When empathy is not enough to solve real problems
A psychologist who worked with severely mentally ill substance abusers argues that misplaced empathy and overreliance on trauma-informed approaches have enabled dangerous public behavior and self-destruction.
According to Glendon Rayworth writing in Washington Examiner, the breaking point came during a recent subway ride when he witnessed a man crouch over an empty seat and urinate — and possibly defecate — apparently so intoxicated or disturbed that he may have mistaken the subway seat for a toilet.
Rayworth brings unique expertise to the debate, having worked in the late 1990s at Bellevue Psychiatric Hospital in New York with street people on a unit dedicated to mentally ill chemical abusers, and again in the late 2010s at the Centre for Addiction and Mental Health in Toronto with a similar population of adolescents and young adults.
The Trauma Narrative Has Gone Too Far
While acknowledging that many drug abusers are victims of trauma, Rayworth warns against the now-dominant trauma-informed perspective that he says has been oversimplified and overapplied. Some people abuse drugs to feel more of something like happiness or confidence, while others seek to feel less anxiety, loneliness, or shame. Many are driven as much by curiosity and pleasure-seeking as by pain avoidance.
The trauma-informed approach replaces “What’s wrong with you?” with “What happened to you?” — a shift Rayworth calls ethically appropriate for many but not practically helpful when misapplied to proportions that excuse and enable self-destructive choices. That is when empathy becomes entropy, he argues.
Personality Disorder and the Limits of Treatment
From a psychological standpoint, Rayworth contends that extreme drug abuse must be understood as a personality disorder — a pattern of self-defeating behavior that resists treatment. Whether genetically predetermined, environmentally predetermined through trauma, or the result of personal choices, these patterns share a common feature: absent external limit setting, people with extreme personality disorders will hurt themselves and others.
The harm ranges from disrupting public transit by urinating or defecating in subway cars to killing someone through impaired driving.
Since such disorders by definition resist treatment, Rayworth argues treatment plans will not work. When something cannot be treated, it must be managed. The most responsible way to manage extreme drug abuse, he maintains, is to contain it — housing the addict with or without their consent, the same way society houses homeless children.
A Three-Pronged Solution
Rayworth proposes what he calls a three-pronged approach: Plan A, prevention; Plan B, treatment; Plan C, containment.
This requires a serious conversation about the recriminalization of certain drugs and drug-related behaviors, though not necessarily all such conduct. No one questions the fairness of criminalizing impaired driving, he notes, so why question the fairness of criminalizing other extreme drug-related behaviors?
Tougher laws can leverage all three approaches. The greatest lesson Rayworth learned working with substance-abusing patients in New York was a simple exhortation: give these patients what they need, not what they want.
Love Requires Protection
From a Christian perspective, Rayworth argues, love is patient and forgiving but also protective. Sometimes protection must trump patience and forgiveness.
He poses a stark question: What is more humane — letting adults roll around in their own excrement after shooting up outside a safe injection site, or feeding, housing, and loving them within the safe confines of a secure setting?
The suspension of freedom for the severely addicted, Rayworth suggests, may be the most loving response society can offer.
With information from Washington Examiner
