I just finished reading your memoir and I wanted to take a moment to thank you. I am a clinical psychologist and am continually interested in expanding my mind and understanding of the human experience. Your book helped me think differently about sociopathy, empathy, logic and choice. Many people (especially clinicians) would like to think that there is a firm line between those who are "personality disordered" and the rest of them. This presupposes that they are perfectly ordered in their own personalities. Why is it that we allow ourselves to be 'a little depressed' or 'have some problems with anxiety' but the notion that we may all be on a spectrum of orderliness to disorderliness in regard to personality is so challenging? While I do not identify with any one personality disorder per se (other than general traits of cluster B), your worldview and approach to life resonated with me at times. I believe that working within one's system of thought and affect instead of against the grain will yield greater results. This is especially true when I apply this to the clients I see in my private practice. There is a difference between the drama that unfolds in our minds and the behavior we choose to enact in the world. I teach my clients to remove (emotional) judgment from choices and evaluate different paths according to the cost benefit ratio.
I asked what she meant about the "drama that unfolds in our minds and the behavior we choose to enact" and whether her patients push back when she tries to get them to be less emotional in their decision-making:
As far as my comment goes, everyone has dark thoughts; some are more willing to admit them. I believe that having the freedom to fantasize and think about whatever you want is freeing and allows you to work out other issues. I actively promote this with my clients and generally find that even the most violent of fantasizing does not lead to action for those that I see. In fact, it usually has deeper, symbolic meaning. I don't believe in judging anyone if I can help it - natural consequences shape behavior. If one is generally an asshole to others, that person will find he or she has few friends. If that works for that person, then great. Otherwise, it's time to review one's strategies and weigh the pros and cons. Personally, I draw the line at not encroaching on the rights of others (even though I would often like to and most of the time don't really care about the rights of people I don't know or who wouldn't affect me). I do this because of the natural consequences of not doing so (i.e. having to deal with pissed off people, losing friends, legal issues) but also because I believe this sort of discipline keeps me mentally fit and in control.
As far as taking emotion out of decision making, I usually give clients a logical reason for examining issues in a particular way. Emotion tends to act as static for our cognitive minds. I look at it like two data streams - one leans towards facts and the other towards instinct. Both hold good information but since emotion is processed by an older part of our brain and doesn't work with information in the same way, we can't rely solely on it as a source of decision making and is better used as an adjunct. Clients tend to see what I mean so it's not a hard sell.