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Psychopathology


Introduction... Treatment Of The Psychopath... To Continuation of this paper...

Copyright Lark Ritchie 1991, 1995, 1996, 1997.

A Model And Aggressive Approach To the Treatment Of The Antisocial (Psychopathic) Personality

Laurentian University

Course: Psychopathology

Prepared By Wm. Lark Ritchie

Feb 13, 1991.

Introduction

"Psychotherapy is based on the assumption that, even in cases where physical pathology is present, the individual's perceptions, evaluations, expectations, and coping strategies also play a role in the development of the disorder and will probably need to be changed if full recovery is to take place. The belief that individuals with psychological problems can change - can learn more adaptive ways of perceiving, evaluating, and behaving - is the conviction underlying all psychotherapy. The goal of psychotherapy, then is to make this belief a reality."

"Nevertheless, there is little that is certain concerning the causation of the sociopathic personality. The dilemma persists: Does a biological defect render it impossible for the individual to learn control, or do incapacitating psychological events of early childhood render it impossible for the biological intact organism to accomplish effective learning"

" Did you ever notice that therapists are so goddamned cautious? They always wait for me. They never really come after me... They just wait for me to come out... I think they are afraid people will pronounce their job title as 'THE-RAPIST'...I need someone who's not afraid of me."

The dream or ideal expressed in the first passage is the self-imposed mandate of almost all psychotherapists. This romantic assumption images the therapist as some "White Knight" or "Don Quixote" on his or her steed off to save the maiden from evil. Although reality seems to eventually intervene, this base premise sits deep within the self of those in the field of psychology and caring people in general. Perhaps it is the recognition that all human beings at one time or another has experienced a situation in which he or she would prefer to reach out to another person for assistance. It is the motivation behind this paper. The belief that individuals with psychological problems can change ...

The attitude expressed in the second passage is an all too common view of the prognosis and eventual outcome of the treatment of the personality disorders classified as Sociopathic or Psychopathic Personality Disturbances - impossible. The statement is in itself self defeating and destructive to the client in that the approach to treatment and eventual outcome has already been accepted as impossible. It also violates the premise or assumption held in the first statement and as such, makes hypocrites of those who internalise such a mandate.

The third statement, from someone who has experienced inadequate therapy and has come away disappointed. It is the initiation of a reaching out for assistance and a significant key to a method for approaching the psychopath/sociopath or difficult or resistant client. It is also cry lamenting the failure of the therapist to discover and understand an individual and that individual's vision of his or her realities.

Traditional methods of treatment for the psychopath by most therapists have been relatively unimpressive save for a few methods and approaches which have been termed "encouraging" rather than effective . The goals of treatment are normally passive in that expectations are pessimistic and negative, with an objective of crisis management rather than recovery and maturing growth. Historically the success rate for recovery has been limited. As compared to other forms of mental illnesses which are treated with a positive and confident attitude, the treatment of the psychopath is on shaky ground because we do not have a model which allows the therapist to hypothesise and develop a clear understanding of the individual and a proper form of treatment. We do not understand.

The aggressive approach suggested in this paper is based on theory, some few case studies, and with some experiences based on only one real person. The psychological model in itself is not new, being a variation and collection based on present models. It and as presented may have flaws, may be incomplete, and remains yet to be fully tested.

The method of treatment challenges our ethical views of the client-therapist relationship. It will cause a reaction deep in the hearts of those that have been trained in the conventional approaches to treatment of mentally ill clients. It challenges the dogmatic practices of superficially trained counselors and therapists working by rote rather than with experience, insight and a recognition of the dynamics of the human personality.

I believe that considering the prognosis for recovery of persons with sociopathic personality disturbances, that drastic measures are in order if we are looking at truly benefiting a human being afflicted by his or her disorder. I can only refer the reader to a quote from Andre Gide: "We can never find new oceans unless we have the courage to lose sight of the shore."

The Antisocial (Psychopathic) Personality

As in all of the personality disorders, the antisocial or psychopathic personality can be positioned anywhere along broad spectrum ranging from mildly annoying to severely destructive with those whom he or she interacts. On a general level, the characteristics of people with this disorder are described as callous, unethical or amoral, incapable of loyalty, and have an inability to adopt and follow accepted modes of behaviour. Such a person usually has an attractive superficial charm and intelligence. The antisocial category includes people from all backgrounds and occupations from the unethical businessperson to the outright criminal. Many are identified through the correctional and court systems while others show up in treatment of alcoholics.

A NIHM epidemiological study reported the prevalence of this disorder to be 2.1%, 2.6%, and 3.3% in three study sites, and figures stated by W. Coville, T. Costello, and F. Rouke in their book "Abnormal Psychology" (1971) reported that about 2 percent of first admissions are diagnosed as "antisocial reaction, and 15 to 20 percent of incarcerated criminals fall into this category. Actual numbers are difficult to specify because the diagnostic criteria for this disorder have been changed with the publication of the DSM-III and DSM-III-R in recent years. Unlike the stereotyped view portrayed in the popular press and movies, along with those described as hostile psychopaths who may be impulsive, severely violent, and remorseless, this category includes individuals who are periodically reliable, capable of pursuing long term goals, and can assume responsibility.

The discriminating factor between these less dramatic cases and a normal population is that these individuals operate and achieve their goals in unethical ways, without consideration for the rights or well being of others. The table presented below describes the general profile of such an individual.

Profile of a Sociopathic Personality

• Inability to understand and accept ethical values.

• Marked discrepancy between level of intelligence and development of conscience.

• Egocentric impulsiveness, irresponsibility, lack of restraint, and poor judgment.

• Inability to profit from mistakes and ordinary experiences.

• Inability to forego immediate pleasures for future gains and long-range goals.

• Ability to put up a good "front" to impress and exploit others.

• Impaired interpersonal relationships.

• Low tolerance for stress.

• Rejection of constituted authority and discipline.

• Facile lying, ready rationalisation, and projection of guilt.

• Talent for being irritating, and distressing to others.

after James C. Coleman - Described in Abnormal Psychology, (pages 128 - 129). Walter J. Coville, Timothy W. Costello, and Fabian L. Rouke ©1960, By Barnes & Noble, Inc. New York, SBN 389 00100

Understanding Through Imagery

To set the stage for this paper I will begin with two analogies describing both the therapist and the psychopath. This imagery, I hope will set a parallel which will create both a recognisable and understandable role for the therapist.

To work with a Psychopath is to hunt down a most intelligent quarry. To recover the Psychopath one must understand the jungle in which he or she lives as well as the being who he or she was, and has become, for the Psychopath is an elusive animal whose motives challenge the therapist in a game of "Catch-me-if-you-can". In dealing with the sociopath or psychopath, the role of the therapist must be one of a skillful, dedicated and traditional hunter, and as well a loving and ruthless parent, willing to remold the tearful clay of personality at the time of the individual's Crisis and Recompensation.

The Therapist as a Hunter

What is the traditional hunter? Early man and members of recent primitive cultures such as the aboriginal peoples, as hunters, held a world view in which a hunter considered himself an integral part of the world. He honoured and respected his prey, realising that in order to continue his existence, he must capture and take the life of some living being which was also an integral part of his world.

The Native, the world over, who survives through means of hunting, still holds this attitude and honour for his prey, realising that its death is a sacrifice, necessary in order to sustain himself and the people of his group. He does not see himself as a machine of destruction, and respects his victim both before and after its killing. He realises that he must track, bait, entice, entrap, or ambush the animal, and that the animal, left to its own accord, is deeply and instinctively developed to survive. Thousands and thousands of years of evolutionary development have selected that animal's behaviours for survival.

The hunter's primary goal was and is to understand that species of animal, and in many cases a certain and individual animal in an intimate way, to know what its behaviours will be, and to take advantage of this knowledge to effect the ultimate goal of capturing the animal. When the traditional hunter needed additional knowledge or fortitude, he consulted with the elder hunters, who provided their wisdom acquired through personal experiences and from legends and teachings about his people and the animal. In many cases, he would have a favourite advisor with whom he could be open, express his doubts, questions and frustrations. And in a statistically significant number of cases, he would be reasonably successful in achieving his goals.

The therapist's search for the inner being of the psychopath must parallel the methods and actions of the traditional hunter seeking an elusive animal. The hunter hunted without malice for days, and sometimes weeks on end, and within himself and his culture, he was justified, and honourable. The therapist must be mature, brave, and capable of the tenderest intimacy. We must be able to add these deep and traditional attitudes and values to our repertoire, and struggle with our current cultural value norms, and with a conviction, risk that what we intend to do is just and right.

The Therapist as a Parent

The recovery of the psychopathic individual demands the approach and attitude of the loving and ruthless parent who realises that in some instances, for the benefit of his or her child, the parent must be cruel to be kind. We see this type of thinking advocated in the "Tough Love" approaches to problem children and adolescents, and reality therapy theory. In addition, the recovery methods must involve an eclectic set of currently well understood reconstructive therapies.

As with a parent, the therapist, if he is to be reasonably and statistically successful, cannot treat the psychopath as a "nine-to-five" affair, working to the fifty minute hour as could be the case when working with a client suffering from a neurotic disorder. As with a parent, the therapist must establish a real relationship and commit him- or herself to the client on a long term basis.

In the presentation of my model, I hope to show the importance of what some might call a Freudian transference, and the role of the therapist as a parent or significant other, as defined by Harry Sullivan. In adopting such a role, both the client and the therapist take a great risk, a risk of an emotional bond that at the present time, may be considered by some to be unethical by professional standards. By this, I mean that the therapist must, at an honest, serious, and personal level, become a long-time "personality parent" of a willing client, and as a parent, the therapist must ultimately, at some time, let the individual "sink or swim". With these thoughts fresh in mind, I would like to discuss my assumptions before beginning to develop a modified psychodynamic model of the psychopathic personality.

Assumptions

Some major assumptions have been made. The first is that based on the relative lack of unique and discriminating causal factors which will be discussed later, I assume that the psychopathic personality is a result of early family and psychological experiences. If this is not so, then the model and the logic will have been in vain.

Second, that when an individual diagnosed as suffering from what DSM-III-R categorises as "antisocial personality disorder" seeks help through his or her own volition, then that individual has come, for at least for a short moment in time, to a point of "crisis" defined as "a crucial turning point in an affair or series of events", and also "a stress situation which approaches or exceeds the adaptive capacities of the individual", and that therapeutic intervention has been welcomed, and recognised as a possible solution to the discomfort being experienced.

Third, that when and individual has been identified and diagnosed as suffering from what DSM-III-R categorises as "antisocial personality disorder" and referred for treatment through the power of the courts or correctional institutions, then that person has been deemed by society to have limited rights, and is subject to approved therapeutic techniques and interventions which have the objective of reducing or eliminating his or her maladaptive behaviour.

Fourth, that the therapeutic interventions, when applied, are applied under strict and consistent supervision, according to established guidelines. This is not to say that the supervision is required to be direct and concurrent, but that a constant communication and "debriefing" between the prime therapist and a resource team must occur frequently and regularly.

And finally, that the prime therapist must be assigned a confidential mentor whom he or she uses as his or her external conscience and point of objectivity during the process. This final requirement is of utmost importance because of the special relationship between therapist and client which must exist to bring about a change in the psychopathic personality. This mentor must be selected by the prime therapist, and be approved by the resource team. The mentor role is a necessary stipulation so that the emotional involvements and entanglements which could obviously be established are shared and consequently diffused, reviewed and assessed daily. The type of interaction between the prime therapist and the mentor would be intimate, and cover the context of the personal emotions of the prime therapist, the process to be similar to the debates common in rational-emotive therapy sessions.

With these assumptions and stipulations in mind, we can begin to develop the model.

Understanding the Psychopathic Person - A Model:

The psychopath is a victim of his/her own making, in that his/her behaviours are a result of lightning fast reactions and self recovery methods motivated by an extremely protective defense mechanism which I believe to be caused by similar, if not the same mechanisms which bring about multiple personalities.

The causative factors are wide and varied, and may not necessarily be identifiable and common between individuals, but they will have happened early in the development of personality, and probably have a lot to do with the traumatic experiences of cognitive dissonance rather than those of a strictly abusive nature. It is this quality on which I base my model. In order to fully detail the model, a summary review of the major theories of personality development and coping mechanisms is in order.

Theoretical Perspectives - A Discussion

The Psychodynamic View

The various psychoanalytical models described by Freud, Jung and others, and the psychosocial models described by Harry Sullivan, Erik Erikson and others all have in common some concept of "self" as an entity which presents a personality as predicated upon a set or sets of principles internalised within some form of mental construct of the individual. Although students and practitioners argue about what the base motivators are, and between the merits of each model, the following discussion of these models distills a basic and common design of personality which has been described from different positions rather than fundamentally different designs. I have concentrated on those models of Freud, Erikson, and Sullivan to illustrate that each is in essence, a more clearly defined restatement of the Freudian model.

Sigmund Freud - Psychoanalytic Theory

In the Freudian psychoanalytic theory of personality development, a normal individual moves from infant to psychological maturity (defined as the ability to love and work - that is, to respond to others sexually and affectionately and be productive); passing through several stages of existence (oral, anal, phallic, latent and genital), resulting in three separate, but interacting systems which constitute the personality: the id, the ego, and the superego.

The id, or the unconscious, is the base system of personality isolated from the external environment, from which the ego and super ego differentiate. It operates according to what Freud called the pleasure principle, reducing tensions through interaction with the ego, operating on the basis of what he termed the reality principle. In the child, the id is active and learning what actions performed by itself brings pleasure in the basic sense. In essence the id stores within itself, or the unconscious, a set, although extremely limited, of behaviours (crying, cooing, basic movement of its body and limbs etc.)which are for a time of benefit to itself.

The ego, driven by the id, mediates between the needs of the organism, and the environment in which the organism lives. It is currently called the organising principle , and it is conscious a great deal of the time. The origin of the ego results from the failure of the id to obtain relief from tension, causing a differentiation of the id to a new state which recognises an internal and an external world. Although not mentioned by Freud, this differentiation is on a minor scale, although by no means insignificant, the development of a first, basic "personality" in the same sense and meaning as applied to the more dramatic creations of multiple personalities brought about by later trauma.

The ego, once initiated, begins to assimilate and store the external world experiences in a mental model, or world view from which it then can choose established courses of conduct rather than "uneducated guesses" at behaviours. We can think of this mental model as a set of stored acceptable rules by which relatively safe behaviours may be selected for interaction with the environment.

The superego is an internal representative of the values and ideals of the society as acquired through the life experiences encountered by the individual. It holds within itself a repository of moral data and rules, the ego-deal, imposed on the developing child by the parents and members of society, and reinforced by a dynamic system of rewards and punishments dealt to him/her by the members of his family, group, and associations. The superego is continually being loaded with such values and ideals until and throughout adulthood. This data represents the ideal, and using this database, the superego inhibits impulses of the id, modifies ego actions from realistic goals to moralistic goals, and strives for perfection in the sense of his/her repository of ideals.

A second structure within the superego is the conscience, which contains a repository of "morally bad" reactions and behaviours collected over time in a similar fashion. As with the ego, and also implied if not the superego may be viewed as a further differentiation of the two basic personalities (id and ego) brought about through the stress caused by parental rewards and punishments while the developing child is operating at the ego level. As discipline and censure is applied, the still amorphous ego "escapes" to a third basic personality which incorporates the attitudes and values or "rules" of his parents, and eventually those of the society.

As we have seen, the individual, in developing from the id through the ego, and to the superego has collected information at each stage and stored this information in repositories at each of these stages. At the id, the information, or rule sets which determine a range of basic survival behaviours; at the ego, an extended set of interactions, and at the superego, a social set of behaviours. At each of these stages, the personality, or the "self", or "I", or "me" uses these sets of rules to select appropriate behaviours.

This Freudian Model is in reality, but an analogy , a schema, a model which provides a frame of reference through which we can develop an approach to interaction with another mind.

Using Freud's tension reducing model, a developing personality faces new anxiety at each new phase in the process. The function of anxiety is to warn of impending danger, causing internal tensions which must be relieved through the actions of the ego influenced by the superego, and are normally beneficial to the survival of the person. When anxiety is excessive, the ego uses unrealistic measures to cope. These measures are called defense mechanisms, and they usually operate at an unconscious level, denying or distorting reality. Freud identified the major defense reactions as repression, projection, reaction formation, fixation, and regression.

These defense mechanisms operate in different ways:

In a traumatic event, the individual may repress an experience from memory and into the unconscious. Such may be in the case of a rape. Using projection, the individual projects an unbearable real or perceived truth to some external person or object. "He hates me" rather than "I hate him". Reaction formation replaces in consciousness an anxiety producing impulse or feeling by its opposite. Denied expression of love is replaced by hate.

When anxiety is too intense, the person may become fixated at a level of development exhibiting behaviours which are inconsistent when compared to behaviours of normally developed individuals. A fifty year old woman may behave at an emotional and maturity level of a eight year old child. A person threatened by some external stimulus may regress to an earlier stage of development. For example, during a particularly stressful situation, a young adult may choose to return home to live with his/her parents for a more stable, secure, and less responsible existence.

Freud also emphasised the role of the early years of childhood in constructing the personality. His two principal mechanisms are identification and displacement. Identification is the process by which one assumes and embodies the characteristics of another within his own personality. "I'm just like daddy" . This identification may come about because of a positive attitude and emulation, or out of fear. I'd better be like dad because I don't want a spanking." . Freud's second major mechanism instrumental to personality development is displacement which may occur when the individual does not have access to its prime objective. For example, a man rejected in love, may substitute his express love to another woman. Displacement, in most cases is a compromise because there is no other choice.

Using these constructs, Freud was able to formulate a model which seemed to reflect reality. Using this model, he and others were able to logically and hypothetically reason an approach to entering the inner world of another person, attempt to understand the nature of the mechanisms by which this individual was motivated, and postulate hypotheses upon which a method of treatment could be applied to move the individual from a state of mental illness and neurosis to an improved frame of mind.

The investigation of the psyche, the analysis, is orchestrated by the psychoanalyst through the techniques of free association and verbal interaction to discover the counterforces operating within the client. The goal of the activity is to help the client understand the nature of his/her problems and to help him/her to reconstruct a more fulfilling and less painful approach to life. In more modern terminology, we could say that Freud indirectly identified the causes and process of differentiation which are now recognised to be at play in the development of the multiple personality disorder.

Neo-Freudian Variations
Carl Jung - Analytical Theory

Jung's model differs from Freud's in a key distinction that supposes two levels of unconscious, the base level collective conscious (what we would normally call "instinct"), and the personal unconscious, in which are stored the repressed or forgotten conscious experiences of the individual. This personal unconscious is comprised of complexes in which are stored the results of experience on an emotional level. For example, a "father complex" or a "power complex".

He described two basic character types or attitudes, the "introvert" and the "extrovert", and four functions of personality: "thinking", "feeling", sensing", and "intuiting". Each of his functions interacting with the complexes, can be viewed as a process and repository of resource information by which, or into which the personality experiences, integrates, and stores the emotional results of life experiences.

The two attitudes set the basis on which the personality evaluates and organises such results of experience; either from an internal or external perspective. He differs from Freud in that he assumes the personality development processes to be ongoing and cumulative, and that the motivation is to achieve an integration or unity of personality. Jung called the force of this drive the self.

This basic design of Jung's model describes an organisation of emotional and behavioral data held within the personality which directs the persons emotional perceptions and behaviours presented to the outside world. Both the personal unconscious and the collective unconscious act as personality resource repositories which the person uses to direct his behaviours. Jung's character types, attitudes and complexes can also be thought of as repositories of behaviour rules which are used by the individual to select his or her range of behaviours. This model is mentally abstract and without much form and cannot be accurately illustrated graphically, which to me signifies that the model is not one which cannot be clearly identified and used for the formation of hypotheses for treatment.

To Continuation of this paper...


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