(PAPD) Case Study: Jim Choate From: aluger@hushmail.com Date: Mon, 12 Mar 2001 14:55:47 -0800 (PST) Cc: cypherpunks@einstein.ssz.com, cypherpunks@lne.com Old-Subject: The Passive-Aggressive (Negativistic) Personality Disorder (PAPD) Case Study: Jim Choate Reply-To: cypherpunks@ssz.com Sender: owner-cypherpunks@ssz.com

On Mon, 12 Mar 2001, Sunder wrote (referring to Jim Choate):

...

I'd wish that:

1. he'd stick to on-topic articles and not give us any random shit he likes

Choate replies:

Every post I send is 'on topic' to crypto, civil liberties, or economics.

Sunder continues, along with Choate's replies:

...

2. he'd post a one or two paragraph quote from the article describing it under the urls.

Keep wanting.

...

3. put all the news stories from one site (slashdot for example) in one email as if it were a digest.

Keep wanting.

...

The way he "helps" us is annoying at best and only one or two notches removed from spam.

What makes you think I'm wanting to 'help' you or whatever 'us' you're refering to.

...

What pisses me off is that I actually do read slashdot regularly, and don't

You just want to be pissed off, and if you can make me the target so much the better.

Discussion: Essential Feature- The passive-aggressive (negativistic) personality disorder is located in Appendix B: "Criteria Sets and Axes Provided for Further Study" of the DSM- IV. Millon (1996, p. 198) proposes a comprehensive concept of a negativistic personality. He asserts that the negativistic personality reflects both this general contrariness and disinclination to do as others wish but also presents with a capricious impulsiveness, an irritable moodiness, and an unaccommodating, fault-finding pessimism. The DSM-IV (1994, p. 733) describes the PAPD essential feature as a pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance in social and occupational settings. The subject, Choate, demonstrates these traits clearly, particularly in the context of responses to otherwise reasonable requests from the electronic social group "cypherpunks" from which the above samples are taken. The general criteria of a personality disorder coupled with at least five of the following is sufficient to warrant a diagnosis of Passive-Aggressive Personality Disorder: procrastination and delay in completing essential tasks -- particularly those that others seek to have completed; unjustified protests that others make unreasonable demands; sulkiness, irritability or argumentativeness when asked to do something that the individual does not want to do; unreasonable criticism or scorn for authority figures; deliberately slow or poor work on unwanted tasks; obstruction of the efforts of others even as these individuals fail to do their share of the work; and avoidance of obligations by claiming to have forgotten them. Examining the small sample above it is clear that Choate meets at least four of these subset criteria. (This author has little doubt that a fifth will quickly emerge with further study). Procrastination and delay in completing any of the tasks requested of him (the addition of more substantive summaries which accompany his rote contributions to the mailing list), unjustified protests that others make unreasonable demands (in the case of Sunder above, Choate's responses to Sunder's request for a more digest format illustrates this), irritability or argumentativeness when asked to do something that the individual does not want to do (while Choate could easily have ignored the request, he chose instead to reply in an increasingly inflammatory and argumentative tone), unreasonable criticism or scorn for authority figures (as evidenced by material in his signature - "Legislators and Judges are the pimps of modern American society.") The passive-aggressive personality disorder was first introduced in a U.S. War Department technical bulletin in 1945. The term was coined by wartime psychiatrists who found themselves dealing with reluctant and uncooperative soldiers who followed orders with chronic, veiled hostility and smoldering resentment. Their style was a mixture of passive resistance and grumbling compliance (Stone, 1993, p. 361). Choate's response seems to mirror this type of response quite closely and further study under the reference of Stone's work should be pursued. The current criteria for the passive-aggressive personality disorder as proposed by the Personality Disorders Work Group for the DSM-IV includes: 1. passive resistance to fulfilling social and occupational tasks through procrastination and inefficiency; 2. complaints of being misunderstood, unappreciated, and victimized by others; 3. sullenness, irritability, and argumentativeness in response to expectations; 4. angry and pessimistic attitudes toward a variety of events; 5. unreasonable criticism and scorn toward those in authority; 6. envy and resentment toward those who are more fortunate; 7. self-definition as luckless in life and an inclination to whine and grumble about being jinxed; 8. alternating behavior between hostile assertion of personal autonomy and dependent contrition (Millon & Radovanov, Livesley, ed., 1995, p. 321). Millon suggests that the most essential features of PAPD are irritable affect; behavioral contrariness, obstructiveness, and sulking; discontented self- image, e.g. feels unappreciated and misunderstood; deficient regulatory control, i.e. poorly modulated emotional expression; and interpersonal ambivalence. They are noted for their interpersonal conflict, verbal aggressiveness, and manipulative behavior. Suicidal gestures and a lack of attention to everyday responsibilities are common (Millon, 1996, p. 198). Little study is needed to recognize the diagnosis as a strong one for the subject Choate. PAPD resistance to external demands is manifested in oppositional and obstructive behaviors. These individuals resent having to conform to the standards set by others. On the other hand, they fear direct confrontation. The combination of resentment and fear leads to passive, provocative behavior (as in the case of the subject Choate and Sunder exchange- wherein subject Choate incites Sunder and seeks to create a situation in which Sunder will escalate the rhetoric). Individuals with PAPD view themselves as self-sufficient but feel vulnerable to control and interference from others (Pretzer & Beck, Clarkin & Lenzenweger, eds., 1996, p. 60). They believe that they are misunderstood and unappreciated, a view that is exacerbated by the negative responses they receive from others for their consistent defeatist stance. They expect the worst in everything, even situations that are going well, and are inclined toward anger and irritability (Beck & Freeman, 1990, p. 339) (DSM-IV, 1994, p. 734). Subject Choate demonstrates this classically, particularly in the context of his often sardonically defeatist and pessimistic inclusions in the titles of his contributions). Individuals with PAPD are often disgruntled and declare that they are not treated as they should be. On the other hand, they are just as likely to express feeling unworthy of good fortune. They have a basic conflict concerning their self-worth; they oscillate between self-loathing and entitlement or moral superiority. Either side of this oscillation can be projected onto the environment. The chaotic nature of this experience of self and others often leads to people beginning to avoid or minimize contact with people with PAPD out of self-protection (Richards, 1993, p. 259). Individuals with PAPD see others as intrusive, demanding, interfering, controlling, and dominating. They believe that other people interfere with their freedom. They experience control by others as intolerable; they have to do things their own way (Pretzer & Beck, Clarkin & Lenzenweger, eds., 1996, p. 60). These individuals are determined that they will not be subject to the rules of others (Beck & Freeman, 1990, p. 227). They resent, oppose, and resist demands to meet expectations from others in a behavioral pattern seen in both work and social settings (DSM-IV, 1994, p. 733). Their main coping strategies are passive resistance, surface submissiveness, evasion, and circumventing of rules (Pretzer & Beck, Clarkin & Lenzenweger, eds., 1996, p. 60). Individuals with passive-aggressive (negativistic) personality disorder are ambivalent within their relationships and conflicted between their dependency needs and their desire for self-assertion. They waver between expressing hostile defiance toward people they see as causing their problems and attempting to mollify these people by asking forgiveness or promising to do better in the future (DSM-IV, 1994, p. 734). These individuals are noted for the stormy nature of their interpersonal relationships. They engage in a combination of quarrelsomeness and submissiveness. Their affect is sullen and they engage in deliberate rudeness. They are resentfully quarrelsome and irritable. They often feel like a victim. Central to the disorder is a pervasive pattern of argumentativeness and oppositional behavior with defeatist and negative attitudes (Millon & Radovanov, Livesley, ed., 1995, p. 317). Richards (1993, p. 260) believes that PAPD may be the most miserable personality disorder. These individuals inflict a great deal of discomfort on others through the use of their anxiety and emotional symptoms. They can become so destructive in their attitudes and so unable to provide rewards to others that they become socially isolated. For individuals with PAPD, authority figures can become the focus of their discontentment. They often criticize and voice hostility toward authority figures with minimal provocation. Their resistance toward authority is expressed by procrastination, forgetfulness, stubbornness, and intentional inefficiency. These individuals are also envious of and resentful toward peers who succeed or are viewed positively by authority figures (DSM-IV, 1994, pp. 733-734). Authority figures are seen by individuals with passive-aggressive (negativistic) personality disorder as arbitrary and unfair. When they are faced with the consequences of not adequately meeting obligations, these individuals will become angry at those in authority rather than seeing how their own behavior has contributed to the situation (Beck & Freeman, 1990, p. 339). Authority figures are defined as intrusive, demanding, interfering, controlling, and dominating. On the other hand, individuals with PAPD also see authority figures as capable of being approving, accepting, and caring. A key issue for individuals with PAPD is the desire to get benefits from authority figures while exerting their freedom and autonomy (Beck & Freeman, 1990, p. 45). The conflict is intense. Individuals with PAPD have a tendency to see any form of power as inconsiderate and neglectful. They are also likely to believe that authorities or caregivers are incompetent, unfair, and cruel. Nevertheless, these individuals are not inclined to rebel directly. They will agree to comply with demands or suggestions but will often fail to perform (or they will perform while experiencing increasing resentment). Then, when there is trouble, these individuals will complain of unfair treatment. They envy and resent others who manage authority situations and who are able to relate to authorities with less difficulty. These individuals believe that their suffering indicts the negligent caregiver or authority figure. They fear control in any form but long for nurturing restitution from those they perceive as having power (Benjamin, 1993, p. 272). Origins of PAPD in the Subject Choate- Stone (1993, p. 361) suggests that the contrary, sulking, and verbal nitpicking behaviors of PAPD appear to have their origin in unending power struggles with parents. The comparative helplessness of youth made it impossible to win in these struggles so the face-saving technique of passive resistance was employed. Parental overcontrol, neglect, or favoring of a sibling can all contribute to the development of the silent protest and grudging obedience associated with PAPD (Stone, 1993, p. 361). It is reasonable to assume that Subject Choate experienced some level of paternal angst and the description of unending power struggles seems apt in this context. Treatment- There are two major ways for individuals with PAPD to enter treatment. The first, and most common, is externally leveraged treatment for those individuals who do not see themselves as having a problem. Someone forced them into treatment, e.g., family, employers, or the legal system. These clients with PAPD have minimal insight; they fail to admit that they are a major factor in the problems they have. The second method for individuals with PAPD to enter treatment is via self-referral for vague complaints, e.g. "I'm just not getting anywhere" (Turkat, 1990, pp. 87-88). All of the personality disorders are composed mostly of abrasive traits that are negative in nature. Maladaptive traits are usually favored over adaptive traits (though there are adaptive traits within all personality disorders) (Kantor, 1992, p. 10). PAPD is a particularly abrasive personality and interpersonal problems are readily identifiable. However, individuals with PAPD do not frequently seek treatment for relationship issues as they consistently blame others for the problems they have. Even if they do come in for treatment for a marital or parent and child problem, they will uniformly demand that the treatment providers "fix" the other person or persons who are at fault for the problems within the relationship. Treatment for individuals with PAPD involves openly exploring the ways they indirectly and unassertively express aggression and neediness toward others by being contrary. Understanding this aggression can allow discovery of the depressive and invalidating experiences underneath -- which lead to a fear of loss of autonomy when others want to be close and a fear of loss of connectedness when others want to be alone (Kubacki & Smith, Retzlaff, ed., 1995, p. 175). This author believes that Subject Choate is unlikely to seek treatment individually and should be compelled to seek treatment in whatever fashion is most likely to produce results. Study continues... At Mon, 12 Mar 2001 17:56:49 -0600 (CST), Jim Choate wrote:

Cool, we've got two wanna be head-shrinkers. This is gonna be fun.

A common countertransference issue with these clients is outrage or punitive anger. They are manipulative individuals who are consistently stubborn, demanding, help-rejecting, critical, and inclined to ridicule both the treatment process and the service providers. Subject Choate has predictably responded in exactly this fashion to the onset of treatment. Identify all avoidance and anxiety-arousing situations. Address these issues with anxiety-management behavioral intervention techniques (Turkat, 1990, pp. 88-89). Cognitive therapy can help these individuals understand that they expect the worst from others and then proceed to behave in such a way that brings out the worst from these same people (Stone, 1993, p. 363). Group therapy provides individuals with PAPD with an opportunity to learn how to manage their hostility. When their hostility emerges, group leaders can comment on hostile behavior and encourage other group members to respond. The group leader can assist these individuals to process what it is they want or need at that moment and to rehearse appropriate behavior within the group context (Ries, TIP #9, 1994, p. 72).