November, 2004. If there is a fundamental substrate linking the area of psychopathology with the broader world of social interaction, it might be identified as human behavior itself. In clinical psychiatry we classify human behavior as normal or abnormal, yet we know there is no sharp line differentiating the two and that the definitional conventions we use to distinguish the two are approximations at best, and at times are arbitrary. Not only is there a continuous, dimensional gradient connecting many psychiatric disorders with non-pathological behavior, but what is called normal behavior in one culture is not necessarily the same in another. Special circumstances (e.g., sleep deprivation, fear of pain, imprisonment) can also precipitate atypical behavior in certain individuals that may not be labeled abnormal given the circumstances. Other ways in which we classify human behavior include legal or illegal, mature or immature, moral or immoral, and ethical or unethical, and these concepts cross the normal/abnormal boundary with respect to ourselves and our patients alike.
One urgent mandate that accompanies medical progress is to anticipate and address the consequences of our success, which can include unintended complications. Among the giant steps of medical progress in the twentieth century was the successful completion of the mapping of the human genome, for the first time making real the potential to understand the complex, polygenic nature of major mental illness. In this issue of the Journal, Appelbaum draws our attention to critical ethical issues that accompany this unfolding rush of new knowledge. Genetic screening and prenatal testing are already in place for some medical conditions, but the appropriate use of this information to guide the choices and decisions of those affected is daunting. There are strong tailwinds moving psychiatry rapidly down this genetic information highway, and Appelbaum wisely recommends that we proceed with caution.
Also in this issue, Kroll and Egan call our attention to the role of the “moral emotions, “ such as guilt, shame, remorse, and regret, in motivating behavior, sometimes by first kindling emotions such as anxiety, disappointment, or frank depression. While we readily recognize absence of guilt or remorse as symptomatic of severe antisocial or narcissistic behavior, we may less often be attentive to what Kroll and Egan call “moral worry” or even the “guilt narratives” that underlie symptoms of anxiety or depression.
Another important aspect of human behavior is one not often addressed on the pages of psychiatric journals. Hall et al. review the profound importance of the animal/human bond in society, not only with respect to pets (“companion animals”), but also in the caretaking responsibilities of farming, ranching, and livestock enterprises. When disaster strikes, as it did recently in the United Kingdom when the foot-and-mouth disease epidemic required the slaughter of thousands of valued animals, the scope of the stress was vast. Not only is the process itself devastating and nearly unbearable for those affected, resulting in large numbers of (mostly unappreciated) new cases of depression, acute stress syndrome, and other conditions, the sequelae in terms of loss of livelihood can be overwhelming. Disaster response planning is a challenge very much on the “front burner” these days, and this dimension of those efforts should claim a meaningful place in such plans.