What/when change is possible

My therapist often deals with bosses, spouses, church leaders, probation officers, etc. who inquire as to whether and how fast behavioral change is possible with someone who suffers from mental problems. He tells them that change is almost always possible, it's just not often possible in that moment. For example, someone who struggles with rage issues may be able to learn to control their temper through years of training and self knowledge and growth, but they may be completely incapable of controlling their temper in any given moment. He says that this restricted ability to control behavior, where mental hardwiring meets a deficit of willpower or skill level, is really hard for people to understand who don't suffer from similar deficiencies in those areas. First, it feels like the person is cheating, coasting through life on excuses while the rest of us have to try so hard. Second, it's difficult to understand how someone couldn't just be able to make a choice in that moment to do something differently, e.g. "just relax".

A lot of people have experienced this frustration with me over the years,. Recently, though, I've had extensive experience with it myself from someone else who has a very entrenched personality disorder, but also has started suffering from major depression symptoms. For various reasons, I am to a large extent responsible for this person and must interact with him various times a week. And every week there is some new flavor of dysfunction going on in his life, despite a comprehensive cocktail of medication and weekly therapy. This week, it's an inability to get out of bed for anything but work. He is already suffering pretty serious health consequences from a lack of exercise, for which he is taking another set of medications. All of his doctors, mental and physical health, tell him to keep trying to exercise. He knows that it will improve not just his physical health, but his depression as well. He knows that he enjoys getting out and walking in nature. But it is just very difficult for him to do it, so difficult that he doesn't quite go to the trouble of trying. I have a very tough time relating to this, and after years of dealing with nearly limitless levels and varieties of dysfunction, my frustration levels can get pretty high.

The crazy thing is that I would have never had this experience at my most sociopathic self. There would be a snowflake's chance in hell that I would have continued to deal with someone like this for longer than a few weeks, maybe a few months in exceptional circumstances. So I've never actually had to confront this type of frustration at someone's inadequacies. The one great thing that has come out of it is that I now have much more cognitive empathy and understanding for what people have to deal with on the other side of the mental health problem equation -- the people without the seemingly intractable problem, but still have to deal with it on a regular basis.

But I think of a parallel -- my grandmother, who suffered a stroke and had to undergo a sequence of physical therapies. She did get better over time -- better bladder control, speech, decreased paralysis, etc. There were also some things that she didn't get appreciably better at -- lack of inhibition, sense of decorum or propriety, respect for the privacy of others, demonstrating an adult level of patience, and certain types of emotional regulation. She had in many ways the mind of a child to her death, but I bet that even in those things she could have seen further improvement -- too bad she didn't live 50 more years to reach that point in her trajectory.

And I know that as much as I have improved over the past few years -- almost no manipulation, more in touch with my emotions, stronger sense of self and identity -- there are still things I probably won't ever be able to do -- affective empathy, strong emotional theory of mind, understanding subtle emotional cues, conforming more closely to social norms and expectations, etc. Or maybe I will, it will just take some future brain surgery and/or 50 years of training. We'll see. 

How to maximize utility of socio relationship?

I thought this was a remarkably insightful comment, left July 7, 2013 at 7:56 AM

HOW TO BEAT A SOCIOPATH ... is the wrong question. If you're trying to beat, that means you're engaged in a competition, and non-socios tend to get revved up by their emotions during competition and thus will make it very difficult for themselves to "beat the socio", while the socio expends much less effort to pick at the non-socio's weaknesses.

Instead, the proper question for non-socios is "How do I maximize the utility to me of the socio relationship?"

In some cases, there may be no utility, so just terminate the relationship, or get out of it with at little damage as possible. In other words, you're in a hole, stop digging, don't try to beat or compete with the socio, just tend to your own needs. Do not feel sorry for the socio, or try to make the socio regret or repent, just leave. (If you can't control your own emotions, particularly to stop worrying about the socio, then you certainly aren't going to be able to control anyone else, including the socios, who are very good at control.)

If there is possible utility, then strictly enforce your boundaries, so the socio cannot damage you. Constantly assess whether you are getting enough from the relationship; do not worry that you are being selfish, trust that the socio is doing the same calculation for themselves, and will leave if they aren't getting what they want, so you can just worry about your own needs.

The tricky thing is to realize that socios imitate emotions to manipulate non-socios. If this satisfies your utility need, then great. Otherwise, realize that the socio has limits, and if you impose unrealistic expectations on the socio, you will just get burned.

It reminds me of this recent tweet:

"I am no more using them than they are using me."
— M.E. (@sociopathworld) January 24, 2014

External vs. internal limitations

I try not to let my diagnosis of being a sociopath define me or change me. One of my friends told me, I think wisely, "I wish that you had never heard of the word sociopath, that you just lived your life without knowing that there was a label for what you are." Labels can be very limiting and I wouldn't want to ever be frozen, without making any effort to grow and develop as a person.

One of my favorite stories of not falling prey to percevied limitations involves the filming of the opening shot of Sunset Boulevard:

For the opening shot of William Holden floating face down in the swimming pool, Wilder wanted a shot from below that would show both the body and the police and photographers standing at the pool's edge.

They tried putting the camera in a waterproof case and putting it on the bottom of the pool, but the quality of the shot was not good. Then art director John Meehan had the idea of putting a mirror on the bottom of the pool. That didn't work either because the water created too much distortion. But Meehan reasoned that because cold water distorts less than warm water, if he could chill the water enough, they could manage. Although extremely uncomfortable for actor William Holden, they got the shot.

The thing is that if the artistic choice was up to Meehan, he probably would have never thought to do that shot because it wouldn't have been within the realm of possibilities for him. That's the problem with growing up -- the more we learn about the way the world works, the less original our thoughts. It was only Billy Wilder insisting that the shot be that way that made Meehan even bother to go through all possible solutions -- if only to prove to Wilder that it could not be done. But it could. And it is one of the most iconic images in all of film.

I often wonder what my personal limits are, if any. Mormons have a teaching that the purpose of life is that all things might fulfill the measure of their creation, people, animals, plants, planets, everything. Mormons also believe that God "created every man different from his brother" and that institutions thrive when "when we take advantage of this diversity and encourage each other to develop and use our talents to lift and strengthen." The basic idea is that we are to be our best selves, whatever that self happens to be. But could most people say with absolute certainty that they even know who their best self is? Where is the proper line drawn between realistic and loving self acceptance and a desire to be "good" in one's own opinion versus the opinions of those who love you? Sometimes I think to myself, God must have created me differently to fulfill a different purpose than other people. But could I really be more normal than I think? Could I grow a conscience? Or practice empathy enough to the point where I too can feel what others are feeling? If I self-identify as a sociopath who will always be flawed in certain ways with limited opportunity for change, would that be a self-fulfilling prophecy?