The Intrapsychic Mechanism of Creativity
and Associated Remission
in Antisocial and Psychopathic Personalities
Willem
H. J. Martens, MD, PhD
Director
of the “W. Kahn Institute of Theoretical Psychiatry and Neuroscience.”
Beatrixstraat
45, 3921 BN Elst
Utrecht,
The Netherlands
WimmartensW@netscape.net.
Growth
of positive and constructive creativity in patients/offenders with psychopathic
or antisocial personality disorder could be linked to the enhancement of their
insight and further emotional, moral and social development; social attitudes
and remission. Significant relationships between creativity and a) authenticity
b) intellectual processing c) a fusion of higher and lower drives d) conflict
between unconscious drives and unsatisfied wishes e) contemplation of all
reality f) the encounter with the world and g) intellectual delight and
spiritual release, which might play a role in the process of remission in
antisocial or psychopathic patients, will be discussed in this article.
Introduction
Creativity is a capacity
with many faces, some sublime, other pathological, and still others somewhere
in between (Grotstein, 1992). It is a power not only mediating between destructive
and constructive processes but creativity is integrating itself into the
personal image if life (Waser, 1991) and it has its roots in imagination and
discovery (Gotz, 1981). The primary of the creative practice is opposed to pure
theoretical knowledge. As the essential theoretical material of the creative
man, he finally understood himself (Salaquarda, 1996). Positive creativity is
equated with innocence and insight with disillusion (Quinney, 1994), and it is
further necessary for transformation of insight into
concretization (Gotz, 1981). Creativity enables us to make contact
with phenomena outside the boundaries of our ego (Martens, 1997), and it allows
us to escape our fate (Maslow, 1963; Arieti, 1976). Moreover, it is essential
to growth as the individual learns, and adapts to his or her environment and to
an inner sense of values (Maslow, 1963). And, a touch of madness could enhance
creativity (Ludwig, 1989), and that can be observed in some categories of
psychiatric patients.
Plato had said that moral
man was preventing from hearing the "Harmony of Spheres" by the
grossness of his body senses. It was believed that heavenly bodies produced
notes, and the harmony of those notes was the "Harmony of Spheres."
But, according to Plato (Republic, book 10) and Aristotle the "Harmony of
Spheres" had also other meanings like "the simplicity of pure
unity", "unity of varity", "appropriate relations of the
whole with its parts" and "the complete sound" (Burnet, 1930).
Hearing the "Harmony of Spheres" is thus a spiritual, contemplative
act, in which constructive, positive creativity and intentions play a
significant role, while all kinds of destructive, antisocial creativity and
intentions would interfere with the ability to hearing the "Harmony of
Spheres." Therefore, it can be said that in particular antisocial and
psychopathic patients are unable to hear the "Harmony of Spheres" or
what I will call "to hear the complete sound about themselves and
others." The senses of antisocial and psychopathic persons are filled with
hate, hostility and destruction and there is no place for empathy and sympathy
with, and love for other persons. Antisocial and psychopathic persons are
tending to devaluate persons to things that can be used or thrown away and they
are not really interested in other people (Martens, 1997). When we speak in
terms of the old Greek philosophers we could say, "Antisocial and
psychopathic individuals can not hear the beautiful sound of other persons and
they can not hear their own sound of possibilities like love, empathy and
sympathy."
Diagnostic Features
According to the criteria
of the fourth edition Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV) (12) antisocial personality disorder (ASPD) are characterized by
features like irritability and aggressiveness, impulsivity or failing to
planning ahead, social maladjustment, reckless disregard for the safety of self
and others, consistent irresponsibility, a lack of guilt or remorse,
deceitfulness, pathological egocentricity, and criminality. In the DSM-IV
"Associated Features and Disorders" persons with ASPD are described
as lacking empathy and they may have an inflated and arrogant self-appraisal,
display a glib, superficial charm. These features have also been referred to as
psychopathic personality disorder (PPD). Diagnostic characteristics of
psychopathy which are not included in the DSM-IV criteria of ASPD are absence
of delusions and other signs of irrational thinking, absence of
"nervousness' or psychoneurotic manifestation; and incapacity for love;
specific loss of insight; unreliability; untruthfulness and insincerity;
suicide rarely carried out; sex life impersonal, trivial, and poorly integrated
(Cleckley, 1988); a conning/manipulative attitude; a parasitic lifestyle;
proneness to boredom/need for stimulation; pathological lying; promiscuous
sexual behavior; and grandiose sense of self-worth (Hare, 1998). Today the
official term is antisocial personality disorder as defined in the DSM-IV.
Capacities, Conditions and Attitudes Which are Linked to Antisocial and
Psychopathic Creative Powers
The following capacities
might be associated with the creative process: intellectual capacities; an
inquiring attitude and an open mind; attention; inspiration (especially the
kind that is directed towards matters outside our limited self); intellectual
and cognitive capacities; intuition; capacity to use feedback from others and
the ability to learn from experiences.
Many psychopaths have
high intelligence (Cleckley, 1988, Dorr & Woodhal, 1986; Martens, 1997) and
demonstrate superior cognitive abilities, reality testing (Dorr & Woodhall,
1986; Martens, 1997), intuition, an inquiring attitude and creativity
(Cleckley, 1988; Martens, 1997), which can be helpful in the psychotherapeutic
process. But, many persons with PPD and ASPD lack abilities a) to use feedback
from other people, b) to learn from experiences (Lykken, 1995), which is
related to low autonomic activity-reactivity (Lykken, 1995, Martens, 2000), and
c) to use their intelligence and cognitive abilities, reality testing,
intuition, inquiring attitude and creativity in a social, constructive and/or
non-selfish way.
Intellectual Processing Resource and Constructive Creativity
Sternberg and Lubart
(1991) found that intellectual processing resource correlated most
significantly with constructive creativity:
· selective encoding - the noticing of potentially relevant information.
Individuals with PPD or ASPD fail to notice and to utilize relevant emotional,
social and/or moral information from other's. This failure might be determined
by:
o their impulsivity, hostility and indifferent/unempathic and immoral attitude;
o low autonomic activity/reactivity and associated poor
fear conditioning in antisocial and psychopathic persons which, in turn, will
bring about an incapacity to learn from experiences (Lykken, 1995; Martens,
2000).
· A reduction of impulsivity, hostility, and an increase of morality,
empathy and a capacity to learn from experiences and (frequently) related to
neurologic and/or biochemical dysfunctions (Martens, 2000, 2002a, 2001d,
2002b), which is necessary to selective encoding in individuals with ASPD and
PPD, can be realized by (a combination of) psychotherapeutic,
neurologic/neurofeedback, and mental training programs (Martens, 2001d), but
this will be discussed later;
· selective comparison - the perception of an analogy between the old and
the new. This will be linked closely with divergent thinking skills and the
ability to make remote association. Psychopaths are frequently in some crucial
situations unable in a specific way to compare new and old information. For
instance, during their hostile, violent and/or sadistic acts they may react
rather on associations with former traumatic experiences than on the situation
itself, while they might not be aware that their aggression is directed on
persons in the past (Martens, 2002a, 2003);
· selective combination - putting disparate pieces of information together
in a novel and useful way. Increase of this particular ability may be linked to
remission in ASPD and PPD (Martens, 1997, 2002a, 2003, 2001e, 2001f). The hate
and aggression of the psychopath is based upon a wrong, dangerous mix of
actual, current images and threatening, painful images from the past (Martens,
2002a, 2003). When the patient becomes aware that those negative experiences in
the past frequently provokes his current anger and hate, he or she will be able
to reformulate and interpretate these images from the past in the present
situation (perception of analogy of the old with the new situation which bring
about anger and hate). Then the pieces of experiences should be put in a new context
(hate and anger exist frequently in old contexts which are not actual anymore)
so that his or her mentality and attitude can be corrected. Psychotherapeutic
approaches in psychopaths should thus be focussed on the enhancement of
selective encoding -. selective comparison -, and selective combination skills
in order to stimulate positive, constructive creative capacities.
Creativity as a Result of Conflict between the Psychopath's Unconscious
Drives and Unsatisfied Wishes
According to Skinner
(1972) creativity will be brought about by reshuffling psychic material which
is unconscious to the individual and therefore only seems spontaneous. The
creative act might be a cognitive behavior pattern which first accessed
unconscious material and then synthesized it in the context of an immediate
stimulus (problem). Several psychoanalytic schools suggest that creativity is a
derivation of primary processes, and that creativity evokes from unconscious
drives. Other psychoanalytical theories suggest that creativity is part of the
mental functioning operative in the id; i.e. the individual uses it to seek
pleasure to avoid pain (Kris, 1952). According to Freud only unhappy people
experience daydreams and fantasies, which are an integral part of the creative
process. Freud (1908) (27) concluded," Unsatisfied wishes are the driving
forces behind fantasies; every separate fantasy contains the fulfilment of a
wish, and improves an unsatisfactory reality. From a psychoanalytical point of
view, creativity may bring about by the conflict between wish fulfilment and
biological drives, and, furthermore, creativity is the sublimation of sexual
drives.
This conflict between
wish fulfilment and biological drives can be observed in many
patients/offenders with PPD or ASPD (Martens, 2002a) . Many patients with PPD
or ASPD are (at least episodically) unhappy with their own (neurobiological
determined) destructive mentality/attitude, impulsivity, hostility,
irresponsibility and lack of social capacities/adjustment (Martens, 1997;
Martens, 2002a, 2003) (6, 19, 22) and wish to change. But these wishes may be
easily interfered with their own biological drives, and neurobiological
determined impulsivity, aggression, hostility, sensation seeking (Martens,
1997, 2000). Indeed, in antisocial and psychopathic individuals the conflict
between wishes and drives may result in creativity, which expresses itself
sometimes in criminal antisocial behavior like fraud, deceitfulness or
manipulation, but sometimes also in non-criminal creative behavior such as high
standard scientific and art performances (Cleckley, 1988; Martens, 1997).
Moreover, antisocial and psychopathic creativity can be a manifestation of the
unconscious wish to create a new character and new life. Some persons with ASPD
or PPD (with or without the help of psychotherapy):
· Become aware of this conflict and unconscious wish and try to fathom
these matters;
· Acquire in this way further self-knowledge, and that might lead to
concrete plans and initiative in order to change one's attitude;
· Sublimate as a result of this his or her destructive, undesirable drives
and wishes and related negative creativity into social, constructive drives and
wishes and positive creativity.
Transformation of Negative into Positive Creativity
Positive, constructive
creativity and growth come from the recognition and transformation of
destructive impulses (Nitsun, 2000). Martens (1997) observed in antisocial and
psychopathic patients in remission a link between positive creativity and
recognition of their destructive impulses, indeed. Transformation of negative
into positive creativity is thus possible in this category of patients.
Psychopathic or
antisocial creativity is not always (as discussed before) the result of the
conflict between wishes and drives, because creativity is for many persons with
ASPD or PPD from time to time a "necessary" tool to survive and to
escape from dangerous or unpleasant circumstances.
Indeed, psychopathic and antisocial traits like irresponsibility, impulsivity,
irritability and aggression; and psychopathic features as fantastic and
uninviting behavior with drinking and sometimes without, and sensation seeking
(are frequently neurobiological determined, Martens, 2000) bring individuals
with PPD or ASPD often in trouble. Furthermore, many psychopaths show low
tolerance of boredom (Hare, 1998) and use creativity a) to avoid boredom and
indirectly b) to increase the level cortical arousal and autonomic activity
which form the neurophysiological basis for boredom (Martens, 1997; 2000).
Nevertheless, creativity that will be utilized in order to avoid boredom or
troubles can lead to positive experiences and constructive, social activities.
Some antisocial and psychopathic persons are able as a consequence of positive
experiences or as a result of impact of serious social contacts or
relationships, eventually in combination with therapeutic effects, (Martens,
1997) to transform negative, destructive creativity into positive creativity
that might be paired with remission.
But, positive, pro-social
creativity requires a responsible, empathic and moral attitude. The author
supposes, that the antisocial or psychopathic person's empathy, morality, and
feelings of responsibility only can grow when he or she is capable to learn
from experiences, because in this way people can escape from their selfish
universe. There are methods to reduce or even to let disappear neurobiological
dysfunctions such as low autonomic activity/reactivity and related monoamine
oxidase (MAO) activity, which determine an incapacity to learn from
experiences, by means of neurofeedback and mental training (increase of
specific attention and growth of capacity to optimal use of normal stimuli),
and/or adequate social and creative activation programs (Martens, 2001d). A
reduction of low autonomic activity/reactivity (and related MAO activity) might
be thus related to an increased ability to learn from experiences which, in
turn, may lead to an enhancement of therapeutic progress. However, when this
autonomic activity/reactivity is normalized with the help of neurofeedback and
special mental training programs, the capacity to learn from experiences will
also depend on abilities, mental conditions and attitudes like:
· an open mind and an inquiring attitude.
· social awareness and - responsibility;
· feelings of guilt or remorse; empathy;
· self-criticism and self-knowledge;
· willing to change and grow behind our former emotional, social and moral
limits;
· regarding of other persons as equal to ourselves;
· development of social coping styles;
· creativity, strategic insight, power and perseverance to realize such a
profound change of mentality.
Furthermore, in order to
reduce antisocial or psychopathic traits (which interfere with positive
creativity) adequate psychotherapeutic and neuropsychiatry treatment is
frequently necessary. Because emotional and moral abnormalities in individuals
with ASPD or PPD are frequently linked to neurobiological defects (Martens,
2001a, 2002b), adequate neurological treatment in combination with specific
psychotherapeutic approaches as ethical therapy (Martens, 2001e) may bring
about a reduction of these neurobiological and associated emotional and moral
dysfunctions. The neurobiological underpinning of traits like impulsivity
(MAO-dysfunctions; 5-hydroxy indoleacetic, CSF 5-HIAA abnormality), aggression
(CSF 5-HIAA - and hydroxytryptamine dysfunctions; low cortisol) and sensation
seeking (cortical underarousal), which determine irresponsible behavior
(Martens, 2000), could be reduced or vanished whith the help of adequate
neurologic treatment eventually in combination with psychotherapy.
But, an increased capacity
to learn from experiences might lead to painful and disappointing experiences
too. Individuals with ASPD or PPD who demonstrate such increased ability are
not able anymore to avoid self-investigation, self-criticism, shame and guilt.
They may be able lesser than before to hate the whole world and to be
indifferent to the harmful consequences of their behavior. They will consider
other people more and more as substantial part of their life, and they might
experience that most other individuals do not deserve their hate, hostile
attitude, lack of empathy and disdain. With the help of psychotherapy the
person in question could be offered support in difficult moments in the process
of change. The psychotherapist should evoke all of the patients creative skills
to investigate their hateful and aggressive attitude towards other people and
discover a new prosocial lifestyle and mentality. They may find out that their
hostile behavior is often not justified and very harmful, also for themselves,
and that a social attitude will bring them to the unknown world of love, social
relationships, social support, thrust and other constructive emotional and
mental powers.
Creativity as a Fusion of Higher and Lower Drives
According to Maslow
(1963) there are three creative categories. The first category of creativity is
a derivation of primary processes (like psychoanalytic theory), but Maslow adds
also cognitive and conative processes to the unconscious drives of the id. The
second category of creativity is the result of higher thought processes. And
the third category is integrated creativity (a synthesis of category one and
two), which is characteristic of the lives of self-actualized, healthy human
beings.
At a given moment in
their life antisocial or psychopathic persons can feel a need to change their
character and mentality and demonstrate intense efforts to (eventually in
combination with therapeutic stimulation) to increase his or her higher mental
(moral, cognitive and reality-testing) and emotional (empathy, sympathy,
loyalty, guilt and remorse) capacities, which may be associated with a)
self-insight and self-knowledge (higher capacities and lower drives; discovery
unknown abilities and possibilities), b) change of mentality, character and
attitude, and c) and control or sublimation of unacceptable or undesirable
drives. As a consequence a fusion of higher capacities and lower drives is
started, because higher insight can be linked to the energy of lower drives.
Arthur Koestler (1964)
believed that uniting pairs of opposites, joining unrelated, often conflictual
information in a new way is an essential part of the creative process. The
author hypothesizes that in antisocial and psychopathic patients pairs of opposites
like unconscious, impulsive, aggressive drives on one hand and eventual wishes
to change and related intellectual and cognitive capacities on the other should
be joined together. Impulsive and aggressive drives may supply energy and
mental power to endure and complete the long-lasting mental transformation
process, while the wishes to change may give the impulsive and aggressive
drives a special spiritual dimension and direction.
Encounter with the World
We see only what we know
(Kuhn, 1962), and I would immediately correct Kuhn by saying that people only
see what they like to know in that particular moment. Because knowledge can be
painful, confronting, or a heavy burden; many persons might be (episodically)
close their eyes and/or mind for that knowledge. When some knowledge menaces to
interfere with or to disturb our self-image and our comfortable, indulged
and/or carefree life-style, many of us will try to neglect or suppress that
knowledge. Persons with ASPD or PPD also see what they want to know, but in
contrast with many normal persons they see a horrible reality where is no place
for real love, compassion and consideration with others. Antisocial or
psychopathic personalities will likely regard other persons love, compassion
and consideration for others as fake or weakness. Nevertheless, the one-sided
and very limited view on reality and the internal life of other people and
associated indifferent and unempathic attitude of patients/offenders with ASPD
or PPD might change as a consequence of some kind of impressive events or
experiences (Black et al., 1995; Martens, 1997; Robins, 1966). Most antisocial
or psychopathic patients in remission show a change of mentality and a sudden
impulse of moral and emotional development and self-insight as a consequence of
impressive and overwhelming live events such as confrontations with the death
of a partner, friend or child; a serious disease; confrontations with other
forensic patients/offenders; falling in love (Martens, 1997). As a consequence
of those impressive events or (creative) encounters persons with ASPD or PPD
discover suddenly or gradually a totally new dimension (emotional, social and
moral aspects) of life. Maslow (1962) said that during the creative encounter
the individual is self-forgetful, thus becoming completely "lost in the
present." Rollo May (1975) suggested, "For the consciousness which
obtains in creativity is not the superficial level of objectified
intellectualization, but an encounter with the world on a level that undercuts
the subject-object split. Creativity is the encounter of the intensively
conscious human being with his or her world." Such encounter is so intense
that the polarity of the world is overlooked and "knows" and hears
the "Complete Sound" or "Harmony of Spheres" in terms of
Plato or Aristotle. In fact, psychopathic and antisocial persons in remission
reported such experiences (Martens, 1997).
Reality, Intellectual Delight and a Way to Release as Source of Creative
Healing Power
Through this vehicle of
the creative experience we explore the perhaps imaginary terrain of intuitive
knowledge and its seemingly mystical element we experience as
"inspiration" (Voake, 1989). Intuitive knowledge and inspiration are
required for recovery or remission in some patients with ASPD or psychopathy
(Martens, 1997).
According to Pythagoras
the highest level of catharsis of the soul is achieved by contemplating the essence of all reality
(Burnet, 1930; Koestler, 1968, page 36). Catharsis is always a creative
process, and according to Pythagoras and Martens (2001e, 2001f) contemplation
of all reality will evoke this creative and curing mental and emotional
process. Although psychopaths show a fairly good reality testing (Dorr &
Woodhall, 1986, Martens, 1997), they demonstrate also a specific lack of
insight (Cleckley, 1988) and (as noted before) they prefer a paranoid, hostile
type of reality in which is no room for love, mercy, compassion and faith (the
world is hard, cold and cruel and other people are not reliable). Like psychopaths
persons with ASPD must also discover the dimension of love, compassion and
thrust. All kind of experiences (spiritual, religious, love, confrontation,
work, enhanced responsibilities, psychotherapeutic progress) can bring them in
contact with this dimension and let them experience the advantage of living
with these aspects of reality (Black et al., 1995; Martens, 1997; Robins,
1966).
It is important that
antisocial and psychopathic traits as aggressiveness, irritability,
impulsivity; which will interfere with a discovery of the world of love,
compassion and thrust; will be reduced. It was discussed before how these
frequently determined personality traits could be diminished with the help of
(combination) of neurologic, neurofeedback (Martens, 2001d), and special
psychotherapeutic approaches such as ethical therapy (Martens, 2001e) and/or
agitation therapy (Martens, 2001f). When persons with ASPD or PPD open their
mind to other views, aspects of realities and related (moral) emotions like
compassion, guilt, remorse, loyalty, sympathy, thrust, and love; they will have
access to new sources of inspiring experiences, creative impulses (unknown
parts of their personality and internal life will flourish) and social
relationship and the world of normal people.
Pythagoras also suggested
that both an intellectual delight and a way to spiritual release, is a way to
the mystical union between the thought of the creature and the spirit of the
creator (Burnet, 1930; Koestler, 1968,pag. 36 ). In fact, a number of individuals
with ASPD or PPD in remission reported that their improvement was caused by a
spiritual or religious experience/release and associated creative (until that
moment unknown higher) power to grow behind one's former limits (Black et al.,
1995; Martens, 1997; Robins, 1966). The author suggests that psychotherapy in
combination with spiritual, philosophical and/or religious training/education
could be helpful in provoking in some antisocial and psychopathic patients
specific creative and healing powers which may be necessary for the realization
of remission. Furthermore, ethical therapy, which is intended to stimulate the
patients' moral and related emotional (moral emotions such as empathy, shame,
guilt, remorse) capacities, may also be helpful in these patients (Martens,
2001e).
Authenticity and Creativity
Authenticity can be
defined as to be true to ourselves. It has something to do with the self and
has something to do with being truthful or sincere (Bovens, 1999). Many
psychopathic and antisocial personalities may be partly authentic and they seem
to be true to themselves, because they refuse and/or are unable to adapt
themselves to the rules and values of society. They are loners and their
(frequently neurobiological determined) psychopathic and/or antisocial
personality traits (as poor development of relationships, hostility,
impulsivity, recklessness, poor fear conditioning, lack of empathy,
deceitfulness, egocentricity, irritability, aggression, failure to planning
ahead) prevents them from conforming themselves to normal life and social
expectations. Otherwise, many persons with ASPD or PPD might be at the same
time partly inauthentic because they demonstrate unreliable and deceitful
behavior.
According to Heidegger
(1927) understanding of being is itself a form of authenticity. For Heidegger
authenticity is a uniquely temporal structure and a process of unfolding
possibilities. Authenticity is a state of being that is active, congruent,
contemplative, dynamic, and teleological - an agency burgeoning with quiescent
potentiality (Guignon, 1993, Mills, 1997). Authenticity can thus be understood
as a form of creative selfrealization, creative inquiring of the world and
our self, and a way to liberate us from our false self,
undesired conditioned responses and wrong choices. Creativity is one of the
major means by which the human being liberates himself from the fetters not
only of his conditioned responses, but also of his usual choices. The concept
of the healthy, self-actualizing, fully-human person seems to come closer and
closer together, and may perhaps turn out to the same thing (Maslov, 1963).
Martens (1997) revealed that psychopaths in remission showed also constructive
creativity which was a means a) to become a healthy, self-actualizing,
fully-human person, and b) to liberate themselves from the fetters and usual
choices. Patients with ASPD or PPD who demonstrate a growth in authenticity and
related positive creativity report on a) a discovery of the internal world of
other people, b) finding of the lost part of their authentic self, namely the
integer, truthful, and vulnerable self; c) unfolding possibilities; and as a
consequence c) the development of moral, emotional and social abilities
(Martens, 1997). A psychotherapy which is targeted towards the development of
full authenticity of psychopathic or antisocial patients (some persons with
ASPD or PPD do really care if they are authentic or not) might be most
effective in combination with ethical - (Martens, 2001e) and agitation therapy (Martens,
2001f).
Dreams and Creativity
Dreams narratology
suggests the close relation of unconscious processes to creativity and the
unity of story making and personal meaning. Creativity serves not only
wish-fulfilment function but also self-fulfilment function. Dreams, as creative
acts, claim a privilege unto themselves (Groves, 1997). The author speculates
that dreams as a consequence of their creative and revealing nature may have an
important role in the remission of these patients.
One of the older forms of
early Greek psychotherapy of acting-out patients consisted in inducing the
patient, by wild pipe music or drums, to dance himself into a frenzy followed
by exhaustion and trance-like sleep (Koestler, 1968, page 29). Martens
(Martens, 2001f) developed a model of agitation therapy in which antisocial or
psychopathic acting out patients/offenders were confronted in a controlled way
with the aggression of other patients/offenders as a reaction on their own
intolerable behavior. In this way aggressive energy can be converted into
creative energy which is directed at acquiring of self-investigation,
self-insight, problem solving and the realization of mental, emotional and
behavioral change. During the therapeutic transformation process aggressive energy
turns into constructive energy which may express itself in contemplation,
self-discovery, and the wish to change. In combination with the tiring,
impressive experiences during the sessions and creative efforts of the patient
to cope with such situations, which are supported by special after care
sessions and/or medication, the therapeutic transformations process might bring
about a curable sleep in the acting-out patient with ASPD or PPD. Furthermore,
they might learn also to discover their core-problems and possible solutions in
their dreams.
Discussion
There is evidence that
positive, constructive creativity may play a significant role in the process of
remission. According to Aristotle persons learn to choose for a creative
lifestyle only if others habituate them to develop certain desires (Schwartz,
1979). The psychotherapist might be the right person to habituate antisocial
and psychopathic patients to create certain desires to develop positive,
constructive creativity. Psychotherapy can have a significant function in the
process of remission because of its possible supportive role in a) the
transformation of negative into positive creativity, b) the discovery of
unconscious drives, reality, moral values and authenticity, the emotional
dimension of life and the utilization of all essential dimensions of
creativity, and c) the realization of character - and mentality change which is
necessary for remission. Because psychopathic or antisocial personalities use
their creativity frequently for realization of their harmful, antisocial
behavior, some psychotherapists are afraid to appeal to the creativity of
persons with ASPD or PPD, which is automatically associated with danger.
Therefore, psychotherapeutic techniques should be developed which enables the
therapist to use the creativity of patients with ASPD and PPD in a systematic
and controlled way. Furthermore, experimental psychotherapeutic research is
needed to discover:
· what are the precise psychosocial and biological determinants of social
and antisocial creativity, and how can this knowledge be utilized in the
psychotherapeutic process?
· if and how is antisocial or psychopathic creativity
linked to their neurobiological dysfunctions? For example, Zuckerman (1994)
observed that cortical underarousal and related low levels of MAO, cortisol and
high concentrations of gonadal hormones determine sensation seeking in persons
with ASPD or PPD. Sensation seeking might be easily accompanied with a creative
attitude which is focussed on to gratification of this need. A precise insight
in the nature of relationship between neurobiological abnormality and
destructive creativity might be necessary to support the transformation process
adequately from destructive into constructive creativity with the help of neurologic,
neurofeedback and/or other therapeutic methods;
· Do different routes to remission in the distinctive categories of
patients with ASPD and PPD (criminal, non-criminal, age-dependent,
gender-dependent, character-dependent) exist? Such knowledge might be important
in order to provide adequate treatment:
· How could specific categories of criminal psychopathic or antisocial
behavior, in which a high level of creativity is required (such as fraud), be
sublimated into socially acceptable activities and creative expressions?
· How should psychotherapeutic candidates be trained that they are able to
use most effectively the creative capacities of patients with ASPD or PPD?
I suggest, that the
experiences of former persons with ASPD or PPD concerning the role of
creativity in their remission process should be utilized optimally in order to
improve existing therapeutic and training programs and the construction of new
prevention and intervention programs. Our knowledge of the role of creativity
in the etiology, course and
remission in ASPD or PPD is very limited and more research is being wanted in
order to explore this area profoundly.
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