Dealing with mentally ill citizens on patrol, Part 3
Part 3: Personality disorders and substance abuse
Parts 1 and 2 of this 4-part series dealt with patrol strategies for handling citizens with serious mental disorders that can impair thought, mood, or rational action. In Part 3, we deal with often less severe, but far more common, problems that affect a large number of citizens in your patrol area and that may often be associated with potentially violent and/or criminal behavior: personality disorders and alcohol and drug abuse.
Personality: Traits, Types, and Disorders
We all have different personality traits, which contribute to our psychological uniqueness as human beings; thus we say, “It takes all kinds…” But when these personal quirks begin to grate harmfully on others or significantly derail our own success, mental health clinicians speak of an individual having a personality disorder, which is defined as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.”
Personality-disordered individuals typically show little insight into their own behavior and have a poor understanding of the adverse impact they have on themselves and others. They characteristically justify their self-defeating or offensive behavior as being due to uncontrollable fate or someone else’s fault. It is the extremes of their self-perception and conduct toward others that distinguish personality disordered individuals from those with more moderate personality traits and styles. On patrol, many of your interactions with these individuals may not necessarily involve potentially violent situations, but more commonly may require you to question them or order them to do some specific action, like leave an area or resolve a dispute with a neighbor.
Histrionic personality is a pattern of excessive emotionality, attention-seeking, need for excitement, flamboyant theatricality in speech and behavior, an impressionistic and impulsive cognitive style, and use of exaggeration to maintain largely superficial relationships for the purpose of getting emotional needs met by being admired and cared for by others.
These will be the overemotional citizens that police often encounter, for whom every rebuff and inconvenience is a major tragedy. These are also the subjects who may try to ingratiate themselves with local officers by virtue of their wit and charm. They crave attention, and officers who are able to project an attitude of empathic concern will probably find these subjects more than willing to cooperate. One problem is that, in their desire to please, they may often change their story to suit what they believe you want to hear. This is usually not deliberate deception, but a virtually unconscious attempt to do anything to put themselves in the best possible light and get you to like them. Careful, gentle probing of inconsistencies may be necessary to get at the facts of a given case.
Borderline personality is a pattern of instability in interpersonal relationships, fragile self-image, and wild emotional swings. In this pattern, individuals may exhibit a pattern of erratic and intense relationships, alternating between over-idealization and devaluation of others: they either love you or they hate you. They may show self-damaging impulsiveness in the form of risky activities, substance abuse, and emotional explosions. Signs of emotional instability include inappropriately intense anger and/or depressive mood swings and possible suicidality. Persistent identity disruption may manifest itself as disturbances in self-image, blurred interpersonal boundaries and relationships, confused goals and values, and a chronic feeling of emptiness that may propel the quest for stimulation via substance abuse or provocation of incidents.
Officers most commonly encounter these individuals on domestic calls or in workplace disputes, since their most intense conflicts involve those with whom they’ve previously had some kind of close relationship. Extremely sensitive to rejection or betrayal, they may respond with intense anger which may escalate to violence. In such cases, be sure to separate the disputing parties and use calming techniques and active listening to convey a sense of sincere concern, backed up by no-nonsense resoluteness that violence won’t be tolerated. Stay away from discussing sensitive issues, which may only further inflame the borderline subject; instead, focus concretely on what you want the subject to do.
Narcissistic personality is a pattern of grandiosity, sense of entitlement, arrogance, need for admiration, and lack of empathy for others’ feelings or opinions. Citizens with this pattern typically get in trouble because they believe rules are for other people and that they are allowed to bend the law because of their special entitlement and powers of perception, insight, and judgment. They expect others to appreciate, admire, and defer to them, and will become irritated or rageful when they don’t get the respect they feel they naturally deserve.
Expect two kinds of reactions from narcissistic subjects. One is an over-familiar, back-slapping camaraderie that implies that he and you are really of equal status or have a common bond: “It’s okay, officer, I understand what you’re trying to do – hey, my uncle’s a cop in Atlanta.” You can use this to your advantage by allowing the subject to “take your side” and emphasize how what you’re asking him to do is of mutual benefit:
The other reaction (sometimes after the first reaction has failed to get the anticipated response) is outrage at not being respected as a special case: “I’m an important man in this community – you can’t treat me like a common criminal!” In these situations, verbally disarm the subject by being somewhat deferential, but at the same time, maintaining the need for your actions:
Avoidant and Dependent Personalities
Avoidant personality is a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to criticism. Even relatively neutral interpersonal interactions or confrontations are approached with trepidation. These are the citizens who may inexplicably go all to pieces at a simple traffic stop. Sometimes their extreme nervousness may convince the officer that they’ve got “something to hide,” thus prompting more a more extensive search and questioning, further agitating the subject. In some cases, the otherwise innocent subject may become so fearful, he or she may attempt to flee or forcefully resist commands, and the ensuing pursuit and/or restraint will then lead to even greater psychological deterioration, in a vicious cycle. These are also the subjects that are most likely (followed closely by the histrionic personality) to just break down and cry during an encounter.
If you need to question these subjects, a collaborative and supportive interview style, rather than a cold and confrontational interrogation, will be the most productive approach. Such individuals may seem to be holding back, but not because of lack of cooperation per se. Rather, their extreme shyness makes it excruciatingly difficult for them to give a coherent narrative in the presence of another human being. In such cases, you may want to emphasize a more gently directive, structured, question-and-answer format of the interview protocol, which may actually make it easier for avoidant types to reveal what they know in piecemeal fashion.
Dependent personality is a pattern of submissive and clinging behavior stemming from an excessive need for care and nurturance. Whereas avoidant subjects fear people and prefer to be away from them, dependent personalities cling to people for guidance and support and fear only their rejection and abandonment. Even more so than with avoidant personalities, dependent types will respond well to a supportive, collaborative approach to questioning. The danger is that, in their eagerness to please, they may be apt to tell you what they think you want to hear, not necessarily what is actually the case, so follow up your open-ended questions with a few close-ended queries to nail down the details. Be careful, however, not to give the impression that you don’t trust the subject, which he or she will take as a mortal wound, and which may therefore close off any further productive communication.
Schizoid and Schizotypal Personalities
The central characteristics of both schizoid and schizotypal personalities include avoidance of others, severe deficiencies in social skills, generalized withdrawal from life, and sometimes impairment in perceptual and cognitive capacities. Schizoid personality is a pattern of aloof detachment from social interaction, with a restricted range of emotional expression. These are people who don’t need people, and are perfectly happy being left to themselves. Schizotypal personality involves more serious disturbances of thinking, more bizarre behavior, and possibly delusions. It is thought that these two personality disorders really represent points on a continuum from schizoid to schizotypal to outright schizophrenia, the latter characterized by severe distortions of thought, perception, and action, including delusions and hallucinations (see Part 2 of this series). In fact, schizoid and schizotypal personality disorders may episodically deteriorate into psychotic states, especially under conditions of stress.
The main interactive feature of interest to patrol officers is that these subjects may seem detached and disinterested during an encounter, not because they’re ignoring or disrespecting you, but because they may be internally preoccupied with their own thoughts and/or because human interaction is of little interest to them to begin with. In most cases, their blank, far-away facial expression and attitude will be quite noticeable. Even where they do communicate, the sometimes bizarre and delusional nature of the information they provide may compromise its validity and usefulness. Encouraging a free narrative will likely yield either an incoherently rambling stream-of-consciousness oration, or a rigidly obsessive reiteration of key ideas or phrases. Instead, it will be more effective to use a firm and directive approach to focus the schizoid subject’s attention on simple, precise questions. These queries should be designed to yield specific, tangible bits of information that can then be painstakingly fitted together to create a coherent narrative of useful information.
Antisocial Personality Disorder
Subjects with antisocial personality disorder are frequently encountered in law enforcement settings because this is as close as one gets to a typical “criminal personality.” These psychopaths (the older term for these subjects) are characterized by a completely self-centered world-view, lack of empathy for others, and a craving for immediate gratification, with little or no frustration tolerance. They have an excessive need for stimulation and excitement, and their behavior is impulsive, erratic, and characterized by difficulty in sustaining any long-term goal-directed behavior. More so than other offenders, punishment seems to have little effect on them, a feature that has both been noted behaviorally and documented neurophysiologically. Commonly, there is a long history of substance abuse and criminal activity, dating from childhood, when the syndrome is known as conduct disorder.
In their youth, antisocial personalities typically have done poorly in academics, especially verbal subjects, although they may possess contrastingly high mechanical skill and athletic prowess. They were probably bullies since grade school. When older, they tend to be unreliable workers. They usually perform poorly on standardized IQ tests, especially in the verbal areas, yet they often possess a very keen social intelligence that they use to “psych out” others in order to exploit them for their own ends. They can be alternatively glibly persuasive, seductive, or threatening with facile ease, often in the same conversation. They are the classic con artists who can turn on the charm or flare into fury if that’s what it takes to get what they want from others. Human beings, in their minds, are just objects to use and throw away, and there is no true sense of loyalty or friendship. People who value such human traits as love, honesty, commitment, or honor are seen by antisocial personalities as fools and suckers who deserve to be exploited.
Probably, the first guideline for law enforcement interaction with these individuals relates to the old adage of not trying to outbullshit a bullshitter. Any intervention that is perceived or misinterpreted as a ploy – and many psychopaths show paranoid traits as well – will be manipulated and exploited by the subject. It’s not all nastiness, either. Officers should be alert to the cunning-conning dimension of the antisocial personality: many of those who deal with these characters, whether law enforcement officers or mental health clinicians, often find themselves “liking this guy too much.” Psychiatrist Roy Lubit speaks of the “intense, emotionless gaze” that many antisocial personalities fix on their interviewers, their attention seeming to be riveted on you in a kind of sham active listening posture, but their facial expression revealing no particular genuine feeling state – because there isn’t any: they’re just searching for an angle to exploit. Often, in dealing with these characters, their overpolite, deferential and friendly demeanor may give you the distinct impression that you’re being greased, or they may be so smooth that you can’t even tell. Don’t fall for it.
The best approach is the most direct. If an arrestable offense has not yet occurred, clearly and firmly explain to the subject what he has to gain from cooperating with you and what he has to lose if he doesn’t. Don’t be baited into a discussion about reasons and explanations; antisocial personalites are experts at using vague or confusing language to mess with your head. Here is one situation where you don’t want to engage the subject in lengthy dialogue. Your attitude should be authoritative: not abrasive, which may impel him to try to save face by becoming confrontational, but not too “officer friendly,” either, which will invariably be seized upon as a weakness to exploit. Remember, the one thing antisocial personalities do respect is power, and if you provide him a face-saving means of ensuring compliance with your request, and firmly present yourself as a reasonable, but no-nonsense officer, the subject may eventually, grudgingly comply – often with a big, shit-eating grin, like the solution was all his idea:
Subject: [after a tense moment, seeming to be deciding what to do, lets out a big laugh] Sure, officer, whatever you say – always want to be a good citizen who helps out the police any way I can. Catch you later, brother. [Saunters away, laughing.]
Alcohol and Drug Abuse
Aside from schizophrenic subjects, alcohol- and drug-intoxication disturbances comprise the bulk of potentially violent mental disorder-related police patrol interactions. In fact, the two diagnoses frequently overlap, as many mentally disturbed individuals are also abusing substances at any given time.
Intoxication and Withdrawal: Signs, Symptoms, and Syndromes
Signs of alcohol intoxication are familiar to any officer who has ever pulled over a drunk driver: slurred speech, unbalanced posture, impaired coordination, and so on, although it is possible for many drinkers who are legally intoxicated to act relatively normally, especially when trying to impress the officer with their intactness. Alcohol has varying effects, depending on the particular user, with some inebriated drinkers becoming more mellow and tractable, others becoming more angry and agitated. In general, alcohol and most other drugs lower inhibitions and self-control, so any intoxicated person has to be approached with caution.
Less common, but potentially more serious, are signs and symptoms of alcohol withdrawal in subjects who are physiologically addicted to alcohol. This usually presents as an agitated state with tremors (“the shakes”). In severe cases, this can be accompanied by hallucinations and/or seizures. An acute state of agitated delirium, characterized by intense fear and tactile and visual hallucinations of vermin crawling on and/or under the skin, is called delirium tremens (“the DT’s”). Typically, such individuals will be so clearly impaired that the need for transport to a medical facility is obvious. Years of long-term heavy abuse of alcohol can also lead to alcoholic dementia, but these patients are likely to be confined to institutions and not typically encountered during regular patrol.
A rare, but more dangerous syndrome is pathological intoxication, where even small amounts of alcohol trigger violent rages in susceptible individuals, which is thought to be due to an electrophysiological disturbance in sensitive limbic areas of the brain. Witnesses will describe an explosion of rage in which the subject appears to be “on automatic” or “like a runaway train,” fueled by adrenalin and capable of inflicting severe damage to anyone who gets in his way. These episodes typically last only a few seconds to minutes, and there is usually at least some recall of the incident by the subject, who may also subsequently express regret at losing control (see also below). During these brief episodes, it is useless to try to talk the subject out of his aggressive action. The only effective strategy is to use appropriate physical restraint to keep him from harming others.
Other substances of abuse have different effects on behavior, depending on their biochemical action within the nervous system. Stimulants (“uppers”), such as cocaine and amphetamine, produce a “racing” kind of high, with rapid thought and speech, erratic and impulsive behavior, and a suped-up energy level. Such individuals may occasionally become violent, but more commonly, they will been seen as simply annoying and raucous, quite similar to the manic state described in the previous column; in fact, many manic subjects deliberately use stimulants to enhance and extend their natural high. Danger may arise when their overconfidence and impulsivity leads to temper flare-ups provoked by confrontations with police.
Central nervous system depressants (“downers”), such as barbiturates (e.g Quaaludes) or benzodiazepines (e.g. Valium, Xanax), have effects similar to alcohol, which include a calming effect, but accompanied by a loosening of inhibitions, which may lead to impulsive and illegal actions. Most calls for service for these users tend to be due to their passing out unconscious in a public place, but they may become combative if they are still confused and disoriented when police or paramedics arrive.
The effects of hallucinogens, such as marijuana, LSD, or angel dust, may range from mellow loopiness to violent delirium. Organic hydrocarbons, such as the glue and paint thinner enjoyed by sniffers or “huffers,” tend to produce a toxic delirious state; these latter substances are also extremely injurious to brain tissue and can produce long-term cognitive impairment.
Dealing with Intoxicated Subjects
Because a behaviorally deteriorated state can be caused by a variety of factors, it is first important to distinguish drug or alcohol intoxication from other medical or psychiatric conditions. Remember, several syndromes may go together: for example, the delusions of a paranoid schizophrenic may be exacerbated by using cocaine, so he smokes some pot to calm down and begins hallucinating, so then he drinks some vodka to quiet the voices, and this interacts with the cognitive effects of a recent concussion he sustained in a fight. Now you’re faced with a fearful, angry, and confused person whose behavior is erratic and unpredictable.
In most cases of alcohol use, the subject’s breath, or your breathalyzer, will give him away. Otherwise, you may have to rely on your knowledge and experience (observational and personal) of intoxicated states. Always approach an intoxicated person with caution. Try to gather as much information as possible about how that person has gotten to where he or she is and whether there is a need for medical attention. Check for weapons and generally assess for danger to self or others. Use tact, patience, and verbal intervention skills – but only to a point. Remember, you’re dealing with a person whose powers of perception, comprehension, reasoning, and self-control have all been impaired by the substance they’ve ingested.
If necessary, call for backup and be prepared to use defensive and/or control techniques, such as spray, taser, or restraint, if necessary. If the subject has not yet committed an arrestable offense, but cannot be safely left on his own, arrange for transport to a receiving facility: better to call the paramedics and let them handle the medical aspects if a severely intoxicated subject is refusing treatment or transport. If it’s a drunk driving case, you’ll probably make an arrest, but still check for medical issues, if necessary. Use your authority appropriately, but always try to treat subjects with reasonable respect – remember, these are often the repeat customers whom you will have to deal with in the future.
To learn more about these topics:
Disclaimer: This article is for educational purposes only and is not intended to provide specific clinical or legal advice.
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