[Paleopsych] NYT: Oh, Fine, You're Right. I'm Passive-Aggressive.

[Premise Checker]

Oh, Fine, You're Right. I'm Passive-Aggressive.
NYT November 16, 2004
By BENEDICT CAREY

The marriage seemed to come loose at the seams, one stitch
at a time, often during the evening hour between work and
dinner. She would be preparing the meal, while he kept her
company in the sun room next to kitchen, usually reading
the paper. At times the two would provoke each other, as
couples do - about money, about holiday plans - but those
exchanges often flared out quickly when he would say,
simply, "O.K., you're right," and turn back to the news.

"Looking back, instead of getting angry, I was doing this
as a dismissive way of shutting down the conversation,"
said Peter G. Hill, 48, a doctor in Massachusetts who has
recently separated from his wife. Even reading the paper at
that hour was his way of adamantly relaxing, in defiance of
whatever it was she thought he should be doing.

"It takes two to break up, but I have been accused of being
passive-aggressive, and there it is," he said.

Everyone knows what it looks like. The friend who
perpetually arrives late. The co-worker who neglects to
return e-mail messages. The very words: "Nothing. I'm just
thinking."

Yet while "passive-aggressive" has become a workhorse
phrase in marriage counseling and an all-purpose label for
almost any difficult character, it is a controversial
concept in psychiatry.

After some debate, the American Psychiatric Association
dropped the behavior pattern from the list of personality
disorders in its most recent diagnostic manual - the DSM IV
- as too narrow to be a full-blown diagnosis, and not well
enough supported by scientific evidence to meet
increasingly rigorous standards of definition.

The decision is likely to have more effect on teaching
guidelines and research than on treatment and insurance
coverage.

But psychologists and psychiatrists with long experience
treating this kind of behavior say it is hard to study
precisely because it is so covert, common and widely
variable.

These experts make a distinction between passive-aggressive
behavior, which most people display at times, and
passive-aggressive personality, which is ingrained and
habitual. In milder forms it can come across as a maddening
blend of evasiveness and contrition, agreeableness and
impudence, and in severe cases is often masked by more
obvious mental illness, like depression.

Yet whether pathological or not, they say, the pattern is
often traceable to a distinct childhood experience. New
research suggests that in many cases it stems from a
positive, socially protective instinct - to keep peace at
home, avoid costly mistakes at work, even preserve some
self-respect.

"Some of the people being demeaned as passive-aggressive
are in fact being extremely careful not to commit mistakes,
a strategy that has been successful for them," if not
entirely conscious, said Dr. E. Tory Higgins, director of
the Motivation Science Center at Columbia University. They
become difficult, he said, "when their cautious instincts
are overwhelmed by demands that they perceive as
unreasonable."

The classic description of the behavior captures a stubborn
malcontent, someone who passively resists fulfilling
routine tasks, complains of being misunderstood and
underappreciated, unreasonably scorns authority and voices
exaggerated complaints of personal misfortune.

But the phrase itself has its roots in the military. Near
the end of World War II, a colonel in the United States War
Department used it to describe an "immature" behavior among
enlisted men, many of them at the end of long tours: "a
neurotic type reaction to routine military stress,
manifested by helplessness, or inadequate responses,
passiveness, obstructionism or aggressive outbursts."

This kind of insolence, among adults protecting themselves
from what they saw as unreasonable, arbitrary authority,
was in part an adaptive behavior, psychologist say, an
effort to preserve some independence amid extreme pressure
to conform.

A similar family dynamic accounts for early development of
the behavior, some researchers argue. Dr. Lorna Benjamin,
co-director of a clinic at the University of Utah's
Neuropsychiatric Institute in Salt Lake City, said people
with strong passive tendencies often grew up in loving but
demanding families, which gave them responsibilities they
perceived to be unmanageable.

First-born children are prime candidates, she said: when
younger siblings are born, the oldest may suddenly be
expected to take on far more extra work than he or she can
handle, and over time begin to resent parents' demands
without daring to defy them.

This hostile cooperation is at the core of
passive-aggression, she and other researchers say, and in
later in life it is habitually directed at any authority
figure, whether a boss, a teacher or a spouse making
demands. These passive-aggressive people, Dr. Benjamin
said, "are full of unacknowledged contradiction, of angry
kindness, compliant defiance, covert assertiveness."

This history hardly excuses the multitude of hedging,
foot-dragging mopes that populate everyday life, but it can
help explain some of their exploits. One Los Angeles woman,
who asked not to be identified (and swore she was not being
passive-aggressive), described a former co-worker who
intentionally made assignments late to employees when she
didn't approve of a project.

At the end of some days, she wrote, this archetypal
passive-aggressive used to hide under her desk to avoid
saying goodnight to people.

Sometimes, however, mild passive-aggressive behavior can be
an effective means to avoid potentially costly
confrontations. In such cases the cooperation is more
significant than the underlying resentment or hostility.

"A joke can be the most skillful passive-aggressive act
there is,'' said Dr. Scott Wetzler, a clinical psychologist
at Montefiore Medical Center in the Bronx and the author of
"Living With the Passive-Aggressive Man." "They recognize a
coming confrontation, and have found a clever way to
release the tension."

It is just this instinctive ability to pre-empt and defuse
that, paradoxically, may lead to more problematic
passive-aggressive behavior.

Dr. Higgins of Columbia has described a personal quality he
calls prevention pride, a kind of native caution in the
face of new challenges, an effort to avoid all errors. He
assesses whether a person is high or low in this style by
asking a battery of questions, like how often they broke
their parents rules, how often they take risks, how often
they have been in trouble by not being careful enough. The
style is adaptive, he said, in that it allows people with a
certain temperament to avoid failure and embarrassment.

In one recent experiment, Dr. Higgins and Dr. Ozlem Ayduk,
an assistant professor of psychology at the University of
California at Berkeley, tested how these especially
cautious people reacted to conflict in relationships. The
researchers had 56 couples who had been together at least
two months keep detailed diaries, answering questions about
conflicts, thoughts about the relationship, moods and their
partners' behavior.

After three weeks, the researchers compared the diaries and
found that people who had a highly cautious personal style
and were especially sensitive to rejection were
significantly more likely than the others to respond to
conflicts by going silent, withdrawing their affection and
acting cold.

"The people in this study were not the type who would ever
say, 'I hate you' to the person's face because they are so
careful not to do something that puts them out there," and
directly offend their partner, Dr. Ayduk said.

The evidence that this sensitivity can be appealing, at
least for a while, is recorded in millions of relationships
that have lasted for years. A 45-year-old college
instructor in Hawaii recently broke off a long relationship
with a man she said was a "wonderful, devoted listener, an
extremely sensitive person."

But in time, she said, it was apparent that he was also
passive-aggressive. On one occasion, she said, he gave away
her seat on an airplane while she was finding a storage
compartment for her luggage, saying he thought she had
taken another seat. On others, he would arrive home early
from work and finish off meals they normally shared,
without explanation. And when he was in one of his moods,
the listening ceased; she may as well not have been in the
room.

"The challenging thing was, you never know what you did
wrong," she said. "That's the difficulty, all these
scenarios, I could not point to what I did. I never knew."

The person who has become hostile may not know exactly
why, either. In some cases, psychologists say, people
unable to recognize or express their annoyance often don't
feel entitled to it; they instinctually let the "little
things" pass without taking the time to find out why they
are so angry about them. Unsure of themselves, they take
care not to offend a spouse, a co-worker or friend. The
anger remains.

When the behavior pattern is deeply ingrained and
compulsive, it is neither adaptive nor merely bewildering,
but can be dangerous, some experts say. At her clinic in
Salt Lake City, Dr. Benjamin treats many people with
multiple diagnoses, from attention deficit disorder to
obsessive-compulsive disorder to intractable depression,
many of them with other problems, like substance abuse or
multiple suicide attempts.

"And I would say that in close to half of them this
passive-aggressive behavior is running the whole show," she
said.

When and if they do get therapy, psychiatrists say, people
with strong passive-aggressive instincts are usually
determined to fail: the therapist becomes the scorned
authority figure. The patients will take their medications
and then report with relish that they don't work. The
patients will follow advice and then complain that it is
senseless, useless. "They are not doing this on purpose;
it's part of a deep-seated ambivalence about getting
better," a determination to expose the authority as
incompetent, said Dr. Marjorie Klein, a psychiatrist at the
University of Wisconsin.

It is left to the individual therapist's skill to deflect
or disarm this determination and get patients to at least
experiment with an alternate strategy to engage their
lives. In one, called cognitive behavior therapy, they
learn to monitor their thoughts, moment by moment, to
recognize when they are angry, and to challenge unexamined
assumptions about confrontation. For example, some people
assume that confronting their boss about a raise will be a
catastrophe, said Dr. Wetzler of Montefiore, but it often
simply is not the case, especially if they have prepared
themselves by learning the market value of their skills at
other companies.

Yet Dr. Benjamin said that often the childhood roots of the
behavior must be faced and felt, and that means revisiting
the parental relationship and learning that it does not
have to set the pattern for all relationships with
authority. "The main challenge is to help them shift from
winning by losing to winning by winning," she said, "to see
that it is they who benefit most when they win, not their
therapist, their spouse or their boss."

Just living with the behavior in someone else can be as
tough as treating it. To manage garden variety
passive-aggressive behavior, psychiatrists often advise a
kind of protective engagement: don't attack the person;
that only reinforces your position as an authority making
demands. Take into account the probable cause of the
person's unexpressed anger and acknowledge it, if possible,
when being stonewalled during a discussion.

And be sure to be on guard against likely retaliation.


"If he agrees to go over to your relatives' place for
Thanksgiving, but you know he's upset about it, make sure
you have alternate transportation to get over there," Dr.
Wetzler said.

"He may take the car and not manage to get home in time to
make it."

http://www.nytimes.com/2004/11/16/health/psychology/16pass.html