Social Parasitism, pathological social dependence, a form of expression of dissocial pathology.

ABSTRACT

This article seeks to establish that the so-called Social Parasitism corresponds to a dissocial behavior, which is the result of temperamental phenomena with biopsychosocial implications and refers to patients who present a passive, exploitative, and chronic way of life at the expense of others. Based on the Transferred Focused Psychotherapy Model (TFP), we will analyze how this clinical manifestation reflects a severe pathology of the superego and corresponds to behaviors of the dissocial spectrum since it implies a form of chronic behavior of exploitation and significant irresponsibility in interpersonal relationships, characterized by the Poorness of the Objectal Investment. We propose to encourage the search and directed evaluation of the whole dissocial spectrum in a way to promote its evaluation, diagnostic, registration, consider its prognosis and establish short- and long-term objectives when possible. This could prevent, decrease, or at least warn about the eventual damages, not only to the patients but to their families and the people or institutions involved.

Key words: social parasitism, pathological economic dependence, severe personality disorders, dissocial conduct.

INTRODUCTION

The denominated Social Parasitism refers to patients who present a passive and chronic way of life at the expense of others, both in their food, clothing, housing, and personal expenses, being these people with the physical and cognitive capacity to do it by themselves, which constitutes an exploitation of others. This clinical manifestation reflects a severe pathology of the super-ego and corresponds to behaviors of the dissocial spectrum since it implies a form of chronic behavior of exploitation and significant irresponsibility in interpersonal relationships, characterized by the poor value given to persons or commitments, i.e., by a lack of objectal investment of others.

Although the problem of Social Parasitism exists, references to Social Parasitism are more related to anthropology, economics, sociology, and philosophy, but it is practically a non-existent topic in Mental Health.

We must consider that even though symptoms, somatizations, disorders (Somatoform, factitious, conversive, hypochondriasis, etc.), and actual diseases can lead to what we know as secondary gains, these could be resolved after helping the patient to become aware, nonetheless knowing there could be a resistance to change or any process of improvement; however, a different situation is given in patients that with full awareness and will use symptoms, exaggerate them or fake them with an exploitative purpose.

Parasitism often goes unnoticed inside homes, where it occurs slowly and progressively, and, therefore, it is sometimes difficult to recognize the limits and accept it as pathological. It is possible that cultural aspects, certain fears related to attachment, possible breakups, and a tendency to avoid conflicts influence the tendency to leave it out of the radar of the evaluation, producing a problem that generally takes place inside the home, where the patient leads a life of irresponsibility, taking advantage of and exploitation while the family suffers the economic and financial consequences, emotional exhaustion, intra-family dysfunction, etc. It is common for us to find cases with this profile, where the dissocial aspects were not evaluated in a targeted manner and therefore not diagnosed or not recorded, hence not addressing this inter-relational pathological area of the patient with their family and with others. On the contrary, professionals tend to focus on clinical areas and surface difficulties, thus perpetuating the current abnormal dynamics. At the other extreme, if parasitic elements are detected, the clinicians often give indications that are extreme for the family without a concordant, progressive, and adjusted work to the possibility of the patients, which leads to the perpetuation of the dynamics, generating more frustration in those involved and affected. For this reason, we wish to alert the professionals and thus keep a clear record of this diagnosis, its prognosis, future objectives, and compliance, making it essential to keep in mind this diagnosis in the evaluation process.

Background of the Social Parasitism Criterion

Although we might think that the Social Parasitism has existed since the beginning of time, the term began to be used and recorded during periods of social upheavals, such as the French and Russian Revolutions, where the term was used in a derogatory manner to refer to a social class belonging to aristocracy or the bourgeoisie, who were accused of living off an unearned income, at the expense of the productive class, which was the working class.

From anthropology, Marrs (1960), author of Social Parasites, defined it as “Anyone whose life is organized in such way that they are not capable to compensate through their services what they consume or take from others, falls into the parasitic classification.”(1)

For Serres, the parasite takes advantage of the host in an abusive way, without exchange, “the parasite takes and gives nothing; the host gives and receives nothing.” “The parasite lives from the host, with them, and in them.”(2) On the social level, Adam Smith states that the purpose of social wealth is to satisfy the human needs and must be the result of the work of each person; however, two types of social parasitism were found: one where the individual has not contributed to generate the wealth they appropriate, and another where the individual could have contributed but obtained an excessive compensation.(1)

The term Social Parasitism, given by its descriptive harshness, produces an impact on whoever hears it, and it could even generate some resistance or apprehension to its use in the evaluation; however, in practice, when using the term, it connotes and explicitly points out “The Problem,” that is how its use within the TFP model has been practical, descriptive, useful, and increasingly common.

Dissociative Parasitic Behavior

Up to this day, none of the specific psychotherapy models, except for the TFP Transferred Focused Psychotherapy, considers the parasitic behavior as an aspect to be assessed, evidenced, diagnosed, and intervened, perhaps because other models are designed for the symptoms and behavior reduction, and because at the basis of the different models and beliefs is the conviction that severe personality disorders (SPD) “cannot be controlled nor much cand be demanded of them,” since they present a “deficit problem” and cannot be required to have control over themselves, let alone be productive in life and generate their own economic livelihood.

For the TFP model, the SPDs have a “conflict” problem that can and must be addressed by appealing to the agentive part of the patient and, if necessary, to their environment. Another reason is due to the fact that the TFP Model moves away from the “goody-goody” strategies and does not avoid the search for hostile and aggressive elements of the patients but rather considers them to be the fundamental elements for a possible integrative work of such aspects, which would subsequently allow positive libidinal aspects to emerge and be maintained, without being destroyed.(3)

The patients to whom we refer generally show up, taken by their family without any reason for consultation from them, with little or no motivation to change, nor real concern about their future and that of others, which generates relational difficulties with parents or families who feel demanded to sustain or maintain them economically, whom we call “Submissive Supporters,” this is to distinguish it from the natural support of parents to children, adolescents or young adults who live at home with their parents in an agreed, collaborative, respectful and harmonious way, fulfilling part of the housework, until being in conditions, within a reasonable time, to start living independently, freely and harmoniously, which is something that parents should encourage and promote for the good of our children and ourselves.

However, we see in our clinic a growing number of male and female children of all ages, who live without making any collaborative efforts with their family, or society, that live at the expense of their parents, siblings, and partners, and ultimately are supported by the Government, either in the form of prolonged licenses, welfare pensions, mental disability, early retirement, or being in some type of State institution (Hospital, prison) which constitutes a significant economic loss for our State and a great drain on their family.

It is of utmost importance to determine what we know as “The Health Floor,” which derives from the consideration of the psychiatric pathology (Axis 1 of the DSM4) and of the Personality Structure or what was called Axis 2 in the DSM IV(4) for this from the structural interview we evaluated the areas (RADIOS): Reality Test, Levels or integration of Aggression, Defense Mechanism, Quality of Objectal Relationships, Value System.

The Integrated Value System would consist of the establishment of a moral structure or what Freud called the Super-ego, which would consist of a system of internalized conscious and unconscious values, reflecting the capacity to commit to universally accepted values and which, under normal conditions, would allow an empathic concern of others, and distinguish right from wrong, with a commitment to values and ideals, guided by a consistent, flexible, and fully integrated “Moral Compass” of oneself and others. However, under pathological conditions, less self-control and higher persecutory anxiety levels may be present, triggering poor to a total absence of concern for others, and from the consequences of one’s actions, with an absence of feelings of guilt, remorse, or genuine regret that can take to adequate reparation.(5-7)

On the other hand, it should be considered that the greater the degree of pathology in Moral Values, the greater the degree of severity of aggressive impulses that can lead to sadism and persecutory fantasies, which will manifest in self-aggressive behaviors or severe psychopathic behaviors.(8,9)

It is also essential to evaluate and determine the Degree of Infiltration of Aggression in Identity, Interpersonal Relationships, Sexuality, Work, and Behavior.

As we know, aggression is an impulse of our nature, and as long as there is an adequate modulation and assertive expression of it along with our demands, it will allow us to adapt to reality. Nevertheless, under adverse conditions, it may dominate the early development of the psychic apparatus with the formation of psychopathological structures typical of severe personality disorders. In these cases, the basic and normal affection of anger is polarized, magnified, and eventually becomes hatred in a nuclear form, which is a chronic, stable, and structural affect, that aims to destroy or dominate the object.(10-12)

It is necessary to point out that antisocial behavior does not constitute a diagnosis in itself, so it is relevant to evaluate in depth both the behaviors that belong to the dissocial spectrum, and fundamentally to determine the type of organization of a specific personality because therein lies the prognosis.

In light of this background, the antisocial behavior has traditionally been defined as acts or manifestations of a gradient spectrum behaviors, progressive, repetitive, and inappropriate for the age of the person, which are characterized by a frequent breach of coexistence rules of the culture to which they belong to, which actively generates harm, prejudice, disrespect of the rights of others or has an aggressive behavior towards other individuals or a group. The behavior can be characterized as a passive parasitic type or covert passive (e.g., lying, stealing, exploitation, social parasitism, etc.), or active overt, or overtly aggressive (e.g., aggravated burglary, kidnapping, property damage, physical assault, sexual, torture of humans or animals, homicide, etc.), however, such behaviors should not constitute per se the diagnosis of the Antisocial Personality Disorder, for that reason Dr. Otto Kernberg, the main creator of the TFP Model, considers that the primary and fundamental elements of the Dissocial Disorder is the absence of significant others and that should be evaluated and analyzed through a structural personality interview along with information from third parties.(13-15)

A significant contribution to the Applied TFP model and the Structural Interview has been formulated and proposed by Richard Hersh, who encourages clinicians directly ask and clarify matters related to finances, and economic situation, including income, spending patterns, debts, loans, and savings. These aspects give much information, which allows us to go deeper into the personality’s organization and encourages the appearance of transferential nuances and dynamics based on the questions.(16)

The TFP Model proposes to evaluate in every patient what we call the antisocial battery, which includes in the diagnostic evaluation period-specific and directed questions about: lies, theft, robbery, fraud, scams, forgery, financial exploitation, dishonesty, parasitism, prostitution, damage to private property, vandalism, harassment, kidnapping, physical or sexual assault, cruelty to people and/or animals, rape, torture, homicide, etc.(17,18)

With the aspects previously described, we could then evaluate and consider the nature of the antisocial behavior and determine its severity: if it corresponds to simple and isolated dissocial behavior without other negative prognostic implications or alternatively, determine whether such dissocial behavior is passive, chronic and severe. In the latter case, because of the destruction of resources involved and because it could be inserted into a low-functioning severe personality disorder, we could find patients with narcissism with dissocial patterns, malignant narcissism syndrome, or in front of a personality disorder with a worse prognosis, such as the antisocial personality disorder or dissocial disorder itself.

In this spectrum of a low organization is likely to find individuals with a severe reduction in sublimatory functions so that their capacity for productivity or creativity will be compromised beyond the needs of survival, in such a way that they present severe and chronic failures in their work or profession, which would condition labor failure. With this then appears the demand of being maintained or subsidized by their family, or the State, adding years of work absence, which increases the difficulty of a possible return to work proportionally(17,18). In this regard, Dr. Michael Stone concludes that it is unlikely that a patient will return to work if their economic income or economic benefit obtained by some type of “welfare assistance” (e.g., Medical leave, welfare pension, disability) is less than 1,5 times of what they would receive if they returned to work since this would avoid making a more significant effort and committing to more responsibilities, in some cases, it could even prevent having to endure the “humiliation” of performing in an inferior job or the resignation of a vengeful expectation.(18,19)

Patients with severe personality disorders (borderline personality organization) have been stopped in their psychic development without presenting any cognitive or neurological limitations that disables them from having a normal life, and therefore there is no valid clinical reason to retire, receive disability pension benefits, nor being supported or maintained by their family or by the State.(16,17,19)

The above is applicable when there is no congenital disease such as mental deficiency or acquired disease such as a cerebral organic deterioration after a cerebral trauma or disease that leaves a defect such as schizophrenia, where for obvious reasons, we cannot propose overly ambitious social and labor goals.

DISCUSSION

As we know, the elimination or reduction of the secondary gain of the disease is one of the most challenging and essential aspects of establishing the initial contract and a viable treatment framework that leads to concrete goals. However, Social Parasitism should not be diagnosed and treated as a “secondary gain,” as it minimizes the magnitude of the severity and the harm of a frank structural dissocial behavior and may thus remain as a “psychological difficulty” that can be intervened later, after obtaining an “alliance” and being in better conditions. This would leave aside a clear permanent and inconsiderate exploitation of those they exploit since the patient maintains captive to their supporter through threats, manipulations, blackmail, self, and hetero aggressions, which can converge and include suicidal threats, before which the family is terrified and desists from any change. Theory and clinical practice show that these dynamics and their opposites will be staged with us as part of the transferential dynamics, and therefore we must keep it in mind and prepare ourselves for adequate management without falling into “good” postures that can be powerful mechanisms that operate in the interaction, such as the countertransference, counter identification, projective identification, omnipotent control and other defensive mechanisms based on excision or derived directly from fear, blackmail, coercion or even worse from carelessness.

The severity of the patients with personality disorders can be very variable. Hence, an exhaustive evaluation of the subject’s current functioning, carried out with sufficient clarity, frankness, and naturalness, covering all areas of functioning is indispensable, even when the patient is unaware of it and does not consider it problematic.

Those of us who have received the contribution and training in TFP have an interest in people or patients: passive, dishonest, chronically dependent, with uncontrolled hetero and self-aggressive impulses, and dissocial behaviors, that deserve to be identified and intervened as soon as possible because the sustained Social Parasitism constitutes an indicator of negative prognosis, which will require greater attention in the most rigorous agreements and frameworks. For this reason, we consider that it is our professional obligation to prevent, diminish or at least warn about possible damage, unfavorable prognosis, and chaotic consequences, not only in the patients but also in their families, who also have and must enjoy the right to have a life in freedom, peace, and dignity, without losses or wastes. In addition, we have a professional obligation and a collective social responsibility since economic resources come from the public system or private entities, so we are all affected; for these reasons, “Social Parasitism” should be incorporated and enter the “scientific knowledge” and therefore to future investigations.

In future articles, we will propose clinical, dynamic, and strategic considerations in the evaluation and, subsequently, proposals for possible interventions and approaches for the relatives of patients with a parasitic profile.

REFERENCES