1 Boring Old Man

The term, Pathological Intoxication, was dropped from the most recent Psychiatric Diagnostic criteria because it’s hard to define, but primarily because of attempts to use it as a legal defense. While it’s not worth arguing if that’s a good enough reason to remove it, it’s worth noting that it is a useful clinical term. Pathological Intoxication refers to a group of patients who undergo a radical personality change when they drink, usually becoming uncharacteristically aggressive. Such people can undergo these kind of personality shifts with a surprisingly small amount to drink. Obviously I’m mentioning this because of the Mel Gibson episode. For someone as rowdy as he was, his blood alcohol wasn’t that high [0.120]. That’s drunk for sure, but Mel was "way drunk." I wouldn’t weigh in on his antisemitism, nor would I be interested in bringing this up in his defense. His behavior and antisemitic rant was awful, no matter what the reasons. But it sure sounds like Pathological Intoxication to me.

So what is Pathological Intoxication? It refers to people, usually alcoholics, who go crazy when they drink. They’re not just "drunk" versions of themselves, they’re Dr. Hydes to their usual Dr. Jekylls. The first case I recall was a thin [as in anorexic], attractive, quiet wife of a Doctor stationed with me in the service. At a party at our house, she had a few drinks, and became a filty mouthed shrew sitting at our kitchen table ranting about her husband’s sexual inadequacy and his private anatomy. He tried to calm her and she became combative and raved on and on. I saw her several times after that, and it was apparent she didn’t recall what she’d said. The marriage broke up not long after that over her drinking behavior. He later told me that her outburst was typical when she drank.

I saw several such cases during my practice years, and they were all the similar – something of a tortured lot. They were all repressed, tense people whose response to alcohol was genuinely "pathological." I came to see it as a symptom of more than just alcoholism, but indicative of relatively severe mental illness – in the sense of "in a lot of pain." Everyone is focused on Gibson’s antisemitism, and I’ll not argue with that. He sure grew up swimming in an ocean of it from his dad. But, I’m not sure that’s the point here. The guy’s pretty sick, I think. I hope he gets more help than just getting sober. That tirade seems like more than just "drunk guy letting it all hang out" or even relapsing alcoholic. It sounds like a symptom of some painful and deep-seated knots that need untying…