The Definition of Insanity

I hear this every week, sometimes twice a day: "The definition of insanity is doing the same thing over and over and expecting different results." No, it isn't.

To be clear, insanity is a legal term pertaining to a defendant's ability to determine right from wrong when a crime is committed. Here's the first sentence of law.com's lengthy definition:

Insanity. n. mental illness of such a severe nature that a person cannot distinguish fantasy from reality, cannot conduct her/his affairs due to psychosis or is subject to uncontrollable impulsive behavior.

Insanity is a concept discussed in court to help distinguish guilt from innocence. It's informed by mental health professionals, but the term today is primarily legal, not psychological. There's no "insane" diagnosis listed in the DSM. There's no "nervous breakdown" either, but that's another post.

Origins of the term "insanity"

Where did this saying come from? It's attributed to Albert Einstein (probably not), Benjamin Franklin (probably not), Mark Twain (probably not) and mystery writer Rita Mae Brown (probably so) who used it in her novel Sudden Death. It's not clear who said it first, but according to at least one blogger it's "the dumbest thing a smart person ever said." The catchy saying has gathered steam in the past few years (example I, II, III), and regardless of the source, it's gotten a lot of mileage.

The dark underbelly of insanity

I'm not in the habit of slamming cute sayings (with one exception), but I think there's a dark underbelly to this one. I've started hearing people use it in the service of avoidance, which is a defense mechanism. Rather than facing their fears, they grab on to this saying for protection against possible failure, pain, or rejection. Some examples:

• "I've asked out two women and been shot down both times, and you know the definition of insanity..."

• "I jogged for a week and actually gained weight. They say the definition of insanity is ..."

• "It's been a month and I'm still crying about his death. I'm living the definition of insanity."

The definition of insanity doesn't have anything to do with jogging. It's important to keep grieving, jogging and asking people for dates because these are areas of life that require some repetition and are quite sane. As a therapist, when I hear these statements I can collude with the protective bubble of the socially accepted catchphrase or challenge it. When met with the examples above, I'll challenge.

Why we confuse the definition of "insanity"

I think the confusion behind this statement is best illustrated by these two words:

Perseveration: the pathological, persistent repetition of a word, gesture, or act.

Perseverance: steady persistence in a course of action in spite of difficulties, obstacles, or discouragement.

Some forms of dementia, traumatic brain injury, anxiety, and OCD can cause people to perseverate. They repeat words and tasks or try repeatedly to solve problems, but are left frustrated and unsatisfied. They're not necessarily insane but stuck in a non-productive pattern due to a glitch in brain function. Some medications or CBT tools may prove helpful.

There's also the psychodynamic construct called repetition compulsion where people unconsciously repeat past conflicts in an attempt at mastery. We want to finish unfinished business, so sometimes we recreate old, unresolved problems for the potential of a better outcome. A typical example would be a guy who desired closeness with his emotionally unavailable mother as a child and therefore seeks out unavailable women in his adulthood. Or a woman who feels it's always her duty to invite her selection of apathetic friends to socialize. Or someone who is drawn to crowds of wealthier/smarter/prettier/etc. people where they always feel left out. They're all trying to finally conquer some old feelings of rejection. But even if they do succeed today, it doesn't erase the pain from the past.

Let's not confuse perseveration with perseverance. A persistent quest against a fear or toward a goal is often the best course of action. Repeating the same constructive behavior over and over, hoping (one day) for a positive result is difficult but virtuous. It's the effort made by eating oatmeal every morning, brushing your teeth after every meal and daily journaling. It's weekly therapy, consistent workouts, and taking time for spirituality. It's Rudy trying over and over to get into Notre Dame. Or Mother Theresa tirelessly serving the poor. Or someone working to systematically overcome shyness, build healthier habits, or communicate better with their spouse. It's a 12-stepper taking it "one day at a time." The qualities of perseverance—consistency, loyalty—are beneficial to health and definitely not insane. And they're doing the same thing every day, hoping for some measure of progress.

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So how do you tell the difference? Perseveration feels compulsive, hopeless, helpless, automatic, and unsatisfying. There is a desire to stop, but stopping doesn't feel like an option. Perseverance feels like striving toward a noble goal, and whether or not it's reached, there is virtue in the effort.

Perseverance is a strong, valuable quality. Perseveration is a troubling issue needing clinical attention. Don't let a quaint saying blur this distinction.