Apologies

Sorry to my few readers for the extreme delay in blogging, life has been cray-cray with a new job, new apartment, and all kinds of crazy new experiences, which will undoubtedly be blogged within the next few weeks. Hope you enjoy the latest!

The Cold, Callous Child: Sociopath in Training

To act without emotion, without a sense of empathy, with little concern for the pain one causes another and even an almost obscene enjoyment of harmful acts. These are symptoms usually reserved to describe most individuals with sociopathy today, also known as Antisocial Personality Disorder. As with most personality disorders, there are age requirements and limits to meet the criteria for diagnosis, and with APD, one must be at least 18. So what happens before 18? It has been shown through most studies that those who qualify for APD as adults presented with symptoms of Conduct Disorder as children. Both are categorized with symptoms of criminal behavior: harm to others, theft and property damage, serious rule violations, deception and defiance. But one key symptom seemed to have been left out of Conduct Disorder that presents in APD: lack of remorse. While most children with Conduct engage in maladaptive behaviors, there is usually resulting remorse or regret, even if it’s simply the fear or disdain of the punishment that inevitably follows. Additionally, studies have demonstrated that most children eventually grow out of such behaviors by the age of 21 rather than progress to the more chilling diagnosis of APD. However, aside from Conduct Disorder, there is no other diagnosis that can accurately diagnose children presenting with possible Antisocial tendencies. But is that to say it doesn’t exist? Can children be sociopaths and should we diagnose them at such young ages?

In my line of work as a therapist working with severely disturbed children, I have handed out many diagnoses of Conduct Disorder and all kids have had similar symptoms as well as similar origins. Most are given this disorder due to serious rule violations (truancy from school or running away from home), deceitfulness (lying about where they are going), theft (stealing from family or local stores), and other negative activities such as drug use, gang activity, etc. One last category included in the diagnosis is of course harm to other people or harm to animals. In nearly all my cases, harm to others has included fighting with peers at school; in rare cases, it was fighting with staff at their school or group homes. All were impulsive acts, poorly thought out, all fueled by anger or pain, and while some did not openly express remorse toward their victims, there was an element of emotional response: anger for being caught and punished or blame toward the victim for upsetting them (typical to avoid self-blame and thus remorse).

In Antisocial Personality Disorder, aggression and acts of violence towards others are rarely impulsive. These behaviors are usually planned and carefully calculated. A premeditated act, there is no crime of passion or rage, just cold, undeserved punishment against some defenseless victim. A good example of such would be Timothy McVeigh, who for months plotted a terrorist attack against the Alfred P. Murrah Federal Building in Oklahoma City. He had no particular victims in mind, no one who upset him other than the US Government. McVeigh detonated a car bomb which caused over $500 million in damage and killed 168 people. When he learned there was a daycare in the building, he wrote the lives of 19 children off as “collateral damage”. He remained calm and collected throughout his arrest, questioning, trial and death. In the remaining years of his life before being executed, he never expressed remorse for his actions.

While it is difficult to imagine a child as cold-hearted as McVeigh, to assume that such characteristics arise purely in adulthood is absurd. Signs and symptoms present themselves early in life. Ted Bundy had such an incident when he was 5, where he stood by his aunt’s bed while she slept. When she awoke, she found him with a devilish grin, watching intently. As she became more alert and aware of her surroundings, she found that she was surrounded by a collection of knives laid on the bed, points directed inward toward her. The book “Children Who Kill" also gives several accounts of disturbed children engaging in acts of cold murder and torture far beyond typical problem children. And I have had the unfortunate business in my 21 months of work as a therapist to come across two such kids.

Both were six years old. My first was much harder to diagnosis: he presented with a mosaic of symptoms, bits and pieces of disorders never quite coming together to conclusively provide one concrete diagnosis. His symptoms ranged from possible autism, Aspergers, or developmental delay, Conduct Disorder or Oppositional Defiance, anxiety, depression, or bipolar disorder. He was moody, most times without antecedent, which would throw him into fits of rage that would last for several hours, or an abundance of depression, triggering crying fits for days. He also presented with a remarkable ability to control his emotions and behaviors, having fits and tantrums at home but not any issues at school. Even in a brief exchange during therapy, while I was explaining that therapy was a safe place to talk about our thoughts and feelings, he angrily retorted “I KNOW!" Taken slightly aback by this abrupt outburst, I calmly addressed it, asking why he felt so frustrated. His physique changed in the flash of a moment: his hunched shoulders sloped, his furrowed brow relaxed, his expression almost angelic, and he sat back and cooly responded “Nothing, I’m fine”, as if he had been caught with his hand in the cookie jar and tried to cover the evidence. He acted aggressively towards his younger brother, 3, whom he would drag around the house from room to room on their tile floors by a small limb, or whom he would calmly walk up to him and without warning scream inches from his face and frighten him to tears. Previous therapists could not pinpoint a disorder, and my task was no easier. While my supervisor pushed for Conduct, at the time to me a conduct disorder diagnosis was a life sentence on a dark road to sociopathy. He was given a provisional diagnosis of conduct, but it wasn’t until 8 months later that I was no longer given an option. A call from his frightened mother informed me that he had killed a duck at the local park, and she believed it was intentional. While somewhat fantastic, she relayed the tale of woe, that he, a pitcher for his local little league with a strong arm, had collected a pinecone, approached a duck by the riverbank, and threw the pinecone full force at the duck’s head. The duck began seizing, no doubt from a hemmorhage, and flopped over in the water, dead. Mom reported he did not seem phased by the incident and did not show remorse. When I later asked him what his intent was, he stated he “wanted to see what would happen”. He later confided that he had the option between the duck and a turtle that was also in the water, but noting the turtle’s protective shell, he stated “I knew if I hit the turtle, nothing would happen, he would just swim away, so I threw it at the duck”. Chilled by this calculated thought process, I reluctantly listed Conduct Disorder on his file.

My most recent case, I cannot go into detail with given that the case is still open, however he presents with a less complex case, nearly no mood lability or developmental delay but similar symptoms of disturbances which resulted in the death of an animal. Both children we exceptionally bright, both came from families with histories of significant mental health issues.

What has become apparent is that in comparison to my typical conduct cases, these children are in a class all their own. While Conduct Disorder has been generally considered the childhood APD, the connection between Conduct and Antisocial Personality Disorder is built on nothing more than a mere resemblance of one another. As previously stated, APD lacks the crucial component of humanity: empathy and care for one another, regret and remorse for our own behaviors, which is not necessarily reflected in CD. But even if the DSM could create a more appropriate diagnosis for children presenting with sociopathy, would the field allow it? Much like my reluctance to diagnose a 6 year old with such a dismal label, many others would most likely be just as apprehensive to diagnose a child with a damning sociopathy label. But as with my dilemma, my concern for labeling a patient and my hesitation to do so did not bring that duck back to life, and it did not make my patient’s difficulties disappear. If anything, it only delayed receiving more appropriate treatment. While labels can be hurtful, refusing to diagnose for fear of social stigma can be far more detrimental and as a therapist it is ethically unsound.

Dan Waschbusch, a researcher at Florida International University, has continued his study in children presenting with similar symptomology as my cases, and even one child named Michael was an almost exact replicate of my first kid with moody lability, hysterical outbursts, calculated aggression and violence toward his siblings and amazing mood control. Waschbusch described the condition as “Callously Unemotional Children”, and began a research camp where many children with the same affliction were sent to be observed and treated. The level of manipulation was immeasurable and bringing these children together could have been a recipe for disaster. Many children ended up worse, some remained the same, few improved, though Washbusch maintains that early intervention and intensive treatment could drastically improve the chances of these children growing into productive members of society. I am not so sure that I agree at this point and time, as an effective treatment cannot have been developed yet; typical behavioral interventions are probably ineffective as a simple system of rewards and consequences mean little to children who struggle with apathy. Certain medicinal interventions have been ruled out such as Ritalin, which would decrease any impulsivity the child suffered from and allow them more time and mental clarity to plan and coordinate more intricate attacks. In residential or treatment facilities they would be grouped with other children either with the same symptoms which they could pair with and learn from, or in facilities with children of different diagnoses they could dominate or harm. But no one wants to write any case off as being hopeless or untreatable and we have to try, at the very least to intervene when it might still make a difference.

It is impossible to claim that Antisocial tendencies don’t exist in children, and it has been demonstrated that it is inappropriate to lump preliminary APD into the Conduct Disorder category. On the other side of the scales lies the concern of wrongly diagnosing a child. What needs to be developed is not only an appropriate diagnosis and supporting criteria, but diagnostic tools to assist in accurately recognizing this disorder in children. Only when that path is paved can we begin to explore and create more effective treatments and help these kids before it’s too late.

Bullying: Bruised and Battered

Hey guys, Happy New Year! We're starting off 2012 celebrating four years of Another Drop in the Ocean (which was really three if you consider the year-long hiatus I took)! Thanks to my readers, however few and far in between, for staying with me and reading my rants and raves about various issues. Admittedly this post is a few days late of my anniversary, but I struggled with topics and you just can't force this stuff out. So here's my latest, inspired by the movie "Cyberbully".

Bullying has been an age-old pastime for children, teens, and even adults. But times have changed, the ante has been upped. The bullying of past decades starkly pales in comparison to the bullying of today. Older generations can recall schoolyard scuffles with a laugh and a shake of the head. Younger generations recall them with pain, trauma, and at times, lifelong impacts on their self-worth. Perhaps this is why so many people don’t take it seriously. Far removed from the reality and severity of the case, many parents, school administrations, and even law-makers tsk tsk the wounded and sweep the problem under the rug. And that is when it becomes deadly.

Back in the day, playground banter was better described as superficial childish name-calling. The classics are ones we’ve all heard: if you wore glasses, you were named four-eyes, if you were fat, they called you various derivatives of tubby, fatty, piggy, etc. If you wore braces you were metal mouth, acne: pizza face, and so on. These were names that would sometimes send kids home crying, only to face their antagonists again the next day. Now I won’t pretend that such names weren’t hurtful or somehow damaging to a child’s confidence, but most usually overcame the experiences and moved on to successful lives.

Nowadays, bullying has reached new levels of brutality that blaze through the barriers of harassment and teeter on the edges of assault. What was once simple teasing, usually on the basis of appearance has escalated to deeply damaging slurs, character defamation and public humiliation. In the golden days, bullying was usually an unfortunate chance encounter by the monkey bars or crossing the wrong street when walking home from school. Now they’ve turned into hunts, with bullies banking on growing intimidation; they scout the school grounds like packs of wolves for weaker prey, and the slaughter is horrific to watch.

My own experiences with bullying were extensive, to say the least. Resigned to wear glasses, in elementary school, I endured the superficial name calling, nothing that left a very deep impact. It wasn’t until I reached Jr. High that the bullying started. I was always heavy but gained much weight as I got older, and my peers took notice. Names like lardo, Free Willy, and fat ass were not in short supply from my classmates, but I was usually able to brush it off.

High school was where it became unbearable. I was heavier than ever, wore glasses, and hardly put any effort or thought into my appearance; I never wore make-up or styled my hair and my clothes were a fashion disaster. Bullying me was like shooting fish in a barrel, and it attracted new patrons all the time. Accustomed to my typical bullies who were in my classes, I was suddenly being attacked by people I’d never met, which caught me off guard. People I didn’t know would trip me in the hallways, one spit gum in my hair as I was walking by, and one day, for no reason at all, while walking down the hallway, a boy passed me and slammed me into the concrete wall before walking on, laughing with his friends. The people I knew were much worse. I endured name-calling and trash talking in class, usually as other students sat by and laughed as my tormentor rattled off painful insults. One episode sent me running out of the class crying. Another pushed me to the brink, and I rose from my desk, approached the student and slapped him across the face. He took a pen and attempted to stab me in the throat, but couldn’t break the skin.

But this was just one level of bullying. Many students began to go out of their way to make my life hell. Students who took issue with me, though for what reason I never knew, started a regimen of harassment. Figuring out my schedule, some would get hall passes, walk by my class, stand in the hallway out of the teacher’s view, and mouth insults and threats to me. At times, during passing periods they followed me to my next class, tormenting me for the three minute trip. Once I reached my room, they would stand outside the door, talk trash, and peek into the class to watch my reactions and laugh at me. I wasn’t safe after school either. There were times when I had to walk home, which left me wide open for attack. One day, two girls made it a point to follow me home to bully me. Never mind the fact that they lived in the opposite direction, they stayed five steps behind me for the twenty minute walk, calling me names like whore, fat ass, slut, bitch, dyke, and fag. When I reached my street, two cars pulled up and multiple students filed out. At first confused by their presence, I realized somehow word had spread that I was being harassed and some anticipated that a fight would ensue. They wanted front row seats. I entered my house and stole glances outside my bedroom window. The girls stood at the foot of my driveway, yelling obscenities and slurs at my house, threatening me before finally disappearing. Even the faculty had their moments. During one class, I tripped and fell back on the floor. The teacher, standing on the far side of the room, blurted out “wow, I felt that all the way over here!” and the class erupted in laughter. Another teacher who also had her assumptions about my sexuality overheard a piece of a conversation about me chasing down a girl and she remarked in front of my classmates “so you’re chasing girls?” with a smirk.

I asked my mother to allow me to be home-schooled in order to get away from the daily torture, but given that I was in the midst of my depression and was becoming increasingly isolated from society, my mother was concerned that if I were home-schooled, I would never leave the house. She refused, and the hell continued, though it ultimately contributed to lasting damage to my self-esteem, and to my suicide attempt my sophomore year.

Today, risks of suicide have increased, creating a new trend called Bullycide, breeding electronically. The internet brings with it not only a new tool for bullies, but the anonymity of false names, faceless interaction, and little to no personal responsibility for your words. Text messages, stalking, degradation, insulting web pages, embarrassing photos, and impersonation are all new ways that bullies have begun to attack their victims. The harassment has reached a new level, where bullies and their minions go above and beyond name-calling and taunting and have actually told their victims that they should kill themselves; the victims obliged. Ryan Halligan told a “friend” he was going to kill himself, and the friend responded “it’s about time”. Another bully told Phoebe Prince she should hang herself. So she did. Ashlynn Conner was only ten years old when she hanged herself in her closet due to excessive bullying.

Sadly, bullying doesn’t stop after high school, as it seems more and more people are failing to grow up. The perpetrators continue on into adulthood intimidating, insulting, lying, back-stabbing, creating drama, and laughing at the pain of their victims, as if someone were filming a sequel to Mean Girls starring the Plastics: All Grown Up. Sitting in my Master’s Program class, I couldn’t believe the insulting and degrading comments I would hear from my cohort about other peers, bullies who were twenty years older than me, but acting like they were sixteen.

Now I’m not going to sit here with my pipe-cleaner halo and pretend I’ve been the innocent by-stander all these years. I have fought fire with fire; I’ve bullied those who bullied me. I remember in high school I was in the girls’ room with my friends and a rival came in. She called me fat ass. Noting her up-turned nose that from the proper angle resembled that of a pig’s snout, I retorted “who are you calling fat, Miss Piggy?” My friends and I laughed and began pressing our noses up with our fingers, snorting at her. A look of pain flashed across her face and she quickly exited the bathroom. My heart sank when I realized I’d lowered myself to her level and hurt her. But even today, I’ve made my comments about people and joined in on the laughter when comments were made by others, even when I knew I shouldn’t have been laughing. It’s a work in progress and I’m always trying to improve myself by taking the high road. Sometimes I fail, but try again the next day.

I hate to sound cliché and regurgitate the heavily spewed dicta regarding the breeding of bullies, but it all rings true. Most bullies suffer from an inferiority complex, they are insecure with low self-esteem, so they put others down not to raise themselves up, but simply to bring their victims down to their level; “if I feel lousy, why should you be so happy?” Misery loves company, yes? Other times they don’t even know they make people feel bad. Again, though I wouldn’t consider myself a bully, there have been times when I’ve unintentionally made people feel dumb while trying to showcase my own intelligence. Now I’m no Einstein, but I’m certainly no Gomer Pyle either. Thanks to all the bullying I endured, I draw most of my self-esteem from the one thing that I succeeded in: academics. But in trying to prove my worth, at times I’ve embarrassed others, moments I still look back on and cringe: “why must I always be right?” And yes, many bullies become such because they’ve been bullied themselves. My usual tormentors came from seemingly perfect families, but I later found their mothers were alcoholics, or their fathers were abusive. People like that just need empathy, love, and forgiveness. Chances are they don’t have many friends anyways; chances are they’ve been hurt by many more bullies. So don’t add insult to injury by becoming another one in their lives. Take the high road, you’ll feel better in the end.

If you're being bullied or see that someone else is, speak up! Visit:
http://www.stopbullying.gov/