Chapter 5 - The Coldest Heart

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Another graphic and disturbing chapter, the titular "coldest heart" of chapter five is a reference to the case of Leon, a teenager whom Perry visits in a maximum security prison for an assessment pending the sentencing phase of his trial. When we are introduced to him, Leon stands accused of the murder and subsequent rape of two girls, ages 12 and 13. Perry's role is to interview him and to gather information on any "mitigating circumstances" that might be relevant to Leon's defense.

Leon's case is a fascinating one, to me, because of the degree to which it is an outlier in terms of psychiatric prevalence. Leon is given a diagnosis of antisocial personality disorder (ASPD), known colloquially as psychopathy or sociopathy, a cluster B personality disorder characterized by "a pervasive pattern of disregard for and violation of the rights of others..." According to the DSM-5, the prevalence of ASPD in the general population ranges from 0.2% and 3.3%, though the rates are higher in males and those affected by low socioeconomic status, particularly in urban areas. To receive a diagnosis, the DSM specifies a number of behavioral and environmental criteria that an individual must meet. Leon appears to satisfy them all:
  1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
  2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
  3. Impulsivity or failure to plan ahead.
  4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
  5. Reckless disregard for safety of self or others.
  6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
  7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
Perry, as well as the DSM, also acknowledge that there is a genetic predisposition toward this type of disorder, which can be triggered by environmental stimuli. Given all of the factors involved, from the neglectful and isolated way Leon was raised to his own genes, Leon's case represents a perfect storm of antisocial development.

In my own work I've encountered two cases of ASPD. Reading this chapter reminded me of those two cases, and the somatic and psychic sensations one experiences when sitting in a room with such a person. My nervous system immediately put me on high alert whenever I was around them - even before I knew their diagnoses - because I could "see" in the subtleties of their behavior that they were dangerous, even on the floor of a psychiatric hospital. I can only imagine how Perry felt sitting across from Leon in a maximum security prison.

Comments

  1. Unknown06 August, 2018 17:02

    Your last paragraph reminded me of my time as an intern at the Travis County Correctional Complex. More specifically, of the very start of my internship... first few weeks or so. I had those same sensations when I first sat down in a room of not just one, but several individuals dressed in white and black stripes. It took me some time before I finally received that a lot of them had good intentions and were desperately trying to better themselves. While at the jail, and surely outside of it, they are consistently dehumanized and looked down on. Coming in to talk to me was empowering for a lot of them, and I know this because they would communicate it to me. Many of them grew up without many positive male role models. They never really had anyone to tell say they were proud of them or that they had done a good job. Some opened up and you could sense how devoid of love and nurture they had been, and it truly changes your perspective on how you see the world. I think that although it might be easy, and understandable, to feel fear when working with certain clients, it probably would also be helpful to remember where a lot of the clients that we work with are coming from, and that they might very likely be more fearful than we are.

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