© 2021 Robert W McBride, LCSW
A Case For Psychopathology
Psychopathology has generally been dismissed by many in the movement as a source of violence in the family.
The movement began by rejecting traditional mental health principals and traditionally trained therapists. As a movement pushing for social change, it ignored psychopathology and focused exclusively on social systems, patriarchy, and male sex role training.
After nearly two decades of working with men who displayed abusive, violent, and criminal behaviors and sharing our experiences with other certified treatment providers who work with these men, it is apparent there are many men in treatment who clearly exhibit signs of psychopathology.
We have found personality constraints, manic-depression, depression and other mental disorders among our clients. In fact, most of our case load is comprised of individuals with varying degrees of personality constraints, and although an educational component is important for intervention, it is not sufficient.
This population often does not get the depth or length of treatment needed to adequately address any psychopathalogical problems.
Many in the movement believe that these men cannot have serious psychological problems because most appear to function well in many other areas of their lives. A common belief about psychological problems is that one must be obviously dysfunctional, eccentric, or incapable of understanding between right and wrong.
Others fear that if we include psychopathology as a source of the violence legal accountability and containment will break down.
Make no mistake, we do not see these men as victims, and we strongly support social and criminal justice responses to violence in the family. After all, most perpetrators would not be in treatment or jail if it were not for the legal response.
However, our experience in working with these men has shown us that without treating the psychological problems in a long-term program there is little hope of meaningful recovery.
Without recovery we fail the victims and the perpetrators.
Research Study
Although what we were seeing in our practice led us to believe that the vast majority of the men we treated had mild to severe personality constraints, we lacked formal proof.
In early 1995, we improved and formalized our information gathering to be more consistent and allow us to catalog specific data on each client. After all the more we know about the individuals we are treating, the better able we are to help them make permanent changes.
We were particularly interested in whether attachment strategy and personality constraints were significant elements in our population and which were most prevalent.
Also of concern were any correlations among;
Attachment strategy
Personality pattern
Income
Multiple arrests for violence in the family
Risk for violence
Substance abuse
Childhood living conditions
Childhood abuse
Education level
The data was collected from self reporting in-take questionnaires, self reporting tests including the MCMI III, police incident reports, probation reports, and treatment notes.
By the middle of 1999, we had collected data on 394 men. The client population were men coming from the middle class suburbs of the Denver area. All but two clients had been court ordered into treatment.
Our sample included:
First time offenders
Men who had failed in other treatment programs
Multiple offenders who had completed other programs
High-risk offenders
Ethnicity
The ethnic profile of our study sample was:
European/American 79 % Native/American 3 %
Latino/American 9 % Asian/American 3 %
African/American 5 % Middle-east/American 1 %
Age
The age range was 18 to 74 years old with a mean age of 35 years.
Income
52 of the subjects withheld income information. The remainder of the sample had a mean income of $39,904 which was skewed because several had incomes exceeding $100,000 with the range being $0 to $250,000.
Education
School dropouts 13 % Some college 19 %
High school level 45 % College graduate 23 %
Less educated subjects were more likely to have multiple arrests for violence in the family than subjects with more education. For example, at the extremes of education
68% of school dropouts had been arrested multiple times for violence in the family
16% of those men with college degrees had been arrested multiple times for violence in the family
We also found that the men with less education showed a significant likelihood of being at high risk for all types of violence as compared to those who had reached higher education levels.
Less educated subjects were more likely to be:
alcohol abusers or
multiple substance abusers
Less educated subjects were more likely to have been raised by a single parent than more educated subjects
52% of school dropouts raised by a single parent
13% of the college graduate subjects raised by a single parent
Men who had experienced multiple living conditions as a child
28% of our sample's school dropouts
24% of high school level
12% of some college
10% of college graduate
Experiential knowledge is that childhood living conditions generally had a significant influence education
Subjects raised by a single parent or experienced multiple living conditions were more likely to have experienced unpredictable and chaotic childhoods
That being the case, they would have been focused on survival rather than academic learning and less likely to have pursued higher levels of education.
Summary of items significantly related to education
Education
school high school some college
dropouts level college graduate
count = 394 50 179 73 92
Multiple arrest for violence in family 68% 50% 34% 16%
High risk for violence 66% 64% 44% 30%
Substance abuser 64% 69% 57% 42%
Multiple substance abuser 46% 47% 21% 12%
Single parent 52% 34% 29% 13%
Multiple living conditions 28% 24% 12% 10%
Education was significantly related to multiple arrests for violence in the family ( x² = 45.12, p<.000); risk for violence (x² = 34.31, p<.001); substance abuse (x² = 44.80, p<<.000); raised by single parent (x² = 25.33, p<.000); multiple living conditions as a child (x² = 12.74, p<.005); and adult attachment strategy (discussed in a future blog).
Multiple Arrests For Violence In The Family
The subjects arrested for violence in the family two or more times are 41% of the sample's population.
Multiple arrests for violence in the family was significantly correlated with risk for all forms of violence.
Multiple arrests for violence in family
Yes No
count = 394 163 231
Low risk (n = 27) 4% 96%
Medium risk (n = 159) 9% 91%
High risk (n= 208) 71% 29%
Multiple arrested subjects were 91% high-risk population
Multiple arrested subjects had a high incidence of substance abuse (83%)
Multiple arrested subjects had a significant level of multiple substance abuse (60%)
44% of multiple arrested subjects were raised by a single parent
30% of multiple arrested subjects experienced multiple living conditions as a child
Multiple arrested subjects for violence in the family generally had a low education level
Summary of items significantly related to multiple arrest for violence in the family
Multiple arrest for violence in the family
count 163
High risk for violence 91% Education
Substance abuser 83% school dropout 8%
Multiple substance abuser 60% high school level 50%
Single parent 44% some college 34%
Multiple living conditions 30% college graduate 16%
Of the factors in the study, multiple arrests for violence in the family was significantly related to risk for violence (x² = 161.38, p<.000); substance abuse (x² = 95.36, p<.000); raised by single parent (x²= 24.69, p<.000); multiple living conditions as a child (x² = 13.25, p<<.000); education (x² = 42.12, p< .000); adult attachment strategy (discussed in a future blog); and personality pattern (discussed in a future blog).
Risk For Violence
Clients were evaluated using a thirty-eight item checklist for the risk they present to others and themselves. The checklist was completed by probation departments and/or the treatment agency prior to entering or upon entering treatment.
7% (n = 27) of the subjects were consider low-risk
40% (n = 159) are considered medium-risk
53% (n = 208) are considered high-risk
Because there were few low risk subjects, we combined them with medium risk for further analysis.
Summary of items significantly related to risk for violence
Risk for violence
Medium High
Multiple arrest for violence in family 8% 71%
Substance abuser 38% 81%
Multiple substance abuser 11% 54%
Single parent 21% 39%
Multiple living conditions 12% 25%
Education
school dropout 10% 16%
high school level 34% 55%
some college 22% 15%
college graduate 34% 14%
Of the factors in the study, risk for violence was significantly related substance abuse (x² = 104.76, p< .000); raised by single parent (x² = 17.72, p<.000); multiple living conditions as a child (x² = 10.29, p< .006); education x² = 34.31, p<.000); adult attachment strategy (discussed in a future blog); and personality pattern (discussed in a future blog).
Substance Abuse
23% of the men admitted abusing alcohol or other drugs had been a problem in their lives
60% actually were or had been substance abusers (alcohol and/or other drugs)
26% of this population abused alcohol
1% used a single drug other than alcohol
34% were multiple substance abusers (alcohol and other drugs)
(Besides alcoholic beverages, multiple substance abusers used marijuana, various uppers and downers, cocaine, heroin, morphine, LSD, and mushrooms)
82% of non-substance abusers had been arrested only one time for violence in the family
36% of the abusers of alcohol only had been arrested only one time for violence in the family
74% of the multiple substance abusers had been arrested two or more times
84% of the multiple substance abusers as compared to
25% of the non-substance abusers are indicated as high-risk offenders
36% of the subjects who were substance abusers were from single parent homes
23% of the subjects who were substance abusers had multiple living conditions as a child
Non-substance abusers had reached higher levels of education than multiple substance abusers
19% of multiple substance abusers had any college
53% of the non-substance abusers had attended college
According to the Substance Abuse and Mental Health Service Administration (SAMHSA), 35.4% of males ages fifteen to fifty-four have had substance abuse/dependence problems in their lifetime and 16.1% in the past year (08/29/95, p.35).
The lifetime substance abuse rate for this study is 25% higher (60%) than the general population
Summary of items significantly related to substance abuse
Substance abuse
Non-abusers Alcohol only Multiple substance
count = 394 159 102 133
Multiple arrest violence in family 18% 36% 74%
High risk for violence 25% 55% 84%
Single parent 22% 28% 42%
Multiple living conditions 13% 17% 29%
Education
school dropout 11% 9% 18%
high school level 35% 38% 63%
some college 20% 26% 11%
college graduate 34% 28% 8%
As previously discussed, substance abuse was significantly related to other factors in the study, multiple arrests for violence in the family, risk for violence. Substance abuse was also raised by single parent (x² = 14.07, p<<001); multiple living conditions as a child (x² = 12.52, p<.002), and education ( x² = 44.80, p<.000). The relationship with adult attachment strategy and personality pattern are discussed in a upcoming blogs.
Raised By a Single Parent
31% of the population of our study were raised in a single parent family
Nationally, “more than one in four children is living in a single-parent home. . .half of all children are likely to spend some time in a single-parent family” (Children's Defense Fund, 1996, p. 10).
The number of subjects raised by a single parent is significantly related to multiple arrests for violence in the family, risk for violence, substance abuse and education
61% of subjects raised by a single parent were arrested two or more time for violence in the family
120 clients raised by a single parent part or all of their childhood 68% indicated as high risk risk for violence
71% of subjects raised by a single parent were substance abusers, 47% use multiple substances
The education make-up of the subjects raised by a single parent was 22% school dropouts, 51% high school level, 18% some college, and 10% earned college degrees.
Subjects raised in a two parent home had more education than those raised by a single parent
22% of subject raised by a single parent dropped out of school
9% dropout rate for those raised in two parent homes
28% of our subjects raised by a single parent attended some or graduated from college
48% of the subjects raised in homes with two parents attended some or graduated from college
Multiple Living Conditions As a Child
Men who had experienced multiple living arrangements (moves among step-families, grandparents, other relatives, foster care, and adoption) were 19% of the study population.
As previously noted, subjects experiencing multiple living conditions as a child is significantly related to multiple arrests for violence in the family, risk for violence, substance abuse and education
60% of subjects who experienced multiple living conditions as a child had been arrested two or more times for violence in the family
69% were indicated as high risk for violence
73% had been or were substance abusers
These subjects were more likely to dropout of school 19% compared to 11% of those not subject to these living conditions
24% of those who had experienced multiple living conditions as a child attended some or graduated from college compared to 46% of those not experiencing childhood multiple living conditions
Childhood Abuse
Emotional abuse often stands on its own without physical or sexual abuse, neglect, or abandonment.
Physical abuse virtually always include an element of emotional abuse
Sexual abuse includes physical and emotional abuse
Neglect involves emotional abuse however a child who is neglected may have been physically or sexually abused. Abandonment of children includes emotional abuse and neglect; the child may also have been physically or sexually abused
For analysis we organized childhood abuse categories into four primary groups—none reported; primarily emotional abuse; primarily physical abuse; and profound abuse. The primary term refers to the abuse that overrides any other forms of abuse, which may have been present.
None None reported, none discerned
Emotional Emotional abuse, emotional abuse and neglect, emotional abuse and abandonment
Physical Physical abuse alone, physical abuse and neglect, sexual abuse, sexual abuse and neglect
Profound Physical abuse and abandonment, sexual abuse and abandonment
Of the 394 cases, no childhood abuse was reported in 29% of the cases
26% of the men admitted violence in their family of origin
71% of the subjects actually experienced childhood abuse including emotional, physical, sexual abuse, neglect, and abandonment
22% of the subjects had experienced primarily emotional abuse
24% experienced primarily physical abuse
25% experienced profound abuse
5 of the 394 men reported childhood sexually abuse during the in-take process
During treatment 11% of the men in treatment report being sexually abused as children (most cases the sexual abuse was perpetrated by a close relative)
A review of national studies in Abused Boys (Hunter, 1990, pp. 25-27) suggests that males who are sexually abused as children (under the age of thirteen) is, conservatively, between 2.5 and 16.0 percent.
Our finding were consistent with national figures however, we suspect that probably more of the men in treatment had been sexually abused as children.
Because these men were so well defended and their culture reluctant to acknowledge males as sexual abuse victims, it is almost impossible for most men to discuss their sexual abuse.
The cultural message is clear, “Men can be perpetrators or heroes but not victims.”
73% of subjects profoundly abused as children had been arrested multiple times for violence in the family
16% of subjects not reporting abuse in childhood had multiple arrests
Profoundly abused subjects as a child were over three and a half times more likely to be high risk for violence
75% of our subjects profoundly abused as children were substance abusers
55% were or had been multiple substance abusers
37% subjects report no abuse were or had been substance abusers
14% were or had been multiple substance abusers
70% of those profoundly abused were raised by a single parent
4% of the subjects not reporting abuse were raised by single parents
52% of the profoundly abused subjects experienced multiple living conditions as a child
1% of subjects reporting no childhood abuse had experienced multiple living conditions
27% of those profoundly abused in childhood dropped-out of school
8% of subjects not reporting abuse in childhood dropped-out of school
22% of the profoundly abused subjects completed some college or graduated from college
62% of the subjects not reporting abuse in childhood completed some college or graduated from college
Summary of items related to abused as a child abused as a child
None Emotional Physical Profound
count = 394 113 89 95 97
Multiple arrest violence in family 16% 24% 56% 73%
High risk for violence 24% 38% 68% 85%
Substance abuser 37% 54% 77% 75%
Multiple substance abuser 14% 21% 12% 70%
Multiple living conditions 1% 21% 5% 52%
Education
school dropout 8% 12% 4% 32%
high school level 30% 45% 59% 51%
some college 25% 20% 17% 11%
college graduate 37% 23% 20% 11%
Of the factors in the study, abused as a child was significantly related to multiple arrest (x² = 65.46, p<.000); raised by single parent (x² = 128.32, p<.000); multiple living conditions as a child (x² = 102.68, p<.000); education (x² = 53.93, p< .000)
Psychopathology
The patriarchy and social training does create in many males notions of male dominance and inequality of women. These beliefs and behaviors were observed in virtually all of the men entering treatment. Most of the men who demonstrated with their denial, minimization, rationalization, and projection were incredulous that their behavior is inappropriate, controlling, abusive, violent, or destructive. These behaviors are not limited by ethnicity or socio-economic group.
If we stereotype and label all men and describe these men's behaviors as typically normal male behavior, we will often miss the psychopathology of men with abusive, violent, and criminal behavior.
If the men in treatment come from the general population of men, we would not expect to find the rates of trauma experienced in childhood or the extremely high rates of dysfunction that exist in this population.
For men arrested for abusive, violent, and criminal behavior who otherwise appear generally ordinary in the community, the question of psychopathology arises from three areas—attachment issues, issues of self, and personality constraints.
Attachment strategy begins to develop in the first year of life and has life long consequences related to the ability to build future personal relationships and a relationship with society. The strategy can be secure or insecure.
The general population insecure attachment strategies are represented in 44% of the people in the United States.
In the general population insecure attachment is represented as,
16% dismissing,
9% preoccupied
19% unresolved-disorganized (van IJzendoorn, M. 1995 Psychology Bulletin, 117. 387-403.)
In our study, 92% of the subjects were described as having insecure attachment strategies.
Insecure adult attachment strategies described as dismissing, preoccupied, and unresolved-disorganized
71% dismissing,
10% preoccupied,
8% unresolved-disorganized
The majority of our study population were profoundly abused as a child and presented a disproportionate percent of the multiple arrests for violence in the family, high risk for violence, substance abuse, raised by a single parent, multiple living conditions as a child and school dropouts.
Each of our concepts of self is made up of an immense matrix of schemas representing enduring and irrefutable beliefs about ourselves, our environment, and our relationship with the environment. Anecdotal experience indicates that maladaptive schemas have a significant influence with men who have abusive, violent, and criminal behavior. Study of maladaptive schemas with regard to abusive, violent, and criminal subjects deserves future consideration.
Personality disorders are enduring, inflexible maladaptive personality conditions developed early in a person's life causing consequential impairment in social functioning.
72% of our subjects indicated having a personality constraints
Estimates of personality disorder in the general population of the United State ranges from 5-15%. Based on a two stage study, Lenzenweger, Ph.D., a psychopathologist at Cornell in Ithaca, estimated that 11% of their nonclinical population had a diagnosable personality disorder (Archives of General Psychiatry. Vol. 54, pp. 345-351).
The men in treatment experienced over twice the rate of insecure attachment strategy and more than six times the rate of personality constraints as the general population.
41% of the clients had been arrested at least twice for violence in the family
90% admitted having committed crimes outside the family
25% higher rate for substance abuse in their lifetime than the national rate for men
71% of this population were abused in their family of origin or by caregivers
The environments and experiences of childhood for most of these men did not teach them appropriate coping skills or tools to cope with the perceived conflict in their adult lives
Beginning with processes of insecure attachment strategies most of these men suffered mild to severe damage to their image of self early in childhood
Distorted concepts of self, the outside environment, and how they relate and cope with others have developed inflexible personality structures that, when faced with perceived conflict, often exacerbate rather than improve the situation for themselves and others.
These men, especially the men at high risk for violence, need to reinvent their lives.
Reinventing their lives includes learning tools to cope with internal and external conflict and examining and restructuring their concepts of self and personality.
For men with more severe psychopathology, the process of habilation and recovery will take at least one to five years of work.
Next we will present information regarding abusive relations