Re "Bad behavior isn't an illness," Opinion, Nov. 5
Theodore Dalrymple makes a good argument for the difficulty of separating some mental disorders from moral lapses.
However, in his statement about intermittent explosive disorder — "it becomes inexplicable as to why outbursts should commonly occur in response to a minor provocation by a close intimate or an associate … the editors [of the DSM-5] would seem to have reflected little on the meaning of their own work" — Dalrymple gets it wrong.
Such outbursts do not "occur completely at random" but rather are responses triggered by an individual's unconsciousness, usually by feelings from the past. An accumulation of such feelings, never brought to rational consciousness and realization, can cause the smallest word, behavior or feeling to result in an outburst.
A major benefit of psychotherapy is the process of bringing these past feelings into our consciousness so that we can better understand how and why we become emotionally triggered in the present.
Susan C. Shell
The writer is a marriage and family therapist.
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