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Externalization

Question:

I have a 20 year old son who has problems with lying, stealing, taking responsibility for his actions, can’t hold a job, and just generally blaming everyone else for his lousy life. He has been on meds for ADD but has always refused to take them. He even went to jail and blamed us, his family, for it! What is wrong and what can we do to help him?

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Answer:

It doesn’t take a psychologist to see that there is something disturbing and wrong with your son’s behavior. What you describe goes beyond mere selfishness. An empathy deficit seems to be present (a fundamental difficulty he may have understanding and/or caring that other people have the same feelings and needs as himself), and then, of course, there is the externalization, lying and massive rationalization. His criminal record suggests that this bad behavior is not merely reserved for members of the family, but rather is part of a larger pervasive personality pattern. Chances are reasonable that we’re looking at someone with Antisocial or Narcissistic Personality Disorder. If this is the case, you should know that these conditions are quite difficult to treat.

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p> To the extent that your son comes to you for resources, you may have some leverage over him, and that leverage may help you to push him in positive directions. For example, if he still lives with you, you can make his continued housing privileges contingent on his behavior in a ‘tough love’ sort of manner. If he is involved with drugs, it would be a good idea for him to become sober, for instance, and you might motivate him in that direction. If he is associating with friends who are themselves antisocial, it would be better for him to find new friends, etc. I don’t have a lot of hope that you will accomplish much, I’m sorry to say. Even regular 20 year olds are hard to reach, and when you add in the possibility of a significant personality disorder, the odds only go down.

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p> It must be very stressful for you to watch your son do the things he does. I can imagine that you might feel a range of difficult emotions including shame, guilt, embarrassment and helplessness. I recommend that your family participate in some counseling to discuss how this affects family members, and how family members can protect themselves. Helping the family come together assertively with regard to the problem in a manner that doesn’t exclude or reject your son, but at the same time refuses to be abused by him may help everyone involved.

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Comments
  • Anonymous-1

    Dr. Dombeck, I cringed while reading your advice in "externalization,' regarding the 20-yr-old son whom you so quickly labeled as anti-social. Many if not most of the 20-year-olds I have encountered are still in the process of separating/distancing themselves from their families-of-origin. One of the primary, age-appropriate ways of accomplishing this developmental task is through behavior experimentation (recreational drug use, drinking and other high-risk behaviors). The only difference between this young man and myself is that I was 20 in 1980, when parents knew better than to panic if their sons and daughters made a few bad decisions. How are young adults supposed to develop into self-reliant adults if we don't give them the space to experiment, but instead diagnose them with a personality disorder. When authority figures like you pathologize "normal," (developmental stage-appropriate) behavior, you are in effect creating a criminal, (perhaps motivated unconsciously by your own need to categorize people). I don't think we know enough about this young man to even guess what if anything needs to be done. In my view, the so-called anti-social act of smoking a joint is a lot less likely to do harm than will, say, telling parents their son's a psychopath. Just because lawmakers say the one smoking weed belongs in jail doesn't mean their right. Perhaps, in the future, your narrow-mindeded misuse of power will be viewed as anti-social behavior. Remember the DSM-IV is a work in progress. Or do you want to arrest all the homosexuals too?

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