291

CAN PSYCHOPATHIC BEHAVIOUR BE CHANGED?

by JOSHUA BIERER,

M.D., F.R.C.P.

the

beginning of this century patients who carried the label schizophrenia generally considered incurable. Starting with Adler, Bleuler and others, a number of papers have appeared claiming that some patients diagnosed as schizophrenics, whatever that might mean, have been helped to a point that they

U P U

to

were

able to cannot

lose their symptoms and live a useful life. make the same statement in rdlat~ian to cases who have been diagnosed as &dquo;psychopaths&dquo;. They are generally still considered ’~incurable&dquo;. Apart from the usual textbooks, leading British psychiatrists were unanimous on that point when they appeared in an I.T.V. programme in London last year. In this paper I would like to describe first 1 a particularly violent type of psychopath; 2 to analyse; 3 to find common features; 4 to discuss; and last but not least 5 to try to describe measures which have been undertaken to relieve the sufferings not only of the patients but of those around the patient who, on the whole, suffer more than the patien’ts. were

One

DIAGNOSIS

What 1

2 3 4

are

the

common

features of these patients?

Pathological egocentridity; Pathological egotism ; Pathological ambition;

There is an unbreachable hiatus between the unbelieveably high ambition and the unbelievably small effort they are prepared to make to achieve these ambitions and they have on the whole no knowledge of, nor insight into, their

anti-social behaviour. There is a blunted sense of marall values between right and wrong). 6 They are pathologically short of time (if

5

7 8

9 10 11l

12

(they have difficu’lty in differentiating

they want something it must be done this ’Second!) They must have their way; they cannot stand refusal or defeat. If one treats them with kindness it generally does not affect them; their demands are likely to grow. They are not choosy in using any method to achieve what they want to achieve. Pure force generally increases their stubbornness and their violence. For the sake of achieving their ambition many of these patients can behave with an extraordinary amount of charm. This charm can very often produce a tremendous amount of harm to other people. CASE HISTORIES

Case 1 :

This happened in 1927, when Alfred Adler, one of the three pioneers of modem sent one off his friends to my home to awake me on a dynamic psychotherapy, Downloaded from isp.sagepub.com at MICHIGAN STATE UNIV LIBRARIES on June 10, 2015

292

Sunday morn’ing. He holiday in the house

asked me if I would like to spend the three months summer of one of Adler’s friends, which was in one of the beautiful

in the Austrian Alps. A young Englishman, who was studying to try to jdin the Diplomatic Service, would be arriving there to spend his holidays. His mother was very worried, because he did not do any studying, he spent his days and nights with prostitutes, drinking and taking drugs. He was completely undisciplined, getting money under false pretences and spending it without any consideration. The mother was very much concerned, not only because he was un’likely to pass his examinations but because he was likely to finish up in prison. He did not admit or accept that there was anything wrong with him and he refused any medical or psychiatric help. He would, therefore, not be prepared to accept me as a psychotherapist and I would have to approach him under the pretence of teaching him International Law. To treat such a difficulty patient at all is not an easy matter, to treat him against his wilt is quite impossible, to treat him under the pretence of teaching him International Law was quite unthinkable, but to refuse such a trust, which a great teacher like Adler had shown in me, would be difficult. I tried to get out of this horrifying task by telling Adler’s friend that I did not speak one word of English. I was immediately told not to worry about it, as the young man spoke German fluently and that the gentleman in whose house we would be living spoke both languages. This friend turned out to be of great help in my difficult task, not only because he spoke German fluently, but he was a gentle and fine man, a pupil of Adler, with deep insight and understanding, who was probably more responsible for any change we achieved in the young man’s behaviour than anything I was able to do. When I met the &dquo;patient&dquo; the first time I was very impressed; he was tal’1 and handsome and a brilliant conversationalist. In the face of this s’ituation I felt the foreign element, unable to understand a word they spoke (the wife of my host did not speak one word of German). If I analyse the feelings I had then, I must have felt more like a patient than my patient! Whenever I tried to give him my lessons, I felt his mind was far away. It took some time before I was able to make contact with the real man who was hiding behind the conceited and proud surface. He told me then that his mother loved and preferred his bother and that he himself had got no chance to gain her love and approval. I had to be very careful in showing h’im that the methods he was using were likely to produce the opposite from what he wanted to achieve. It was not easy to get time to attend and to accept the &dquo;lessons&dquo;-he was preoccupied with other things having become very likely the star of the nightlife of this small resort. It was the most difficult task I had to face ever. I would not claim that I ever &dquo;reached&dquo; him or that I was able to gain his full confidence, but he did attend the &dquo;lessons&dquo;-and he spoke about himself. As a teacher I failed completely, as he did not pass any examinations as far as I know, but something must have happened to him, because the completely undisciplined and violent psychopath who lived the life of a useless parasite became the famous writer, who made more money from his work and has given more pleasure to hundreds of millions of people as very few other writers have done in the history of mankind. resorts

Case 2 : The head of

a

hospital

asked

me

to see a

surgeon

urgently.

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He had to stop him

293 the way up to the operation theatre to start operating, because he was not able to stand on his feet, having taken so many drugs. He came reluctantly, as he had been 2 years in psychoanalytic treatment which according to his statement was of no help to him. on

He told me the following story : His wife divorced him and he was under Court Order not to go near her house, not to molest her in the street and not to see his children. He was very unhappy over all this, but it was very difficult for him to control himself. He was trying to relieve his suffering by taking all kinds of drugs. He admitted that he had been torturing his wife for many years but &dquo;she had to blame herself for it&dquo;. Many years ago when he was travelling as a ship’s doctor from Canada and they were stopping in Newfoundland, the Captain of his ship told him that the boat in which his wife was travelling had just entered the same harbour, although this was not planned. He went to see her, believing it would be a great surprise to her-which it was, because he found her in bed with another man. What was worse and what he could not forgive her for, was that his child was sleeping in the same cabin. That he had had hundreds of affairs before that date was not considered by him to be a good enough excuse not to blame her. He admitted that his rages were so uncontrolled that he hit her quite often very badly and in one rage he threw his children into his racing car and drove the car on an &dquo;M&dquo;-road (autobahn) on the wrong side, against the traffic, to kill the lot. It is difficult to imagine a surer way of killing than that. Thank God, the children made such a noise that they forced him in the last second to go off the road ! Can one imagine the shock to and the conflict in children who loved their father to know that he intended to kill them. He told me quite a lot about his childhood and his past. His parents emigrated from Europe to Canada and as they had no money they had to work very hard. They were unable to give him any time, and he grew up without any love, attention or affection. He became a complete egotist without being able to have any feelings for anybody. He became a &dquo;machine man&dquo; which I called the &dquo;GOLEM&dquo; type (see The International Journal of Social Psychiatry ,Volume 22, No. 3 (1976)). He jumped into bed with an innumerable number of girls without experiencing the slightest concern. He was a master of seduction, he was able to get anything out of them-and when he got what he wanted, when he had squeezed them like one squeezes a lemon, he threw them into the rubbish bin without the slightest consideration or conscience. It was sad and puzzling to see them still crawling out of the rubbish bin trying to kiss the feet of the &dquo;hero&dquo; who has in the meantime eloped with somebody else. During the year he was under my treatment he behaved amazingly well: he did not interfere with his wife, he was well behaved when he met her in concert halls, he was allowed to see his children again and he was kind to them, he did not take drugs and he was able to operate. I believe that this was the result of his adopting me as his father. He loved his father (and hated his mother), who died a short time before he came into my treatment. I did my utmost to persuade him to give up surgery, which he hated and he succeeded in doing that. His life was dedicated to the arts and he got a satisfactory job in this field. Considering the history and the circumstances of this case the change to a new career must be considered an achievement, especially as I understand he is doing well. However I had to give up his treatment when he transgressed our agreement. Downloaded from isp.sagepub.com at MICHIGAN STATE UNIV LIBRARIES on June 10, 2015

294 I tell my

patients at the beginning of treatment that I will stop treatment immediately they tell me a lie and are not prepared to admit it. He was not, so I could not help it, as I have found from long experience that the worst thing a therapist can do is to compromise on principles, but I would not insist that I am necessarily right in every case ! I do not mind if they do not tell everything, but I cannot continue when there is

a

lack of mutual trust.

Case 3 : A member of a Royal Family got herself into awful trouble, because she dared fall in love! This might not be a crime, but when one happens to be a Princess, some families it is a &dquo;crime&dquo; to fall in love with a &dquo;Baron&dquo; (which is a much lower rank of nobility! The pressure of the family was so strong that the Princess had to give up her beloved one. One year later she fell in love again-and who do you think was the &dquo;lucky fellow&dquo;. Obviously a &dquo;Baron&dquo; again ! ! Such repeated revolt had to be broken with all means available. She was told that she would be disinherited and that the family would have nothing to do with her. What can one powerless Princess do against the determined will of a united and financially very powerful family? One would think she could not do anything! However, the ingenious methods the mind of a little Princess can use had not been reckoned with. She joined the underworld, she frequented the most despicable places, mixing, drinking, taking drugs with members of the underworld. They found her in the gutter unconscious from drink and drugs-and what a meal that provided for a special type of Press. They overate themselves with story after story ! The reputation of the family was at stake. A &dquo;Baron&dquo; would have been a saving grace-but it was too late, the family could not find a Baron in the underworld ! In their desperation the family accepted their doctor’s advice to have her admitted to the psychiatric hospital of the University. The Professor in charge of the hospital was in trouble; he wanted to please the powerful family, but on the other hand he knew that a certain type of psychopathy in a certain stage of her battle &dquo;for he rights&dquo; is as dangerous as a shark who has smelled blood! A young assistant, who saw the Professor’s dilemma and who wanted to please the &dquo;boss&dquo; offered his advice : &dquo;Herr Professor, why not get in touch with the man Bierer in London who specialises in this type of patient? He is unorthodox but having suffered persecution he seems to understand people who believe that they have been persecuted-and he gets their co-operation&dquo;. &dquo;Dankeschon, Herr Gutenbroten, please get me this mans telephone number&dquo; said the Professor. I had just arrived in my office when the telephone rang. &dquo;Here is Professor I have a Princess here, who has made Brandt, Head of the University Clinic in a lot of trouble for her family-and the newspapers have made a big story out of it. I would be most grateful if you would take her off my hands&dquo;. I just said to him &dquo;Send her tomorrow morning by the first plane-I will be at the airport waiting for her&dquo;. When she arrived the next day I just asked her one question &dquo;Do you like children ?&dquo;. She replied &dquo;Yes, I adore them&dquo;. I said &dquo;You are starting work tomorrow morning as an Assistant to the person in charge of the Day Hospital for autistic to to

...

children&dquo;. The Princess, who had wasted her life so far with the sumptious and meaningless life of her family and with the useless life of the members of the underworld, Downloaded from isp.sagepub.com at MICHIGAN STATE UNIV LIBRARIES on June 10, 2015

295 had

suddenly become a responsible person doing a meaningful and useful job. Forgotten were the Barons, the family, the underworld and their doings and the drugs. She was doing this job very satisfactorily for years and lived as part of my family in my house for three years. In the end she could not help herself fulfilling the family’s wishes : she met and

married a &dquo;real Prince&dquo; and gave birth to six children. I did not see her for about 17 years-when I met her and her children again recently she told me that her husband had run away with another woman and left her penniless. I do not know if she gave him any reason for it, but I was impressed how well the children looked and how courageously she took her fate, in spite of the fact that she had to live on National Assistance. Not knowing all the facts I do not claim that this patient who carried the label of &dquo;psychopath&dquo; had changed fundamentally, but one thing is clear, that she lived a uesful life for many years in spite of the past. Case 4 : The fourth case f would like to describe is one of a married couple, an actor and an actress. A psychoanalyst rang me up one day and asked me for help with the fol’lowing words: &dquo;I have been treating a couple for two years-and I am afraid that the husband might kill his wife tonight.&dquo; I have described this case in detail in The International Journal of Social Psychiatry, Volume 22, No. 3 (1976) on pages 197-200 under the title &dquo;Lovemaking -An Act of Murder&dquo;. I showed in this case how violent psychopathic behaviour can be related to 1 A mother who cannot show any love and affection; 2 To the upbringing of the patient by a cruel mother substitute; 3 To the craving created in the patient for a loving mother substitute. 4 With the fact that such an aim cannot be achieved as an upbringing like his has not enabled the patient to develop the &dquo;Love Apparatus&dquo; without which people have not got a chance to give or to accept love and/or affection. 5 To a wild and hopeless search for affection, resulting in violent behaviour; lacking in insight he blames his partners to such a point that he has to use all his controlling power not to kill them. 6 With violence as the result of frustration, when insight was not acquired in time. Case 5 : The next case refers to a young man whom I had known for some time. About couple of years ago a pupil df mine asked my advice in relation to a young man she had fallen for, but whom had a violent temper. I saw the young man a couple of times- and I advised the pupil to get rid of her new lover as soon as she could. As he would not agree to have any treatment and I realised that he was a dangerous man, I had no hesitation in giving her the above advice. It was not easy for her at first to accept my advice and secondly, to carry it out until she realised that this was the only way. She did succeed in the endand I died not hear any more abou’t this young man. I was rather surprised to get a telephone call from him after about two years. He asked for an appointment, which I gave him. He told me, when I saw him, that he had married a girl after he had known her only for three weeks and he believed that he loved her dearly, but he had nearly killed her three times-and he was a

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296

frightened that he might succeed the next time. The first time it was quite bad, but they made it up by going to bed and enjoying sexual intercourse. It is amazing how lovemaking can become more satisfying to some people after acts of violence. The second time it happened in his cottage in France, where he hit her so badly that he thought she was dead : she forgave him again, but it was still worse; he not only hit every part of her body, but he destroyed her whole flat; he broke every piece of furniture, he not only tore every piece of her personal belongings, but he poured oil paint on them, on all the carpets and on all the walls (different colours !) I rang up the wife and persuaded her to come and see me. It took me some time to make her realise that her life was in real danger and in the end I persuaded her to accept my suggestion of Total Separation Treatment. This treatment means no contact of any kind between the two partners. Although he said at first he could not live without her, he accepted this suggestion with some relief and he -

-

moved back to his own house. But it was not him, it was her who came to his house after one week, begging him to come back to her flat. I had always thought that the self-preservation instinct was the strongest,. but it appears that some peoples’ DEATH-WISH is the strongest! I know from long experience that the total separation treatment only works when it is carried out completely without compromise. I warn patients who agree to this treatment, at the onset that I will stop treatment if they do not keep to our arrangement..In consequence of that I stopped seeing them. When I started to write this paper I wanted to know what happened to them. I rang one of the telephone numbers I had. He answered and he told me that he could not stand it any longer and that he had sent her away. A few days after the above my telephone range at 1 a.m. A voice said : &dquo;This is David. I am smashing up my whole house and I am going to kill myself. Will you ring up Sulamith and tell her that; she is staying with her parents. She promised to join me for the weekend but she did not keep her word&dquo;. He gave me Sulamith’s telephone number but it was the wrong number. I rang up a friend of David’s, who went to see him. It was true that he had smashed up all his furniture, including the antiques and two original Turners, to small bits and pieces. He destroyed many things in the rest of the house. This case shows his impatience, his great intolerance and his violent streak in his early childhood and the same in his father. They show his inconsistency of mood, his pathological egocentricity and inferiority complex. This case shows the inability of this type of patient to stick to treatment and the degree of violence against others and even against their own belongings.

Case 6 : Some years ago I received a letter from a man I did not know asking me to see his son, who was in prison serving a three-year sentence. When I went to see him he told me that he had appealed against his sentence and he would like me to support his application. After speaking to him for a couple of hours, I told him that I could only recommend a longer but not a shorter sentence. When I looked at him at that moment I suddenly realised that there was a completely different man in front of me : the smiling face on top of a relaxed and free-moving body had suddenly changed into a ’tiger’, a body with convulsed muscles ready to jump at me, expressing but not saying, &dquo;You bastard, my father pays you to help me - and you intend to harm me!&dquo; Realising his very hostile and rather dangerous expression I added ’







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297

guiltily, &dquo;I am a doctor and I am here to help you. If I support your application and you are discharged earlier, I am going to warn you. You will be again jumping into the first car you are able to get hold of, as you have done so often before, and as a result of that you are likely to be back here for 5 or for 7 years. For your sake I am not prepared to help you to get into a worse position than the one you are in now&dquo;. The ’tiger’ suddenly changed from a dangerous to an impatient position and he . said, &dquo;What else then do you suggest I do ?&dquo; I said, &dquo;I am prepared to treat you whilst you are in prison. When you have progressed to the point that you will not have to drive away cars which do not belong to you, I will then be very happy to - recommend a reduction of your sentence&dquo;. We parted on more friendly terms as he realised that my original statement was in his own interest and not the expression of a hostile intention. I wrote to the Chief Medical Officer of the prison service proposing his transfer , to a prison in London. However, the answer was in the negative,. When he left prison, after having served his sentence, he and his father bombarded me with letters and telephone calls, asking me to take him on for treatment. I told them that , nothing had changed, that this was a case where treatment should be given in prison, to a point that the vicious circle can be broken. However, as there was no obvious way of breaking the vicious circle, I gave in in the end and agreed to undertake the impossible task of treating him. I said impossible as I could not see how this patient could break his long lasting compulsion. However for two months it appeared as ~if my assumptions were wrong: he did not take any cars away, he ’took on a job with a builder and did some very hard physical work. He regularly attended his individual and group-therapy sessions. I have to mention here that he was a practicing homosexual throughout his life. One day a foreign girl approached him in a pub asking him if he cold offer her a bed. She had live up to that day in a flat which belonged to a &dquo;h’o~mosexual&dquo;-and he had suddenly become amorousand she did not like it! (Life can be very strange sometimes!) The outstanding beauty of this girl had suddenly &dquo;unhinged&dquo; the feelings of another homosexualhe agreed immediately and she moved into his flat. Later in the day he invited the girl to go out with him in the evening. She refused and she had a previous engagement. He was furious, but he controlled ’himse’1’f. When he came back from work he found out that she had crawled into the flat through the window to dress herself for the evening. (He did not give her the key to the flat). When she returned late at night he attacked her physically-and the police were called by the neigh’bours. Two days later he spoke in the group-therapy session telling everybody how well he was-and that he had overcome his original compulsion to drive away cars, hich do not belong to him. A few days later the police rang up, telling us that they ad caught him in a University town, (where he had studied before and where he was nown to the police, because he had served his prison sentences there), breaking into Club at night time, driving a stolen car. He admitted to the group later that he as already in possession of the car, when he spoke to the group a few days earlier. y original refusal to take on his trea’tment was justified---but this did not make e happier. Even if he was ‘5incurable&dquo; I could not let him down now having tarted-so I appeared in court and agreed to continue his treatment under the 01’lowing conditions: 1

2 3 4

That he would attend his treatment sessions That ’he would not drink alcoho’l; That he wou’ld hold down a job; That he would not drive or steal any cars;

regularly for one year;

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°

298 5

That I would

report

to

conditions;

she

court

iimmed’iately

he broke any of the above

The judge sentenced him ’to 4 years imprisonment but put hi’m on probation subject to the above conditions. For one year, whilst under the treatmen’t order, he kept the above conditions 1’iving in the house of his new girlfriend, keeping a job and even studying for a further degree. After a short time ~in his new job his workmates

elected him

to

represent them in their Union and he

was even

elected

on

to

representative board of the local Labour Party. He lived, as I mentioned above, in the house of his new girlfriend, a normal heterosexual life, but he was stil’1 egocentric, dictatorial, expecting that his girlfriend, would provide everything, in spite of the fact that he con’tributed very little to the cost of running the house and feeding him. He had an excellent excuse, that he was saving for a new house for both of them, as the house they lived in belonged partly ’to the former husband of his girlfriend. He sometimes lost his temper, but he could be very charming too, inviting the girlfriend, and her mother out, although this did not happen very often. During the year of treatment ordered by the Court, he attended the treatment quite regularly and did not get into trouble with the police or the Court. However things changed after the one year compulsory treatment order came to an end : he gradually stopped attending the individual and group-therapy sessions, he stopped studying, he left his job and he became very violent. His girlfriend, who looked after him with the greatest devotion and suffered hell through his misbehaviour, locked him out one night because she had had enough and because she was frightened of him, when he did not come home by 1 a.m. He broke a window, came into her room and hit her for 1 t hours. She survived only because she was a sportswoman and because she succeeded ’in escaping in the end. The girlfriend dropped her charges eventually-and he succeeded in getting himself back into her house. He continued to live off her-and to gamble away all the money he received the

from the Public Funds. SUMMARY

wi’th a power complex as strong as that of Hitler, but a man more knowledgealble and more intelligent and with a more brilliant mind, but a man as dangerous as Hitler. He would have no compunction and no hesitation in constructing an H-bomb and letting it loose to destroy a great part of this world. The experience with men of power the world had in the last century should, I believe, help to awake the conscience of the world. Steps should be taken to limit the power of these men. I do not want to give the impression that the lust for power has increased in the last century; people have not changed, but the means of destruction have increased dangerously. What can we learn from this case of extreme violence and extreme anti-socia behaviour? Even he was able during the one year &dquo;compulsive&dquo; ’treatment to atten regularly the treatment sessions, to keep a job, to study, to be elected as a represen tative of his working pals, to deve’lop feelings for a woman and have heterosexua relations in spite of the fact that he was a practicing homosexual before, to behav less violently.

This is

a case

of

a man

CONCLUSIONS

such people and giving in every respect has in the past not producer results. Pure force has more often than not made them more bitter, more stubborn

Spoiling

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299 and

more difficulty. compulsion combined with strong motivation (patient-therapist relationship) might have a chance to produce

and deep pather results in certain

cases.

The type of

only

psychopath described above costs the community a fortune; i’t is question of keeping him for the rest of his life, but the damage he causes and the community can be immense. is, therefore, justified to propose the establishment of the following experi-

not a to individuals

One ment :

A Universal Development Scheme, where these people will have a chance to develop any of their innate abilities. As people generally develop only 5-10% of their potential, there is plenty of scope for development. It will be a sort of University plus Polytechnic, where everybody would be able to study anything from bricklaying and plumbing and shorthand typing to becoming a doctor, an accountant or even a poet (if this could be learned at all). But at the same time everybody would have to work-and everybody would have a manual or practical as well as a theoretical subject or ability. Everybody will be paid according to his ability and according to his output. Emphasis will be laid on incentives. Convicted prisoners will be given a chance to take part, but the &dquo;University Centres&dquo; will be &dquo;graded&dquo; according to the immediate danger the individual might be to the community. Part of their earnings would be saved and released only after their &dquo;discharge&dquo;. We must consider that the present prison system in completely useless. Is it not senseless that the greater the damage a criminal has caused the community, the more the community has to pay for him. Should it not be the opposite, that the a criminal has caused, the more he should pay back to the The above proposal should help to carry out such a project! I admit this proposal would cost a lot of money because each &dquo;student&dquo; (this is the title I would like to give them, because they will become students of life, as they will be taught how to live successfully without relying on crime) will have his

greater the damage

community!

personal therapist. A lifelong prisoner costs the community probably more than £ 100,000. A University town for 10,000 students would save, once it is established, one thousand million pounds. The running of such a project should, once it is established, not cost anything, or very little, as everybody will be working, producing and paying his share in the form of fees and taxes. But even if all the services could be paid by the students, the actual fact that people who would otherwise be a continuous burden on the community are adding to the amount of productivity, is a double benefit, because the state not only gains the £ 1,000 of added productivity but it saves the £ 1,000 it would have to pay for keeping the prisoner. To summarise: Psychopaths are difficult, but they are not hopeless or incurable. To justify the last sentence, the following case should be noted. Case 7 : A young boy was treated for years by the child psychiatrist in charge of the childrens’ department. I saw him from time to time in the corridor of the hospital, but I had no administrative or therapeutic contact with him, as I dealt with the patients in the adults department. However, when he grew out of the childrens’ department age group, and the child therapist he was attached to suddenly died, he started to drop into my private house apparently looking for some replacement. He started to attend a self-governed therapeutic Social Club. The Social Therapist Downloaded from isp.sagepub.com at MICHIGAN STATE UNIV LIBRARIES on June 10, 2015

300 started me

to to see

take an interest in him and he became very attached to her. She asked him. I saw the mother and father together and separately and I got the

following picture: The mother came from a very rich and a very religious family where to marry &dquo;beneath&dquo; them was not done and where to marry outside their religion was a sin and where to have an illegitimate child was a crime. The mother succeeded in committing the lot. She had to hide the baby in Switzerland in a house. He was brought up as the continuous symbol of shame and sin, without the atmosphere of a loving home, that means without a father and a mother. When I met him as a therapist he was already in his twenties living with his father. Mother had to live separately because the son hated her and threatened her continuously-he was tall, broad-shouldered and very strong. He was out of work as he could not keep any job-he got in trouble mainly by attacking people physically. He went to prison but he was lucky: when he stabbed a man with a knife it went in next to the heart and not into the heart. He went from woman to woman, priding himself on having a number of different ones every night. No wonder that this overtime nightwork was not very conducive for productive daywork. During the time I was seeing him he met a girl, who had been my patient some time ago, in the patients’ club. He fell for her very heavily and they became intimate friends. After some time he persuaded father to leave and move to mother’s flat and the girl moved in with him. I knew the girl well, as I had stopped her treatment when she broke our agreement and I knew that she had done itbefore. She would get engaged and break it off before the announced marriage took place. I knew that she would not be satisfied by being married to a man who had nothing and that he would not gain enough confidence to act like a grown up man, being dependent on mother’s moods financially. I advised mother to release the trust funds which she had established for him. She accepted my advice and the result was quite remarkable. The boy, whom had always hated his mother and expressed the desire to kill her, changed co~mp~letely-and he realised he was wrong, whatever mother had done in the past had been for his good : he started to love his mother. The mother was so overwhelmed that she fell around my neck wherever she met me, thanking me for what I had done. The patient, who was completely promiscuous, did not even look at another girl-and it appeared that he was able to satisfy her completely sexual’ly, which she had not experienced before. They appeared to get on wonderfully well, when she suddenly became true to her style-and walked out on New Year’s Eve. He was wild with rage and sorrow. He wanted to telephone her, to visit her, to attack her, to rape her, to do the most incongruous things, a~ he said he could not live without her. I had to restrain him with the greatest possible pressure, telling him that I would never see him gain unless he followed my advice. I advised h’im not to approach her in any way because she needs time and any pressure would on~ly bring about the opposite result. I advised him only to write a letter saying he was sorry that she did not,love him. If she did not, it would be senseless to get married. With his best wishes for a happy future. After a few weeks she came back and they married. I am convinced that a psychiatrist, who can rely on his experience, has a duty to give advice----and not just to listen. This is a case where a psychiatrist has changed : his hatred of his mother turned to love; his irresponsible polygamy turned into a monogamous love relationship and he was able to take control of his violent and murderous reactions.* I would like to pay tribute to the dedicated and brilliant work of the female Downloaded from isp.sagepub.com at MICHIGAN STATE UNIV LIBRARIES on June 10, 2015 who has taken a major part in the treatment of this difficult case.

psychotherapist

301

Case 8 : Whilst in many cases of mental aberrations it is the patient who is the foremost sufferer, in the case I will describe here it was the environment which suffered. A medical colleague, whom I have known for many years, consulted me one day about her son. She was the friend of a very good friend of mine and I met her many times before she consulted me. She was an intelligent, good person, a devoted doctor and a good companion in a social setting. As far as I remember she has never mentioned her son before to me. She said that she had come to see me because she was in a state of desperation : &dquo;at the end of her tether&dquo;, and near to a major breakdown. Her story, in short, was as follows : Her husband, whom she had divorced, was a psychopath and an alcoholic. His father, who was an internationally known political figure, was considered to be a very kind man and liked by many people. The father and his wife were politically so busy that they were not able to give much time to their children. Being the son of very famous people is in itself such a great handicap that few children can get through it without any harm. Th’is son (let us call him Samuel) was never able to compete with father, who succeeded in changing the history of the whole nation. Samuel was never able to keep a job down and he lived an obscure life as an addict. He was neither able to play the role of a loving husband nor the role of a father whom one cou’ld trust, and who could be a good example. When this female doctor, the wife of this addict, brought her son, Daniel, to see me he was very far gone. He consumed one or two bottles of whisky per day. He was unable to continue doing his work properly. He was threatened with dismissal from his important job. To his mother and later to me he would give his word of honour that he would not touch alcohol anymore. However, he still smelt of alcohdl and he hid bottles away in the bonnet of his car, in the lavatory or hanging outside the house from the roof. It would be understandable if one would jump to the conclusion that one could not expect anything else from a man who had such a useless psychopath and addict as a father and a disrupted family home. However, following the principle of Social Psychiatry, looking at the &dquo;Total Set Up&dquo; I will describe now the important facets of this case. Daniel was married to a Danish wife, with whom he had three very healthy and normal children,. He played the role of a good husband and a devoted father. The trouble was that he was &dquo;too good&dquo;, according to his wife. He was very weak and she resented to have to look after &dquo;four children&dquo; an to have nobody on whom she could lean. She fell for another man (’let us call him Paul) to the point that she became his complete slave. As soon as Paul telephoned her she would run to him, at any time, day or night. She told Daniel, the husband about her sexual dependency on this man, but even more she got the husband to take her to Paul’s flat and to cdllect her when &dquo;all the fun was over&dquo;. Daniel loved his wife so much that he did all that without ever saying anything or refusing. But this was not all! Paul came and visited Tirza (the wife’s assumed name) in her house and stayed the night upstairs with her whilst the husband was there, sleeping downstairs. In the morning he said to Daniel (the husband) &dquo;I hope you did not hear when I made love to Tirza last night&dquo; ! Could anybody else, than such a type, have the cruelty, the lack of sensitivity and the sadism to say such a thing to a loving husband ! Obviously he knew that Downloaded from isp.sagepub.com at MICHIGAN STATE UNIV LIBRARIES on June 10, 2015

302 was too weak to knock him out or to object in any way. However, the for the husband did not end here! One day Paul gave up his flat and moved into the home of Daniel and Tirza, with all his belongings. This happened at a time when Daniel and Tirza were in individual and group therapy with- me. With their consent I invited Paul to attend the same group. He was supposed to be a journalist, but he was really a frustrated writer. His brain was trained and geared towards convincing people that the sunniest of days was, in fact, midnight! He would use any method to try to achieve this extraordinarily d’ifficult tasks. He tried and nearly succeeded to convince the group that he was not an unscrupulous and sadistic psychopath, who exploits women without any consideration and without compunction, in a completely egocentric and egotistic way, Without any consideration of other people’s feelings, including the feelings of the person whom he professed to love. He maintained, in front of Daniel and Tirza and the group that he was the &dquo;greatest benefactor&dquo;, and that we should all be grateful to him. Tirza was not in love with Daniel, she was sorry for him. She loved him and he could provide for her physical needs, whilst her husband could not. The little bit of hospitality he received was not enough payment for his excellent &dquo;services&dquo;. &dquo;Race horses, like the Derby winners, fetch more than a million pounds these days&dquo;. Although the group were horrified by such language it took them some time to open Tirza’s eyes to the point that she asked Paul to move out of her house-but it took her very much longer to liberate herself from the power Paul had over her.

the husband

degradation

Daniel and Paul were both, at some time of their lives, called psychopaths. In my opinion Daniel was not a psychopath. It was true he was lying badly, but only when he had to hide his bottles. He was not anti-social, nor an egotist, he was a devoted father and ready to do anything for anybody. He loved his wife, in spite of all the humilitation he had to endure. He was weak, yes, but not vicious or revengeful. In his quiet way he was ambitious, but he would not want to achieve his ambitions by walking over bodies. He was unable to resist alcohol, but he could differentiate between right and wrong. He always tried to keep his job and to be a devoted father. Although divorced he still has lunch everyday with his children and with Tirza. Last, but not least, he has not touched alcohol for the last six years! Paul is an excellent example of a psychopath, having most of the symptoms as described in the beginning of this article. According to him we were all mad and we needed treatment, he did not need treatment, so he dropped out after having attended a few group therapy sessions : &dquo;Psychopaths might need treatment but not I, who is a benefactor ofHumanity!&dquo; DISCUSSION

writing this paper I wanted to draw the attention to the fact that many psychopaths are often brilliant people, both ruthless and at the same time without any inhibitions or conscience. Being very ambitious they sometimes get to the top and are in full control of nations and continents. With the advent of Nuclear Power the danger to Humanity is, therefore, imminent! On the other hand, the opinions accepted by many psychiatrists that psychopaths cannot be influenced, nor can their behaviour pattern be changed, cannot be supported on the evidence given in this paper. There are still too many definitions of what we mean by psychopaths. This paper has been written with the intention to encourage and to accelerate a discussion on new approaches to the problem of psychopathy. In

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303 SUMMARY

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7

As there are still so many definitions of psychopathy a comprehensive definition is being put forward for discussion. History has shown that there are still too many psychopaths who have too much unlimited power. With the advent of Nuclear Power this danger has become a danger to the existence of this planet. It has become a most urgent task for the responsible people of this world to find a way to achieve a compulsory physical and mental examination of people with national and international power every six months. To say that it is impossible to achieve this is not good enough. Many things in History appeared impossible, but became possible 20-50 years later. The so-called &dquo;Freedom of the Individual&dquo;, which has been the most precious achievement of Democracy should not be used to enable unscrupulous people to destroy this planet. Psychopathic behaviour can be changed-and new methods of treatment should be tried out. Dangerous psychopaths should be locked up, not in prisons, which is generally neither productive nor therapeutic. Special &dquo;Guarded Colonies&dquo; or &dquo;Special Universities&dquo;, where psychopaths could use their ambitions, their active brains in a constructive way, being useful to the community and to themselves and having been given the chance to go back to the community with enough savings in their hands and with the right advice how to use them. The limitation for the judges in English Courts that psychiatric treatment can only be ordered for one year is sometimes useless. Judges should be given the right to order compulsory treatment for as long as therapeutically necessary or advisable. To enable us to think about and carry out these new experiments it is essential that we change out ingrained opinion that psychopathic behaviour cannot be

changed.

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Can psychopathic behaviour be changed?

291 CAN PSYCHOPATHIC BEHAVIOUR BE CHANGED? by JOSHUA BIERER, M.D., F.R.C.P. the beginning of this century patients who carried the label schizoph...
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