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
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.
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."
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.
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.
· American Psychiatric Association (1994). Diagnostic and statistical manual of mental Disorders, 4th edn, DSM-IV. Washington, DC: APA.
· Arieti, S. (1976). Creativity: the magic synthesis. New York: Basic Books.
· Black, D.W., Baumgard, C.H., & Bell, S.E. (1995). A 16- to 45-year follow-up of 71 men with antisocial personality disorder. Comprehensive Psychiatry, 36, 130-40.
· Bovens, L. (1999). Authencity in Kurosawa. Journal of Value Inquiry, 33, 227-237.
· Burnet, J. (1930). Aristoxenus of Tarentum, elements of harmony. In J. Burnet J (Ed.) Early Greek Philosophy. Part I. Thales to Plato. Baltimore: Black.
· Cleckley, H. (1988). Mask of sanity. St. Louis, MO: C. V. Mosby.
· Dorr, D., & Woodhall, P.K. (1986). Ego dysfunctions in psychopathic psychiatric inpatients. In W.H. Reid, D. Dorr, J.I. Walker, and J.W.Bonner JW (Ed.) Unmasking the psychopath New York: W. W. Norton & Company.
· Freud, S. (1908). Creative writers and day-dreaming. Standard edition of the psychological works of Sigmund Freud. Volume 9. New York: Freudian Society.
· Gotz , I.I. (1981). On defining creativity. Journal of Aesthetics and Art Criticism, 39, 297-301.
· Grotstein, J.S. (1992). The enigmatic relationship of creativity to mental health and psychopathology. American Journal of Psychotherapy, 46, 405-21.
· Groves , J.E. (1997). The narrative and rhetoric of dreams: six literary fragments by anovelist. American Journal of Psychotherapy, 51, 1-13.
· Guignon. C. (1993). Authenticity, mental values, and psychotherapy. In C. Guignon (Ed.) Cambridge companion to Heidegger. Cambridge: Cambridge University Press.
· Hare, R.D. (1998). The PCL-R assessment of psychopathy: some issues and concerns. Legal and Criminological Psychology, 3, 100-22.
· Heidegger, M. (1927/1962). Being and time (J.Macquarrie & E. Robinson,translators). San Francisco: Harper Collin; 1927)/1962.
· Koestler, A. (1962). The Sleepwalkers. London: Hutchinson & Co.
· Koestler, A. (1968). The art of creation. London: Arkana, p. 29, 36.
· Kris, E. (1952). Psychoanalytic explorations in art. New York: International Universities Press.
· Kuhn, Th. (1962). The structure of scientific revolutions. Chicago: University of Chicago Press.
· Ludwig, A.M. (1989). Reflections on creativity and madness. American Journal of Psychotherapy, 43, 4-13.
· Lykken, D. (1995). The antisocial personalities. Hillsdale, NJ: Lawrence Erlbaum.
· Martens, W.H.J. (1997). Psychopathy and Maturation (MD-dissertation). Tilburg University, The Netherlands. Maastricht: Shaker Publishing; 1997.
· Martens, W.H.J. (2000). Antisocial and psychopathic personality disorders: causes, course and remission - a review article. International Journal of Offender Therapy and Comparative Criminology, 44, 406-430.
· Martens, W.H.J. (2001a). Moral capacities of antisocial and psychopathic persons. In D.C. Thomasma, D.N. Weisstub, & Th. Kimbrough-Kushner (Ed.) International library of ethics, law and the new medicine. Dordrecht: Kluwer Academic Publishers (In Press).
· Martens, W.H.J. (2001d). Effects of antisocial and social attitudes on neurobiological functions. Medical Hypotheses, 56, 664-71.
· Martens, W.H.J. (2001e). A theoretical framework for ethics therapy as a distinctive forensic therapeutic specialization. International Journal of Offender Therapy and Comparative Criminology, 45(2), 383-394.
· Martens, W.H.J. (2001f). Agitation therapy for antisocial and psychopathic personalities: an outline. American Journal of Psychotherapy, 55(2): 234-250.
· Martens, W.H.J. (2002a). The hidden suffering of the psychopath. Psyciatric Times, 19(1), 1-17.
· Martens, W.H.J. (2002b). Criminality and moral dysfunctions: neurologic, biochemical and genetic dimensions. International Journal of Offender Therapy and Comparative Criminology 2002b, 46(2), 170-182.
· Martens, W.H.J. (2003). Constructive functions of aggression in psychopaths. Forensic Psychiatry Online, April 18: 1-20.
· Maslov, A. (1962). The creative attitude. San Jose, Ca: Psychosynthesis Distributions.
· May. R. (1975). The courage to create. Toronto: Bantam.
· Mills, J. (1997). The false Dasein: from Heidegger to Satre and psychoanalysis. Journal of Phenomenological Psychology, 28, 42-65.
· Nitsun, M. (2000). The future of the group. International Journal of Group Psychotherapy, 50, 455-72.
· Plato (1976). The republic. USA: Pinguin.
· Quinney, L. (1994). Weiskel's sublime and the impasse of knowledge. Philosophy and Literature, 18, 309-319.
· Robins, L.N. (1966). Deviant children grown up: a sociological and psychiatric study of sociopathic personality. Baltimore, MD: Williams & Wilkins.
· Salaquarda. J. (1996). Art is more powerful than knowledge. Synthesis Philosophica,11, 49-63. 25.
· Schwartz, A. (1979). Aristotle on education and choice. Educational Theory, 29, 97-107.
· Skinner, B.F. (1972). Lecture on "having a poem". In B. F. Skinner (Ed.) Cumulation record. 3rd ed. New York: Appleton-Century-Crofts, p. 345-55
· Sternberg, R.I., & Lubart, T.I.. (1991). An investment theory of creativity and its development. Human Development, 34: 1-31
· Voake, R.L. (1989). Footsteps after thought: metaphorical approaches from within. New York: Lang.
· Waser, G. (1991). Creativeness as a potential for survival in the abyss between fear of and longing for death. Schweizerische Rundschau fur Medizin Praxis, 80, 178-182.
· Zuckerman, M. (1994). Behavioral expression and biosocial bases of sensation seeking. New York: Cambridge University Press; 1994.