Axis II: Cluster B

Cluster B.

Axis II Cluster B patients have an inadequate "endoskeleton," or lack one
altogether, in their behavioral control. Whether they lack conscience, or
will, or impulse control varies and is debateable from case to case. The
hospital, or group home, or family must create an "exoskeleton" around them
to contain their behavior. This might be a reward system, constant
monitoring, or removal of tempting or dangerous items. Sometimes the
initial treatment for a drunk is to put him somewhere he can't get at
alcohol.

We do something similar with children, who gradually develop internal
controls, and even adults can learn them.

Just recognise when you can't explain it or appeal to people's better
nature any further. When people can't, they can't, and saying "they
should" isn't helpful.

For example, some child molesters are guilt-free and live by manipulation.
Others have genuine sorrow and self-hatred. The sorrow and self-hatred may
not prevent them from reoffending. They may need the same degree of
accountability as the sociopath. We fall into the trap - a half-truth, as
usual - of believing that if they really, really understood, they wouldn't
do it. But understanding is often irrelevent to changing behavior.
Insight can help maintainchanges later, but that is quite different.

Guess what. I wasn't really talking about drunks and child molesters. I
was talking about everyone. Insight, and feeling really sorry, may not
change your behavior. In fact, if you've been trying that strategy for
years and are still losing your temper, that should tell you how inadequate
the strategy is.

The same applies for trying to change loved ones. If you've already tried
explaining and making them feel bad, maybe it's time to try something else.