Sunday, June 24, 2012

Just Like His Father? Book Review

I just got the book Just Like His Father? by Liane Leedom. (She has a website here.) Unfortunately, it's not as good as I hoped it would be.

Firstly, she doesn't use the terminology right. She recognizes that there's a difference between antisocial personality and psychopath. But she uses psychopathy to refer to only the most severe kinds of psychopaths, and describes all antisocial people as having characteristics (lack of empathy, impaired moral reasoning) that only psychopaths have.

If it was just a matter of using the words differently, that wouldn't be a problem. But then she assumes that researchers are talking about psychopaths when they're really just talking about antisocial personality, and therefore misinterprets the significance of their results. She makes empathy and remorse sound a lot more environmentally determined than they really are, because she combines research on environmental risk factors for non-psychopathic antisocial personality with research on the empathy and remorse problems of psychopaths.

The two most common subtypes of individuals with conduct problems (ODD, CD and/or antisocial personality - often those three form a developmental progression) are psychopathy and behavioral dysregulation. Here's a summary of how the two differ:
  • Emotional (affective) empathy for others, and capacity for remorse - A deficit in this area is a defining characteristic of psychopathy while behaviorally dysregulated people range from normal to increased affective empathy. The only people they lack empathy for are their victims, and even then, this isn't always true. When behaviorally dysregulated people lack remorse, it's because they've found an excuse that's sufficient to convince themselves that they did nothing wrong; psychopaths don't need to convince themselves because 'wrong' has no meaning to them.
  • Self-esteem - Psychopaths are typically grandiose and narcissistic, meaning their self-esteem is too high. Behaviorally dysregulated people very often have low self-esteem, which can be both a cause and an effect of their conduct problems.
  • Depression/anxiety - Fearlessness is one of the classic traits of psychopathy; in addition,  psychopaths rarely get depressed as a side effect of lack of guilt/shame and high self-esteem. In contrast, many behaviorally dysregulated people have mood disorders (depression or bipolar) or anxiety disorders, especially PTSD (the link between trauma and conduct problems is stronger in these individuals than in psychopaths).
  • Aggression - Both psychopathy and behavioral dysregulation are associated with reactive aggression, ie aggression that is motivated by strong negative emotions and not intended to achieve a certain goal. However, only psychopaths show an increase in proactive aggression, meaning premeditated, goal-directed aggression. So, while both psychopathic and behaviorally dysregulated kids are likely react to being called names by beating up the name-caller, only psychopathic kids are likely to calmly walk up and pick a fight with a kid so they can steal a toy while the other kid is freaking out.
  • Moral reasoning - Psychopaths can sometimes talk a good talk, but they find the concept of right and wrong very difficult to understand. Behaviorally dysregulated people have no such difficulty; they are largely normal in moral reasoning, but their mood and impulse control issues mean that their behavior doesn't match their standards; or else they chose a different moral code to follow (such as loyalty to a gang - psychopaths don't make good gang members).
  • Cause - Psychopathy is strongly genetic, with a small environmental component. Behavioral dysregulation is strongly environmental, with a small genetic component (mainly in terms of ADHD and bipolar disorder predisposing to behavioral dysregulation).
So, clearly, there's a big distinction between the umbrella diagnoses that lump psychopathy and behavioral dysregulation together, and psychopathy itself. Psychopathy isn't just more severe antisocial personality - it's a distinct condition.

So that's my biggest criticism. But not my only one.

Next, regarding impulse control, she talks as if all impulses are bad ones. Impulses can be good, bad or neutral. You can, for example, have the impulse to hug a loved one, or to go play on a swing. Neither of those are bad things to do (as long as the context is appropriate). In addition, it's possible to have too little impulsivity - this is the personality type known as overcontrolled, who are at high risk for anxiety disorders, depression and obsessive compulsive personality disorder. It's important to strike a balance - give into your positive and neutral impulses and resist your negative ones. However, for a child with too little impulse control, a focus on building impulse control is a good thing. Willpower acts like a muscle, and practicing it will make it improve.

I was especially disappointed by her chapter on moral reasoning. She parrots Kohlberg's stages of moral reasoning, which were discovered in the 1950s, and entirely misses all the newer moral reasoning research that is relevant to her topic. In particular, she makes no mention of the moral/conventional distinction, a moral test in which psychopaths show especially notable differences. The vast majority of people draw a distinction between against the rules and morally wrong (causing harm to others) - ranging from 3 to adult (younger kids aren't testable on this test), across many cultures, and including most atypical populations, such as abused children, non-psychopaths with conduct problems, autistic kids, and so forth. Only psychopaths and people with certain kinds of brain injuries fail to draw a distinction between rules and morality.

This research is far more relevant than Kohlberg's stages. While people with conduct problems, and particularly psychopaths, do show a statistical trend towards lower Kohlberg stages, this difference is far less pronounced than the difference on the moral/conventional distinction. (They certainly aren't all fixed at stage 0 - even some psychopaths score at stage 3 or 4, although they're probably espousing beliefs they don't personally share. And a committed gang member would likely score at least at stage 3, because this stage involves ideals such as loyalty to your in-group.)

Another problem, which she only hints at indirectly, is her lack of understanding of the distinction between cognitive and affective empathy. (On page 64 she mentions that blind or deaf kids are often delayed in empathy development, and on page 66 she talks about difficulty reading emotions, with no indication that she recognizes that those two examples are discussing a totally different kind of empathy than the rest of her book is.)

Cognitive empathy is the ability to accurately identify other people's emotions and to imagine another person's perspective; affective empathy is experiencing an emotional response more appropriate to your perception of another person's situation than to your own situation. (I say 'your perception' because inaccurate perception of others doesn't mean a lack of affective empathy, even though it means their emotional response may not fit the other person's actual experience.)

Autistic people typically struggle with cognitive empathy. In addition, individuals with ADHD can often have issues with cognitive empathy as well. Blind or deaf kids are often mildly delayed in cognitive empathy (with the exception of Deaf of Deaf kids) but usually catch up, except in the case of deaf people exposed to language very late. However, all of those people (unless they happen to be psychopaths as well) have entirely normal affective empathy. When they behave unempathetically, it's because they don't know, not because they don't care.

Psychopaths, in contrast, have severe problems with affective empathy. Their emotions always or almost always arise solely from their own situation, regardless of how others around them are doing. If they see someone else is unhappy, they won't feel unhappy themselves, even though they can tell the other person is in distress.

Psychopaths aren't entirely normal in cognitive empathy. They have specific difficulty recognizing certain emotions (most often fear). In addition, pre-pubertal psychopaths have a mild delay in development of cognitive empathy, which resolves around their preteens or early teens (my guess is that's when they realize they could benefit from learning to manipulate people). But impairment in cognitive empathy is not one of primary characteristics of psychopathy.

Another issue is that she buys into the widespread myth that criminality is on the rise. It used to be on the rise, back in the 1960s and 70s. The reason was because the Baby Bommers were aged around 15-25 back then, and that's the age group that has the highest rate of criminal behavior. Since the Baby Boomers have outgrown the high-crime age, the rate of crime has gone down dramatically as a result. Furthermore, our preventative efforts have worked - the rate of crime among 15-25 year olds has gone down as well. However, crime reporting has gone up, and along with it, public fear of crime, which she only serves to encourage.

My last criticism is regarding references. She is actually unusually good at providing references for what she's saying - I've seen many books where there are no references given whatsoever. In contrast, she provides a total of 129 references, which I have every intention of tracking down and reading as many as possible. But she has a few claims provided without any references to support them, and they are given in the same tone of certainty as the referenced claims. For example, on page 115, she claims that giving a child with high sensation seeking the intense stimulation that they crave is a bad idea - they'll adapt to it and become even more sensation-seeking. She provides no references for this.

As far as I know, this question has not actually been studied. While it may seem common-sense to her, psychology research has many examples of common-sense ideas that turned out to be wrong (such as the idea that infants will cry more if you promptly pick them up whenever they cry). And you could easily make a counter-argument that if you don't give the kid intense but appropriate stimulation, they'll seek out their own intense stimulation through inappropriate means. I don't know which model is right, and she doesn't either. She should've made this clear in her book, instead of providing her unresearched claim in bold text like it's especially significant. (Another example is her claim of an inverse relationship between aggression and affection, which she presents complete with a illustration to cement the concept. This, too, is unreferenced.)

Last, I personally disagree with her take on social dominance and respecting authority. She argues that to handle a child's strong desire for social dominance, you should socialize them into respecting adult authority figures. However, while this may make the child more obediant while they're a child, it seems to me that this will only strengthen their social dominance orientation in the long term. After all, social dominance orientation is not simply a drive - it's also a worldview. Social dominance orientation has two components; a worldview in which someone always has to be on top, and a strong desire that that person be them. Her advice seems like it's designed to reduce the desire to be on top while strengthening the worldview that someone has to be on top. So the kid learns the lesson that, realistically, a child can't be the boss. But once he grows up, he'll soon realize that he can be the boss if he does the right thing.

Sadly, individuals high on social dominance orientation, though they dearly want to be leaders, are usually terrible leaders because they will toss out morals in favour of more power. And people high in authoritarianism, which also involves the worldview that 'someone must be on top' (they believe good comes from submission to authority), will typically blindly follow their leader even if he does trade morals for power. So even if this strategy works and the kid sticks to following authority, he'll be an easy tool for an unjust ruler. It's important not to overemphasize submission to authority - that's what led ordinary, decent Germans to support Hitler's persecution of the Jews and the others he labeled 'undesirable'.

Despite all these criticisms, it is a good book. She has many bits of excellent advice. Her emphasis on a strong parent-child bond is probably the most valuable message in her book - she's quite right when she says that for fearless children the parent-child bond is extremely important to their development of conscience. And her advice on how to build a parent-child bond (keep your child with you, don't ever tease them, be responsive to their needs, show empathy for their emotions even as you set limits on their behavior) is excellent advice.

Other parts I like are: the recognition that single parenthood, while suboptimal, is often not a choice; the advice to explain the reasons behind rules and tell the kid what he/she should do instead of the misbehavior; recognizing that tantrums can result from a legitimate gripe; and the recognition that impulsive kids who want to please should be handled gently.


Blogger Adelaide Dupont said...

Hello Ettina!

So much to think about with Just like his father?. 16th-17th of June 2012 I was researching Liane's work too, though did not go to the stage of obtaining the book.

So psychopaths have deficits in cognitive and affective empathy, though one (cognitive) is milder than the other?

Good points about sensation seeking and how we need to find a model which works.

Yes, impulsive kids who want to please should be handled gently and sensitively.

I started learning about impulsivity from B Terry Brazleton. He gave the example of a child who wanted to play with his father's work computer (an example from the early 1990s).

Social dominance! Does that usually come from and functions within peer groups (both immediate and wider)? Good that you pointed out that social dominance is a worldview and a drive (a drive searching for a worldview? a worldview powered by a drive? multiple drives?). That has implications for how we handle it.

Connection between aggression and affection: very culturally meditated. (Reference: Montagu and Cairns).

A few years ago I would have made the psychopathy = antisocial personality convergence like Leedom did.

Behaviour and standards - that mismatch has caused a lot.

Who lacks empathy for victims? What about targets?

Good contradict on "Criminality is on the rise".

Have you read Mercer's Myths and misunderstandings about child development? It's a text I would recommend for developmental psychology students and parents.

Terminological inexactitude!

7:59 PM  
Blogger Ettina said...

"A few years ago I would have made the psychopathy = antisocial personality convergence like Leedom did."

Me too. But if you're going to write a book on the topic, you should learn the difference. One of her references, Hare's book Without Conscience, actually clearly explains the distinction between psychopathy and antisocial personality.

7:54 AM  
Blogger Unknown said...

Liane will talk a good story until confronted with questions about what she knew and when?

Then is is damaged, ?????

Her Child is a victom of her rage, although a vehicle for sale of her book.

10:40 PM  

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