22. Exceptions and Exceptional - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Conflict, Control, and Out of Control in Couples and Couple Therapy
Chapter 22: EXCEPTIONS AND EXCEPTIONAL


Individual variations express in communication, interactions, and behaviors along a continuum of assertiveness, aggression, and abuse.  Gender, class, and cultural models, stress, emotional and cognitive development, family training, and characterological values and traits determine how much and how carefully the individual is attuned to boundaries along the continuum.  Individual attitudes, values, beliefs, and motivations and their stability or volatility create variance in how strictly one adheres to or takes exceptions to rules and boundaries.  The rules and boundaries may be codified in law, professional ethical standards, and religious code.  They may be determined by authoritative fiat or community consensus in social or cultural mores and family models.  Or, they may come from a personal morality.  The personal morality may be a higher code constituting an extension of socially accepted rules and expectations.  Individual autonomous values may cause an individual to sacrifice personal benefit he or she is entitled to based on social, cultural, and legal standards.  On the other hand, he or she may become more assertive and aggressive than is sanctioned in order to fulfill some higher purpose.

In the movie "Sling Blade" (Thornton, 1996) the main character Karl Childers who is mentally handicapped makes a choice that is clearly wrong and unquestionably illegal.  He has been released after spending twenty years in a mental hospital for killing his mother and another person.  Karl is a gentle soul nevertheless, and he becomes friends with Frank, a young boy.  He observes Doyle, the abusive boyfriend of Linda- Frank's mother.  Over the course of the story, it becomes clear that Doyle is abusive to Linda and will be abusive to young Frank.  Despite his mental challenges, Karl realizes that Linda is too damaged to resist Frank and will doom herself and young Frank to a life of abuse by staying with him.  Although he knows that he will be sent away again for the rest of his life, Karl decides to save Frank and kills Doyle.  As the targets of cinematic manipulation, the audience aligns with Karl's moral dilemma and his choice to resolve it.  An exception to the legal prohibition to kill another was tolerated if not accepted or praised.  The larger community can be appreciative and respectful of such moral choices that are clearly exceptions to generally held practices.

While such exceptional behavior and values may be honored, other exceptions to relationship, societal, and legal standards can be highly problematic.  An individual can hold exceptions that permit and even require otherwise forbidden aggression, abuse, and violence.  As discussed earlier, for example O'Hearn and Margolin (2000, page 169) reported research that some men felt that physical male to female aggression is somewhat justifiable when the wife rejects or embarrasses the husband such as flirting with another man in his presence or repeatedly calling him "stupid."  Many people immediately change the rules, including taking the right to discard held values if they feel that the other person has been disrespectful, abusive, or violent first.  They feel entitled to spout cruel words that violate civil boundaries of discourse.  These exceptions become the foundation for domestic violence in conjunction with the individual's emotional reactivity.  The therapist should identify the values, rules, and boundaries for assertiveness and aggression, along with those for abuse and violence.  Most critically, the therapist also must identify any implicitly or explicitly held exceptions to these values, rules, and boundaries.  The therapeutic process would involve renegotiating and asserting acceptable healthy exceptions.  Specifically, the therapist must get the couple to remove any exception that bypasses prohibitions to abuse and be violent.  There can be no exception that allows for abusive or violent behavior.  That must include feeling disrespected or hurt first.  In order, to remove this exception, the partners must learn how to be assertive and aggressive confronting disrespect or hurt (intended or unintended) without crossing over to abuse.

There are people who hold types of singular functional morality rather than social or legal codes or values based on mutuality and community well being.  In the balance of values, a self-serving effective tactic or strategy to maintain control becomes more acceptable... if he or she can gain benefit and not suffer harm from it.  For some people, however such egocentric functionality is not balanced with other values, but is the only standard for behavior.  These people unfortunately hold and cannot give up a major exception to behavioral standards.  This exception is of being exceptional.  Specifically, as an exceptional person, the standards of society, culture, and law are not applicable to the individual.  Such an individual holds that rules and boundaries are for other people and not him or herself.  Therefore, civility and mutuality between partners in a couple is unimportant or less important than staying exceptional and staying in control.  Abuse or domestic violence therefore becomes another calculated tool to stay exceptional and in control as long as he or she is not punished for it.

Etiology and characteristics of domestic violence perpetrators and influences affecting increased risk of physical abuse repeated make distinction for a very important and distinct subgroup of perpetrators.  Sociopaths, psychopaths, or antisocial individuals, particularly men with antisocial personality disorder are significantly distinct to examine separately for how they function socially, in couples, and their perpetuation of intimate partner violence.  Not so much as being exceptional, such individuals experience, feel, think, and function differently than most others.  And would need to be treated differently.  One of the key factors for assessing and understanding intimate partner violence is anger or rage associated with and/or triggering the behavior.  While applicable to many perpetrators, anger does not apply in the same manner to antisocial individuals.  "...men with cold and callous interpersonal traits may not experience or express anger and jealousy, even though they may be violent... antisocial and psychopathic features seemed to suppress the expression of abandonment fears... Like dysphoria, it is possible that abandonment fears are experienced but are not articulated among partner violent men.  While abandonment fears may be the primary causal emotion, it, like dysphoria, may be expressed only in terms of secondary emotions of jealousy and anger (Greenberg and Safran 1989)" (Costa and Babcock, 2008, page 401).

Another important factor for assessment and understanding to direct therapeutic strategies is how emotional reactivity to attachment distress trigger violent responses.  This is relevant to many perpetrators but "Other intimate partner abusers show patterns of antisocial behavior that do not appear to be linked to mood or abandonment fears.  ASPD is characterized by manipulation of others for personal gain and persistent disregard for and aggression toward others, including romantic partners (American Psychiatric Association 2000).  Antisocial individuals often lack empathy and tend to do whatever is necessary (e.g., hit, lie, con others) to get their own way (American Psychiatric Association 2000).  Similarly, batterers with ASPD may use violence as an instrument to resolve conflict with their partners and to maintain power and control in their relationships (Babcock et al. 2000; Holtzworth-Munroe and Stuart 1994)" (Ross and Babcock, 2009, page 608).  Rather than their emotional reactivity triggering an intense abusive response, antisocial perpetrator are purposeful in their application of violence.  This fits within the overall personality of the antisocial person who manipulates the world by virtually any means necessary.  Abuse or domestic violence as much as charm or elegant elocution is therefore another tool of the sociopathic toolkit.  If Dirk for example, is a sociopath or has antisocial personality disorder, many common and effective therapeutic strategies and interventions are rendered ineffective.  His investment and goals in therapy despite verbal commitments to the contrary will be markedly different from those the partner requests or the therapist anticipates.  Dirk would manipulate the therapist and therapy for his personal sociopathic satisfaction as he has manipulated Madeline and any other part of the world he can.  Therapy needs to fundamentally and drastically change with an individual with antisocial personality disorder in the couple.

IDENTIFICATION OF ANTISOCIAL PERSONALITY DISORDER
Changing or adjusting therapy presupposes the therapist's ability to identify the sociopathic partner.  An extremely adept sociopath can offer a compelling performance and appear in couple therapy to want to carefully consider his or her actions.  The sociopath may seem to be completely sincere in therapy.  He or she acts contrite, deeply invested in gaining rapport with the therapist, and demonstrating him or herself worth of trust.  The therapist may be coerced into believing the sociopath's goals are honorable as opposed to being conniving and manipulative.  The therapist may want to believe and trust the sociopath is invested and has good intentions.  When the couple therapist fails to identify that he or she is dealing with a couple in which one of the partners is sociopathic, the resultant clinical work will undermine the non-sociopathic partner's interests.  If the sociopath is not exposed, therapy and the therapist will be abetting the sociopath's agenda. Couple therapy proceeds based on the false assumption that the two partners are mutually struggling with dynamics they have developed together.  With a sociopathic partner, the relationship has not been jointly volitionally evolved.  It is the product of consistent manipulation for the sociopath's benefit.  If the therapist misses the pattern of antisocial machinations in the relationship, therapy unfortunately and possibly tragically validates and perpetuates the sociopath's exploitation of his or her partner.

The knowledge and sophistication of the therapist regarding these dynamics is critical.  As identification of the sociopath is critical for effective couple therapy, identification of therapist experienced who has worked with antisocial personality disorder in couples is also essential.  The exploited and abused partner therefore is strongly recommended to critically research the qualifications of a potential therapist.  Speaking to the partner, "For this reason—especially if your self-esteem has been battered in a relationship- I encourage you to explore assertively with a prospective therapist the extent of his or her experience with narcissistic and sociopathic personalities.  Your inquiry should be met with absolute respect.  A defensive response should rule the therapist out.  And so should vague, general responses, along the lines of, 'Well, yes, I've worked with these kinds of clients.  Is that what you're asking?'  The answer is 'no.'  That's not what you are asking.  You are asking for a more substantive response, characterized by the therapist's interest and patience to discuss in some depth his or her clinical background with the personality-disordered population" (Powercommunicating.com viewed July 19, 2012).  A nice and naive therapist would probably be the worse therapist for the couple- in particular, for the partner of the sociopath.  He or she is much more likely through ignorance to perpetuate the sociopath's domination, manipulation, and abuse, if not domestic violence against the partner, than facilitating safety and change.

FEATURES AND CRITERIA OF ASPDO
The therapist should recognize the characteristics of antisocial personality disorder.  "Everything they do is directed towards self-gratification, and exploiting others by playing to their emotions is a well-honed skill.  They know the difference between right and wrong, but lacking conscience, they tell lies and scheme without obvious signs of remorse or guilt.  The may learn to mimic expressions of feelings, such as guilt or sorrow, but will not actually feel those emotions.  These individuals can be highly intelligent, successful and charming and inevitably persuasive.  Some will engage in criminal activities and have prison records.  Others will use their talents in legitimate occupations, engage in white-collar crime, and appear perfectly normal to friends and acquaintances.  They dominate their intimates, see people in terms of their usefulness or as obstacles to be removed, and are quick to anger if their needs are thwarted.  Retaliation is appealing and often carefully planned, as they have a natural inclination to hurt others (Babiak, 2004)" (Wileman, 2008, page 115).  The therapist may tend to trust in the words of a client based on assuming the client's investment in getting the most out of the therapy.  However, if the individual is mostly invested in self-gratification, then being gratified in charming or fooling the therapist will be what he or she wants to get out of the therapy.

The therapist might consider the possibility of antisocial personality disorder as well as narcissism if the client is highly successful.  In both these personality disorders, the individual is driven to be successful.  The narcissist is driven to prove his or her worthiness through competence.  The sociopath is driven to control others and his or her world.  Personal power, financial accumulation, social status, and professional achievement would be outcomes of such drive.  Inquiring about how the individual has become successful, especially about how he or she has handled challenges by other people may reveal underlying manipulation and vindictive instincts.  The therapist should note "an attitude that openly denies any special authority to moral reasons and conceives of the moral point of view as being just as optional as a certain political or religious stance.  To give an individual with this attitude a convenient label, and following the established tradition, I shall call him an amoralist, and his general position (or, perhaps, his condition) with regard to morality will be referred to as amoralism.  Even though the term 'amoralist,' as used in the philosophical literature, may have wider denotation, it is convenient to limit the present analysis to the psychopathic or sociopathic personalities only" (Zavaliy, 2008, page 87-88).   The therapist should examine whether explanations or reasons for actions- in particular those that may have been hurtful or harmful are expressed from such a self-centered self-serving morality.  "That's what he or she gets" expressed in a matter-of-fact, cold, or proud fashion should alert the therapist to potential sociopathy.

The antisocial personality presents in a unique manner, as otherwise socially reprehensible behavior that causes discomfort to others is egosyntonic for the sociopath.  "That's what he or she get" is not only presented as normative values, but also with confidence and comfort.  Ironically, although the sociopath believes him or herself to be exceptional, he or she experiences his or her amoral choices or behavior as nothing exceptional.  If not for the abusive connotations of the declaration, the sociopath's assertion may otherwise sound quite eloquent and rational.  "It is also well known (e.g., from fiction literature and popular films) that psychopaths can be quite charming and often exhibit a level of intelligence that is significantly above average; they are able to achieve a high social status and to function successfully in various social arrangements for extended periods of time.  As Stout observes, this peculiar 'disfigurement of character' that she calls 'sociopathy' is unique in that  '…all of the other psychiatric diagnoses involve some amount of personal distress or misery for the individuals who suffer from them.  Sociopathy stands alone as a 'disease' that causes no dis-ease for the person who has it, no subjective discomfort.  Sociopaths are often quite satisfied with their lives' (2005, p. 12).  Wolman likewise argues, 'sociopathy seems to be more a social than a medical problem' (1987, p. 22).  And Cleckley (1982) reports that psychopaths, when brought to the psychiatric facilities, are routinely discharged upon closer examination, since most of them are absolutely healthy as far as the accepted standards of mental health are concerned.  As a result, he continues, there exists not a small confusion among the medical practitioners, social workers and the law enforcement officials as to whether a psychopath belongs to a psychoanalyst's chair, a psychiatric ward, a priest's office or a prison cell" (Zavaliy, 2008, page 88).  The therapist's appeal to imagine being in someone else's shoes or prompting empathy is beneath the sociopath's consideration.  Or, he or she may feign compassion to the therapist or other persons but hold within a superior dismissal of others feelings or rights.

A sociopath may clearly recognize and understand what is socially acceptable and/or legally permissible and what is not.  He or she can readily acknowledge that others who commit socially undesirable behaviors or break the law would be held accountable and be punished.  However, the sociopath often simultaneously will believe that he or she is not or should not be held to the same expectations and consequences.  Punishment is for other people.  He or she holds an exception for him or herself.  This "is a reference to a lack of the feature that we have identified as being necessary for acting within the moral domain, viz., willingness to universalize one's normative judgments.  On a minimal interpretation of this condition, one ought to apply similar evaluative pronouncements in similar situations or to similar persons, unless there is an essential difference between them" (Zavaliy, 2008, page 91).  The sociopath is convinced that he or she "should not be punished for doing X simply because it is he who did it, not the other person."  The sociopath is able to separate moral issues and moral logic from his or her daily choices and behavior.  Socially defined moral codes are understood but are experienced as external to the sociopath.  "In their eyes, it has a status of an optional perspective, which has no intrinsic priority over any other normative concerns, such as considerations of self-interest or (as the case may be) the aesthetic values.  Such an attitude naturally suggests a fundamental difference between us, the moralists, on the one hand, and 'them', the amoralists, on the other.  This perceived difference, among other things, may justify a refusal to apply the familiar categories of moral and legal responsibility" (Zavaliy, 2008, page 92).  The therapist may be able to engage the sociopath in an extensive discussion about moral values and social consequences, but then be stunned to find the sociopath makes little or no connection to his or her actions or beliefs in life.  In a hypothetical intellectual discourse, the sociopath can be very articulate and nuanced about what "people" or "others" or society can and should behave.  It just has nothing to do with what the sociopath can do and does.

The degree or scope of moral egocentrism varies from person to person.  The therapist should examine the extent, breadth, and depth for each individual.  "The amoral condition is a matter of degree, and it can vary significantly both with regard to its scope, and its intensity.  The individual cases may exhibit various degrees of moral unresponsiveness, ranging from partial and temporal exclusion of a certain group of people from the domain of all moral subjects (as regularly occurring during wars), to more persistent cases of selective amoralism (e.g., racist or ethnocentric attitude), and culminating in extreme instances of thoroughgoing moral apathy (psychopaths; serial killers).  Likewise, one can be more or less indifferent to the universal ends of morality, and the strength of one's moral motive need not remain the same over time.  Thus it appears that there exists continuity between the 'normal' subjects and amoralists, including the most radical cases of psychopathy" (Zavaliy, 2008, page 92).  If the scope of amorality is limited to certain areas that are defined by family, community, or cultural experiences, the therapist can potentially try to expand or adapt the scope.

Some abusive individuals engage in manipulative or premeditated violence to waylay threats to their authority.  The sociopath may be deeply invested in keeping control over a partner.  Control and dominance over the partner may be how such an individual perceives an intimate relationship.  Using "proactive violence here to quash his partner's opposition or attempts at dominance make sense in light of the personality correlates of antisocial individuals, who may 'stop at nothing to avoid being pushed around' (American Psychiatric Association 2000, p. 703)" (Ross and Babcock, 2009, page 614).  Proactive violence is not incompatible with reactive violence from being challenged by partners' behaviors that trigger similar issues of control and loss of dominance.  The spectrum of abusive styles includes exclusively proactive violence or reactive violence and many combinations of both purposeful and triggered abuse.  The therapist should not anticipate some pure model but be available to the individual's personal style.

ORIGINS OF ASPDO
There are various theories as to the origins of antisocial personality disorder from inherent genetic predisposition to environmental, family, or cultural causes.  For example, "The disinhibited psychopath is hypothesized to suffer from a neurodevelopmental maturational deficit that is responsible for a relative inability to use inner speech to modulate attention, affect, thought, and behavior.  Under conditions of social frustration or ambiguity, behavior regresses to the use of more primitive aggressive response strategies to effect changes in the social environment" (Miller, 1987, page 137).  Antisocial personality disorder may be seen not so much as a disorder per se but development that has gone astray.  Babies are extremely egocentric with no real awareness or concern about others' feelings, needs, or well being.  Other people are either useful or not useful in meeting personal needs.  They are either effective or efficient or not in serving their egocentrism.  As such, all babies or all individuals start out as sociopaths in a sense.  Most individuals grow out of or get through this stage within attentive and nurturing family environments.  However, the sociopath gets stuck in this egocentric stage.  The antisocial behavior arises out of the self-centered and self-serving agenda.  This is a natural stage for the baby but not for a socialized community members, children in groups (school for example), or adults.

The right or wrong of actions relative to not just personal gratification but also of benefit or harm to others gets internalized in a conscience.  The antisocial personality lacks this conscience.  Moral perspectives that incorporate the larger community or the conscience "is understood in part as the ability to transcend one's egotistic desires and preferences, to consider the interests of others in making a decision, and experience guilt and remorse when others are adversely affected by one's actions.  In the same vein, David Lykken observes that 'the psychopath is characterized by a lack of the restraining effect of conscience and of empathic concern for other people' (1995, p. 115).  These authors seem to agree that pathologic egocentricity and, as a result, total lack of empathy for others in distress sets the psychopath apart from the ordinary people, even from people with little inclination toward altruistic acts or the ones of reserved and apathetic disposition.  An extreme amoralist, on most accounts, markedly stands out from the usual cases of the indifferent, wayward or criminal individuals" (Zavaliy, 2008, page 90).
Any given individual is not necessarily completely or always antisocial.  Antisocial behavior and attitudes is within the spectrum of normal personality rather than distinct from it.  Antisocial values, attitudes, and thinking may be extremely common, while antisocial behavior uncommon or rarely exhibited for some individuals.  Whereas individuals who show psychotic behaviors that correlate with psychotic thinking, with antisocial personality disorder "we are mostly limited to observing the behavioral manifestation of this condition, and there are little, if any, reliable internal physiological ('somatic') or invariable psychic symptoms (Zavaliy, 2008, page 93).  Since most people outgrow extreme infantile egocentrism but often retain some degree of self-centeredness, the sociopath may be considered not to be qualitatively different.  He or she would be on a more extreme end of a continuum of egocentrism.  As such assessment may be more appropriately conceptualized as how antisocial or profoundly egocentric an individual may be.

Internal antisocial or egocentrism in attitudes, values, or beliefs that does not express behaviorally may be considered relatively mild sociopathy.  In fact, without behavioral manifestation, other people including the spouse or partner are not negatively affected.  Such individuals despite possibly highly antisocial internal processes would not be considered sociopaths or having antisocial personality disorder.  Other individuals would be considered "more" antisocial if there is occasional and perhaps, not extremely toxic behavior.  They become diagnosable and thus labeled as having antisocial personality disorder because of observable behavior.  The therapist would need to be alert to a covert or secretive sociopath who manages abusive or violent activities under some veil of secrecy or propriety.  He or she may be able to present plausible explanations for choices that "inadvertently" have "unintended" consequences.  Unless the breadth and depth of the person's behavior is uncovered, the therapist or any person engaged in new or occasional relationship with him or her would not see the pattern of antisocial actions.  Society needs to so alert as well to such individuals who have propensity to gain positions of power.  They thus have potential to cause great harm on a more massive scale.  Their need to maintain control and dominance can be activated by dynamics within a company, team, organization, or government.

KUNLANGETA AND ARANKAN
Since antisocial behavior may be more or less overt and observable, it is difficult to estimate the percentage of such amoral individuals.  Individuals with patterns of behavior deemed unacceptable occurs within various communities, organizations, and families.  At the same time, it appears that antisocial behavior exists in different societies.  Of significance "there is interesting anthropological evidence suggesting that psychopathy is not an artificial construct of the Western psychiatric science.  Martha Stout, a psychiatrist and sociologist, argues, 'sociopaths, by various names, have existed in all kinds of societies, worldwide and throughout history' (2005, p. 136).  And an anthropologist Zane Murphy reports that during her extended field work among the Eskimos of Alaska, and the Yorubas tribe in Nigeria she discovered that these two very different communities have a concept that closely parallels our concept 'psychopath'- someone who consistently violates the accepted norms of society and lacks the necessary emotive apparatus to feel genuine guilt or remorse over his deeds.  The Eskimos have a word kunlangeta, which refers to a person 'whose mind knows what to do but he does not do it' (Murphy, 1976, p. 126).  A kunlangeta person consistently lies, cheats, steals and refuses to go hunting, and when other men are out of village, he takes sexual advantage of many women.  As Murphy observes, the awareness of the rules is not in question here, and the violations happen despite numerous reprimands from the elders and are due to reasons other than ignorance or negligence.  The Yorubas of Nigeria, too, have an abstract word with similar meaning, arankan, which refers to a person 'who always goes his own way regardless of others, who is uncooperative, full of malice, and bullheaded'.  A pattern of behavior characteristic of a kunlangeta in Alaska and an arankan in Nigeria is similar enough to the various descriptions of the extreme amoralists in our own culture to elicit a strong sense of cross-cultural reality of this phenomenon" (Zavaliy, 2008, page 89).

In addition to awareness and identification of antisocial personality disorder or sociopathic individuals and behaviors in other societies is whether their society boundaries are asserted and consequences administered for violations.  Is such behavior consisted problematic and to be avoided, but without social and legal penalties?  In some societies, antisocial or sociopathic behavior may be regrettable yet acceptable at least, to some degree.  What American psychology considers antisocial personality disorder or mainstream American society considers sociopathic may be considered appropriate behavior according to circumstances within different communities or societies.  Corporal punishment for children and for wives can be considered not only culturally appropriate but the required response.  Killing a child or a wife, which is considered homicide in American law may be deemed a moral right and obligation for a father, husband, or family for some moral transgression.  The identified behavior may not be a transgression or even a minor moral failing for many Americans.  When the therapist examines for cultural values and expectations regarding partner or spousal behavior and rights, it is important to consider cross-cultural issues.  However, while incorporating cross-cultural dynamics and conflict in the therapy, the therapist must also maintain ethical and legal boundaries against child abuse and domestic violence.  In other words, respect for another cultural model for treatment of children and wives does not preclude therapy, the therapist, and most critically parents or spouses from American law.  While a parent or partner may claim moral and/or cultural rights to violent behavior, that does not make him or her immune to the consequences of violating American legal boundaries as long as the behavior occurs in the United States.  Therapist cultural sensitivity and respect must not imply cross-cultural permission to act illegally.

ADDRESS:
433 Estudillo Ave., #305
San Leandro, CA 94577-4915
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
phone: (510) 614-5641
fax: (510) 889-6553
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