In last week’s post, we began a discussion about how conscience development is impeded in some individuals, especially those with prominent narcissistic or aggressive traits in their personality makeup (see: Aggressors, Narcissists, Conscience, and Character). This week’s post presents an example of how someone with traits associated with aggressive personality formation can have difficulty forming the kind of conscience that will enable them to exercise responsible control over their emotions, impulses, and behavior.
Before I present today’s illustrative vignette I need to make some disclaimers. The “case” you’ll be reading about describes a young boy I encountered in a psychiatric facility. But the fact is that in my early years of practice I consulted to several institutions and dealt with hundreds of young persons manifesting various degrees of character impairment and displaying many similar behaviors and problems necessitating their treatment in a restricted setting. And to ensure complete anonymity and confidentiality the story your about to read is not only a “composite” of different happenings but also contains some deliberate distortions with regard to identifying information (names, gender, places, age, etc.). Nonetheless, there are no distortions of the psychological dynamics and realities the story is meant to illustrate. And the intervention techniques I describe using in this particular vignette are actual techniques I’ve used hundreds of times in many cases.
The Case of Jonathon
Jonathon was an 8 year-old whose parents had been at their wits end for a while. He’d been suspended from school many times over his first two years and had been recently suspended from an “alternative” classroom. He had a habit of biting, hitting, and kicking other children, throwing temper tantrums, and cussing at his teacher. He rarely followed directions and was a one-man instrument of pure disruption in the classroom. As you might suspect, he’d been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and placed on Ritalin. The medicine helped a little, but his behavior was still so unmanageable he simply couldn’t seem to function at school. His parents had tried everything. Spanking never worked and there were simply no “privileges” left for them to take away. They were reticent to view him as someone needing psychiatric hospitalization, but they saw few options left. The boy appeared to have no conscience and no empathy or remorse. Whenever he hit anyone or did anything wrong, he tried to justify it, blamed others, and seemed to shrug off any concern others expressed to him about his behavior. And he never seemed to stop and think about what he was doing or what his actions were costing him or those around him.
To Jonathon, his first day at the hospital, seemed like just another day and a just another place. And despite all the structure built into the ward’s milieu and the presence of highly trained staff ready to intervene and impose consequences, nothing seemed to impact him. The treatment program operated on a “level” system whereby patients gained privileges by meeting certain goals and demonstrating good control over their behavior. But Jonathon had been there two weeks already and hadn’t advanced at all in the program.
The Jonathon’s attending physician had asked me to interview him, administer a battery of tests, render my own opinion on diagnosis, propose some therapeutic interventions, and consider taking him on as a therapy client. So I went to the unit in which he was housed to escort him to the interview and testing room. Before I knew it, however, Jonathon was leading himself down one of the hospital corridors, having absolutely no idea and seemingly not caring where exactly we needed to go. I waited patiently and in silence at the beginning of the corridor and he eventually came back and just looked at me. Then I slowly started down the corridor and once again, he raced ahead. I stopped immediately and again waited. Eventually, he came back. We did the same behavioral “dance” in the hallway 3 or 4 more times until finally he looked at me quizzically and appeared more receptive. “Follow me,” I said, and led him a few steps down the hallway to the room I planned to use. “Good.” I proclaimed. “Very good. You did well, so we’ll try this again.” I went back to the unit, asked him to have a seat in the day area, and made a few notes in his chart. Then I asked him to come with me again. Thinking he knew right where to go, once again he raced ahead, going straight to the room we’d been to earlier. But once again, I waited at the beginning of the hallway. Eventually, he came back. And of course, for awhile we did the “dance” again. But when he finally waited for me to lead, I ushered him to a room different from the one before. When we entered, I again commended him for following my direction and promised that we’d do it yet again, then took him back to the unit. I also deliberately made him wait a little longer in the waiting area before coming to get him once more. I’m not exactly sure how many times we did our unusual “dance” down the hallway and returned to the unit before Jonathon decided to simply let me lead and then follow my direction. But it did eventually happen. Instead of racing ahead on his own, he just looked at me and when I said “Let’s go,” he followed me to the place I decided we’d go. And when we got to our destination and before we began our tasks, I reinforced him heavily for paying attention to me, following my lead, and controlling his urge to simply “do” and think later. We played many other “games” like this over a period of weeks and before long the staff was noticing some real differences in Jonathon’s behavior.
Jonathon had two traits in his makeup that my experience taught me increase the risk of him shaping up to be a relatively aggressive personality (for more on the aggressive personalty and aggressive personality sub-types see: Aggressive Personalities: An Upcoming Refresher Course and Aggressive Personalities: The Sub-Types). And if these aspects of his personality weren’t modified soon, I knew he could eventually develop a personality disorder, perhaps even an antisocial personality disorder. So in my interactions with him, I chose to focus on his deficient impulse control and predisposition toward aggressive modes of functioning (not violent aggression motivated by anger, but rather overly energetic, aggressive, pursuit of goals – even undefined goals). Like many who have aggressive personality traits, Jonathon was like a car whose gear shift is always in “drive” mode, gas peddle is always full to the floor, and has no brakes. He simply had to learn to how to exercise voluntary control over his impulses – a real challenge for a kid “wired” to act first and think later. He also had to develop a conscious willingness to submit to a higher “authority,” accept guidance and direction, and to pay attention to directives given him – a challenge for anyone predisposed to be so self-directed. And I needed to find a benign but reliable ways to help him learn these lessons. I also had to remember that teaching these crucial lessons and securing compliance is always accomplished most effectively when the focus is kept on the relatively small and innocuous aspects of life. Firmness and persistence is also a must. So in my interactions with Jonathon, I took care not to lord my authority over him or ruthlessly demand his subservience or surrender. But I sent some very clear, consistent messages about where the authority resided (i.e., who would lead or set direction and who would be expected to follow), and the importance of him exercising control over his impulses, the need for him to pause and take time to stop and think about things before jumping into action, and most especially, the value in him displaying a willingness to submit to guidance and subordinate his will to that of some authority. All these things were done in small, innocuous exercises, similar to the “dance” down the hallway that characterized our initial encounter. I also crafted some special lessons on the benefits of making an effort to pay closer attention (which didn’t come easy for Jonathon). Toward that end, in those lessons, and indeed in all my interactions with Jonathon, I used the technique of selective speaking and reinforcement that I outline in both In Sheep’s Clothing and Character Disturbance). And whenever Jonathon made the effort pay attention and stay engaged with me or to meet any of the objectives I set for him, even in a minor way, I reinforced him quite generously. Gradually, he not only “bought into” the regimen I crafted for him but also came to relish the time we spent together – largely, I think, because it was full of something he had experienced very little of in the past: reinforcement.
Jonathon stayed in the hospital longer than most of his peers. But by the time he was discharged he not only had become much better mannered but also didn’t seem to have as much trouble focusing. And after two years of intensive follow-up, he was not only doing okay in a regular classroom but also was no longer taking medication. It’s always preferable for children to develop sufficient inner resources to self-manage as opposed to being forever dependent on external structure or medication.
Next week’s post will feature an vignette about a young man whose self-image was so distorted (inflated) that he simply couldn’t form a healthy relationship with any “higher power,” solidify a healthy conscience, and keep himself from inviting disaster into his life and the lives of many others. The vignette does not have the kind of positive outcome that the one presented in this post did. However, it’s a case that illustrates well what can go wrong when someone’s self-image gets pathologically out of balance.
That must have been a great challenge right there. Especially important is that conscious willingness to submit to a higher authority. Without that an aggressively goal-seeking human is a wheeler-dealer.
Dr Simon, I don’t think this is in contradiction to anything you’ve written. Aren’t there some people, who actually see themselves as messengers of a higher power, don’t merely profess but actually believe in their cause, and commit horrid actions while justifying them as service to their higher power, the old “ends justify the means”? I’m not talking about covert aggressors, who profess loudly, but in their hearts are all out for themselves, first and foremost. I’m talking about fanatics, who actually think of themselves as servants of a higher authority and think they do right, even if it’s the vilest act imaginable.
How is this to be interpreted? Is it explainable by the neurotic-CD -continuum? Can it be a matter of different blends of personality types and clustering of different personality traits? Is fanaticism like this a matter of buying into an extreme, irrational belief system to which an individual is attracted because of pre-existing twisted world of thinking or because of which an individual’s thinking becomes more distorted as time goes on? Is it a matter of lying to oneself, so this supposed “submission” is, in this kind of case, actually oneself to feel self-righteous without needing to care about “useless moral issues”? Can it simply be that they have invested into some self-created lie so much they’ve started to believe it themselves?
You ask a really great question, J, and one that would take quite some time and a lot of thought to reply eloquently to. That said, let me briefly say that there are those individuals who have deceived themselves so much and for so long about their true motives (proclaiming to serve a “higher power” while really only lusting after power themselves), that they actually come to believe that they’re doing something other than what they’re really doing. And there are also other individuals who have even carried such a charade to the point of delusion, whereas there are still others who are themselves the victim of delusional thinking they never invited. So to sum it up a bit simplistically but succinctly, lying to yourself is not the same as being delusional, although doing it intensely and often can lead to one to become delusional. And to the extent that a person has a conscience and a degree of “neurosis” they might construct primitive, unconscious defenses that block their conscious awareness of their self-deception. And it’s hard to know, just from the outward manifestation, what dynamics are playing out underneath, so you have to look at other indications about whether the person is primarily “neurotic” or disturbed in character.
What’s up with no discussion lately?
Dr. Simon,
I have an eleven year old granddaughter who is ADHD. I have seen many narcissistic behaviors of hers. When my daughter is trying to coach her to get ready for school, she tries some of the same tactics as your patient. However, there are time constraints that prohibit taking time out to go through the dance as you call it.
Do you have any suggestions where we can go to get help for her? We live in Columbus Ohio.
Noel, Has your granddaughter been evaluated for Fetal Alcohol Syndrome? No offense against your daughter and please don’t take this the wrong way BUT, the most common initial diagnosis for someone with FAS is ADHD among a host of other things including personality disorders. There is a huge difference between someone with FAS who also has ADD and someone who just has ADHD. Do you know if there is ANY chance that your daughter drank while pregnant? Again, no offense intended.
Thanks for your input, but I never saw any sign of drinking or substance abuse during her pregnancy or any other time. So I don’t think that is a concern.
To add: there is a history of ADHD in my granddaughters father’s family.
Then that is probably the accurate call Noel. I just wanted to mention it. I hope you find some answers……..I do believe there is help for ADHD and in Columbus Ohio you should have a good chance of finding it.
I know someone whom I believe is a covert aggress. personality. This man whom I was dating
appeared to be this sweetheart of a person wanting to hang the moon for me and I was paying
close attention and was very slow to becoming intimate with him because I wanted to get
to know him better and some things were seeping through and I felt he wasn’t really whom
he was pretending to be so I like to read a lot and was shocked when I found In Sheeps Clothing……
from the day after I read the book I broke up with him telling him that It just wouldn’t work
He wanted to stay in contact (in the friend zone) but calling me everyday and cooing over me.
I was really trying to just phase him out nicely because I was sort of afraid of making him mad.
I have found men with large Egos can get very angry. He is in the same business and I do not
Want him for an enemy. He really seems delutional. He calls me more than a buddy would
and my tone is always just what only a friends would be. He is a very successful responsible, hard
working man but controlling and I would never ever consider him as a love interest I think his
Kindness to me is a lie. Dr Simon could you pls elaborate on this type. I see him as the married
Man (he’s not married) in your book who took advantage of the secretary..that type.
I feel I’m on shaky ground because of what he might try and do to me when he realizes I’m never going for him. I don’t think it’s about me it’s about winning. I cannot get away from him.
and I need some advise.
Jenny
Jenny, please read this article about how to get someone like this to loose interest in you. I’m not saying it absolutely will work but it is a safe way to try to get him to disengage.
http://180rule.com/the-gray-rock-method-of-dealing-with-psychopaths/
grey rock is awesome!
Jenny, you raise my awareness here of the many other “manifestations” of this personality which, although depicted well in my book, have not been discussed in any depth in any of the blog articles. I’ll try to fashion some posts that address this. And if a lot of time goes by and I still haven’t done it, please remind me!
?
Timothy,
You must have read my mind.
Jenny, You need to make yourself boring and someone he does not WANT to go for. Make him loose interest.
Dr Simon I wanted to ask if a young child such as Jonathon in your article has already progressed to quite violent behaviour would you have handled him in the same way? Also I wanted to ask about the differences in aspergers syndrome and psychopathy? Is there a distinctive difference or could one be confused with the other?
Tori,
The people with ASD’s that I know are by nature very honest, they are sticklers for rules and will speak up if something isn’t right. Their social awkwardness means that they are not good liars. They are very protective of others.
RS
I understand what you’re saying RS I have worked with children with this disorder and know they have their strict patterns and rituals etc… that seems to be very consistent with Autism but was wondering more about aspergers particularly with regard to violent behaviour.
Aspergers IS Autism
RS — No, Aspergers is NOT autism. True, it is on the autism spectrum, but symptoms are different. WHERE?? pray tell, do you find these nuggets of misinformation??
Asperger’s vs Autism – Autism Delaware
http://www.delautism.org/AboutAutism/Whati...
The Autism Society of Delaware
What distinguishes Asperger’s syndrome from autism is the severity of the symptoms and the absence of language delays.
Again, however the pesky DSM is in the mix. Changing this, combining that……. WHY do I think there is a link with the DSM and insurance claims? 🙂
Elva, there is a big similarity between Aspergers and Fetal Alcohol Syndrome/ FASD in that, because many people with FASD can function fairly well in SOME areas( although the level of “functioning” can be unpredictable and unreliable) people assume that they are normal in all areas. so with Aspergers, they don’t have the same “in your face” symptoms that people with Autism have but they are still affected and different than the general NT population.? Do you think that is accurate? It’s my layman’s understanding.
Unrelated::::: When I try to type a post, as I’m typing I can’t see what I have typed on the right side of the box until I get to the end of a line……I don’t know….it makes it hard to put a thought or sentence together sometimes.
Elva,
The DSM 5. Aspergers no longer exists as a diagnosis. It is now called ASD, Autism.
RS
Hi Tori and Puddle — No, Aspergers patients are generally not violent. The best introduction to autism spectrum disorders that I’m familiar with are Simon Baron-Cohen’s books — he’s a British Ph.D. specializing in this area. His books are very easy to read, you can find them on Amazon and read the reviews for yourself. Google for baron-cohen books. (In case you are wondering, Sacha Baron-Cohen is his cousin.) And they are not expensive. His book “Men and women: the essential difference” was a great help to me. Also, you can find interactive online tests for systemizing, empathy, autism, aspergers — multiple choice, each test will give you a score at the end. According to the asperger’s test, which I took twice, I’m probably borderline Aspergers. Puddle, you seem to be on the right track in your current understanding of aspergers — hope this information will be helpful. Peace and Hope from Elva
Elva, I took several of the available tests and scored high (ish) but as I said, there is a very strong similarity between FASD and Aspergers. That is VERY interesting bough Sacha Baron-Cohen!!
SO, something I heard SOMEwhere along the line……too far back to remember but I think it was on an Asperger’s site? That the Aspergarians(?? Sorry, made up word) don’t like Baron-Cohen. I have no idea where I heard this or how to substantiate what I’m saying so it’s kind of a little silly to mention this BUT,,,,,it was something negative about his writings.
I hate it when something stirs in my memory like that but won’t take form and connect.
I think I’m thinking, or trying to think, about someone else……..The thing I remember ready=ing was a comment someone made about someone doing more harm then good in their writings about Aspergers……I have it all mixed up. So sorry!!
Hi Puddle — yes, I vaguely remember someone being critical of Baron-Cohen, but you can find criticism about nearly anyone. He has a couple of opinions that I don’t agree with, but overall, I still consider him to be a good intro. (and, heh, he has the Ph.D. and I don’t!)
Glad you looked up the poem — keep trekking onward and upward!! Peace and hope from Elva
Elva, it sounds right that the point of contention was over a certain aspect and his opinion or view of it But again, I’m not at all sure it was him this was about. It said something about the opinion and writings of this person had done more damage and caused more of a set back than anything or one else had…….There is another name trying to break in to my mind..this was two years or so ago during the very dark days of the aftermath so it could be ALL tangled up with who only knows what!
Onward and upward! You’re funny!
Puddle
Hi again Puddle — I’m sure there are other books available — maybe Dr. Simon could point out some good sources — I just point out the ones I have found and I certainly am not aware of all the info out there — well, back to the sewing machine! Peace and hope from Elva
Elva,,,,,I wonder. There is something going on in all of this……Asperger’s, Autism,Psychopathy,,,,,,,,,,,,,I’m not saying that people with Autism or Asperger’s are psychopaths…..I know that is a serious point of contention and sensitive issue in the Asperger’s and Autism community so I’m trying to be careful with words. but the similarities are very interesting and they mentioned something in this article about “the extreme male brain” theory Baron-Cohen proposes……..then the Ppath sexually insatiable appetite………Do you ever get a feeling that you have an understanding about something but it is still unrealized? Or that you have realizations that are happening so fast you can’t quite grasp them?
http://sfari.org/news-and-opinion/investigator-profiles/2011/simon-baron-cohen-theorizing-on-the-mind-in-autism
Hi Elva, thank you. I was aware aspergers comes under the same umbrella but know there is a distinct difference between aspergers and autism. I’ve found from just my own experience aspergers children are usually quite intelligent and can do well at school etc but have trouble with social interactions and do tend to get frustrated with emotional responses. But as I said was wondering if there was any links to violent behaviour. I read an article on the web that suggested there could be in some children (though there are so many untruths out there as we all know). And yes Puddle I agree you have to be very sensitive with links to other issues like Psychopathy and will admit I was rather hesitant in asking but that’s why I thought I’d ask Dr Simon and thought he might be able to shed some light. I’ve been thrown in the deep end recently and have been relying on my own intuition when handling a serious behaviour disorder and I kept recalling this story on Jonathon and another from Dr Simon’s examples as in some ways they seem to fit.
Hi Tori 🙂 I may be wrong about this BUT, I think two things regarding the violent behavior issue you are referring to….
1). Because people with Aspergers, or any a typical neurological make up, have a characteristic problem with communication, processing and expressing emotions and experiences, being understood, etc………I think there can be a lot of frustration in social interactions and life in general. I can see how this frustration could boil over?
2) just like some NT people are violent or have a violent, explosive coping problem, I would imaging someone with a condition like Aspergers could too. For a lot of these atypical neurological conditions, there is a relatively small window for significant emotional growth to take place. from what I have read about FASD, it’s somewhere between 8 and 12 (I could be totally wrong about the age). It is a time that it is VERY important for the individual to have a solid and caring environment and someone who understands what they are dealing with in order to be of the very most help. A lot, and I mean a LOT, of those windows never get used to the degree or in the way they need to be, for various reasons. It’s very sad to me, probably because I can understand first hand what it is like not to get the help you needed, when you needed, and to be judged erroneously.
So just speculating based on what I’ve read and experienced! 🙂
also, their inability at times to express or even identify what they feel, together with not knowing social protocols for showing empathy, means they can look as though they lack empathy.
RS
also, the strong desire for repeated patterns and rituals can look like controlling behaiour…
RS
wondering what my ex would have benefited from, but knowing that he isn’t interested at this late stage of the game to get any type of healing. Still you can’t help wondering if anybody could have intervened early on. He seemed (who really knows?) to have been a preemie that was spoiled from early on. He had his mom totally bluffed into thinking he needed extra care even in his 40’s. He just knows how to manipulate people and come out smelling like a rose no matter what he does. People are just too easy for him. He needed somebody to not give in to the scam he was selling/to look into his eyes and say” that’s not true is it”? early on. Every year he learns to get better and bolder and smoother so who knows if he would have ever been rehabilitated into being a decent human being. Guess we’ll never know. Dr. Simon, as always, you give hope to the next generation to stop this crazy cycle.