I have a HUGE struggle with the concept of whether my difficult child is REALLY mentally ill, or just plain mean. It's easy for me to see depression, bipolar, and so many challenges in this way--chemical imbalances, no choice in the matter. But the lack of remorse? The seeming lack of a normal conscience? No empathy? I really wish I could see this as an illness, because I think it would help me be a lot more tolerant and would help me LIKE my difficult child a lot more. But...I believe my difficult child has CHOSEN these behaviors, and I think of illness as lacking that component of choice. I have trouble with the fact that medications are so ineffective with this crowd. We have had many periods of time when my difficult child has been compliant with the medication regimens, and I think so many options and combinations have been tried, that it is not reasonable to continue that route. That's maybe the only factor my difficult child and I agree upon. She doesn't want any more medications, and I don't want her to put these powerful chemicals in her body when there is no positive result. I also see in my own difficult child the capacity to control her behaviors when it benefits her in some way; it seems to be a willful, manipulative thing. As for the pay-off for her? I don't think she has wanted the negative consequences that have come her way. I sure don't think she wanted me to call the police when I have done that; I think she underestimated me and thought she could get by with her behavior and get the better of me. Back to making her own rules, thinking she is somehow entitled to special treatment, and believing that with persistence she could take over control of my house. Is that illness? I think it would be a lot less painful if I could find a way to see it as illness. In researching "personality disorder" I found that, in an earlier time, the DSM termed it "character disorder." Have we just tried to make it sound nicer? Some personality disorders make sense to me to be termed that way, but I have a big problem getting past the manipulative, dishonest, warped view of right and wrong, especially central to antisocial personality disorder. I really do want to see my child as ill rather than mean, but I just can't get there. How have you reconciled this?