Recently I went to a show by comedian Wil Anderson and he spoke of what we commonly call addiction and mental illness. Now, I don’t mean to spoil the show for anyone, but I thought some points he made were very valid (and hilarious).
Last week I wrote about the strain mental illness places on relationships and about having more tolerance for the mentally ill. The point arose about certain people then using their illness as an excuse to any and all misbehaviour. I suggested that the person whose behaviour is really a result of their mental illness and not just personality traits will often lack insight into what it is they are doing or saying, but upon being confronted will often be apologetic of their behaviour and try to change. The person who is simply someone acting wrongly and then not apologizing for their behaviour but rather suggesting it is all part of their illness and you are in fact wrong for judging them negatively – that person is most probably just a person will a bad attitude who happens to also have a mental illness. Of course, it’s not always that simple and the lines are often very blurry between what is intentional misbehaviour and what is sequelae to the condition. Now, let me raise another scenario (which Wil Anderson raised in the show): what about those people that don’t have a mental illness diagnosis misbehaving?
What I mean is people who are not known to be suffering any mental illness suddenly noted to be doing something wrong and then identifying themselves as mentally ill and thus not responsible for their misbehaviour. As an example suggested by Wil is someone like Tiger Woods who as far as everyone (even his partner) knew was just a normal guy doing extraordinary things on the golf course. Then it became widely known that he was engaging in sex with a lot of women outside of his marriage, and without the knowledge of his spouse. He didn’t deny what was reported, but he did then claim to have a sexual addiction which no-one not even close family and friends had ever known he had. Not having ever met Mr. Woods, I can’t comment on his specific case but the questions that arises are: Isn’t that suspect timing for a diagnosis? And is there such a thing as sexual addiction?
Diagnostically a mental disorder implies that there is interference in a person’s social and or psychological functioning due to the behaviour, for example loss of jobs or relationships, etc. Substance abuse / addiction implies that a ‘substance’, which can be anywhere from alcohol, heroin, or a behaviour such as gambling, continues to be used/repeated despite negative sequelae from it. For example, a person who uses intravenous heroin on the weekends for recreation and the rest of the week holds down a job and has a good relationship with friends and relatives and is not in financial strife isn’t a “heroin addict”, simply a heroin user. If as a result of his heroin use he came to lose his job, money, relationships, housing, etc. and still continued to use heroin despite this, then that person could be said to have an addiction. The interesting thing about celebrities claiming sexual addictions (or other mental illnesses for that matter) to account for their misbehaviour is that they do often lose out financially and psychosocially after their misbehaviour is uncovered. The usual course of the story is that they then enter an addiction rehab centre and they’re “cured”. Suspect? Maybe. Real? You could anecdotally note that celebrities seem to have a much lower relapse rate after rehab than your traditional addict entering a rehab program… or maybe they have better support systems as a result of money and/or fame or family and friends… or some would say maybe they were never sick in the first place. It’s easier to cure a paraplegic who can walk than one with a severed spinal cord.
What about sexual addiction? If it meets the criteria of interfering negatively on a person’s psychosocial functioning and the person continues to engage in it despite these negative effects, then a person can be addicted to almost any substance or behaviour. A person with a sexual addiction, for example, may continue to engage in repeated sexual activity until the extent that it impacts on their ability to hold down a job because they ‘need’/want sexual stimulation at regular times, they may struggle to keep stable romantic or even family/friend types of relationships because of promiscuity and perhaps even indiscrimination as to sexual partners or context; it may cause legal problems, and it may cause physical health complaints such as sexually-transmitted infections. The short answer is yes, there is such a thing as sexual addiction. Is everyone who cheats on their partner a ‘sex addict’, though? No, of course not. If he/she manages the rest of their life well and just happens to be very adept at concealing sexual encounters with other people from their partner, then they’re probably not ill, just claiming to be so as to deny responsibility for their behaviour. Which raises another concept Wil Anderson spoke about, you can’t be “a little” addicted, or “a little” mentally ill. Psychiatry makes it really easy, actually: you either meet the criteria for a mental disorder or you don’t.
And one last topical mention: Charlie Sheen. When he started shooting off his mouth, behaving differently to the ‘good boy’ Charlie Sheen we all for some reason thought we knew, people started branding him as “bipolar”. Now, Mr. Sheen himself denied ever being diagnosed with bipolar disorder and reported drug and alcohol use which he was not ashamed of. Was he lacking insight into the manic phase of a bipolar disorder? Could be. Or maybe he just wasn’t sick at all and is one of a few celebrities who is honest enough not to use a mental disorder as an excuse for general human misbehaviour.
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