Susan G. Bednar, LCSW

Is it Illness or Misbehavior?

If you watch the dramas that unfold over the misbehavior of public figures, you’ve probably noticed that very frequently someone will be caught red-handed engaged in something sordid—multiple affairs, heavy drinking or drug use, embezzlement—with a predictable outcome.  Suddenly they proclaim they have a previously undiagnosed addiction and check themselves into rehab.  They hope, of course, that the public will buy their story and excuse their misdeeds if they seem sincere about getting help.  Maybe they really do have a problem.  Maybe they don’t.  Similar stories play out in courts every day.  Domestic abuse is blamed on an untreated alcohol problem, for instance, or someone pleads mental illness was the reason for their criminal actions.  Sometimes there really is a problem that contributes to the misbehavior.  Sometimes there isn’t.

Perhaps you have also struggled with a friend or partner’s misbehavior, wondering all the while whether there is something wrong with them or if they are just being a jerk.  Most of us don’t want to come down too hard on someone if their actions are the result of a mental health problem, but neither do we want to let them off the hook by excusing reprehensible behavior.

So how do you tell the difference, and how do you hold someone accountable for misbehavior if you aren’t entirely sure?

Did illness make them do it?

The legal definition of insanity sets a rather high bar.  In order to be judged legally insane, the individual must be so mentally ill that they cannot distinguish fantasy from reality, cannot conduct their own affairs due to their psychosis, or be subject to uncontrollable impulsive behavior.  Probably few people would actually want to be judged as legally insane, because although they may escape punishment for their crimes, they are likely to be involuntarily committed to a mental health facility for a lengthy period of time.  Pleading insanity probably tends to be a desperate move by someone who is facing very serious consequences, or someone who is genuinely so disturbed that this fact is readily apparent to the court.  The overwhelming majority of mental health problems are not nearly this severe or obvious.

It is true that some mental health problems increase the odds of misbehavior.  For instance, someone with attention deficit disorder may indeed be forgetful, inattentive, and disorganized, making it more likely that they will fail to carry out responsibilities from time to time.  Alcoholics may indeed develop problems with communication and anger management, making angry outbursts more likely.  An individual with bipolar disorder may have mood swings that render them unpredictable and increase the likelihood that they will engage in reckless behavior.  Depression may sometimes result in neglect of important tasks and responsibilities.  Individuals with narcissistic personality disorder are notoriously lacking in empathy and can be cruel and exploitative, while those with borderline personality disorder may struggle with forming and maintaining stable relationships over time, and may leave a trail of broken friendships behind them.  As it turns out, any mental health problem that can afflict us can also affect our behavior, but rarely is the impact so strong as to render us incapable of appropriate behavior.  Unless someone is so psychotic as to be separated from reality, they do retain a degree of control over and responsibility for their actions.  That means that although their illness may partially explain their actions, it doesn’t constitute an excuse for bad behavior.  We are responsible for our own behavior, ill or not.

You may find it easier to understand the nature of this responsibility if you think about the potential negative consequences for physical health problems.  For instance, if someone has epileptic seizures, we certainly would not blame them for their illness.  If that person were to stop taking their medication and go out driving on the interstate, however, we most certainly would hold them responsible for any lives lost as a result of their irresponsible behavior.  Although they did not cause their illness, and most likely it is not within their power to cure their illness, they do retain a certain amount of responsibility for their actions.  They can seek out and cooperate with treatment.  They can refrain from engaging in behaviors that are likely to put other people at risk.

As a mental health professional, I view mental health problems in a very similar way.  If an abusive individual maintains that alcohol has made them violent, I would certainly encourage them to seek out, cooperate with, and complete alcoholism treatment, as well as to formulate a sound relapse prevention plan.  Yet I would still expect them to remain violence free, and would hold them accountable for any violent behavior, whether or not they were drinking.  Similarly, if an individual has a personality disorder that is clearly causing problems for others in their life, I would certainly support their efforts to seek and cooperate with treatment—which will probably be long term—but I would not excuse continued mistreatment of others.  When I hear someone proclaim, “That’s just the way I am” as a way of excusing misbehavior, it doesn’t fly with me.

Setting Limits

It is possible to be both firm and compassionate.  You can be sympathetic about a friend’s difficulty keeping commitments, while still holding the expectation that they will take steps to get better at that.  You can understand that your depressed friend may not be getting as much done as usual lately, yet still support their efforts to get help and hold the expectation that once this has begun to improve they will make a better effort.  You can certainly understand a friend’s struggle with addiction, while insisting that your continued friendship rests on their making a real effort towards recovery.  It doesn’t have to be one or the other.  Cutting someone a little slack as they go through hard times is compassionate and kind.  Excusing continued bad behavior that is within someone’s power to change is enabling them to continue bad behavior.  In the long run, accepting their excuses does not help them change—it just makes change less likely.

If you really aren’t sure whether a loved one is suffering from some mental disorder, but their behavior is causing problems for you, why not be a good friend and inquire gently as to what has been going on for them?  It may not be what you imagine.  On the other hand, if the person is struggling with a problem that may be a health or a mental health problem, why not encourage them to seek help?  Your encouragement and support may help them take steps to help themselves.  It is not necessary for you to make a diagnosis, any more than it would be if your friend were experiencing a medical problem.  Neither is it a sign of friendship to suffer in silence if their actions are causing you distress.  You can continue to be a supportive friend while still setting limits in regards to acceptable behavior.


Important Note:  This blog is intended for informational and discussion purposes only, and does not substitute for professional care.  Your circumstances may differ from those discussed, and your needs may be different.  If you are experiencing distress you feel unable to resolve on your own, please seek assistance from a qualified professional of your choice.