When is behavior an illness?

This sounds like a simple question, yet it is a fundamentally important one. It is a question that I for one have tried to answer to some degree of rational certainty over the many years of my work in the mental health field. It is a question that a recent news article I happened to read once again raised in my mind.

Briefly, the article: “Cheaters do prosper, but are they psychologically ill?” from the Globe and Mail: http://www.theglobeandmail.com/life/health-and-fitness/health/conditions/cheaters-do-prosper---but-are-they-psychologically-ill/article4258538/. The study reported there found that university students who admitted to cheating scored high on personality traits of psychopathy. This suggests that psychopathy which in its most extreme forms can translate to Psychopath may be associated with self-reported cheating. The one obvious question that I would ask is why do we think that cheaters are honest about reporting if they cheat or not – but that is a question for the researchers.

Cheating clearly has adaptive value and in evolutionary terms probably has an evolutionary advantage. It happens in every society that I know of and I would not be surprised if it is common behavior in animals, particularly primates. So what does this say about how we think about “normal” behavior and “illness”?

Obviously this is very complex and one blog can not address this issue. But we can start. So here is one thought to help us think more. Most if not all behaviors that we exhibit, occur on a continuum or spectrum. The point at which a particular behavior “crosses” from “normal” to pathological depends on many things. Think of it as “carving nature at the joints”. How we decide where to carve is very complicated and lots of different perspectives come into play, including; statistics; probability theory; social and cultural frameworks; emotion; history; personal bias; etc.  One of the cutting points commonly considered, is: does it create harm to self or others, does it lead to impairment in functioning? Does stopping or diminishing the behavior lead to better outcomes for all concerned?

What do you think about this as a “cutting point”. What other “cutting points” do you think are useful?