Character Disorders
Character Disorders
Psychoanalytic theory of character structure
The diagnosis of character disorder is accepted generally as describing an individual whose behavior disturbances bring him into conflict with his immediate environment or society at large. Although a character disorder has certain similarities to a neurosis, it differs in the particular extent to which the disorder affects a person’s entire behavior. The neurotic individual has a specific symptom, arising from internalized conflict and felt as alien and uncomfortable. The individual with a character disorder has a much more pervasive disturbance; most or all of his behavior and his responses are directed by the disorder, but he does not feel this as either pathological or uncomfortable. He is unaware that his way of coping with life is actually symptomatic of his conflicts, which are consistently externalized.
The range of aggressive and antisocial behavior patterns that sociologists designate as social problems—for example, juvenile delinquency, drug addiction, criminal recidivism—involve the actions of individuals who would be diagnosed by psychiatrists as having character disorders. The cost to society of these forms of illness is obvious, but there are other types of character disorder that tax society in much more subtle ways. The costs may lie in disturbed marital relationships; in difficult, if not disruptive, behavior in work situations; in the general inhibition of an individual’s real capacities; and even in influence on the political attitudes and action of the individual.
The steady increase of character disorders in the general population has been recognized as a matter of concern to sociology as well as to the behavioral sciences, and the contributions of both may be needed to provide us with an accurate view of the etiology of these emotional disturbances.
Psychoanalytic theory of character structure
Any understanding of character disorders requires some background in the evolution of contemporary theories of character structure. In the United States, these theories are grounded primarily in Freudian concepts. The concepts of psychoanalytic theory originally were used to explain neurotic behavior and were not applied explicitly to the total picture of character structure; but as the theory later developed the term “character” began to be employed more frequently, and the literature began to refer to character traits, type, and structure; character neuroses; neurotic character; and character disorders.
Freud’s earliest conceptions about character formation (see The Interpretation of Dreams and Three Essays on the Theory of Sexuality) were based on libido theory, with its emphasis on psychobiological factors, and proposed a classification of character in terms of the erogenous zones: oral, anal, phallic, and genital. In its later evolution, psychoanalytic theory employed the structural, libidinal concept of personality, in which the determining agencies were the id, the ego, and the superego. Freud viewed character as being an attribute of the ego, with the superego the most decisive element in its development.
But not until Wilhelm Reich’s work (1925) did psychoanalytic theory and practice focus specifically on the problem of character. Reich, departing from Freud’s psychobiological determinism, emphasized the influence of the social order on character formation, defining character structure as “the crystallization of the sociological processes of a given epoch.”
Contemporary theories of character development tend to stress one of two directions. The first, begun by Freud and elaborated by the psychoanalysts who emphasized ego aspects, stems from Freud’s instinctual drive theory. Karl Abraham, Isador Coriat, Sándor Ferenczi, Anna Freud (whose brilliant work on the defense mechanisms introduced a new dimension for the theoretical understanding and treatment of character disorders), Erik Erikson, Heinz Hartmann, Ernest Jones, Annie Reich, and Richard Sterba expanded this theory. The second was developed by the neo-Freudians—Erich Fromm, Karen Horney, Abram Kardiner, and Harry Stack Sullivan—and stresses the role of cultural factors rather than of instinctual roots in character formation.
Despite disagreements among schools, Gitelson’s definition of character (1963, p. 4) as “an adaptive synthesis of forces stemming from the biological givens, the quality of the infantile environment, the psychic structure, the character of the identifications, and the mores of the social group in which later maturation and development occurs” would probably be acceptable to most behavioral scientists, who would agree with Gitelson that character “is an action and reaction pattern which has crystallized out of this flux of factors.” Lustman, who views character as a dynamic process, a constantly evolving phenomenon throughout life, described the relationship between defense, symptom, and character and concluded that all symptomatic acts have intimately related characterological structures (1962). These are the relationships that must be understood in the character disorders.
Character types—whether those designated by Freud as the erotic, the obsessional, and the narcissistic, or, for example, those designated by Horney as the aggressive neurotic character, the detached character, the character with idealized self-image, and the character who externalizes— do not occur in pure form. The relatively arbitrary labels various disciplines and schools use to classify types refer to the traits that seem most prominent and powerful in influencing behavior, although each type would include mixtures from the others.
Types of character disorders
In the extensive psychoanalytic literature on the character disorders, the types are described in terms of the neuroses with which each is most closely allied, whether they be the hysterical (erotic), the compulsive (anal), or the narcissistic (oral). But, as in character typology, each type actually contains an admixture of responses that would have to be classified in the other categories.
The hysterical character. For reasons that are probably largely cultural, the hysterical character is found more frequently among women than men. In terms of behavior patterns, one finds in this type a tendency to coquetry in walk, expression, and speech; a general sexualizing of relationships in inappropriate situations; and often a pattern of frequent and unsuccessful sexual relationships. Other traits—lability of emotion, unexpected dramatic behavior, strong suggestibility, a tendency to represent fantasy as fact—are more concealed. In pure form, the hysterical character is nervous, agile, and lively. When the type appears with depressive, autistic, and retiring features, it is no longer specifically hysterical.
Psychoanalytic theory postulates that the hysterical character develops out of an unresolved Oedipus complex. The “normal” person, having successfully resolved the Oedipus complex and given up the wish for incest and the wish to eliminate the father (mother), is free to transfer his genital interests to a heterosexual object that has taken the place of the incest object. For the hysterical character, the heterosexual object merely represents the incest object. Frequent affairs, then, symbolize both the incest wish and the attempt to escape the anxiety it creates. In the depressive type of hysterical character, the genital–incestuous fixation is replaced to some extent by a regression to oral mechanisms [seeHysteria].
The compulsive character. Frugality, orderliness, and obstinacy, all of which were considered by Freud to be anal traits, are strongly intensified in the compulsive character. When the infant’s toilet training is severe and rigid, the child may overcomply with this demand from his parents to master his instinctual drives. Orderliness, punctuality, and propriety, for example, are reaction formations of obedience; when these reaction formations break down, as they frequently do, an orderly person may become surprisingly disorderly. Frugality may represent a continuation of anal retention, motivated either by erogenous pleasure or by fear of loss. Stubbornness or obstinacy is often a rebellion against those early environmental demands, carried over into adult life, or else a method of resorting to passive aggression to attain one’s way against superior forces.
Whereas the hysterical character constantly seeks to repeat the Oedipal incest wish, the compulsive individual copes with the unresolved Oedipus complex by maintaining rigidly the incest prohibition, producing a marked conflict between id and superego. This conflict results in the repression of aggressive and sexual impulses. The repressions may lead to the substitution of sadistic impulses, which are often converted into a harsh morality.
Underlying such obvious behavioral symptoms as compulsive orderliness or rigid obstinacy are marked feelings of impotence, against which the compulsive individual may try to defend himself by unusual striving for social achievements. Because they do not in reality provide enough compensation, he is caught in a circular process of striving and feelings of inadequacy, inferiority, and emptiness.
Perhaps the most striking symptom in the compulsive character is the characteristic dissociation of ideas from affects. His defense mechanisms are extremely effective, but they produce a restrained, self-controlled, cautious individual, incapable of spontaneity. Internalizing the early outer demands for self-control so that they no longer concern merely the demand for cleanliness but invade every aspect of his functioning, the compulsive character develops a rigid, chronic, intractable mode of reaction [seeObsessive-compulsive disorders].
The narcissistic character. Narcissism is an oral trait, in which there is an emphasis on taking and giving, which is associated with the “nursing mother.” The normal traits of generosity and altruism, for example, represent identification with the person by whom one wants to be fed. Curiosity, too, may actually be an oral trait representing hunger transposed to mental activity. Oral neurotic characters, then, have an insatiable desire for supplies from the external world for the satisfaction of immediate needs. This demand can be expressed in two patterns of behavior, which are at first glance antithetical—the neurotically “independent” character and the neurotically “dependent” one. Both suffer from oral deprivation as the original trauma. The independent character, however, having regained the security of primary narcissism, feels that “nothing can happen to him”; the second is forever attempting to obtain restitution for the original deprivation and searches outside for all gratifications. A not uncommon type in this group is the chameleon character, who seems to need to fulfill all the assumed expectations of others and probably has multiple and evanescent identifications.
Both the pessimistic (depressive) and the sadistic (redress-demanding) character types fall into the group of narcissistic disorders. Both attitudes actually express a demand that the world should take care of one, although the depressive expresses the demand passively while the sadistic personality resorts to active aggression.
The psychopathic character. In psychobiologic psychiatry, the term character disorder refers specifically to the psychopathic personality. In psychoanalysis, psychopathic personality refers to one of the entire group of character disorders. Juvenile delinquency and criminal recidivism, for example, are usually considered forms of psychopathic behavior. Yet psychopathic personality is one of the least exact diagnoses in psychiatry and psychoanalysis, with little consensus as to the dynamic processes involved in producing it or its behavior.
If Freud’s classification were broadened to include a urethral type as an opposite of the anal type, the range of pathological character types would expand to include the impulsive as an opposite of the compulsive. The impulsive type is characterized by a deficiency or weakness in the superego, expressed somatically in persistent enuresis, and might well be correlated with psychopathy.
It was suggested by Michaels (1955) that such impulsive disorders be divided into two types: the first, the impulsive psychopathic character, would embrace the psychopathic personality, Edward Glover’s impulsive type, and the impulse disorders described by John Frosch and Joseph Wortis; the second, the impulsive neurotic character, would include Wilhelm Reich’s impulsive character, Franz Alexander’s neurotic character, and Glover’s reactive neurotic group. The impulsive psychopathic type would be the individual who tends to externalize his conflicts, with superego disturbances less serious than those in the psychotic but more impairing than those in the neurotic; the impulsive neurotic form tends to have internalized conflicts and neurotic mechanisms closer to the compulsive (obsessional) kind.
The severe juvenile delinquent (aggressive, hostile, and antisocial—the boy who lies, steals, and is persistently truant) shows perhaps the clearest form of impulsive psychopathic behavior. This kind of child drives for immediate satisfaction without regard for the rights or feelings of others; he is incapable of sustained interest or effort or of profiting from experience. Unable to bind tension, such individuals are impelled to impatient action.
Michaels (1959a) suggested that a specific type of impulsive psychopathic character presents a clinical syndrome in which the cluster of identifying traits are maleness, aggressiveness, persistent enuresis, concrete language, reading disabilities, and acting upon impulse (primary acting out). With the hypothesis that this kind of character has a unique configuration of personality with a special psychosomatic disposition, from the viewpoint of libido theory one can regard the emotional disability as impulsiveness, and from the viewpoint of ego-superego organization as lack of control. He is the actor, rather than the thinker, whose style of behavior is characteristically motoric and action oriented.
Michaels (1959a; 1959b) provides an elaboration of Freud’s original description of acting out (1914).
If, as suggested in a previous study (Michaels 1955), persistent enuresis and juvenile delinquency be considered character disorders of a functional nature, then the most primitive form of the impulsive psychopathic character would be an immature, undifferentiated pre-Oedipal personality, with poor object relationships, faulty identifications, a high degree of narcissism, a strong tendency to repetition compulsion, little ability to bind tension or tolerate anxiety, little sublimation of impulses, and a lack of differentiation in the ego and superego. He would have few feelings of shame and guilt, a minimum of conflict, and primitive defense mechanisms.
In contrast, the impulsive neurotic character has dormant psychopathic tendencies, which are held in check by the compulsive neurotic components in his character. Unlike the psychopathic character who comes into conflict with legal authority because of aggressive and antisocial acts, which express his unambivalent hatred, the neurotic individual would be apt to create friction at home and in marriage, as well as on the job, and show a history of provoking hostile responses from the environment. This character type suffers from his problems, his doubts, his ambivalence, and his guilt. He is, in effect, the impulsive psychopath with more maturity, greater differentiation in the ego and superego, and a greater internalization of conflict, so that his aggressive hatred is bound and neutralized by defensive reaction formations.
Kaufman and his collaborators (Kaufman 1963), in their studies of character disorders in juvenile delinquents, found that impulsivity is associated with ego mechanisms designed to protect the personality from being overwhelmed by a mass of uncontrolled anxiety. Where one person might deal with anxiety by running away from the situation that causes it, the juvenile delinquent acts impulsively, in denial of the anxiety. Much of the research indicates that these children are coping with separation anxiety or annihilation anxiety rather than castration anxiety.
Other character disorders . More severe character disorders, which are related to borderline psychoses, have been described in children—particularly in autistic children, atypical children, symbiotic children, and children with ego variations.
Frosch (see Ross 1960) describes the psychotic character disorder—which is markedly different from the neurotic character disorder—in which there are disturbances in the relationship to reality, in the sense of reality, and in the capacity to test reality. The symptoms may resemble the process of an actual psychosis, but they are usually transient and reversible. Within the category of psychotic character disorders are such conditions as borderline states, ambulatory schizophrenia, and “pseudoneurotic” schizophrenia. Whatever the etiology of these conditions, they require specialized treatment because their severity may make even minimal functioning difficult. The symptomatology of these disorders is sufficiently bizarre to be recognizable to laymen, unlike neurotic character problems, which are usually perceived as “normal” variations and condemned or approved within a framework of moral and ethical value judgments.
Biological and social aspects
Since character structure seems to involve a combination of biological, social, and psychological phenomena, the problem of developing an integrating theory is a difficult one. Many biological factors—such as sex; age; race; organic disease; and the influence of drugs, hormones, and body build—need to be better researched and understood. The pioneers in psychosomatic research have made a start in this direction by trying to delineate the personalities characteristic of specific disease syndromes. In social psychology, Schachter and Latané’s provocative research (1964) on the relationship between psychopathy and adrenal functioning in the criminal recidivist indicates the myriad possibilities for research along physiological and biological lines.
Benjamin’s observations of infancy and childhood have contributed significantly to unraveling the problem of constitution, predisposition, and innate endowment (1961). Similar observations have been made in five main areas: sensation, motility, variations in instinctual drives, autonomic nervous system patterns, and ego variations. Although a psychoanalytic theory of character formation should include analyses of defensive styles, ego functions, and the operation of the energy principles, as well as a clear understanding of developmental considerations, this kind of integrating theory has yet to be formulated.
The complex problem of juvenile delinquency and its causes and treatment is approached differently by psychiatrists, criminologists, sociologists, and the police. Impulsive psychopathic behavior in any form demands more immediate and dramatic attention from society than do the results of the other forms of character disorder and consequently most vividly demonstrates the multiple theoretical viewpoints pertaining to human behavior. A sufficiently broadened psychoanalytic theory, offering a general systematic psychology of personality, would be pragmatically useful to the other specialists who must cope with the direct social consequences of these illnesses. What we need is a general synthesizer who has a dynamic psychology of human nature and who is at home with the disciplines of biology, psychology, and sociology.
Sociological interest in the juvenile delinquent has centered on that aspect of his behavior that is expressed in antisocial actions. In fact, Talcott Parsons and Edward Shils utilize action as a main bulwark of their sociological theory. Psychiatry has put forth three philosophical approaches to the understanding of this kind of problem: the psychobiologic, the psychoanalytic, and the combined psychobiologic and psychoanalytic.
Shaw (1929) and his collaborators among the sociologists center their theories about juvenile delinquency on the effects of general social disorganization; Robert K. Merton stresses socially induced deviations; Harrison G. Gough offers a sociological theory of psychopathy; and Albert J. Reiss, Jr., applying a sociological approach that incorporates psychoanalytic psychology (in a rapprochement with the clinician), views delinquency as a consequence of the type of relationship established among personal and social controls.
If we consider the character disorders as reflecting a continuum of control, we can move from deficient capacity to control (impulsive psychopathy, delinquency) to a high capacity to control (compulsiveness, obsessive-compulsive neurosis). The concept of control offers a common meeting ground for the biologist, the psychologist, and the sociologist. What remain to be determined are the relative strengths of the biological, psychological, and social factors in determining the development of control.
Anna Freud (1963) reformulated a position on the complementariness of heredity and environment in normal children, postulating that there are constitutionally inherent lines of development, including the maturational sequences in the development of libido and aggression (id) and, although less well-known, certain innate tendencies toward organization, defense, and structurization (ego). Accidental environmental influences single out individual lines for special promotion in development. The clinical problems of the choice of an organ for a psychosomatic disturbance, somatic compliance, and the choice of the symptom and form of the neurosis are one set of unsolved problems. Character choice is a much more difficult problem because it involves the question of social compliance. Hartmann (1950), for example, stated that “a given social structure selects and makes effective specific psychological tendencies and certain developmental trends.” David Riesman states the same hypothesis sociologically.
Until an interdisciplinary collaboration produces a theory that permits a reasonably scientific understanding of the causation and dynamics of character problems, treatment will remain extremely difficult because it is expensive and prolonged in the cases of the character neuroses. Nonetheless, once an individual develops sufficient insight to recognize that he has a problem, psychoanalytic therapy can sometimes produce constructive change, almost an impossibility in the case of psychopathy, where psychoanalysis is ineffective because the potential patient is too free of conflict or guilt to be amenable to therapy. Sociology may design social reforms that lead to a decrease in the incidence of psychopathic development, but it cannot alone find the answers to help the individual psychopath once his character choice has been made. Only an integrated theory will make it possible to predict, prevent, and ameliorate the wide-ranging character disorders that afflict society.
Joseph J. Michaels
[See alsoPsychopathic personality. Other relevant material may be found inCrime; Delinquency; Psychoanalysis.]
BIBLIOGRAPHY
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