Introduction
MAX may be a 42-year-old male detainee anticipating a final appeal on a passing sentence. He features a long history of criminal and savage behavior, starting in childhood. MAX’s case gives knowledge into basic brain research and social administration zones, counting determination, treatment, treatment approaches, family bolsters, and community effects. Analyzing MAX’s foundation and current circumstance through these focal points can offer assistance in creating a more comprehensive understanding of his clutter and needs.
Diagnostic Information
Based on the DSM-5 criteria, MAX can be analyzed with antisocial personality disorder (ASPD). He shows a need for regret, misdirection, impulsivity, forcefulness, careless ignoring of the security of self and others, consistent untrustworthiness, and a need for sympathy (Hurlow, 2023). He, too, meets the criteria of disappointment to comply with legal behaviors, as proven by over and over-performing criminal acts that are grounds for captu His history of conduct disorder before age 15, including acts of cruelty to animals, also supports an ASPD diagnosis.
Some other diagnoses that could be considered include intermittent explosive disorder due to recurrent, problematic, impulsive aggression. Antisocial behavior can also have overlaps with borderline personality disorder (Carlyle et al., 2020). However, MAX’s pervasive pattern of disregard and violation of others’ rights points most directly to ASPD as his primary disorder.
The main behavioral goals for MAX should be reducing violent and criminal behavior and increasing empathy and appropriate social functioning. However, MAX lacks any motivation to change his behaviors. This essentially means external control via incarceration is the only realistic management strategy, given the severity of the violence MAX has perpetrated. Probation, parole, or community release would be completely inappropriate, given his high risk of reoffending without such external constraints.
Medical Treatment
There are currently no medications specifically approved for antisocial personality disorder. However, medications may be used to manage associated conditions like anxiety, depression, or impulse control problems on an individual basis. For MAX, anti-anxiety medications or beta blockers could potentially be trialed to reduce feelings of inner tension and subsequent aggressive outbursts when triggered. If substance abuse issues are contributing to his violent acts, pharmacological assistance with sobriety maintenance may also help mitigate behaviors long-term.
Any medical treatments would need to be continued chronically rather than acutely since ASPD represents an engrained pattern of dysfunction versus an acute crisis-oriented state. Again, these medications would be aimed at managing symptoms rather than “curing” MAX or fundamentally changing his programming. Without internal motivation to change, pharmacology can only provide peripheral assistance by lightly dampening urges and compulsions to act out.
Therapy Approaches
Recommended therapy approaches for MAX include cognitive behavioral therapy (CBT) to modify criminal thinking patterns and build skills like empathy, problem-solving, anger management, and a more positive personal identity (Orkun Karabatak, 2023). Motivational interviewing techniques could also help increase insight into the destructiveness his behaviors cause both within himself and external victims and society. However, MAX would need at least a minimal level of engagement for interventions like CBT, motivational interviewing, or group therapies to have any chance of having a positive impact.
MAX’s below-average intelligence, evidenced by his academic issues and inability to maintain steady employment, could also impact his ability to benefit from insight-oriented approaches. His complete lack of motivation for change negatively impacts his prognosis as well. In cases like MAX, where violent fantasies cross over into horrific criminal actions like murder, external control via incarceration is genuinely the only realistic management strategy. Keeping MAX confined securely behind bars ensures he has no access to further potential victims or opportunities to feed destructive compulsions.
Family Support
MAX grew up in an unstable family environment with an incarcerated biological father and a lack of maternal caregiver support. This suggests he failed to form a secure attachment in childhood, leading to the callous disregard for others, lack of empathy, and thirst for control characteristic of ASPD (Chen & Chen, 2023). Coming from a criminal background, his father likely normalized antisocial, violent behavior from a young age as well. Having his mother abandon the relationship when he turned 19 also indicates a further disruption in early formative bonds.
MAX has had no contact with family for over 20 years now. Appointing a dedicated caseworker could help discover if any supportive relatives or friends who could advocate for MAX’s basic needs still exist. A caseworker could also help trace family history in more depth, given that MAX’s Father was also incarcerated (Sawyer, Zunszain, Dazzan, & Pariante, 2018). Often, violent criminality runs across generations, and upbringing plays a key role. However, family therapy is extremely unlikely to impact MAX’s engrained behaviors at this point without fundamental internal motivation to change. Support persons may require their counseling as well to healthily cope with effects stemming from MAX’s disorder-driven actions rippling negatively across a wide circle.
Community Impact
Individuals with severe antisocial personality disorder often face social exclusion and discrimination due to the violating nature of crimes perpetrated against victims and society as a whole. However, while the community needs protection from further violence, addressing root causes like adverse childhood experiences (ACEs) and lack of access to mental health resources could work to prevent future cases from developing. Keeping young children safe and increasing community-based early intervention programs for trauma and conduct disorder are key preventative public health goals.
Organizations like prisoner advocacy groups, criminal justice reform advocates, and forensic social workers can support prisoners like MAX to lobby for properly funded correctional mental health services. Access to counseling, skill-building programs, medication management, and step-down, transitional community re-entry facilities all need drastic improvement in the prison system. Specifically, increasing wraparound services for families struggling with children demonstrating early conduct disorder behaviors could provide upstream aid in stopping the trajectory toward adult violent criminality altogether.
MAX’s chronic, violent criminal history demonstrates he poses an exceptionally high risk of violence and danger both to himself and society as a whole if he were released without strict external constraints. His disturbing lack of remorse, paired with intensely deranged behaviors like committing murder, indicates the most potent possibility that successful rehabilitation in adulthood is unlikely at this point. Support should focus first on keeping the larger community safe and second on pushing for funding to humanely meet MAX’s basic needs within permanent restrictive confinement, given that treatment-resistant severe violent offenders are exceptionally rare.
Conclusion
Antisocial personality disorder represents an engrained dysfunctional pattern that is notoriously challenging to fundamentally treat or change over the long term, especially in severe cases like MAX. A comprehensive biopsychosocial approach can help appropriately manage associated dangerous behavioral symptoms but cannot force internal motivation missing as the most vital ingredient for healing growth (Wasserman et al., 2023). This case highlights gaps around preventatively catching at-risk children earlier, showing conduct disorder warning signs as well as widely improving supportive correctional rehabilitative programs aimed at the imprisoned offending population. Protecting vulnerable populations from harm by securely confining violent criminals must be society’s priority before considering the needs of the perpetrators themselves. Simultaneously improving early and later interventions could help curtail sources fueling societal problems represented by MAX’s severe disorder across the lifespan continuum.
References
Carlyle, D., Green, R. C., Maree Inder, Porter, R., Crowe, M., Mulder, R., & Frampton, C. (2020). A Randomized-Controlled Trial of Mentalization-Based Treatment Compared with Structured Case Management for Borderline Personality Disorder in a Mainstream Public Health Service. Frontiers in Psychiatry. https://doi.org/10.3389/fpsyt.2020.561916
Hurlow, J. (2023). Antisocial Personality: Theory, Research, Treatment By Richard Howard and Conor Duggan Cambridge University Press. 2022. £29.99 (pb). 220 pp. ISBN 9781911623984. British Journal of Psychiatry, 222(4), 179–180. https://doi.org/10.1192/bjp.2022.169
Orkun Karabatak. (2023, July 14). Cognitive Behavioral Therapy (CBT) for Criminal Behaviors. Retrieved December 4, 2023, from ResearchGate website: https://www.researchgate.net/publication/372428345_Cognitive_Behavioral_Therapy_CBT_for_Criminal_Behaviors
Sawyer, K., Zunszain, P. A., Dazzan, P., & Pariante, C. M. (2018). Intergenerational transmission of depression: clinical observations and molecular mechanisms. Molecular Psychiatry, 24(8), 1157–1177. https://doi.org/10.1038/s41380-018-0265-4
Wasserman, D., Arango, C., Fiorillo, A., Levin, S., Peters, A. C., Rao, G., … Sanchez‐Villanueva, T. (2023). Pushing forward public mental health agenda and promotion of mental health. World Psychiatry, 22(1), 170–171. https://doi.org/10.1002/wps.21052
Chen, I-Jun., & Chen, Z. (2023). A study of the mechanism for intergenerational transmission of gender roles in single-parent families. Heliyon, 9(12), e22952–e22952. https://doi.org/10.1016/j.heliyon.2023.e22952
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