Curing Psychopathy

I got this press release and a copy of Willem Martens' new book on psychopaths who are no longer psychopaths:

[T]he new book of William Martens – MD, PhD. The Firebirds among the Psychopaths – Development and Remission in Psychopathy,” will be available from January 15 2015 on Amazon, Barnes & Noble, Google Play, Kobo, Apple iBookstore etc; ISBN: 978-2-7659-0740-4

This book is an attempt to describe and make understandable this rare phenomenon of complete remission in psychopathy and the developmental embedding of it. In this book the history of the concept of psychopathy; the psychosocial, psychodynamic, genetic and neurobiological aspects, the diagnostic tools as well as the therapeutic determinants of the phenomenon will be discussed in this volume.

A complete remission of psychopathy is defined as complete disappearance of all such manifestations of disease.  The case reports of remitted criminal and noncriminal psychopaths which are presented in this book are the only examples of real remission in a sample 667 patients which were treated in a forensic psychiatric hospital between 1966 and 1995. This a percentage of just nearly 2% .They might become “weller than well” as Karl Menninger called this phenomenon in his study of remitted in schizophrenic patients. This means that these patients are not just cured, but their life as very much enriched by the experience of conquer the disorder and self-transformation. They will continue improve still further.

Sociopath treatment

There is no "cure" for sociopathy, but it can be managed well or it can be managed poorly. Sociopaths don't respond very well to punishment, but they do respond to incentives. As discussed in this little blurb, referencing the successful treatment of teenage sociopaths:

Psychopaths aren’t murderers and criminals by their nature, they’re simply people without compunction. Naturally this can make them callous and cold, but it doesn’t automatically make them dangerous. In fact, in cases where it has been demonstrated and proven to psychopaths that they will personally benefit from abiding by rules, then it is possible they can become relatively well assimilated into society. Let me explain, where traditional treatment is used, (like psychotherapy or counseling), the sessions merely act as a kind of unintentional specialized training to help psychopaths more effectively mimic healthy emotional behavior. They are not treated or helped by traditional therapy as any insane (or sane) person might be. But Dr. Robert Hare developed a system whereby by accepting that the psychopath may never be anything but rational and uncaring, and used logical process to demonstrate that it is in their own interest to behave appropriately. Apparently there are criminal rehabilitation systems which are testing out this process, offering instant rewards for psychopathic subjects who follow the rules, appealing to their need for instant gratification and it is shown to be relatively effective. This is the first treatment in the history of psychopathy that has been been effective at all.

What is the difference between a successful sociopath and a less successful one? Sometimes I wonder if it's a matter of chancing upon a good thing first and sticking with it rather than a bad one -- like we're monkeys in an experiment, and if you press one button you get heroin, if you press another you get food, and if you press another you somehow get sexual pleasure. Once you find a good thing, you'll probably just stick with it, right? I always got good results being legit, ever since I was little, but if I didn't, or if my first good results came from being less legit, I'm sure I would have gone that way.

But if you want to "manage" yourself or someone else, I do think the key is incentives and immediate gratification. The caveats are that the incentive cannot be discretionary (because sociopaths will see it as arbitrary and not actually associate it with their own behavior) and the reward can't seem too good or the task too hard, otherwise he will spend all of his time trying to figure out how to trick you into giving him the reward without actually completing the task.

Experts on sociopathy

The following were taken from an article on Dr. Robert Hare, psychopathy expert.

History of the term psychopath:

The condition itself has been recognized for centuries, wearing evocative labels such as "madness without delirium" and "moral insanity" until the late 1800s, when "psychopath" was coined by a German clinician. But the term (and its 1930s synonym, sociopath) had always been a sort of catch-all, widely and loosely applied to criminals who seemed violent and unstable.

Why we should care about psychopaths:

Psychopathy may prove to be as important a construct in this century as IQ was in the last (and just as susceptible to abuse), because, thanks to Hare, we now understand that the great majority of psychopaths are not violent criminals and never will be. Hundreds of thousands of psychopaths live and work and prey among us.

On their inability to respond to punishment or learn from negative experiences:

For his first paper, now a classic, Hare had his subjects watch a countdown timer. When it reached zero, they got a "harmless but painful" electric shock while an electrode taped to their fingers measured perspiration. Normal people would start sweating as the countdown proceeded, nervously anticipating the shock. Psychopaths didn't sweat. They didn't fear punishment--which, presumably, also holds true outside the laboratory.

On the sociopaths' lack of familiarity with emotional language:

Hare made another intriguing discovery by observing the hand gestures (called beats) people make while speaking. Research has shown that such gestures do more than add visual emphasis to our words (many people gesture while they're on the telephone, for example); it seems they actually help our brains find words. That's why the frequency of beats increases when someone is having trouble finding words, or is speaking a second language instead of his or her mother tongue. In a 1991 paper, Hare and his colleagues reported that psychopaths, especially when talking about things they should find emotional, such as their families, produce a higher frequency of beats than normal people. It's as if emotional language is a second language--a foreign language, in effect--to the psychopath.

On the potential for abuse:

"We'll let people out [of prison] on the basis of scores on this, and we'll put them in. And we'll take children who do badly on some version of this and segregate them or something. It wasn't designed to do any of these things. The problems that politicians are trying to solve are fundamentally more complicated than the one that Bob has solved."

On using the diagnosis to argue in favor of the death penalty:

"A psychological instrument and diagnosis should not be a determinant of whether someone gets the death sentence. That's more of an ethical and political decision."

On the sociopath's level of humanity:

Are these people qualitatively different from us? "I would think yes," says Hare. "Do they form a discrete taxon or category? I would say probably--the evidence is suggesting that. But does this mean that's because they have a broken motor? I don't know. It could be a natural variation." True saints, completely selfless individuals, are rare and unnatural too, he points out, but we don't talk about their being diseased.

On the possibility of a cure:

Asked if he thinks there will ever be a cure for psychopathy--a drug, an operation--Hare steps back and examines the question. "The psychopath will say 'A cure for what?' I don't feel comfortable calling it a disease. Much of their behaviour, even the neurobiological patterns we observe, could be because they're using different strategies to get around the world. These strategies don't have to involve faulty wiring, just different wiring."

A prosthetic moral compass?

Like many sociopaths, I have my own way of organizing the world and coming up with shortcuts for good decisions. I like to use economics and the principles of efficiency. Most of the time my method tracks what the majority think is the moral thing to do. Why don't we kill? Because if it were really more efficient to take another person's life, the murderer should be able to pay enough money to the victim that he would consent to the murder. Along the same reasoning, murder of animals is fine because animals don't have the access to capital markets or earning potential to be able to buy their life, right? Wrong. Because otherwise that would also apply to slaves. See? It's complicated. Hard to keep track of things. But it's only a prosthetic moral compass, so what do you expect?

Here's an oft-asked question: If there were a cure for sociopathy, would I take it? Or do I really believe that sociopathy is just another way of navigating the world, an acceptable variance in human behavior? Would it be a betrayal to "my people" to accept a "solution" to a "problem" that they don't think needs solving? A significant portion of the deaf community feels that cochlear implants are an affront to legitimate deaf culture. What if there there were a cochlear implant for the heart? Wikianswers seems to think there's one coming:

In cases where brain damage is too severe to permit [normal therapy], new developments in technology in the next decades will bring implantable devices that may be able to be used in the brain, along with other means including synthetic replacement neurotransmitters, to carry nerve impulses along paths formerly silent and unused in the sociopath's brain.

I'm not one to get my information from wikianswers, and I haven't been able to find out what new technology this person was referring to, but it still is an interesting idea. Particularly if it stopped being evolutionarily advantageous to be a sociopath, I think I would seriously consider getting a mechanical device to "fix" my "broken" brain.

At the very least, I think it would be interesting to experience what others experience, even for a limited duration or in a limited capacity.  I was just reading in the NY Times about how John Elder Robison (Aspie and author of the memoir "Look Me in the Eye") underwent some experimental treatment that "had given him a temporary insight into other people he had not had previously".  If something like that were possible for people like me, I would almost certainly choose to do it.  I feel like that sort of insight can only be a good thing.