What A. I. Will Do for Psychotherapy ($)

A.I. is enabling us to find causes while we've only previously been able to catalog by symptoms.

“Mental stress assessment remains riddled with biases caused by subjective reports and individual differences across societal backgrounds. To objectively determine the presence or absence of mental stress, there is a need to move away from the traditional subjective methods of self-report questionnaires and interviews.”
— Kit et al. (2023), computer scientists and mechanical engineers

Diagnoses Versus Definitions

Lacking an etiology, theory, or biological cause for aberrant mental behaviors, the Diagnostic and Statistical Manual of Mental Disorders provides common definitions, descriptions, and criteria. Its diagnoses are not medical, they’re descriptive. They don’t ascribe reasons, causes, or mechanisms; they classify.

The problem with this is that languages change, as do behaviors, expectations, and definitions. This subjectivity creates one set of problems, and our lack of control over these changes creates another.

This is not a problem in the case of unique, neurological dysfunctions. People who have lost basic abilities of speech, memory, movement, or recognition can be distinguished without prejudice or bias. But people whose behaviors inhabit the boundaries of what’s culturally acceptable cannot be fairly or accurately identified.

This isn’t just a problem for therapists, educators, and researchers, it’s also a problem for those who experience these conditions. For example, chronic fatigue and fibromyalgia are two presumably biological conditions for which we cannot find biological causes. The medical establishment can no longer dismiss these as psychosomatic. Psychosomatic elements are involved, as they are in everything, but that is not sufficient.

All somatic conditions contain or involve psychological elements, but in cases such as these, we’re unable to tell the extent of either, nor are we able to distinguish between them. We need to take classification to a higher level, the level of life histories, diets, attitudes, and actions.

There are various dramatic psychological dysfunctions we’d like to better understand. Some, like depression and anxiety, can be traced to trauma, environment, and individual differences. We can see addiction as self-medication that’s gotten out of hand. Other conditions, like paranoia and anxiety, arise from mental dysregulation of too much fear, too little cognitive control, and a lack of resilience.

Personality Disorders

Personality Disorders (PDs) have a strong emotional component. They’re characterized by avoidant, dependent, obsessive-compulsive, paranoid, schizoid, oppositional, impulsive, histrionic, and antisocial behaviors. All human interactions have or should have emotional components. The emotions that correlate with PDs that are distinctive in their extremes.

These disorders come with odd intellectual attitudes, but it’s their emotional impact that delivers a gut punch that is unintended, poorly justified, and unexpected. This behavior leads those who deliver it to be judged to be bad people by those who receive it. Therapists may have a hard time being more accepting.

Behavior is culturally relative. Deviance can be ascribed to unusual circumstances in cultural contexts. It takes an extensive history to determine whether it’s a person’s thinking or their circumstances that are causing their behavior. Besides wide ranging cultural norms, various groups support a wide range of acceptable behaviors.

Intolerance, exploitation, sexual license, high risk, and aggressive behaviors are encouraged within some groups. It’s tempting to consider all members of these groups as having disordered personalities. To some extent we do; we say, “boys will be boys,” but‌ there is a difference between those people who cannot see what's wrong versus those who support what’s right within their circles. Think of predatory Catholic priests.

Borderline

Borderline Personality Disorder (BPD) is seriously harmful, variously presented (Biskin 2015). BPD is “strongly connected to self-narratives, which manifest excessive incoherence, causal gaps, dysfunctional beliefs, and diminished self-attributions of agency” (Szalai 2020). It can be disguised and may be difficult to recognize.

The term “borderline” reflects this difficulty in its reference to behaviors that share elements of both neurosis and psychosis. People with BPD comprise 2% of the general population, 10% of the outpatient population seeking psychotherapy, and 20% of inpatients. Previously considered irremediable, more positive, nuanced prognoses have since been recognized (Cristea et al. 2017).

The implication of cultural attitudes in BPD behavior is reflected by a three times higher diagnosis in women (Qian et al. 2022), even though just as many men exhibit BPD behavior. The different aberrant behaviors of men (Sansone and Sansone 2011) are either tolerated or prosecuted as criminal.

The short-form definition of neurosis is, in my mind, a feeling of being flawed in oneself, leading to camouflage, evasion, depression, self-sabotage, and self-harm. In contrast, I think of psychosis as seeing oneself assailed by outside threats, leading to intolerance, exclusion, resentment, paranoia, and aggression. Many of these are attributes that can be rationally justified. There is evidence that greater verbal ability correlates with a person with BPD’s greater ability to “fit in” (Galletta et al. 2020).

Identifying Causes