ANTISOCIAL REACTION

A form of “socio- pathic personality disturbance” characterized by impulsive, egocentric, unethical behavior.The antisocial, or psychopathic, individual acts as if he has no conscience, no sense of responsibility, and no concern for the welfare of other people. He lives for the moment, fails to profit from experience, feels no genuine loyalty to any person, group, or code of behavior. He is clearly abnormal, yet he cannot be classified as neurotic, psychotic, or mentally retarded.This type of personality occupies a twilight zone between the ordinary individual and the hardened criminal. The category includes a varied assortment of unscrupulous businessmen, confidence men, shyster lawyers, quack doctors, crooked politicians, prostitutes, and impostors. They are rarely committed to mental hospitals (and therefore constitute only .1 per cent of first admissions) but sometimes serve jail or prison sentences for their offenses. Most of them, however, manage to keep out of the hands of the law and talk their way out of conviction.Psychopathic behavior is believed to be considerably more common among males than females.Psychiatrists have long had difficulty in interpreting and classifying this disorder. Prichard (1835) coined the phrase “moral insanity,” applying it to an individual in whom “the moral and active principles of the mind are strongly perverted and depraved,” making him “incapable ... of conducting himself with decency and propriety in the business of life.” The term “moral imbecile” was also widely used in the nineteenth century to indicate that these individuals were intellectually sound but ethically defective. Many investigators felt this was a congenital condition, and the term “constitutional psychopath,” or “constitutional psychopathic inferior” came into use. The inferiority was believed to consist primarily in insensitivity to moral distinctions and failure to develop warm and responsible personal relationships. This description seemed to apply to such a wide variety of personalities that many investigators sought to discard it as a catch-all, “wastebasket” concept, merely including individuals who could not be covered by the standard classifications.The next step was to eliminate the idea of constitutionality from the title and substitute the more general term “psychopathic personality.” The term “psychopathic” was then criticized as implying mental illness, and the American Psychiatric Association (1952) therefore renamed the disorder “antisocial personality,” defining it in the following way:“This term refers to chronically antisocial individuals who are always in trouble, profiting neither from experience or punishment, and maintaining no real loyalties to any person, group, or code. They are frequently calloused and hedonistic showing marked emotional immaturity, with lack of sense of responsibility, lack of judgment, and an ability to rationalize their behavior so that it appears warranted, reasonable, and justified.”This definition indicates that antisocial personalities may display a wide range of symptoms. Various recent writers (Cleckley, 1959; Heaton-Ward, 1963; Wirt et al. 1962) have attempted to list these symptoms in greater detail, although they recognize that they do not all apply to every case. The major features seem to be: (1) defective conscience: failure to understand, feel, and accept ethical standards in spite of glib assertions and pretensions; (2) good intelligence: used mainly to get around the law and rationalize immoral behavior, but without intellectual distortion in the form of delusions or hallucinations; (3) absence of anxiety: acts out tensions instead of transforming them into neurotic symptoms, and feels no sense of guilt for aggressive behavior;(4) a good front: an engaging, congenial manner which impresses others even while exploiting them; (5) inability to form attachments: a shallow emotional life with no sense of devotion, gratitude, or loyalty, usually accompanied by a promiscuous, irresponsible, and impersonal sex life; (6) disregard for truth: glibly makes promises he will never keep, often lies gratuitously, even when detection is certain, makes up stories to give his ego a lift (“pseu- dologia fantastica”); (7) self-defeating behavior: frustrates his own apparent aims by actions that bring on failure and disaster even at the height of success; (8) rejection of authority and discipline: hates to be held down and feels that ordinary social regulations do not apply to him; also feels hostile to constituted authority in school and society, and may engage in criminal activity without being a professional criminal;(9) lack of foresight: lives for the pleasures of the moment, disregards long- range goals; though he wants to “be somebody” and “have everything,” he will not plan or work for these goals;(10) extreme irresponsibility: tries to give the impression of reliability, but actually shrugs off all responsibility to family and friends; (11) failure to learn from experience: shows poor judgment and does not profit from mistakes; blames others for disasters entirely due to him; persists in his bad conduct even when he promises to change.There is little agreement about the origin of the antisocial personality pattern. Even though the term constitutional has been discarded from the title of this disorder, it is frequently pointed out that the general characteristics— particularly impulsive, egocentric, “acting out” behavior—appear early in life. Many authorities believe there is evidence of a hereditary neurologic disorder, but others have submitted contradictory reports.Some investigators (Hill and Watter- son, 1942; Silverman, 1944) have found abnormal electroencephalographs (EEG) patterns in 50 to 80 per cent of cases, but this finding has also been challenged. Others have pointed out that individuals whose brains have been damaged are not usually antisocial personalities, although epidemic encephalitis is sometimes followed by aggressive activity. A recent study by Stott (1962), however, has given the brain disorder theory some impetus. He found a positive relationship between congenital disorders and antisocial behavior, and attributed this behavior to impairment of higher control centers in the nervous system. Eysenck (1960) also argues that the psychopath lacks the ability to inhibit his impulses due to a basic defect, but he attributes the defect to a slower rate of conditioning than among normal individuals. More specifically, he believes that the psychopath does not develop an adequate conscience because he does not acquire the conditioned reactions that lead to normal social behavior. These investigations leave open the possibility that constitutional differences in the nervous system may be at least contributing factors in antisocial behavior.Even if antisocial individuals have a constitutional tendency to act out their impulses, we still have to explain why these impulses tend to be aggressive and egocentric. Today’s investigators are not satisfied with the simple assertion that they were “bom that way.” They have therefore attempted to search out psychological and environmental factors that might give rise to this particular “life style.” Undoubtedly community influences play a role in some cases, since crowded conditions and deprivation create hostile attitudes, and delinquent gangs set a pattern for antisocial behavior. But these do not appear to be the key factors for two reasons: psychopathic tendencies frequently make their appearance early in life, before neighborhood influences could have much effect; and antisocial individuals are by no means concentrated at the lower socioeconomic levels—in fact, a high percentage come from middle- and upper-class families.Investigators have therefore examined the home environment and parent- child relationships of psychopaths. Heaver (1943), Greenacre (1945), and others have found that in a large proportion of cases the mother was easygoing and overindulgent, and the father distant, stem, hard-driving, and highly successful. The child was not only caught between two conflicting sets of attitudes, but frequently the father was critical of the mother and the mother was contemptuous of her husband’s desire to be an important man. The child therefore failed to develop a deep attachment to either parent, although he usually found it easier to adopt the easygoing attitudes of his mother than to live up to his father’s expectations. In doing so, he developed a pattern of concealing and excusing himself for his inadequacies. These investigators also stress the fact that such families put on a good fagade in order to conceal their inner conflicts from the world. This, too, contributes to the shallowness of the child’s emotions and his feeling that he must put on an act to win social approval. It is not a far cry from such an attitude to the superficial charm and tendency to manipulate other people that characterize the antisocial personality. Nor is it hard to understand that a boy who has been rejected by a remote, fearsome father may become hostile and resentful toward all authority as he grows up.Although this family pattern seems to occur in many cases, Cleckley and others have pointed out that other background factors may lead to antisocial tendencies. Some fathers—mothers, too—serve as direct models for their children’s irresponsibility, egocen- tricity, and unethical behavior. Since they themselves have no regard for the rights of others and follow a policy of getting what they want by any means, the children follow suit.In spite of the fact that feelings of anxiety and guilt are not apparent on the surface, some authorities believe they are nevertheless present. Franz Alexander (1930) concluded that most destructive individuals, including psychopaths, have a “neurotic character” due to severe, unconscious conflicts, and interpreted their tendency to act out their impulses as an attempt to ward off anxiety. Others have suggested that the self-defeating behavior of these individuals is due to feelings of guilt and an unconscious need for punishment. This might help to account for their tendency to bring on disaster even in the midst of success, as well as their need to continue their illegal behavior until they are caught and convicted.In spite of these suggestions, a great many observers feel that the etiology of this disorder is still a mystery. Cleckley (1959), who has devoted a lifetime to the subject, states: “My own experience with psychopaths certainly does not suggest that they appear only in families of inferior moral or intellectual levels ... I have not regularly encountered any specific type of error in parent-child relations in the early history of my cases ... I do not believe that convincing evidence of the causal factors and developmental pattern of psychopathy has yet been established.”Successful treatment of the antisocial personality is largely a hope for the future. The behavior patterns of these individuals are so firmly established and they have so little self-understanding genuine desire to change, that they are extremely resistant to therapy of any kind. Standard psychoanalysis cannot be used with them, although experience with hypnoanalysis—a combination of analytic and hypnotic techniques—has resulted in some success (Lindner, 1945). Intensive, long-range psychotherapy is sometimes effective, although it is hard to get the patient to stay with the treatment. (Thorne, 1959).Milieu therapy, combining individual and group treatment with a warm and permissive environment, seems to be a promising approach. It has resulted in radical personality changes among many young boys at such residential treatment centers as the Wiltwyck School and the Hawthorne-Cedar Knolls School, both in New York. On the basis of experience in schools of this kind, as well as the experience of Maxwell Jones in his “therapeutic community” in England, it may be that the treatment of the future will take place in special institutions. Such institutions would utilize the total environment to encourage responsible behavior and redirection of the psychopath’s superior intelligence into constructive channels.The antisocial personality sometimes takes spectacular form, as illustrated in the account that follows:Illustrative case: ANTISOCIAL REACTION One of the boldest impostors of recent times was Ferdinand Waldo Demara, Jr. As an adolescent, he ran away from a rather tragic family situation and after unsuccessful attempts first to become a Trappist monk and then to teach school, he joined the army. Soon thereafter he went AWOL, joined the navy, and was assigned to duty on a destroyer during World War n. Here, by a ruse, he got hold of some navy stationery with which he managed to obtain the transcript of college grades of an officer who was on leave. He then “doctored” this transcript by substituting his own name and adding some courses; when photostated, it looked so impressive that he used it to apply for a commission. While waiting for his commission to come through, he amused himself by obtaining other records, including the full credentials of a Dr. French, who had received a Ph.D. degree in psychology from Harvard. Informed during a visit to Norfolk that he could expect his commission as soon as a routine security check was completed, he realized that such a check would surely expose him. Under cover of darkness, he left his navy clothes on the end of a pier with a note that “this was the only way out.”Now that Demara was “dead”—drowned in the oily waters off Norfolk—he became Dr. French. He obtained an appointment as Dean of Philosophy in a small Canadian college and taught courses in general, industrial, and abnormal psychology. Eventually, however, he had a disagreement with his superior and reluctantly left.During this period he had become friends with a physician by the name of Joseph Cyr and had learned a considerable amount about the practice of medicine from him during the cold winter months when neither man had much to occupy his time. Interested in the possibility of getting a license to practice in the States, the trusting doctor had given Demara a complete packet including baptism and confirmation certificates, school records, and his license to practice medicine in Canada.Using these credentials, Demara now obtained a commission as lieutenant in the Royal Canadian Navy. His first assignment was to take sick call each morning at the base. To help solve his problem of lack of knowledge in the field, he went to his superior officer and told him that he needed material to prepare a thumb guide for people in lumber camps, where physicians are not usually immediately available. His superior cooperatively compiled a small booklet which Demara then used faithfully as his guide. He also studied medical books and evidently picked up considerable additional medical knowledge. In any event, when later assigned as medical officer aboard a destroyer in the combat zone in Korea, he successfully performed a number of difficult operations. When his ship was sent to Japan for refitting, an eager young press information officer seized on Dr. Cyr’s exploits and gave them the full treatment. His copy was released to the civilian press and the “miracle doctor” became world famous. But the publicity proved to be his undoing, for it led to queries to the real Dr. Joseph Cyr as to whether the physician mentioned in the press release was a relative, and when Dr. Cyr saw the newspaper picture, he was shocked to find that it was his old friend.Dropped from the Canadian Navy without fanfare—largely because he had managed to get a license to practice medicine in England and was now a licensed physician—Demara went through a difficult period. Wherever he went, he was soon recognized, and he lost job after job. He managed to work for a year at a state school for retarded children and did so well that he received a promotional transfer to a state hospital for the criminally insane. Here he found that the patients seemed to be attracted to him and that he was able to communicate with them. The experience began to bother him and he started to drink heavily and eventually resigned.One morning after a prolonged drinking bout, he woke up in a Southern city and realized his drinking was getting out of hand. He joined the local chapter of Alcoholics Anonymous as Ben W. Jones, whose credentials he had acquired along the way. With the help of sympathetic friends in Alcoholics Anonymous and a few fraudulent references obtained by ingenious methods, he was hired as guard in a state penitentiary. Here he did a remarkable job, instituting a number of badly needed reforms in the maximal security block. Again he found himself able to communicate with the men, and he was promoted to assistant warden of maximal security. Ironically, one of his reform measures was to ask the townspeople to contribute old magazines, and before long one of the prisoners read the issue of Life which contained his picture and case history and recognized the new assistant warden.Trying to get away lest he wind up as a prisoner in the same penitentiary, Demara was jailed in a nearby state and given considerable publicity but eventually released. Some time later he telephoned the author from whose book this material is adapted to say, “I’m on the biggest caper of them all. Oh, I wish I could tell you.” (Adapted from Crichton, 1959)