Filtering Out the Crazy
Intentional Interview Series #2
Posted July 7, 2020
Remember 1998's movie Rounders with Matt Damon? You're absolutely right, it is a classic and here's a classic line from it that provides unexpected illumination for people interested in the “Intentional Interview,” and how to increase awareness of mental health problems that could sabotage our efforts at having a great relationship:
“Listen, here's the thing. If you can't spot the sucker in your first half-hour at the table, then you are the sucker."
Yes, this is pretty mean language for a counselor to use, but there's a lesson here that applies to professional counselors as much as it does to romantics trying to raise the odds of success and that lesson is: epidemiology. Both groups are subject to serious bias that affects outcomes that matter.
Oh, if you thought epidemiology was only about epidemics and viruses and so on you could be forgiven in these times of pandemic. However, "epidemiology" also applies to mental health. There's a known rate of mental illness in the general population and known rates of each type of mental illness. You can look up the numbers for yourself with a simple online search at a variety of reputable sites like NIH, the National Institute of Mental Health.
- Alcoholism or, as we now call it, alcohol use disorder? 8% to 12.7%, so let's round to 10%.
- Other drug use disorders? About 4 million adults or 2% of the general population.
- Serious problems with depression in a given year? 17 million adults or about 7% of all of us.
- Then there are anxiety disorders coming in at the tippy top at 40 million adults in a year or about 18%.
- Attention deficit/hyperactivity disorder? Another 17 million and again 7% of the general population.
There's a lot more, but you get the idea: Mental health problems are very common. Fortunately, they are also very responsive to treatment. The biggest problem is that most people don't get the treatment they need and, yes, that brings us to dating, which brings us to the “Intentional Interview.”
Now remember, when we're talking about mental illness that is diagnosed by a professional, we're talking about a condition that, to be diagnosed, must cause some impairment and usually, some distress. Let's focus on the impairment part because that will likely go to the heart of a person's capacity to enjoy an intimate relationship. To put it another way, impairment cripples our ability to give and receive love. Now, any of us can easily fall in love with someone who has, say, a drinking problem. But is that sort of a problem one with a high probability of successful outcomes in relationships? And, by success, we're not talking about the miserable couple who stay married. We're talking about lasting happiness.
The way this works for psychotherapists of every flavor out there is that we all tend to get in a bubble of seeing the same problems over and over and we often fail to question that. The only way to burst that bubble is for all of us to develop an open mind to the science of epidemiology. Don’t worry, all you need is an awareness of the mental illnesses' prevalence, not a junior therapist badge. So if I, as a clinician, go for years without seeing a case of alcohol use disorder then I'm likely one of the suckers Dr. Matt Damon was referring to in the film Rounders.
Likewise, another excruciating mental health problem that often destroys any chance of success in love is the personality disorder. There are 10 commonly recognized personality disorders and, collectively, they have a prevalence of 19% in the general population. That's right, all by themselves. That's in addition to the millions of other people suffering from mental health problems. Sometimes two or three problems overlap (we call this "comorbidity") and we'll have, say, a patient with borderline personality disorder who also has an eating disorder or a substance abuse problem or both.
We don't need to get a degree to start wondering if someone has a personality disorder. They all tend to have a few things in common like an impaired capacity for self-awareness. In other words, they don't really see what they themselves are doing that needlessly escalates their problems. A person with a personality disorder really doesn't see that there's anything they can do about it because their problems are caused by others' behaviors. Imagine being married to someone like that. You might want to also remember that, although there is treatment, it takes a long time with these patients. Their prevalence? Depending on the source, 9% to 19% of the general population. Again, most never get treatment. Frankly, due to professional bias, most never get diagnosed.
The generally accepted rate of adult mental illness in the U.S. is roughly one out of every five people every year. Because mental illness has always been part of our collective experience this is no reason to panic—but it is a reason to exercise prudence as we audition and interview applicants for a leading role in our lives. Although co-morbidity is a fact, it is my belief that we under-report rather than over-report mental conditions.
Over the last 30 years, my clients report that they wished they'd known these facts of life before signing on the dotted line of a marital relationship. It's not that the mentally ill are unlovable or that they deserve any sort of stigma. What is true is that although they feel a need for a boyfriend or a girlfriend, what they really need is a therapist. Our failure to recognize and embrace this is like asking a lover with a broken leg to run that 6K with you next month. They just can't do what you're looking for them to do—yet.