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Gilbert Puga
Abnormal Psychology
Psy-16

Diagnostic Exercise Grading Sheet

Name _______________________________________________________
Film ________________________________________________________
1. Complete DSM-IV-TR 5/ DSM-V Axis Diagnosis ____15 points Max
Axis I_____
Comments______________________________________________________________
________________________________________________________________________
2. Quality of Diagnostic detail from film ______50 points Max
Comments______________________________________________________________
________________________________________________________________________
3. Journal Article

__________35 Points Max

APA Style ______5 points

Article Summary _______15 points
Application of Treatment_______15 points
TOTAL ______ minus

deduction_______

GRADE________/100

90-100=A; 80-89=B; 70-79=C; 60-69=D; 0-59=F

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A Clockwork Orange
Axis I: 301.7 - Antisocial Personality Disorder

Diagnostic Criteria for 301.7 Antisocial Personality Disorder

A. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15
years, as indicated by three (or more) of the following:
(1) failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly
performing acts that are grounds for arrest
(2) deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit
or pleasure
(3) impulsivity or failure to plan ahead
(4) irritability and aggressiveness, as indicated by repeated physical fights or assaults
(5) reckless disregard for safety of self or others
(6) consistent irresponsibility as indicated by repeated failure to sustain consistent work behavior or
honor financial obligations
(7) lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or
stolen from another
B. The individual is at least age 18 years.
C. There is evidence of Conduct Disorder with onset before age of 15 years.
D. The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a manic
episode

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Alex DeLarge, the narrator and protagonist of the film A Clockwork Orange, meets a
majority of the diagnostic criteria for Antisocial Personality Disorder, according to the
Diagnostic and Statistical Manual for Mental Disorders 4th ed. The following will serve as an
explication of how this character meets these criteria via the deviance of behavior shown
throughout the film.
As a preface, it is important to note that to qualify for diagnosis of Antisocial Personality
Disorder, various symptoms must have been present also in childhood. While the film portrays
an 18 year or older Alex DeLarge, the original novel alluded to Alex already having been a
frequenter of reform institutions by the age of 15; thus being grounds to qualify him for
diagnostic criterion B (subject is at least 18 years of age) and C (evidence of conduct disorder
with onset prior to 15 years of age) in the DSM-IV-TR.
In the opening of the film, we see a sinister gaze sported by DeLarge; with his unusual
attire, fake eyelashes on one eye, and a bowler hatvery characteristic of the surrealistic tone of
the film. He is sitting with his droogs or gang, in a milk-bar, consuming milk-plus. Milk-plus is
a drug-laced (presumably a stimulant) milk product, that DeLarge says, ...sharpens one up for a
bit of the old ultraviolence. Substance use being one of the minor diagnostic features of APD
and as for the ultraviolence itself that DeLarge sadistically revels in, it is very clearly defined in
the next scenes.
Alex and his droogs come across a singing homeless man, who had apparently been
drinking excessively underneath an overpass and as they approach, DeLarge narrates his disgust
for the dirty old drunkie and then shoves his cane into the man's stomach with a grin. The poor
man makes a comment on the existential plight of the current state of this dystopian world they

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live in, devoid of any law and order, whilst Alex and his droogs brutally beat him with clubs,
chains, and strong kicks.
Here is shown the first of many examples of Alex DeLarge meeting criterion A-1, A-4
and A-7, through a remorseless attack on a man undeserving of such violence. The subtleties of
Alex's proclaimed disdain for filthy old drunkies are unclear, but one might surmise that there
may have been a negative association with alcoholic behavior at some point in his early years.
This next scene features Alex and his gang stumbling across a rival gang, who are in the
midst of sexually assaulting a young woman in a derelict casino. DeLarge decides to spoil their
reprehensible sexual conquest with touting insults as a means of inciting a brawl, in which the
rival gang is happy to oblige. A brutal display of violence with various weapons then takes
place, set to Gioachino Rossini's La Gazza Ladra (The Thieving Magpie)classical pieces being
a common motif throughout the film, presenting a strange sense of irony. After DeLarge's
droogs violently beat the rival gang into submission, with their clubbing and whipping only
deterred by the distant sound of police sirens, Alex makes a whistle to rally his crew and make a
quick getaway.
Once again, another violent altercation has taken place (criterion A-4), but this time
reciprocated by others. Adding to the impulsive decision to begin the fight in the first place
(criterion A-3), is the disregard for his own and his gang's safety after seeing the rivals had
knives and weapons (criterion A-5). There was also a more excessive dimension to the fight with
throwing and being thrown through windows and smashing each other with shards of glass and
furniture.
Their getaway vehicle was a 1970 M-505 Adams Brothers Probe 16, which DeLarge

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identified as a Durango '95. With great maniacal laughter, Alex and his gang played hogs of
the road recklessly speeding on dark, rural country roads, causing several accidents by running
vehicles off into the black shadows of the countryside. He also nearly runs over a man who tried
to warn the young men of the pulled over diesel truck blocking the road, in which DeLarge
simply drove dangerously underneath it after the driver dove out of the way. Alex narrates what
was next on their list of deviant acts for the night, the old surprise visit, a personal form of
slang for home invasion, in which the next scene is arguably the most disturbing of the film.
Continuing with the reoccurring instances of disregard for the safety of one's self and
others (criterion A-5), and reckless impulsivity of joyriding dangerously in presumably, a stolen
car (criterion A-1 and A-3), DeLarge and his droogs were in a seventh heaven of boyish delight
as they sped down the road which at any moment could have proved fatal. It is to be noted that
Alex's face in particular holds a darker, more malevolent demeanor as he is running vehicles off
the road, or nearly runs over a man, without even so much as a blink or moment's hesitation.
Alex and his gang approach an upper-class cottage on the outskirts of town, home to an
affluent writer and his younger wife. They trick the woman into opening the door by pretending
there had been an accident and urgency to need to use the telephone. Alex's droogs burst into the
cottage and carried the woman off whilst DeLarge kicked the writer to the ground, and
proceeded to destroy a good portion of the man's work space before turning his attention back to
the victims. Alex began to happily sing Gene Kelly's Singin' in the Rain and syncopates his
physical assault on the couple with the rhythm of the song. After he gags them with tape, he
took a sharp pair of scissors and began cutting off pieces of the woman's red jump suit until she
stood naked, dropped his trousers, and with a last sadistic smirk, finished the song in the face of

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the writer and it is implied that the woman is raped in front of her husband.
This startling behavior meets all the criteria for APD diagnosis mentioned in the previous
scenes, but now with an added orgiastic sexual element that further dives into the depraved
antisocial tendencies of Alex DeLarge's persona. There is an association he makes with his love
of music and the pleasure he gains from these ultraviolent indulgences and revels in both
simultaneously as shown with the syncopated assault on the two victims.
The film soon takes a turn after this same ruse is pulled at a health and fitness enthusiast's
home. Except, after assaulting the woman with a sculpture, a new consequence befalls Alex; he
had unwittingly committed murder. Though Alex is as carefree and remorseless about it as just
another night of the ultraviolent sort, a twist of the plot results in his droogs assaulting him in
return and leaving him to be caught and take the blamefor they grew tired of him pulling their
strings. The interrogation scene that follows with the police further explicates the malignance
within Alex's psyche as he doesn't flinch or cower in the face of police threats and excessive
rough handling, but simply smiles and assaults the policemen in return.
Though there are numerous other incidents that occur throughout the film that further
qualify Alex DeLarge for diagnosis of Antisocial Personality Disorder, including consistent
truancy issues in school (criterion A-6), deceitfulness towards his parents (criterion A-2), the
dark reverie of sadistic scenes he fantasizes about whilst listening to Beethoven's 9th Symphony
or reading the Old Testament, but the scenes provided are sufficient. The narrating Alex does
throughout the film is key inner dialogue that identifies his lack of remorse regarding any of his
actions and notably a complete absence of moral agency. It epitomizes the sadistic basis behind
his behavior as he impulsively engages others violently without regards to consequences, nor to

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the peril of himself or others, and is constantly caught up in violation of the law.

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Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B.
(2009). Multisystemic therapy for antisocial behavior in children and adolescents.
New York, NY: Guilford Press.
Multisystemic therapy (MST) is derived from a social ecological model, that is, the vast and
varied social layers that the youth are immersed in throughout life, including; caregiver and/or
parental attention, peer influences, and factors regarding their immediate environment (e.g.
school, neighborhood, etc). A model which is broader than other forms of family systems theory.
The key interventions of MST however, are focused on parental/caregiver involvement. There is
emphasis on equipping the parental figures in the young person's life, such that they will be able
to utilize familial strengths (i.e. love for the adolescent, social support) towards the rehabilitation
or treatment of the youth in terms of overcoming obstacles set in place through abusive elements,
deviant peer influences, and environmental stressors.
The partnership between therapist and caregivers aids in guiding the adolescent away
from toxic peer influence and improve social functioning, with aims of embedding the adolescent
in an environment conducive to prosocial behavior, rather than antisocial. These interventions
entail intermediary goals set by the therapist on a weekly basis that contribute towards a larger
overarching goal in the decrease of antisocial behavior and social functioning improvement.
The process essentially is broken into nine principles. The first being Finding the fit, or
hypothesizing the links between the adolescent's social ecology and antisocial behavior. From
there, utilizing systemic strengths to be the means of achieving change (e.g. adolescent's desire to
gain approval of a parent, a parent's unconditional devotion, etc). Increasing responsibility
amongst all family members involved towards conducive behavior towards overarching or

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intermediary goals being the third principle. By targeting specific, well defined problems, it is
necessary that interventions should be focused on the present and be action-oriented. There also
needs to be a systematic intervention on sequences of behavior that occur between several
factors that contribute to targeted problems, such as the dynamic between parent, child, and
reports at school or from others. All interventions must also be appropriate for the
developmental needs of the adolescent; the rewards should be tailored to their age level. It can
not be understated how important continuous effort will be in maintaining progress towards
established goals. Means of evaluation and accountability should also be set in place to ensure
successful outcomes and finally, set into motion a generalization of effective empowerment of
the caregivers and other parties involved in order to address each other's needs efficiently
through varied contextual situations.

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Application of Treatment
It is to be noted that in the film A Clockwork Orange, after Alex DeLarge is found guilty
of murder and sent to a penitentiary, he manipulated his way into an experimental treatment
known as the Ludovico technique, a form of aversion therapy used to rehabilitate criminals. In
context of the film it was a torturous, immoral treatment where the patient is strapped to a chair,
forced to watch violent films whilst being drugged, and through classical Pavlovian style
conditioning, learn to associate the fear and nausea, induced by the drug, with the act of violent
behavior. Inadvertently, it also caused him to react this way listening to his favorite classical
composer, Beethoven, which was an added cruelty. This would be an example of a treatment that
should not be used under any circumstance.
If Multisystemic Therapy is to be utilized, then assessing Alex DeLarge's referral
behaviors will be the place to begin. The program is personally tailored to the individual, and his
parents are to be notified and encouraged to take part in the intervention. From what can be
gathered from the film, his parents are not overtly neglectful, but moreso ignorant of the
antisocial habits their son takes part in on a daily basis. They do have a familial care and
devotion that may be on the reserved side and passive, but present nonetheless. Alex is shown to
be generally warm and respectful towards them. These two aspects will be the familial strengths
necessary to build on towards prosocial behavior gains.
The next step would be to layout a plan of overarching goals, and intermediary ones to
achieve along the way. It is clear from the perspective of the film, that his droogs are of
particular importance to him. He enjoyed being in the position of command and the validation
they provided for him only encouraged more of the reckless behavior they took part in. As an

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integral part of DeLarge's social ecology, there would be a need to find a replacement to fill that
void left by removing him from the clutches of the gang. With his love of classical music,
perhaps a group activity in the arts would be of benefit. Alex's parents could also become
involved and continue to encourage this fortunate passion of his, guiding him into prosocial
associations of the arts and away from violent ones.
Maintaining an action-oriented momentum within the intervention, perhaps a job of some
sort regarding his passion where he could talk about Ludwig Van Beethoven all day long would
be a solid anchor for him, whilst fitting in other minor obligations for continued evaluation and
accountability which could prompt rewards that are suitable to his prosocial interests. There
would also be an intermediary goal of weaning him off milk-plus if not quitting immediately. It
was clear from the film, that it only exacerbated his impulsivity and deviant behavior.
Contingency plans are also going to be necessary in the event he runs into his former
droogs around town. This is where supervision is going to be of great pertinence. A continuous
involvement of his support system will include keeping an eye on him as they say.
Continuing with the generalization phase of properly equipping Alex and his support
system of family members, contingencies for a variety of possible trip-ups along the way
towards prosocial behavior can be flexibly interchanged to see what works best and most
efficiently. With a program tailored to the individual, the treatment most certainly will not look
the same for every case.
As deplorable as the behavior shown in the film was, there may have been hope for Alex
DeLarge. He only lacked the social ecology conducive to a more positive development
throughout his life, in which within the realm of the hypothetical, he might've gained the

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attention of his family and more suitable mental health professionals to treat him effectively and
in such a way that any human being deserves.

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References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Burgess, A. (2001). A Clockwork orange. New York: Norton.
Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B.
(2009). Multisystemic therapy for antisocial behavior in children and adolescents.
New York, NY: Guilford Press.