Released in 1971, the film A Clockwork Orange shocked audiences with its stark portrayal of sadistic, thrill-seeking youths and a society struggling to deal with them. Adapted from Anthony Burgess’s 1962 novel of the same name, the film focuses on the relationship between the individual and the institutions of family, education, law and mental health that shape modern life. The main character, Alex, is arrested after persisting in criminal activity and after a short stay in prison undergoes rehabilitative treatment. This treatment is ultimately unsuccessful and the film ends with Alex being released from his sentence with the suggestion that he will soon be returning to his old lifestyle. It is the intention of this essay to discuss the behaviour of Alex – its causes, diagnoses and treatments.
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Focus on the Individual
A.
In both the film and the novel, the main character narrates the occurrences of his life. Alex presents himself through the narration as a relatable and likeable person referring to himself as, “your humble narrator” and to the audience as his brothers. His honesty in relating his crimes is disarming and his presumption of innocence and victimisation is at times convincing. In the place of remorse and repentance, Alex revels in the recounting of his misdeeds. This revelry is matched by the pleasure he appears to take in performing various crimes including rape, assault, murder, breaking and entering and theft. These crimes are usually committed with his three friends during night-long rampages involving reckless driving of stolen cars, gang fights and the use of simple schemes to convince strangers to allow entry into their homes, much to their misfortune. These nights begin at the Korova Milk Bar where Alex and his friends imbibe recreational drugs that in Alex’s words “…will sharpen you up and make you ready for a bit of the old ultraviolence.” Alex maintains a position of dominance within the group of friends using camaraderie, scorn and violence. His days are spent sleeping mostly. The film portrays little of Alex’s home life – some time spent listening to music, a meal with his parents, playing with a pet snake and a visit from a post-corrective advisor. A cold distance is felt between Alex and his parents, his only affections are for his snake and Beethoven. He suffers the presence of the condescending and sleazy post-corrective officer who clearly holds no sway over Alex’s decisions. Throughout, Alex demonstrates a callous disregard for the suffering he inflicts upon others, fawning and manipulative behaviour towards those between himself and something he wants and a complete disinterest in the consequences of his actions.
B.
The definition of abnormal has been carefully refined within the field of abnormal psychology. Barlow and Durand (2009) describe it as “a psychological dysfunction within an individual that is associated with distress or impairment in functioning and a response that is not typical or culturally expected.” This broad definition directs research while more specific criteria define abnormal behaviour in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, 2000). While Alex does not appear to experience any distress directly because of his behaviour, it does lead quickly to horrible consequences. These consequences do nothing to abate his
inclinations. Alex fails to function well at school, inside his home or with friends. He demonstrates neither productivity nor the ability to build and maintain healthy emotional bonds. He takes pleasure in that which is unpleasant and is unloving towards those who love him. He is a character both socially unacceptable and morally abhorrent. Alex’s behaviour is quite clearly abnormal as the word is understood in psychology today.
C.
While ostensibly lacking a definite setting in time, the film is placed within the shift from religious and moralistic conceptions of human behaviour to more scientific, psychological conceptions, specifically behaviourism which was popular during the writing of the novel. The exact nature of Alex’s abnormal behaviour is surmised at by several characters in the film in loosely spiritual or folk psychology terms. Even during Alex’s rehabilitative treatment which is conducted by psychologists no disorder, complex, illness or disease is presented as an explanation for his behaviour. It is presumed by the psychologists that the cause of the behaviour can be dealt with using a form of aversion therapy called within the film the Ludovico technique. After a demonstration of the effects of the treatment, the prison priest argues there has been no cure, simply a removal of the ability to choose wrong, to which the Minister of the Interior retorts, “We are not concerned with motive, with the higher ethics… The point is that it works!”
This is far removed from current diagnostic standards. Alex appears to quite clearly demonstrate antisocial personality disorder (APD; as described in the DSM-IV-TR; American Psychiatric Association, 2000). He demonstrates each of the diagnostic
criteria presented by the DSM-IV-TR to distinguish APD. Observation of his behaviour and access to his criminal record would almost certainly suffice to make this diagnosis. In the case of observation being unfeasible and his criminal record being unavailable as Alex is under the age of 18 for most of the film, psychometric testing could be used to reveal disorder. Hare’s PCL-R 20-item checklist (Hare & Neumann, 2006) is widely accepted within the field as the most valid and reliable method of diagnosing APD (Grann, Langström, Tengström & Kullgren, 1999). It was initially developed to assess men accused or convicted of crimes. Subjects are given a semi-structured interview in which they are measured against 20 items that cover the affective, interpersonal and behavioral characteristics of the prototypical person with APD. A derivative of this test, Psychopathy Checklist – Youth Version (Forth, Kosson, & Hare, 2003), would most likely be used. Alex as he is presented in the film scores strongly on every item except one, not being old enough to engage in marital relationships.
The issue of Alex’s age is prickly. According to the DSM-IV-TR (2000) the diagnosis of antisocial personality disorder requires a person be at least 18 years old. In the novel, Alex is introduced at the age of 15 and is 18 by the end. Therefore at the time of his treatment, Alex would have been diagnosed as having conduct disorder which is closely linked and may act as a precursor to APD (Dolan, 2004 ;Farrington, 1995). The film, in its translation of the text, removes the ending and increases the ages of the younger characters by several years. That Alex refers to himself throughout the film using words that mean young man, man and teenager suggests he is under but close to 20 years old. While there can be no definitive answer to the question of his age, there are
several reasons to believe that in the film, Alex was 18 years or older at the time of his treatment which occurs around halfway through the film. The actor playing Alex was 27 years old at the time of filming. Also, due to slight changes and selections made, Alex’s behaviour in the film aligns more closely with APD than his behaviour in the novel. What is most strongly suggestive, however, is that the film could not have been distributed in most countries if the consensual sex scene involving Alex were to be understood as taking place between underage people.
By the film’s end it is clear Alex displays behaviour and personality traits that almost epitomise APD. While at the time the novel was written this disorder had yet to be distinguished in psychology, today it has been the subject of more thorough research than any other personality disorder.
D.
While no absolute cause has been agreed upon, much has been learned of the nature of APD. What has been agreed upon is that an integrated model of causation is needed. Empirical research has uncovered influencing factors that can be usefully divided into primary, predisposing and precipitating causes. Genetic and neurological research has led psychologists to consider neurological deficiency as a predisposing cause of APD. Studies have implicated the frontal lobe as a crucial area of study. Damage to this area causes personality changes similar to the disorder (Meyers, Berman, Scheibel & Hayman, 1992; Damasio, Tranela, & Damasio, 1990). Also, studies of violent criminals have revealed a large majority suffer neurological damage (Blake, Pincus, & Buckner, 1995; Kiehl et al., 2004). One study found within a group of 31 confessed or sentenced
murderers, 64 percent displayed frontal lobe abnormalities (Blake et al., 1995). Genetic influences have been suggested in family, twin and adoption studies (Rhee & Waldman, 2002). A study found that the adopted children of mothers convicted of felony were more likely than adopted children of mothers without convictions to develop APD (Crowe, 1974). It has been observed that people with APD do not differ significantly from the general population on neuropsychological tests (Hart, Forth, & Hare, 1990). Thus, current research is aimed away from general brain damage and at slighter differences in brain function. Important avenues of investigation on genetic influences have been made into serotonergic functioning and stress-regulating mechanisms in the brains of people with APD. Also of interest are the observed low fear of punishment and physiological underactivity (Retz, Retz-Junginger, Supprian, Thome, Rosler, 2004; van Goozen, Fairchild, Snoek, & Harold, 2007).
What was particularly interesting about Crowe’s adoption study (1974) was the finding that children of felony convicted mothers who spent time in an orphanage were more likely to develop APD than those who didn’t, whether their mothers had been convicted of a felony or not. This strongly suggests a relationship between genetic and social, environmental developmental influences. Strong causal links have been observed between APD and dysfunctional families (Granic & Patterson, 2006), substance abuse, stress (Myers, Stewart, Brown, 1998) and socioeconomic status (Gelhorn et al., 2005; Laaksonen et al., 2007). In the absence of these, a person predisposed to APD may in fact lead an undisturbed life.
Further causal relationships are found occurring immediately prior to the disorder manifesting. In the case of APD, substance abuse, life stress, boredom and mere opportunity (Raine, Venables, & Williams, 1990) have been shown to strongly increase the likelihood of problem behaviour. APD is seen to be the result of a complex interplay of these causal factors.
E.
Very little information is given of Alex’s life before his introduction in the film. What is given parallels closely the life common to people with APD. During the visit from his post-corrective adviser, it is revealed Alex is frequently absent from school and is often in trouble with the law. His interactions with his parents are false and dominating while they in turn are passive and detached. The apartment building in which Alex and his parents live is dilapidated suggesting the family is rather poor. Lastly, his relationships with his friends are domineering and affection. These glimpses into his life accord neatly with that of a person with APD.
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F.
These aspects of Alex’s life loosely cover the social influences of his disorder apparent in the film. As the story takes place in a dystopian near-future and much of the film is concerned with Alex’s experiences of social institutions, it is useful to consider a social structural model of mental health. The immediate environment of Alex’s upbringing is a lower socioeconomic, high population density area. Crime and poverty are high. Youth gangs are active at night and police presence is light. National crime rates are increasing beyond previously seen levels. It is insinuated throughout the film that
bureaucracy and science conceptualise and treat humans as mechanical things. Studies have shown that a lower socioeconomic upbringing is linked to mental illness in general as well as several strongly contributing factors in the development of APD (Dohrenwend et al., 1992; Laaksonen, et al., 2007).
Poor parenting contributes to and is caused by low socioeconomic status (Chronis et al., 2007). Inconsistent parenting is strongly linked with the development of APD (Robins, 1966). Early childhood abuse and a lack of discipline and parental involvement through adolescence are also strong causal factors (Chronis et al., 2007; Luntz & Widom, 1994). What is often referred to as a “coercive family process” describes a relationship between a child and his or her parents in which problem behaviours are submitted to for convenience and reinforced. This leads to less parental involvement and more problem behaviours (Chronis et al., 2007; Patterson, DeBaryshe, & Ramsay, 1989). These behaviours can ultimately develop into APD (Patterson, Reid, & Dishion, 1992). The end result of this process is reflected closely in the relationship Alex has with his parents.
Socioeconomic status also influences the likelihood of substance abuse. Studies have shown strong links between life stress associated with socioeconomic status and substance abuse among adolescents and adults (Mott, Brown, & Myers, 1995; Stewart & Brown, 1998). These behaviours in turn encourage the development of APD (Myers et al., 1998). Alex habitually engages in substance abuse prior to criminal acts. His parents’ social status and his immediate environment can be seen to influence this behaviour.
Throughout the film, the systems of law, politics, religion, education and social services are shown as self-serving, indifferent to the individual and even at times foolish. The legitimacy and effectiveness of each is challenged in different ways. The education system is remarkably absent for a film about a high-school student. Social services in the form of the post-corrective advisor are presented as less concerned with the well-being of the individual than with statistically measured performance. The political sphere is represented by the Minister of the Interior feigning concern and taking whichever side of each issue appears most popular. Religion, portrayed by the prison priest, is concerned with and fooled by outward displays of religiosity, to say nothing of its subtle lechery. The law is made little of by the petty and foolish Chief Guard. Its legitimacy is compromised when Alex meets two friends who have become police officers. These old accomplices proceed to torture Alex in a display of beat police tyranny. The institutions that buffet Alex’s life and his socioeconomic disadvantages are instrumental in the development of his disorder.
Focus on the Environment
A.
The environment in which Alex lives encourages his disorder and provides opportunities for it to manifest. The overarching indifference and antagonism of major social institutions and the dysfunctions of his immediate interactions compound to facilitate the development of APD. This is a near optimal environment for drawing out Alex’s antisocial predisposition. It is no surprise then that he is almost the epitome of APD.
B.
These institutions are portrayed as such in the film in order to contend the various trends in modernity of treating and thinking of humans in ways comparable to that of machines is at first oppressive and morally wrong and ultimately ineffective. While not a perfect example of the real-life expression of the disorder, the character of Alex is a textbook example of APD. Further, although, the characters are used to express an argument, Alex’s experiences of social institutions and his reactions to them are remarkably faithful to modern psychological research.
C.
Alex’s interactions with those immediately around him are portrayed accurately. Alex capably presents a good impression to those around him. Only two characters express immediate dislike towards him even though many are aware of his criminal history. The considerable bafflement of those obligated to guide, punish and correct Alex is typical. His motivations are mysterious and apparently contrary to his general deportment. Also typical is the affectionless relationship between Alex and his parents and his self-serving, domineering relationship with his friends. To those with authority Alex is pleasant and agreeable sometimes to the point of being sycophantic.
D.
APD is very difficult to treat with few studies reporting positive results (Meloy, 2001). The treatment given to Alex is unsuccessful in helping his disorder. This is unsurprising as it was not properly diagnosed. Alex maintains his usual manner of self-
presentation during and after the aversion therapy. His behaviour in general is temporarily limited by physical suffering triggered by unacceptable intentions. However, his choices aren’t changed, only his ability to act on them. If diagnosed today, treatment plans might involve individual or group psychotherapy or cognitive behavioural therapy (DSM-IV-TR, 2000). Group therapy, however, can lead to unfavourable results. A study found intensive group therapy led to an increased risk of violent reoffending (Harris & Rice, 2006). What is crucial to therapy is the correction of emotional responses (DSM-IV-TR, 2000). The most successful treatments for children are parent training (Patterson, 1986; Sanders, 1992). This kind of treatment endeavours to encourage acceptable behaviours and discourage those that are unacceptable. Due to Alex’s age and ability to manipulate others, individual psychotherapy would be most likely to have a beneficial impact.
E.
Outside professional therapy, there are several ways Alex might have been able to improve at least to a point at which he could function in society. Stronger parental involvement, more positive engagement with education and social services and a better understanding of consequences would have all contributed positively. Unfortunately, each of these factors is antagonised by the disorder. Self-improvement is a steep climb with loose footing. Just as the paranoid person needs to trust his oppressors, the person lacing humanity needs to recognise the humanity in others.
Conclusion
A Clockwork Orange is a rather faithful portrayal of APD. The film introduces a well-crafted antihero displaying an old disorder in a new world. The main character Alex plainly demonstrates the history, peculiarities and persistence of APD. The social forces influencing its development are portrayed bluntly as facilitating and reinforcing Alex’s abnormal behaviour. The in-film diagnosis and treatment are beneath current standards. However, their lack of success is not too far removed from the results of treatments today. As research continues to pursue the causes and cures of APD a complex interplay of genetics, environment, society and development is uncovered.
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