THE ANTISOCIAL CHARACTER Louis R. Hott
In the early 1950s, I interviewed a 20-year-old man on the prison ward at Bellevue Psychiatric Hospital who had planned, conspired, and helped commit a double murder with ruthless disregard for the consequences of his actionsJ In a very businesslike way he had persuaded a companion, a schizophrenic who was an only son of two physicians, to poison them by having them both drink champagne, which the instigator had filled with arsenic, on the parents' wedding anniversary night at a "celebration" by this foursome. The police listed their deaths as a double suicide for more than a year. Meanwhile, a life insurance policy of $150,000 was shared by the two youths. The reason for their eventual arrest was my patient's need to impress his girlfriend by constantly boasting of his role in killing his friend's parents; she eventually informed the police about the crime. As a result, both young men were placed on the prison ward for examination and observation. The couple's son was diagnosed as a schizophrenic and my patient as a "psychopathic personality." During my psychiatric interviews with him, he neither showed consciously remorse, guilt, shame, nor anxiety, nor did he admit feeling any of these emotions. He admitted readily to his part in the murder, which he said was, to him, an experience similar to Oscar Wilde's "In Search of a New Experience." He did not have any remorse about his actions, except for the regret he felt about being apprehended and imprisoned. He admitted seeing nothing wrong with murder, stealing, or any other immoral or amoral actions, provided he or anyone else could "get away with it." He showed no psychotic illness or symptoms. I demonstrated that his unconscious, idealized image of perfectionistic behavior, with its unrelenting "shoulds" of absolute moralistic standards and unconscious guilt and anxiety, was so burdensome to him that he felt that the only way to relieve himself of this powerful pressure was to externalize his problems and overthrow in one fell swoop all of these social pressures, by Louis R. Hott, M.D., Medical Director Emeritus, Karen Horney Psychoanalytic Clinic; Assistant Clinical Professorof Psychiatry, New York University School of Medicine. The American Journal of Psychoanalysis © 1979 Association for the Advancement of Psychoanalysis
Vol. 39, No. 3, 1979 0002-9548179/030235-10501.00
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trying to rid himself completely of any feelings of conscience, as well as conscious guilt, anxiety, or other humane feelings. As he often said, "1 do not believe in your kind of morality." His past history and disturbed family background were typical of his problem. During the late 1960s, I was concerned by the growing worldwide group and individual violence, which produced a marked disturbance in people's mutual-respect. 8 In 1974, in a lecture honoring my late close friend and associate Dr. Andrew Bernath, who had spent two years in a Nazi concentration camp, I discussed "Individual Aggression and a Violent Society. ''9 I was then influenced by a series of violent, senseless crimes in San Francisco, as well as the tragedy of the Watergate scandal. One of my primary concerns was preventing compulsive antisocial character behavior, individually or in groups, and attempting to help build a more hopeful society. I would like to consider the history of a man whose parents were both very troubled. His father was illegitimate and poor, and had two unsuccessful marriages. The father's third wife was his second cousin, 23 years his junior. Their son was the individual I am discussing. The family moved seven times, causing the child to change schools five times. He did poorly in school, and had sudden outbursts of temper. He never finished high school and ran away from home. He had no stable environment. At age 17 he lived in Vienna, living literally the life of a tramp, sleeping in flophouses and gutters, roaming the streets, never working. He called himself an artist and dressed shabbily in a bohemian style, wearing cast-off Hassidic clothing given to him by a Jewish clothes dealer. He was an unwashed tramp, cunning, shrewd, articulate, living by his wits. After seven years living this way, he moved to Munich, Germany, as a vagabond in order to escape military service in Austria. In Munich, he was a derelict, described by his friends as cunning, cold, ruthless, detached, alienated, shrewd, lacking self-control, unable to accept discipline, having no remorse, conscience, overt guilt or anxiety. He would do anything to exploit, get his own way, and shape events to suit his own needs. He had developed a magnetic force in his speech, using arrogance, lies, and cunning to worm himself into high government service. He felt that he had a mission to convince people to follow his way. He described his own youth as a hard struggle for survival and self-assertion. He stated freely that he was "the only one who is right and no one else matters." He convinced many people that he could lead them to achieve the impossible goals of grandeur and the magical solutions of power and wealth through his cunning artistry and ruthless deception, without guilt, remorse, anxiety, or concern. He often openly boasted of this in his autobiography. His name was Adolph Hitler. s'6'I° This brings us to our present topic--the antisocial character. Let me quote from the New York Times:
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On the front stoop of a renovated tenement on 119th Street and Second Avenue the other day, the Harlem Renegadessat dri nking scotch and soda from plastic cups without benefit of ice to relieve the afternoon's humidity. It was another gray and sticky day, just one more in a string of them. When you say summer, you say the streets, muggings, robbings, killings, said Eulogia Cedeffo, leader of the Renegades,is I would like to mention that the renovated tenement mentioned on 119 th Street was where I spent my early childhood, before this so-called renovation took place, and the cohesive, pleasant neighborhood I knew then has become the battlefield of the sick antisocial characters today. Here, however, I want to differentiate between the compulsive, sick, antisocial character and the spontaneous, free, healthier individual who is antiviolence, whom I did not consider earlier in my concern with antisocial characters and their behavior. Before going into the basic differences between these two groups, it would be clearer to differentiate them from those asocial characters who are not able to live in a social setting of any kind. These are the individuals who have withdrawn their interest from the environment almost entirely and transferred most of their psychic energies to a way of life that eventually has no relationship to reality. They have a narcissistic preoccupation of such proportions that there is a marked dissociation of thoughts from any feelings. I would like to reemphasize that the sick antisocial character is not psychotic and does not manifest any of the usual psychotic symptomatology. The sick antisocial character is the one who is compulsively, chronically driven to be hostile to society's well-being, as well as to his or her own well-being, without conscious conflict, control, anxiety, guilt, knowledge, or concern about these actions. However, there is another group of people, who are antiviolence, who are not compulsively driven, but who appear to be more spontaneously involved and interested in the good of society, as well as their own welfare. This group does not have the apparent irrational and self-aggrandizing motives of the antisocial characters, who are sick, compulsive, and destructive to themselves and society. The healthier so-called antiviolence person can and will often stand up for his or her rights, participating not only as an individual, but also in a collective group. These persons show spirit, purpose, and knowledge of methods, and are involved in decisions and actions that express a point of view, as part of the cultural aspects of the environment and of life itself. Above all, their motivation is not compulsive and is not destructive for the sake of destruction. They are stimulated by humane reasons--even if some of us may disagree with their point of view or philosophy. Because they are against the social injustice that they have experienced, they technically may be viewed as antisocial only in their behavior in a specific sense of here and now.
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However, they can and do live with others in a nonisolated community, as a total body with real concern for life, welfare, and the good of all mankind. Their purpose is to secure the welfare of all, living together with loyalty and morality. Companionship with others is most important, as well as the acceptance of a division of duties and work. Their primary incentives are to hold society together by mutual relationships and interdependencies; they have a capacity to form close personal and group attachments. This unique appearance and limited antisocial specific form of behavior development is quite different from the sick, permanently compulsive, antisocial character pathologically destructive to self and others in a sociopathic-psychopathic manner. It is important to be able to distinguish between these two separate forms of antisocial behavior. In early American history, antisocial-like behavioral reactions occurred when the colonists rose up against British rule back in 1688, long before the Declaration of Independence. At present, an ideological reorientation is also taking place, in order to establish new aspects of social justice. A transformation of the old establishment, with alternative life styles, is in order. Our institutions and ideologies may need to be restructured. This new generation is more committed to a real sense of brother- and sisterhood, as well as to ecological balance, social sharing, decentralized government, and regional and true democratic revival. These positive, healthy, specific, time-limited antisocial people, as I see it, are interested in their own and society's creativeness and spontaneity. Their main purpose is to bring about a better and newer form of constructive living. Now I would like to return to that negative, sick, destructive, and compulsive antisocial character who is without the capacity to form any real and significant attachments, loyalties to person, self, group, and without any sense of codes, except, perhaps, in a form of subcultural society, which fulfills merely a narcissistic, self-aggrandizing need. These chronically ill, compulsive antisocial characters are extremely callous, seek immediate gratification and pleasure, and lack the potential to withstand normal human frustrations. They are devoid of any sense of responsibility. In spite of repeated punishment, education, or rehabilitation, they fail to learn to modify their behavior. They lack social judgment and utilize verbal rationalizations at will. They are convinced that their actions are reasonable and warranted, despite repeated evidence to the contrary. They have failed to develop a socialized self-concept and a socialized view of others. Their motivation is merely for self-aggrandizement, with the acquisition of power, idealization, money, material goods, and self-glorification, as well as control of others for their own immediate pleasure and satisfaction. In various studies of the sick, compulsive antisocial character, the following etiological factors, individually or in combination, often exist. (It is helpful to
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recall the history of Adolph Hitler.) Usually, it begins with the individual being an unwanted or illegitimate child. The mother often lives a pathological life style, with few resources to offer the child, presenting constant negative attitudes toward the child's birth and growth. This may be true of the father, as well. The child very often feels that it fails to live up to the unreasonable, fantasized requirements of both parents. Often, desertion, divorce, institutionalization, and foster homes are part of the history. These children are also often exposed to overt violence and abuse by parents and others. The use of alcohol and drugs, sexual problems, and the like are part of the background of the family of the potentially sick, compulsive, antisocial character. The family usually moves frequently, offering no stable roots for the child to develop. Authority goals for this growing child are never clearly established. Rarely is mature affection, tenderness, or trust shown. There is always a lack of parental cooperation with authority, either overtly or covertly. This child, who will become the sick, blindly compulsive antisocial character later in life, cannot identify with parental role models of socialization or values of society. Parental distortions of authority are often present. This concept of the sick antisocial character began as early as 1806 with Pinel's case of manie sans de/ire ("mania without delirium") in a French peasant, who in a fit of rage threw a woman down a well. 19This was the first description of the sick antisocial character. In 1835, Prichard used the term "moral insanity," which he said affected only the morality of the individual. 2° In 1888, Koch called this disturbance "psychopathic inferiority," and then developed this into the concept of "constitutional psychopathic inferiority. ''13 In the twentieth century, the constitutional aspect was abolished and replaced by the concept of the "psychopathic personality," which was in use until 1952; it included various pathological emotional states of so-called "hysterical personalities," or "pathological sexuality," which are really sexual deviations and perversions. The well-known concept of the psychopathic personality with amoral and antisocial trends also included compulsive antisocial personality disturbances, with additional aspects of dyssocial behavior. In 1952, compulsive antisocial personalities were always included under sociopathic personality disturbances, similar to Partridge's classification in 1930. SociopatNc personalities similar to psychopathic personalities included subgroups of drug addiction, alcoholism, sexual problems, dyssocial and antisocial reactions. It is important to note here that the dyssocial individual has problems with society and therefore is considered deviant in socialized behavior. However, this is not the same as the antisocial compulsive sick character, who is blindly against society, as the dyssocial person has personal difficulty and conflicts with society because of a prior abnormal or ethnically different moral envi-
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ronmental life experience. Nevertheless, the dyssocial person is still capable of warm, loyal, and close feelings. "Dyssocial" means having a problem with society. A strictly antisocial character is blindly against that society with compulsive, destructive, uncontrollable drives. What are the early signs of the potentially sick antisocial character? Emotional immaturity, with a lag in emotional growth, is one of the earliest and most important indicators of things to come. ,at one time, this problem was more common among men. However, now it appears that more women are also showing these antisocial character problems, perhaps as part of women's newer and increasing role in society. These compulsive antisocial characters also have the quality of being impulsive, responding instantly to their own primitive desires and feelings. Their personalities are dominated by primitive drives, to the exclusion of rational behavior. They never really learn true socialized lines of conduct, and will be oversensitive, stubborn, with frequent outbursts of temper tantrums and senseless rage, even as youngsters. At an early age, they will often steal, run away, be uncontrollable, enuretic, destructive, sulky, quarrelsome, deceitful, obstinate, defiant, boastful, shameless, and erratic. Often the antagonism or open rebellion will be against an obviously dominating parent. As adolescents they will resist the ideals and mores of family, and will often tend to socialize on lower levels. Deceit, sadism, lack of delicacy and affection, selfishness, ungratefulness, narcissism, exhibitionism, egocentricity, demanding everything and giving nothing to others are characteristic hallmarks of these people. They have no critical awareness of their motivations and are unable to judge their own behavior as different from anyone else's. They thus lack conscious feelings of anxiety, loyalty, guilt, or remorse, and are often restlessly searching for unattainable goals. Thus, they have no real, healthy goals and seem superficially satisfied with their inadequate hostile activities. They cannot stand any routines, jobs, or requirements. They demand immediate gratification of their desires and wishes, without concern for others' feelings or interests. Most important, they are unable to form real relationships, due to such severe alienation, detachment, and a compulsive lack of any sense of social values. This makes them unreliable, callous, selfish, irresponsible, impulsive, guiltless, without conscience or conscious feelings of anxiety. They are unable to learn or benefit from previous experiences. Even though these persons often appear charming, plausible, and talkative, they must dominate their environment, and they utilize externalization as a main form of defense to blame others. Their acting-out behavior, based on their shallow living, can lead to bizzare, criminal, or extreme eccentric behavior. Their personalities have a type
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of lacunal defect, which limits them to a single form of behavior, such as stealing, lying, swindling, or promiscuity, to fill the emptiness they experience. Frequently, encouragement by their environment of ambivalent, hypocritical, and double-bind messages leads to greater solidification of this sick antisocial character development. The psychopathology of these sick antisocial characters is clearly based on amoral and ethical blunting, with no sympathy for their fel low human bei ngs. Their behavior continues to be destructive to all social order. Their emotional lives are superficial and shallow, making them incapable of mature relationships and unable to feel deeper emotions, especially love. Since they cannot organize constructive expressions of healthy feelings of assertion, they will appear to lack real ambition, application, seriousness of purpose, or foresight. As Jenkins said, they have failed in the main process of socialization. 11They thus become unstable, irritable, arrogant, vindictive, and brutal, without remorse for their actions against society. They have compulsive, rebellious attitudes toward authority and society and strong feelings of inner emptiness, producing vicarious shallow living with cynicism and lack of shame, honor, or sympathy. They cannot experience affection or gratitude, or other social and esthetic sentiments, because of this severe inner emptiness. Frustrations can cause uncontrollable dangerous actions, because of such severe alienation. As a result, they feel neither remorse nor conscious guilt about theft, embezzlement, forgery, sexual attack or other violence. They will even take perverse pleasure in their constant struggle with the law, with feelings of unhealthy compulsive pride in their illegal accomplishments. It must always be borne in mind that cultural, economic, and social forces may determine antisocial character behavior, or provoke it in one who is even so predisposed. A clarification of standards of character and a sense of authority have to be established if help is to be given to these people. Often, treatment of entire families or parental involvement in treating the compulsive antisocial character is required. Dealing with hostility and allowing increased anxiety and guilt to develop are positive assets in treatment, in other words, our goal at the beginning of treatment is to help them become at least more "neurotic," in terms of openly and consciously experiencing anxiety and guilt. We must keep in mind that neurotic character disturbances are really quite different from antisocial characters. Antisocial characters attempt to resolve conflicts by amoral or antisocial behavior, rather than through neurotic symptoms. The neurotic character disorder compulsively acts out, in order to relieve the excessive anxiety and guilt, with a related search and need for punishment. The neurotic character does feel conscious guilt, shame, and unworthiness, and is able to develop a social code of ethics. Thus it would be helpful for the sick,
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compulsive antisocial character to experience these feelings. It frequently becomes necessary for this compulsive antisocial character, who is influenced by pernicious social and cultural factors, to be removed from the influence of this environment and placed in a warm, humane, accepting environment in which a therapeutic relationship--individually or in groups--can develop. The use of warm substitute parental figures is important here. By doing this, a clarification of standards of behavior and a sense of authority are established. In studies of chronic criminals and the unhealthy antisocial character, a chaotic home environment, with early deprivation, parental separation, rejections, and deviances has been the common denominator in all of these instances. Studies by Bowlby2 and Goldfarb 3 suggested a relationship between maternal deprivation in early life and severe personal disorders later. Their studies often showed that delinquents were frequently found to be the product of maternal deprivation, specifically in the first five years of life. No feelings of love or affection were shown these children, who, therefore, could not form later meaningful interpersonal or intrapsychic relationships. Follow-up studies confirmed these findings. Retrospective and control led repeated studies of sick antisocial characters continue to show these findings. Rutter studied maternal deprivations and family discord as causes of compulsive antisocial character development. ~ Lewis also showed the same,14 as did Robins, 21 who studied 524 children referred for unhealthy antisocial character behavior and followed them for 30 years. Socialization is developed through adequate, consistent, and honest discipline. Twin studies also have shown that environmental and social influences, rather than hereciity, play the crucial role. Sick antisocial characters are incapable of love, according to Kernberg, 12 because of their extreme narcissism. Bok1 defines a lie as a statement made with intention to mislead. She justifies some lying, as in Samuel Johnson's case of misdirecting a thief who asks the direction in which his victim has fled. She attempts to determine when a lie is justifiable or not. If the survival of another innocent person or oneself is at stake, then lying is in order. She refers to moral reasons for and against lying. Use of placebos by doctors or not telling a patient the truth if he is dying are considered to be unethical lying. She also concerns herself with the ethics of social science researchers who deceive their subject~ for the sake of an experiment. She gives the example of Milgrim's experimentff in which the subjects were told they were sending increasingly painful electric shocks into people who were really actors feigning increased pain. These people were misled, and as a result, did what they felt legitimate authorities wanted them to do, in spite of the supposedly sadistic pain they were inflicting. This she called "professional deceit"; people were misled and also given to believe that as long as an authority approves, they could cause pain to anyone or do anything they are told to do
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by authority, regardless of how antisocial their actions may be. "We only followed orders" is a well-known phrase by now. A recent study of moral judgment and moral conduct in the psychopath is found that the latter's achievement of high scores on moral reasoning was due to a lack of feeling guilt. The study distinguishes between the poor moral judgment and higher moral knowledge, as well as the discrepancy between knowledge and conduct, in the psychopath. This is similar to my concept of the psychopath's unconscious unreasonable idealized standards. This study demonstrated six stages of development of moral judgment. Stage one is the orientation to one's own primary needs and the fear of punishment. Stagetwo is the unconditional satisfaction of personal desires. Stage three is the beginning of a spontaneous desire to have others think well of one, by adhering to social norms. Stage four is the acceptance of authority. Stage five is the acceptance of contractual legislative principles. Stage six is the development of conscience. A breakdown of these stages can lead to antisocial character development of an unhealthy compulsive form. The therapy of the sick antisocial character is often successful if a therapeutic community is used for group or individual therapy, combined with a job-related controlled environment. The use of authority of a legitimate nature and of punishment that is also rewarding and that allows for development of experiencing conscious anxiety, guilt, love, and other positive feelings is required. Because of their inadequate inhibitions and inability to experience consciously normal anxiety, these people must be helped to establish their own internal as well as external controls. Our goal is to help them become real human beings with all of the conscious anxieties, guilts, and feelings that people experience. I have also tried to differentiate the unhealthy compulsive antisocial character from what I would call a healthier, noncompulsive person who is trying to reach not only individual fulfillment, but also social betterment. I believe that this newer concept of a healthier antisocial behavior-type person is an important development in our present society. A recent NIMH study,4 suggests that those with highest levels of norepinephrine in the limbic system of the brain, aiid the lowest levels of serotonin, had the highest rate of aggressive, hostile, destructive behavior. ~Serotonin is thought to dampen aggressive drives and control impulses. Also, the study claims that serotonin is higher in females than in males. Therefore, a person with large amounts of serotonin may get angry but is unlikely to translate that feeling into action. Norepinepherine, on the other hand, is the chemical brain messenger that allegedly sustains those hostile aggressive drives. Therefore, treatment of such aggression with use of medication that will enhance serotonin synthesis, or at the sametime dampen norepinephrine synthesis, is indicated. The study does not question whether the so-called chemical imbalances described are inherited, environmentally caused, or
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both. However, one of the authors, Goodwin, did state that even though the chemical balance of the brain could be a genetic endowment, nevertheless, some permanent chemical changes in the brain may be caused by destructive negative child-rearing practices. Thus, the age-old question "Does sadness cause tears, or do tears cause sadness?" is again implied. It is axiomatic, as far as I can see, that a holistic relationship exists between environmental influences and genetic predispositions, or endowments. Thus, we all are influenced by our total experiences, external and internal, upon our basic unique endowments from conception throughout life; from the womb to the tomb. References
1. Bok, S. Lying, Moral Choice in Public and Private. New York: Pantheon, 1976. 2. Bowlby, J. Forty-four juvenile thieves. Int. J. Psychiatry, 25(19): 107, 1944. 3. Goldfarb, W. Psychological privation in infancy and subsequent adjustment. Am. J. of Orthopsychiatry, 15: 247, 1945. 4. Goodwin, B., et al. N.I.M.H. Report of Biochemical Links to Aggression. Presented at the American Psychiatric Association, Atlanta, GA, May 1978. 5. Heiden, K. Der Fuehrer. Cambridge: Riverside Press, 1944. 6. Hitler, A. Mein Kampf, (Am. ecl.). Boston: Houghton Mifflin, 1941. 7. Hott, L. R. Reflections on psychopathic personality. Lecture at the New York Academy of Medicine, May 26, 1954. 8. Hott, L. R. Individual and massaggression. Behav. Neuropsychiatry, August 1970. 9. Hott, L. R. Individual aggression and a violent society. Am. J. Psychiatry, 34: 305-310, 1974. 10. Joseph. W. C. The Mind of Adolph Hitler. New York: Basic Books, 1972. 11. Jenkins,P,.L. The psychopathic or anti-social personality.J.Nerv. Ment. Dis., 131 : 318, 1960. 12. Kernberg, O. Borderline Conditions and Pathological Narcissism. New York: Jason Aronson, 1975. 13. Koch, J. A. L. Psychopathic Inferiority, 1888. 14. Lewis, H. Depressed Children. London: Oxford University Press, 1954. 15. Link, Scherer, and Byrne. Moral judgment and moral conduct in the psychopath. Can. Psychiatr. Assoc. J., 1978, as reported in Psychiatric News, April 21, 1978. 16. Maitland, L. Crime in the city is a seasonal matter. The New York Times, August 5, 1978. 17. Milgram, S. Obedience to Authority. New York: Harper & Row, 1973. 18. Partridge, G. E. 5ociopathic Personalities. 1930. 19. Pinel, P. A Treatise on Insanity (Manie sans Delire). New York: Hafner, 1962. 20. Prichard, J. C. A Treatise on Insanity. London: Gilbert and Piper, t835. 21. Robins, L. R. Deviant Children Crown U p - - A 5ociological and Psychiatric Study of Sociopathic Personality. Baltimore: Williams & Wilkins, 1966. 22. Rutter, M. Parent-child separation: psychological effects on children. J. Child Psychol. Psychiatry, 12: 233, 1971. Reprint requests to 301 E. 62nd St., New York, NY 10021.
In the early 1950s, I interviewed a 20-year-old man on the prison ward at Bellevue Psychiatric Hospital who had planned, conspired, and helped commit a double murder with ruthless disregard for the consequences of his actionsJ In a very businesslike way he had persuaded a companion, a schizophrenic who was an only son of two physicians, to poison them by having them both drink champagne, which the instigator had filled with arsenic, on the parents' wedding anniversary night at a "celebration" by this foursome. The police listed their deaths as a double suicide for more than a year. Meanwhile, a life insurance policy of $150,000 was shared by the two youths. The reason for their eventual arrest was my patient's need to impress his girlfriend by constantly boasting of his role in killing his friend's parents; she eventually informed the police about the crime. As a result, both young men were placed on the prison ward for examination and observation. The couple's son was diagnosed as a schizophrenic and my patient as a "psychopathic personality." During my psychiatric interviews with him, he neither showed consciously remorse, guilt, shame, nor anxiety, nor did he admit feeling any of these emotions. He admitted readily to his part in the murder, which he said was, to him, an experience similar to Oscar Wilde's "In Search of a New Experience." He did not have any remorse about his actions, except for the regret he felt about being apprehended and imprisoned. He admitted seeing nothing wrong with murder, stealing, or any other immoral or amoral actions, provided he or anyone else could "get away with it." He showed no psychotic illness or symptoms. I demonstrated that his unconscious, idealized image of perfectionistic behavior, with its unrelenting "shoulds" of absolute moralistic standards and unconscious guilt and anxiety, was so burdensome to him that he felt that the only way to relieve himself of this powerful pressure was to externalize his problems and overthrow in one fell swoop all of these social pressures, by Louis R. Hott, M.D., Medical Director Emeritus, Karen Horney Psychoanalytic Clinic; Assistant Clinical Professorof Psychiatry, New York University School of Medicine. The American Journal of Psychoanalysis © 1979 Association for the Advancement of Psychoanalysis
Vol. 39, No. 3, 1979 0002-9548179/030235-10501.00
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trying to rid himself completely of any feelings of conscience, as well as conscious guilt, anxiety, or other humane feelings. As he often said, "1 do not believe in your kind of morality." His past history and disturbed family background were typical of his problem. During the late 1960s, I was concerned by the growing worldwide group and individual violence, which produced a marked disturbance in people's mutual-respect. 8 In 1974, in a lecture honoring my late close friend and associate Dr. Andrew Bernath, who had spent two years in a Nazi concentration camp, I discussed "Individual Aggression and a Violent Society. ''9 I was then influenced by a series of violent, senseless crimes in San Francisco, as well as the tragedy of the Watergate scandal. One of my primary concerns was preventing compulsive antisocial character behavior, individually or in groups, and attempting to help build a more hopeful society. I would like to consider the history of a man whose parents were both very troubled. His father was illegitimate and poor, and had two unsuccessful marriages. The father's third wife was his second cousin, 23 years his junior. Their son was the individual I am discussing. The family moved seven times, causing the child to change schools five times. He did poorly in school, and had sudden outbursts of temper. He never finished high school and ran away from home. He had no stable environment. At age 17 he lived in Vienna, living literally the life of a tramp, sleeping in flophouses and gutters, roaming the streets, never working. He called himself an artist and dressed shabbily in a bohemian style, wearing cast-off Hassidic clothing given to him by a Jewish clothes dealer. He was an unwashed tramp, cunning, shrewd, articulate, living by his wits. After seven years living this way, he moved to Munich, Germany, as a vagabond in order to escape military service in Austria. In Munich, he was a derelict, described by his friends as cunning, cold, ruthless, detached, alienated, shrewd, lacking self-control, unable to accept discipline, having no remorse, conscience, overt guilt or anxiety. He would do anything to exploit, get his own way, and shape events to suit his own needs. He had developed a magnetic force in his speech, using arrogance, lies, and cunning to worm himself into high government service. He felt that he had a mission to convince people to follow his way. He described his own youth as a hard struggle for survival and self-assertion. He stated freely that he was "the only one who is right and no one else matters." He convinced many people that he could lead them to achieve the impossible goals of grandeur and the magical solutions of power and wealth through his cunning artistry and ruthless deception, without guilt, remorse, anxiety, or concern. He often openly boasted of this in his autobiography. His name was Adolph Hitler. s'6'I° This brings us to our present topic--the antisocial character. Let me quote from the New York Times:
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On the front stoop of a renovated tenement on 119th Street and Second Avenue the other day, the Harlem Renegadessat dri nking scotch and soda from plastic cups without benefit of ice to relieve the afternoon's humidity. It was another gray and sticky day, just one more in a string of them. When you say summer, you say the streets, muggings, robbings, killings, said Eulogia Cedeffo, leader of the Renegades,is I would like to mention that the renovated tenement mentioned on 119 th Street was where I spent my early childhood, before this so-called renovation took place, and the cohesive, pleasant neighborhood I knew then has become the battlefield of the sick antisocial characters today. Here, however, I want to differentiate between the compulsive, sick, antisocial character and the spontaneous, free, healthier individual who is antiviolence, whom I did not consider earlier in my concern with antisocial characters and their behavior. Before going into the basic differences between these two groups, it would be clearer to differentiate them from those asocial characters who are not able to live in a social setting of any kind. These are the individuals who have withdrawn their interest from the environment almost entirely and transferred most of their psychic energies to a way of life that eventually has no relationship to reality. They have a narcissistic preoccupation of such proportions that there is a marked dissociation of thoughts from any feelings. I would like to reemphasize that the sick antisocial character is not psychotic and does not manifest any of the usual psychotic symptomatology. The sick antisocial character is the one who is compulsively, chronically driven to be hostile to society's well-being, as well as to his or her own well-being, without conscious conflict, control, anxiety, guilt, knowledge, or concern about these actions. However, there is another group of people, who are antiviolence, who are not compulsively driven, but who appear to be more spontaneously involved and interested in the good of society, as well as their own welfare. This group does not have the apparent irrational and self-aggrandizing motives of the antisocial characters, who are sick, compulsive, and destructive to themselves and society. The healthier so-called antiviolence person can and will often stand up for his or her rights, participating not only as an individual, but also in a collective group. These persons show spirit, purpose, and knowledge of methods, and are involved in decisions and actions that express a point of view, as part of the cultural aspects of the environment and of life itself. Above all, their motivation is not compulsive and is not destructive for the sake of destruction. They are stimulated by humane reasons--even if some of us may disagree with their point of view or philosophy. Because they are against the social injustice that they have experienced, they technically may be viewed as antisocial only in their behavior in a specific sense of here and now.
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However, they can and do live with others in a nonisolated community, as a total body with real concern for life, welfare, and the good of all mankind. Their purpose is to secure the welfare of all, living together with loyalty and morality. Companionship with others is most important, as well as the acceptance of a division of duties and work. Their primary incentives are to hold society together by mutual relationships and interdependencies; they have a capacity to form close personal and group attachments. This unique appearance and limited antisocial specific form of behavior development is quite different from the sick, permanently compulsive, antisocial character pathologically destructive to self and others in a sociopathic-psychopathic manner. It is important to be able to distinguish between these two separate forms of antisocial behavior. In early American history, antisocial-like behavioral reactions occurred when the colonists rose up against British rule back in 1688, long before the Declaration of Independence. At present, an ideological reorientation is also taking place, in order to establish new aspects of social justice. A transformation of the old establishment, with alternative life styles, is in order. Our institutions and ideologies may need to be restructured. This new generation is more committed to a real sense of brother- and sisterhood, as well as to ecological balance, social sharing, decentralized government, and regional and true democratic revival. These positive, healthy, specific, time-limited antisocial people, as I see it, are interested in their own and society's creativeness and spontaneity. Their main purpose is to bring about a better and newer form of constructive living. Now I would like to return to that negative, sick, destructive, and compulsive antisocial character who is without the capacity to form any real and significant attachments, loyalties to person, self, group, and without any sense of codes, except, perhaps, in a form of subcultural society, which fulfills merely a narcissistic, self-aggrandizing need. These chronically ill, compulsive antisocial characters are extremely callous, seek immediate gratification and pleasure, and lack the potential to withstand normal human frustrations. They are devoid of any sense of responsibility. In spite of repeated punishment, education, or rehabilitation, they fail to learn to modify their behavior. They lack social judgment and utilize verbal rationalizations at will. They are convinced that their actions are reasonable and warranted, despite repeated evidence to the contrary. They have failed to develop a socialized self-concept and a socialized view of others. Their motivation is merely for self-aggrandizement, with the acquisition of power, idealization, money, material goods, and self-glorification, as well as control of others for their own immediate pleasure and satisfaction. In various studies of the sick, compulsive antisocial character, the following etiological factors, individually or in combination, often exist. (It is helpful to
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recall the history of Adolph Hitler.) Usually, it begins with the individual being an unwanted or illegitimate child. The mother often lives a pathological life style, with few resources to offer the child, presenting constant negative attitudes toward the child's birth and growth. This may be true of the father, as well. The child very often feels that it fails to live up to the unreasonable, fantasized requirements of both parents. Often, desertion, divorce, institutionalization, and foster homes are part of the history. These children are also often exposed to overt violence and abuse by parents and others. The use of alcohol and drugs, sexual problems, and the like are part of the background of the family of the potentially sick, compulsive, antisocial character. The family usually moves frequently, offering no stable roots for the child to develop. Authority goals for this growing child are never clearly established. Rarely is mature affection, tenderness, or trust shown. There is always a lack of parental cooperation with authority, either overtly or covertly. This child, who will become the sick, blindly compulsive antisocial character later in life, cannot identify with parental role models of socialization or values of society. Parental distortions of authority are often present. This concept of the sick antisocial character began as early as 1806 with Pinel's case of manie sans de/ire ("mania without delirium") in a French peasant, who in a fit of rage threw a woman down a well. 19This was the first description of the sick antisocial character. In 1835, Prichard used the term "moral insanity," which he said affected only the morality of the individual. 2° In 1888, Koch called this disturbance "psychopathic inferiority," and then developed this into the concept of "constitutional psychopathic inferiority. ''13 In the twentieth century, the constitutional aspect was abolished and replaced by the concept of the "psychopathic personality," which was in use until 1952; it included various pathological emotional states of so-called "hysterical personalities," or "pathological sexuality," which are really sexual deviations and perversions. The well-known concept of the psychopathic personality with amoral and antisocial trends also included compulsive antisocial personality disturbances, with additional aspects of dyssocial behavior. In 1952, compulsive antisocial personalities were always included under sociopathic personality disturbances, similar to Partridge's classification in 1930. SociopatNc personalities similar to psychopathic personalities included subgroups of drug addiction, alcoholism, sexual problems, dyssocial and antisocial reactions. It is important to note here that the dyssocial individual has problems with society and therefore is considered deviant in socialized behavior. However, this is not the same as the antisocial compulsive sick character, who is blindly against society, as the dyssocial person has personal difficulty and conflicts with society because of a prior abnormal or ethnically different moral envi-
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ronmental life experience. Nevertheless, the dyssocial person is still capable of warm, loyal, and close feelings. "Dyssocial" means having a problem with society. A strictly antisocial character is blindly against that society with compulsive, destructive, uncontrollable drives. What are the early signs of the potentially sick antisocial character? Emotional immaturity, with a lag in emotional growth, is one of the earliest and most important indicators of things to come. ,at one time, this problem was more common among men. However, now it appears that more women are also showing these antisocial character problems, perhaps as part of women's newer and increasing role in society. These compulsive antisocial characters also have the quality of being impulsive, responding instantly to their own primitive desires and feelings. Their personalities are dominated by primitive drives, to the exclusion of rational behavior. They never really learn true socialized lines of conduct, and will be oversensitive, stubborn, with frequent outbursts of temper tantrums and senseless rage, even as youngsters. At an early age, they will often steal, run away, be uncontrollable, enuretic, destructive, sulky, quarrelsome, deceitful, obstinate, defiant, boastful, shameless, and erratic. Often the antagonism or open rebellion will be against an obviously dominating parent. As adolescents they will resist the ideals and mores of family, and will often tend to socialize on lower levels. Deceit, sadism, lack of delicacy and affection, selfishness, ungratefulness, narcissism, exhibitionism, egocentricity, demanding everything and giving nothing to others are characteristic hallmarks of these people. They have no critical awareness of their motivations and are unable to judge their own behavior as different from anyone else's. They thus lack conscious feelings of anxiety, loyalty, guilt, or remorse, and are often restlessly searching for unattainable goals. Thus, they have no real, healthy goals and seem superficially satisfied with their inadequate hostile activities. They cannot stand any routines, jobs, or requirements. They demand immediate gratification of their desires and wishes, without concern for others' feelings or interests. Most important, they are unable to form real relationships, due to such severe alienation, detachment, and a compulsive lack of any sense of social values. This makes them unreliable, callous, selfish, irresponsible, impulsive, guiltless, without conscience or conscious feelings of anxiety. They are unable to learn or benefit from previous experiences. Even though these persons often appear charming, plausible, and talkative, they must dominate their environment, and they utilize externalization as a main form of defense to blame others. Their acting-out behavior, based on their shallow living, can lead to bizzare, criminal, or extreme eccentric behavior. Their personalities have a type
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of lacunal defect, which limits them to a single form of behavior, such as stealing, lying, swindling, or promiscuity, to fill the emptiness they experience. Frequently, encouragement by their environment of ambivalent, hypocritical, and double-bind messages leads to greater solidification of this sick antisocial character development. The psychopathology of these sick antisocial characters is clearly based on amoral and ethical blunting, with no sympathy for their fel low human bei ngs. Their behavior continues to be destructive to all social order. Their emotional lives are superficial and shallow, making them incapable of mature relationships and unable to feel deeper emotions, especially love. Since they cannot organize constructive expressions of healthy feelings of assertion, they will appear to lack real ambition, application, seriousness of purpose, or foresight. As Jenkins said, they have failed in the main process of socialization. 11They thus become unstable, irritable, arrogant, vindictive, and brutal, without remorse for their actions against society. They have compulsive, rebellious attitudes toward authority and society and strong feelings of inner emptiness, producing vicarious shallow living with cynicism and lack of shame, honor, or sympathy. They cannot experience affection or gratitude, or other social and esthetic sentiments, because of this severe inner emptiness. Frustrations can cause uncontrollable dangerous actions, because of such severe alienation. As a result, they feel neither remorse nor conscious guilt about theft, embezzlement, forgery, sexual attack or other violence. They will even take perverse pleasure in their constant struggle with the law, with feelings of unhealthy compulsive pride in their illegal accomplishments. It must always be borne in mind that cultural, economic, and social forces may determine antisocial character behavior, or provoke it in one who is even so predisposed. A clarification of standards of character and a sense of authority have to be established if help is to be given to these people. Often, treatment of entire families or parental involvement in treating the compulsive antisocial character is required. Dealing with hostility and allowing increased anxiety and guilt to develop are positive assets in treatment, in other words, our goal at the beginning of treatment is to help them become at least more "neurotic," in terms of openly and consciously experiencing anxiety and guilt. We must keep in mind that neurotic character disturbances are really quite different from antisocial characters. Antisocial characters attempt to resolve conflicts by amoral or antisocial behavior, rather than through neurotic symptoms. The neurotic character disorder compulsively acts out, in order to relieve the excessive anxiety and guilt, with a related search and need for punishment. The neurotic character does feel conscious guilt, shame, and unworthiness, and is able to develop a social code of ethics. Thus it would be helpful for the sick,
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compulsive antisocial character to experience these feelings. It frequently becomes necessary for this compulsive antisocial character, who is influenced by pernicious social and cultural factors, to be removed from the influence of this environment and placed in a warm, humane, accepting environment in which a therapeutic relationship--individually or in groups--can develop. The use of warm substitute parental figures is important here. By doing this, a clarification of standards of behavior and a sense of authority are established. In studies of chronic criminals and the unhealthy antisocial character, a chaotic home environment, with early deprivation, parental separation, rejections, and deviances has been the common denominator in all of these instances. Studies by Bowlby2 and Goldfarb 3 suggested a relationship between maternal deprivation in early life and severe personal disorders later. Their studies often showed that delinquents were frequently found to be the product of maternal deprivation, specifically in the first five years of life. No feelings of love or affection were shown these children, who, therefore, could not form later meaningful interpersonal or intrapsychic relationships. Follow-up studies confirmed these findings. Retrospective and control led repeated studies of sick antisocial characters continue to show these findings. Rutter studied maternal deprivations and family discord as causes of compulsive antisocial character development. ~ Lewis also showed the same,14 as did Robins, 21 who studied 524 children referred for unhealthy antisocial character behavior and followed them for 30 years. Socialization is developed through adequate, consistent, and honest discipline. Twin studies also have shown that environmental and social influences, rather than hereciity, play the crucial role. Sick antisocial characters are incapable of love, according to Kernberg, 12 because of their extreme narcissism. Bok1 defines a lie as a statement made with intention to mislead. She justifies some lying, as in Samuel Johnson's case of misdirecting a thief who asks the direction in which his victim has fled. She attempts to determine when a lie is justifiable or not. If the survival of another innocent person or oneself is at stake, then lying is in order. She refers to moral reasons for and against lying. Use of placebos by doctors or not telling a patient the truth if he is dying are considered to be unethical lying. She also concerns herself with the ethics of social science researchers who deceive their subject~ for the sake of an experiment. She gives the example of Milgrim's experimentff in which the subjects were told they were sending increasingly painful electric shocks into people who were really actors feigning increased pain. These people were misled, and as a result, did what they felt legitimate authorities wanted them to do, in spite of the supposedly sadistic pain they were inflicting. This she called "professional deceit"; people were misled and also given to believe that as long as an authority approves, they could cause pain to anyone or do anything they are told to do
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by authority, regardless of how antisocial their actions may be. "We only followed orders" is a well-known phrase by now. A recent study of moral judgment and moral conduct in the psychopath is found that the latter's achievement of high scores on moral reasoning was due to a lack of feeling guilt. The study distinguishes between the poor moral judgment and higher moral knowledge, as well as the discrepancy between knowledge and conduct, in the psychopath. This is similar to my concept of the psychopath's unconscious unreasonable idealized standards. This study demonstrated six stages of development of moral judgment. Stage one is the orientation to one's own primary needs and the fear of punishment. Stagetwo is the unconditional satisfaction of personal desires. Stage three is the beginning of a spontaneous desire to have others think well of one, by adhering to social norms. Stage four is the acceptance of authority. Stage five is the acceptance of contractual legislative principles. Stage six is the development of conscience. A breakdown of these stages can lead to antisocial character development of an unhealthy compulsive form. The therapy of the sick antisocial character is often successful if a therapeutic community is used for group or individual therapy, combined with a job-related controlled environment. The use of authority of a legitimate nature and of punishment that is also rewarding and that allows for development of experiencing conscious anxiety, guilt, love, and other positive feelings is required. Because of their inadequate inhibitions and inability to experience consciously normal anxiety, these people must be helped to establish their own internal as well as external controls. Our goal is to help them become real human beings with all of the conscious anxieties, guilts, and feelings that people experience. I have also tried to differentiate the unhealthy compulsive antisocial character from what I would call a healthier, noncompulsive person who is trying to reach not only individual fulfillment, but also social betterment. I believe that this newer concept of a healthier antisocial behavior-type person is an important development in our present society. A recent NIMH study,4 suggests that those with highest levels of norepinephrine in the limbic system of the brain, aiid the lowest levels of serotonin, had the highest rate of aggressive, hostile, destructive behavior. ~Serotonin is thought to dampen aggressive drives and control impulses. Also, the study claims that serotonin is higher in females than in males. Therefore, a person with large amounts of serotonin may get angry but is unlikely to translate that feeling into action. Norepinepherine, on the other hand, is the chemical brain messenger that allegedly sustains those hostile aggressive drives. Therefore, treatment of such aggression with use of medication that will enhance serotonin synthesis, or at the sametime dampen norepinephrine synthesis, is indicated. The study does not question whether the so-called chemical imbalances described are inherited, environmentally caused, or
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both. However, one of the authors, Goodwin, did state that even though the chemical balance of the brain could be a genetic endowment, nevertheless, some permanent chemical changes in the brain may be caused by destructive negative child-rearing practices. Thus, the age-old question "Does sadness cause tears, or do tears cause sadness?" is again implied. It is axiomatic, as far as I can see, that a holistic relationship exists between environmental influences and genetic predispositions, or endowments. Thus, we all are influenced by our total experiences, external and internal, upon our basic unique endowments from conception throughout life; from the womb to the tomb. References
1. Bok, S. Lying, Moral Choice in Public and Private. New York: Pantheon, 1976. 2. Bowlby, J. Forty-four juvenile thieves. Int. J. Psychiatry, 25(19): 107, 1944. 3. Goldfarb, W. Psychological privation in infancy and subsequent adjustment. Am. J. of Orthopsychiatry, 15: 247, 1945. 4. Goodwin, B., et al. N.I.M.H. Report of Biochemical Links to Aggression. Presented at the American Psychiatric Association, Atlanta, GA, May 1978. 5. Heiden, K. Der Fuehrer. Cambridge: Riverside Press, 1944. 6. Hitler, A. Mein Kampf, (Am. ecl.). Boston: Houghton Mifflin, 1941. 7. Hott, L. R. Reflections on psychopathic personality. Lecture at the New York Academy of Medicine, May 26, 1954. 8. Hott, L. R. Individual and massaggression. Behav. Neuropsychiatry, August 1970. 9. Hott, L. R. Individual aggression and a violent society. Am. J. Psychiatry, 34: 305-310, 1974. 10. Joseph. W. C. The Mind of Adolph Hitler. New York: Basic Books, 1972. 11. Jenkins,P,.L. The psychopathic or anti-social personality.J.Nerv. Ment. Dis., 131 : 318, 1960. 12. Kernberg, O. Borderline Conditions and Pathological Narcissism. New York: Jason Aronson, 1975. 13. Koch, J. A. L. Psychopathic Inferiority, 1888. 14. Lewis, H. Depressed Children. London: Oxford University Press, 1954. 15. Link, Scherer, and Byrne. Moral judgment and moral conduct in the psychopath. Can. Psychiatr. Assoc. J., 1978, as reported in Psychiatric News, April 21, 1978. 16. Maitland, L. Crime in the city is a seasonal matter. The New York Times, August 5, 1978. 17. Milgram, S. Obedience to Authority. New York: Harper & Row, 1973. 18. Partridge, G. E. 5ociopathic Personalities. 1930. 19. Pinel, P. A Treatise on Insanity (Manie sans Delire). New York: Hafner, 1962. 20. Prichard, J. C. A Treatise on Insanity. London: Gilbert and Piper, t835. 21. Robins, L. R. Deviant Children Crown U p - - A 5ociological and Psychiatric Study of Sociopathic Personality. Baltimore: Williams & Wilkins, 1966. 22. Rutter, M. Parent-child separation: psychological effects on children. J. Child Psychol. Psychiatry, 12: 233, 1971. Reprint requests to 301 E. 62nd St., New York, NY 10021.
