Psychological Reports, 1992, 70, 979-991.
O Psychological Reports
1992
THE MALEVOLENT PERSONALITY DISORDER? ' DAVID FARLEY HURLBERT
CAROL APT
U.S. A m y
Uniuersio of Texas at San Antonio
Summary.-The identification of any new psychopathology or syndrome has been based on numemus clinical enquiries and theoretical discussions and has assumed an important place in the literature of psychology and psychiatry. Using two case descriptions and the subject described in a recent book, this report presents a theoretical discussion of an unusual personality organization, referred to as the malevolent personality disorder. Differential diagnosis, theorizing about pathogenesis, clarification of salient psychodynamics, and treatment considerations are explored.
The United States is a large, technologically advanced society. Complex organizations such as bureaucracies have taken over many of the functions formerly entrusted to the family, such as work, religion, and health care, among others, and the family itself has undergone many role changes and role shifts within the past several generations. As society has experienced so many changes within the last hundred or so years, many of the traditional norms that served as unmistakable indicators of right and wrong have been replaced by norms that are often confusing or conflicting (Bassis, Gelles, & Levine, 1991). Durkheim (1912) was concerned that modern society contained so many inconsistencies and ambiguities that individuals often had to resort to deviant means to achieve their goals. Hirschi (1969) believed that the weakening of the bonds between the individual and society made deviance a very real possibility. According to MasIow (1970) the highest human need is for self-actualization. Although some psychologists have criticized his work for its failure to clearly define "self-actualization," researchers interested in examining the various facets of human motivation have often found his hierarchy of human needs to be germane (Vander Zanden, 1987). If one accepts Maslow's thesis that individuals strive for self-actualization, and its concomitant values of over-atl life satisfaction and fulfillment, then one must look at what avenues society provides its members to realize those psychological goals. In addition, Schlenker (1980) believes that people gravitate toward those situations and individuals who will enhance their self-esteem and will gain them social approval. One of the most common settings in which individuals attempt to realize their potential and to glean a sense of identity is the workplace. The feeling that one's work is meaningful is shared by many individuals in a vari'Address corres ndence to Captain Hurlbert, Adult and Adolescent Counseling Center, 324 North Main, ~ e E n Texas . 76513.
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ety of jobs and professions (U.S. Department of Commerce, 1980; The Roper Poll, 1989). Yet dissatisfaction with one's work is a persistent problem (Work in America, 1973; Quinn & Staines, 1979; Howard, 1985). Blue collar workers, especially, report dissatisfaction with the regimentation of their jobs and with their lack of participation in decision-making (Work in America, 1973; Passel, 1990). Organized religion is an important component in many people's lives. Yet even our religious institutions have become increasingly bureaucratic in the twentieth century. From the move to saying Catholic Mass in English rather than in Latin to drive-through churches in California, religion in America is changing. As it becomes more modernized and more bureaucratic the individual loses personal identity and finds it increasingly difficult to gain a personal meaning from the sermons or prayers. The bureaucratization of religion has also weakened the traditional constraints on our behavior; society and religion no longer consistently agree on what is right and what is wrong (Giddens, 1991). The family used to be the primary source of our identity and taught us norms and values that were reinforced in all other social settings. There was value consistency in society among most societal institutions. Yet the dissolution of the small, traditional community has given way to the rise of the modern bureaucratic state (Durkheim, 1912). Our families are no longer our sole source of identity, and they are not the setting that dictates our life goals to us and provides us with the means with which to achieve them. As Americans we are increasingly on our own when it comes to making a life for ourselves. We are taught to value independence over group affiliations and to sever primary ties when it is in our best interest to do so. But, if we are armed with a solid repertoire of middle-class values and behaviors, higher education, and contacts within the working world, many of us have a good chance for a comfortable life. There are, however, some individuals who strive toward self-actualization, especially through the world of work, who do not have at their disposal the means for doing so. Given the emotional problems grounded i n a dysfunctional family, inappropriate coping skills, or consistent academic failure, among others, the traditional routes of self-fulfillment are denied to them. Especially in the spheres of interpersonal relationships and work, people find themselves resorting to bizarre and deviant means to achieve their desires for self-esteem, social approval, and self-fulfillment. In this paper, we will examine two case histories we believe are illustrative of individuals who resort to nontraditional means of achieving traditional ends. In addition, we will look at an account of similar behavior w h c h was the subject matter of a recent book. Given the similarities in the backgrounds and in the behaviors of these three individuals, they appear to mani-
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fest a group of characteristics we have chosen to term the malevolent personality disorder. To operationalize the term malevolent, the following case reports focus on those behaviors deemed to be malevolent. Case I
A 35-year-old housewife was initially seen for situational depression following the death of her father. Over a three-month period, the patient was seen weekly in supportive psychotherapy. Since significant marital problems were also apparent, she was encouraged to have her husband enter therapy with her. She was initially reluctant to d o w contact with her husband, but finally agreed to bring him to some future sessions. During the course of therapy, long-term patterns of interpersonal conflicts became increasingly apparent. She had recently terminated her membership in the second church in six months. She explained these terminations by alleging that both churches contained members who were "closed-minded" and "didn't like me." Through further exploration, information emerged that conflicts had arisen within both organizations that appeared to result from her interactions with several church members. She apparently chose several members whom she wanted to befriend, but soon complained that they, as well as the entire congregation, began to avoid her. When pressed for eIaboration, she admitted that she had "used" these individuals to spread rumors and gossip about others in the church. She then stated that the congregation as a whole began to ostracize her, and she withdrew her membership. She then joined a second church and immediately volunteered to become the organist. This activity placed her in the church on Tuesday and Thursday evenings, and on many occasions she was alone in the building. On one such evening she telephoned the minister and told him to come over right away, as she had discovered that someone had broken into the church. Once he arrived, she showed him the disarray and stated that she thought someone had broken in through a window in search of money or property. She did not, of course, tell the minister that it had been she who had staged the incident. During therapy, she appeared pleased that she had brought this crime to the attention of the minister and that she was able to provide the police with the same information. Although she denied stealing anything, she appeared amused that she had been able to instigate such a scheme without being discovered. However, in this church, as in the one before, she was eventually accused of spreading gossip and rumors about members of the congregation, and finally left. The patient also recounted another incident that occurred when she was caring for her ill mother-in-law. She stated that she purposely untied the elder lady's dog in the early hours of the morning. Upon discovering that the animal was missing, the mother-in-law was visibly upset. The client then
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spent considerable time and effort to find and return the animal to a much relieved woman. Later, in the absence of her husband, she reported several similar situations in which she created conflicts between her husband and their children. Her childhood history revealed other malevolent acts. For example, as a child she had thrown eggs on her father's car several times which eventually led to multiple car eggings within the neighborhood and the punishment of two boys who were wrongfully accused of the acts. Case 2
A 34-year-old middle-management executive entered into therapy with complaints of career stress and marital problems. H e stated that his wife had threatened to divorce him if he did not seek treatment. During telephone conversations with his wife to verify his attendance at therapy sessions, she described her husband as having a "sick" sense of humor. She stated that she had asked him for a divorce upon discovering that he had been giving her amphetamines without her knowledge. During the course of therapy, the wife proved to be a reliable informant and provided a history of other malevolent acts that her husband had committed and had shared with her. When confronted about these allegations, the client professed penitence and explained his behaviors by saying, "I only meant them as a joke." At work, he admitted to being particularly adept at starting rumors about co-workers without seeming to be malicious. In fact, he told of how he had destroyed a central computer program in which many important records were lost at great expense to the organization. H e then reported having taken the initiative to investigate the loss by interviewing a great number of employees. H e also stated that in so doing he was able to gather "dirt" on a considerable number of co-workers. He told of having spent long hours working to reconstruct the records in a self-initiated project designed as much to impress his superiors as to find the missing data. He also admitted to having taken great pleasure in giving his wife mild doses of amphetamines (Ionamin) on several occasions during a four-month period. H e would then take great care to console her and sympathize with her complaints of jitteriness and insomnia. In another incident, he described how he had cut all four tires on his "best friend's" car. He also claimed that he and his friend still often spoke of the incident and speculated as to whom the perpetrator(s) might have been. He recounted another incident that he orchestrated at an apartment complex in which he used to reside. He admitted to having set the garbage dumpster on fire on two separate occasions. In each instance, he waited until a crowd had begun to form around the burning dumpster. As soon as he had an audience, he identified himself as the person who first noticed the fire.
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H e then proceeded to answer most of the usual questions about what had happened, when it had occurred, etc. Although the client denied any fascination with fire, he told of another incident that had occurred while he was at a party in a friend's home. H e stated that he had taken a lit cigarette and dropped it on the carpet. He brought the burning cigarette to the attention of the hostess, who became understandably irritated. He then proceeded to take great pains to help her clean up the burned area and offered helpful suggestions on how she could make the burn less noticeable. He empathized further by joining the hostess in making rude remarks about the carelessness of smokers. Since the client was a nonsmoker, he was never suspected of having dropped the cigarette. Subject The third individual we would like to discuss is a woman by the name of Genene Jones. She was the subject of a 1989 book by Peter Elkind entitled "The Death Shift: The True Story of Nurse Genene Jones and the Texas Baby Murders." According to the account by Mr. Elkind, in 1981 Ms. Jones was a Licensed Vocational Nurse (LVN) working in the pediatric intensive care unit at a public hospital in San Antonio, Texas. While she was in the hospital's employ, babies in the PICU began dying in record numbers. At first, the only common denominator that could be identified among the deaths was the fact that they all occurred during Nurse Jones' shift, the 3PM-11PM shift. A later investigation turned up evidence to support the allegation that Ms. Jones had been giving the critically ill babies in her care excessive doses of heparin. This anticoagulant drug was commonly used in the PICU to keep IV and arterial lines open and free from clotted blood. When given in large amounts, heparin caused the infants to bleed profusely and to suffer a drop in blood pressure severe enough to cause cardiac arrest. Shortly after leaving the public hospital in San Antonio, Ms. Jones went to work for a pediatrician in a newly opened clinic in Kerrville, Texas. She continued her practice of giving critically ill infants and children life-threatThis medication is a muscle ening drugs; this time she used su~cin~lcholine. relaxant sold under the brand name of Anectine. When given in excessive doses it can cause seizure-like symptoms which can result in cardiac and/or respiratory arrest. Ms. Jones was usually present when each child to whom she had injected one of the two above-mentioned drugs "coded." A "code" is a medical emergency and will inevitably bring about a flurry of activity from the surrounding medical personnel. Ms. Jones found these codes to be exciting; some eyewitnesses to these events described her during these emergencies as "sweaty and excited, in an almost sexual euphoria" (p. 341). Others pointed to her "heaving body, her white face, and the strange, terrible look of excitement in her eyes" (p. 285). Still other coworkers identified her seeming desire to save the life of a child as motivated by her own need to be the center of attention (p. 341).
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Ms. Jones' childhood was characterized by feelings of low self-esteem and by her belief that her parents favored her sister over her. She considered herself neglected by her family and friends. Her father died when she was seventeen, and she later remarked that, when this happened, "the world went dark" (p. 19).
DISCUSSION The three individuals described above exhibit behaviors that we have chosen to term the malevolent personality disorder (MPD). Although the choice of such a term might indicate mischievous behavior, the syndrome may be actually quite serious. In a mass society such as ours, individuals are often forced to seek nontraditional routes to find the kind of fulfillment readily attainable from traditional societies. Alienation has often left individuals with the feeling that they cannot control events in their own lives and that their efforts will not necessarily produce the desired outcomes. A concomitant feature of modernization is what Max Weber (1946) called rationalization, or the organization of social and economic life according to what is the most efficient and technologically sound (Giddens, 1991). Like a l l societal trends, bureaucratization and rationalization have consequences for the lives of individuals; they often leave the citizens of mass societies with the perception that their everyday lives are meaningless (Bassis, et al., 1991). Many people join formal organizations (the workplace, for example) and voluntary organizations (churches, synagogues, community groups) in an attempt to make a living, find good use for their skills and talents, or to give meaning to their lives. Yet the depersonalization inherent in many of these organizations can leave members feeling insignificant and powerless. For example, the woman presented in Case 1 was a housewife. Although domestic work and childcare are keys to the maintenance of a functional family, housewifery is a devalued endeavor. Either because it is not paid labor or because it is primarily the province of women, those who engage in it full time are not held in high esteem in a society prone to judging members by how much money they make. The woman in this case report joined several different religious organizations, and in each one was dissatisfied and disillusioned. Whatever her expectations had been when she joined each church, they were not fulfilled. She then resorted to bizarre means to gain attention and to glean a feeling of importance. When she was merely a congregant, she was just another face in the crowd. When she volunteered to play the organ for the church her position became slightly elevated. But for reasons known only to her, this was not sufficient; she needed an additional boost to her ego. By staging a break-in and being the one to report i t to the minister she accomplished several goals. The first was that she gained the leader's undivided attention. By informing him of the "break-in," she was
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able to provide him with information that no one else could. Because she had "discovered" the mess in the church, she was immediately elevated to a position of authority; anyone who wanted to know what had happened had to come to her to find out. By voicing her alarm, she was also able to convey to the minister her loyalty to the church and the religion. I n so doing, she portrayed herself to a superior as a concerned and committed congregant and her status as the sole source of information to the police, thereby reaffirming her special status to powerful people outside the group. For Nurse Jones, her work in the PICU was not just a job, it was a calling of a higher order. I t was she who was saving lives; it was she who was present during the critical moments of life and death. Yet as an LVN she was on one of the lowest rungs of the medical hierarchy. Due to the increase in medical knowledge and in medical technology, the practice of nursing increasingly requires nurses who are educated, not just trained. As such, an LVN is not usually in a position to make decisions regarding patient care, only to carry out others' decisions. But Ms. Jones often took it upon herself to make such decisions and to insist that her hierarchical superiors (RNs, interns) carry them out. She took advantage of the chaos surrounding a medical emergency to exert her authority and to give herself a position of prominence and importance. I n addition, a modern hospital is a super-rational institution; patient care is ostensibly carried out in the most efficient, technologically advanced manner. Many of the functions formerly entrusted to nursing personnel are now accomplished by machines. I n the PICU, for example, vital signs, fluid output, and brain activity are monitored electronically. Although this is considered to be a reliable and efficient way of tending to patients, it also has the effect of decreasing the over-all contact that nurses have with patients. Nurse Jones did not like to be separated from her critically ill patients by machines. As Elkind writes of her behavior in the PICU, "influence and attention were slipping from her grasp. They weren't listening to her anymore; they were making her feel ordinary and ineffectual. After all the hours that she had put in, a l l that she had sacrificed for the unit, she was on the verge of becoming just another LVN. She could not allow that to happen" (p. 62). Each of the three individuals profiled in this paper were ordinary people leading ordinary lives. Yet each of them, in a personal way, wanted to be something more. None had the kind of extraordinary skills, education, or abilities that would allow them to carve a unique niche for themselves. They each wanted to accomplish something that is difficult in a mass society; they wanted to stand out from the crowd. They wanted to redefine themselves in such a way that they would seem not only special, but super-human and beyond reproach. T h s goal involves aspects of impression management (Goffman, 1959).
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In our interactions with others, our behavior involves not only actions, but the responses to those actions. If, as Schlenker and Leary (1982) suggest, we possess a tendency to want to present ourselves in the most favorable light, then we are also capable of changing our behavior to effect the most advantageous outcome (Vander Zanden, 1987). The process whereby we alter our behaviors according to what we desire the outcome to be is called "impression management" (Goffman, 1959). This process can involve subtle cues we send out, or it can entail outright manipulation of reality designed to have others act in accordance with our wishes (Vander Zanden, 1987). In the above cases these three individuals blatantly manipulated events and people to make themselves appear to be important and heroic. Individuals with Malevolent Personality Disorder must play to a crowd. They are more likely not to carry out their plans in a one-on-one setting, as this requires the kinds of interpersonal skills they may not possess. Attempting to transform one's identity in front of one individual is risky, as the lone person in the audience is not subject to the kind of group consensus that influences opinion and might question the individual directly about specific personal actions. A process of negotiation might ensue that would lessen the individual's ability to influence perceptions. When such an individual carries out a particular act designed to make himself appear positively to the group, the next step is to choose an informant. The choice of an informant is crucial as it must be someone who will believe the given definition of the situation without question. The informant must also be in a position within the group that is influential enough to influence others' perceptions. The informant must be in some kind of leadership position, as the leader of a group is often defined as one who is in a position to guide and motivate the members (Hollander, 1985). The leader of a group is often determined by the nature of the group (Lippa, 1990), and the choice of the hostess of the party in Case 2 was perfect; the choice in Case 1 of the minister of the church was equally effective. In Case 2, the individual dropped a burning cigarette on the carpet and then told the hostess about it. He took great pains to help her clean up the burn and to appear concerned and helpful. In so doing, he was presenting himself in a favorable light. The hostess, in turn, thanked him profusely and proceeded to tell others about his actions. As the hostess of the party, she was in a slightly elevated position than the guests, and the one from whom information about Case 2's efforts originated. A party is essentially a focused activity. Even though there are often several small enclaves of people in various corners of the house talking about different things, they are still there for the same reason-to have a good time. There is more likely to be attitudinal consensus among people who are together in the same place at the same time doing the same thing than there
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is among individuals with different values, in different locations, engaged in different activities. Individuals who are part of such a focused group are more likely to be subject to the group polarization phenomenon (Myers & Lamm, 1976). By virtue of their presence in a particular setting and their membership in the group, they are more k e l y to accept the agreed-upon definition of reality (Johnson, 1974; Johnson, Stemler, & Hunter, 1977; Mackie & Cooper, 1984), especially when that reality is presented to them by the group leader (Hollander, 1985). Also, the values involved in rescuing a burning cigarette from a carpet are relatively simple to anticipate; they involve respect for property, cleanliness, orderliness, courtesy while in someone else's home. The man in Case 2 decided upon his reality and then presented it to the informant. The informant then presented it to the group where it was subjected to group consensus until it became an agreed-upon reality and his identity was redefined in such a way that he was the heroof the party. Case 1 involved similar phenomena. The lady in question decided upon her course of action and its likely outcome. She then chose the minister as her informant who, in turn, presented her version of reality to the rest of the congregation. The fact that she was also able to appear important to outsiders (the police) was an added benefit. Like Case 2, she was manipulating easily predicted values-respect for property, the recognition of the church as sacred ground, and lawfulness in general. She, like the above case, maintained personal involvement and manipulated the perceptions of a small, cohesive group in which there was consensus of value. The case of Ms. Jones was similar, at fitst. Her definition of reality was that she was a super-nurse, one who recognized impending disaster and was the first to rush in and save a life. Her manipulation of the PICU was not difficult to accomplish, as it involved individuals engaged in similar activities with similar values about nursing, health care, and the care of critically ill children. However, her choice of an informant was problematic, as she was unable to identify one individual to whom she could feed information. Although her informants varied, they were still likely to be whatever medical personnel were present in the PICU at any given time. And as such, they were likely to share many of the same values that she professed, such as concern for patients, a desire to save lives, and a commitment to medicine. If Ms. Jones had been able to confine knowledge of her behaviors to those present in the PICU, she might have been able to carry out her plans indefinitely. She was able to carry them out as long as she did because she was a member of a large impersonal bureaucracy. Individuals with this syndrome can often thrive on the miscommunication that can occur in a highly stratified complex organization. Once the behavior of the person with malevolent personality syndrome becomes known to outsiders, the behavior is
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subject to a multiplicity of interpretations that threaten the individual's desired definition of reality. In a large bureaucracy such as a hospital, such individuals often hear of an occurrence, but since they have no direct knowledge of it, can only rely on rumor and hearsay for their information. A lack of communication in the hospital as a whole worked to the advantage of Ms. Jones. Mr. Elkind writes, "Nursing errors weren't being documented. Doctors and nurses at all levels had an adversary relationship, and their communication was ineffective even at critical times" (p. 101). This was also the case with the executive described in Case 2. Once the news of a computer disaster was made known to members outside his immediate department, they were at the mercy of the rumor mill to provide them with the details. As long as the outsiders in his case were still in the same company but not in his immediate work area, they could be counted on to maintain a similar definition of reality. As was the case with Ms. Jones, the outsiders were members of the hospital staff but were not members of the PICU staff. Ms. Jones ran into trouble when individuals outside the hospital and outside the medical profession began to learn of her behaviors. One by one, parents of deceased infants who had been in Ms. Jones' care began to question the circumstances surrounding their children's deaths. Hospital administrative personnel became involved, as did medical personnel outside the hospital, attorneys, the public, and the news media. Once these outsiders became aware of her endeavors, each was subject to his own definition of reality, and the Uelihood that Ms. Jones' credibility would be questioned increased. For an individual with this Malevolent Personality Disorder to succeed, he must have control over a small, cohesive situation. Barring that, he can take advantage of the lack of communication that often exists in a bureaucracy. Once the individual has committed the heroic act, he must stick around to experience the consequences of the act, as this forms the crux of the person's disorder. For such an individual, the ego needs immediate and firsthand gratification. In Case 1, the woman had to be present to be questioned by the minister and later by the police. She needed to stay with her mother-in-law long enough to receive thanks for locating the missing dog. I n Case 2, the businessman could not have left the party after rescuing the burning cigarette; he had to be present to receive the thanks of the hostess and perhaps even kudos by some of the guests. Ms. Jones constructed her scenarios in such a way that she was always present when a medical emergency occurred. It is difficult to say how many episodes an individual with this syndrome can accomplish before being found out. Even though individual ruses are possible, such as occurred with Case 1, in which the lady unleashed her
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mother-in-law's dog, and in Case 2, in which the individual gave his wife amphetamines, the episodes are best played out in a group. When one attempts to manipulate numbers of people, the possibility always exists that one will lose control over the situation. This is what happened with Ms. Jones, who initially did not count on so many disparate types of people becoming involved in her situation. Individuals who successfully carry out such plans will want to repeat them, as they entail great boosts to the self-esteem. I n addition, each act must appear unplanned, as true acts of bravery and courage are often considered to be. However, an individual cannot repeat the same episode without risk of discovery. If the man in Case 2 had gone to another party and done the same thing, he would have run the risk of being characterized as someone who rescues burning cigarettes from carpets rather than as one who saves the day. Ms. Jones was eventually discovered because, among other reasons, she carried out her actions in the same setting over and over again. To prolong discovery, the individual needs to have a wide behavioral repertoire, as Case 2 did. H e seemed prepared to practice his craft in a variety of situations and appeared able to ~ r e d i c tlikely reactions from a variety of people and settings. Individuals with a more limited behavioral repertoire must often wait until the right situation presents itself. Ms. Jones did not d o this and repeatedly reconstructed the same type of event. Although we have little psychological data on these individuals, and a fd psychological profile of people with the proposed Malevolent Personality Disorder is not yet available, we can speculate on some of these features. Individuals with the disorder exhibit emotional immaturity and egocentrism. Although they may cleverly plan their actions, they see the consequences only in terms of how they will benefit them. Potential harm and inconvenience to others is minimized or ignored if it is believed that their actions wd produce the desired results. They have low self-esteem. With dysfunctional relationships in the past or in the present, these individuals have a low opinion of themselves. I t is also likely that they have major life stressors and dysfunctional relationships with significant others. Their coping mechanisms appear impaired, as they react to stress and to life difficulties with flights into fantasy. I n their fantasies they are larger than life; they save the day. Their fantasies allow them to escape from the problematic and mundane world and into a comfort zone. I n this realm their identities are redefined in such a way that they seem super-human and possibly beyond reproach. These fantasies draw attention away from their everyday selves; inadequacies and insecurities are erased in favor of a redefined self, albeit one that is temporary and situation-specific. Individuals who show symptoms of a malevolent personality also present with histories of lying or manipulation. Mr. Ellcind refers to Ms. Jones' "love
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of falsehood" (p. 341); the woman in Case 1 presented with a hstory of lying and spreading rumors. Although this is a primitive form of impression management, it can serve to portray a person in a more favorable light than might otherwise be possible. Lying and manipulation are common features of dysfunctional families and could also represent a vestige of one's actions. These are key features of individuals with this proposed malevolent personality syndrome. When individuals with malevolent personality characteristics present for treatment, issues of self-esteem must be targeted. Family background must be explored to identify possible sources of low self-esteem. In addition, information must be sought on current or past memberships in formal or voluntary organizations, as past memberships in formal or voluntary organizations provide ample opportunities for the realization of malevolent personalities' scenarios. Current relationships and possible sources of dissatisfaction and stress must be targeted, and coping resources must be explored. By the time an individual with malevolent personality characteristics presents for treatment, it is likely that many dysfunctional patterns of interaction have become firmly ingrained. I t is only through long-term therapy that key issues, such as self-esteem, inappropriate coping, and the inordinate need for fantasy, will be identified and addressed.
Fina I Comment Although evidence is still needed here for empirical vahdity and it is as yet an open question whether malevolent personality symptoms form a distinct character disorder, the similarity of these cases is striking. I t appears that malevolent personality syndrome is more than a casual collection of unusual symptoms. Rather, it seems reasonable to propose that there is some specificity to the symptoms which comprise a Malevolent Personality Disorder. I t is perhaps of questionable value, however, to elaborate a diagnostic category on the basis of symptomatology alone without regard for a dynamic understanding. Further clinical case reports and psychodynamic formulations may assist in our understanding of some aspects of a malevolent personality syndrome. Also, more knowledge regarding the phenomenology of the symptoms is needed. Controlled studies of malevolent behavior patterns to provide a guide for prognosis and diagnosis are needed, as are more experimental studies aimed at estimating the extent to which individuals with malevolent personalities behave in predictably characteristic ways in response to the manipulation of specific independent variables. Valid criteria also need to be developed to assess the malevolent personality with minimal inference. While it is felt that the construct of malevolent personality is clinically
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useful, one must conclude that at present considerably more research is needed in virtually every area of investigation. REFERENCES BASSIS,M. S., GELLES,R. J., & LEVINE,A (1991) Sociology: an introduction. New York: McGraw-Hill. DIJRJCHEIM,E. (1947) The elementary forms of religious life. (J. W. Swain, Trans.) New York: Free Press. (Original work published 1912) ELKIND, P. (1989) The death shifr: the true story of nurse Genene Jones and the Texas baby murders. New York: Viking Penguin. GDDENS,A. (1991) Introduction to sociology. New York: Norton. GOFFMAN,E. (1959) The presentation ofself in everyday life. New York: Doubleday. HIRSCHI,T. (1969) Causes ofdelinquency. Berkeley, CA: Univer. of California Press. HOLLANDER, E. E? (1985) Leadership and power. In G . Lindzey & E. Aronson (Eds.), Handbook of social psychology. Vol. 11. New York: Random House. Pp. 485-537. HOWARD,R. (1985) Brave new workplace. New York: Viking. JOHNSON, N. R. (1974) Collective behavior as group-induced shift. Sociological Inquiry, 44, 105-110. JOHNSON,N. R., STEMLER,J. G., & HUNTER,D. (1977) Crowd behavior as "risky shi£t": a laboratory experiment. Sociometry, 40, 183-187. LIPPA, R. A. (1990) Introduction to social psychology. Belmont, CA: Wadsworth. MACKIE,D., & COOPER,J. (1984) Attitude polarization: effects of group membership. Journal of Personalily and Social Psychology, 46, 575-585. MASLOW,A. H. (1970) Motivation and personality. (2nd ed.) New York: Harper & Row. MYERS,D. G., & LAMM, H. (1976) The group polarization phenomenon. Psychological Bulktin, 83, 602-627. PASSEU, P. (1990) Blue collar blues: who is to blame. The New York Times, 139(J8, 118), p. D2. Q ~ N R. , P., & STA~NES,G . L. (1979) The 1977 quality of employment survey. Ann Arbor, MI: Institute for Social Research. ROPERPOLL.(1989) General survey ofpublic opinion. Storrs, CT: The Roper Center. SCHLENKER, B. R. (1980) Impression management: the self-concept, social identity, and interpersonal relations. Monterey, CA: Brooks/Cole. SCHLENKER, B. R., & LEARY,M. R. (1982) Social anxiety and self-presentation: a conceptualization and model. Psychological Bulletin, 92, 64 1-669. OF COMMERCE.(1980) Characteristics of the population below the poverty U.S. DEPARTMENT level. (Current Population Re rts, Series P-60, No. 124, July, 1980) Washington, DC: U.S. Government Printing 0 E c e . VANDERZANDEN, J. W. (1987) Soc~alpsychology. (4th ed.) New York: Random House. WEBER,M. (1946) From Mar \Vebt-r essays in sociology. (H. Gerth & C. Wright-Mills, Trans. & Eds.) New York: Oxford Univer. Press. Work in America: report of a ecial Task Force to the Secretary of Health, Education, and Welfnre. (1973) ~ a m b r i z e MA: , MIT Press.
Accepted April 20, 1992.
O Psychological Reports
1992
THE MALEVOLENT PERSONALITY DISORDER? ' DAVID FARLEY HURLBERT
CAROL APT
U.S. A m y
Uniuersio of Texas at San Antonio
Summary.-The identification of any new psychopathology or syndrome has been based on numemus clinical enquiries and theoretical discussions and has assumed an important place in the literature of psychology and psychiatry. Using two case descriptions and the subject described in a recent book, this report presents a theoretical discussion of an unusual personality organization, referred to as the malevolent personality disorder. Differential diagnosis, theorizing about pathogenesis, clarification of salient psychodynamics, and treatment considerations are explored.
The United States is a large, technologically advanced society. Complex organizations such as bureaucracies have taken over many of the functions formerly entrusted to the family, such as work, religion, and health care, among others, and the family itself has undergone many role changes and role shifts within the past several generations. As society has experienced so many changes within the last hundred or so years, many of the traditional norms that served as unmistakable indicators of right and wrong have been replaced by norms that are often confusing or conflicting (Bassis, Gelles, & Levine, 1991). Durkheim (1912) was concerned that modern society contained so many inconsistencies and ambiguities that individuals often had to resort to deviant means to achieve their goals. Hirschi (1969) believed that the weakening of the bonds between the individual and society made deviance a very real possibility. According to MasIow (1970) the highest human need is for self-actualization. Although some psychologists have criticized his work for its failure to clearly define "self-actualization," researchers interested in examining the various facets of human motivation have often found his hierarchy of human needs to be germane (Vander Zanden, 1987). If one accepts Maslow's thesis that individuals strive for self-actualization, and its concomitant values of over-atl life satisfaction and fulfillment, then one must look at what avenues society provides its members to realize those psychological goals. In addition, Schlenker (1980) believes that people gravitate toward those situations and individuals who will enhance their self-esteem and will gain them social approval. One of the most common settings in which individuals attempt to realize their potential and to glean a sense of identity is the workplace. The feeling that one's work is meaningful is shared by many individuals in a vari'Address corres ndence to Captain Hurlbert, Adult and Adolescent Counseling Center, 324 North Main, ~ e E n Texas . 76513.
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ety of jobs and professions (U.S. Department of Commerce, 1980; The Roper Poll, 1989). Yet dissatisfaction with one's work is a persistent problem (Work in America, 1973; Quinn & Staines, 1979; Howard, 1985). Blue collar workers, especially, report dissatisfaction with the regimentation of their jobs and with their lack of participation in decision-making (Work in America, 1973; Passel, 1990). Organized religion is an important component in many people's lives. Yet even our religious institutions have become increasingly bureaucratic in the twentieth century. From the move to saying Catholic Mass in English rather than in Latin to drive-through churches in California, religion in America is changing. As it becomes more modernized and more bureaucratic the individual loses personal identity and finds it increasingly difficult to gain a personal meaning from the sermons or prayers. The bureaucratization of religion has also weakened the traditional constraints on our behavior; society and religion no longer consistently agree on what is right and what is wrong (Giddens, 1991). The family used to be the primary source of our identity and taught us norms and values that were reinforced in all other social settings. There was value consistency in society among most societal institutions. Yet the dissolution of the small, traditional community has given way to the rise of the modern bureaucratic state (Durkheim, 1912). Our families are no longer our sole source of identity, and they are not the setting that dictates our life goals to us and provides us with the means with which to achieve them. As Americans we are increasingly on our own when it comes to making a life for ourselves. We are taught to value independence over group affiliations and to sever primary ties when it is in our best interest to do so. But, if we are armed with a solid repertoire of middle-class values and behaviors, higher education, and contacts within the working world, many of us have a good chance for a comfortable life. There are, however, some individuals who strive toward self-actualization, especially through the world of work, who do not have at their disposal the means for doing so. Given the emotional problems grounded i n a dysfunctional family, inappropriate coping skills, or consistent academic failure, among others, the traditional routes of self-fulfillment are denied to them. Especially in the spheres of interpersonal relationships and work, people find themselves resorting to bizarre and deviant means to achieve their desires for self-esteem, social approval, and self-fulfillment. In this paper, we will examine two case histories we believe are illustrative of individuals who resort to nontraditional means of achieving traditional ends. In addition, we will look at an account of similar behavior w h c h was the subject matter of a recent book. Given the similarities in the backgrounds and in the behaviors of these three individuals, they appear to mani-
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fest a group of characteristics we have chosen to term the malevolent personality disorder. To operationalize the term malevolent, the following case reports focus on those behaviors deemed to be malevolent. Case I
A 35-year-old housewife was initially seen for situational depression following the death of her father. Over a three-month period, the patient was seen weekly in supportive psychotherapy. Since significant marital problems were also apparent, she was encouraged to have her husband enter therapy with her. She was initially reluctant to d o w contact with her husband, but finally agreed to bring him to some future sessions. During the course of therapy, long-term patterns of interpersonal conflicts became increasingly apparent. She had recently terminated her membership in the second church in six months. She explained these terminations by alleging that both churches contained members who were "closed-minded" and "didn't like me." Through further exploration, information emerged that conflicts had arisen within both organizations that appeared to result from her interactions with several church members. She apparently chose several members whom she wanted to befriend, but soon complained that they, as well as the entire congregation, began to avoid her. When pressed for eIaboration, she admitted that she had "used" these individuals to spread rumors and gossip about others in the church. She then stated that the congregation as a whole began to ostracize her, and she withdrew her membership. She then joined a second church and immediately volunteered to become the organist. This activity placed her in the church on Tuesday and Thursday evenings, and on many occasions she was alone in the building. On one such evening she telephoned the minister and told him to come over right away, as she had discovered that someone had broken into the church. Once he arrived, she showed him the disarray and stated that she thought someone had broken in through a window in search of money or property. She did not, of course, tell the minister that it had been she who had staged the incident. During therapy, she appeared pleased that she had brought this crime to the attention of the minister and that she was able to provide the police with the same information. Although she denied stealing anything, she appeared amused that she had been able to instigate such a scheme without being discovered. However, in this church, as in the one before, she was eventually accused of spreading gossip and rumors about members of the congregation, and finally left. The patient also recounted another incident that occurred when she was caring for her ill mother-in-law. She stated that she purposely untied the elder lady's dog in the early hours of the morning. Upon discovering that the animal was missing, the mother-in-law was visibly upset. The client then
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spent considerable time and effort to find and return the animal to a much relieved woman. Later, in the absence of her husband, she reported several similar situations in which she created conflicts between her husband and their children. Her childhood history revealed other malevolent acts. For example, as a child she had thrown eggs on her father's car several times which eventually led to multiple car eggings within the neighborhood and the punishment of two boys who were wrongfully accused of the acts. Case 2
A 34-year-old middle-management executive entered into therapy with complaints of career stress and marital problems. H e stated that his wife had threatened to divorce him if he did not seek treatment. During telephone conversations with his wife to verify his attendance at therapy sessions, she described her husband as having a "sick" sense of humor. She stated that she had asked him for a divorce upon discovering that he had been giving her amphetamines without her knowledge. During the course of therapy, the wife proved to be a reliable informant and provided a history of other malevolent acts that her husband had committed and had shared with her. When confronted about these allegations, the client professed penitence and explained his behaviors by saying, "I only meant them as a joke." At work, he admitted to being particularly adept at starting rumors about co-workers without seeming to be malicious. In fact, he told of how he had destroyed a central computer program in which many important records were lost at great expense to the organization. H e then reported having taken the initiative to investigate the loss by interviewing a great number of employees. H e also stated that in so doing he was able to gather "dirt" on a considerable number of co-workers. He told of having spent long hours working to reconstruct the records in a self-initiated project designed as much to impress his superiors as to find the missing data. He also admitted to having taken great pleasure in giving his wife mild doses of amphetamines (Ionamin) on several occasions during a four-month period. H e would then take great care to console her and sympathize with her complaints of jitteriness and insomnia. In another incident, he described how he had cut all four tires on his "best friend's" car. He also claimed that he and his friend still often spoke of the incident and speculated as to whom the perpetrator(s) might have been. He recounted another incident that he orchestrated at an apartment complex in which he used to reside. He admitted to having set the garbage dumpster on fire on two separate occasions. In each instance, he waited until a crowd had begun to form around the burning dumpster. As soon as he had an audience, he identified himself as the person who first noticed the fire.
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H e then proceeded to answer most of the usual questions about what had happened, when it had occurred, etc. Although the client denied any fascination with fire, he told of another incident that had occurred while he was at a party in a friend's home. H e stated that he had taken a lit cigarette and dropped it on the carpet. He brought the burning cigarette to the attention of the hostess, who became understandably irritated. He then proceeded to take great pains to help her clean up the burned area and offered helpful suggestions on how she could make the burn less noticeable. He empathized further by joining the hostess in making rude remarks about the carelessness of smokers. Since the client was a nonsmoker, he was never suspected of having dropped the cigarette. Subject The third individual we would like to discuss is a woman by the name of Genene Jones. She was the subject of a 1989 book by Peter Elkind entitled "The Death Shift: The True Story of Nurse Genene Jones and the Texas Baby Murders." According to the account by Mr. Elkind, in 1981 Ms. Jones was a Licensed Vocational Nurse (LVN) working in the pediatric intensive care unit at a public hospital in San Antonio, Texas. While she was in the hospital's employ, babies in the PICU began dying in record numbers. At first, the only common denominator that could be identified among the deaths was the fact that they all occurred during Nurse Jones' shift, the 3PM-11PM shift. A later investigation turned up evidence to support the allegation that Ms. Jones had been giving the critically ill babies in her care excessive doses of heparin. This anticoagulant drug was commonly used in the PICU to keep IV and arterial lines open and free from clotted blood. When given in large amounts, heparin caused the infants to bleed profusely and to suffer a drop in blood pressure severe enough to cause cardiac arrest. Shortly after leaving the public hospital in San Antonio, Ms. Jones went to work for a pediatrician in a newly opened clinic in Kerrville, Texas. She continued her practice of giving critically ill infants and children life-threatThis medication is a muscle ening drugs; this time she used su~cin~lcholine. relaxant sold under the brand name of Anectine. When given in excessive doses it can cause seizure-like symptoms which can result in cardiac and/or respiratory arrest. Ms. Jones was usually present when each child to whom she had injected one of the two above-mentioned drugs "coded." A "code" is a medical emergency and will inevitably bring about a flurry of activity from the surrounding medical personnel. Ms. Jones found these codes to be exciting; some eyewitnesses to these events described her during these emergencies as "sweaty and excited, in an almost sexual euphoria" (p. 341). Others pointed to her "heaving body, her white face, and the strange, terrible look of excitement in her eyes" (p. 285). Still other coworkers identified her seeming desire to save the life of a child as motivated by her own need to be the center of attention (p. 341).
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Ms. Jones' childhood was characterized by feelings of low self-esteem and by her belief that her parents favored her sister over her. She considered herself neglected by her family and friends. Her father died when she was seventeen, and she later remarked that, when this happened, "the world went dark" (p. 19).
DISCUSSION The three individuals described above exhibit behaviors that we have chosen to term the malevolent personality disorder (MPD). Although the choice of such a term might indicate mischievous behavior, the syndrome may be actually quite serious. In a mass society such as ours, individuals are often forced to seek nontraditional routes to find the kind of fulfillment readily attainable from traditional societies. Alienation has often left individuals with the feeling that they cannot control events in their own lives and that their efforts will not necessarily produce the desired outcomes. A concomitant feature of modernization is what Max Weber (1946) called rationalization, or the organization of social and economic life according to what is the most efficient and technologically sound (Giddens, 1991). Like a l l societal trends, bureaucratization and rationalization have consequences for the lives of individuals; they often leave the citizens of mass societies with the perception that their everyday lives are meaningless (Bassis, et al., 1991). Many people join formal organizations (the workplace, for example) and voluntary organizations (churches, synagogues, community groups) in an attempt to make a living, find good use for their skills and talents, or to give meaning to their lives. Yet the depersonalization inherent in many of these organizations can leave members feeling insignificant and powerless. For example, the woman presented in Case 1 was a housewife. Although domestic work and childcare are keys to the maintenance of a functional family, housewifery is a devalued endeavor. Either because it is not paid labor or because it is primarily the province of women, those who engage in it full time are not held in high esteem in a society prone to judging members by how much money they make. The woman in this case report joined several different religious organizations, and in each one was dissatisfied and disillusioned. Whatever her expectations had been when she joined each church, they were not fulfilled. She then resorted to bizarre means to gain attention and to glean a feeling of importance. When she was merely a congregant, she was just another face in the crowd. When she volunteered to play the organ for the church her position became slightly elevated. But for reasons known only to her, this was not sufficient; she needed an additional boost to her ego. By staging a break-in and being the one to report i t to the minister she accomplished several goals. The first was that she gained the leader's undivided attention. By informing him of the "break-in," she was
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able to provide him with information that no one else could. Because she had "discovered" the mess in the church, she was immediately elevated to a position of authority; anyone who wanted to know what had happened had to come to her to find out. By voicing her alarm, she was also able to convey to the minister her loyalty to the church and the religion. I n so doing, she portrayed herself to a superior as a concerned and committed congregant and her status as the sole source of information to the police, thereby reaffirming her special status to powerful people outside the group. For Nurse Jones, her work in the PICU was not just a job, it was a calling of a higher order. I t was she who was saving lives; it was she who was present during the critical moments of life and death. Yet as an LVN she was on one of the lowest rungs of the medical hierarchy. Due to the increase in medical knowledge and in medical technology, the practice of nursing increasingly requires nurses who are educated, not just trained. As such, an LVN is not usually in a position to make decisions regarding patient care, only to carry out others' decisions. But Ms. Jones often took it upon herself to make such decisions and to insist that her hierarchical superiors (RNs, interns) carry them out. She took advantage of the chaos surrounding a medical emergency to exert her authority and to give herself a position of prominence and importance. I n addition, a modern hospital is a super-rational institution; patient care is ostensibly carried out in the most efficient, technologically advanced manner. Many of the functions formerly entrusted to nursing personnel are now accomplished by machines. I n the PICU, for example, vital signs, fluid output, and brain activity are monitored electronically. Although this is considered to be a reliable and efficient way of tending to patients, it also has the effect of decreasing the over-all contact that nurses have with patients. Nurse Jones did not like to be separated from her critically ill patients by machines. As Elkind writes of her behavior in the PICU, "influence and attention were slipping from her grasp. They weren't listening to her anymore; they were making her feel ordinary and ineffectual. After all the hours that she had put in, a l l that she had sacrificed for the unit, she was on the verge of becoming just another LVN. She could not allow that to happen" (p. 62). Each of the three individuals profiled in this paper were ordinary people leading ordinary lives. Yet each of them, in a personal way, wanted to be something more. None had the kind of extraordinary skills, education, or abilities that would allow them to carve a unique niche for themselves. They each wanted to accomplish something that is difficult in a mass society; they wanted to stand out from the crowd. They wanted to redefine themselves in such a way that they would seem not only special, but super-human and beyond reproach. T h s goal involves aspects of impression management (Goffman, 1959).
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In our interactions with others, our behavior involves not only actions, but the responses to those actions. If, as Schlenker and Leary (1982) suggest, we possess a tendency to want to present ourselves in the most favorable light, then we are also capable of changing our behavior to effect the most advantageous outcome (Vander Zanden, 1987). The process whereby we alter our behaviors according to what we desire the outcome to be is called "impression management" (Goffman, 1959). This process can involve subtle cues we send out, or it can entail outright manipulation of reality designed to have others act in accordance with our wishes (Vander Zanden, 1987). In the above cases these three individuals blatantly manipulated events and people to make themselves appear to be important and heroic. Individuals with Malevolent Personality Disorder must play to a crowd. They are more likely not to carry out their plans in a one-on-one setting, as this requires the kinds of interpersonal skills they may not possess. Attempting to transform one's identity in front of one individual is risky, as the lone person in the audience is not subject to the kind of group consensus that influences opinion and might question the individual directly about specific personal actions. A process of negotiation might ensue that would lessen the individual's ability to influence perceptions. When such an individual carries out a particular act designed to make himself appear positively to the group, the next step is to choose an informant. The choice of an informant is crucial as it must be someone who will believe the given definition of the situation without question. The informant must also be in a position within the group that is influential enough to influence others' perceptions. The informant must be in some kind of leadership position, as the leader of a group is often defined as one who is in a position to guide and motivate the members (Hollander, 1985). The leader of a group is often determined by the nature of the group (Lippa, 1990), and the choice of the hostess of the party in Case 2 was perfect; the choice in Case 1 of the minister of the church was equally effective. In Case 2, the individual dropped a burning cigarette on the carpet and then told the hostess about it. He took great pains to help her clean up the burn and to appear concerned and helpful. In so doing, he was presenting himself in a favorable light. The hostess, in turn, thanked him profusely and proceeded to tell others about his actions. As the hostess of the party, she was in a slightly elevated position than the guests, and the one from whom information about Case 2's efforts originated. A party is essentially a focused activity. Even though there are often several small enclaves of people in various corners of the house talking about different things, they are still there for the same reason-to have a good time. There is more likely to be attitudinal consensus among people who are together in the same place at the same time doing the same thing than there
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is among individuals with different values, in different locations, engaged in different activities. Individuals who are part of such a focused group are more likely to be subject to the group polarization phenomenon (Myers & Lamm, 1976). By virtue of their presence in a particular setting and their membership in the group, they are more k e l y to accept the agreed-upon definition of reality (Johnson, 1974; Johnson, Stemler, & Hunter, 1977; Mackie & Cooper, 1984), especially when that reality is presented to them by the group leader (Hollander, 1985). Also, the values involved in rescuing a burning cigarette from a carpet are relatively simple to anticipate; they involve respect for property, cleanliness, orderliness, courtesy while in someone else's home. The man in Case 2 decided upon his reality and then presented it to the informant. The informant then presented it to the group where it was subjected to group consensus until it became an agreed-upon reality and his identity was redefined in such a way that he was the heroof the party. Case 1 involved similar phenomena. The lady in question decided upon her course of action and its likely outcome. She then chose the minister as her informant who, in turn, presented her version of reality to the rest of the congregation. The fact that she was also able to appear important to outsiders (the police) was an added benefit. Like Case 2, she was manipulating easily predicted values-respect for property, the recognition of the church as sacred ground, and lawfulness in general. She, like the above case, maintained personal involvement and manipulated the perceptions of a small, cohesive group in which there was consensus of value. The case of Ms. Jones was similar, at fitst. Her definition of reality was that she was a super-nurse, one who recognized impending disaster and was the first to rush in and save a life. Her manipulation of the PICU was not difficult to accomplish, as it involved individuals engaged in similar activities with similar values about nursing, health care, and the care of critically ill children. However, her choice of an informant was problematic, as she was unable to identify one individual to whom she could feed information. Although her informants varied, they were still likely to be whatever medical personnel were present in the PICU at any given time. And as such, they were likely to share many of the same values that she professed, such as concern for patients, a desire to save lives, and a commitment to medicine. If Ms. Jones had been able to confine knowledge of her behaviors to those present in the PICU, she might have been able to carry out her plans indefinitely. She was able to carry them out as long as she did because she was a member of a large impersonal bureaucracy. Individuals with this syndrome can often thrive on the miscommunication that can occur in a highly stratified complex organization. Once the behavior of the person with malevolent personality syndrome becomes known to outsiders, the behavior is
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subject to a multiplicity of interpretations that threaten the individual's desired definition of reality. In a large bureaucracy such as a hospital, such individuals often hear of an occurrence, but since they have no direct knowledge of it, can only rely on rumor and hearsay for their information. A lack of communication in the hospital as a whole worked to the advantage of Ms. Jones. Mr. Elkind writes, "Nursing errors weren't being documented. Doctors and nurses at all levels had an adversary relationship, and their communication was ineffective even at critical times" (p. 101). This was also the case with the executive described in Case 2. Once the news of a computer disaster was made known to members outside his immediate department, they were at the mercy of the rumor mill to provide them with the details. As long as the outsiders in his case were still in the same company but not in his immediate work area, they could be counted on to maintain a similar definition of reality. As was the case with Ms. Jones, the outsiders were members of the hospital staff but were not members of the PICU staff. Ms. Jones ran into trouble when individuals outside the hospital and outside the medical profession began to learn of her behaviors. One by one, parents of deceased infants who had been in Ms. Jones' care began to question the circumstances surrounding their children's deaths. Hospital administrative personnel became involved, as did medical personnel outside the hospital, attorneys, the public, and the news media. Once these outsiders became aware of her endeavors, each was subject to his own definition of reality, and the Uelihood that Ms. Jones' credibility would be questioned increased. For an individual with this Malevolent Personality Disorder to succeed, he must have control over a small, cohesive situation. Barring that, he can take advantage of the lack of communication that often exists in a bureaucracy. Once the individual has committed the heroic act, he must stick around to experience the consequences of the act, as this forms the crux of the person's disorder. For such an individual, the ego needs immediate and firsthand gratification. In Case 1, the woman had to be present to be questioned by the minister and later by the police. She needed to stay with her mother-in-law long enough to receive thanks for locating the missing dog. I n Case 2, the businessman could not have left the party after rescuing the burning cigarette; he had to be present to receive the thanks of the hostess and perhaps even kudos by some of the guests. Ms. Jones constructed her scenarios in such a way that she was always present when a medical emergency occurred. It is difficult to say how many episodes an individual with this syndrome can accomplish before being found out. Even though individual ruses are possible, such as occurred with Case 1, in which the lady unleashed her
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mother-in-law's dog, and in Case 2, in which the individual gave his wife amphetamines, the episodes are best played out in a group. When one attempts to manipulate numbers of people, the possibility always exists that one will lose control over the situation. This is what happened with Ms. Jones, who initially did not count on so many disparate types of people becoming involved in her situation. Individuals who successfully carry out such plans will want to repeat them, as they entail great boosts to the self-esteem. I n addition, each act must appear unplanned, as true acts of bravery and courage are often considered to be. However, an individual cannot repeat the same episode without risk of discovery. If the man in Case 2 had gone to another party and done the same thing, he would have run the risk of being characterized as someone who rescues burning cigarettes from carpets rather than as one who saves the day. Ms. Jones was eventually discovered because, among other reasons, she carried out her actions in the same setting over and over again. To prolong discovery, the individual needs to have a wide behavioral repertoire, as Case 2 did. H e seemed prepared to practice his craft in a variety of situations and appeared able to ~ r e d i c tlikely reactions from a variety of people and settings. Individuals with a more limited behavioral repertoire must often wait until the right situation presents itself. Ms. Jones did not d o this and repeatedly reconstructed the same type of event. Although we have little psychological data on these individuals, and a fd psychological profile of people with the proposed Malevolent Personality Disorder is not yet available, we can speculate on some of these features. Individuals with the disorder exhibit emotional immaturity and egocentrism. Although they may cleverly plan their actions, they see the consequences only in terms of how they will benefit them. Potential harm and inconvenience to others is minimized or ignored if it is believed that their actions wd produce the desired results. They have low self-esteem. With dysfunctional relationships in the past or in the present, these individuals have a low opinion of themselves. I t is also likely that they have major life stressors and dysfunctional relationships with significant others. Their coping mechanisms appear impaired, as they react to stress and to life difficulties with flights into fantasy. I n their fantasies they are larger than life; they save the day. Their fantasies allow them to escape from the problematic and mundane world and into a comfort zone. I n this realm their identities are redefined in such a way that they seem super-human and possibly beyond reproach. These fantasies draw attention away from their everyday selves; inadequacies and insecurities are erased in favor of a redefined self, albeit one that is temporary and situation-specific. Individuals who show symptoms of a malevolent personality also present with histories of lying or manipulation. Mr. Ellcind refers to Ms. Jones' "love
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of falsehood" (p. 341); the woman in Case 1 presented with a hstory of lying and spreading rumors. Although this is a primitive form of impression management, it can serve to portray a person in a more favorable light than might otherwise be possible. Lying and manipulation are common features of dysfunctional families and could also represent a vestige of one's actions. These are key features of individuals with this proposed malevolent personality syndrome. When individuals with malevolent personality characteristics present for treatment, issues of self-esteem must be targeted. Family background must be explored to identify possible sources of low self-esteem. In addition, information must be sought on current or past memberships in formal or voluntary organizations, as past memberships in formal or voluntary organizations provide ample opportunities for the realization of malevolent personalities' scenarios. Current relationships and possible sources of dissatisfaction and stress must be targeted, and coping resources must be explored. By the time an individual with malevolent personality characteristics presents for treatment, it is likely that many dysfunctional patterns of interaction have become firmly ingrained. I t is only through long-term therapy that key issues, such as self-esteem, inappropriate coping, and the inordinate need for fantasy, will be identified and addressed.
Fina I Comment Although evidence is still needed here for empirical vahdity and it is as yet an open question whether malevolent personality symptoms form a distinct character disorder, the similarity of these cases is striking. I t appears that malevolent personality syndrome is more than a casual collection of unusual symptoms. Rather, it seems reasonable to propose that there is some specificity to the symptoms which comprise a Malevolent Personality Disorder. I t is perhaps of questionable value, however, to elaborate a diagnostic category on the basis of symptomatology alone without regard for a dynamic understanding. Further clinical case reports and psychodynamic formulations may assist in our understanding of some aspects of a malevolent personality syndrome. Also, more knowledge regarding the phenomenology of the symptoms is needed. Controlled studies of malevolent behavior patterns to provide a guide for prognosis and diagnosis are needed, as are more experimental studies aimed at estimating the extent to which individuals with malevolent personalities behave in predictably characteristic ways in response to the manipulation of specific independent variables. Valid criteria also need to be developed to assess the malevolent personality with minimal inference. While it is felt that the construct of malevolent personality is clinically
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useful, one must conclude that at present considerably more research is needed in virtually every area of investigation. REFERENCES BASSIS,M. S., GELLES,R. J., & LEVINE,A (1991) Sociology: an introduction. New York: McGraw-Hill. DIJRJCHEIM,E. (1947) The elementary forms of religious life. (J. W. Swain, Trans.) New York: Free Press. (Original work published 1912) ELKIND, P. (1989) The death shifr: the true story of nurse Genene Jones and the Texas baby murders. New York: Viking Penguin. GDDENS,A. (1991) Introduction to sociology. New York: Norton. GOFFMAN,E. (1959) The presentation ofself in everyday life. New York: Doubleday. HIRSCHI,T. (1969) Causes ofdelinquency. Berkeley, CA: Univer. of California Press. HOLLANDER, E. E? (1985) Leadership and power. In G . Lindzey & E. Aronson (Eds.), Handbook of social psychology. Vol. 11. New York: Random House. Pp. 485-537. HOWARD,R. (1985) Brave new workplace. New York: Viking. JOHNSON, N. R. (1974) Collective behavior as group-induced shift. Sociological Inquiry, 44, 105-110. JOHNSON,N. R., STEMLER,J. G., & HUNTER,D. (1977) Crowd behavior as "risky shi£t": a laboratory experiment. Sociometry, 40, 183-187. LIPPA, R. A. (1990) Introduction to social psychology. Belmont, CA: Wadsworth. MACKIE,D., & COOPER,J. (1984) Attitude polarization: effects of group membership. Journal of Personalily and Social Psychology, 46, 575-585. MASLOW,A. H. (1970) Motivation and personality. (2nd ed.) New York: Harper & Row. MYERS,D. G., & LAMM, H. (1976) The group polarization phenomenon. Psychological Bulktin, 83, 602-627. PASSEU, P. (1990) Blue collar blues: who is to blame. The New York Times, 139(J8, 118), p. D2. Q ~ N R. , P., & STA~NES,G . L. (1979) The 1977 quality of employment survey. Ann Arbor, MI: Institute for Social Research. ROPERPOLL.(1989) General survey ofpublic opinion. Storrs, CT: The Roper Center. SCHLENKER, B. R. (1980) Impression management: the self-concept, social identity, and interpersonal relations. Monterey, CA: Brooks/Cole. SCHLENKER, B. R., & LEARY,M. R. (1982) Social anxiety and self-presentation: a conceptualization and model. Psychological Bulletin, 92, 64 1-669. OF COMMERCE.(1980) Characteristics of the population below the poverty U.S. DEPARTMENT level. (Current Population Re rts, Series P-60, No. 124, July, 1980) Washington, DC: U.S. Government Printing 0 E c e . VANDERZANDEN, J. W. (1987) Soc~alpsychology. (4th ed.) New York: Random House. WEBER,M. (1946) From Mar \Vebt-r essays in sociology. (H. Gerth & C. Wright-Mills, Trans. & Eds.) New York: Oxford Univer. Press. Work in America: report of a ecial Task Force to the Secretary of Health, Education, and Welfnre. (1973) ~ a m b r i z e MA: , MIT Press.
Accepted April 20, 1992.
