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Book Review: Mental Hospitalization: Myths and Facts about a National Crisis

well, if not better, than do nonpsychopaths: Quay’s because it is “incomplete and inexplicit”; Hare’s because of its lack of comprehensiveness. Three of the four theories draw upon a biological basis and fail to give adequate attention to ecological factors, and the other, Cough’s, is primarily sociological. Doren’s integrative theory attempts to remedy the shortcomings of the others. Doren draws heavily from leaming theory, and to a lesser extent the influence of psychosocial theory can be seen in the importance that he attaches to such factors as the power of transference and countertransference. Using this framework, he encompasses what he believes to be the most promising empirically validated aspects of the four theories enumerated above. These aspects, however, do not stand alone but become operational when three key components are added-control, challenge, and partial helplessness. Control is “being able to regulate one’s own rewards.” In striving for these rewards attainable through control, the focus is upon shortterm gains, and the psychopathic individual is concerned only about self. Challenge is the desire to “get away with something.” The psychopath is hypothesized to have a relatively low degree of cortical arousal and therefore seeks challenging situations for stimulation. The psychopath may well see a challenge in a situation that may not appear challenging to the nonpsychopathic individual. The psychopath gets a thrill from beating someone at his own game, for example, committing a crime and then eluding the police. In this instance the thrill is experienced both in the crime and in eluding the police. This low level of cortical arousal and partial helplessness are, according to Doren, “imperative factors for the development of psychopathy.” Partial helplessness conditioning teaches the child that the same behavior may elicit punishment or reward and that either outcome is highly variable. Persistence becomes key, insofar as the child learns to tolerate punishment knowing that the reward will eventually come. Outgrowths of this conditioning are a distorted view of people and the environment, a tendency toward antisocial behavior, and an aberrant way of getting needs met. Doren’s integrative theory points to several treatment considerations. First and foremost, it is important not to accept too readily the accuracy of historical information provided by the client: second, assess the likelihood of psychopathy early in treatment. Needless to say, this may save considerable frustration and disappointment later in therapy. Keeping in mind the psychopathic individual’s need for control and challenge is a sine qua non for successful intervention. After alerting therapists about “traps to avoid,” Doren discusses direct and indirect behaviors that evolve in the treatment process. He offers strategies and suggestions that facilitate the use of these behaviors as positive treatment processes rather than as counterproductive or negative transactions. Even the most skilled therapist who has had considerable experience working with psychopathic individuals is susceptible to being hoodwinked and at times feels exasperated. Psychopathy, however, is treatable. This book is a valuable addition to the literature regarding psychopathy. Doren thoroughly reviews four of the better known theories that attempt to explain the psychopathic individual. He also makes a contribution with his integrative theory. At times, however, the theory loses coherence because it attempts to integrate so much. A point that comes through quite strongly, though, is that to understand and treat the psychopath one must attend to biological, ecological, and behavioral factors. Understanding and Treating the Psychoparh should be in the library of every therapist who works with personality-disordered clients.