01/25/2013 06:09 pm ET Updated Mar 27, 2013

The Lance Armstrong Interview -- Your Reactions and One From a Shrink That Might Just Surprise You

No one needs to be a psychiatrist to interpret the myriad reactions to Lance Armstrong's interviews with Oprah Winfrey. Whether we've had enough already or are sick over it, this is sensible and self-evident given the two-hour "content." Here are the top five reactions I've been hearing: 1. "Who cares?" 2. "He's still lying." 3. "That wasn't a real apology." 4. "Is he a control freak, or what?" and 5. "Enough already!" Let's examine these, and then consider one more reaction, mine -- it might surprise you.

1. "Who cares?" is really the frustrated way of skirting the "why do I care?" question. The answer, I believe, is different for different people. Perhaps we wanted to believe in the seemingly impossible. Surviving potentially lethal cancer to go on and set all time records for endurance and physical achievement? More than extraordinary. His Livestrong organization for cancer awareness? We wanted to see Armstrong as an inspiration -- as a true hero. The world needs heroes, after all. That's probably why we all cared, riveted. He disappointed us by turning out not to be the person he claimed to be. By saying, "who cares?" we are washing our collective hands of the whole mess. That's fine with me, as long as we take note of what we are really feeling underneath: disbelief, and ultimately, despair in the possibility of the heroic.

2. "He's still lying" is an expression of the struggle to believe how many lies Armstrong has actually told over these many years of his lauded career. "How can he not be lying at this point?" we reason, and that makes sense. The kernel of the interview seems to be this: he never delivered any answer to Oprah Winfrey's question as to why he is coming forward now to come clean. He alluded to, with the most emotion akin to contrition we have seen him muster to date, something about being moved by his son's faith in him. Did that simply pierce through such enormous pathologic bravado and character armor? Really? I am not satisfied as yet either.

3. Feeling that "that wasn't a real apology" reflects a deep sense that his remarks were insufficient. While he took responsibility for his actions, he coursed over his banquet of lies, his demolition derby of cruelty, and his splendid feats of wrongdoing rather handily. While he vowed to make amends, he seemed challenged to convey a truly deep sense of remorse. Though he copped to wrongdoing, it felt far from complete. As a totality we are left wondering whether he was sincere at all. Even a touch of insincerity spoils a true apology.

4. A strong reaction along the lines of "is he a control freak or what?" keys off of Armstrong's fundamental and limitless desire to be in charge of every step of every [encounter] he is involved with. There is consistent historical evidence of this behavior -- as well as plenty on display during his interview with Oprah. I can't say whether he was always this way, or whether this resulted from his developmental history and/or his battle with cancer. I can say that not everyone who survived cancer as he did turns out this way. Often, for example, we see the opposite result -- survivors demonstrating an easygoing appreciation together with a profound sense that so much of the day-to-day worries with which we concern ourselves really don't matter.

5. The "enough already!" reaction is likely to be a healthy desire to limit our exposure to something that probably doesn't affect our life directly. Hey, it's his life -- his choices -- and while there are many who are directly affected, most of us tuning in to the story needn't lose our perspective. This is his -- not our -- problem.

I, however, say "not enough." From a psychiatrist's perspective there is something missing from the conversation, something that limits understanding. What I am referring here to a true formulation -- a clear, concise consideration of cause and effect, of the specific psychological factors that drove Armstrong to do what he did. As he is not my patient, and as I have not examined him, I cannot diagnose him for to do so would be to over-step good ethical bounds. Yet, in order to try to assist in our collective struggle to make good sense of these behaviors, let me offer a few observations.

We know Armstrong met the challenge of advanced stage testicular cancer with a drive to do anything and everything to survive. Let's suppose he took his resolve and commitment from here and transformed that commitment to become the seed and template of unyielding desire to win in his athletic competition, beat the odds, and in doing so set world records. We know he may have been exposed to blood products, blood enhancement, and testosterone treatment as a patient. Let's suppose he came to consider these to be familiar, even necessary allies in the fight against cancer. He did not consider them like other doping substances. It may not have been a leap then to consider them an ally in his next battle, dominating the cycling world. He got carried away with his desire and yearning to be the best -- even perpetrating a reality so different from that which he otherwise asserted -- in order to continue on in his endless quest to dominate at any cost to himself, his family, and his supporters.

Can Armstrong apologize meaningfully without a whole understanding such as this? I do not think so. Was he honest in his reveal so far? Not enough came across to satisfy me. He said he was in therapy but he did not share any real in-depth self-awareness. I believe Armstrong got carried away by forces he could not completely control, only some of which he was initially aware and understood, their origin and extent he has only begun to fathom.

Out of awareness motivations are the norm in human existence. We all have them. This is why we must strive to increase our understanding of what drives us, of the nature and full extent of our willingness to go beyond what we agree to be fair play. People do not naturally act in accord with their highest self at all times. Make no mistake: human nature is not an excuse here. Rather it provides an explanation when considered in sufficient detail. Through my work over two decades treating patients who need to develop their understanding of what drives them, I believe in broadening and deepening the beam of awareness. Let's really make sense of what all is happening here, I say. Such is the work of therapy. The start in any such journey is the courage to be honest. Insight is a sinking feeling that Armstrong needs to discover and embrace, if he is willing and if he is able.