"Antisocial Personality Disorder & The Five Elements" By Robert A. Vena

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By Robert A. Vena

The American Psychiatric Association's Diagnostic and Statistical Manual defines Antisocial Personality Disorder (ASPD or APD), as "a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood."  It is considered a personality disorder under western medicine classification, crosses all ethnic boundaries, and occurs in about 3% of males and 1% of females within the general population.  There are no specific tests to accurately determine whether or not an individual has antisocial personality disorder, but manipulation and deceit are key features of this pattern.  The patient must exhibit at lease three of the following specific signs and symptoms in order to be diagnosed: * Failure to conform to social norms, as evidenced by repeatedly committing crimes

* Repeated deceitfulness in relationships with others; repeated lying, use of aliases, or conning of others for personal gratification or materialistic gain

* Failure to think or plan ahead (acting on impulse)

* Irritability, anger, and aggression as shown by repeated assaults on others and frequent incidence of physical confrontations

* Reckless disregard for self-safety and the safety of others

* Consistent irresponsibility, such as failure to establish a pattern of good working habits or honoring of financial obligations

* Lack of remorse or guilt over wrongdoing, as indicated by an indifference towards or rationalization of having hurt, mistreated, or stolen from others

An important aspect of this disorder is that it is not diagnosed in individuals younger than 18 years of age. In order to diagnose, the individual must be at least 18 years of age and have shown the above symptoms since the age of 15.
Individuals suffering with APD have extreme difficulty developing and maintaining positive relationships.  They display a callous disregard for the rights and feelings of others, and their social interactions tend to be exploitative and riddled with deceit, manipulation, and dishonesty… all of which are geared towards personal gain and/or gratification.  They feel little or no guilt for their actions and believe themselves to be faultless.  They become easily frustrated and act out their conflicts in a manner that is both impulsive and irresponsible, oftentimes blaming their actions and behaviors on others.  People with this disorder stand an increased risk of drug and alcohol abuse, and often partake in dangerous, promiscuous behavior.  They are vulnerable to anxiety, major depression, and other disorders (such as bipolar disorder, narcissistic personality disorder, and self-mutilation), and face an increased risk level of premature death by violent means (such as homicide, suicide, and accidents due to their own extreme daring behavior).  Repeated incarceration, troubled marriages, extended unemployment, and homelessness are all common elements in the lives of those suffering with antisocial personality disorder.  The exact cause of antisocial disorder is unknown, but there have been many studies done that show support for both genetic and environmental factors in the development of this pattern.  It has been found that the disorder is more common among first-degree relatives of those suffering from this disorder than among those in the general population.  Criminals exhibiting antisocial personality tend to have criminal records that are more like those of their biological fathers than those of their adoptive fathers.  It has also been found that children who have uninvolved parents are more likely to develop this disorder than those who do not. Medications do not treat the behaviors exhibited in those suffering from this disorder, and it has proven very resistant to treatment of any kind.  Although behavioral change is an extremely important aspect of treatment, it has been found that punishment rarely modifies or improves the behavior and judgment of these individuals.
With regard to the low rate of success in treatment of this disorder, a significant part of the problem lies with the fact that people who suffer from it rarely (if ever) see themselves as the problem.  Instead, they tend to see the world and those around them as having the problems.  Therefore, they rarely seek out treatment for themselves.  Their failure to conform to the rules of society and criminal behavior more-often-than-not leads to incarceration.  If there is any bright side to all of this, it lies with the fact that the disorder tends to remit with time, with a remission rate of about 2% every year in patients over 21 years of age.
Based on my research, antisocial behavior disorder appears to be a type of Kuang condition stemming from a form of Phlegm-Fire Harassing the Heart (or, Phlegm Obstructing the Heart Orifices).  The condition most probably begins at an early age, in individuals who have experienced severe emotional turmoil or who have inherited the condition genetically.  Left unchecked and untreated over time, this emotional stagnation eventually leads to Qi stagnation, which, in turn leads to the generation of fire that can have an impact on the Heart Orifices and the entire body/emotion system. Looking at this disorder from a Five Elements perspective, it seems almost too easy to see how each of the elements can play a role.  After all, the elements are so intimately tied and bound to one another that they really cannot be separated one from the other.  It is quite possible that treatment of each of the five elements, in a well-planned and methodical way, can help to bring the system back into balance.  But first, we will deal with Fire, the element of the Heart and it’s paired organ systems, the Small Intestine and the Pericardium/San Jiao (or, Triple Burner).  When our Shen, or Spirit, declines due to obstruction or imbalance of the Heart and its orifices, our spirit of humanity disintegrates too.  And when it reaches a critical point of desperation, the criminal mind gives us a clear signal by shouting out loudly for help.
Within the human organism, it is the Heart that houses the Shen and plays the important role of ‘Emperor’.  When the Emperor is ill - when there is an imbalance of Fire - there will be imbalance and chaos throughout the entire organism… both mentally/spiritually and bodily/physically.  As stated above, individuals suffering with APD have extreme difficulty developing and maintaining positive relationships. Fire is active… it rises upwards and creates an atmosphere of warmth and love.  An individual whose Fire element is out of balance would be incapable of providing emotional warmth and affection to those around him/her.  Because their Fire element is out of balance, they are emotionally incapable of maintaining meaningful, long-term relationships with others.  They tend to be cold and calculating in their dealings with others and fail to feel any sense of guilt or remorse in the harm that they cause to those around them.  The Pericardium serves as protector of the Heart.  But not only does it guard the physical heart, it also protects love relationships of any kind.  Together with her sister organ, the San Jiao, whose ‘burning spaces’ serve to heat the entire body/mind system, it is responsible for the connection, warmth, and harmony that all our relationships depend on to stay alive.  It is quite easy for a person with APD to lie, use deceit, and con others with little or no remorse whatsoever for the hurt they are causing.  Clearly, this is a part of the system that may be greatly suffering.  It might explain why broken marriage and divorce is such a common occurrence amongst those suffering from this disorder. The Small Intestine holds the role of ‘Separating the Pure from Impure’, which in the emotional sense can be directly related to our mental faculty of distinguishing right from wrong.  Sufferers of APD display very little control over this faculty, as is shown by their repeated criminal actions and promiscuously dangerous behavior, which can oftentimes lead to self-inflicted injury and/or their own death.
The Earth is the vehicle upon which we make our way through time and space, and travel across the Universe.  It is upon Earth that we move through the never-ending cycle of revolutions, rotations, seasons, nights, days, weeks, months, years, births, lives, and deaths.  We are grounded to Earth by our own feet, and Earth is the stuff we are made of.  It is this material that feeds and sustains us.
Earth energy is our connection to life itself, and without it the world seems crazy and out of harmony - life becomes chaotic and desperate.  It is our connection to Earth that keeps us balanced and centered in life.  It provides us a home base, and a center to operate from.  Without Earth we are homeless and lost.
The Spleen and Stomach are the paired organs of the Earth element.  In Chinese Medicine the Spleen is considered to be the foundation of existence of all the other organs.  Without the transforming and transporting functions of the Earth energy of Spleen and Stomach, all other parts of the body would be starving for the energy and nourishment they need.  When the Earth energy of the Spleen/Stomach is lacking, one may experience symptoms such as deadness of feeling and a general lack of a sense of connection to the world and life in general.
A lack of harmony within Earth energy may explain the APD sufferer’s repeated incidence of incarceration, extended bouts of unemployment, and homelessness.  There is simply no connection to Earth energy there to keep the sufferer in a healthy mindset and desiring a stable and nourishing environment of any kind.  It may also explain the sufferer’s consistent display of irresponsibility, such as failure to establish a pattern of good working habits or honoring of financial obligations.  The cycles and schedules, routines and timetables of everyday life simply don’t work for these individuals.
    Sympathy is the emotion of Earth energy.  APD sufferers display no sympathy or compassion whatsoever towards the victims of their crimes.
Metal is the element of structure and strength.  It is Metal energy that connects and holds together the vast networks and meridians that lie within us at every level.  It is what keeps us upright and what keeps the internal lines of communication open and functioning properly.  With an imbalance of Metal comes breakdown of the lines of communication.  And once this happens, dissention, rebellion, and disintegration quickly follow.
Rules and laws are the structure that holds our society together.  By following the rules, we remain upright citizens.  Failure to follow the rules makes us criminal.  Using this analogy, it is easy to understand why someone suffering from an imbalance in Metal energy would show total disregard for, and violate the rights of others on such a regular basis.  The APD sufferer is consistent in this, and in their failure to conform to social norms, as evidenced by their repeated criminal activity and disregard for the law.  These individuals are far from being what society considers upright citizens.  The lines of communication within these individuals have long since collapsed, and the revolution is underway and in full swing.
    The Kidney and Urinary Bladder are the paired organ system of Water energy.  The Kidney is said to house ‘Will Power’ and ‘Ambition’.  A person who lacks will power and ambition is expressing an imbalance in Water energy. APD sufferers show a clear lack of will power, and it can be seen in their inability to control their own lives and refrain from repeatedly committing serious crimes and offenses against those around them.  As stated above, it is extremely difficult to modify or improve the behavior and judgment of these individuals.  This could quite possibly be due to a severe Water energy imbalance, which leaves them with little, or no sense of will power.
The Urinary Bladder is responsible for storage and elimination of fluid waste from the body, and key to this function is its ability to be flexible and to adapt to the constantly changing fluid levels within our bodies.  An imbalance in Water energy can quite possibly lead to an inability to adapt to our environment.  The APD sufferer’s inability to conform to social norms can very well be attributed to a Water energy imbalance.
  Fear is the emotion associated with Water energy.  An imbalance in Water may also lead to a decrease in an individual’s capacity to experience ‘appropriate levels’ of fear.  APD patients seem to exhibit a lack of fear of consequences and personal harm, as evidenced by their repeated criminal offenses and their life threatening and daring actions.
    Wood energy is what keeps us rooted and balanced in life.  Without it, we are unable to create roots for ourselves, and we cannot flourish and grow in a positive, healthy way.  Perhaps it is due to an imbalance in Wood energy that APD sufferers are unable to create roots for themselves.  And maybe this is why we see in them an increased rate of broken marriages and homelessness, and why they frequently make use of aliases.
    The Liver and Gallbladder are the paired organ system of the Wood element.  In Chinese Medicine, the Liver is seen as a ‘General’ who excels in strategic planning, and the Gallbladder as being responsible for our decision-making capabilities.  An imbalance in Wood energy can cause a disruption in an individual’s ability to make good decisions and to think or plan ahead in a constructive manner.  As we have seen, APD patients show a glaring inability to make appropriate decisions or to think and plan ahead.  They are notorious for acting on impulse, regardless of the possibility of negative consequences that may ensue from their actions.
    Anger is the emotion of Wood energy, and ‘Shouting’ is its sound.  An imbalance in wood energy can cause an excess of both anger and shouting.  APD sufferers seem to experience this excess as seen in their continued displays of irritability, anger, and aggression toward others.  These individuals are well known for committing repeated assaults on others, as well as for their frequent incidence of physical confrontations.
As acupuncturists, I believe we can bring some sense of order and balance back into the lives of those who suffer with antisocial personality disorder.  In addition to using the acupuncturist’s needle and herbal formulas to bring the elements back into harmony, we can introduce these individuals to relaxation and centering techniques such as meditation, Tai Chi, Qigong, and Qigong breathing exercises.
By doing all that we can to improve the condition of these individuals, we not are not only helping them, but may, in turn, be preventing further harm from coming to those who might be their victims.


Nei Ching: The Yellow Emperor’s Classic of Internal Medicine.
    Translated by Ilza Veith, University of California Press, Berkeley, CA., 1972

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