A leading psychiatrist contends that many of the problems we've
always blamedon 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.
