fide diseases (or, as they are known, disorders). The effort to objectify, distance, and render dispassionate those behaviors and symptoms that stir emotional controversy too often results in a diagnosis that legitimizes an unquestioned and distinctly culpable “biochemical imbalance” whose existence would seem to require the latest pharmaceutical key to lock and unlock its gatekeeping.
We caution against such a simplistic and narrow view of neurotransmitter isolation and supremacy. Consider the analogy of regulating vehicle propulsion: Though we may program and accurately target rockets and cruise missiles, the human motor vehicle driver still must constantly adjust to ever-changing conditions on the road. For this, he needs a flexible brain, one that works and adjusts on a dose-independent basis, 24 hours a day, seven days a week, as necessary.
Many children and adults with ADD/ADHD or other conditions do have systemic functions (and sometimes biological structures) that are distinctly different from what is considered normal. Genetic contributions and predispositions to behavioral and emotional styles are increasingly accepted and assumed.
We have no dispute that some people function neurologically “differently” than others, probably for a variety of reasons. We assert however, that these individuals cannot adequately be typecast into formulae for neurotransmitter designer modification, either by drugs or other intrusions. Despite the convenience of labeling and diagnosing people and the mass production of chemicals that do modify brain function, symptomatic individuals have whole brains that respond interactively. Some are more flexible than others, and some have more limiting genetic vulnerabilities. Yet, all are capable of changing for better function through learning and of retaining those improvements.
Alas, it seems that the neurologically “different” are often cast as the sport objects for contests between the proponents of self-directed will and the acolytes of the medical “ill” model — this thankless social role in addition to their personal struggles. When the question arises regarding who or what is in charge of personal responsibility and/or dysfunction, political movements and individual constituents can become passionate indeed.
The “ill versus will” or “neurological versus volitional” arguments have played out along different societal cadres and belief systems. In one sense, it is an archetypal philosophical dilemma about the nature of man. In another sense, it has very real, present-day impact upon the self-images and courses of action of the thousands of families who struggle with ADD/ADHD and/or neurological differences.
We see that today, perhaps in reaction to past moralistic excesses and recent scientific discoveries, technology is frequently used to objectify, distance, and render dispassionate the very personal experiences and attitudes that are — let’s face it — passionate and emotional. This trend does not get around the problem; it merely evolves into another movement. The cult of the neurotransmitter has recast the dilemma into nouveau science.
Though they espouse different attitudes and language, the medical establishment and traditional psychology have viewed dysfunction from the “ill” perspective, relegating the patient to limitations (or even incapacitation) due to suffocating influences beyond his control. Physicians use the language of neurophysiology, speaking in neurotransmitter lingo that describes the “lack of access” to brain capacities. Psychologists articulate the problems as the “inaccessibility of coping resources” due to a variety of factors ranging from childhood experiences to poor modeling to inadequate development of cognitive or emotional skills.
The bottom line messages decoded from the commonalities between mainstream medicine and psychology have traditionally been:
Fortunately, these dogma have begun to yield to new scientific discoveries about brain function and structure, progressive psychological treatments, and advances in pharmacology.
We are no longer bound by rigid classification or the adherence to a cultish party line about the limitations of brain function or the role of the brain’s owner.
Ironically, the cult of the neurotransmitter has brought about some startling discoveries and changes in practice across numerous disciplines dealing with mental health issues.
Important amongst these is a phenomenon described by psychiatrist Peter Kramer in his landmark book, Listening to Prozac. The phenomenon is known as bracket creep. (No, it is neither a mold nor bacteria!) This seemingly unsanitary term refers to the cross-migration among symptoms and diagnoses of mental conditions — the “creeping” of one category of mental disorder across the boundaries of others; that is, across once-rigid brackets of diagnostic classification.
After the introduction of SSRI antidepressants, doctors noticed that drugs approved and prescribed for one condition were often very effective for others. Prozac, the vanguard SSRI, was ancestral in this process.
Soon, the cross-migration and cross-prescription of drugs became commonplace, evolving into the current ubiquitous “polypharmacy (multi-drug) management” of dysfunction. Physicians often try to manage symptoms by prescribing “off-label” (this means prescribing drugs for conditions other than for which they were FDA-approved). Thus, antidepressants and anxiolytics (anxiety-reducing drugs) are often prescribed for ADD/ADHD. Psychostimulants are used to treat depression. And, anticonvulsants (used to treat epilepsy) are prescribed to subdue the hyperactivity and overarousal common to ADD/ADHD. A surprising but common practice is the prescription of hypertension (high blood pressure) medication or antihistamines to induce sleepiness in youngsters wired be either their hyperactive nervous systems, the effects of stimulants prescribed for ADD/ADHD, or both.
Regardless of the serious practical concerns and long-term effects of such polypharmacy management, the implications of these results are striking: Bracket creep evidence shatters older rigid notions about the sanctity, boundaries, and even the classification legitimacy of diagnoses held as indisputable.
All of a sudden, the game has changed! The relief that accompanies diagnosis must be tempered by the lack of substance in the diagnosis. Imagine the refrain:
“Thank God, someone finally figured out I have ADD/depression/OCD/anxiety disorder/cerebral irritability/central nervous system disorder/temporal lobe disorder…”
Here is the good news: Despite the uncertainty of traditional diagnoses, bracket creep evidence is quite consistent with robust and pragmatic models of brain functioning. DSM-IV has more concern for the brain than the brain has for DSM-IV; the brain simply does not follow its rigid rules! The overlap in pharmaceutical off-label efficacy for different conditions parallels our own findings with regard to people’s responses to EEG neurofeedback.
When the brain becomes organized and self-regulated, symptoms from disparate conditions ameliorate. The ADD child sheds depression, the migraine patient loses her PMS, the epileptic becomes less obsessive and more evenly focused!
What a marvelous testimony to the innate flexibility and plasticity of the human brain! A death knell, indeed, to the narrow-minded cult of the neurotransmitter.
At first blush, bracket creep sounds like something to be cleansed. Actually, its reality cleanses our clouded preconceived notions about how the brain works.
Speaking of which, a funny epithet to this discussion comes from a reluctant boy who didn’t want us to tamper with his brain. He resisted Dr. Steinberg’s attempts to attach the electrodes with the objection:
“But, isn’t this brainwashing?”
“No, it’s actually a training so that your brain can get in touch with and demonstrate your intelligence on a regular basis.”
“Okay.”
“Then again, maybe your brain does need washing.”
On the issue of personal responsibility and causative origins for behavior, it seems we have come full circle. The traditional and Victorian view of will as the governor of action and compass of discretion had yielded to the rebellion of recent ages that promoted extradition of cause from people in the name of illness. If one’s ship were listing or even sinking, it was duly because of biological imbalances in the captain. Indeed, the pursuit of rescue in this domain led to the conclusion that so many captains were laid low (or missing) due to circumstances beyond their control that the vessels could not independently navigate, and had to be towed by scientific and administrative guard.
We have something different to offer — different in the sense of resolving the issue of division between “ill or will”, “neurological versus volitional”. We propose the self-regulation model.
In this model, the natural plasticity of the brain is the vehicle for reaching the resolution of symptoms. Treatment is the catalyst for healing, rather than the indispensable additive.
Brain-training through EEG biofeedback is a natural vehicle for brains of all varieties to exercise their opportunities. We have provided a well-tuned instrument (computer electronics), but the brain is the musician. The notes are the neurotransmitters of communication, of melody and background, harmonics and dissonance, rhythm and solo, text and context. Neurotransmitters, like musical notes or alphabet letters, are merely building blocks — characters in a production that must be synthesized, developed, executed, and appreciated by the individual.
We believe that self-regulation fuses the compatible aspects of neurobiology with personal responsibility and self-control. Self-regulation is not a new invention, but rather a rubric for explaining what is already at work and determinant in brain function and behavior. Like other natural forces in the universe, self-regulation is a given, always there, always exerting its influence, always lending its leverage to those who follow its rules. Just as we can find ways to defy or cooperate with gravity (which, incidentally, always has its way), we can use a variety of tools to promote self-regulation.
This new ideology draws upon some poignant parallels. Here is an example: In Listening to Prozac, Dr. Kramer recounts the story of a patient with years of psychotherapy to reconstruct her faulty personality. Ostensibly, this was necessary to correct what was psychologically determined to be damage caused by early childhood experiences. However, Prozac quickly intercepted this incomplete, lengthy, and arduous process. It made the patient well despite the history. With immediate evidence too stunning to ignore, Prozac obviated the patient’s history as an inevitable determinant of illness and of a supposedly necessary treatment method.
Neurotransmitter changes? Certainly. But let’s not ignore the transformation. By such experiences, our philosophy and our openness to the realities that science only insinuates should widen. Quantum physics exists, and so does quantum healing. We should be aware that causes and effects are not the delineated province of double-blind studies funded by the pharmaceutical industry.
The parallel? The patient who comes in for his EEG biofeedback session, and beams,
“Hook me up, Doc, and let’s rewrite my history.”
In the search for answers to the travails of ADD/ADHD and others disregulation disorders, we run into dichotomies. One side says we are ill, that we can’t help it. It wrests control from us as individuals and conscripts us into the cult of the neurotransmitter, swallowing the sacraments, and worshipping technology and science we can barely fathom. The treatment is an impersonal neurophysiological modification of biochemical imbalance.
The other side blames us for wanton lack of discipline, possible moral turpitude, and certain selfishness and self-absorption. It accuses us of suffering from the “Me generation” dressed up as medical diagnosis. Its treatment is spiritual transformation.
The very process of diagnosis and classification presupposes and manufactures a kind of “Panama Canal” disorder with man-made locks and levels and artificial controls. All in the name of regulation, safety, and commerce. Then “bracket creep” floods us in a continuous flow, and the force of reality carries us downstream with the feeling we are drowning.
What to do? Assert our will… or take a pill? Be passively ill… or engage in active drill to rectify the problem?
We insist that disregulation is the problem, and that correcting disregulation solves these paradoxes.
Patients engage in EEG biofeedback training to relieve symptoms. They enter treatment in distress, and leave in transformation. People are not reducible to chemical formulae, response times, or neurosynaptic uptake. They are whole individuals. In the process of becoming again whole, they undergo transformations in entirety, integration, aliveness, and personal responsibility. We may change electrical settings to encourage their brains to learn more effectively, but they are active participants who are very much “in charge.”
Whether they hide behind “ill” or “will” in the service of dysfunctionality obscures the real issue: A disregulated brain cannot be as “response-able” as it wants to be; and the disregulated state depletes the brain of its natural wants. When given the right information — its own functional information — the brain wants to want, on its own. That is the essence of will, and it is the best way, where possible, to heal ill.
End from ADD: The 20-Hour Solution.
To live is to be embattled. In some form or other, we are constantly struggling to counteract the forces that can destroy us. Often, we are unaware of these battles. But when illness strikes and painful symptoms reveal the cost of the fight between our immune system and pathogens, we come to understand nature at a different level. Sometimes our adversaries blatantly invade. Alternatively, they may take up residence and usurp our resources. There are parasites, mutations, and life forms that mimic our bodies and even our minds. They take and take and don’t give back. By the time we notice, much damage may have already occurred.
Cancer is that way. It takes over and eats away health. We can burn, poison, irradiate, starve, and excise it. We try to save the host at all costs, and often these costs are dramatic. Surprisingly, we have treated mental illness the same way. This may be shocking to consider (pardon the pun). In the interest of reducing barbarism, we have established a more humane (but ineffective) treatment for mental issues that we would never suggest for cancer: talking to it! The idea (and pseudoscience) that one can reason with and persuade pathology to leave may be unique to contemporary society (professionals, that is. Most consumers regard psychotherapy with disdain.). But the dilemma of who is “in charge” of behavior has persisted for millennia through many forms or religion and spiritual endeavor. The notion that reality comprises more than what is observable and tangible has widespread human recognition. We are cognizant of the duality that threads through life, whatever your favorite angle: good and evil, life and death wishes, microbes and immune systems, etc.
In the end, we must treat the symptoms, even as we explore and argue about underlying causes. When the “good” wins, we remain healthy and alive. When the other entities prevail, illness and dysfunction spread. It’s a dynamic balance, and we all want to be in charge.
When disease encroaches, we are often overwhelmed by fear and weakness; so, submission to experts and those who want to lead become attractive and the course of least resistance. Victims welcome help. In such cases, passivity is the expected and praised position. The forces of health and illness are clearly identified and separated. Internal duality is not seen as an issue.
However, behavioral maladaptation always presents with conflicting duality: is the “suspect” a perpetrator or victim? Is he “in charge” or instead the residual recipient of forces beyond his own control. Moreover, does he purport to be in control? Or does he blame others (poor childhood, poverty, genetics, etc.)?
Fundamentally, it’s the familiar question of “will or ill.”
As outlined in my writings and my practice, I take the position of combining spiritual deference and humility with neuroscience and genetics. I believe we are all “pre-wired” for predispositions to talents, diseases, and personalities—but that these outcomes are quite far from deterministic. It is through choice and reinforced practice that most outcomes are manifest. God is ultimately in charge, but he gives us the precious power of choice. We don’t choose to have tumors, but we do choose behaviors. Yet, our behaviors eventually become the products of various combinations of biology, autonomy, and conditioning.
It’s time to grow up, individually and collectively as a society. Each of us must live accountably and responsibly. Whining, complaining, and self-pitying are the countenance of the enemy. To be truly accountable and responsible, we must implement what is evidenced about neuroscientific methodologies for brain self-regulation and its impact upon self-control and responsible behavior choices.
Mature readers will certainly remember the TV sitcom (circa 1960), Leave It to Beaver. Even in the age of “repression, innocence, sexism, racism, simplicity, and cliché,” the character portrayals rang true. Remember Eddie Haskell? He was brother Wally’s friend, the smart-mouthed, two-faced, insincere sycophant—his surface good manners belied a sneaky, mischievous, diabolical character. Eddie represented the phony schemer, the pest who exposed and denigrated altruism and responsibility. He was a great foil, a counteractive dark character who made us laugh and think about mischief, selfishness, deception, and responsibility. Eddie traveled the low road, while pretending to take the high road. To what extent was Eddie “in charge” of his character and behaviors. How did you enter the story? With whom did you identify—Eddie, Wally, Lumpy, Ward, June, or Beaver?
You might have a family member, friend, or associate who resembles Eddie Haskell. And he is only one stereotyped example of those whose self-serving behaviors exasperate others but justify themselves.
While the great strides toward curing cancer are encouraging, I’m more cautious about the battles within human nature and their ramifications from problematic behavior. The age-old quandary persists about who is in charge and what to do about bad behaviors.
Hollywood, take note: it’s time for a modern reconstruction of well-worn themes—perhaps call it, “Leave It to Behavior.”
Whether it’s the ravages of disease, the pernicious effects of sin, or the exasperation of untoward behavior, an anguished refrain applies: “Baby, you’re killing me!”
— Mark Steinberg, Ph.D.
