Is ANYONE just a jerk?

Great Debates
1

Or lazy? Or selfish? Or any number of personality traits and behaviors that - while undesirable, fall short of a diagnosable, treatable, and potentially compensable pathology?

Let me acknowledge off the bat that I DO NOT deny that mental and emotional illness exists and CAN BE devastating. And I’m a huge fan of subsidized health care and other government social programs. I guess this could be viewed as just one more in a long line of threads asking if mental and emotional illness is over diagnosed. Let me explain what got me thinking along these lines today.

My job involves people seeking disability benefits. Every day I review hundreds - if not thousands - of pages of medical records. But my background and expertise is law, not medicine. In RARE instances - I’d estimate fewer than 5% of individuals - examining or treating mental health professionals suggest the possibility of malingering or secondary gain. And there is the ever popular drugseeking behavior, though that is more relevant to people complaining of pain. But out of the thousands of case records I’ve reviewed, I can’t recall a psychiatrist, psychologist, counselor, or social worker ever saying, “You know, this guy just has a negative disposition.”

I’m also not opposed to providing assistance to people who are just jerks. Or who had lousy role models and upbringing. Or who made mistakes. But in my mind, helping someone develop the tools needed to function in society is distinct from diagnosing them as experiencing a pathology.

What is the purpose - within the mental health community - of widening their diagnoses? I guess my preference would be to characterize people as within the range of normal - yet entitled to assistance, rather than characterizing them as “disabled.”

There is somewhat of a circular influence occurring. I perceive that health care providers diagnose individuals, because such diagnoses and treatment is perceived necessary to entitle someone to added care and benefits. But IME gov’t programs take their cue from the medical communities, accepting - for example - the APA’s criteria in the DSM in describing what constitutes disability.

2

I would assume a mix of a desire to help people and create new consumers for their products. No different than how in the medical community the definitions of things like high cholesterol, diabetes or hypertension keep becoming more and more stringent.

I’m not sure where the cutoff is either. What separates a run of the mill jerk from someone with a cluster B personality disorder?

3

Yeah - I dunno, But it just strikes me as odd that I’ve never encountered a psych saying someone is just unpleasant ad needs to shape up. I’d think I’d see such a thing at least on rare occasion.

I acknowledge the possibility that the sample I am dealing with - people seeking disability benefits - might be skewed in some way I don’t understand.

It seems to me that - at least for SOME portion of folk encountering mental/emotional/personality difficulties, some sore of “tough love” type of treatment might be beneficial. Acknowledging that life sucks and a person has disadvantages, but they still need to figure out how to fit in and survive as best they can.

4

You are making the assumption that just telling someone to stop being a jerk and do the right thing will work – for anyone, ever.

I have not seen this happen, myself. Maybe it does but it has to be pretty damn rare.

Many people are confused by the term “tough love”. The operative word is actually “love”, as in, “we are going to do whatever it takes to help you, even if it doesn’t feel that way or look that way to you right now.”

It isn’t “tough” as in "tough shit puppy we are kicking you to the curb because you don’t deserve help. Hope you find yourself, or something. "

5

I don’t endorse this view, but let’s say that the expectation that people can change for the better, minus medication, is inherently false.

If you force someone lazy to get a job, then they’ll go to a workplace and do nothing until they’re fired. All you’ve accomplished is to waste a full wage’s worth of money on someone who didn’t deserve it, and wasted the time of all of the people who had to try and work around the guy while expecting him to be productive.

That’s economically inefficient.

And let’s say that if we tell the guy that he can never hold a job and we have no interest in supporting him either, so he’s on his own to find a plot of dirt somewhere in the wilderness to grow food, or starve to death, whichever is his preference. And, again, we’re assuming that this will not change this person. He’ll be lazy and allow himself to die.

But now we’ve lost a potential worker. While it is true that he never did contribute, that doesn’t mean that this isn’t a loss to the economy. Someone gave him food and education for years and years. He could have done things in life to give back to society, were it not for his laziness.

And so say that the cost of his medication is even thousands of dollars per year, and it will turn him from being a lazy person into a productive person. Even a minimum wage would be sufficient to demonstrate that the expense on the cost of medication was worth it.

And is our person less happy because we have made him productive through medication? No, because we’ve changed how his brain works. That’s how we have made him productive.

He’s happy and the world is a better place. We have one more person contributing back to society, he’s happy, and everyone’s happy to work with him. The only cost is that we force him to take his medications, on the basis that we have - as a society - decided that an inability to be a productive member of society is equivalent to insanity.

6

Would you call Carl Panzram a jerk or evil?

7

I believe there is always a reason why jerks are jerks. People don’t just wake up one morning and decide they just want to be a jerk. Maybe they have a mental illness. Or they have been shaped by their environments to be a jerk. Or their “jerkiness” is a response to unmet psychological or physical needs.
I don’t know if a precise diagnostic label is necessary to help jerks stop being jerks, but I do think a modicum of understanding and compassion is required. Like, a person who has been spending the last ten years in a prison will likely have a different mien from someone else. They may be abrupt and gruff and may not give the most effusive expression of gratitude in response to basic courtesies. Is this person a jerk because they want to be a jerk? Or are they acting like you’d expect someone to act if they just did hard time and maybe they need to be judged by a different standard?

8

Everyone is someone else’s “jerk”.

9

There IS a mental health diagnosis that pretty much says “jerk”. It isn’t used much these days, IMO. One of the problems with diagnosing someone with this disorder is the stigma that attaches itself automatically.

10

What business is it o’ yours?! You think you’re better’n me?!

11

Which one do you have in mind? There are several that come to mind immediately for me.

12

[quote=“Dinsdale, post:1, topic:823404”]

But in my mind, helping someone develop the tools needed to function in society is distinct from diagnosing them as experiencing a pathology.

What is the purpose - within the mental health community - of widening their diagnoses? I guess my preference would be to characterize people as within the range of normal - yet entitled to assistance, rather than characterizing them as “disabled.” /QUOTE]

If people are characterized as “within the range of normal,” wouldn’t that in itself disqualify them for disability benefits/assistance? Therapists can’t help people who can’t afford to pay them and whose care isn’t subsidized. Well, they could, but they wouldn’t get paid. Or am I being too cynical here?

13

According to the American Psychiatric Association, “The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) is the product of more than 10 years of effort by hundreds of international experts in all aspects of mental health.”

Think they’re going to expend all that effort and babble, then wind up labeling someone a “jerk”?

You’ll have to wait for DSM-VI.

14

I don’t think you are too cynical at all. My impression is that our social services have evolved such that - in large part - they depend on describing people as “impaired” or “disabled” in order to provide assistance.

I admit my practice is skewed, but I VERY FREQUENTLY see people who appear to rely on their diagnosis as an excuse for them not putting forth effort. (Again, by no means am I suggesting this is true of ALL people diagnosed w/ mental illness.) It seems to me that it sets up a perverse set of incentives. Many people impress me as happy to have a diagnosis they can rely on as justification for their lot in life. I’m not sure what system would provide assistance/education/training on some other basis, but I perceive negative effects of the current dynamic.

And yes, Ulfreida, I have encountered MANY instances of people reforming their behavior in response to being told that their behavior was unacceptable and would have negative consequences. Isn’t that what happens all the time with well-parented children? And I have been in several social situations when - to varying extents - people have chosen to alter their behaviors after being clearly told that certain behaviors would not be tolerated. And I have adopted different behaviors myself when confronted with how my words and actions are perceived.

monstro mentions the ex-con having challenges fitting in with civilian life. I believe it is inexcusable that the US does not provide greater assistance for ex-cons - especially in light of our zeal for incarceration. As opposed to assisting them reincorporate into society, we put up roadblocks - and then act shocked at recidivism. Lacking such assistance, our current system encourages ex-cons to make one of their first stops the local SSA office where they apply for disability benefits. :smack:

Similarly, SSA used to pay disability benefits for drug and alcohol abuse. There was a 2-year limit on such benefits, and recipients were required to be enrolled in treatment programs. When it was decided that we oughtn’t provide even such a limited safety net to substance abusers, guess what happened? It turned out that none of those folk were actually substance abusers. No, the mental health community characterized them as bipolar! :rolleyes:

And Sage Rat - personally I have no objection to anyone using substances legal or illegal if those make them a pleasanter, more useful member of society.

15

Is anyone just a ‘jerk’? I think we need to define what a jerk is. Everyone has their own opinion on the matter and it’s highly cultural. So I would say that there is no one that universally meets a ‘jerk’ definition.

Is anyone selfish? I would posit that everyone is selfish. It’s the defining trait of humanity. Sometimes people get secure enough that they can do unselfish things and even grand unselfish things-running into burning buildings or whatnot, but humanity’s base state is selfishness.

16

Um, Isnt it that the Dr’s are just NOT sending such patients, to you to apply for aid?

Which would seem to be a good thing, and also seems the most likely explanation to me. So you’re only seeing applications from people who have already been vetted for malingering etc.

17

I didn’t intend this to be about the specific labels I chose. (My initial inclination was “asshole”.)

Instead of the current system of characterizing people in terms of how they deviate from “normal”, I think I would prefer an expanded definition of what normal is. Meaning, normal people encounter all manner of frustrations and stresses, and for most of us, living a decent life involves considerable hard work and tough choices. Yet normal people are capable of dealing with even significant stresses (traumas?) over time, remaining self-sufficient productive (or at least nondestructive) members of society.

I can imagine social services being offered on terms similar to libraries. Essentially - free-of-charge, and available to whomever wants to take advantage of them. Our library has amazing resources available, yet I don’t see them having to turn people away at the door. If someone feels a need for assistance - job training, counseling, education, whatever, they should be able to pursue it without the hassle and stigma of being diagnosed as exhibiting a medical condition.

18

One would think that. And I suspect it is a large part of what I see.

But the claimants I see are generally not “sent to me” by doctors. Some are referred to doctors by their lawyers (another issue), but others are proceeding pro se. Some portion of claimants have very limited medical histories. But if they allege any mental/emotional problems, we send them out for a consultative exam. It is extremely rare to have one of those come back as identifying “no diagnosable impairment.”

Instead, a failure to seek treatment or to comply with prescribed treatment is often viewed as an aspect of various conditions. It seems as tho the mere fact of someone being unsuccessful in life is viewed as establishing the existence of a pathology. Rather than a person’s - say - depression being a reaction to their job loss/SO’s infidelity/drinking, the overwhelming tendency seems to be to characterize the job loss/SO’s infidelity/drinking as manifestations of the depression.

19

I mean, yes, they exist. And maybe they might lie about having a mental condition. But, if they aren’t lying, then the primary definition of a mental disorder is a way of thinking that impairs one’s functionality. In other words, if someone genuinely thinks they have a problem with anxiety, then they have an anxiety disorder.

For them not to have a disorder, they’d have to believe they were capable of dealing with their issues on their own, and not seek help.

Again, if they aren’t lying. You can always lie to try and cover up just being a jerk. That said, it may be hard to detect liars, as mental health evaluations are usually based around the idea that the patient accurately reports their distress. They only can easily detect those who are just being random: if they are consistent, it’s hard to tell using the standard testing.

I would hope that, given your situation, they would have tests designed to detect fakers.

20

I see this ALL.THE.TIME.

Plenty of people are just jerks with nothing wrong with them. That’s pretty much a constant refrain among the MH professionals I work with.