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Release: March 8, 1999

UI psychiatrist publishes book on antisocial personality disorder

IOWA CITY, Iowa -- Some men seem to break all the rules, drifting from job to job, abusing alcohol or drugs, abandoning their families, running into trouble with the law. Almost everyone knows such a man, whether firsthand or from media accounts. But few realize that a disturbingly common psychiatric disorder may be at the root of these men's behavior.

Donald W. Black, M.D., professor of psychiatry at the University of Iowa College of Medicine, wants to change that. His new book, "Bad Boys, Bad Men: Confronting Antisocial Personality Disorder," published in March by Oxford University Press, examines this condition and the trouble it causes.

"I find it incredible that a disorder affecting at least seven million Americans is the subject of such little attention," Black said. "Many of us are affected by people with this condition, from the women they batter to the taxpayers who pay for their adjudication and incarceration. I hope this book stirs more discussion of these issues."

In the psychiatric sense, antisocial refers not to people who are shy or withdrawn, but rather to those who disregard all of society's regulations and expectations. At their worst, people with antisocial personality disorder (ASP) seem to completely lack a conscience, acting only with their own interests at heart.

Black argues that many social problems ­ from crime to drug abuse to "deadbeat dads" ­ can be traced to ASP. His book also details the history of ASP as a psychiatric disorder, discusses its symptoms in detail, outlines treatment strategies and offers advice for families dealing with the condition. It is written for a general audience and includes many examples of antisocial behavior drawn from recent headlines.

ASP is found mostly in men and always begins early in life. "These people start out as troubled children and end up as very troubled adults," Black said. "We just don't see cases of bad men who were not bad children."

Not all children with behavior problems go on to develop ASP, Black explains. However, the kids who misbehave the most stand the greatest chance of becoming antisocial. The problem spans all areas of life, from education to work to relationships.

The range of problems associated with the disorder may distract attention from their common cause. "Too often we see an individual's behavior blamed on his alcoholism, abusive childhood or some other issue without the realization that he has been difficult from day one," Black said.

Although ASP probably stems from a blend of hereditary and environmental factors ­ perhaps including genetics, birth injury, body chemistry and home life ­ Black maintains that people with the condition should be held responsible for their actions.

"People with ASP will blame everyone but themselves for their problems. If they are to get better, they have to learn to accept responsibility," he said. "Ever since this disorder was first defined by psychiatry, critics have worried that it would become a license for bad behavior. It isn't. People with ASP have the ability to choose right from wrong, but they simply fail to do so."

"Bad Boys, Bad Men" draws on case studies from Black's research, including a profile of notorious serial killer John Wayne Gacy, who was diagnosed with ASP at the UI in the late 1960s. Gacy's story, Black said, presents an example of the disorder at its most deadly extreme.

Black's experience with ASP began during his medical residency training in psychiatry. The sheer number of problems associated with the disorder and psychiatry's trouble treating it led him to research the condition further.

He conducted a follow-up study of men diagnosed as antisocial at the UI in order to discover what happened to them decades after their initial diagnoses. Most, he found, never improved, and some became even worse.