What/when change is possible

My therapist often deals with bosses, spouses, church leaders, probation officers, etc. who inquire as to whether and how fast behavioral change is possible with someone who suffers from mental problems. He tells them that change is almost always possible, it's just not often possible in that moment. For example, someone who struggles with rage issues may be able to learn to control their temper through years of training and self knowledge and growth, but they may be completely incapable of controlling their temper in any given moment. He says that this restricted ability to control behavior, where mental hardwiring meets a deficit of willpower or skill level, is really hard for people to understand who don't suffer from similar deficiencies in those areas. First, it feels like the person is cheating, coasting through life on excuses while the rest of us have to try so hard. Second, it's difficult to understand how someone couldn't just be able to make a choice in that moment to do something differently, e.g. "just relax".

A lot of people have experienced this frustration with me over the years,. Recently, though, I've had extensive experience with it myself from someone else who has a very entrenched personality disorder, but also has started suffering from major depression symptoms. For various reasons, I am to a large extent responsible for this person and must interact with him various times a week. And every week there is some new flavor of dysfunction going on in his life, despite a comprehensive cocktail of medication and weekly therapy. This week, it's an inability to get out of bed for anything but work. He is already suffering pretty serious health consequences from a lack of exercise, for which he is taking another set of medications. All of his doctors, mental and physical health, tell him to keep trying to exercise. He knows that it will improve not just his physical health, but his depression as well. He knows that he enjoys getting out and walking in nature. But it is just very difficult for him to do it, so difficult that he doesn't quite go to the trouble of trying. I have a very tough time relating to this, and after years of dealing with nearly limitless levels and varieties of dysfunction, my frustration levels can get pretty high.

The crazy thing is that I would have never had this experience at my most sociopathic self. There would be a snowflake's chance in hell that I would have continued to deal with someone like this for longer than a few weeks, maybe a few months in exceptional circumstances. So I've never actually had to confront this type of frustration at someone's inadequacies. The one great thing that has come out of it is that I now have much more cognitive empathy and understanding for what people have to deal with on the other side of the mental health problem equation -- the people without the seemingly intractable problem, but still have to deal with it on a regular basis.

But I think of a parallel -- my grandmother, who suffered a stroke and had to undergo a sequence of physical therapies. She did get better over time -- better bladder control, speech, decreased paralysis, etc. There were also some things that she didn't get appreciably better at -- lack of inhibition, sense of decorum or propriety, respect for the privacy of others, demonstrating an adult level of patience, and certain types of emotional regulation. She had in many ways the mind of a child to her death, but I bet that even in those things she could have seen further improvement -- too bad she didn't live 50 more years to reach that point in her trajectory.

And I know that as much as I have improved over the past few years -- almost no manipulation, more in touch with my emotions, stronger sense of self and identity -- there are still things I probably won't ever be able to do -- affective empathy, strong emotional theory of mind, understanding subtle emotional cues, conforming more closely to social norms and expectations, etc. Or maybe I will, it will just take some future brain surgery and/or 50 years of training. We'll see.