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Delinquent and normal adolescents
Delinquent
and Normal Adolescents
By Daniel Offer, Richard C. Marohn, and Eric Ostrov
T
HE PURPOSE OF THIS ARTICLE is to describe a research and treatment program for juvenile delinquents. Within the context of the study, a series of semistructured interviews of delinquent adolescents and matched normal controls has been undertaken, The interviews were structured to elicit the teen-agers’ responses regarding eleven aspects of their current lives. We were searching for behavioral and attitudinal norms within and between the delinquent and normal groups. Findings concerning the major differences and similarities between the two groups will be outlined. Sociological and socioeconomic conditions have been given a central role in explainMost of these sociological studies ing the etiology of juvenile delinquency. 499~11~19-21 have described lower-class delinquency. Recently, interest in middle-class delinquency has increased because of the rise in juvenile crimes in relatively stable middle-class environments. 13 The sociological studies have emphasized poor economic conditions, deteriorating neighborhoods, downward mobility, the formation of a delinquent subculture with its own values (i.e. gang delinquency), and the theory of drift. Psychiatrists and psychoanalysts have studied mainly middle-class delinquents whom they treated in their consulting rooms. The etiology of delinquency, thus, has been attributed by psychiatrists and psychoanalysts to the personality characteristics of the juvenile delinquent.‘*698 Johnson and Szurek, lo while giving a psychological explanation, described the etiology of delinquency in terms of the family system. According to their theory, there is a superego defect in the parent that is communicated to the child, and the child ends up acting out the unconscious fantasies of the parents. There are remarkably few reports that attempt to combine the sociological and psychiatric findings. (Baittle and Kobrin’ are among the few exceptions). A recent article by McCord’ * illustrates the lack of cross-disciplinary communication. In his article, on the psychological aspects of delinquency, not a single reference is made to a psychiatric or psychoanalytic study. The overall purpose of the research program on juvenile delinquents was to study the behavior and psychodynamics of the delinquent adolescent and his family and to compare the data collected to data previously obtained by Offerls from a study of normal adolescents, and to determine what factors contributed significantly to delinquent behavior among teen-agers. We studied a group of juvenile delinquents whose past behavior conclusively demonstrated that delinquency was one of their major problems. We studied biological, psychological, and sociological variables in order to ascertain which variables contributed significantly in the past to the outbreak of delinquent behavior. Since we had an opportunity to observe the teenagers closely for From the Institute for Psychosomatic and Psychiatric Research and Training, Michael Reese Hospital, and the Michael Reese Unit, Illinois State PsychiatricInstitute, Chicago, Ill. Supported by Grant A 70-15 from the Illinois Law Enforcement Commission, June 1971. Daniel Offer, M. D.: Associate Director, Institute for Psychosomatic and Psychiatric Research and Training, Michael Reese Hospital, Chicago, Ill. RichardC. Marohn,M.D.: Chief; Michael Reese Unit, Illinois State Psychiam’c Institute, Chicago, Ill. Eric Ostrov: Research Associate, Michael Reese Unit, Illinois State PsychiatricInstitute, Chicago, Ill. Comprehensive Psychiatry, Vol. 13, No. 4 (July/August), 1972
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at least three months, we studied a host of variables on the unit. The factors that led to antisocial behavior on the unit were studied, and staff attitudes toward the patients were carefully monitored. Hence, a study of the interaction of the complex set of variables under close observation led us to a better understanding of the outbreak of delinquent behavior on a larger scale. And, an analysis of the biopsychosocial variables in our sample led us toward a better understanding of the etiology of juvenile delinquency. It was our hypothesis that there were different types of juvenile delinquents. Specifically, we hypothesized two major classes of delinquents: Juvenile delinquents whose behavior resulted from an underlying (and unidentified) depression, and juvenile delinquents whose impulsive behavior was caused by an underlying character disorder. The character disorder may have been psychopathic (i.e. deficient superego development), or immature (i.e. poor ego development). The foregoing types were not exclusive of one another. In addition we theorized that (1) since all juvenile delinquents were going to be treated psychiatrically, we had an opportunity to examine the kind of psychotherapy best suited to delinquent adolescents. Our follow-up study helped us in assessing the extent of the success (or failure) of the method of therapy. (2) The study of the staffs attitudes aided us in developing a profile of the person who could work most effectively with adolescents. Since we also studied probation and police officers, we were able to compare the attitude of law enforcement personnel with that of the psychiatric staff. (3) The study of the communication of affect and nonverbal communication between the teenagers and the adult world (parents and staff) was crucial for the understanding of acting-out behavior. It was our hypothesis that in the second class of delinquents (those suffering from an underlying character disorder) the psychopathology was shared by both generations in the family. We therefore predicted that these families would perform differently on our instruments than the group of families in which the teenager was suffering from an underlying depression. Using Milmoes ’ 4 techniques of filtered interviews, we predicted that there would be more discrepancy between the ratings of the filtered vs. nonfiltered (verbal) interviews in parents of the character disorder group of nondelinquent psychiatric patients and the siblings of the patients studied. METHOD The juvenile delinquency project has been in operation at the Illinois State Psychiatric Institute since March 1969. Ten juvenile delinquents are hospitalized on the Michael Reese Service of the Institute at any given time. The male and female patients sre between the ages of 13 and 17 and are in need of psychiatric hospitalization. Our group included patients who had performed any of the delinquent acts of theft, larceny, assault, property destruction, sexual promiscuity, truancy, and drug abuse. We included neurotics, character disorders, borderline characters, and antisocial, paranoid, and schizoid personalities. We excluded psychotics, schizophrenics, mental defectives, and patients with organic brain diseases. The average stay in the hospital was four months. Patients were treated as indicated, with individual, family, and/or group psychotherapy. They almost always continued their therapy in the outpatient department. During the first month of hospitalization, one senior author interviewed all patients in semistructured psychiatric interviews. These interviews were identical to the ones that he previously administered to a specially selected group of normal* adolescents. “*t6 Out of the 84 normal teen-agers that were studied previously, and they were matched to 25 juvenile delinquents. The first populations were matched for age, sex, race, and social class. *The definition of normality utilized in this project is “normality as average.” (For details see Offer and Sabshin.“)
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Their average age was 15.5 years. There were three black students in each group. The average social class was 3.5, based on a scale of one through seven of the National Opinion Research Center of the University of Chicago. (Only the father’s occupation was utilized for the analysis of social class). All of the adolescents came from intact homes. Within the context of each interview (see the Semistructured Interview at end of this article), we asked the adolescents questions regarding: impulse control (question 1) vocational and educational goals (questions S-7), attitudes toward idealism, altruism, and concern for others (question 3), sexuality (question 8) and coping abilities and ego strength (questions 2 and 9). Each interview was separately dictated shortly after it was given. The typed material was later given to an independent rater who rated the interviews, based on a specially constructed rating scale. (See the Ratings for the Semistructured Interview at end of this article.) The purpose of the rating scale was to determine objectively which items differentiated between the delinquent and normal population and which did not. Reliability of the ratings were checked with a second rater who rated 15% of the interviews. The ratings were found to be reliable. The Fisher Exact Test was used to determine levels of significance, and only findings that reached the 0.05 level of significance will be reported. Description of the Treatment Program The Illinois State Psychiatric Institute is a 250-bed state hospital devoted to research training and service. The Michael Reese Unit is a closed ward that provides psychiatric, psychological, medical, nursing and social services, activity therapy, and school and vocational counseling to hospitalized delinquents. The unit served not only as the site of the research project, but also as a testing ground for developing model methods of treatment intervention. Patients chosen for admission to the unit are screened by the treatment and research staff once a week. Referrals come from private therapists, probation officers, courts, social agencies, and schools. Our definition of delinquency is society’s definition: namely, violation of the law, whether known to the authorities or not. Violation includes offenses such as theft, running away, truancy, and drug abuse. Most of our patients have had contact with the police, and many had already been held in detention centers or were on probation. The hospital program was structured around school, activities, and group meetings. A ward staff of 14 childcare workers, psychiatric nurses, and psychiatric aides maintained the on-going milieu. Crucial to the success of any inpatient treatment program for adolescents is the philosophy that combines structure and limit settings with an emphasis on understanding deviant behavior rather than merely punishing it.’ Privileges within the hospital were not rewards for good behavior, but were responsibilities given to the adolescent consistent with his capacities, controls, and progress in therapy. Although these comments apply in general to the treatment of adolescents, they are especially pertinent to the treatment of delinquents. Privileges on the unit were reviewed weekly by a committee of five permanent staff members and the patient’s therapist. This committee, called the Adolescent Progress Review, not only reviewed the behavior and privileges of each patient, but also discussed these issues with the adolescent every week. Decisions were made in line with the treatment plan that was developed at the therapist’s weekly team meeting in which the patient’s progress in therapy treatment goals and staff issues as they applied to the treatment of the individual patient were discussed. The day and early evening hours on the unit were structured around school, activities and group meetings. A school program with teachers who were interested in understanding and modifying unusual behavior and who possessed the capacity to motivate the resistant student provided the patient with opportunities to enhance his coping abilities in social skills. Activities both within the hospital and community had similar advantages but provided diversion, the release of energy, and grist for the therapeutic mill. Small group therapy meetings and daily ward meetings were particularly useful to the adolescent because they focused on the important role played in his life by his peers, as well as on the influence of others on his delinquent behavior, and on the management of group antisocial and contagious behavior in a hospital. Because of the ready ability of the adolescents to split the staff and to provoke intense countertransference feelings in adults, open communication between staff members was particularly im portant. The impulsive adolescent’s need for instant gratification and his capacity to seduce such gratification from the psychotherapist made it imperative that administrative decisions such as privileges and passes be made by an interdisciplinary committee (the Adolescent Progress Review mentioned before). This approach provided consistency and continuity for all the patients.
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The aftercare and follow-up treatment program was provided through a number of means. Outpatient psychotherapy was usually continued after the patient was discharged from the hospital. This took the form of individual psychotherapy sessions with a therapist as well as family therapy sessions that had been begun prior to discharge. A weekly discharge group met, and a number of patients were involved in this activity as well. Rarely were our discharged patients referred to another facility such as mental health clinics or family service agencies, or to private therapists; but, such resources could have been utilized if necessary. RESULTS
The delinquent group smoked cigarettes and drank alcohol significantly more than the normal group, and also had a more permissive attitude towards both. We do not have data concerning drug experiences and attitudes towards drugs in the normal group. In the delinquent group, two thirds had smoked marihuana, and half had taken drugs excluding heroin. Only one patient had taken heroin. The attitude of the delinquent group was: 25% were against all drugs except marihuana, 25% felt drug taking was up to the individual, 25% were for all drugs except heroin, and 25% refused to give an opinion. In other words, 75% of the patients were positively inclined towards marihuana. There was a significant difference between the groups’ attitudes toward education. The delinquents were decidedly more negative in their feelings about school and studying. The normal group was more concerned with its vocational and educational future than was the delinquent group, and rated it as one of its top three concerns. The delinquent adolescents displayed less imagination in describing their values and attitudes than did the normal adolescents. The normal group gave more complex answers because they saw more possibilities. It was the delinquent group that saw the world in black-and-white terms; the normal group left more room for variation. The delinquent group had significantly more and earlier heterosexual experience. The delinquent teenagers believed that it was more important to have friends of the opposite sex and did not feel that relationships with either their parents or with peers of the same sex were very important. There were marked differences in the two groups’ abilities to cope with the effects of anxiety, depression, shame, guilt, and anger. (p < 0.001). The normal group was able to tolerate ambivalent feelings towards parents and/or siblings with insight and with very little acting out. As one would expect, the delinquent group showed little ability to tolerate ambivalent feelings and resorted to acting out whenever the feelings became too intense. The relationships between the psychiatrists and the interviewees (the Research Alliance) was much better in the normal than in the delinquent group. No differences were found between the two groups in idealism, altruism, the concern for fellow human beings, the wish for meaningful relationships, or the awareness of individual problems. DISCUSSION
The two groups studied were chosen, in part, because they belonged to the two polarities in the present-day adolescent population. One, the delinquent group, was composed of teenagers whose behavior had been impulsive, antisocial, and who, in addition had serious personality difficulties. The second group, the normal one, was composed of adolescents who were typical or modal in their behavior. They did not function in the superior range, but throughout their lives they had shown the capacity to adapt to themselves, their families and friends, and to their social environments.
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They had minimal neurotic conflicts, were active doers, and did not rebel significantly against their parents or society. The question can legitimately be asked whether we obtained more complex information from our normal subjects because we were able to develop a better research alliance with them. We cannot give a complete answer, but it is our distinct impression that the healthier teen-agers were able to develop a better and more meaningful relationship with us because they had stronger egos and were less threatened by relationships with adults. We also have to keep in mind the possibility that in each study we obtained, at least in part, the data we were seeking. Rosenthali calls this effect the experimenter effect in behavioral research. Thus, the normal teenagers supplied us with more normal data, and the delinquent with less. However, it is important to stress that both groups participated in the study voluntarily and without financial remuneration. In addition, our findings pointed to unexpected similarities as well as to differences between the two groups. We found great differences between these two groups in impulse control, ego structure, and coping style. The delinquent group had a more primitive ego structure and was less able to tolerate frustration or to plan for the future. They needed to gratify themselves when an impulse arose or when the social environment placed limits (through laws) on their functioning. Hence, they smoked, drank alcohol, and took drugs when they were frustrated or tense. They had not developed the defense of sublimation sufficiently, and their future goals, education, or a better vocation were too distant to have a meaningful effect. In the area of sexuality, which is so intimately tied with aggression, we also saw a need or wish for immediate gratification. Early sexual gratification may also have had the disadvantage of replacing too rapidly the homosexual friendships that are important in the development of the individual teenager (in that they help him to have a better capacity for object relationship). Deutsch’ describes the situation for adolescent girls: “I consider those girls who are involved prematurely in ‘free love’ as not the victors but the victims of the rebellious adolescent society. A great number of them are still involved in their earlier relationships with girlfriends. They ‘fool around,’ as the saying goes, with boys-but it is still with a side glance at the girls, and the heterosexual activity actually shows very little inner participation.” Blos3 describes a type of frantic heterosexual activity that is defensive. He explains this in terms of the preoedipal attachment to the parent that is now revived. The pseudoheterosexuality of this type of delinquent adolescent serves as a defense against the regressive pull to the preoedipal parent, that is, against homosexuality. The apparent early maturation of the delinquent group can have many negative (neurotic) consequences. Our findings concerning attitudes were different from what we expected. Our data demonstrated that when teenagers are matched by sex, age, race, and social class, there were no significant differences between certain values held by delinquent and normal teen-agers. We have found in the past that although parents and teenagers differ on many issues, the differences fade when they deal with the basic issues-ethics, religion, and politics. I5 We have not studied the value systems of the parents or of the delinquents to any great extent. It is, however, important to stress that in our study no differences in idealism, altruism, or concern for others was found between the delinquent and normal groups. The sociological theories, described in the introduction, that placed such heavy emphasis on the difference in values might have been more apparent
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than real. They might have reflected the fact that sociologists have, by and large, studied lower-class and gang delinquency and compared the values of the teenagers to the prevailing middle-class norms. CONCLUSIONS It has been our experience in treating juvenile delinquents admitted to a psychiatric hospital that the most important aspect of the treatment program is the group experience. Individual therapy can supplement the milieu experience and optimally should come after the adolescent has developed a better capacity for controlling his acting out. This can be judged best by closely observing the adolescent’s behavior on the unit, in the school, and in his interactions with his peers. The move back to the community is the final test. During the first few weeks home the adolescent will encounter much stress, and his newly acquired ego strength will undergo multiple tests. If the teenager survives them he is truly on the road to recovery. In summary, this multivariable, biopsychosocial study of juvenile delinquents and its contrast with normal teenagers previously studied will aid us in further understanding the psychology and behavior of delinquent adolescents. It will, hopefully, shed some light on the environmental, interpersonnel, and intrapsychic factors that lead to outbreaks of delinquent behavior among teenagers. The model treatment program will help us to understand how we can treat these adolescents. Finally, once the etiological factors that contribute to juvenile delinquency are elucidated we should be able to treat the early manifestations of juvenile delinquency and possibly even to develop reasonable preventive programs. The delinquent adolescents demonstrated poorer impulse control and superego development. In addition, they had fewer emotional resources available to them. Their ability to cope was limited, and when crises came their way they acted to relieve the pressures. They were not as flexible as their normal peers and could not utilize external resources to relieve internal pressures. Hence, their frustration tolerance was low, and their ability to postpone gratifications was very limited. SEMISTRUCTURED
INTERVIEW
Explain the purpose of the research. Basically it is to find out from teenagers what their feelings and thoughts on important issues are; an opportunity for a dialog. 1. What does he think of smoking, drinking, and taking drugs during high-school years? What have been his experiences? What is his attitude toward it? What does he think of the dropout problem? 2. Give two typical early memories. 3. If he had three wishes, what would they be? What would he do with a million dollars? If he were alone on a desert island and could have one person with him, whom would he select? 4. His picture of the ideal mother, father, and teacher. Whom, outside his family, does he admire most? 5. What are the three major problems of teenagers? How do they affect the important
(DELINQUENTS-NORMALS) people in his life (e.g., parents, siblings, boyfriends, girlfriends, teachers, and ministers)? 6. What are his goals for the future? What does he think he will be lie 10 years from now? 7. What are his vocational and educational goals for the future? Did he work or go to school? In either case, did he get pleasure from his activity? 8. Does he feel it is important for a teenager to have a girlfriend? The answer is explored in great detail. We obtain information on dating history and sexual behavior. 9. The subject’s ability to cope with the following affects are explored: anxiety, depression, shame, guilt, and anger. The subject is asked to give examples of the kind of experiences he had with these affects, how long they
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lasted, what he does to cope with them, and how successful he is.
10. What did he think of the interview? Any comments, additions, or questions?
REFERENCES 1. Aichorn, A.: Wayward Youth. New York, Meridian, 1925. 2. Baittle, B., and Kobrin, S.: On the relationships of a characterological type of delinquent to the milieu. Psychiatry 27:6, 1964. 3. Blos, P.: On Adolescence. New York, Free Press, 1962. 4. Cohen, A. K.: Delinquent Boys: The Culture of the Gang. Glencoe, Free Press, 1955. 5. Deutsch, H.: Selected Problems of Adolescence. New York, International Universities, 1967, p. 100. 6. Eisler, K. (Ed.): Searchlights on Delinquency. New York, International Universities, 1949. 7. Falstein, E., Feinstein, S. C., and Cohen, W. P.: An integrated adolescent care program in a general psychiatric hospital. Amer. J. Orthopsychiat. 30:276, 1966. 8. Friedlander, K.: The Psychoanalytical Approach to Juvenile Delinquency, New York, INP, 1947. 9. Glueck, S., and Glueck, E.: Family Environment and Delinquency. Boston, Houghton Mifflin, 1962. 10. Johnson, A. M., and Szurek, S. A.: The genesis of antisocial acting out in children and adults. Psychiat. Quart. 21:323, 1952. 11. Matza, D.: Delinquency and Drift. New York, Wiley, 1964.
12. McCord, W.: Delinquency: psychological types. In Sills, D. L. (Ed.): International Encyclopedia of the Social Sciences, Vol. 4. New York, MacMillan, Free Press, 1968. 13. Miller, J. G.: Research and theory in middle class delinquency, Brit. J. Crim., 33:51, 1970. 14. Milmoe, S., Rosenthal, R., Blanc, H., Chafetz, M., and Wolf, I.: The doctor’s voice: Postdictor of successful referral of alcoholic patients. J. Abnorm. Psychol. 72:78, 1967. 15. Offer, D.: The Psychological World of the Teen-ager. New York, Basic Books, 1969, p. 193. 16. -, and Offer, J. L.: Profiles of normal adolescent girls. Arch. Gen. Psychiat. 19513, 1968. 17. -, and Sabshin, M.: Normality. New York, Basic Books, 1966, p. 105. 18. Rosenthal, R.: Experimental Effects in Behavioral Research. New York, AppletonCentury-Crofts, 1966. 19. Shaw, D., and McKay, H.D.: Juvenile Delinquency and Urban Areas. Revised Edition. Chicago, University of Chicago Press, 1969. 20. Short, J. F., Jr., and Strodtbeck, F. L.: Group Process and Gang Delinquency. Chicago, University of Chicago Press, 1965. 2 1. Thrasher, F. : The Gang. Chicago, University of Chicago Press, 1936.
Ratings for Semi-structured Interview (Delinquents - Normals) Name of Student 1. Has he A. Smoked tobacco? l.Yes~-NO_ 3. N.A. If No, does he approve? 1. Yes _ 2.No_ B. Drunk alcohol? 1. Yes2.No3. N.A. _ If No, does he approve? 1. Yes 2.No-
C. An attitude toward the dropout problem? 1. Students should leave at will_ 2. Students should continue in school 3. Does not care _ 4. N.A. D. Smoked marihuana more than once? 1. Yes 2.No3. N.A. _ E. Taken drugs (other than marihuana and heroin) more than once? 1. Yes-
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2.No3. N.A. F. Taken heroin more than once? 1. Yes _ 2.No3. N.A. G. An attitude toward drugs? 1. Against all drugs, including marihuana 2. Against all drugs except marihuana 3. For all drugs except heroin _ 4. For marihuana only 5. Drug taking is up to the individual 6. Drugs can be helpful _ 1. N.A. _ 2. Early memories (Is anyone mentioned in them?) 1. Yes2.No3. N.A. 3. Three wishes A. Happiness 1. Mentioned 2. Not mentioned _ 3. N.A. B. Success (and good job) 1. Mentioned 2. Not mentioned 3. N.A. _ C. Wealth 1. Mentioned 2. Not mentioned 3. N.A. _ D. Academic achievement (and intelligence) 1. Mentioned 2. Not mentioned _ 3. N.A. _ E. Athletic achievement 1. Mentioned _ 2. Not mentioned 3. N.A. F. Altruism (and idealism) 1. Mentioned _ 2. Not mentioned 3. N.A. G. Interpersonal relations 1. Mentioned 2. Not mentioned 3. N.A. _ H. Other 1. Mentioned _ 2. Not mentioned 3. N.A. _
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4. Million dollars A. Invest or save 1. Mentioned 2. Not mentioned 3. N.A. _ B. Give to parents 1, Mentioned 2. Not mentioned _ 3. N.A. _ C. Buy things for self 1. Mentioned _ 2. Not mentioned _ 3. N.A. _ D. Buy things for parents 1. Mentioned _ 2. Not mentioned 3. N.A. L_ E. Give some to charity 1. Mentioned 2. Not mentioned 3. N.A. _ F. Other 1. Mentioned _ 2. Not mentioned _ 3. N.A. _ 5. Desert Island A. Be with parent 1. Mentioned _ 2. Not mentioned _ 3. N.A. c_ B. Be with teacher (or coach) 1, Mentioned _ 2. Not mentioned 3. N.A. _ C. Be with other adult 1. Mentioned _ 2. Not mentioned 3. N.A. c_ D. Be with student of the same sex 1. Mentioned 2. Not mentioned 3. N.A. _ E. Be with student of opposite sex 1. Mentioned 2. Not mentioned 3. N.A. _ F. Other 1. Mentioned _ 2. Not mentioned 3. N.A. 6. Three problems A. Vocational and educational goals 1. Mentioned 2. Not mentioned 3. N.A. _
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B. Impulse control (and drugs and delinquency) 1. Mentioned _ 2. Not mentioned 3. N.A. C. Interpersonal relations 1. Mentioned L_ 2. Not mentioned 3. N.A. _ D. Growing up I. Mentioned _ 2. Not mentioned 3. N.A. E. Handling sex 1. Mentioned _ 2. Not mentioned 3. N.A. F. Other 1. Mentioned 2. Not mentioned 3. N.A. _ 7. Future goals 1. Generally positive 2. Generally negative 3. N.A. _ 8. To have girl (or boy) friends 1. Are important _ 2. Not important _ 3. Don’t know 4. N.A. 9. Does subject have a friend of the opposite sex? l.Yes_ 2.No_ 3. N.A. 10. Has had sexual relations 1. Yes _
2.No3. N.A. _ 11. Based on response to questions concerning anxiety, depression, shame, guilt, or anger, subject’s psychological sophistica tion was 1. Excellent; ability to tolerate ambivalent feelings toward parents and/or siblings with insight and without acting out 2. Good; ability to tolerate ambivalent feelings toward parents and/or siblings with little insight and without acting out 3. Fair; ability to tolerate ambivalent feelings toward parents and/or siblings without insight but with minima1 acting out 4. Poor; no real ability to tolerate ambivalent feelings and much acting out 5. N.A. 12. Subject’s relationship with interviewer was 1. Excellent; subject gave elaborate answers and introduced new material of his own _ 2. Good; subject gave elaborate answers without introducing new material of his own 3. Fair; simple and direct answers 4. N.A. 13. Subject was 1. Very likeable _ 2. Likeable 3. Somewhat likeable _ 4. Not likeable -
and Normal Adolescents
By Daniel Offer, Richard C. Marohn, and Eric Ostrov
T
HE PURPOSE OF THIS ARTICLE is to describe a research and treatment program for juvenile delinquents. Within the context of the study, a series of semistructured interviews of delinquent adolescents and matched normal controls has been undertaken, The interviews were structured to elicit the teen-agers’ responses regarding eleven aspects of their current lives. We were searching for behavioral and attitudinal norms within and between the delinquent and normal groups. Findings concerning the major differences and similarities between the two groups will be outlined. Sociological and socioeconomic conditions have been given a central role in explainMost of these sociological studies ing the etiology of juvenile delinquency. 499~11~19-21 have described lower-class delinquency. Recently, interest in middle-class delinquency has increased because of the rise in juvenile crimes in relatively stable middle-class environments. 13 The sociological studies have emphasized poor economic conditions, deteriorating neighborhoods, downward mobility, the formation of a delinquent subculture with its own values (i.e. gang delinquency), and the theory of drift. Psychiatrists and psychoanalysts have studied mainly middle-class delinquents whom they treated in their consulting rooms. The etiology of delinquency, thus, has been attributed by psychiatrists and psychoanalysts to the personality characteristics of the juvenile delinquent.‘*698 Johnson and Szurek, lo while giving a psychological explanation, described the etiology of delinquency in terms of the family system. According to their theory, there is a superego defect in the parent that is communicated to the child, and the child ends up acting out the unconscious fantasies of the parents. There are remarkably few reports that attempt to combine the sociological and psychiatric findings. (Baittle and Kobrin’ are among the few exceptions). A recent article by McCord’ * illustrates the lack of cross-disciplinary communication. In his article, on the psychological aspects of delinquency, not a single reference is made to a psychiatric or psychoanalytic study. The overall purpose of the research program on juvenile delinquents was to study the behavior and psychodynamics of the delinquent adolescent and his family and to compare the data collected to data previously obtained by Offerls from a study of normal adolescents, and to determine what factors contributed significantly to delinquent behavior among teen-agers. We studied a group of juvenile delinquents whose past behavior conclusively demonstrated that delinquency was one of their major problems. We studied biological, psychological, and sociological variables in order to ascertain which variables contributed significantly in the past to the outbreak of delinquent behavior. Since we had an opportunity to observe the teenagers closely for From the Institute for Psychosomatic and Psychiatric Research and Training, Michael Reese Hospital, and the Michael Reese Unit, Illinois State PsychiatricInstitute, Chicago, Ill. Supported by Grant A 70-15 from the Illinois Law Enforcement Commission, June 1971. Daniel Offer, M. D.: Associate Director, Institute for Psychosomatic and Psychiatric Research and Training, Michael Reese Hospital, Chicago, Ill. RichardC. Marohn,M.D.: Chief; Michael Reese Unit, Illinois State Psychiam’c Institute, Chicago, Ill. Eric Ostrov: Research Associate, Michael Reese Unit, Illinois State PsychiatricInstitute, Chicago, Ill. Comprehensive Psychiatry, Vol. 13, No. 4 (July/August), 1972
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at least three months, we studied a host of variables on the unit. The factors that led to antisocial behavior on the unit were studied, and staff attitudes toward the patients were carefully monitored. Hence, a study of the interaction of the complex set of variables under close observation led us to a better understanding of the outbreak of delinquent behavior on a larger scale. And, an analysis of the biopsychosocial variables in our sample led us toward a better understanding of the etiology of juvenile delinquency. It was our hypothesis that there were different types of juvenile delinquents. Specifically, we hypothesized two major classes of delinquents: Juvenile delinquents whose behavior resulted from an underlying (and unidentified) depression, and juvenile delinquents whose impulsive behavior was caused by an underlying character disorder. The character disorder may have been psychopathic (i.e. deficient superego development), or immature (i.e. poor ego development). The foregoing types were not exclusive of one another. In addition we theorized that (1) since all juvenile delinquents were going to be treated psychiatrically, we had an opportunity to examine the kind of psychotherapy best suited to delinquent adolescents. Our follow-up study helped us in assessing the extent of the success (or failure) of the method of therapy. (2) The study of the staffs attitudes aided us in developing a profile of the person who could work most effectively with adolescents. Since we also studied probation and police officers, we were able to compare the attitude of law enforcement personnel with that of the psychiatric staff. (3) The study of the communication of affect and nonverbal communication between the teenagers and the adult world (parents and staff) was crucial for the understanding of acting-out behavior. It was our hypothesis that in the second class of delinquents (those suffering from an underlying character disorder) the psychopathology was shared by both generations in the family. We therefore predicted that these families would perform differently on our instruments than the group of families in which the teenager was suffering from an underlying depression. Using Milmoes ’ 4 techniques of filtered interviews, we predicted that there would be more discrepancy between the ratings of the filtered vs. nonfiltered (verbal) interviews in parents of the character disorder group of nondelinquent psychiatric patients and the siblings of the patients studied. METHOD The juvenile delinquency project has been in operation at the Illinois State Psychiatric Institute since March 1969. Ten juvenile delinquents are hospitalized on the Michael Reese Service of the Institute at any given time. The male and female patients sre between the ages of 13 and 17 and are in need of psychiatric hospitalization. Our group included patients who had performed any of the delinquent acts of theft, larceny, assault, property destruction, sexual promiscuity, truancy, and drug abuse. We included neurotics, character disorders, borderline characters, and antisocial, paranoid, and schizoid personalities. We excluded psychotics, schizophrenics, mental defectives, and patients with organic brain diseases. The average stay in the hospital was four months. Patients were treated as indicated, with individual, family, and/or group psychotherapy. They almost always continued their therapy in the outpatient department. During the first month of hospitalization, one senior author interviewed all patients in semistructured psychiatric interviews. These interviews were identical to the ones that he previously administered to a specially selected group of normal* adolescents. “*t6 Out of the 84 normal teen-agers that were studied previously, and they were matched to 25 juvenile delinquents. The first populations were matched for age, sex, race, and social class. *The definition of normality utilized in this project is “normality as average.” (For details see Offer and Sabshin.“)
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Their average age was 15.5 years. There were three black students in each group. The average social class was 3.5, based on a scale of one through seven of the National Opinion Research Center of the University of Chicago. (Only the father’s occupation was utilized for the analysis of social class). All of the adolescents came from intact homes. Within the context of each interview (see the Semistructured Interview at end of this article), we asked the adolescents questions regarding: impulse control (question 1) vocational and educational goals (questions S-7), attitudes toward idealism, altruism, and concern for others (question 3), sexuality (question 8) and coping abilities and ego strength (questions 2 and 9). Each interview was separately dictated shortly after it was given. The typed material was later given to an independent rater who rated the interviews, based on a specially constructed rating scale. (See the Ratings for the Semistructured Interview at end of this article.) The purpose of the rating scale was to determine objectively which items differentiated between the delinquent and normal population and which did not. Reliability of the ratings were checked with a second rater who rated 15% of the interviews. The ratings were found to be reliable. The Fisher Exact Test was used to determine levels of significance, and only findings that reached the 0.05 level of significance will be reported. Description of the Treatment Program The Illinois State Psychiatric Institute is a 250-bed state hospital devoted to research training and service. The Michael Reese Unit is a closed ward that provides psychiatric, psychological, medical, nursing and social services, activity therapy, and school and vocational counseling to hospitalized delinquents. The unit served not only as the site of the research project, but also as a testing ground for developing model methods of treatment intervention. Patients chosen for admission to the unit are screened by the treatment and research staff once a week. Referrals come from private therapists, probation officers, courts, social agencies, and schools. Our definition of delinquency is society’s definition: namely, violation of the law, whether known to the authorities or not. Violation includes offenses such as theft, running away, truancy, and drug abuse. Most of our patients have had contact with the police, and many had already been held in detention centers or were on probation. The hospital program was structured around school, activities, and group meetings. A ward staff of 14 childcare workers, psychiatric nurses, and psychiatric aides maintained the on-going milieu. Crucial to the success of any inpatient treatment program for adolescents is the philosophy that combines structure and limit settings with an emphasis on understanding deviant behavior rather than merely punishing it.’ Privileges within the hospital were not rewards for good behavior, but were responsibilities given to the adolescent consistent with his capacities, controls, and progress in therapy. Although these comments apply in general to the treatment of adolescents, they are especially pertinent to the treatment of delinquents. Privileges on the unit were reviewed weekly by a committee of five permanent staff members and the patient’s therapist. This committee, called the Adolescent Progress Review, not only reviewed the behavior and privileges of each patient, but also discussed these issues with the adolescent every week. Decisions were made in line with the treatment plan that was developed at the therapist’s weekly team meeting in which the patient’s progress in therapy treatment goals and staff issues as they applied to the treatment of the individual patient were discussed. The day and early evening hours on the unit were structured around school, activities and group meetings. A school program with teachers who were interested in understanding and modifying unusual behavior and who possessed the capacity to motivate the resistant student provided the patient with opportunities to enhance his coping abilities in social skills. Activities both within the hospital and community had similar advantages but provided diversion, the release of energy, and grist for the therapeutic mill. Small group therapy meetings and daily ward meetings were particularly useful to the adolescent because they focused on the important role played in his life by his peers, as well as on the influence of others on his delinquent behavior, and on the management of group antisocial and contagious behavior in a hospital. Because of the ready ability of the adolescents to split the staff and to provoke intense countertransference feelings in adults, open communication between staff members was particularly im portant. The impulsive adolescent’s need for instant gratification and his capacity to seduce such gratification from the psychotherapist made it imperative that administrative decisions such as privileges and passes be made by an interdisciplinary committee (the Adolescent Progress Review mentioned before). This approach provided consistency and continuity for all the patients.
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The aftercare and follow-up treatment program was provided through a number of means. Outpatient psychotherapy was usually continued after the patient was discharged from the hospital. This took the form of individual psychotherapy sessions with a therapist as well as family therapy sessions that had been begun prior to discharge. A weekly discharge group met, and a number of patients were involved in this activity as well. Rarely were our discharged patients referred to another facility such as mental health clinics or family service agencies, or to private therapists; but, such resources could have been utilized if necessary. RESULTS
The delinquent group smoked cigarettes and drank alcohol significantly more than the normal group, and also had a more permissive attitude towards both. We do not have data concerning drug experiences and attitudes towards drugs in the normal group. In the delinquent group, two thirds had smoked marihuana, and half had taken drugs excluding heroin. Only one patient had taken heroin. The attitude of the delinquent group was: 25% were against all drugs except marihuana, 25% felt drug taking was up to the individual, 25% were for all drugs except heroin, and 25% refused to give an opinion. In other words, 75% of the patients were positively inclined towards marihuana. There was a significant difference between the groups’ attitudes toward education. The delinquents were decidedly more negative in their feelings about school and studying. The normal group was more concerned with its vocational and educational future than was the delinquent group, and rated it as one of its top three concerns. The delinquent adolescents displayed less imagination in describing their values and attitudes than did the normal adolescents. The normal group gave more complex answers because they saw more possibilities. It was the delinquent group that saw the world in black-and-white terms; the normal group left more room for variation. The delinquent group had significantly more and earlier heterosexual experience. The delinquent teenagers believed that it was more important to have friends of the opposite sex and did not feel that relationships with either their parents or with peers of the same sex were very important. There were marked differences in the two groups’ abilities to cope with the effects of anxiety, depression, shame, guilt, and anger. (p < 0.001). The normal group was able to tolerate ambivalent feelings towards parents and/or siblings with insight and with very little acting out. As one would expect, the delinquent group showed little ability to tolerate ambivalent feelings and resorted to acting out whenever the feelings became too intense. The relationships between the psychiatrists and the interviewees (the Research Alliance) was much better in the normal than in the delinquent group. No differences were found between the two groups in idealism, altruism, the concern for fellow human beings, the wish for meaningful relationships, or the awareness of individual problems. DISCUSSION
The two groups studied were chosen, in part, because they belonged to the two polarities in the present-day adolescent population. One, the delinquent group, was composed of teenagers whose behavior had been impulsive, antisocial, and who, in addition had serious personality difficulties. The second group, the normal one, was composed of adolescents who were typical or modal in their behavior. They did not function in the superior range, but throughout their lives they had shown the capacity to adapt to themselves, their families and friends, and to their social environments.
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They had minimal neurotic conflicts, were active doers, and did not rebel significantly against their parents or society. The question can legitimately be asked whether we obtained more complex information from our normal subjects because we were able to develop a better research alliance with them. We cannot give a complete answer, but it is our distinct impression that the healthier teen-agers were able to develop a better and more meaningful relationship with us because they had stronger egos and were less threatened by relationships with adults. We also have to keep in mind the possibility that in each study we obtained, at least in part, the data we were seeking. Rosenthali calls this effect the experimenter effect in behavioral research. Thus, the normal teenagers supplied us with more normal data, and the delinquent with less. However, it is important to stress that both groups participated in the study voluntarily and without financial remuneration. In addition, our findings pointed to unexpected similarities as well as to differences between the two groups. We found great differences between these two groups in impulse control, ego structure, and coping style. The delinquent group had a more primitive ego structure and was less able to tolerate frustration or to plan for the future. They needed to gratify themselves when an impulse arose or when the social environment placed limits (through laws) on their functioning. Hence, they smoked, drank alcohol, and took drugs when they were frustrated or tense. They had not developed the defense of sublimation sufficiently, and their future goals, education, or a better vocation were too distant to have a meaningful effect. In the area of sexuality, which is so intimately tied with aggression, we also saw a need or wish for immediate gratification. Early sexual gratification may also have had the disadvantage of replacing too rapidly the homosexual friendships that are important in the development of the individual teenager (in that they help him to have a better capacity for object relationship). Deutsch’ describes the situation for adolescent girls: “I consider those girls who are involved prematurely in ‘free love’ as not the victors but the victims of the rebellious adolescent society. A great number of them are still involved in their earlier relationships with girlfriends. They ‘fool around,’ as the saying goes, with boys-but it is still with a side glance at the girls, and the heterosexual activity actually shows very little inner participation.” Blos3 describes a type of frantic heterosexual activity that is defensive. He explains this in terms of the preoedipal attachment to the parent that is now revived. The pseudoheterosexuality of this type of delinquent adolescent serves as a defense against the regressive pull to the preoedipal parent, that is, against homosexuality. The apparent early maturation of the delinquent group can have many negative (neurotic) consequences. Our findings concerning attitudes were different from what we expected. Our data demonstrated that when teenagers are matched by sex, age, race, and social class, there were no significant differences between certain values held by delinquent and normal teen-agers. We have found in the past that although parents and teenagers differ on many issues, the differences fade when they deal with the basic issues-ethics, religion, and politics. I5 We have not studied the value systems of the parents or of the delinquents to any great extent. It is, however, important to stress that in our study no differences in idealism, altruism, or concern for others was found between the delinquent and normal groups. The sociological theories, described in the introduction, that placed such heavy emphasis on the difference in values might have been more apparent
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than real. They might have reflected the fact that sociologists have, by and large, studied lower-class and gang delinquency and compared the values of the teenagers to the prevailing middle-class norms. CONCLUSIONS It has been our experience in treating juvenile delinquents admitted to a psychiatric hospital that the most important aspect of the treatment program is the group experience. Individual therapy can supplement the milieu experience and optimally should come after the adolescent has developed a better capacity for controlling his acting out. This can be judged best by closely observing the adolescent’s behavior on the unit, in the school, and in his interactions with his peers. The move back to the community is the final test. During the first few weeks home the adolescent will encounter much stress, and his newly acquired ego strength will undergo multiple tests. If the teenager survives them he is truly on the road to recovery. In summary, this multivariable, biopsychosocial study of juvenile delinquents and its contrast with normal teenagers previously studied will aid us in further understanding the psychology and behavior of delinquent adolescents. It will, hopefully, shed some light on the environmental, interpersonnel, and intrapsychic factors that lead to outbreaks of delinquent behavior among teenagers. The model treatment program will help us to understand how we can treat these adolescents. Finally, once the etiological factors that contribute to juvenile delinquency are elucidated we should be able to treat the early manifestations of juvenile delinquency and possibly even to develop reasonable preventive programs. The delinquent adolescents demonstrated poorer impulse control and superego development. In addition, they had fewer emotional resources available to them. Their ability to cope was limited, and when crises came their way they acted to relieve the pressures. They were not as flexible as their normal peers and could not utilize external resources to relieve internal pressures. Hence, their frustration tolerance was low, and their ability to postpone gratifications was very limited. SEMISTRUCTURED
INTERVIEW
Explain the purpose of the research. Basically it is to find out from teenagers what their feelings and thoughts on important issues are; an opportunity for a dialog. 1. What does he think of smoking, drinking, and taking drugs during high-school years? What have been his experiences? What is his attitude toward it? What does he think of the dropout problem? 2. Give two typical early memories. 3. If he had three wishes, what would they be? What would he do with a million dollars? If he were alone on a desert island and could have one person with him, whom would he select? 4. His picture of the ideal mother, father, and teacher. Whom, outside his family, does he admire most? 5. What are the three major problems of teenagers? How do they affect the important
(DELINQUENTS-NORMALS) people in his life (e.g., parents, siblings, boyfriends, girlfriends, teachers, and ministers)? 6. What are his goals for the future? What does he think he will be lie 10 years from now? 7. What are his vocational and educational goals for the future? Did he work or go to school? In either case, did he get pleasure from his activity? 8. Does he feel it is important for a teenager to have a girlfriend? The answer is explored in great detail. We obtain information on dating history and sexual behavior. 9. The subject’s ability to cope with the following affects are explored: anxiety, depression, shame, guilt, and anger. The subject is asked to give examples of the kind of experiences he had with these affects, how long they
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lasted, what he does to cope with them, and how successful he is.
10. What did he think of the interview? Any comments, additions, or questions?
REFERENCES 1. Aichorn, A.: Wayward Youth. New York, Meridian, 1925. 2. Baittle, B., and Kobrin, S.: On the relationships of a characterological type of delinquent to the milieu. Psychiatry 27:6, 1964. 3. Blos, P.: On Adolescence. New York, Free Press, 1962. 4. Cohen, A. K.: Delinquent Boys: The Culture of the Gang. Glencoe, Free Press, 1955. 5. Deutsch, H.: Selected Problems of Adolescence. New York, International Universities, 1967, p. 100. 6. Eisler, K. (Ed.): Searchlights on Delinquency. New York, International Universities, 1949. 7. Falstein, E., Feinstein, S. C., and Cohen, W. P.: An integrated adolescent care program in a general psychiatric hospital. Amer. J. Orthopsychiat. 30:276, 1966. 8. Friedlander, K.: The Psychoanalytical Approach to Juvenile Delinquency, New York, INP, 1947. 9. Glueck, S., and Glueck, E.: Family Environment and Delinquency. Boston, Houghton Mifflin, 1962. 10. Johnson, A. M., and Szurek, S. A.: The genesis of antisocial acting out in children and adults. Psychiat. Quart. 21:323, 1952. 11. Matza, D.: Delinquency and Drift. New York, Wiley, 1964.
12. McCord, W.: Delinquency: psychological types. In Sills, D. L. (Ed.): International Encyclopedia of the Social Sciences, Vol. 4. New York, MacMillan, Free Press, 1968. 13. Miller, J. G.: Research and theory in middle class delinquency, Brit. J. Crim., 33:51, 1970. 14. Milmoe, S., Rosenthal, R., Blanc, H., Chafetz, M., and Wolf, I.: The doctor’s voice: Postdictor of successful referral of alcoholic patients. J. Abnorm. Psychol. 72:78, 1967. 15. Offer, D.: The Psychological World of the Teen-ager. New York, Basic Books, 1969, p. 193. 16. -, and Offer, J. L.: Profiles of normal adolescent girls. Arch. Gen. Psychiat. 19513, 1968. 17. -, and Sabshin, M.: Normality. New York, Basic Books, 1966, p. 105. 18. Rosenthal, R.: Experimental Effects in Behavioral Research. New York, AppletonCentury-Crofts, 1966. 19. Shaw, D., and McKay, H.D.: Juvenile Delinquency and Urban Areas. Revised Edition. Chicago, University of Chicago Press, 1969. 20. Short, J. F., Jr., and Strodtbeck, F. L.: Group Process and Gang Delinquency. Chicago, University of Chicago Press, 1965. 2 1. Thrasher, F. : The Gang. Chicago, University of Chicago Press, 1936.
Ratings for Semi-structured Interview (Delinquents - Normals) Name of Student 1. Has he A. Smoked tobacco? l.Yes~-NO_ 3. N.A. If No, does he approve? 1. Yes _ 2.No_ B. Drunk alcohol? 1. Yes2.No3. N.A. _ If No, does he approve? 1. Yes 2.No-
C. An attitude toward the dropout problem? 1. Students should leave at will_ 2. Students should continue in school 3. Does not care _ 4. N.A. D. Smoked marihuana more than once? 1. Yes 2.No3. N.A. _ E. Taken drugs (other than marihuana and heroin) more than once? 1. Yes-
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2.No3. N.A. F. Taken heroin more than once? 1. Yes _ 2.No3. N.A. G. An attitude toward drugs? 1. Against all drugs, including marihuana 2. Against all drugs except marihuana 3. For all drugs except heroin _ 4. For marihuana only 5. Drug taking is up to the individual 6. Drugs can be helpful _ 1. N.A. _ 2. Early memories (Is anyone mentioned in them?) 1. Yes2.No3. N.A. 3. Three wishes A. Happiness 1. Mentioned 2. Not mentioned _ 3. N.A. B. Success (and good job) 1. Mentioned 2. Not mentioned 3. N.A. _ C. Wealth 1. Mentioned 2. Not mentioned 3. N.A. _ D. Academic achievement (and intelligence) 1. Mentioned 2. Not mentioned _ 3. N.A. _ E. Athletic achievement 1. Mentioned _ 2. Not mentioned 3. N.A. F. Altruism (and idealism) 1. Mentioned _ 2. Not mentioned 3. N.A. G. Interpersonal relations 1. Mentioned 2. Not mentioned 3. N.A. _ H. Other 1. Mentioned _ 2. Not mentioned 3. N.A. _
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4. Million dollars A. Invest or save 1. Mentioned 2. Not mentioned 3. N.A. _ B. Give to parents 1, Mentioned 2. Not mentioned _ 3. N.A. _ C. Buy things for self 1. Mentioned _ 2. Not mentioned _ 3. N.A. _ D. Buy things for parents 1. Mentioned _ 2. Not mentioned 3. N.A. L_ E. Give some to charity 1. Mentioned 2. Not mentioned 3. N.A. _ F. Other 1. Mentioned _ 2. Not mentioned _ 3. N.A. _ 5. Desert Island A. Be with parent 1. Mentioned _ 2. Not mentioned _ 3. N.A. c_ B. Be with teacher (or coach) 1, Mentioned _ 2. Not mentioned 3. N.A. _ C. Be with other adult 1. Mentioned _ 2. Not mentioned 3. N.A. c_ D. Be with student of the same sex 1. Mentioned 2. Not mentioned 3. N.A. _ E. Be with student of opposite sex 1. Mentioned 2. Not mentioned 3. N.A. _ F. Other 1. Mentioned _ 2. Not mentioned 3. N.A. 6. Three problems A. Vocational and educational goals 1. Mentioned 2. Not mentioned 3. N.A. _
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B. Impulse control (and drugs and delinquency) 1. Mentioned _ 2. Not mentioned 3. N.A. C. Interpersonal relations 1. Mentioned L_ 2. Not mentioned 3. N.A. _ D. Growing up I. Mentioned _ 2. Not mentioned 3. N.A. E. Handling sex 1. Mentioned _ 2. Not mentioned 3. N.A. F. Other 1. Mentioned 2. Not mentioned 3. N.A. _ 7. Future goals 1. Generally positive 2. Generally negative 3. N.A. _ 8. To have girl (or boy) friends 1. Are important _ 2. Not important _ 3. Don’t know 4. N.A. 9. Does subject have a friend of the opposite sex? l.Yes_ 2.No_ 3. N.A. 10. Has had sexual relations 1. Yes _
2.No3. N.A. _ 11. Based on response to questions concerning anxiety, depression, shame, guilt, or anger, subject’s psychological sophistica tion was 1. Excellent; ability to tolerate ambivalent feelings toward parents and/or siblings with insight and without acting out 2. Good; ability to tolerate ambivalent feelings toward parents and/or siblings with little insight and without acting out 3. Fair; ability to tolerate ambivalent feelings toward parents and/or siblings without insight but with minima1 acting out 4. Poor; no real ability to tolerate ambivalent feelings and much acting out 5. N.A. 12. Subject’s relationship with interviewer was 1. Excellent; subject gave elaborate answers and introduced new material of his own _ 2. Good; subject gave elaborate answers without introducing new material of his own 3. Fair; simple and direct answers 4. N.A. 13. Subject was 1. Very likeable _ 2. Likeable 3. Somewhat likeable _ 4. Not likeable -