A leading psychiatrist contends that many of the problems we've always blamed on character flaws may be due to mild versions of full-blown mental disorders like depression. Here's what you can do to keep your brain healthy.
Although the face Sandra presents to others is that of a relaxed and loyal friend, internally she is never at ease--she is driven to clean the house obsessively or diet obsessively, or, most recently, to shop obsessively, having run up a a debt of $15,000 within a few years' time. We might guess that Sandra comes from a dysfunctional family. Perhaps her parents were too demanding? or drank too much, or inflicted upon her their bad habits and character flaws. But neither we nor Sandra might suspect that there might be something biological going on.
Or take the case of Lou, a man who continually scans his body for signs of trouble, despite being in excellent condition for a man of 50. Lou not only worries obsessively about minor physical ailments, but compulsively questions his physician -wife about whether any of these troubles might be cancer. How do we explain Lou's behavior? Perhaps we see it as "normal craziness" similar to the obsessive neatness of the main character Jerry on the television show Seinfeld. Maybe we also view Lou as the victim of a bad childhood. What we don't think is that Lou, like Sandra, might be at the mercy of his own flawed brain chemistry.
But neuropsychiatry is now discovering that a great deal of "normal craziness" in fact is heavily influenced by the genetics, structure, and neurochemistry of the brain. Every troublesome personality likely has its roots in an unsuspected brain difference: the loner, the gifted person who cannot seem to live up to his or her potential, the needy neighbor you can't get off the telephone, the confirmed bachelor, the man who cannot talk about his feelings, or even the husband who throws tantrums like a four year old. Neurologists and biopsychiatrists are now finding that the normal problems of normal people are gray and silver shadow versions of full-color mental illnesses. They're the same thing in outline, but indistinct in detail, and not easy to recognize for what they are. Just as shadows cast a pall across a day that might otherwise be sunny and clear, these "shadow syndromes" cast a shadow over the realms of work and love.
Life changes when we begin to realize that people can have subtle, hidden, or partial mental disorders. The impulse to blame people or their parents for their problems loses its power. The profound and corrosive sense of shame we feel over our own behavior begins to lift when we understand that it can be created by subtle differences in the brain. And the notion of the shadow syndrome helps us to see that talk therapy needs to address our biological selves as well as our psychological selves. Sandra, for example, sought out therapists and doctors to help her change her behaviors, but they focused on the fact that she was adopted--a fact that she had thought little about. However her childhood may be affecting her, Sandra faces challenges shaped by the facts of her biology as well, and she needs the help of her therapists in doing so.
This is not to dismiss our environments as a major source of who and what we are. A child with an innately anxious temperament who is born to an innately anxious mother may grow up to be a different person from the child with the anxious temperament whose mother does not share his difficulty. But the "new" biology can help us understand how environment and biology work together to create the person--an understanding that we can use to make the changes we wish and hope to make.
Diagnosing Shadows
In order to understand "normal craziness," we can learn from "craziness" that is not so normal, such as schizophrenia or severe manic depression. Psychiatrists diagnose their patients with these and other disorders according to syndromes described in DSM-IV, the Diagnostic and Statistical Manual, Fourth Edition. A syndrome is a set of behaviors that consistently appear together, and which the patient, the doctor, or the patient's friends and family can observed and describe. However, real people often come into the doctor's office exhibiting only one or two symptoms of a particular syndrome, or may fit every aspect of a syndrome down to the smallest detail and yet be so mildly affected that even a good therapist might miss the diagnosis. In fact, most everyday people seem to have minor bits of this syndrome, small pieces of that.
Lou's hypochondriacal behavior can be seen as a mild version of obsessive-compulsive disorder (OCD), and Sandra has shown "streaks" of the syndromes on the anxiety spectrum. Other common shadow syndromes are mild but hidden depression; hypomania, a mildly manic state where a person possesses extraordinary energy and productivity and lacks ordinary self-doubt; mild rage problems, such as that of the tantruming husband; mild attention deficit disorder (ADD), which does not unravel a life but may leave it disorganized; and autism-like social deficits that make a person incapable of relating well to others.
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bad habits,
brain,
brain chemistry,
craziness,
dysfunctional family,
genetics,
mental disorders,
mental illness,
neatness,
neurochemistry,
neuropsychiatry,
noise,
physical ailments,
shadow syndrome,
tantrums,
television show
