Antisocial Personality Disorder

Name: The Grinch

Source: How the Grinch Stole Christmas! (Movie, 2000)

Background Information

The Grinch, who is bitter and cave-dwelling creature, lives on the snowy Mount Crumpits, a 10,000 foot high mountain that is north of Whoville. His age is undisclosed but he looks to be in his 40’s and does not have a job. He normally spends a lot of his time being alone in his cave. The patient appears to be suffering from antisocial personality disorder with depressed mood. There was no background history on his family, as he was abandoned as a child. The Grinch was taken in by two ladies who treated him like he was their own like every other Who children with love for Christmas. He does not have any social relationship with his friends and family. The only social companion the Grinch has is his dog Max. There was no history of drug or alcohol use. The Grinch did have some life difficulties when he was a little boy being made fun of the way he looks at his school. The Grinch had no goal in his life except to stop Christmas from happening. The coping skills and weakness was to run away from his problems and leave the town, rather than facing problems.

Name: The Joker

Source: The Dark Knight (movie, 2008)

Background Information

The Joker is a disturbed and malicious villain who is the archenemy of Batman. His age is unknown but he looks to be in his late 40’s to early 50’s. His gender is obviously male with brown eyes, and sandy, light green hair. He does not have a “real” job, but some consider running the streets with thugs to be one of them. He spends majority of his time plotting to corrupt and destroy Batman along with bringing the city of Gotham to the ground. His overall health status is unknown, but to the naked eye, he physically looks ill along with the deep razor cuts to both sides of the mouth representing a permanent smile. Psychologically he appears to suffer from antisocial personality disorder, which is evident by his hasty behavior and lack of disregard to others. He does not have a relationship with his parents or relatives. The only social relationships he does have are those with thugs and delinquents. There is no evidence of drugs or alcohol use, although he reports that his father was an extremely abusive alcoholic, who attacked he and his mother with a blade, cutting him along the corner of his lips. The only goal in The Joker’s life was to destroy Batman and everything in his path. His only coping skill and weaknesses were to see someone other than himself get hurt along with Batman. He would then vanish from sight seemingly as if he had run away from his problems, not wanting to face the consequences.

Description of the Problem

The problems The Joker displays are tremendous. To begin, he absolutely hates Batman and everything to do with justice and peace. He seems to hate everything about himself as well, considering he has to hurt others around him to feel better. His only purpose in life is to destroy Gotham for no apparent reason and to destroy Batman considering he is constantly in The Joker’s way to destruction. The Joker wanted humans to understand that they were “bad” and destroyers when all the while he was the one committing crimes. The Joker expressed absolutely no empathy for his ruthless actions along with being extremely sadistic. He blatantly disregarded laws and socials norms of society as a whole, all of which are related to antisocial personality disorder.

Diagnosis

According to DSM-IV-TR criteria, the appropriate diagnosis would be Antisocial Personality Disorder (301.7)

1. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:
   1. Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are groups for arrest.
      • The Joker was constantly being arrested and reprimanded by law enforcements due to his ruthless behaviors. At times it was difficult to catch The Joker committing a crime, but once he was he was punished (for a short amount of time) he would later escape to commit more crimes.
   2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning other for personal profit or pleasure.
      • At one time, The Joker dressed as Bozo the clown while robbing the Gotham National City Bank. He manipulated his whole crew into robbing the bank and told them they would all split the money. However, The Joker ends up killing his crew and getting away with the money.
   3. Impulsive behavior or failure to plan ahead.
      • The Joker planned seemingly impossible tasks without thinking about the consequences afterward. At one time, he tried to blow up the Gotham General Hospital. Hitting his detonator, the majority of the bombs failed to blow therefore causing him to steal a nearby city bus as a quick getaway.
   4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
      • Without a doubt The Joker was constantly fighting, assaulting, torturing, or murdering another individual. One in particular would be Batman. Batman would fight The Joker, throwing him from wall to wall and all while The Joker would be laughing hysterically.
   5. Reckless disregard for safety of self or others.
      • He cared very little about his own safety considering he told Batman to run him over with his Batpod. This seemed to also be an attempted sign of sucide. Also, blowing up a hospital, violently blowing up a prison inmate, and using innocent people as police officer targets are all ways he disregarded the safety for others.
   6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
      • The Joker was never considered to have a job. However, he would steal to receive cash payments and money to support himself.
   7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
      • The Joker never apologized for his behavior nor having any remorse for killing innocent people. He enjoyed chaos and hurting people along with himself. He still didn’t feel remorse for being in jail considering that he brutally killed an inmate while there.
2. The individual is at least age 18 years.
   • The Joker is in his late 40’s to early 50’s.
3. There is evidence of Conduct Disorder with onset before age 15 years.
   • It may have taken place with his abusive father when he was younger which caused the scarring on his face. It is not known how old he was when this occurred.
4. The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode.
   • The Joker’s behavior was constantly out of the norm. His ruthless behavior was continual for long durations of time so the presence of a Manic Episode would not be unlikely.

Accuracy of Portrayal

The average person watching the film would see that The Joker is a typical psychopath. The average person would learn the basics of antisocial personality disorder and character qualities an individual must hold in order to be classified as a psychopath. However, with antisocial personality disorder, it seems to remit by age 40 and is known to be higher among young adults than older adults. The Joker seemed to peek in his violent streaks at this age. Another inaccurate portrayal of antisocial personality disorder being used in the film was that majority of individuals suffering from antisocial personality disorders have high amounts of drug use and abuse. Drug use causes individuals to perform dysfunctional and out of the norm types of behavior. They seem to not care about the risk involved. The Joker was never seen using any types of drugs in the film. He would constantly cause harm to others on his own will without the use of mind alternating drugs. However, there were strong accuracies of portrayal. For instance, he was a male, came from an abusive childhood, had zero empathy, and performed extremely risky and ruthless behaviors. The film helped show the most extreme form of antisocial personality disorder.

Treatment

Antisocial Personality Disorder is difficult to treat, considering the fact that individuals do not believe they are in need of treatment. If a patient is taken into to counseling, there is usually a lack of improvement as the patient is usually uncooperative. The treatment that would most likely work for The Joker would be treatment in long-term structured residential settings to which he would be placed in an environment in which he cannot hurt others. If he modifies his behavior appropriately he will be able to earn privileges such as performing a non- threatening hobby of his. Since The Joker has not developed any healthy relationships in his lifetime, using psychotherapy along with behavior modification would help. Developing a relationship with a therapist would probably be beneficial for him as well. Since The Joker expressed a few signs of suicide attempts, it may be that he is suffering from depression as well. An antidepressant may help his depression and irritability. Even though antidepressants do not actually treat an individual with antisocial personality disorder, they can help with these types of comorbid conditions.

https://youtu.be/utfHPQ6TqPY