How a Dangerous Patient Got That Way

Brave Merida

When I first saw “Mr. X” in my waiting room, I thought his head was on fire. Striking, spiked red hair aflame. My mistake. It was his heart.

Before long, he would be on the verge of doing harm. Or, as he saw it, putting things right; being something like an avenging angel on the side of all that he believed to be just and good; a kind of holy warrior.

This is the story of how he went from being depressed and disgruntled to someone who might kill. But it is also a story about what happens when hearts are inflamed with rage.

Until only a short time before the “X-Man” consulted me, he was the sort of guy who, when you saw him in a crowd, the crowd stood out. Hardly a mutant superhero. His physical stature and undistinguished facial features made him appear to be an average man in every way: average nose, average mouth, average height — you get the picture. Back then his hair was conservatively fashioned, not spiked, and my patient colored it a less startling shade.

Mr. X did not welcome attention, you see. Attention in his life had never signaled kindness.

His parents were unkind. His teachers had been unkind. His first wife was unkind. And his kids wanted no part of him other than financial support. They believed his first wife, who said that he was a scoundrel. Thus, we have a man who was abused and neglected, bullied by school mates, and badly treated by wife #1. The divorce had been financially ruinous and somehow that woman had managed to win his children’s favor.

The X-Person was reasonably bright and worked in a technical field of endeavor. He’d made a decent living, but watched as others surpassed him. Some of them were minorities, and rather than looking at possible short-comings in himself (his relatively clumsy social skills, for example), he thought that they were getting unfair promotion. In short, he became a bigot.

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Then the final blow: a financial downturn and the loss of his job. He came to me after several months of a futile job search. He was both depressed and embittered. My patient had tried to play by the rules and, it seemed to him, the referee was always penalizing him. Having no close friends, the only things he could count on were his second wife’s support and that of his religious faith, which he relied on more and more. It was not the religion of his parents, but one that he’d chosen some time after his divorce.

Therapy was aimed at keeping him afloat emotionally so that he could succeed in finding a proper job. To the extent that he opened himself to looking at his life of travail, the treatment attempted to help him grieve his losses. But, let’s just say that the goal of keeping him from curling into a ball was working, while relieving him of his back-pack of unresolved grief was not.

Several months in, however, it was clear that he was beginning to think about violence. Acting out. Targeting others. And he increasingly saw the religious texts that he faithfully read as indicating that wrong was being done in the world and that it was his job to right that wrong. Indeed, he felt that it would be irresponsible and sacrilegious not to.

Interestingly, Mr. X was untroubled by war and wished to have no part in supporting it or protesting it. Nor was he concerned with children who were abandoned or starving. No, his concern was for the unborn, but his anger was against those who conspired to prevent their birth. Specifically, physicians who performed abortions.

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This X-Man was uncomfortable after telling me this. He was more than smart enough to recognize that, if he talked about a plan of action or specified a target, I was required to report him to those authorities who might prevent the worst. When I questioned him about the inconsistency between valuing the lives of the unborn and the likelihood of destroying lives of innocent bystanders in addition to the “murderers” he hated, he brushed-off the thought. When I mentioned the commandment “Thou shalt not kill,” he was unfazed. Yet it came from the book he called “holy.”

To my patient, there was no problem in killing the MDs, and anyone else who might die in addition to the doctors would be “collateral damage,” worth the accomplishment of his goal. He did not expect to be punished by the god he worshipped and didn’t care what civil authorities might do to him.

It was clear to him and to me that my concern about potential carnage (he denied “yet” having a plan and claimed he hadn’t definitely decided to do anything) was getting in the way of his treatment. Within a few weeks he indicated that he could no longer trust me because I seemed too concerned about “the others” who, he believed, were beneath contempt. He wasn’t sure if he wanted another therapist when I offered to help him find one, because, he said, “They’d have to report me, too.” Assuming, of course, that he went further with his thinking and actually did come up with a plan and a specific target.

When he terminated therapy I was worried. I continued to try to keep phone contact, calling him every few weeks. And, before long, there was a change. The X-Man landed a job. He sounded buoyant, no longer angry, and free of the obsessive preoccupation with going out of this world in a glorious bloodbath, along with the evil soul or souls whose existence he wanted to erase. This frustrated man was frustrated no more, throwing himself into a job that felt fulfilling and interesting. And I breathed a sigh of relief.

As I look back on that man and that time, I sometimes think about what it takes to go over the line. Would this X-Man, lacking X-Men-like super powers that might have made him feel better about himself, have killed if he hadn’t found work just then? I think he might have. Would he have killed only because his religion saw his targets as sinning? No. With a different religion or no religion, he still could have justified his action. Righteous anger is always self-justifying.

Most, if not all religious documents are like a Rorschach Inkblot: one person looks at the picture and sees a butterfly, while another looks at the same picture and sees a vampire bat. The Bible recommends stoning as the punishment for adultery, but we haven’t heard of too many Jews or Christians taking that point seriously lately. In religion, interpretation is everything. No, this man could have been almost any isolated soul who had a sorry history of disappointment, heartbreak, and failed attempts to make his life better; and a bunch of anger ready to blossom into a mushroom cloud.

Nagasaki, 20 Minutes After the Atomic Bomb Explosion in 1945

Nagasaki, 20 Minutes After the Atomic Bomb Explosion in 1945

We humans look for justification for our actions, sometimes before we act, but always after. And we tend to find it. “They’ve got weapons of mass destruction,” said the government, “so let’s invade Iraq before they kill us.” “Slavery is in the Bible (and is not there rebuked) so God intended for us to keep slaves,” as the slave-holding Southern States used to argue. Even the god described in the first book of the Bible, the Book of Genesis, is the intelligent designer of the first-ever genocide, which we conveniently think of as the benign story of Noah and the Ark. God’s reasons?

The LORD saw that the wickedness of humankind was great in the earth, and that every inclination of the thoughts of their hearts was only evil continually.  And the LORD was sorry that he had made humankind on the earth, and it grieved him to his heart. (Genesis 6.5 and 6.6).

As Blaise Pascal said, “The heart has its reasons of which reason knows nothing.”

The top image comes from the movie Brave. Some details of this story have been changed to protect the identity of the patient.

Forgiveness: If and When?

Much is made, especially by the religious, about the importance of forgiveness. But the topic is worthy of some discussion before one gives a blanket endorsement to forgiveness of everyone and everything. Should all acts be open to forgiveness? Is apology essential before there is any forgiveness? Are some offenses unforgivable? Are some people permitted more leeway to act inappropriately and exempt from the expectation of apology?

First off, who has the right to forgive? Only those who have been injured. I have no right to forgive your mistakes unless you have done me harm in some fashion. Certainly, this right might include an injury done to someone I love, if I too will have suffered pain due to the harm done to the other person. The idea that I can’t forgive you for an injury you did to someone I don’t know, for example, is allied to the notion of legal standing. I can’t bring a law suit against you unless the court agrees that I have a stake in the matter. As the old saying goes, “I don’t have a dog in this race.” That doesn’t mean that I don’t care about what happened; rather, it means that in matters of injury, compensation, or apology, I’m not directly involved.

Another consideration is whether the injury is ongoing. If someone is in the process of playing practical jokes on you day after day, to take an example that is relatively small, would you forgive his poor taste or judgment? He’d probably laugh at you if you did, because that individual sees nothing wrong with what he has done. Better to get him to stop or get out of his way, than to consider any generosity of spirit on your part that is likely to go unappreciated.

Then there is the question of apology. Let’s assume the joker just mentioned has a moment of self-awareness, or perhaps has been persuaded that his actions are rude. What must he do to apologize? According to Aaron Lazare’s book On Apology, he should acknowledge what he did to hurt you, say that he is sorry, and attempt to compensate you in some way. In the case of public humiliation caused by the practical jokes, for example, it would be appropriate (although perhaps impractical) for the prankster to make a public admission of his foolishness in front of the same people who were present when he embarrassed you. Moreover, he must do his very best to make sure that his boorish behavior isn’t repeated. Simply saying “I’m sorry” isn’t enough. Nor is it sufficient to state, “I’m sorry if I’ve hurt you,” a turn-of-phrase we hear from public figures, but one that is absolutely inadequate. According to Lazare, it is crucial that the transgressor be precise in admitting what exactly he did that caused harm, leaving no ifs, ands or buts, and making no excuses. This is the same sort of thing that happens in court, when, after a plea bargain, the accused admits exactly what he did without excusing it away, and recounts the consequences that followed from that behavior. In legal terms it is called “allocution.”

With respect to the question of some offenses being unforgivable, that is for the injured party to decide. Murder, rape, torture–all terrible–still permit the possibility of forgiveness if it is in the capacity of the afflicted to give it. The same answer would apply to the question of having a different standard for the behavior of one person than for another. We all do this in practice, accepting the failures and misbehavior of those we love when we aren’t so generous with a stranger who does exactly the same thing; and we often let things go without apology.

Forgiveness, however, is not the same as forgetting. If you have been injured, it is most often worth remembering who did what to you, lest you put yourself at risk of being hurt once again. Nor does forgiveness require that you continue your relationship with the person who harmed you; it is sometimes good judgment to forgive the person at the same time that you end the relationship with him.

Relationships are messy and we all can do better and be kinder. Many people have trouble telling others when their actions have caused an injury. The victim can suffer silently or in grumbling discontent, and passive-aggressively try to pay-back the injurer in some indirect fashion. Often, the hurt that the injurer caused is inadvertent and might be easily remedied if the one who has done the harm is told gently but firmly that he caused unhappiness.

Of course, some relationships, if they regularly cause injury, can be quickly dispensed with at little cost. But for those closest to us, we usually will suffer more and longer before limiting contact or severing the bond with that individual. And contact with parents or siblings, for example, cannot be replaced. So, for most of us, we will usually put up with some measure of unhappiness in order to keep a place in our lives for even the unrepentant relative. And, in part, it depends on how much one is willing to put up with.

There is at least one additional very important and useful reason to forgive. It follows from the old Italian expression, “If you want revenge, you should dig two graves (one for yourself and one for the object of your revenge).” The point here is that carrying anger is costly and letting go of that anger might allow you to be happier and more at ease in the rest of your life.

But, be careful not to let go automatically and too soon. Anger is often a necessary part of getting over an injury. While it doesn’t always have to be expressed at someone else, neither is turning the other cheek invariably the best policy for your psychological well-being. Writing about your feelings will oft-times help, and talking to a friend or counselor can be useful. But once you are through the stage of anger, forgiveness is at least a possibility.

Still another reason for accepting an apology and forgiving is that the relationship can be continued and sometimes improved by the act of mutual understanding that is involved. Life is full of disagreements and differences, in addition to unintentionally hurt feelings. Those parties who can survive conflicts, communicate about them, and come to a point of acceptance, understanding, and appreciation often are bonded together more strongly by the experience.

It takes maturity to know when to ignore something and when, instead, to confront the person who has injured you. Most things probably aren’t worth the trouble of a conflict, lest one always be fighting and accusing others. Best to wait for a cool and calm moment to decide whether confrontation is worth it, than to act in the over-heated instant. That is nothing more than common sense.

But, as a wise man once said, common sense is rather uncommon.