Table Of ContentThe Impulsive
Personality
UNDERSTANDING PEOPLE WITH DESTRUCTIVE
CHARACTER DISORDERS
The Impulsive
Personality
UNDERST ANDING PEOPLE WITH DESTRUCTIVE
CHARACTER DISORDERS
Howard Wishnie, M. D.
Cambridge Hospital
Harvard Medical School
Plenum Press' New York and London
Library of Congress Cataloging in Publication Data
Wishnie, Howard
The impulsive personality.
Includes index.
1. Personality, Disorders of. 2. Impulse. 3. Narcotic addicts. 4. Criminal psychology.
5. Sociopathic personality. 6. Psychotherapy. I. Title. [DNLM: I. Antisocial person-
ality. 2. Compulsive behavior. WM210 W814]
RC554.W57 616.8'58 77-23464
ISBN-13: 978-1-4684-2297-9 e-ISBN-13: 978-1-4684-2295-5
DOl: 10.1007/978-1-4684-2295-5
First Printing - October 1977
Second Printing - November 1979
© 1977 PlI!num Press, New York
Softcover reprint of the hardcover 1st edition 1977
A Division of Plenum Publishing Corporation
227 West 17th Street, New York, N.Y. 10011
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
To the memory of
EL VIN V. SEMRAD,
a man who taught generations of
therapists that humanism and compassion are the
cornerstones of psychotherapy
Preface
I began this book with two purposes. One goal was to present
clinical information to support the belief that many of society's
allegedly unh'eatable people could be helped to change their de-
structive patterns of living. A second purpose was to present a
clear and simple primer for two groups of workers in the field.
Most treatment institutions depend upon the services of
nurses, aides, guards, and corrections officers. These people, who
are the least prepared, do the hulk of the treatment. Because
impulsive people learn much from their daily interactions out-
side of formal therapy, the understanding and the training of this
"front-line" working staff are crucial. These staff members may
find the second part of the book more helpful because of its use
of clinical examples and techniques.
The other group for whom this book is written includes
those who are beginning in the mental health or corrections
field. The concept of useful treatment of impulse-ridden people
has only begun to be introduced into professional training pro-
grams. The assumption that these individuals were untreatable
has kept many professionals at the fringes of this field. For this
reason, I hope that the book will find its way into the hands of
psychiatric residents, psychologists, social workers, nurses, pro-
bation officers, prison guards, youth workers, policemen,
judges, etc.
vii
viii PREFACE
The book is divided into two sections. The first four
chapters deal with my beliefs, experiences, and theoretical un-
derstandings. The rest of the book provides a series of practical
experiences and concepts. The material does not attempt to pro-
vide a specific answer, only an approach that can be combined
with other ideas to develop treatment methods.
HOWARD WISHNIE
Cambridge
Acknowledgments
The understanding and organization of any material is an effort
that draws upon the experience of many people. In this effort, I
am indebted to many people.
There are, first of all, the many patients and staff members
at various institutions from whom I have learned. They provided
the experiences that forced me to reexamine old beliefs in order
to achieve different perspectives.
Five teachers in my early training deserve special thanks
from me and many other students: Drs. Elvin Semrad, Jack
Ewalt, Elizabeth Zetzel, John MacKenzie, and Irene Briggin.
These teachers, through their direct supervision and writings,
sensitized me to the pain inherent in one's early development
and later behavior. My learning experience with these five doc-
tors forms the underpinning for this work.
As my interests shifted toward impulsive people, three
other teachers were a consistent help and stimulus. Drs. George
Vaillant, Norman Zinberg, and Arnold M. Ludwig are already
known for their clear thinking in the area of addiction and im-
pulse disorders. They constantly challenged me to rethink my
premises and refine my ideas.
The organization of this book received much of its impetus
for completion from Mrs. Evelyn Stone, whose encouragement
was of immeasurable value.
ix
x ACKNOWLEDGMENTS
Dr. Richard Cowan was both companion and support
throughout my Lexington experience, a burden he shared with
Mr. Larry Welding and Mrs. Emily Cummings. Together we
four formed a nuclear group that tried to work for change when
others said it was impossible.
During all of this, my wife has sustained and reassured me.
Her belief in my capacity to understand and to make sense of
my experience allowed me to pursue the task of writing. She,
and the children, tolerated the days and weekends when I wrote
and was not with them.
H.W.
Contents
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. xv
Chapter 1 The Author's Premises ................... 1
Character Traits Can Change! ... . . . . . . . . . . . . . . . . . . . . 1
Treatment Is a Means of Changing Character. . . . . . . . . . 1
Treatment and the Needs of the Individual. . . . . . . . . . . . 3
Society's Unreasonable Expectations. . . . . . . . . . . . . . . . . . 4
Social Pressures and Impulsive Behavior .............. 6
Staff Attitude and Impulsive Behavior. . . . . . . . . . . . . . . . . 7
Drug Addiction as a Manifestation of Impulsive
Behavior.. . . . .. . . . . . . . . . . . . . . . . . . .. . . .. . . .. . . . .. 8
Specific Premises about Drug-Addicted Impulsive
Individuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 10
Chapter 2 The Settings and the People. . . . . . . . . . . . . . .. 23
Lexington . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 23
The Composite Patient at Lexington . . . . . . . . . . . . . . . . .. 29
A Psychiatric Hospital Setting ....................... 33
An Outpatient Clinic for Drug Abusers ............... 35
Chapter 3 Character Disorders ...................... 37
Personality Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 38
xi
xii CONTENTS
Paranoid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 38
Schizoid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 39
Explosive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 39
Antisocial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 39
Passive-Aggressive ............................... 39
Borderline Personalities. . . . . . . . . . . . . . . . . . . . . . . . . .. 40
Depression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 40
Low Self-Esteem ................................. 40
Inability to Form Close Personal Relationships. . . . . .. 41
Manipulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 44
Nonpsychotic Techniques of Avoidance ............. 48
Inability to Examine One's Own Behavior . . . . . . . . . .. 49
Action to Avoid Feeling. . . . . . . . . . . . . . . . . . . . . . . . . .. 52
Other People Are Unreal. . . . . . . . . . . . . . . . . . . . . . . .. 54
No Continuity in Patterns of Events. . . . . . . . . . . . . . .. 55
Inability to Tolerate Criticism. . . . . . . . . . . . . . . . . . . . .. 56
Inability to Plan ................................. 57
Inability to Delay Gratification. . . . . . . . . . . . . . . . . . . .. 58
Entitlement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 59
No Experience Bearing Anxiety or Discomfort. . . . . .. 61
Self-Destruction ................................. 63
Examples of Depression ............................ 67
Chapter 4 Developmental Defect. . . . . . . . . . . . . . . . . . . .. 71
Normal Development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 72
Loss .............................................. 75
Reactions to the Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 78
Guilt and Conscience . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .. 90
...Jnadequate Personal Relationships. . . . . . . . . . . . . . . . . . .. 91
Summary ......................................... 92
Chapter 5 Games................................... 95
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 95
Kinds of Games . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 99
Killing with Kindness. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 99
Con tracts ....................................... 102
Peace at Any Price . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
