Malice and Asperger Syndrome

Digby TantamMalice and Asperger Syndrome

Doris Lessing, in her novel, The Fifth Child (Lessing, 1989), describes the impact on a family, previously loving and stable, of having a fifth child. This child in his intransigence and his propensity for outrageous and hurtful behaviour, challenged all their liberal pre-conceptions and brought the family to the brink of dissolution. This kind of maliciousness is not something that is normally associated with Asperger Syndrome: too many sufferers seem too innocent, too law abiding, and too unaware of their own self interest to be described as malicious. Yet this is the best translation of the word that Asperger used for several of the children that he described in his classic paper of 1944 (Asperger, 1944), see (Frith, 1991) for translation. In this paper I shall consider whether children and adults with pervasive developmental disorder can sometimes be rightly described as being malicious; how can this be recognised; and some ideas about management.

A young man with Asperger syndrome rang his favourite Aunt to say that her husband had been killed in a road traffic accident on his way home from work. The report was a complete fabrication as became apparent an hour later when his Uncle arrived home.

The Aunt was disgusted at her nephew’s action because she did not feel it was explicable. It challenged her sense of what could be expected in the world. Moreover, she had always thought that she was close to the young man and had, indeed, recently helped him out. The action was therefore inexplicable in a narrower sense, in being undeserved. It challenged another belief that she had always taken for granted that people got their just desserts. It seemed to other family members that the young man’s only motive was to cause mischief and mental suffering, and they wanted to distance themselves from him to protect themselves.

Acts of malice like this include creating unnecessary uproar which stops a social activity from taking place, calling a person names or revealing embarrassing information about them, being spiteful to them in other ways for example damaging their property, or hurting others. These hurts can range from surreptitious pinching through to serious violence. Fortunately, serious violence is rare and may not be more commonly exhibited by people with AS than by members of the general population (Ghaziuddin, Tsai and Ghaziuddin, 1991). However, when serious violence, arson, anlawful killing or grievious bodily harm may seem undeserved, it is often directed at someone who is vulnerable, and it seems inexplicable because there is little or no apparent benefit to the person with AS who commits the harm. These three characteristics, undeserved, lack of compunction, and gratuitous, are linked to an observer’s perception of an act being malicious. They are each factors which make it hard to identify with the perpetrator. Rather than thinking that ‘there but for the grace of God’, an observer is likely to feel horrified and to want to cut off contact with the perpetrator.

Alice’s parents had split up when she was in her early teens, and her father had remarried a younger woman. Her father and his new wife had a daughter, and Alice was very interested in her. The parents were pleased and several times left the baby with Alice.

Alice on two of these occasions mixed ground glass into the baby’s food before feeding the baby with it. Alice knew that this could cause the baby serious harm, even kill the baby. Alice explained her actions by saying that she wanted to see what would happen. She also said that she did not want the baby to die, but did feel excitement after she had fed the baby the poison.

Several features of Alice’s actions often recur in malicious actions by other people with AS. Younger children may be targets, quite
often siblings. There is often an experimental explanation given and, afterwards, there is a lack of remorse or fear.

The real explanation is elusive. Wing (personal communication) has suggested that the person with AS may harm others in the furtherance of a special interest.

Roger was fascinated by archaeology. Once he had turned 18, his parents thought that they could safely leave him at home whilst they went on a well-deserved holiday. When they came back, they found that Roger had dug up the back garden and re-shaped it into the appearance of a typical archaeological dig.

Roger’s explanation, that he thought his parents would get as much pleasure out of his landscape redesign as he did, rings true. Of course, he got that wrong, but his lack of understanding of his parents’ perspective may explain that. There is no sense that Roger was seeking to harm his parents, and his actions do not have the malicious quality that Alice’s do. His pursuit of his special interest was at the expense of his parents but he was not primarily interested in harming them. Alice had no prior interest in poisoning, but her intention was to cause harm or at least to test out her power to cause it.

Richard, for no apparent reason, seemed to target one particular teacher at school. He made slighting remarks about her at first, and then became increasingly crude in his language until she became so distressed that she said to the head-teacher that either he went, or she did. He was barred from her class and when this behaviour was repeated with another teacher, also female, he was suspended from school.

Richard was at first considered to be seeking the attention of the teacher, but his behaviour got worse when she tried to ignore his provocative remarks and to attend to him when he was being more appropriate in his behaviour. Newson has suggested that behaviour like Richard’s is motivated by ‘pathological demand avoidance’. That it disrupts a social situation in which expectations are made of a person, for example the classroom, before the person’s inability to meet those expectations is manifest. Like the attention-seeking explanation, pathological demand avoidance runs up against the problem that the behaviour leads to other kinds of social demand. Richard was, for example, quizzed by many people about why he had behaved as he did and was as much at a loss to answer as he would have been in the classroom.

Elizabeth Newson’s description of pathological demand avoidance syndrome has drawn attention to the existence of people with a
pervasive developmental disorder who meet criteria for Asperger syndrome, but who are not currently recognized by professionals.

They tend to be amongst the children diagnosed with conduct disorders or adults with antisocial or borderline personality disorders. They present problems because of their apparently malicious behaviour, but they do not strike others as having
deficits in non-verbal communication or unusual patterns of interest. The reaction of other people may be very much like the
reaction described in Doris Lessing’s book.

Hugo is fifteen. He has been barred from school, and is enrolled in college although he rarely goes. His parents are separated and he has a distant relationship with his father, who has been in only intermittent and unsupportive contact with the family in the ten
years since he left. His mother works, and is unsure what Hugo does during the day. Sometimes she comes home to find things broken. Hugo will not tell her what has happened. Hugo has acquaintances, but no real friends. She thinks that he is used by some of his older and more street-wise acquaintances to run errands, and that he may be involved in crime. Hugo is often threatening to his mother, and she is quite frightened of him. He is particularly disturbed if there is any alteration in the arrangements at home, and insists that his mother tells him of when she will leave the house, when she will return, and when the evening meal will be ready.His older brother avoids Hugo because Hugo has deliberately broken belongings of the brother in the past. He urges his mother to put Hugo out, but she is reluctant to do so because she is sure that Hugo will be exploited by others who are more on qui vive than Hugo himself is. She is aware that Hugo’s self-care needs constant monitoring. He has trouble with change and avoids shopping; he cannot cook without getting mixed up; he cannot keep track of money; and he needs to be prompted about shaving and bathing.

This is a composite account, and the difficulties of a particular person with this type of Asperger presentation will vary. However, there are some important common features.

Firstly, the person with this form of Asperger syndrome (which I shall call TFAS for short) lacks the obvious eccentricity and clumsiness of many of the people who would be instantly recognizable as having Asperger syndrome. Secondly, the person with TFAS often seems immature and, at first sight, incapable of the actions attributed to them. The appearance of immaturity is partly due to a lack of lines or shadows on the face, as if the person has not lived asfully as most people. This may be true, in the sense that living life involves reacting strongly to it. The appearance of immaturity is also due to the person with TFAS’s lack of social awareness. He or she is often curious and asks personal questions of anotherperson at first meeting, or wants to handle something that the other person has with them. This often seems innocent, almost disarming, but there is something of an edge to it. One is not quite sure whether the person with TFAS is really innocent or is testing the limits of one’s tolerance. Thirdly, the level of the person with TFAS’ disability is concealed. The account that the person gives of their life avoids or explains away problems of all sorts, including problems in everyday living such as the self-care problems that Hugo had.

The concealment often extends to the characteristic symptoms of Asperger syndrome. A person with TFAS rarely has a special interest but, if anything, they have a lack of interests in the world. Although they may express an interest in football, their interest is not the passionate one of the fan or of the amateur player. It is more as if the person with TFAS knows that some interest is expected of them. In fact a person with this form of Asperger syndrome may spend long periods in inactivity.

Repetitive activity is concealed, too. Parents may report that their son or daughter with TFAS has stereotyped activities which
become very intrusive at home, but are usually concealed when the person is with a stranger. Repetitive questioning may be one, but others may be rocking, smoothing the hair, repeating words, or vocalizations. Sometimes these stereotypes are quite similar to those of people who have Tourette syndrome but they are not confined to sniffing or swearing. As in some people with Tourette syndrome and indeed some young people with obsessional disorder, people with TFAS are more likely than other people with AS to fly into a rage. This explosive anger is frightening can lead to hitting or breaking things. However, it may also have a detached quality as if the person does not feel their anger, only shows it.

It is my impression that the proportion of girls with TFAS is higher than the proportion of girls with other expressions of Asperger syndrome. Girls have a greater range of provocative behaviour at their disposal than boys, and girls with TFAS may create particular outrage because of this.

Tricia who was 12 horrified the school librarian by asking for as many books as possible on the Yorkshire Ripper or, failing that, on other serial killers. Amanda lived in a small town close to a large Army base. Whenever she saw a soldier she would walk up to him and make a Nazi salute, shouting “Sieg Heil!”. Some months after this, Amanda caused further worry to her parents by disappearing for long periods. She was eventually spotted by a family friend on a motor-bike many miles away from home. It came out that Amanda would go to a particular café frequented by young motor-bikers and would approach one of them, usually a stranger, asking to be taken for a ride. Felicity used to go to one of the shopping malls near her home, stand in the centre of one of the long, glass-lined isles, and scream as loudly and for as long as she could.

Each of these girls, and indeed each of the people with TFAS that I have mentioned, prompted other people to say, “Why are they doing this?” I do not think that the answer to this question is that these young people are evil or even, as Doris Lessing suggests in the Fifth Child, that they of a different race to humanity. I do think that they are baffled by the world around them, but they are also desperate to conceal that inadequacy. I think that Elizabeth Newson is right in supposing that there is an element of avoidance in the uproar that people with TFAS cause. However, avoidance is not always the motive as some socially distressing actions by people with TFAS are initiated by them out of an apparently clear blue sky. The common theme is, I think, a sense of powerlessness which a person with TFAS tries to circumvent by using their power to shock or to disrupt.

But this raises a further question. Why should a person with TFAS be powerless? The reason is, I think, because they are very poor at non-verbal communication. However, their difficulties are not the problems of non-verbal expression that other people with Asperger syndrome have, but problems of non-verbal interpretation. They have difficulty reading other people’s faces, and probably their gestures and tones of voice, too. Being outrageous helps to overcome this problem because other people, when they are very emotionally aroused, emit more and more obvious cues about what they are feeling. And the fact that you have predictably elicited strong feeling in someone else may be more rewarding than the fact that the feeling is hostile or distressing.

People with TFAS may seem uncannily good at winding others up, but they have had plenty of opportunity to learn how to do this. What they cannot so easily do is to participate emotionally themselves in the social encounter. They learn about social situations, rather than learning in them.

This problem may be associated with other difficulties, like an impaired ability to tell yourself the story of how another person will look at a behaviour, and like the tendency to lump everyone together in the same group of people who are against you. More research needs to be done to find out what the difficulties are precisely. However, I do know that I now regularly ask people who I suspect of having TFAS to match faces (taken from a widely used set of test faces) by emotional expression and they make many more errors than would be expected given their intelligence. Sometimes parents will confirm that they have noticed the difficulties in this area that their son or daughter has. More often, it has not been noticed before. This is not surprising.

It is very hard to spot that someone, say, thinks that you are angry whenever you look disgusted or that you are surprised whenever you look frightened. However, a consequence of the fact that other people do not notice the problem is that the person with TFAS is more likely to conceal their difficulties too. That, or so it seems to me, is the beginning of their real problems. For, in not being able to call on other people’s assistance or support, the person with TFAS finds themselves failing to find friends or to gain influence in social settings. The fact that people with TFAS then resort to coercive means would surprise us less than it does if we were aware of their handicap. I hope that this article may be a small contribution to this greater awareness.

Acknowledgements:

I am grateful to my partner Emmy van Deurzen for her constant support and encouragement to me to understand the personal
context in which all of us act.

References:

1. Asperger, H. (1944) Die “Autistichen Psychopathen” in Kindersalter. Archiv fur Psychiatrie und Nervenkrankenheiten 117, 76-136.

2. Frith, U. (Ed.). (1991) Autism and Asperger’s syndrome. Cambridge: Cmabridge University Press.

3. Ghaziuddin, M., Tsai, L. Ghaziuddin, N. (1991) Brief report: violence in Asperger syndrome, a critique. In Journal of Autism and Developmental Disorders 21, 349-354

4. Lessing, D. (1989) The Fifth Child. London: Paladin.

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