Gaining empathy for those with personality disorders

Posted on September 30, 2013

(Last Updated On: April 1, 2016)

I wrote a post called Antidepressants and weight-loss, and how to make dieting and exercise work better for you if you have issues with depression, which started off:

From the lecture I reference below: “Depression is the most damaging disease you can experience.” Notice the word DISEASE. If you are one of those people who hears “depression” and thinks “wuss” you are woefully misinformed.

That lecture was by Robert Sapolsky:

One thing I didn’t elaborate on much, and why I posted that video, is I feel there is such a stigma against those with depression, personality disorders, or addictions. One essentially of, “Suck it up pussy.” Even those with their own issues can’t empathize for others. The lawyer who says to me, “How can people get so fat? I don’t understand. It’s like, just eat less and exercise!” To which I respond, “I know, right? It’s like, how can lawyers be so unhappy? Just blow sunshine up your ass and smile more often!”

I know growing up I couldn’t understand things of this nature. How could someone be depressed? Rather than be empathetic, I was much more on the side of, “It sounds like you’re choosing to be unhappy.” It was more ignorance than anything else.

When you deal with people trying to change their bodies you run into every type of personality you could imagine. Depressed, narcissistic, bipolar, alcoholics, drug addicts, you name it. You know where those in healthcare, but the non-psychiatric world, are dramatically underprepared? Dealing with the vagaries of human personality. Nobody teaches you how to talk to a 55 year old, divorced, lonely, overweight, depressed, chronic pain suffering woman. And you can’t merely refer every person you see to a psychologist. You, yourself, need to be able to talk to these people. You don’t need to be able to treat them, but you need to be able to handle them.

Ironically, the lack of empathy towards those with personality disorders is often what they need most.

Learning the backgrounds of the mentally unstable

For me, a simple way I gained empathy for this group was to learn more about them.

One of the most common traits amongst this group is a troubled childhood. Alcoholic parent(s), divorce, non-loving parents, best friend died, sexual abuse, etc. As I’ve gained experience I’ve seen this over and over. Whether it’s friends, clients, relationships, some of the stuff you learn about people’s childhoods is pretty haunting. You gain patience and understanding when you learn a reason so and so has trouble trusting people is because their dad beat them.

Here’s where empathy comes into play. Anyone who has been around the mentally unstable knows full well how hard of a time they have regulating their emotions. Where you know, if you say that one sentence, that may be the difference between a calm conversation and a fight breaking out. Why would this population have trouble regulating their emotions? How did mom and dad have such a negative impact?

Think about some neglectful parents you know. How they may be unresponsive, late to help their child, if they’re drunk or high their mind may be in a cloud, whatever it may be. Now, watch what happens in the video below.

Notice when mom doesn’t react the baby goes ape shit? The baby doesn’t know what’s going on. “Should I be upset? Should I be happy? Should I scream? WHAT THE HELL MOM?!?!”

I was at a pool party recently. My girlfriend has 6 young nieces and nephews. With all those kids running around someone is bound to fall on the ground once in a while. One of the nephews was sprinting after a ball, tripped and fell. What was his first reaction? Think when you’ve seen a young kid fall on the ground. What do they immediately do? Cry? Not usually. They pop their head up, look at mom or dad, mom usually freaks out, hence, the kid then freaks out.  Dad exasperates “He’s fine! You’re making him think it’s worse than it is!” The kid learned from mom (or whomever) what just happened is scary (or not), so, they learn how to react in that type of scenario. Usually, mom wins out, thus, the screaming and crying after a fall.

We learn to regulate our emotions through others. When growing up, who are you around most? Your parents. What happens if you have crappy parents? You may have crappy ability to deal with your emotions.

This is why group therapy is so pivotal in dealing with the mentally unstable. They have to learn to regulate their emotions when around others. What’s the best way to learn? Through others.

If you want an up close look at this, watch the Rehab with Dr. Drew series. You’ll see the the importance of the therapists as outlets of emotion. They’re trying to teach the patients that, when stressed, to a degree, it’s ok to be upset / angry / whatever, but you need to learn how to come back down from that, without drugs or alcohol. If you never had parents with concern for your emotions, you may have never learned this.

(Obviously, I’m simplifying this whole thing. Feel free to research more to learn the nuance of all this. It’s cool stuff.)

As someone who had a stable upbringing, learning these things helped me quite a bit. It made me say, “I didn’t have to deal with those types of negative things, I need to have some empathy for those who have.” If you consistently work with this population it’s crucial to be able to empathize with them. Not only does it make you better at your job, perhaps by increasing your patience; it can help those you’re working with to deal with their emotions. By not losing your cool when your client wants to, you’re helping the client learn how to not lose their cool too.

There is certainly a rebuttal to all this. “I had a shitty upbringing and I didn’t let it control my life. I used it as motivation etc. etc.” The point being many believe yes, some people have had a tough road, but, at some point you need to take responsibility and turn things around. There are countless examples of the ol’ rags to riches story; I would be hard pressed to say they didn’t have merit.

However, what if, for some, they truly didn’t have control? What if something else was dictating their thoughts and emotions?

Bugs in the brain

Let’s bring Robert Sapolsky back into the picture. There is a site called People from all over the world record lectures about various topics, then you can watch them as if you were in a classroom. I was recently watching one by Sapolsky titled Being Human: Life Lessons from the Frontiers of Science. There are all kinds of cool topics covered. What happens when monkeys are able to eat like westernized humans? Is trying to be stress free actually unhealthy? The brain science of a bad mood, as well as nostalgia. I’m going to reference the lecture “Bugs in the Brain.” 

Sapolsky discusses various parasites and their affect on animals.

  • One which changes the hormone levels in crabs, causing them to dig holes in the sand. The hole ends up being where the parasite can lay its eggs.
  • One which can cause an ant to become photophilic i.e. attracted to light. This causes the ant to climb something like a plant, from the darker ground to where light is more available. The ant will climb to a specific height, then die at that height, whereby the parasite begins to reproduce on top of the ant.
  •  Viruses which, right before our bodies attack them, know to change their proteins so our immune systems can’t recognize them.
  • One which lays eggs on the fur of the rodent. Then, the parasite will chemically make the rodent scratch and bite their fur. Why? So the rodent ingests the eggs, where inside the rodent there is a nice reproductive environment.

Things can become even more intricate as well, where the parasite will go after not one, but two different species. It may cause one animal to be blind, making it prone to a predator. The predator eats the prey, whereby the parasite can reproduce inside the gut. Then, once excreted, the feces is ingested by the first animal; restarting the cycle.

Sapolsky references a parasite which makes fish gills less efficient. The fish then has to swim closer to the ocean surface to get oxygen, making it more likely a bird will eat it. Bird then takes a dump into the ocean; fish eats the droppings; fish gills don’t work as well, so on and so forth.

I think most of us have some remedial knowledge of parasites, but, things like the above are crazy.

Sapolsky finishes with an even more amazing example. A parasite called toxoplasma gondii. “Toxo” is primarily found in cat feces. What eats cat poop? Rodents. What do cats eat? Rodents. You see the similarity in the other parasites above. What’s even crazier about toxo is it’s been found toxo will manipulate rodents in one specific way: Make them more attracted to cats.

To keep them away from cats so they can stay alive, rodents have evolved to hate the smell of cat pee.  Rats do other things like stay in dark places and avoid open space. Toxo is so intricate it travels through a rat’s brain and literally changes the circuitry. It will leave everything else alone. It’s not general fear it changes, or general behavior, the parasite is capable of changing one circuit in the brain. Telling the rat, “Cat pee = bad” to “Cat pee = awesome.” The rat will still fear all other predators. Toxo only makes rats attracted to the one predator it can reproduce in, cats.

In a more general sense, the parasite causes the rat to become suicidal. (Sapolsky references another parasite which gets grasshoppers to jump into water and drown themselves.)


Do humans get infected by toxo?

YES! Apparently, this is why pregnant women and newborns are encouraged to avoid cats, specifically their feces. I have never heard about this, but sure as hell will never forget it. (All my friends who hates cats are thinking, “I TOLD YOU SO!”)

Toxo has been associated with an increased risk of:

  • Schizophrenia
  • Disinhibition of men
  • 3-4x more likely to get killed in car accidents from reckless speeding
  • Increase in impulsive suicide

Sapolksy mentions this is an emerging area of science we know little about, but if you take a minute you can think of a million scenarios where this could be important. That person who out of nowhere lost their mind, killed 10 people and themselves, yet everyone who knew him goes, “I can’t believe they would do this. He was such a nice person.” Maybe it’s a parasite which suddenly overtook their brain?

And, coming back to our main point, that person with the personality disorder who, no matter what, just won’t change? Maybe there’s something in their brain controlling them, something we simply don’t know about yet.

Sapolsky finishes the lecture with:

“What this also does is teach us a little bit of evolutionary humility. We humans are very proud of ourselves, we have opposable thumbs, we can work iPads, we have big brains, all this fancy mammalian stuff. What this toxo story teaches you is we are not necessarily the most evolved or clever species out there.”

Think about this the next time you find yourself frustrated with a mentally unstable person. I’m sure there are a lot of people out there who could make a change. I’m also sure there are a lot of people out there who absolutely wish they were not depressed, bipolar or suicidal. Who never thought they’d become what they currently are. Who have tried every avenue, only to learn 30-40% of antidepressants actually work, that the mortality rate for addiction is similar to cancer. We may just now be finding out why the failure rates for these conditions are so high, and “lack of willpower” is becoming an increasingly unlikely answer.

Months later I’m in the same place
No music made, feeling like a failure
And trust me it’s not dope to be 25 and move back to your parent’s basement
I’ve seen my people’s dreams die
I’ve seen what they can be denied
And “weeds not a drug” – that’s denial
Groundhog Day life repeat each time
I’ve seen Oxycontin take three lives
I grew up with them, we used to chief dimes
I’ve seen cocaine bring out the demons inside
Cheatin’ and lyin’
Friendship cease, no peace in the mind
Stealin’ and takin’ anything to fix the pieces inside
Broken, hopeless, headed nowhere
Only motivation for what the dealer’s supplying
That rush, that drug, that dope
Those pills, that crumb, that roach
Thinkin’ I would never do that, not that drug
And growing up nobody ever does
Until you’re stuck, lookin’ in the mirror like I can’t believe what I’ve become
Swore I was goin’ to be someone
And growing up everyone always does
We sell our dreams and our potential
To escape through that buzz
Just keep me up, keep me up

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