What if oncologists refused to treat patients with terminal cancer? Chalking up the afflicted for dead, imagine that they withhold treatment that could extend the quality of life for those dying as well as for those around the dying. I would imagine that there would be a great murmur from society, proclaiming such withholding of treatment to not only be unethical but antithetical to the promise of life. Why then is it acceptable to withhold treatment from those having personality disorders? This post will focus particularly on the lack of available treatment options for those with Antisocial Personality Disorder (ASPD), but this can extend to other disorders considered taboo or worthy of scorn by society; those such as Narcissistic Personality Disorder and Histrionic Personality Disorder. “Fluffy” disorders such as Borderline Personality Disorder (BPD) are not meant to be part of this discussion.
That said, consider how Borderline Personality Disorder is approached these days. In the past three decades, great advances have been made in treating Borderline Personality disorder and enriching the quality of life for those with the disorder as well as those that are affected tangentially by the afflicted. This would seem to imply that the longstanding belief that all personality disorders are forever is somewhat false. Disordered behavior only exists so long as those having the disorder have their lives disrupted as a result of the disorder. With that in mind, recent strides in BPD research imply that disordered behavior can be regulated and lives improved.
Why then do so many therapists and mental health professionals refuse to treat those with ASPD, for instance? If no work is done to try and help those with ASPD then we are left with a self-fulfilling prophecy: those with ASPD have the condition for life because there are no treatments available to rein in such behavior, and no treatments are available for ASPD because the larger mental health professional body refuses to touch ASPD patients due to assumptions that the condition is for life. I am not optimistic that this will change beyond a very localized level. ASPD patients are choked dry by an endless cycle of referrals by professionals that have little problem charging money for conditions they know that they refuse to treat. That is unethical, yet no one speaks up. There is no outcry as with the hypothetical example I led this post with.
Yes, with ASPD in particular, there are many unknowns. It is unknown how those who are imprisoned differ from those that remain out of legal trouble yet still have ASPD. However, to my knowledge, there are no endeavors to attempt to find such differences. The two groups are assumed to be equivalent. There are no curious minds that are willing to rise above the frustration they face with the typical challenges that ASPD patients bring. Mental health professionals are hellbent on picking low-hanging fruit that has been successfully treated and documented previously.
And thus the self-fulfilling prophecy will come to pass and those (admittedly few, though we have no statistics available on this) wishing to understand and corral their personality disorder and antisocial proclivities will remain left in the wastelands. It is unfortunate, unethical, and ultimately detrimental to a society that has decided that antisocial behavior is unacceptable. I’m sure that many of my neurotypical readers will gladly accept such a prophecy; it’s what is best for the prison business and what is easiest to ensure that antisocial individuals will not harm them. They are as lazy and intellectually stunted as the mental health professionals whose very charge is to help anyone who seeks it, without value-judgement and with a good-faith effort.