What exactly is psychopathy?

A reader sent this interesting article from one of our favorite researchers, Jennifer Skeem, whose previous attack on the PCL-R caused Robert Hare to take her to court and delay the publication before it was eventually released. The article is sort of an interesting primer on psychopathy and summary of the most recent research. She has her own ideas about the correct delineation of psychopathy that seems reasonable. First she discusses why there are so many ideas about what exactly sociopathy is:

As we will discuss, many of the controversies surrounding psychopathy stem from fundamental disagreements about its basic definition, or operationalization. The scope of phenomena encompassed by the term psychopathy has varied dramatically over time, from virtually all forms of mental disorder (psychopathy as “diseased mind”) to a distinctive disorder characterized by lack of anxiety; guiltlessness; charm; superficial social adeptness; dishonesty; and reckless, uninhibited behavior (Blackburn, 1998). Even contemporary conceptualizations of psychopathy contain puzzling contradictions. Psychopaths are often described as hostile, aggressive, and at times revenge driven (N. S. Gray, MacCulloch, Smith, Morris, & Snowden, 2003), yet they are also characterized as experiencing only superficial emotions (Karpman, 1961; McCord & McCord, 1964). They are impulsive and reckless, yet apparently capable of elaborate scheming and masterful manipulation (Hare, 1993). They can rise to high levels of achievement or status in society, attaining success in business and public life, yet present as criminals whose behavior is so poorly thought out and lacking in regard even for self-interest that they occupy bottom rungs of the social ladder

Given these contrasting depictions, it is scant wonder that some experts have concluded that the concept of psychopathy, as commonly understood, is disturbingly problematic: a “mythical entity” and “a moral judgment masquerading as a clinical diagnosis” (Blackburn, 1988, p. 511), “almost synonymous with ‘bad’” (Gunn, 1998, p. 34), “used by the media [to convey] an impression of danger, and implacable evil” (Lykken, 2006, p. 11). In the words of William and Joan McCord (McCord & McCord, 1964), two influential figures in the historic literature on psychopathy, “the proliferation of definitions, the tendency to expand the concept to include all deviant behavior, the discrepancies in judgment between different observers——these pitfalls in the history of the concept—— are enough to make a systematic diagnostician weep” (p. 56).

She then (optimistically) asserts that all is not lost, that sociopathy is a thing and we can figure out what that thing is through careful parsing of the literature and empirical evidence. First she dispels some myths:

• Psychopathy is synonymous with violence: "However, psychopathy can and does occur in the absence of official criminal convictions, and many psychopathic individuals have no histories of violence."
• Psychopathy is synonymous with psychosis: "In contrast with psychotic patients, psychopathic individuals are generally rational, free of delusions, and well oriented to their surroundings"
• Psychopathy is synonymous with antisocial personality disorder (ASPD): "The difference arises largely because measures of psychopathy include personality traits inferable from behavior, whereas measures of ASPD more exclusively emphasize antisocial, criminal, and (to a lesser extent) violent behavior."
• Psychopathic individuals are born, not made: "Contemporary understanding of the pervasive interplay of genetic and environmental influences in determining behavioral outcomes of various kinds argues against the likelihood that any psychiatric condition, including psychopathy, is entirely 'born' or 'made.'"
• Psychopathy is inalterable: "some recent empirical work has emerged to suggest that personality traits in general, and psychopathic traits more specifically, undergo change across major developmental transitions"

The article is quite long. I will probably keep going back to it over the next month or so and perhaps sharing things that I learn here.

Different children

Selections from a NY Times book review about children with unique issues:

Andrew Solomon’s enormous new book, “Far From the Tree: Parents, Children, and the Search for Identity,” is about children who are born or who grow up in ways their parents never expected.

Mr. Solomon explained that “Far from the Tree” took 11 years. It stemmed from a 1994 article about deafness he wrote for The New York Times Magazine. In the course of reporting it, he said, he realized that many issues confronting the deaf are not unlike those he faced as someone who was gay. 

A few years later, watching a documentary about dwarfism, he saw the same pattern again. Eventually the book grew to also include chapters on Down syndrome, autism, schizophrenia, disability, prodigies, transgender identity, children who are conceived during a rape and those who become criminals.

Mr. Solomon said he included criminal children after deciding that society’s thinking on the subject hadn’t really advanced very much, even while it has on autism and schizophrenia. “We still think it’s the parents’ fault if a child becomes a criminal or that something creepy must have gone on in that household,” he said. He included the children of rape because he discovered that their mothers shared a lot with all the other mothers in the book. “They feel alienated, disaffected, angry — a lot of the things a mother feels about a child with a disability.”

This kind of commonality, he went on, was something he discovered only while writing. “Each of the conditions I describe is very isolating,” he said. “There aren’t that many dwarfs, there aren’t that many schizophrenics. There aren’t that many families dealing with a criminal kid — not so few but not so many. But if you recognize that there is a lot in common in all these experiences, they imply a world in which not only is your condition not so isolating but the fact of your difference unites you with other people.”

“Forewarned is forearmed,” he said. “Some things, on some scale, go wrong in everyone’s life. I think I have perfectionist tendencies, but I know you can’t go into parenthood thinking, ‘I’m going to love my child as long as he’s perfect.’ Rather, it should be, ‘I’m going to love my child whoever he is, and let’s see how he turns out.’ ”

I wonder how many parents can say that about criminal or sociopathic children -- that they appreciate the experience of raising a child with those unique difficulties and that they love their child no matter what. Still, it is a nice, aspirational thought.

Socios: all in the family

This is one of my favorite songs. I love the lyrics: "One child grows up to be somebody that just loves to learn and another child grows up to be somebody you'd just love to burn. Mom loves the both of them, you see it's in the blood. Both kids are good to mom -- blood's thicker than mud." Of course when I first heard the song I thought I heard "Somebody that just loves to burn," which was obviously more applicable, but the rest is true -- my family loves me just as much as my empath siblings. But with the holidays upon us, I have been thinking about socio family members. Some think that as many as 1 in 25 people are sociopaths, and if that's the case you'd imagine that even more people have a sociopath in the family. Or maybe you turn out to be the sociopath in the family, like the man in this article:

Jim Fallon recently made a disquieting discovery: A member of his family has some of the biological traits of a psychopathic killer.
* * *
Three years ago, as part of a personal project to assess his family's risk of developing Alzheimer's disease, Dr. Fallon collected brain scans and DNA samples from himself and seven relatives. At a barbecue soon thereafter, Dr. Fallon's mother casually mentioned something he had been unaware of: His late father's lineage was drenched in blood.

An early ancestor, Thomas Cornell, was hanged in 1673 for murdering his mother. That was one of the first recorded acts of matricide in the Colonies. Seven other possible killers later emerged in the family tree. The most notorious was distant cousin Lizzie Borden of Fall River, Mass. In 1892, she was accused and then controversially acquitted of killing her father and stepmother with an ax.

As a lark intended to enliven family get-togethers, Dr. Fallon decided to analyze the data from the Alzheimer's project to see whether anyone in his family matched the profiles of killers he had studied. His initial subjects included himself, his three brothers, his wife, and the couple's two daughters and son.
* * *
To his surprise, Dr. Fallon found that the analysis of his own brain showed he had inherited certain high-risk forms of MAOA and other various aggression-and violence-related genes.

"I'm the one who looks most like a serial killer," he says. "It's disturbing."
* * *
"I'm still in balance, but I seem to have low emotional engagement," says Dr. Fallon, noting that the brains of many cold-blooded murderers reveal a similar picture.

Dr. Fallon thinks that one vital factor may have prevented him from becoming a killer. "I had a charmed childhood," he says. "But if I'd been mistreated as a child, who knows what might have happened?"

The moral of this story to me is be careful how much you preach about genetic testing and forced imprisonment of sociopaths because you may turn out to be one of us.

Raising genius

I really enjoyed this article by Andrew Solomon in the NY Times Magazine, "How do you Raise a Prodigy?" I thought the parallels between raising a prodigy and raising a sociopath were compelling. He first talks about his recent research in parents that raise children with special issues:

Prodigies are able to function at an advanced adult level in some domain before age 12. “Prodigy” derives from the Latin “prodigium,” a monster that violates the natural order. These children have differences so evident as to resemble a birth defect, and it was in that context that I came to investigate them. Having spent 10 years researching a book about children whose experiences differ radically from those of their parents and the world around them, I found that stigmatized differences — having Down syndrome, autism or deafness; being a dwarf or being transgender — are often clouds with silver linings. Families grappling with these apparent problems may find profound meaning, even beauty, in them. Prodigiousness, conversely, looks from a distance like silver, but it comes with banks of clouds; genius can be as bewildering and hazardous as a disability.

He then goes on to express some of the particular difficulties in raising any child who is different than the norm, particular a child who is different from the parents themselves, and how there are no easy rules:


Children who are pushed toward success and succeed have a very different trajectory from that of children who are pushed toward success and fail. I once told Lang Lang, a prodigy par excellence and now perhaps the most famous pianist in the world, that by American standards, his father’s brutal methods — which included telling him to commit suicide, refusing any praise, browbeating him into abject submission — would count as child abuse. “If my father had pressured me like this and I had not done well, it would have been child abuse, and I would be traumatized, maybe destroyed,” Lang responded. “He could have been less extreme, and we probably would have made it to the same place; you don’t have to sacrifice everything to be a musician. But we had the same goal. So since all the pressure helped me become a world-famous star musician, which I love being, I would say that, for me, it was in the end a wonderful way to grow up.”

While it is true that some parents push their kids too hard and give them breakdowns, others fail to support a child’s passion for his own gift and deprive him of the only life that he would have enjoyed. You can err in either direction. Given that there is no consensus about how to raise ordinary children, it is not surprising that there is none about how to raise remarkable children. Like parents of children who are severely challenged, parents of exceptionally talented children are custodians of young people beyond their comprehension.

I love the Lang Lang quote. It is such a great acknowledgment that different folks require different strokes. If there is anything that I hope to achieve with the blog and getting people to think about the presence and role of sociopaths in society, it is probably to preach this gospel that we're all really different from each other in ways that we too often either ignore or pretend don't exist. There's nothing wrong with heterogeneity, in fact it is probably what keeps us so viable as the dominant species on this planet. Monster babies are born into all types of family every day. But the word monster need not mean B movie horror matinees, it could also be someone more like Lang Lang.

Pigeonhole diagnosis

Some people wonder why I want to be out at all -- if I am successfully passing and living a fulfilling life, why not just keep doing that? Part of me likes the fun and intrigue involved in my attempts to pass and the ability to hide in plain sight. Part of me is also resentful of the mental energy required for that task. I wonder what my life and brain would look like if I didn't feel compelled to mask certain things and constantly be putting on a show. If I've managed a certain level of success from without the system, what might I be able to accomplish within?

I was reading this Wired article by David Dobbs, author of the well-known article in the Atlantic comparing children to either Orchids or Dandelions (which are sociopath children? the answer may surprise you). In this article he discusses how our society treats those with mental illnesses, specifically schizophrenia:


A large  World Health Organization study, for instance, found that “Whereas 40 percent of schizophrenics in industrialized nations were judged over time to be ‘severely impaired,’ only 24 percent of patients in the poorer countries ended up similarly disabled.’ Their symptoms also differed, in the texture, intensity, and subject matter to their hallucinations or paranoia, for instance. And most crucially, in many cases their mental states did not disrupt their connections to family and society.

Watters, curious about all this, went to Zanzibar to see how all this worked. He learned that there, schizophrenia was seen partly as an especially intense inhabitation of spirits — bad mojo of the sort everyone had, as it were. This led people to see psychotic episodes  less as complete breaks from reality than a passing phenomena, somewhat as we might view, say, a friend or coworker’s intermittent memory lapses.

For instance, in one household Watters came to know well, a woman with schizophrenia, Kimwana,

was allowed to drift back and forth from illness to relative health without much monitoring or comment by the rest of the family. Periods of troubled behavior were not greeted with expressions of concern or alarm, and neither were times of wellness celebrated. As such, Kimwana felt little pressure to self-identify as someone with a permanent mental illness.

This was rooted partly in the idea of spirit possession already mentioned, and partly to an accepting fatalism in the brand of Sunni that the family practiced. Allah, they believed, would not burden any one person with more than she could carry. So they carried on, in acceptance rather than panic. As a result, this delusional, hallucinating, sometimes disoriented young woman passed into and out of her more disoriented mental states while still keeping her basic place in family, village, and work life, rather than being cast aside. Almost certainly as a result, she did not feel alienated, and her hallucinations did not include the sort of out-to-get-me kind that mark paranoid schizophrenics in the West.

This, writes Watters in enormous understatement, “stood in contrast with the diagnosis of schizophrenia as [used] in the West. There the diagnosis carries the assumption of a chronic condition, one that often comes to define a person.”


Of course I'm not stupid about wanting to out myself completely and without proper care. Dobbs goes on to describe the complete ostracizing of a Western schizophrenic from her friends and academic community upon her diagnosis. But I do wonder what effects struggling to conform to a particular societal standard of superficial normality has had on me. Perhaps I wonder so much because my family actually is really supportive, like the family of the woman Kimwana. I often credit their support for how I turned out, particularly their religious beliefs that I would not be burdened with more than I could carry. And so my sociopathy does not define me. I wonder if society were equally supportive, what a difference that might make?

Should a sociopath have children?

A reader writes:


I just happened on this website a few days ago and have been devouring it over the past few days. I have come to realize that I am a "sociopath". I don't like the terminology and its scary the way people seem to think about this term. nevertheless, i have learned from reading the various posts to finally understand what I know was going on with myself for years. language was always intentional to me. I have always felt like the social sphere is work for me. work that I can be good at, mind you, but work nonetheless. i am very promiscuous and have a difficult time being faithful to my partners. etc. etc. My question though is: can i have children? Or the better question: should I have children as a sociopath? One the one hand, I feel as though my strength is that I am very deliberate and intentional in my interaction with anyone and I would be a very deliberate "loving" parent. I worry that the stress of juggling my life along with children will make me vulnerable to some bad behaviors as a parent. I have noticed that impulse control can be a problem but have learned over the years to take time to act on fear and anger or get out of the situation. I usually need lots of time to talk to myself to come down from an angry situation. I don't think a young child would necessarily bring these out in me since I am pretty good at redirecting these feelings. Nevertheless, that is the big question that I have for the group. I am not worried about being a criminal because I am not a violent person and I see the risks of that way of life pretty clearly. I have made moral mistakes at my job in the past and I have learned to lead in the open and with consensus at my job. My relationship, thankfully, is going ok despite the fact that I can't be faithful sexually.  

Anyway, that is my question: should a sociopath have children?

I've also thought about whether I would be a good or a bad parent.  I think the answer is just that I would be a different parent.  I would want any children I have to be around other people who are more emotional, more loving, so they get used to that.  I would still want them to be like me, but bilingual.  Basically, I would want them to be able to turn my way of thinking off and on.

Sociopaths in literature: East of Eden's Cathy

Probably the most prototypical sociopath portrayal in literature is Cathy from Steinbeck's East of Eden.

I believe there are monsters born in the world to human parents. Some you can see, misshapen and horrible, with huge heads or tiny bodies; some are born with no arms, no legs, some with three arms, some with tails or mouths in odd places. They are accidents and no one's fault, as used to be thought. Once they were considered the visible punishment for concealed sins.

And just as there are physical monsters, can there not be mental or psychic monsters born? The face and body may be perfect, but if a twisted gene or a malformed egg can produce physical monsters, may not the same process produce a malformed soul?

Monsters are variations from the accepted normal to a greater or a less degree. As a child may be born without an arm, so one may be born without kindness or the potential of conscience. A man who loses his arms in an accident has a great struggle to adjust himself to the lack, but one born without arms suffers only from people who find him strange. Having never had arms, he cannot miss them. Sometimes when we are little we imagine how it would be to have wings, but there is no reason to suppose it is the same feeling birds have. No, to a monster the norm must seem monstrous, since everyone is normal to himself. To the inner monster it must be even more obscure, since he has no visible thing to compare with others. To a man born without conscience, a soul-stricken man must seem ridiculous. To a criminal, honesty is foolish. You must not forget that a monster is only a variation, and that to a monster the norm is monstrous.

It is my belief that Cathy Ames was born with the tendencies, or lack of them, which drove and forced her all of her life. Some balance wheel was misweighed, some gear out of ratio. She was not like other people, never was from birth. And just as a cripple may learn to utilize his lack so that he becomes more effective in a limited field than the uncrippled, so did Cathy, using her difference, make a painful and bewildering stir in her world.

There was a time when a girl like Cathy would have been called possessed by the devil. She would have been exorcised to cast out the evil spirit, and if after many trials that did not work, she would have been burned as a witch for the good of the community. The one thing that may not be forgiven a witch is her ability to distress people, to make them restless and uneasy and even envious.
. . .
Even as a child she had some quality that made people look at her, then look away, then look back at her, troubled at something foreign. Something looked out of her eyes, and was never there when one looked again. She moved quietly and talked little, but she could enter no room without causing everyone to turn toward her.

She made people uneasy but not so that they wanted to go away from her. Men and women wanted to inspect her, to be close to her, to try and find what caused the disturbance she distributed so subtly. And since this had always been so, Cathy did not find it strange.

Cathy was different from other children in many ways, but one thing in particular set her apart. Most children abhor difference. They want to look, talk, dress, and act exactly like all of the others. If the style of dress is an absurdity, it is pain and sorrow to a child not to wear that absurdity. If necklaces of pork chops were accepted, it would be a sad child who could not wear pork chops. And this slavishness to the group normally extends into every game, every practice, social or otherwise. It is a protective coloration children utilize for their safety.

Cathy had none of this. She never conformed in dress or conduct. She wore whatever she wanted to. The result was that quite often other children imitated her.

As she grew older the group, the herd, which is any collection of children, began to sense what adults felt, that there was something foreign about Cathy. After a while only one person at a time associated with her. Groups of boys and girls avoided her as though she carried a nameless danger.

Cathy was a liar, but she did not lie the way most children do. Hers was no daydream lying, when the thing imagined is told and, to make it seem more real, told as real. That is just ordinary deviation from external reality. I think the difference between a lie and a story is that a story utilizes the trappings and appearance of truth for the interest of the listener as well as of the teller. A story has in it neither gain nor loss. But a lie is a device for profit or escape. I suppose if that definition is strictly held to, then a writer of stories is a liar -- if he is financially fortunate.

Cathy's lies were never innocent. Their purpose was to escape punishment, or work, or responsibility, and they were used for profit. Most liars are tripped up either because they forget what they have told or because the lie is suddenly faced with an incontrovertible truth. But Cathy did not forget her lies, and she developed the most effective method of lying. She stayed close enough to the truth so that one could never be sure. She knew two other methods also -- either to interlard her lies with truth or to tell a truth as though it were a lie. If one is accused of a lie and it turns out to be the truth, there is a backlog that will last a long time and protect a number of untruths.
. . .
Nearly everyone in the world has appetites and impulses, trigger emotions, islands of selfishness, lusts just beneath the surface. And most people either hold such things in check or indulge them secretly. Cathy knew not only these impulses in others but how to use them for her own gain.

It is quite possible that she did not believe in any other tendencies in humans, for while she was preternaturally alert in some directions she was completely blind in others.

Special skill set

People often wonder whether sociopaths are born with their special skill set or whether it is acquired. I think it is a little bit of both. I think it is sort of like perfect pitch. Some people are apparently born with perfect pitch, or the ability to ascertain the frequency of sound waves not only relative to other frequencies, but relative to an absolute pitch, e.g. A = 440 Hz. If they do not keep this talent up (e.g. by never learning a musical instrument or otherwise doing anything musical), they will lose it. Similarly, I think there are a lot of survival or predatory talents that sociopaths excel at that other people have been equally inclined towards at one point in their lives, but have just failed to keep up or continue their education in those areas. I saw this recently referenced in an article about a class on survival skills being taught in New York's Central Park to yuppie urbanites. From the New York Times:

“These are time-tested skills,” Mr. Hobel said. “Many years ago we all used to know them, and now we’re bringing them back.”

The key to surviving in the wilderness, he explained, is conserving precious time and energy by remaining calm and aware. “The more skills we have, the more capable we are,” he said.

One eerie exercise focused on heightening awareness, with students closing their eyes and trying to sense danger lurking nearby. “Two people have been watching us the whole time,” Mr. Hobel said. “Can you feel their presence?”

To our surprise, we all could, and pointed to two thick logs, in front and behind us, in mud and leaves. From behind them suddenly arose two of Mr. Hobel’s associates dressed in full camouflage, their faces painted, who had been lying there unnoticed for an hour.

I actually have noticed my friends improving in these skills after spending time with me. They get used to seeing the world from a slightly different perspective, and ever after they have a bit more situational awareness and/or insight into primitive human nature that they weren't really developing before. Most people don't like to daily drudge through a parade of horrible what-ifs, but it actually can be quite fun once you get good at it. And of course, as I learned from being a musician, visualizing yourself doing something successfully makes actually doing that thing in real life infinitely easier. It may not be a pitch perfect performance, but neither will it be the disaster that it could have been had you never imagined yourself having to do those things or be that person. Not everyone wants to survive or excel in life, but for those that do, practice makes perfect.

I actually think I would be a very effective life coach.