Impact News

Responding to Violence, Suicide, Psychosis and Trauma

Nepotistic patterns of violent psychopathy: evidence for adaptation?

I’ve seen a number of articles along similar lines of late. The argument seems to be that psychopaths rarely harm close family, while those with mental illnesses sometimes do. As a result, psychopathy could be seen as adaptive rather than disordered. On the other hand I have heard that in the US some judges are viewing psychopathy as a mitigating factor in sentencing. Strange, since most would hope that psychopaths, with full access to their faculties when they perpetrate atrocities should be locked up for longer?!

http://www.ncbi.nlm.nih.gov/pubmed/22973244?dopt=Citation

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Beyond Abuse: working with high risk service users

This dramatic course delivered by Dr Iain Bourne is open for applications by Sitra:

12th September 2012 in Southampton

25th October 2012 in London

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THE PSYCHOPATH

Here we go, the scary word. Lets see what the angelfire website has to say:

Psychopaths cannot be understood in terms of antisocial rearing or development. They are simply morally depraved individuals who represent the “monsters” in our society. They are unstoppable and untreatable predators whose violence is planned, purposeful and emotionless. The violence continues until it reaches a plateau at age 50 or so, then tapers off. Their emotionlessness reflects a detached, fearless, and possibly dissociated state, revealing a lower autonomic nervous system and lack of anxiety. It’s difficult to say what motivates them – control and dominance possibly – since their life history will usually show no bonds with others nor much rhyme to their reason (other than the planning of violence). They tend to operate with a grandiose demeanor, an attitude of entitlement, an insatiable appetite, and a tendency toward sadism. Fearlessness is probably the prototypical (core) characteristic (the low-fear hypothesis). It’s helpful to think of them as high-speed vehicles with ineffective brakes. Certain organic (brain) disorders and hormonal imbalances mimic the state of mind of a psychopath.

There are four (4) different subtypes of psychopaths. The oldest distinction was made by Cleckley back in 1941 between primary and secondary. However, we’ll explore the other two subtypes first:

DISTEMPERED PSYCHOPATHS are the kind that seem to fly into a rage or frenzy more easily and more often than other subtypes. Their frenzy will resemble an epileptic fit. They are also usually men with incredibly strong sex drives, capable of astonishing feats of sexual energy, and seemingly obsessed by sexual urges during a large part of their waking lives. Powerful cravings also seem to characterize them, as in drug addiction, kleptomania, pedophilia, any illicit or illegal indulgence. They like the endorphin “high” or “rush” off of excitement and risk-taking. The serial-rapist-murderer known as the Boston Strangler was such a psychopath.

CHARISMATIC PSYCHOPATHS are charming, attractive liars. They are usually gifted at some talent or another, and they use it to their advantage in manipulating others. They are usually fast-talkers, and possess an almost demonic ability to persuade others out of everything they own, even their lives. Leaders of religious sects or cults, for example, might be psychopaths if they lead their followers to their deaths. This subtype often comes to believe in their own fictions. They are irresistible.

PRIMARY PSYCHOPATHS do not respond to punishment, apprehension, stress, or disapproval. They seem to be able to inhibit their antisocial impulses most of the time, not because of conscience, but because it suits their purpose at the time. Words do not seem to have the same meaning for them as they do for us. In fact, it’s unclear if they even grasp the meaning of their own words, a condition that Cleckley called “semantic aphasia.” They don’t follow any life plan, and it seems as if they are incapable of experiencing any genuine emotion.

SECONDARY PSYCHOPATHS are risk-takers, but are also more likely to be stress-reactive, worriers, and guilt-prone. They expose themselves to more stress than the average person, but they are as vulnerable to stress as the average person. They are daring, adventurous, unconventional people who began playing by their own rules early in life. They are strongly driven by a desire to escape or avoid pain, but are unable to resist temptation. As their anxiety increases toward some forbidden object, so does their attraction to it. They live their lives by the lure of temptation.

Blimey! This reads a bit like description of people I have come across in the past and really didn’t like. The trouble with these labels, like slogans, is that they highlight one aspect of a person and encourage you to see everything else as irrelevant.

I have met many people who are undoubtedlly struggling with schizophrenia, depression, anxiety and somatic disorders. Yet while I might want to label people I don’t like, or who do terrible things as “psychopaths” – actually I have only encountered one person who accurately fits the description. Let him be called BOB!

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Antisocial Personality, Sociopathy, and Psychopathy

I’m aware that although I use these terms on various courses (“Difficult, Disturbing and Dangerous Behaviour” and “Working with Violent Perpetrators” there is considerable confusion and media hype about the use of the above terms. So I thought I woulkd put together a series of postings (for the most part lifted from the literature) to sort out what we are talking about. This has been prompted by a very interesting study that I recently came across “Validating female psychopathy subtypes: Differences in personality, antisocial and violent behavior, substance abuse, trauma, and mental health” – unfortunately to interpret the study would, for many of us, be like a new language.

A very helpful article in this respect can be found at http://www.angelfire.com/zine2/narcissism/antisocial_sociopath_psychopath.html. I will take some quotes directly from that site:

People who cannot contain their urges to harm (or kill) people repeatedly for no apparent reason are assumed to suffer from some mental illness. However, they may be more cruel than crazy, they may be choosing not to control their urges, they know right from wrong, they know exactly what they’re doing, and they are definitely NOT insane, at least according to the consensus of most scholars (Samenow 2004). In such cases, they usually fall into one of three types that are typically considered aggravating circumstances in addition to their legal guilt — antisocial personality disorder (APD), sociopath, or psychopath — none of which are the same as insanity or psychosis. APD is the most common type, afflicting about 4% of the general population. Sociopaths are the second most common type, with the American Psychiatric Association estimating that 3% of all males in our society are sociopaths. Psychopaths are rare, found in perhaps 1% of the population.

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Dangerous and severe personality disorder – Questions and Answers

The condition known as dangerous and severe personality disorder has, in fact, no legal or medical basis. Yet the government is pouring £126m over three years to develop a variety of DSPD services. David Batty explains

* David Batty
* guardian.co.uk, Wednesday 17 April 2002 09.44 BST
* Article history

What is dangerous and severe personality disorder?

Personality disorder refers to patterns of behaviour or experience resulting from a person’s particular personality that differ markedly from those expected by society and lead to distress or suffering to that person or to others. The government first introduced the term DSPD in a consultation paper Managing Dangerous People with Severe Personality Disorder in 1999, which proposed how to detain and treat a small minority of mentally disordered offenders who pose a significant risk of harm to others and themselves. Specialist services to deal with these people, most of whom are thought to be serious violent and sex offenders, were proposed in the white paper Reforming the Mental Health Act in December 2000.

What are the traits associated with DSPD?

The condition’s characteristics have yet to be clearly defined. But it is thought to be an extreme form of antisocial personality disorder (ASPD) – the diagnosis most commonly associated with psychopathy. The key traits of ASPD include failure to make intimate relationships, impulsiveness, lack of guilt, and not learning from adverse experience. ‘Psychopathic disorder’ is a legal term used in the current mental health legislation to refer to people who have “a persistent disorder or disability of mind… which results in abnormally aggressive or seriously irresponsible conduct.”

How many people have DSPD?

The white paper to reform the mental health act states that 2,00-2,400 people in England and Wales are estimated to have DSPD, although some government officials say there are up to 2,500. According to the Home Office, about 1,400 are estimated to already be in prison. A further 400 are estimated to be patients in high security psychiatric hospitals, with between 300 and 600 at large in the community. About 98% of those with DSPD are believed to be men. However, with the new disorder’s definition still unclear, many psychiatrists contend these figures are just speculation.

Where will people with DSPD be treated?

By 2004 there will be 300-320 high security places to detain, assess and treat DSPD. The 92-bed unit on D-wing at Whitemoor prison, Cambridgeshire, began assessing prisoners last September, offering treatment from March. Another 80 places will be provided at a newly built unit at Frankland prison, Durham, from early 2004. There will be 140 additional places for those with DSPD in special hospitals by April 2004. A new 70-bed unit at Rampton hospital, Nottinghamshire, is due to open in October 2003. Another unit will be built at Broadmoor hospital, Berkshire. DSPD services will also be set up at medium secure prisons and hospitals and in the community to treat and support those assessed as safe to be released or discharged. Community programmes are expected to be piloted in south London and the north-east.

How is DSPD diagnosed?

Assessment on the DSPD unit at Whitemoor high security prison lasts 14 weeks. Inmates undergo psychometric tests to assess their dangerousness and to measure the severity of their personality disorder. They also have a series of interviews with a psychiatrist, while care staff record how disturbed and challenging their behaviour is from day to day. The clinical team then evaluates whether a connection can be made between dangerousness and severe personality disorder by examining the inmate’s past and current offending behaviour and how they interact with other prisoners and staff. Jamie Bennett, head of the Whitemoor DSPD unit, said prisoners would need a long history of sex or violent offences to meet the criteria.

What treatment is there for DSPD?

Inmates at Whitemoor and Rampton receive a psychological therapy called dialectical behavioural therapy (DBT), which aims to help them respond to everyday situations in a problem solving manner rather than emotionally and aggressively. This more positive mindset should enable them to take part in rehabilitation programmes, such as reoffending reduction courses. However, DBT has predominantly been used to treat women with borderline personality disorder who deliberately harm themselves and there is little evidence it will prove effective in helping those with DSPD.

What prompted the DSPD programme?

Much of the impetus for the DSPD programme has come from high-profile cases such as that of Michael Stone, who in 1996 attacked Josie Russell and killed her mother and sister several years after his personality disorder was deemed untreatable. The Home Office regards those with DSPD as “a group hitherto poorly served by criminal justice or mental health services” and believes “the serious nature of the crimes they typically commit has a disproportionate impact on the public’s fear of crime.” The Mental Health Act 1983 only allows people to be committed to hospital where psychiatrists believe the person is treatable and many do not believe personality disorder is. But proposed reform of the mental health act would allow detention of people with PD – even, in some cases, if they had committed no crime.

How much will the programme cost?

The government has set aside £126m over three years to develop high security, medium security and community DSPD services. The prison service has been allocated £70m and the NHS £56m. Although Home Office officials were unable to estimate treatment costs in high security settings, Dr Ian Keitch, head of DSPD at Rampton, said treatment at the hospital was projected to cost £180,000 per bed per year. Although this is £30,000 more than current treatment costs for patients believed to have DSPD, Dr Keitch said this was less than treatment costs for female self-harmers – £200,000. However, he admitted the cost could not be justified on current evidence. Peter Tyrer, professor of community psychiatry at Imperial College, said a £2m three-year research programme to assess the effectiveness of the treatment programmes, should lead to improved cost efficiency.

Why is the term so controversial?

DSPD currently has no legal or medical basis and many doctors regard it as a political invention. A survey of nearly 1,200 psychiatrists published in the British Journal of Psychiatry in 2000 found almost two-thirds disagreed with the plan for detaining people with personality disorders, and almost a third said they might boycott it. There is no firm evidence base for the disorder or the new assessment and treatment programmes. The Royal College of Psychiatrists says there is no “entirely satisfactory” diagnosis of antisocial traits that threaten public safety. A recent study in the Lancet warned DSPD is so vaguely defined that six people would have to be detained to prevent one from acting violently, raising major concerns about civil liberties.

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The Dangerous Behaviour Masterclass 3 – Mapping Violence

Sorry for the delay. In the last Masterclass a distinction was made between Difficult and Dangerous behaviour. We have to go into this in greater depth, but at this point in the Masterclass we are simply in the process of mapping out the terrain and identifying important processes and principles. In this mapping process, one dimension can be “dangerousness” while another might be “form.” There are some others, but at this stage let’s just think one step ahead. “Form” describes the type of behaviours involved.

Typically on training courses participants express a concern about a form of behaviour or type of person(s). “What if they are drunk”, “I deal with addicts”, ” I’m really concerned about a stalker”, “Well that’s okay, but what if you’re surrounded by a gang of thugs”, “I can deal with most situations, but what if they are completely crazy?”, “What if someone is completely on a mission to do you some harm?” – and then the additional concern “What if I lose it (panic, freeze, react inappropriately, lose control of myself)?”

All these situations, and more will be dealt with in this Masterclass. Here we will briefly consider “Form” or the perceived type of behaviour with which we might be confronted. I say “perceived” because there is an extremely complex interplay between what goes on in the minds of the protagonists during a conflictual situation – again an issue to which we return.

If Difficult-Dangerous is the “depth” dimension, then what is the breadth? This is the more common arena for academics and there are many formulations to choose from. I choose to go my own way, not out of arrogance but because I arrive at the situation from a different position. I want to know what to do when confronted with all these frightening situations not just to explain them.

For this reason, I see violence as something in motion, and therefore something must be pushing it forward. What could be these “forces?” None of us would worry if they were were static – I could be supremely confident if I knew the person in front of me wouldn’t hit me. The next question, obviously, is then what pushes the behaviour into violence. I have thought about this – motives, drivers, incentives, urges, impulses – actually, in most cases we will never know.

None-the-less, in-practice, it turns out to be very helpful to be able to assess what is driving the aggressor’s behaviour – but a different language is necessary. Here I am suggesting that we label aberrant behaviour as either: Dysphoric, Psychotic or Psychopathic. These are not mutually exclusive – obviously someone could, for example, be impassioned through a delusional belief system. The important practical question is – what is is driving the behaviour? If, somehow, we could remove the driving force, perhaps the behaviour would lessen?

These driving forces, I have briefly described below (their intricacies we will explore later)

DYSPHORIC BEHAVIOUR
This is the most common form most people will encounter. It is fueled or driven by emotion (usually unpleasant and several). It happens because the principal prontagonistics are overcomed by anger, frustration, humiliation, annoyance, irritation, euphoria, etc – and these overide thoughts or other considerations.
PSYCHOTIC BEHAVIOUR
Mental health issues affect one in four of us. It is important to notice also that 80% of violent crime is perpetrated by people with no psychiatric history – alcohol is by far the best predictor of violence. Most psychiatric patients are more worried about what others may do to them than what they may do to others. None-the-less, violence does occur when people become disturbed though drugs, severe intoxication or florid psychosis – and here it is often the fear of the unknown rather than the actual danger that fuels our concerns. The driving factors are confusion, delirium, delusions, hallucinations. Each may be associated by terrifying and potentially violent outcomes, but the question we have to ask is “what is the driving force?” For example, what would be most effective – dealing with the “voices” or reducing the anxiety?
PSYCHOPATHIC BEHAVIOUR
This is behaviour primarily driven by a goal which in the perpetrator’s mind supercedes all other consequences. Often professional criminal activity is ascribed to this grouping. It is important to understand that we are not talking categories of people here, only of behaviour. I don’t suspect that Wayne Rooney considers the feelings of the opposition’s goalie as he slams the ball into the net! This behaviour is primarily predatory but could equally apply to white collar business people and not involve any interpersonal violence.

There is still much more to know! In the next Masterclass we will explore the relation between Dissociation and Violence, and then following that Violence, Dissociation and the Brain. Then we can begin to put the whole picture together again and describe, in detail, good effective practice in violent dyadic situations. From there we will consider issues such as gang/group/ violence, bullying, crisis teamwork skills, personal control issues, post-incident reactions and support – interspersed with with anything interesting and relevant I can throw at you!

Hasta la vista!
Dr Iain Bourne
IMPACT Training & Consultation Ltd
E-mail: impact@dangerousbehaviour.com
Web: http://www.dangerousbehaviour.com

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