[Note: What follows are near-verbatim extracts from Theodore Millon’s published works, cited under References. This information is based, for the most part, on information conveyed in the typewritten note that accompanied Lucas Helder’s pipe bombs [] and should be read in conjunction with the original analysis, conducted May 4, 2002.]
Luke Helder’s letter to the Wisconsin student newspaper, the Badger Herald [] offers a great deal more than the mailbox note [] used in my initial (May 4, 2002) analysis. The pain avoidance valence remains present in the longer letter, which confirms my initial impression of an avoidant (active-detached) personality disorder. It also confirms that Helder does not have sadistic (aggressive) tendencies, which the nature of the crime (but not the initial mailbox note) may initially have suggested. What I do see in the longer letter, however, is clear evidence of formal thought disorder, some delusional thinking, and possibly perceptual disturbances. It seems quite clear that there has been some personality decompensation (probably fairly recent) and that an Axis I disorder should be added to flesh out the clinical picture. The presence of “positive” vs. “negative” symptoms has implications for Helder’s premorbid personality pattern (in terms of Axis II avoidant/active-detached vs. schizoid/passive-detached personality disorder).
In contrast to narcissistic or histrionic personalities, who enjoy being the center of attention, avoidant personalities shun the limelight for the relative safety of obscurity. Whereas narcissistic and histrionic personalities seek and demand admiration, avoidant personalities withdraw to a niche where they can be alone and comfortable. Easily shamed or humiliated, they are hypersensitive to negative evaluation, and fear criticism, disapproval, or rejection. Their sensitivity to criticism and rejection may be so acute that it extends to a fear of merely disappointing others. Avoidant personalities are particularly sensitive to being judged by those in positions of authority, where verdicts are presumably more powerful and absolute in their condemnation. They are plagued by feelings of inadequacy, avoid talking about themselves, seldom reveal their true feelings to others, and resist any life change or activities that might bring them into public view. They are unwilling to become interpersonally involved with others unless they are certain to be liked; thus, they typically have just a few trusted friends.
Because they cannot express their emotions directly (for fear of humiliation), avoidant personalities may express their feelings in poetry and artistic activities. In an assertion that seems particularly relevant to the Helder case, Millon and Davis (2000) contend that avoidant personalities “can be highly creative in the privacy of their apartment, or become superheroes in their own fantasy life, but in the real world it’s best not to attempt anything that might bring attention to oneself” (p. 141).
Normal-range variants of the avoidant personality pattern (i.e., circumspect and inhibited types), though private, are interpersonally courteous and restrained. They feel unsure of themselves and are sensitive to social indifference and rejection. Thus, they are attuned to the feelings and opinions of others and need social approval to flourish. In situations where they feel accepted by others, they can overcome their fear of embarrassment, open up, be friendly and cooperative, and work productively with others—showing sensitivity, a good sense of humor, and a well-developed artistic capacity.
Few people exhibit personality patterns in pure or prototypal form; more often, individual personalities represent a blend of two or more prevailing orientations. Based on the note left in mailboxes where bombs were planted (see May 4, 2002 analysis), the hybrid avoidant type most likely to apply to Luke Helder is the conflicted avoidant, which includes features of the negativistic (passive-aggressive) personality. As stated by Millon and Davis (2000), “conflicted avoidants combine the basic withdrawal of the avoidant pattern with the negativist’s tendency toward interpersonal guerilla warfare” (p. 144). They experience internal discord and dissension; ambivalently fear both independence and dependence, are confused, tormented, and embittered, and feel misunderstood, unappreciated, and demeaned. Although they see no alternative but to depend on supporting persons and institutions, they experience an undercurrent of deep resentment for this dependency. Conflicted avoidants display their moods more erratically than does the “pure” avoidant pattern, and may strike out indirectly, being fearful of open confrontation. During times of diminished stress, they may deny past resentments and attempt to portray an image of general contentment; however, under stress their pacific surface demeanor easily gives way to impulsive hostility and they may seethe with thoughts of revenge at those who fail to recognize their need for affection. The typical behavior pattern is one of angry acting-out, followed in turn by remorse and regret. Avoidants indulge excessively in fantasy and imagination, both as a means of replacing anxiety-arousing cognitions of inadequacy and low self-worth, and as a means of gratifying needs that cannot be met, owing to their social withdrawal. Those with comorbid negativistic traits may see themselves dispatching their enemies with a swift, confident fury. A complicating factor is that avoidants are unable to orient their thoughts and emotions logically, tending to become lost in personal irrelevancies and autistic asides (superficially resembling the schizotypal pattern), which may further alienate them from others. It should be noted, however, that there is no direct evidence of a negativistic tendency in Luke Helder’s letter to the Badger Herald.
As is often the case with Axis I/Axis II comorbidity, there is a logic that links Axis II personality patterns with Axis I clinical syndromes. One such comorbidity that warrants consideration in the case of Luke Helder is dissociative disorder. For the avoidant, feelings of self-estrangement may arise as a protective maneuver to diminish the impact of excessive stimulation, the pain of social humiliation, or a devalued sense of self. For avoidants, dissociative states may stem from the intentional use of cognitive interference, through which they disconnect themselves from intrusive thoughts and feelings (Millon, 1996, p. 273).
In the differential diagnosis, I would also consider a brief delusional formation (perhaps in conjunction with a dissociative state). Such reactions may develop as sequelae of severe depersonalization feelings or as a result of being thrust into situations of excessive responsibility and stimulation. These transient delusions are usually bizarre and nonsensical (Millon, 1996, p. 274).
Finally, another comorbidity to consider is a schizophrenic syndrome. Avoidant personalities are among the personalities most inclined to decompensate into disorganized schizophrenic episodes, not only because they are easily overwhelmed by external and internal pressures but because disorganization is an extension of their characteristic protective maneuver of interfering with their cognitive clarity (see Coping Strategies below). The likely clinical picture will be one of forced absurdity and incoherence, and a concerted effort to disrupt cognitive logic and emotional stability (Millon, 1996, p. 273).
The avoidant type may have an inborn sensitivity to pain, exacerbated by a history of repeated exposure to threatening life circumstances such as parental rejection. Consequently, these personalities are preoccupied by life preservation; that is, avoidance of sadness and anxiety generated as emotional responses to psychic pain.
In my opinion, the best clue to Luke Helder’s state of mind at the time of his bombing spree is the vexatious nature of the internalized object representations of avoidant personalities. The internalized residue of past experiences with significant others that inhere in the mind of the avoidant are quite readily activated. They are composed of intense, conflict-ridden memories of problematic early relationships. Moreover, there is a paucity of recollections of a more rewarding nature to draw on or to dispose one to a more optimistic perception of the world. Owing to the pervasiveness of these troublesome memories, there are few avenues and mechanisms to channel needs, bind impulses, resolve conflicts, or deflect external stressors. Thus, avoidants are trapped in the worst of both worlds, seeking to avoid both the distress that surrounds them and the emptiness and wounds that inhere within them; hence, they are neither at home in the world, nor do they find solace and freedom in themselves (Millon, 1996, p. 263).
Children reared in a family setting in which they are belittled, abandoned, censured, or otherwise devalued, will have their natural robustness crushed, and acquire in its stead attitudes of self-deprecation and feelings of social alienation. Thus, they may learn, in a highly generalized way, to avoid attaching themselves to others, acquiring in the process a sense of mistrust of their social environment (Millon, 1996, p. 279).
Avoidants depend excessively on fantasy and imagination to achieve a measure of need gratification and to build what little confidence they may have in their self-worth (Millon, 1996, p. 264). These tendencies may become evident by adolescence, in a constellation of avoidant tendencies that Millon has termed the “inadequacy syndrome.” Inadequate adolescents dread facing the social responsibilities and expectations that society has established for their age group and are fearful that they will falter in finding a mate, getting a job, and so on. Although these individuals do not question or reject the established values and goals of the larger society, they experience repeated failures in their quest to fit in, thus slipping into increasingly isolated behaviors — preoccupying themselves with watching TV, daydreams of glory, and other forms of fantasy escape (Millon, 1996, pp. 267–268).
To ensure a modicum of personal tranquility, they may defensively engage in a series of cognitive reinterpretations and digressions, intentionally destroying the clarity of their thoughts by intruding irrelevant distractions, tangential ideas, and discordant emotions. By upsetting the smooth and logical pattern of their cognitive processes, avoidants further diminish their ability to deal efficiently and rationally with events. This impedes their ability to attend to the most salient features of their environment, focusing their thoughts, or responding rationally to events. In sum, they fall prey to coping mechanisms that further aggravate their original difficulties and intensify their alienation both from themselves and from others (Millon, 1996, p. 281).
Final Diagnostic Impressions
On balance, the likely final diagnosis on Axis I is delusional (paranoid) disorder, grandiose type. The likely Axis II diagnosis remains avoidant personality, with possible decompensation during the prodromal period, resulting in the emergence of schizotypal traits (cognitive and perceptual distortions, primarily odd beliefs, some loosening of associations). However, because delusional disorder usually does not occur until middle age, the possibility of a schizophreniform disorder should be considered in the differential diagnosis.