The Interpersonal Perspective

Whereas the psychodynamic perspective was classically concerned with internal conflict, the interpersonal tradition focuses on relationships between persons and the impact of their communications, both developmentally and in the here and now.

Within the interpersonal tradition, behaviors are often organized in terms of the interpersonal circle. According to Kiesler (1996), the antisocial personality represents almost pure interpersonal hostility. Offering descriptions at two levels of severity, he summarizes the actions of the moderately pathological form of antisocials as oppositional, irritable, and rude (p. 14). In addition, they are quick to argue, ignore the feelings of others, resist cooperation, and readily provoke disputes. Their extreme form Kiesler regards as rebellious, vicious, and vulgar (p. 15). Moreover, they exhibit blatant defiance and ruthlessly attack, torment, and abuse others who thwart their intentions.

Using her SASB model, Benjamin (1996) paints a similar picture. Unlike Kiesler, however, her model suggests that antisocials also seek to control others, while vigorously resisting any and all attempts by others to control them. They may refuse to make child support payments, for example, mainly because they have been exacted by external authority. According to Benjamin, this provides an important distinction between antisocial behaviors and those that are merely criminal. Criminal behaviors are antisocial only when they contain the additional interpersonal element of establishing or perpetuating some form of control over others, without regard to the impact of their actions. Accordingly, criminal actions geared exclusively toward personal gain, for example, do not qualify as evidence of an antisocial personality.

Antisocials not only seek control, according to Benjamin, but also do so pridefully. The exploitation of others, whether by conning or coercion, for example, makes them proud, regardless of how the lives of others are affected. Thus, they may guiltlessly abuse others physically, even critically injuring them, to secure control over a relationship or express their own autonomy. For example, a spouse who confronts her antisocial husband too forcefully about his infidelity potentially faces an ambulance ride to the emergency room. Antisocials' willingness to assault others violently, even jeopardizing life itself, serves an important instrumental purpose: causing others to think twice about taking any control for themselves or even about asking that their rights or welfare be respected. Instead, the antisocial believes that others should automatically assume a posture of submission.

Consider the case of Oscar, introduced in Case 5.2. Oscar's aggressive urges are hardly sublimated by his supervisory role. Whereas constructive intervention requires knowing the strengths and limitations of those supervised, Oscar would rather intimidate and coerce. He argues even with his own supervisor, which is the immediate reason for his referral. He refers to his wife as "the bitch" and demeans everything she does. Prideful aggression features strongly in his history. Moreover, he is rarely at work on time, is absent without explanation, collects overtime pay that is apparently undeserved, and lets substance use interfere with his job. When he presents for therapy, he attempts to excuse his actions through a fabrication that would make him out to be the sympathetic party. He is not interested in the consequences of his actions; instead, his strategy is to be so threatening that no one dares get in his way. He even views therapy as a punishment and vows revenge, saying that those who have wronged him have "brought it on themselves."

Like Oscar, many antisocials see the world as suspended in what Thomas Hobbes referred to as a "state of nature": Competition is the rule, survival is the goal, and no one can be trusted. To the extent that antisocials reflect on the content of human nature, people are seen as inherently selfish creatures whose motives are power and control. Toni (from Case 5.1) comments on this worldview when she sneers at religious feeling, asserting, "Jesus don't love nobody, or at least he don't love me," and again when she declares, "No one ever felt guilty for what they did to me." Likewise, instead of working out his problems, Oscar is interested in avenging himself. Such attitudes are characteristic of antisocials, for whom morality is an illusion, goodness is weakness, and trust is naive.

Given such a world, the behaviors of the antisocial, particularly lack of remorse, can be seen as a functional adaptation. Because others are only too willing to exploit and hurt, it is a well-developed conscience that is pathological. Giving in to guilt would only mean leaving yourself open to domination and exploitation at some future date. Success in taking advantage of someone yields a sense of triumph in a game where everyone has exploitation as his or her hidden agenda.

How does the antisocial personality develop from the interpersonal perspective? Children exposed to neglect, indifference, hostility, and physical abuse are likely to learn that the world is a cold, unforgiving place. Such infants lack normal models of empathic tenderness. Rather than learn how to be sensitive to the emotional states of others, they instead develop enduring resentments and an unwillingness to reflect on the consequences of their own actions. Without adequate parental controls, future anti-socials never learn to control aggression adequately. In fact, they usually learn that physical intimidation and violence can be used instrumentally with peers and siblings to coerce their behavior. Further, a violent parent provides a violent role model. Children who watch one parent verbally threaten or beat the other into submission eventually imitate this pattern in their later relationships.

CASE 5.2

Employed as a maintenance supervisor, Oscar was referred to the university's employee assistance program (EAP) because of a harsh, dictatorial interpersonal style. He missed two previous appointments and was 20 minutes late today. His history is marked by a long series of arguments with coworkers, which appear to be increasing in frequency.1 Although he is rarely at work on time, he has somehow managed to collect overtime pay from the university for the past three pay periods, and his time sheets are being examined for evidence of fraud. He is belligerent with both his supervisor and the crew he manages. On several occasions, staff has complained that they smelled alcohol on his breath.

Oscar is 33 years of age, about 6 feet tall, with an average build and dark good looks. Edgy and irritable, he remains seated only with difficulty. He simmers as he discusses the details that have brought him here. He immediately takes the position of one who has been wronged and launches into a heart-wrenching story of how life has mistreated him cruelly. He regales an elaborate tale of how his mother is sick in the hospital, and there is no one but him, the dutiful son, to take care of her. He has been late or absent from work to take care of her, and he needed the extra money to pay her medical bills and her rent as well as take care of his alcoholic brother and his eight shoeless children. These are interesting claims in light of the fact that his mother died six years ago and he hasn't seen his bachelor brother in more than two years.

Eventually, pieces of Oscar's history unravel. He came to the United States illegally at age 4. The family subsisted as seasonal pickers on farms throughout the Southwest. He speaks condescendingly about his parents, noting that they pretended to be what they were not, never had a home, had too many kids, were usually without running water, and were never home. Verbally, they insisted he keep clean, show respect, and study the books they carried from farm to farm. Nevertheless, any chance for learning was apparently undermined by Oscar's aversion to authority. Occasionally, his parents would rise up to assert their authority, but these episodes were short-lived. During his teenage years, he was in and out of juvenile detention centers mostly for truancy and assault.

Trust is the theme of this first meeting. Married at 18, Oscar refers to his wife simply as "the bitch." Apparently, her cooking is inadequate, she puts the kids and her job before him, and worse, she gets angry if he does not come home after work. Furthermore, he draws an angry comparison between "the bitch" and his coworkers, both supervisors and subordinates alike. Like her, they fail to appreciate him and would "fall flat on their faces" if he suddenly disappeared. "They have it easy," he says with obvious resentment. "I carry all the responsibility." Oscar is angry, viewing therapy as a disciplinary action and punishment. He makes it clear that the actions of his supervisors and subordinates will not soon be forgotten.

Oscar speaks with a cool calculation. Not ruled by anger, his actions are instead planful, but punctuated by an underlying rage. He believes the world to be a hostile place requiring deliberate defensive and offensive actions. When asked about his plans of revenge, he replies with cold and unblinking eyes, "They brought it on themselves."

1Numbers mark aspects of the case most consistent with DSM criteria, and do not necessarily indicate that the case "meets" diagnostic criteria in this respect.

Antisocial Personality Disorder DSM-IV Criteria

A. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:

(1) failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest

(2) deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure

(3) impulsivity or failure to plan ahead

(4) irritability and aggressiveness, as indicated by repeated physical fights or assaults

(5) reckless disregard for safety of self or others

(6) consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations

(7) lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

B. The individual is at least age 18 years.

C. There is evidence of Conduct Disorder with onset before age 15 years.

D. The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode.

Reproduced with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric Association.

Benjamin (1996) makes a crucial distinction: Early abuse explains antisocial aggression, but not a need for autonomy and a resistance to and resentment of control. Neglect and abuse are rather nonspecific factors, implicated in the early childhood of many personality disorders, perhaps especially borderlines, as well as a host of Axis I disorders. What shifts the child down a specifically antisocial pathway? For Benjamin, the answer lies within the context of parenting. Although usually neglectful, the parents of future antisocials, she states, sporadically become stern disciplinarians. A cocaine-abusing mother or an alcoholic father, for example, might suddenly decide to "put the house in

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