 So, we were basically talking about displaced aggression when we met last. So, today we will know continue with that. Our focus now is to go towards that end of aggressive behavior, which invites the intervention of the experts, which invites the individual who is actually displaying aggression in that form to get into touch with people who specializes in certain form of maladaptive behavior handling, so that he or she can get some benefit out of their expertise. Basically what we had done was that we had been talking about how an individual becomes aggressive, what could be the strong correlates of aggression. What in fact triggers aggression, how it can become very brutal, we took a long spectrum and now we are going towards the end of that end of the spectrum of aggressive behavior, where the behavior is not considered to be normal, that form of aggression is not considered to be normal. We will debate at two points, because certain form of aggressive behavior you would realize that although clinically it is considered to be a pathological form of aggressive behavior, but somehow culturally it is still accepted, culturally people do not consider that to be an act of a pathological aggression, so that also we will debate. So last time we had talked about the displaced aggression, just I thought I will once again begin with it, because here you find the reference of bullying, finding a scapegoat, finding a weaker member of your own community whom you can thrash and in psychology you will find whole lot of literature on bullying behavior. Today what we are trying to primarily do is to look at the pathological form of aggressive behavior and here also we will move gradually, you remember our first module where we had started with a normal set of behavior and then we had come to borderline defenses and from borderline defenses we went to a pathological form of behavior. Here also we will exactly do the same, till now we have talked about the normal form of aggressive behavior, we would now be talking about the borderline cases of aggressive behavior and where it takes a turn where it becomes pathological. Now aggression is also considered to be an outcome of compensatory behavior or reaction formation, you remember we had talked about compensation, we had talked about reaction formation when we were talking about defense mechanisms, you remember task oriented reaction patterns, defense oriented reaction pattern, there we had talked about it. If you look at the compensatory behavior, it is usually of two types, one is that there could be a compensation in kind or there is another form of compensatory behavior what is called as compensation by substitute. Now, what happens in the case of compensation in kind, one has an unusual drive which finally makes him or her achieve in the area where the short coming lies. So, I as an individual realizes my deficiency and put excessive effort in order to overcome it. Now, why it is called compensation is that usually say it is something like you have a small pit in the ground and you are told to fill it, the moment you realize that your lawn has a small pit and say you dig out much more of mud to compensate for it, fill the gap, what you finally do is far more compared to what was actually needed. So, compensation in kind refers to that type of thing, usually what happens in the normal situation you will be told that say you are deficient of certain score say for example, say you are in your school days and the report of one of the test comes which suggests that you are weak at mathematics for example. The moment you realize that I am weaker in my numerical abilities all you do is that you will more effort parents will look at it they will try to make you more make more effort in that area maybe you are given a private tutorship in order to fill that gap, but it is not that say you start only and only working in the area of mathematics because you want to fill the gap that does not happen. So, that is a normal way of handling deficiencies, but in compensatory behavior what happens you realize the gap the deficiency and you try to compensate for it and that compensation usually is very, very you know vigorous type of an attempt. So, it would be something like you know majority of your time that you devote for academic activities is dedicated only to numerical abilities. So, that is now compensation in kind. So, it basically is an intensification of something which is otherwise considered to be normal. So, when you try to know come forward with the mechanism which will help you overcome the problem the short coming that you are experiencing it is a normal behavior when you make it excessively intense it becomes compensation in kind. Usually people who are you know trying to compensate for a deficiency that they have realized you would realize that if you touch them on that issue suddenly become very aggressive. Now we come to compensation by substitute this is a different mechanism here also you realize a deficiency, but then you know that it is beyond my purview you know I cannot handle it. So, what you do is that you develop ability of some other kind to compensate for what you do not have now usually take the same example in your school days you get your test results and you realize that you are extremely you have done extremely bad at mathematics. The very realization that you have been under performer in your mathematics test makes you recall that over last couple of years since class fifth or sixth you have been not terribly performing in your mathematics test or later on you realize that I am even you know bad at physics I have difficulty memorizing all those long long reactions. So, you cannot do well in my chemistry tests, but then you realize that somehow you play hockey very well you play football very well you play cricket very well and then comes the you know situation where you start realizing that I am excellent and at something, but I have been consistently poor at something. Compensation by substitute would be that you use the skill that you have you maximize it so that it can compensate for the loss that it is being incurred. So, I know that I cannot do good at my numerical things and therefore, I compensate it by becoming the best player of my school team. I realize that my school does not have a choice, but to keep me you know holding with themselves in most of the schools you would realize that you have a set of students who are academically weak the school would have otherwise not entertained them in their school, but still they take pride in doing that because these are the students who are very good at track and field events at sports and they bring all those laurels to the school and therefore, they are still retained. In jobs in most of the institutions of higher education you find certain seats which are reserved for students who have been exceptional players in their school days. So, you realize that there is a possibility that if I do not have an ability and my all my best effort still cannot make me compensate for it. Let me know extra achieve in areas where I am very good, where I am excellent and this is compensation by substitute. Now, this is a common means of adjustment to failure and frustration. I have failed in something, there is something has been a great source of frustration for me and then I try to compensate it and compensatory behavior usually boosts your ego and it positively affects your self-steem. So, if you are successful in terms of compensating the deficiency that you had in the past, it further adds to your ego strength, your self-steem increases and that means that overall you are far more stable, far more happier. Compensation as a mechanism has nothing wrong in it. The reason why we are discussing compensation in kind and compensation by substitute is that there is certain degree of frustration and aggression which is attached to the compensatory behavior. So, as I told you sometime back that in compensation in kind because you put much extra effort in trying to plug in the deficiency that you have realized, what happens is that the moment you are touched upon the softer issue, the issue of deficiency or the extra effort that you are making, it makes you aggressive. Similarly, if you are trying to compensate by substitute, you would ensure that nobody should point finger to the area of your original deficiency. Everybody should point finger at the area where you have developed at a strength and you have achieved. The moment somebody points finger towards the original area of deficiency, it perturbs you, it makes you very aggressive. This is how this compensatory mechanism fuels aggressive behavior, but as such this behavior is not considered to be pathological unless you take certain attempts which does not make you pathological, but can make others realize that you are perhaps doing something which otherwise you should not have done. Very recently last week when we had this medicine research, there was a news of women volleyball player from Lucknow. She lost one of her foot sometime back. So, it was a national level player of volleyball, well known player and some thing took place in the train and she was thrown out of the running train and finally one of her foot was imputed. This means that she can no more play volleyball. The reason I am quoting her example is that last week there was a news saying that she has taken training in mountaineering and this week perhaps she will be making an attempt to climb Mount Everest. You realize your deficiency, one of your foot is imputed and you realize that you can no more be seen in the field of the court of volleyball. So you decide of going to another height where usually people who are otherwise able who have too good working fit even they cannot climb, you decide to climb with the help of one artificially. This is a form of compensatory behavior. I know of somebody who has the clubbed fit, you have seen the fit people instead of our foot are like this, but some people have fit like this. So he had this clubbed fit and that too his toe was somehow like this. So this means half of the fit will basically bear the whole body weight and in certain months of the year when you have reduced level of moisture in the air, when you would walk for long because of the dry skin and because the whole body weight was on that part of the fit, the skin of the fit will crack. I have seen it myself, it used to crack and it would not be a profuse bleeding, but some amount of blood at times used to come, but otherwise it would hurt because the skin would crack even though it is not bleeding it used to hurt him. And because we do not have shoes for people like this, so he was forced only and only to wear sleeper and I have seen him he was very active. He was the one who would go to the field very frequently meet the clients to all type of staffs very active and would ensure that he walks where rest all others walk. He was always given the choice that why do not you take a scooter somebody who is on a scooter or a bike, why do not you sit at the back and he or she can make you reached that point and he will always ensure that I will walk, he will have cracks in the evening his wound would hurt like anything he would apply ointments and all those things, but he would ensure that I would walk. These are compensatory mechanisms, I know of another interesting person very well known person who was at one of the famous institutes in our country, he was a faculty there and at some point in time during the process of negotiation for marriage, he was made to realize that you do not have the wealth of my proportion and therefore, you should not have even thought of coming to our house for a relationship. The reason was that he was somebody in the teaching capacity and had gone to a grooms place probable grooms place who was from a very very affluent family very rich family all those into trades diamond trade and stuffs like this. And after this episode within very short span of time he decided to leave India he went abroad again remained in the same profession but went abroad and I am told I have not heard from the primary source I have heard from the secondary source that several years later he came back went to the same person whom he had initially gone to for negotiating marriage he went there with his passbook and he said that now I have left this country I am there and this is my passbook I will not ask you how much you have in your bank account but now you can see my bank account. These are different types of stories you will here know hundreds and hundreds of such stories where you would realize that see at the surface it looks simply like an action of compensation. But imagine somebody who has a child of a marriageable age would have crossed certain age know and at that time at that point in your life you decide to leave a country go to a place where the exchange rate will certainly be you know much much higher for compared to your own currency you go earn like anything. You know how much you know agitated that person would have been within that I have to achieve this target and how and this entire you know the boiling within would have continued that finally made him you know come back after certain number of years go to the same house meet the same person and say this is my passbook know you may like to have a look at it know and these are the know things which makes compensatory reaction. Fuel aggressive behavior like anything you know you keep on keep on boiling within in fact the last part of this very module today when we come to the end the last slide would have something where you would see that finally aggression is inflicted on the individual know so I myself become the source of my own anger I become a victim of my own anger will come to that also. Now over aggressive behavior might be a reaction to fear it is quite possible that one is experiencing or the anticipation of fearful situation might also trigger over aggressive behavior usually you would realize that people who are caught in certain type of situations you remember the movie Titanic when the safety boats were supposed to be sent to the sea there was a security guard who had initially open fire you remember that sequence now when you have situation like that where you realize that situation is of an exceptional nature where life and death runs parallel and you do not know which step will lead you to what when you realize that things are beyond your control and you anyhow you have to struggle your best to hold the situation those are the time when you would realize that many people become extremely aggressive in nature this guard on the Titanic in that episode shows that type of a behavior you I am sure none of you have met people who have experienced communal violence if you get a chance if you talk to them they will tell you what finally made them do what they did so you would realize that now when you experience the fear that your survival is at stake the survival of your near and near ones are at stake then you realize that most of us were turned extremely aggressive now this is basically a situation of reaction formation ideally you are extremely scared and you should remain scared but in turn you become aggressive you remember when we were talking about defense mechanism we had talked about reaction formation that inwardly you feel something else and outwardly you express it in a different form now such type of reactions basically are considered to be the borderline cases that now your aggression might any time cross the limit of the clinical acceptance limit of aggressive behavior inability to control one's impulse of course we see this also in people and which is otherwise considered to be a disorder that if you repeatedly realize that you are unable to contain your anger then this inability might be actually a form of disorder we will come to that if you look at the whole description of psychiatric disorders different type of behavioral problems given by the American psychiatric association which is considered to be the Bible for clinical diagnosis no it is called diagnostic and statistical manual DSM popularly it is called DSM the version that is available right now which is being used worldwide is DSM for TR TR is text revision so fourth edition of DSM the fifth edition of DSM will very shortly it will come and there are interesting ways know how these committees are constituted you would be very amused to know that for small of behavioral problem or psychiatric disorder there would be a very big team of the experts who have been working in that area and they choose experts from around the world so say for example say panic anxiety for example so for panic anxiety there would be a whole board those would work for years would know look at all types of behavioral symptoms that has been reported to clinics across the world they will compile them do all types of things and finally come with a diagnostic criteria right now we will come to some other diagnostic criteria now many psychiatric disorders such as antisocial personality disorder for example there is something called conduct disorder substance related disorder where you go for abusing substances mood disorder they all include certain degree of inability to control your impulse those who have strong urges for abuse of substances this also reflects certain degree of inability to control your desire your impulse but then American psychiatric association has put another category named impulse control disorders and this includes know many types of problems such as intermittent explosive disorder, kleptomania, pyromania, pathological gambling, trichetylomania and impulse control disorder which is not otherwise classified now these are classified disorders there could be impulse control situations where it has not been classified into these categories what we will do is that we will know look at each of them and then the first three will further go into the details of it looking at the diagnostic criteria for it intermittent explosive disorder basically reflects the inability of an individual to resist aggressive impulse that results into serious assault or damage of property. So, you have that inner impulse which you realize that you are unable to control and finally what it results into is a serious assault to somebody know you apply punches here and there at the softer parts of the body make the person profusely bleed or all types of know deformity that can take place or you commit extreme damage to the property of the individual and all this is guided by basically your inability to not having the your inability to control your impulse you have that impulse and suddenly gets converted into action and definitely from a social view point if you look at it it is a disproportionate reflection of your anger somebody say for example who commits an error of a lower magnitude usually even in the court of law you would realize that the punishment the quantum of punishment is also lower. So, usually more and more grave is the more and more severe is the nature of crime that you have committed more and more intense becomes the quantum of punishment, but in the case of intermittent explosive disorder irrespective of the severity of the problem the quantum of the punishment maximizes. Then comes kleptomania this is a very interesting type of a problem where one shows inability to contain the desire that impulse of a stealing objects remember this is difference this is completely different from theft and robbery. Here what happens you steal objects which you are not going to use personally and you are not even going to use that object for monetary benefit monetary benefit means that you steal an object you do not use it yourself rather you sell it in the market and derive monetary benefit out of it kleptomania is completely different no you steal things which you are not going to use which you are not going to sell and make a monetary benefit, but you have that inner urge to steal those objects and you take pride in doing that. I do not know if you are aware of a very famous actress of Hindi cinema of yesterday years who had this kleptomanic tendency of stealing spoons so whichever hotel wherever she would go around the world she had the tendency to take minimum of one spoon from the table she had she had a huge collection and because she was a very well known cine actress therefore her name was never brought to limelight no no one would say that wife was just for a single spoon why to no say that you have stolen one spoon so you allow doing that. Somebody from one of the royals family from Europe also had this tendency and because he was from the royal family and the case would might be blown out of proportion in the media therefore he always was scotted by a secretary who would just keep following him. So this man would no keep stealing things and that secretary will keep making a list of the objects which were stolen by the prince and once the prince leaves out with his cavalcade this man will make the payment that fine so that the fact that the prince is kleptomanic is not known to the rest of the world. So this is kleptomania this is again a problem where you have difficulty containing your own impulse then we come to a very peculiar type of an impulse control disorder what is called as pyromania pyromania is an uncontrolled desire in an individual to put things on fire. So you just know out of nothing you simply tend to keep some put something on fire and when it burns it know you are extremely amused to look at it usually it is very rare to find people who would show this type of a tendency but it is not that exceptional also you will find people who derive pleasure out of setting things on fire something and then immediately you set that object on fire and you derive pleasure out of it. Small adaptive gambling of course is another interesting feature where you go for gambling to the pathological extent sometime back we had an invited lecture where only seven eight of you had come there was a whole one hour long lecture on pathological gambling and then we come to another type of impulse control disorder what is called as trichotillomania here an individual you will just know coil the finger around the here and pull it out. So you derive gratification out of pulling out your own hairs know and this is an impulse know you cannot control. So you just do like this and then you pluck one here another third and keep on doing that and usually if you look at the scalp of people suffering from this you will find that they have very minimal hairs know and there would be no wounds of plucking the hairs because they keep on keep on doing that. Now onwards what we will do primarily we have understood know the five different types of impulse control disorders now what we would do is that we would take the first three and exactly look at the diagnostic criteria for that remember that these are the diagnostic criteria which has exactly been taken from the DSM-4-TR we first come to intermittent explosive disorder. A several discrete episodes of failure to resist aggressive impulse that results in serious assaultive acts or destruction of property. So basically you have discrete episodes know means one today another one tomorrow after a week fifteen days twenty days. So there are discrete episodes of the inability shown by the individual to have control over the aggressive impulse and it has always resulted into certain forms of assault. You just come to the room twenty minutes after the class is commenced and then you come and you see somebody sitting on the chair where you sat one week back and suddenly know you apply one punch know that this is the chair where I sat last week. These are disproportionate type of reactions or you cause excessive damage oh it is so much of you know heat and this room seems to be little stuffy why this is AC is not working and you will find such type of episodes also being reported in many of the boarding schools. How many of you have been to boarding schools? None oh then talk to your friends who have been into boarding schools they will tell you that usually it is you know eighth ninth tenth eleventh that is the usual stage when you know students in the boarding setup they usually take pride in you know committing damage to the property of their own boarding set school. Now such behavior usually do not qualify to be intermittent explosive disorder because there are not frequent episodes of it know there are not too many episodes of it. But even if you find somebody who has been doing it whenever he or she has got this opportunity then it invites the care of specialized. Then be the degree of aggressiveness expressed during the episode is grossly out of proportion to any precipitating psychosocial stress and also your reaction will be disproportionate know somebody is taking a chair and if you shout if you hit the individual all these are disproportionate reactions. The aggressive episodes are not better accounted for any another mental disorder now there is a rider that you should not be actually suffering from any other type of mental disorder and are due to the direct physiological effect of a substance or a general medication condition. So, say if you have been intoxicated if you have been know given a drug which makes you much more impulsive then in that know under the influence of that type of psychiatric disorder or substance intake if you commit such type of behavior then it is not considered to be intermittent explosive disorder. If you are not a sufferer of a psychiatric disorder if you are know not suffering from a substance abuse or induction of certain type of chemicals in your body and still you have a tendency of repeatedly know showing your inability to control your anger where your reactions are disproportionate and you commit damage to the property of the individual or to the physical well being of the individual then it is considered as intermittent explosive disorder. We need to think really know because you would find many such cases where the individual concerned has not been actually put to scrutiny for diagnosis of what actually he or she is suffering from. We have repeatedly been taking example of know that gang rape episode in Delhi last December even today morning I was listening to the 7 o clock news and there was a news of somebody being gang raped in Delhi last night. I guess perhaps this weekend there was crime bureau report suggesting that I do not remember the exact figures but it was more than 100 percent increase in the crime against women in Delhi right from if teasing to rape everything was more than 100 and 123 percent increase in something 111 percent increase in something but it was always more than 100 percent increase. Now, when you catch hold of an individual of committing an act which violates the acceptable code of conduct from the legal view point from the social view point from both the view points unfortunately in our country such people are not subjected to a rigorous type of scrutiny. Clinical diagnosis which will tell you that fine you actually belong to this category and hence instead of getting punishment you should get a treatment the reason I am saying this is that our conviction rate has been lower in our country conviction time has been very long 10 year 12 years and then somebody is convicted and after people have come out of the jail it has been realized that this most of them most of them not all but most of them commit same type of crime again in their life. This somehow know should make us rethink that is it that the whole system of giving punitive know measures to others in terms of refraining from certain type of social acts you realize that it is actually not working all you have been able to do is to segregate that individual or those set of individuals from the society for certain period of time. So, you put them behind the walls they are not into the regular interaction with the society but then once this time frame is over of the say whatever quantum of punishment was say 3 years 5 years 7 years when you go back mingle with the main stream of the society after certain time you once again repeat that act this means that punitive measure are actually not worked. In fact I want to go into the details of it but if you are interested read about know reward and punishment in psychology there is a whole lot of very rich literature on this which primarily suggest that punishment as a module will never be effective in terms of reforming you and that is the reason say I do not know if you have seen the drivers here when they drive in the city they drive without the seat belts because here in this part of the country there is no in no enforcement of this rule when these taxi drivers take you to Lucknow throughout their highway they would be without their seat belts before of certain crossing in Lucknow all of them will suddenly know put the seat belt and when you ask them why have you done this say nae nae here put chalan kate jatae this means that the usage of seat belt has nothing to do with your personal safety and security it has to do with the fear psychological literature suggest that punishment works like this and therefore if you have immediate presence of the deterrent the person will not commit the act but in the absence the person will certainly commit that act because he is guided by the force that you are putting there in turn if you convert it into you know certain forms of positive reinforcement then you realize that it works like anything you would still find people driving in places where the seat belt norm is not at all followed somebody even for a shorter distance from his main gate to the parking area again he will know use the seat belt and then only go and therefore know it makes sense for everybody at right from the smallest levels say for example here where I have seen some of you coming late by 10 minutes 20 minutes throughout the semester but I have never ever thought of saying that no see the watch what time are you coming to the class 50 percent of the class time is over and then you are making an entry there is no point saying that according to me following this reward punishment model if you find it interesting people who find it interesting say right now we had know this kumbh Mela in Allahabad you would find people who are 70 80 years old in the chilled December winter know for the Mela they will know go for a kalpas which is basically staying for the one full month on the banks of the river Ganges 4 o'clock in the morning before the sun rises you take off your clothes you go and take a holy dip you are guided by certain things which you find very rewarding okay very sorry pop do okay now getting rid of the sin is so rewarding for you that you are able to pay any price that you have to pay for it coming late to the class okay you do not find it rewarding and therefore you come late by 20 minutes or you decide only to come for mid-seminates and which is fantastic okay so in terms of containing such type of intermittent explosive disorder also there is a need where you need to actually filter out that was this a single episode because law will not look at whether it was a single episode or repeated episode one single episode if you are caught then there is a defined quantum of punishment you will have to suffer the brunt of it but then is there a way of no going for a long-term handling of such problems as of now we do not have that we go to kleptomania okay here there is a recurrent failure to resist impulses to steel objects that are not needed for personal use or for monetary value so you are not going to use that spoon you are not going to sell it off okay increasing sense of tension immediately before committing the theft so have you have extremely of you know tension within you and once you are you know doing that act you have a sense of pleasure and gratification in great degree of relief when not after but at the time of committing okay the stealing is not committed to express anger or vengence and is not in response to any delusion or hallucination no so in your full sane state of mind you have attention which rises within you you commit the act and commitment of the act is pleasurable remember usually for most of the things for most of us post act is more gratifying okay say pre act there is a tension which is true for most of the things peri act peri means during the commitment of the act the tension is still there but actual gratification comes after the act is completed in case of kleptomania you realize that gratification pleasure comes while you are committing that and therefore you feel more and more repeating the same act okay and of course this is stealing the rider is that the stealing is not better accounted for by any conduct disorder manic episode or antisocial personality disorder so if you are an antisocial psychopath if you have a conduct disorder conduct disorder is basically your inability to comply to norms okay and if you have been the sufferer of manic episodes if you are suffering from any of these things then you cannot be classified as kleptomanic and then we come to the last one that is peri mania okay there is a deliberate and purposeful fire setting on more than one occasion tension or effective arousal before that so tension is there okay before you put the thing on fire fascination with interest in curiosity about or attraction to fire and its situational context so in what type of situation are you putting things on fire a repeated episode you will find some type of unrest people shouting slogans and one very very small subset of that crowd which will deliberately try to put the police vehicle on fire so that situational context in which you know perform your act gives you extreme degree of pleasure pleasure gratification or relief when setting fire and when witnessing or participating in its aftermath okay so while you commit that act you derive gratification out of it you derive pleasure out of it once the act is over when you look at the aftermath of it oh great this whole building know how beautifully it has burned know everything has collapsed rubbles fume ashes all those things you still find it gratifying for normal people you know you feel very sorry about it the fire setting is not done for monetary gain the rider here as an expression of socio-political ideology or to conceal criminal activity to express anger or vengeance improve one's living circumstances so basically you have the full set of riders here that you should not actually be under the influence of these conditions the E and F okay these riders should not be there then only your act qualifies to be considered as an act of pyromania again I would say that most of the violence that you would see okay because people are not tested for whether they are pyromaniac or not and therefore they are all clustered as mob behavior so when you face the court of law it said that no this thing happened and then this group of you know students were caught by the police force when they were putting certain things on fire okay but I am sure if you really make all of them undergo clinical investigation a small set will still be qualifying for pyromania okay and we then we come to one of the slide which we had seen earlier when we were we initially started our discussion on aggressive behavior that there could be situations where aggression is inwardly directed no and therefore the entire destructive aggressive behavior that you usually see which is usually no inflicted on others there could be a possibility when that aggressive behavior the whole destructive tendency in that aggressive act is inflicted on the self okay the image that you see here is of a Tibetan student in New Delhi okay when Chinese delegate was supposed to come to India okay there was a massive protest by the Tibetan community here in Delhi and all out of sudden this boy suddenly had put himself on fire if I remember correctly he was brought to the hospital with 84% burn most probably and in next three days he finally succumbed to his injuries he died but imagine situation when somebody would decide to show that manifest that entire aggression on one own self okay the common ones that you can see at times it is not very common but usually in a larger population you will find a small number doing that I am repeating that example no you smoke cigarette and then you hurt yourself with the cigarette but okay this is once again a self destructive behavior okay when you finally decide to self emulate yourself you know the consequence okay once the consequence is known now paramedia is fine you are at least putting something else on fire okay but you know finally what this fire will lead to the consequence is known to you the aftermath is known to you here you know the consequence and still that act of aggression that extreme sense of destructiveness is inflicted on one own self okay so this was all about the aggressive behavior.