Individuals and systems are bound by context.  For instance, although according to surveys, higher rates of domestic violence are demonstrated among African Americans than whites, when the confounding effects of poverty and racism are eliminated, that difference between ethnicities also disappears (Hamel, 2005, 30).  Ethnicity as a contributing issue, therefore, is ruled out in the etiology of domestic violence and instead, classism and racism stand indicted.

As competent researchers and practitioners, we look for confounding contextual factors that speak against narrow viewpoints such as those that would suggest that “African Americans are violent” (Hamel, 2005).  In short, in our investigations of individual trees we don’t miss the forest or the dirt or the sky.  We want to see the detail, as well as the whole picture.

In Gender-Inclusive Treatment of Intimate Partner Violence: A Comprehensive Approach, Hamel describes individuals dealing with “psychopathy,” as “essential untreatable” (54).  Although I understand the pragmatic intent of treating immediate issues of violence with an attitude of triage, I am unsure how perpetuating such worldviews positively impacts the likelihood of developing treatment methodologies in the future.

As an MFT, I believe that one of the primary limitations that competent therapists deal with is an awareness of the confines of our own sight.  We can only see that which we think is possible to see.  In our educational system, it is vital that we learn both the importance and efficacy of triage, but also employ significant questioning whenever an individual or their diagnosis is deemed “untreatable.”  Certainly, in the present moment, some individuals live with diagnoses that are unresearched, difficult and/or impossible to treat.  Antisocial Personality Disorder, the “psychopathy” Hamel refers to falls in this category.  However, that is only for the present moment.

As the future of mental health and the future of many individuals without the resources, knowledge or connections to advocate for themselves or their loved ones, we have a responsibility to read any claims of “terminal” with both a skeptical eye that questions the details of validity and a wide angle lens that notices the wider contextual factors that may be contributing to that claim.  For instance, Robert Foltz, a research whom I much admire, wrote regarding the treatment of Conduct Disorder (an established pre-cursor to Antisocial Personality Disorder, or “psychopathy”), its “likely that that brain changes in youth with psychiatric disturbances are actually the product of their life experiences rather than the cause of their symptoms” (2008, 7).

I appreciated Hamel’s description of assessment of domestic violence.  I especially appreciated the focus toward practitioners evident by the straight-forward counsel regarding assessment tools and biases to notice.  I did take issue with his description of “psychopathy” as untreatable, not because it is untrue, but because there simply are not treatments yet.  It is possible to describe the extreme limitations in providing treatment for specific diagnoses without effectively describing them as terminal.  In the education of future counselors, even simply stating “right now, there is not a treatment” is preferable, because it includes the “right now.”

Foltz, R. (2008).  Behind the veil of conduct disorder: challenging current assumptions in search of strengths. Reclaiming Children and Youth. 16(4). 5-9

Hamel, J. (2005). Gender-inclusive treatment of intimate partner abuse: A comprehensive approach.  Springer Publishing Company: New York, NY.

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