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Ask the Mental Health Expert Archives 2001-2004

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Apathetic Individual

Q. What do you do with a male in his mid twenties who absolutely does not care about anything? He has always been this way and will confess readily that he acts excited, sad, etc. when he thinks that is the response that is required. However, he really and truly says he doesn't care about anything. He is not saying anything suicidal; he just has no emotional response. Is this a disorder and should he seek help?

A. It's hard to believe there's truly a human being who does not really care about anything--usually, this is just the cover story. I think the first issue to address with a young individual like this is underlying diagnosis. What might be termed apathy or amotivational syndrome is not a disorder in its own right, but a symptom in search of a diagnosis.

Apathy may be seen, for example, as part of the negative symptom cluster of schizophrenia. It may sometimes be seen in depressed individuals. Apathy is a frequent neurobehavioral complication in patients with acquired brain damage (see Andersson et al, Apathy and depressed mood in acquired brain damage: relationship to lesion localization and psychophysiological reactivity. Psychol Med 1999 Mar;29(2):447-56). Using a tool called the Apathy Evaluation Scale (AES), this study found that apathy and depression in brain damaged patients share common features, but may be differentiated. (By the way, some apathetic individuals with underlying brain dysfunction may respond to psychostimulant medication, such as methylphenidate. Depressed individuals, of course, would do better on an antidepressant).

Another fairly common cause of amotivational syndrome is substance abuse--especially heavy, chronic marijuana abuse or solvent abuse. If the individual in question has not yet had brain imaging and neuropsychiatric as well as personality testing (e.g., MMPI), I would strongly consider these assessments. I would also suggest using one of the standard depression rating scales (Beck, Hamilton, Zung, etc.) to see how he scores. From a more psychodynamic perspective, it is my observation that many people who claim they don't care about anything are really betraying a deep-seated fear about trying to do anything--usually for fear of failing at it.

"I'm not interested" is really a kind of cop-out. Sometimes, exploring their anxiety about failure can be a fruitful road. In this regard, I highly recommend the book "A Guide to Rational Living", by Drs. Albert Ellis and Robert Harper. As Ellis and Harper put it: "People who lead a lazy, passive existence and who keep saying that 'nothing really interests me very much' are almost always... defending themselves against some irrational fear, especially the great fear of failure."

And yes, if either the individual in question, or those around him, are significantly unhappy with this state of affairs, I think the individual deserves a thorough diagnostic evaluation. After that, treatment recommendations may emerge.

June 2002

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