Am I the asshole or the hemorrhoid

Calling children oppositional, disagreeable, or defiant, especially if the behavior is persistent or targeted, is very common at school and at home. While some parents and teachers might wonder why a child would do this or that despite repeated punishments, others may simply give the consequences to change behavior. While a therapist or a parent might mull over the child’s intentions or needs, some pedagogues just give clear and consistent instruction on how to follow the rules, and equally clear punishments when the rules are broken. In order to fully judge the nature of a transgression, or the intention of a transgressor, context and details are essential. Devoid of context, one cannot determine the malice or good will of either the rule breaker, the rule maker, or the rules themselves.

Adults are also called oppositional, uncooperative, or treasonous. The labels used can lead to very different interventions and outcomes, e.g. "outspoken, mischievous, opinionated" feels very different than "insubordinate, difficult, or anti-social". The moral and psychological health of a culture is shaped by how the people in authority label the people that do not conform. When leaders cannot tolerate fair and meaningful competition and use pejorative labels to stifle protest, the health of the body politic suffers. Reflexively marginalizing disruptive individuals for being assertive leads to divisions among groups, and psychological splits within individuals. Expelling or scapegoating people that are not compliant with the in group impoverishes the whole group, leads to cynicism, and eventually corruption.

James Madison, (Federalist Paper #10) proposed that fair play amongst differing political groups should be structurally maintained and enforced. Since fractiousness is part of human nature, it should be managed constructively for the benefit of the whole group. The American Revolution was fought partly to create constitutional structures for managing differences in political opinions, instead of suppressing them. The role of the loyal opposition in parliamentary politics has been cherished and defended in England. The gadfly was elevated to an iconic place in Western history when Plato martyred Socrates in the final four dialogues. Transgressive heroes such as Neo from the Matrix, Uncle Jesse from Full House, and Ren from Footloose are American icons. Even Barry Goldwater in the Conscience of a Conservative argued for a principled and organized resistance to the status quo.

Sadly, throughout the 20th century, psychiatric diagnoses and medication were misused by authoritarian doctors, parents, teachers, and politicians to control individuals and groups and to limit legitimate civic opposition. (Particularly in the Soviet Union and The Republic of China) There are ten mental health disorders in the DSM-V and the ICD-11 that include oppositional or argumentative behavior in their criteria. While anti-social behavior is a colloquial expression, it can be a dangerous diagnosis in the wrong hands. Psychiatric diagnostic descriptions by themselves do not consider the validity of the opposition nor the moral ground for the authority, only their presence. Such a context neutral approach is more universal and more utilitarian. But, it is essentially a-moral. These diagnoses do not take into consideration any history, context, or specific moral framework. Thus, in the hands of morally corrupt authorities, such tools can be used to codemn and marginalize political adversaries or direct public disapproval to specific groups of people.

Authoritarian personalities and the societies that support them highly value the performance of conformity as a tool to maintain control over groups. Mislabelling someone as anti-social or oppositional implies that they are toxic to the body politic - but there is no way to know from a label if it was fairly applied without the details and context.

When authority figures misuse labels to exploit the people that they are meant to protect, being the hemorrhoid that offends the asshole is a civic duty. As a physician that means taking the time to look more closely at the details, making the effort to see the context clearly, and advocating for the fair, objective, and consistent use of our knowledge and power.