When is crazy really crazy?

Originally posted in the Santa Monica Daily Press on May 9, 2013
www.smdp.com

Dear New Shrink,
After all the news regarding the Boston Marathon bombing, I find myself wondering, when is crazy really crazy and when is it not? Are these brothers crazy? Are they sick or are they evil? What makes for these differences?
Thank you for anything you might add.

Signed,
Confused, Crazy or Evil?

Dear Confused,
An excellent question, truly a smart one and I say that because most people just have an opinion, emotionally based, never giving it any further thought.
The word “crazy” is used very loosely in our society and generally comes out of making a joke or having a fairly strong opinion about something that differs from your own.
In clinical or scientific forms, mental illness is a quantifiable concept based on the Bell Curve. If one falls underneath the bell of this curve, which accounts for a little more than two-thirds of us, then one is considered normal. If you are at either end, outside of the curve, or if you are an outlier, then you can be considered abnormal. Outliers are people falling way outside of the curve and in science there are usually only a few and they are eliminated from results in order to maintain the curve.
So what you have is a concept where anyone that is not of the norm might be called crazy.
A famous psychiatrist named Thomas Szasz originally challenged this concept. He felt strongly that people differ greatly based on their cultures, languages and therefore social norms vary a great deal and that it is wrong to judge somewhat as being crazy or ill because they are different from us. He criticized his own profession for labeling someone as having a mental disorder because they did not conform to the social norms of our society. He further argued that psychiatry has used it as a means of social control.
If you saw the movie “Shutter Island,” then you might understand Dr. Szasz’ argument. Fortunately we have come a long way since then; just 30 years ago people who did not like the behavior of an unruly teen or difficult relative could get them locked up in a hospital and medicated if they demonstrated odd behaviors and/or if the person had the money to influence a psychiatrist. This is now outlawed. As research evidence of genetic contributions to mental illnesses grows, and medicines truly help those people who suffer, the categorization becomes more justifiable and somewhat easier to make a distinction.
However, sometimes (what we call) mentally ill people are not suffering and they do not think anything is wrong with them.
So can definition simply be on the basis of someone else being different in his or her social norms or philosophical thinking? As we grow more diversified, both here at home and globally, there are clearly differences in standards, beliefs and behaviors and it might just be best for us to try to understand them versus judging them, even if we don’t agree or something seems odd to us.
Not only would this foster tolerance and integration instead of segregation and hatred, but also it might help us to get into the mindsets of others and stop some of the violent behavior like we just witnessed with the Boston bombings.
Many people are calling the Boston bombers “sick,” probably because what happened makes us feel sick. But so far there is no real evidence that they were mentally ill. They believe what they believe. Even with our definition of mental disorders, they would only qualify if we compare them to our thinking; they are not different from the thinking of the group to which they belong.
It is a personal opinion that any thinking that includes the harming or killing of others is wrong and most of us would agree. But is it mental illness or evil?
I would say that the Sandy Hook killing of young children or the Colorado shooting in the movie theater were a function of mental illness.
The Boston marathon bombing seems more like evil, yet you have some suggesting sociopathy, which seems to fit, but then the discussion turns to the brain differences on scans between sociopaths and normal and you start moving back toward the illness concept. I would venture to say that anyone that is so filled with hatred that they cannot empathize with a different perspective and that they believe they have a right to murder because of their view is in someway sick. But again, is it crazy sick or sick evil? An excellent question and I am obviously answering a question with a question but trying to understand this and understand each other might just help us all out.