Case Analysis of Alex Delarge (1971) Character

Le Thanh Hoang Thang

Department of Psychology, James Cook University

PY3103: Mining the Mind: Psychopathology

Tutor: Praveen Nair

 Case Analysis of Alex Delarge (1971) Character

The case study aims to critically analyse a psychological disorder of Alex DeLarge, a

fictional character in “A Clockwork Orange", a dystopian crime film, released in 1971. The

movie is renowned for its thought-provoking investigation of violence, free choice, and societal

control. It centres on Alex, the main character, and is set in a desolate, dystopian London. He is

the leader of a little gang of "droogs" and is infamous for his ultra-violent deeds, such as assaults,

robberies, and sexual assaults. Although Alex’s psychological disorder is not diagnosed in the

film, by employing Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-

5) combined with several scenes in the movie, it is likely that Alex has developed Antisocial

Personality Disorder (ASPD) (American Psychiatric Association, 2013). To explore why Alex is

assumed to be diagnosed with ASPD, the case study will first explain what Antisocial Personality

Disorder is. Then, DSM-5 will be employed to demonstrate criteria proving that Alex has

suffered from ASPD. Finally, by applying the 4P Factor Model, factors making Alex susceptible

to ASPD will be clarified. Cultural aspects are also considered during the application of the 4P

Factor Model.

According to Goodwin and Guze (1989), an antisocial personality disorder is

characterised by a pattern of exploitative, selfish, and guiltless behaviours. Among the symptoms

include a failure to follow the law, a failure to maintain steady work, a failure to create solid

interpersonal connections, and the exploitation of others for one's own advantage (American

Psychiatric Association, 2013). The studies of Grant et al. (2004) and Compton et al. (2005)

found that ASPD has a lifetime prevalence of 0.5% to 1% in women and 2% to 4% in males. The

research of Robins et al. (1984) indicated that prevalence is highest in those between the ages of

24 and 44 and declines between 45 and 64. To accurately diagnose Alex’s case, depending on the
definition and symptoms of ASPD is not enough. Therefore, it is necessary to use the DSM-5 to

form the basis for diagnosing Alex’s ASPD.

Application of DSM-5

The DSM-5 regulates four diagnostic criteria for ASPD. For criterion A, there are seven

sub-features within it (see Table 1). The patient must display one of the seven sub-features in

order to meet this requirement; however, Alex met four of them. To be more specific, there was a

series of Alex’s wrongdoings such as attacking an old men, fighting with the Billy-boy gang,

sexually attacking a women, housebreaking, murdering another women, driving recklessly. More

details would be included in the Table 1. These violent behaviours may be consistent with three

sub-features of Criterion A, including A1) lawless behaviours, A4) irritability and

aggressiveness, and A5) risking self and others’ safety. In addition, he did not show remorse for

his antisocial conducts, aligning with A7) lacking remorse. For criterion B, because he is

eighteen, so he meets the requirement. However, he does not meet criterion C since there is no

specific information about conduct disorder with onset before age 15 years. Finally, he meets

criterion D. The reason is that he does not show any schizophrenia and bipolar disorder’s

symptoms. Therefore, his ASPD is totally dependent from the two disorders.

Table 1

DSM 5 Criteria for Antisocial Personality Disorder

Criteria Description Checklist Note

Criteria A: Ignorance of and Met Met four sub-features

disregard for the rights of others

from the age of 15, as demonstrated

by one of the following seven sub-

features:

Criteria A1: Failure to abide by laws Met Alex committed a series of

and standards through actions that wrongdoings such as attacking

result in or would justify criminal an old men, housebreaking,

arrest sexually attacking a women,

murdering a women

Criteria A2: Lying, deception, and Not Met Alex did not lie, deceive, and

manipulation, for profit or manipulate

self-amusement

Criteria A3: Impulsive behaviour Not Met Alex did not conduct

impulsive behaviours

Criteria A4: Aggression and Met Alex aggressively attacked his

irritability shown by frequent friends, police officers

assaults on others or friends

Criteria A5: Disregards safety of self Met Alex drove recklessly, killed a

and others women

Criteria A6: Consistent Not Met No pattern of irresponsibility

irresponsibility was recorded

Criteria A7: Lack of remorse for Met He did not demonstrate any

actions remorse for his actions

Criteria B: The individual is at Met Alex is at the age of 18

least 18 years
 Criteria C: Before the age of 15, Inconclusive No detail was specific about

there was a history of conduct this issue

problems

Criteria D: The antisocial Met No evidence of

behaviour does not occur in the schizophrenia or bipolar

context of schizophrenia or bipolar disorder’s symptoms

disorder

4P Factor Model

The 4P Factor Model is a variation of the biopsychosocial model with a more practical

orientation that neither Engel nor Ghaemi highlighted in their respective 1977 papers (Bolton,

2014). Predisposing, precipitating, perpetuating, and protecting are the four Ps, which are used in

three domains: biological, psychological, and social. Predisposing factors include figuring out

potential biological contributors (like organic brain injury and birth defects), genetic

vulnerabilities (like a family history of mental health issues), environmental factors (like

socioeconomic status, trauma, or attachment history), and psychological or personality factors

(like core beliefs or personality factors) that may increase a person's risk of experiencing a

particular mental health difficulty (Macneil et al., 2012). Precipitating factors are significant

occurrences before the condition manifests, such as substance use or interpersonal, legal,

occupational, physical, or financial pressures (Macneil et al., 2012). Perpetuating factors contain

factors which maintain the present challenges. These may comprise of ongoing substance abuse,

recurring behavioural patterns (such as avoidance or safety behaviours in anxiety disorders or

withdrawal in depressive disorders), biological patterns (such as insomnia in mania and insomnia

or hypersomnia in depression), or cognitive patterns (such as attentional biases, memory biases,

or hypervigilance) (Macneil et al., 2012). Protective factors are finding strengths or resources

that could lessen the effects of the condition. These may consist of personal traits, talents,

hobbies, and social support (Macneil et al., 2012). Because the 4P Factor Model could provide a

comprehensive strategy for comprehending the root causes of mental issues from several angles

(Selzer & Ellen, 2014), it is possible to understand which factors that led Alex suffer from

ASPD.

Predisposing Factors

For biological factors, one factor contributing to the development of Alex’s ASPD is his

gender. It is found that man are more likely to suffer from ASPD than woman (Compton et al.,

2005; American Psychiatric Association, 2013). Therefore, because Alex’s gender is male, he has

a higher likelihood of developing ASPD.

There are three two social risk factors that may have contributed to the growth of Alex’s

ASPD. First, his parents does not control him strictly. In the movie, Alex can be free to do

anything he wants without being supervised by his father and mother. They never ask him

detailed and suspect what he did when he is not at home at night. Teenagers who get inadequate

parental supervision are more likely to associate with other juvenile offenders, which can

enhance the risk that they would engage in criminal activity (Schoeler et al., 2016). Because Alex

lacks supervision from his parents, it has raised greater chances for him to play with bad peers,

triggering him to commit wrongdoings. Second, lack of school management is also a

predisposing factor constituting Alex’s ASPD. Achakanalli and Kumbhar (2017) assert that the

educational setting affects students' personality. They contend that two factors that raise the

likelihood of children skipping class are a lack of teacher monitoring and a lack of school
discipline. These reasons can explain why in the movie, although he did not attend school for

seven consecutive days, his teacher and the principal did not have any solution to bring him back

to the school. Once again, this has helped Alex have chances to commit crimes without being

controlled by the school.

Cultural Considerations

It should be noticed that the background of the film is set in a dystopian London and this

is an important cultural factor in diagnosing Alex’s APSD. Dystopia is an imagined place or state

where everything is unpleasant or awful, generally one that is authoritarian or has ruined the

environment, according to Oxford Dictionaries. It is sometimes used as an opposite of utopia, a

phrase Sir Thomas More devised and which serves as the title of his best-known book, which

was released in 1516 and outlines a plan for a perfect society with no crime, violence, and

poverty. From this information, we can understand that Alex is living in a society in which its

culture norms glorify violence and deviant behaviour. Living in a community having such norms

may have motivated Alex to do lawless actions. If he lived in a society which does not have this

culture, Alex would be less likely to conduct socially unacceptable behaviours.

Precipitating Factors

For psychological factors, Alex appears to have high self-esteem, which led to his

physical attack towards his friends. He considered himself a great leader of the gang, so when his

gang members suspected his ability to lead the gang, he had felt angry to this suspect by

physically attacking his members to prove that he deserves to be their boss. It is found that when

a person with a narcissistically inflated picture of themselves encounters someone who

challenges that perspective, aggression and violence are most likely to occur (Baumeister et al.,
1996; Baumeister et al., 2000; Bushman & Baumeister, 1998; Bushman et al., 2009). Therefore,

when Alex feel that his self-esteem is being threatened, this has triggered him to conduct

physical violence on his friends.

For social factors, peer encouragement plays an important role in making Alex commit

housebreaking and murder a women. To be more specific, Alex’s gang members are those

suggesting Alex to illegally break into the women’s house. This has led Alex to conduct a series

of wrongdoings. Association with criminal peers affects an individual's criminal behaviour

(Agnew, 1991; Matsueda & Anderson, 1998; Weerman, 2011).

Perpetuating Factors

Peer participation is the social perpetuating factor that contributes to Alex’s ASPD. In

every Alex’s illegal activity, his peers always participate with him. This has motivated Alex to

commit crimes. An individual's criminal activity is influenced by their relationships with

criminal peers (Agnew, 1991; Matsueda & Anderson, 1998; Weerman, 2011).

Protective Factors

Protective factors that are able to suppress Alex from suffering from ASPD are

insignificant. Physical health of those developing ASPD tend to be worse (Goldstein, 2008);

nevertheless, this is not the case of Alex when he seems to have good physical health. The

evidence is that he does not have any health problem in the movie. In addition, he also loves

listening Beethoven’s music as a way to enjoy his life. However, the impact of these protective

factors is not profound enough to help Alex combat his ASPD.

Cultural Considerations
 Positive social influences and support networks may not exist in the dystopian society,

which might exacerbate ASPD symptoms. When these protective elements are absent, it may be

harder for Alex to fight against or get rid of these features. In a dystopian society, there may be

little or no access to mental health treatment or proper rehabilitation programs. This is true in the

case of Alex when he could not have the right to choose the intervention which is suitable for

him. Instead, he was forced to be treated with a new Ludovico technique. This technique made

him suffer from mental pains instead of truly changing his nature. Thus, lacking access to

supporting services might contribute to the persistence of his ASPD.

Conclusion

In conclusion, Alex, the main character of the movie “A Clockwork Orange", is believed

to suffer from Antisocial Personality Disorder. The belief is supported with the application of

DSM-5 in diagnosing his mental disorder. By observing his behaviors and actions in some scenes

of the film, it is found that he met three in a total of four criteria for ASPD. However, it should

be noticed that this diagnosis may not be completely accurate because it is not implemented by a

mental health practitioner with professional training. In addition, through employing the 4P

Factor Model, factors leading to Alex’s ASPD have been explored from different aspects. Alex’s

gender, lacking parental, and school supervision are the biological and social risk factors

predisposing Alex’s disorder. Living in a dystopia is an important cultural consideration for

diagnosing Alex’s predisposing risk factors. Alex’s high self-esteem and his peer encouragement

are the precipitating factors of his ASPD. For perpetuating factors, peer participation in illegal

activities is the social factor keeping Alex’s symptoms to continue occurring. Good physical

health and the passion for Beethoven’s music are the protective factors for Alex but their impact

may not be profound enough. Under cultural norms glorifying violence and deviant behaviour
like the dystopia, it would prove challenging for Alex to seek positive social influences and

support networks as well as access to proper intervention and rehabilitation programs to treat his

disorder. However, from Alex’s case study, it is hoped that people with ASPD will have

opportunities to treat this mental disorder properly and effectively.

 References

Achakanalli, C., & Kumbhar, S. I. (2017). Socio-economic factors responsible for increasing

juvenile delinquency and various rehabilitative measures of government. Scholarly

Research Journal for Humanity Science & English Language, 6(30), 8352–8361.

https://oaji.net/articles/2017/1201-1546069187.pdf

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders.

https://doi.org/10.1176/appi.books.9780890425596

Agnew, R. (1991). The interactive effects of peer variables on delinquency. Criminology, 29(1),

47–72. https://doi.org/10.1111/j.1745-9125.1991.tb01058.x

Baumeister, R. F., Bushman, B. J., & Campbell, W. K. (2000). Self-Esteem, narcissism, and

aggression: Does violence result from low self-esteem or from threatened egotism?

Current Directions in Psychological Science, 9(1), 26–29. https://doi.org/10.1111/1467-

8721.00053

Baumeister, R. F., Smart, L. M., & Boden, J. M. (1996). Relation of threatened egotism to

violence and aggression: The dark side of high self-esteem. Psychological Review,

103(1), 5–33. https://doi.org/10.1037/0033-295x.103.1.5

Bolton, J. (2014). Case formulation after Engel—The 4P Model: A Philosophical case

conference. Philosophy, Psychiatry, & Psychology, 21(3), 179–189.

https://doi.org/10.1353/ppp.2014.0027

Bushman, B. J., & Baumeister, R. F. (1998). Threatened egotism, narcissism, self-esteem, and

direct and displaced aggression: Does self-love or self-hate lead to violence? Journal of
 Personality and Social Psychology, 75(1), 219–229. https://doi.org/10.1037/0022-

3514.75.1.219

Bushman, B. J., Baumeister, R. F., Thomaes, S., Ryu, E., Begeer, S., & West, S. G. (2009).

Looking again, and harder, for a link between low Self-Esteem and aggression. Journal of

Personality, 77(2), 427–446. https://doi.org/10.1111/j.1467-6494.2008.00553.x

Compton, W. M., Conway, K. P., Stinson, F. S., Colliver, J. D., & Grant, B. F. (2005).

Prevalence, correlates, and comorbidity of DSM-IV antisocial personality syndromes and

alcohol and specific drug use disorders in the United States. The Journal of Clinical

Psychiatry, 66(06), 677–685. https://doi.org/10.4088/jcp.v66n0602

Goldstein, R. B., Dawson, D. A., Chou, S. P., Ruan, W. J., Saha, T. D., Pickering, R. P., Stinson,

F. S., & Grant, B. F. (2008). Antisocial behavioral syndromes and Past-Year physical

health among adults in the United States. The Journal of Clinical Psychiatry, 69(3), 368–

380. https://doi.org/10.4088/jcp.v69n0305

Goodwin, D., & Guze, S. B. (1989). Sociopathy (antisocial personality). In Psychiatric diagnosis

(4th ed.). Oxford University Press.

Grant, B. F., Stinson, F. S., Dawson, D. A., Chou, S. P., Ruan, W. J., & Pickering, R. P. (2006).

Co-Occurrence of 12-month alcohol and drug use disorders and personality disorders in

the United States: results from the national epidemiologic survey on alcohol and related

conditions. Alcohol Research, 29(2), 121. https://www.questia.com/library/journal/1P3-

1069201471/co-occurrence-of-12-month-alcohol-and-drug-use-disorders
Macneil, C. A., Hasty, M. K., Conus, P., & Berk, M. (2012). Is diagnosis enough to guide

interventions in mental health? Using case formulation in clinical practice. BMC

Medicine, 10(1), 1–3. https://doi.org/10.1186/1741-7015-10-111

Matsueda, R. L., & Anderson, K. (1998). The dynamics of delinquent peers and delinquent

behavior. Criminology, 36(2), 269–308. https://doi.org/10.1111/j.1745-

9125.1998.tb01249.x

Robins, L. N. (1984). Lifetime prevalence of specific psychiatric disorders in three sites.

Archives of General Psychiatry, 41(10), 949.

https://doi.org/10.1001/archpsyc.1984.01790210031005

Schoeler, T., Theobald, D., Pingault, J., Farrington, D. P., Jennings, W. G., Piquero, A. R., Coid,

J. W., & Bhattacharyya, S. (2016). Continuity of cannabis use and violent offending over

the life course. Psychological Medicine, 46(8), 1663–1677.

https://doi.org/10.1017/s0033291715003001

Selzer, R., & Ellen, S. (2014). Formulation for beginners. Australasian Psychiatry, 22(4), 397–

401. https://doi.org/10.1177/1039856214536240

Weerman, F. M. (2011). Delinquent peers in context: A longitudinal network analysis of selection

and influence effects. Criminology, 49(1), 253–286. https://doi.org/10.1111/j.1745-

9125.2010.00223.x