Showing posts with label diagnoses. Show all posts
Showing posts with label diagnoses. Show all posts

Wednesday, May 16, 2012

Nurture trumping nature

I have posted before about James Fallon, neuroscientist, University of California, Irvine, professor, psychopath expert, and successful psychopath (?) before.  I thought this video was worth posting as well because it targets more the personal experience of what his family thinks about who he is and his childhood was instrumental in Jim not developing into a killer, despite his brain and genetic predispositions.




6:55: His mother tells him about how Lizzie Borden is a cousin of his.  On one line of his family there were at least 16 murderers.

7:54: He decides to check the brain scans and DNA of his family members for the brain signatures and genes linked to psychopathy.  He discovers everyone is normal except for him, who has the brain scan signature of a killer and all of the genetic markers predisposing to impulsivity, violence, etc.

10:05: Reaction from his family "I knew there was always something off.  It makes more sense now."  "Everything that you would want in a serial killer he has in a fundamental way."  "It was surprising but it wasn't surprising."  "He's always had a standoffish part to him."

11:00: Jim is honest with himself "I have characteristics or traits, some of which are . . . psychopathic." he gives the example of how he could blow off an aunt's funeral.  "I know something's wrong, but I still don't care."

11:40: Why wasn't he a killer?  "Whether genes are triggered or not will depend on what happens in your childhood."

12:28: "It turns out that I had a unbelievably wonderful childhood."

I think this is an interesting and accurate portrayal of what a high functioning psychopath might look like.  I think people expect to see very obvious differences, but frequently they're not obvious or they're not really visible.  It's like this response from Jennifer Kahn, author of that NY Times Magazine article on psychopathic children, when asked about whether the child's behavior was more or less extreme than she expected:

I think I expected Michael to be more immediately extreme. When I arrived, he was on his good behavior, but he did get extreme later in the night. Something that Waschbusch said he struggles with is that it is hard to define what is prepsychopathic behavior and what is behavior caused by a different kind of problem — it does tend to cross different diagnoses. It wasn’t the screaming or fits or slamming the toilet seat that struck me; it was the calculated coldness and the flip between emotional states. But I had expected it to be more obvious. When I entered the house, of course, I was thinking of adult psychopaths who have led criminal lives for decades, which is normally how they come to our attention. I was maybe expecting a child version of that, but of course that’s kind of ridiculous. Even among adult psychopaths, that would be a small minority.




Monday, May 14, 2012

Kid sociopath

Quite a few people emailed me this NY Times article that has hit the most emailed: Can you Call a 9-Year-Old a Sociopath?"  Here are selections (the article is quite long, but an engaging read):
  • “We’ve had so many people tell us so many different things,” Anne said. “Oh, it’s A.D.D. — oh, it’s not. It’s depression — or it’s not. You could open the DSM and point to a random thing, and chances are he has elements of it. He’s got characteristics of O.C.D. He’s got characteristics of sensory-integration disorder. Nobody knows what the predominant feature is, in terms of treating him. Which is the frustrating part.” . . . . Following a battery of evaluations, Anne and Miguel were presented with another possible diagnosis: their son Michael might be a psychopath.
  • Currently, there is no standard test for psychopathy in children, but a growing number of psychologists believe that psychopathy, like autism, is a distinct neurological condition — one that can be identified in children as young as 5.
  • “If they can get what they want without being cruel, that’s often easier,” Frick observes. “But at the end of the day, they’ll do whatever works best.”
  • “This isn’t like autism, where the child and parents will find support,” Edens observes. “Even if accurate, it’s a ruinous diagnosis. No one is sympathetic to the mother of a psychopath.”
  • “As the nuns used to say, ‘Get them young enough, and they can change,’ ” Dadds observes. “You have to hope that’s true. Otherwise, what are we stuck with? These monsters.”
  • “They’re not like A.D.H.D. kids who just act impulsively. And they’re not like conduct-disorder kids, who are like: ‘Screw you and your game! Whatever you tell me, I’m going to do the opposite.’ The C.U. kids are capable of following the rules very carefully. They just use them to their advantage.”
  • Their behavior — a mix of impulsivity, aggression, manipulativeness and defiance — often overlaps with other disorders. “A kid like Michael is different from minute to minute,” Waschbusch noted. “So do we say the impulsive stuff is A.D.H.D. and the rest is C.U.? Or do we say that he’s fluctuating up and down, and that’s bipolar disorder? If a kid isn’t paying attention, does that reflect oppositional behavior: you’re not paying attention because you don’t want to? Or are you depressed, and you’re not paying attention because you can’t get up the energy to do it?”
  • Most researchers who study callous-unemotional children, however, remain optimistic that the right treatment could not only change behavior but also teach a kind of intellectual morality, one that isn’t merely a smokescreen. . . . “I try to tell him: You’re here with a lot of other people, and they all have their own ideas of what they want to be doing. Whether you like it or not, you just have to get along.”
  • “I’ve always said that Michael will grow up to be either a Nobel Prize winner or a serial killer.”

Some of these selections are regarding a clinical study/camp for these youngsters.  That was probably the most entertaining part--seeing how they interact with each other.

  • The study had a ratio of one counselor for every two children. But the kids, Waschbusch said, quickly figured out that it was possible to subvert order with episodes of mass misbehavior. One child came up with code words to be yelled out at key moments: the signal for all the kids to run away simultaneously.

And this little vixen:

  • Charming but volatile, L. quickly found ways to play different boys off one another. “Some manipulation by girls is typical,” Waschbusch said as the kids trooped inside. “The amount she does it, and the precision with which she does it — that’s unprecedented.” She had, for example, smuggled a number of small toys into camp, Waschbusch told me, then doled them out as prizes to kids who misbehaved at her command. That strategy seemed particularly effective with Michael, who would often go to detention screaming her name.



Sunday, May 13, 2012

Quote: oversimplifying

There is a tendency, considered highly rational, to reason from a narrow set of interests, say survival and procreation, which are supposed to govern our lives, and then to treat everything that does not fit this model as anomalous clutter, extraneous to what we are and probably best done without. But all we really know about what we are is what we do. There is a tendency to fit a tight and awkward carapace of definition over humankind, and to try to trim the living creature to fit the dead shell.
***
We inhabit, we are part of, a reality for which explanation is much too poor and small.

--Marilynne Robinson

Thursday, March 8, 2012

Is sociopathy a real thing? (part 2)

My response:

This is a very insightful question.  I think this is one of the issues that comes from basing the diagnosis of sociopathy primarily on behavior.  First of all, I agree.  I am not sure that sociopathy is even a "real thing".  I do think it's interesting that there seem to be people that are very similar to each other, but I think that is bound to happen in the spectrum of human personalities and behavior -- that you would be able to find people clumped together in any part of the spectrum.  Sociopathy may just be a particularly intriguing segment of personality traits because of the disparately large effect they seem to have on the lives of others and the unique motivations that drive their behavior.  Yes, I think that sociopaths brains may look different, but our brains are constantly adapting and are constantly being impacted by our experiences, thoughts, and decisions (caveat, there is some evidence that aspects of the brain you wouldn't expect to see changing in a lifetime are also statistically different in sociopaths than the general population).  There's just so much we don't know about sociopathy that I am hesitant to actually come to any conclusions myself about its nature.

Even assuming that sociopathy is a "real thing" (as much as anything can be real), I think that it is difficult to study and understand.  There's a chicken and the egg problem in terms of coming up with a diagnosis -- you need to identify sociopaths before you can make a list of their traits and you need a list of their traits to identify them.  To the extent that there is somewhat of a history of what constitutes a "sociopath," that helps, but there really is so much variation between even modern researchers in terms of their conception of the defining characteristic(s) of a sociopath.  On top of that, everyone seems to agree that environment plays a big role in any gene expression, and particularly a tendency to become a sociopath, with some researchers believing that certain subtypes are born while other types are made.

I personally don't feel like most of my behavior is all of that shocking or antisocial, particularly when compared to certain populations like the prison population.  It's interesting that you say that [Eastern Europe] has a calloused population.  I've visited other places that have an overall low baseline level of empathy and prosocial behavior (the Netherlands, Israel, Egypt, Vietnam, among others).  I don't know what sociopaths would look like in those cultures.  My guess is not necessarily any worse than the general population, just like uranium pollution may be difficult to detect in an environment with a high baseline level of radioactivity.

One thing is for certain, sociopaths do not have a monopoly on calloused behavior.

Tuesday, August 30, 2011

Defining normal

Before I jump into a small rant, let me say that I believe there are true differences between sociopaths and neurotypicals. I also believe that the number of people who could be classified "neurotypicals" may be an actual minority (e.g. less than 50%). Furthermore, I understand that defining someone as being neurotypical does not necessarily mean that this person is "normal" or somehow better than everybody else who is not neurotypical. Let's call those the three assumptions.

My problem with some of the sociopathy research et al. is that too often people do not account for these assumptions. We talk about sociopaths being 1-4% of the population as if the other 96-99% are normal, maybe even the opposite of the sociopath. Maybe we believe that if sociopaths have low empathy, then everyone else has robust empathy? Maybe if we believe that if sociopaths do not feel guilt, everyone else must? Maybe if we say that sociopaths frequently engage in crime, then no one else does?

It's interesting, I started this blog in part to help people realize that sociopaths are natural human variants. I thought at the time that the big challenge would be to try to showcase some of our strengths in a more positive light, that we have more in common than people maybe realize. Recently I have been thinking that the real problem is not in getting people to believe that we're better than they think, but that they are worse than they think.

The weird thing about the three assumptions mentioned at the beginning is that I think most people don't believe them, not really. Most people assume that they are that minority of "normal" people instead of thinking that they might be one of those majority of people who are a little jacked up. Equally if perhaps more troubling is that many people lament that the psychological world would label half or more of us with a diagnosis/neurosis. So what if the majority of people have a label? Doesn't that seem equally if not more probable than assuming that half of the people in the world are pretty much interchangeable in terms of brain/emotional function? I understand the urge to define normal as the way most people are, but if there is not a clear way that most people are, is it really that helpful to distort our definition of "normal" to arbitrarily include some small deviations and not others?

The appeal of defining normal as whatever you happen to be is quite convenient. No need to confront the possibility that maybe you aren't as empathetic as they seem. Maybe your conscience doesn't have quite the sway that you thought it did. Maybe you are both capable and incapable of much more than you had hoped. Maybe you have a lot more in common with sociopaths than you'd like to think. Maybe it is just one big long spectrum with only a few of us at the extremes and the rest of us huddled closer to the middle. Could it be that self-diagnosed sociopaths are just much more honest with themselves than the rest of you who sneer, "that's not sociopathic, everyone does that." Could both be true? That something could be sociopathic and that everyone does that? Or most people do that? Specifically, you -- that you sometimes do those things? Does that make you normal or me?

Monday, June 14, 2010

I'm not a crook

From Friday's NY Times, an article with accusations of potential censorship against everyone's favorite psychopath scholar with a monopoly on this poorly understood disorder, Robert Hare, regarding his alleged overemphasis of criminality in the PCL-R:
Academic disputes usually flare out in the safety of obscure journals, raising no more than a few tempers, if not voices. But a paper published this week by the American Psychological Association has managed to raise questions of censorship, academic fraud, fair play and criminal sentencing — and all them well before the report ever became public.

The paper is a critique of a rating scale that is widely used in criminal courts to determine whether a person is a psychopath and likely to commit acts of violence. It was accepted for publication in a psychological journal in 2007, but the inventor of the rating scale saw a draft and threatened a lawsuit if it was published, setting in motion a stultifying series of reviews, revisions and legal correspondence.
***
The inventor of the clinical test, Robert D. Hare, an emeritus professor of psychology at the University of British Columbia, sees a different principle at stake.

“The main issue here is that these authors misrepresented my views by distorting things I said,” he said in a telephone interview. “I have been doing this work for 40 years and never seen anything like it.”
***
The paper — “Is Criminal Behavior a Central Component of Psychopathy?” — was circulated widely among forensic psychologists well before publication. Experts say the scientific issue it raises is an important one.

Dr. Hare’s clinical scale, called the Psychopathy Checklist, Revised, is one of the few, if not the only, psychological measures in forensic science with any scientific backing. Dr. Hare receives royalties when the checklist is used; he called the income it generated “modest” compared with providing paid expert testimony — which he said he does not do.

Dr. Skeem and Dr. Cooke warned in their paper that the checklist was increasingly being mistaken for a complete definition of psychopathy — a broader personality construct that includes deceitfulness, impulsivity and recklessness, though not always aggression or illegal acts. The authors contended that Dr. Hare’s checklist warps that concept by making criminal behavior a more central component than it really is.

Dr. Hare maintains that he has stressed “problematic, not antisocial or criminal, behavior” and that his comments were distorted.

Dr. Skeem said she was “just worn out” by the prolonged dispute.

“When we first wrote the paper,” she said, “we saw it simply as a call to the field to recognize we were going down a path where we were equating an abstract concept with a checklist, and it was preventing us from looking at the concept more closely.”

The report appears in the June issue of the journal Psychological Assessment — that is, along with a rebuttal by Dr. Hare, and a return response from Dr. Skeem and Dr. Cooke.
The abstract of the offending paper:
The development of the Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 2003) has fueled intense clinical interest in the construct of psychopathy. Unfortunately, a side effect of this interest has been conceptual confusion and, in particular, the conflating of measures with constructs. Indeed, the field is in danger of equating the PCL-R with the theoretical construct of psychopathy. A key point in the debate is whether criminal behavior is a central component, or mere downstream correlate, of psychopathy. In this article, the authors present conceptual directions for resolving this debate. First, factor analysis of PCL-R items in a theoretical vacuum cannot reveal the essence of psychopathy. Second, a myth about the PCL-R and its relation to violence must be examined to avoid the view that psychopathy is merely a violent variant of antisocial personality disorder. Third, a formal, iterative process between theory development and empirical validation must be adopted. Fundamentally, constructs and measures must be recognized as separate entities, and neither reified. Applying such principles to the current state of the field, the authors believe the evidence favors viewing criminal behavior as a correlate, not a component, of psychopathy.

Thursday, May 13, 2010

Playing doctor (part 2)

From a reader (cont.):
Looking back on that first email I can see that I have selected some 'terrible' things I have done on purpose. So perhaps a little insight into how I view the world generally would be more informing.

I look at things in a very logical way. But to an extent that seems 'wrong' to other people. I am a strong believer in the Law and Economics movement and tend to analyse everything through this lens. Often this is very tame: for instance, it seems fine to me that people should be allowed to sell their organs on an open market: this would clearly save lives.

Other times people seem more shocked. I see no problem, for instance, why a poor man who wishes to feed, educate and clothe his family should not be allowed to sell his right to live to another (even if it means being slowly tortured to death, or just slavery) in order to provide that. I have decided that violence against another without consent is usually wrong after reading Posner's enlightening arguments.

This has also led me to make 'racist' or 'sexist' conclusions, although I see only difference not superiority or inferiority. I never hesitate to make my viewpoint known and can always back it up with an arsenal of data and rationality. In any event I always build strong rapport with anyone I talk to so I can say more or less whatever I want.

I do feel like something is missing. But I don't think it is a complete lack of conscience. I don't think it is a complete void. I've never been completely honest in my life, however. I am always manipulating and lying. It has got to the point where there is really no difference for me. It is effortless... Sometimes I don't even notice I am doing it and I never really care afterwards. As I said, I've never been able to maintain a friendship.

Wednesday, May 12, 2010

Playing doctor (part 1)

A favorite childhood game of mine. Shall we give it a go?
Dear sir,

I just stumbled across your website. I hadn't really considered it but given what I tell you, what do you think is the chance? I don't really care either way but that would be funny.

I used to kill wasps when I was young. When I was 18 I caught a hedgehog in my garden, stabbed it right through and poured boiling water over it, hahaha lol. So I stabbed it again...then I impaled it with a shard of wood and threw it into my neighbour's garden. It was squealing for like an hour. When I saw its little face it almost looked human.

I used to get angry and kick my dogs. I really like them though.

When I was a little older, I was put into a mental hospital for telling a girl I was going to kill her. She pissed me off. I was never diagnosed though.

Past 5 years I've been studying law at one of the top universities in the world. It was only meant to take 3. But I just disappeared for two of them and did drugs and fucked prostitutes.

I've bled my parents dry. I get probably 1k dollars per week from my parents. They are idiots. I've spent it all on drugs and alcohol. I only just got internet cause I'm bored.

I've been caught drink driving a few times...idk. I had a job for a few months but I just left randomly during the day without telling anyone. Lost that, my dad got me that job so he looks like a retard now lol.

I don't have any real friendships. I cut everyone out when an important social circle dies. I've never been able to maintain a friendship.

But I would never consider myself a sociopath because I can get very angry about girls. When I know they like me I assume they are 'mine' and if they do otherwise I rage, sometimes for months. I can be quite obsessive. I think I'm just fucked up...what do you think?

Yours faithfully,
My response:
I don't think that getting "angry" at girls precludes the possibility of you being a sociopath. A more predictive indicator is that you seem apathetic about a vilified diagnosis, e.g., "I don't really care either way but that would be funny." Should we post your story on the blog and see what others think?

Friday, April 23, 2010

Diagnosis sociopath: DSM/Hare

DSM
The scientific push to explain how actions were determined externally is attributable to the large behaviorist movement that occurred in the United States during the mid-20th century. This focus on deviant behavior was criticized by some because all classes of criminals (e.g., thieves, sex offenders) were pushed into the same category (i.e., Sociopathic Personality Disorder). In effect, the focus shifted from the abnormal internal processes of the psychopath to include generic and overly inclusive deviant behaviors of many types of (offending) individuals. Another distinction for this diagnosis was the existence of antisocial and dyssocial sociopaths. The dyssocial sociopath was identified as a professional criminal who could be extremely loyal to his comrades (e.g., members of organized crime).


DSM-II
The dyssocial sociopath distinction was eliminated with the publication of the DSM-II (APA, 1968). Smith (1978) contended that the extreme loyalty to family and friends made this classification represent no other pathology except illegal behaviors. The personality characteristics of the psychopath were not conveyed in the dyssocial sociopath. The antisocial classification that remained still focused on the psychopath’s personality traits. For example, the DSM-II described this type of individual as callous, impulsive, selfish, and unable to learn from experience. However, some critics maintained that the DSM-II did not provide specific diagnostic criteria for the disorder (Hare, 1996).

DSM-III and DSM-III-R
The issue of explicit diagnostic criteria was solved with the publication of the DSM-III (1980) and the DSM-III-R (1987). Following both manuals, the diagnosis for psychopathy was called Antisocial Personality Disorder (ASPD); however, it no longer focused on personality traits. The criteria were changed by emphasizing behaviors. The DSM-III Task Force felt that the clinical inferences necessary to determine the personality characteristics of a psychopath lowered the reliability of the diagnosis. Therefore, a diagnostic shift to behavioral characteristics commonly associated with the disorder was considered more reliable for identification purposes than were the personality factors explaining why the behaviors occurred (Hare, 1996). However, the new criteria were so broad they included almost every known criminal offense (Stevens, 1993).

At least one member of the DSM-III Task Force was not convinced that this new diagnosis appropriately represented the psychopathy construct it was designed to identify and measure. Millon (1981) wrote of his dissatisfaction with the Task Force’s diagnosis of ASPD, alleging that “the write-up fails to deal with personality characteristics at all, but rather lists a series of antisocial behaviors that stem from such characteristics”(p. 182). In addition, he explained that too great an emphasis was placed on delinquent and criminal behaviors for the diagnosis. Millon also cited instances where some individuals with similar psychopathic personalities will express these characteristics in socially appropriate ways. In other words, he argued that the ASPD diagnosis was overly inclusive. Following Millon’s (1981) criticisms, not everyone who engages in criminal behavior experiences an absence of anxiety, guilt, or has shallow emotions. Furthermore, some psychopaths do not fit under the ASPD diagnosis, given the heavy emphasis on illicit conduct in adolescence and adulthood. Indeed, consistent with Millon’s observations, some researchers conclude that the newest nomenclature for psychopathy (i.e., ASPD) sacrifices validity for the sake of reliability (Hare, 1998). Hart and Hare (1997) contended that “there is little systematic experimental evidence to support the validity of the DSM criteria” (p. 25).

DSM-IV (1994)
The objections leveled against the DSM determination of ASPD resulted in slight changes in the DSM-IV diagnosis. According to the DSM-IV (APA, 1994), ASPD “has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder” (p. 645). Hare (1998) suggested that although this inclusion makes it easier for forensic psychologists or psychiatrists to discuss psychopathy in their evaluations or court testimony, greater confusion exists regarding the association between ASPD and psychopathy. Indeed, although the DSM-IV diagnosis retains the emphasis on antisocial behavior, many individuals diagnosed may not be psychopathic.

HARE’S PSYCHOPATHY CHECKLIST–REVISED
This particular objection prompted Hare (1980) to develop his Psychopathy Checklist (PCL), followed by a more revised version; namely, the PCL-R. Both the PCL and the PCL-R attempt to operationalize the concept of psychopathy based on the primary features of Cleckley’s (1941) original criteria. The PCL-R is a more quantifiable and semistructured interview with good reliability, validity, and norms).

Factor 1 represents interactional/emotional style and has been described as aggressive narcissism . Items that load on Factor 1 are more indicative of personality traits, including, among others, (1) glibness and superficial charm, (2) grandiose sense of self-worth, (4) pathological lying, (5) conning/manipulative, (6) lack of remorse, (7) shallow affect, (8) callous lack of empathy, and (16) failure to accept responsibility for one’s own actions.

Factor 2 items address behaviors or behavioral styles common to psychopaths, including, among others, (3) proneness to boredom, (9) parasitic lifestyle, (10) poor behavioral controls, (12) early behavioral problems, (13) lack of realistic long-term goals, (14) impulsivity, (15) irresponsibility, (18) juvenile delinquency, (19) revocation of conditional release. Whereas Factor 1 items remain relatively stable over time, Factor 2 items can diminish with age. Additionally, in Hare (1996), only Factor 2 items have any correlation with the DSM-IV’s ASPD diagnosis.

Thursday, April 22, 2010

Diagnosis sociopath: mask of sanity

(cont.)
The publication of Cleckley’s text, The Mask of Sanity (1941), marked the beginning of the modern clinical construct of psychopathy, and his characterization has remained relatively stable to the present day. Cleckley based his description of the psychopath on observations of White, middle-class male patients, residing as inpatients of a mental hospital. The conceptualization of the psychopath by Cleckley focused on the patient’s intrapersonal characteristics or “inferred, nonobservable, processes."

Cleckley recognized that many psychopaths never became involved with the criminal justice system. Moreover, many could succeed in business or in other endeavors, particularly in those careers that offered considerable material success. Cleckley observed that the primary psychopathic characteristics of glibness, superficial charm, emotional detachment, and lack of remorse or guilt could be used for successful criminal or noncriminal careers. Psychopaths can pursue what they want without experiencing anxiety attributable to a concern for how their actions might impact others.

In the wake of Cleckley’s findings, the word psychopath became popular among laypersons as well as mental health professionals. Ellard attributes this notoriety to the term’s status as both an explanation for and a cause of depraved and frequent criminal behavior. He cautions, however, that this logic was as inherently circular and suspect during Cleckley’s period as it is today. Illustrating the tautological nature of Cleckley’s psychopath, Ellard questions, “Why has this man done these terrible things? Because he is a psychopath. And how do you know that he is a psychopath? Because he has done these terrible things”.

Wednesday, April 21, 2010

Diagnosis sociopath: the hate

(cont.)
The appropriate designation for what is today known as psychopathy underwent several changes and iterations. In 1891, Koch used the term psychopathic inferiority to characterize individuals who engaged in abnormal behaviors due to heredity but who were not insane. They were determined to have moral defects, but these defects were not equated with viciousness or wickedness. This new terminology (i.e., psychopathic inferiority) described emotional and moral aberration based on congenital factors and found wide acceptance in Europe and America. However, notwithstanding Koch’s efforts, the meaning of psychopathy in subsequent years once again became something quite pejorative but also something more reflective of the internal world and personality traits of the individual.

Maudsley (1897/1977) was a British psychiatrist who asserted that persons prone to moral imbecility could not be rehabilitated in prisons. Maudsley argued that moral imbecility was caused by cerebral deficits. As such, he believed it was useless to punish those who could not control their actions and wrote the following as evidence of moral imbecility: "When we find young children, long before they can possibly know what vice and crime means, addicted to extreme vice, or committing great crimes, with an instinctive facility, and as if from an inherent proneness to criminal actions . . . and when experience proves that punishment has no reformatory effect upon them—that they cannot reform—it is made evident that moral imbecility is a fact, and that punishment is not the fittest treatment of it."

Krafft-Ebing (1904) was even less sympathetic toward those considered morally depraved[,] assert[ing] that such individuals were “without prospect of success” and commented that “these savages . . . must be kept in asylums for their own[good] and [for] the safety of society.” It was at this historical juncture that psychopathic individuals were regarded as impervious to rehabilitation and that chronic social deviance was equated with pathology.

By 1915, Kraepelin expanded Koch’s psychopathic inferiority terminology to contain categories essentially defined by the most vicious and wicked of disordered offenders. His psychopathic personalities described in detail the “born criminal . . . the excitable, shiftless, impulsive types, the liars, swindlers, antisocial and troublemaking types”. Clearly with these characterizations, Kraepelin moved the focus of psychopathy back to one of moral judgment and social condemnation.

Interestingly, as Millon et al. (1998, p. 19) note, his categories of psychopathic personalities more closely represent our conceptualization of psychopathy and ASPD today. He described these disordered individuals as "the enemies of society . . . characterized by a blunting of the moral elements. They are often destructive and threatening . . . there is a lack of deep emotional reaction; and of sympathy and affection they have little. They are apt to have been troublesome in school, given to truancy and running away. Early thievery is common among them and they commit crimes of various kinds."

Tuesday, April 20, 2010

Diagnosis sociopath: origins

(cont.)
As previously stated, the psychopathy construct has a long history with changing personality patterns and clinical characteristics, dating back through the past two centuries.

Phillipe Pinel is generally credited with recognizing psychopathy as a specific mental disorder. Pinel advocated for appropriate, moral treatment rather than cruel interventions (e.g., bloodletting, cold baths) as the preferred method of intervention for the psychiatrically ill (Pinel, 1801/1962). Pinel’s contributions occurred in France shortly after the French Revolution. Prior to this time, France was ruled by a strict class structure and sanity was judged by the Old Testament of the Bible. In 1801, Pinel observed that some of his patients engaged in impulsive acts, had episodes of extreme violence, and caused self-harm. He noted that these individuals were able to comprehend the irrationality of what they were doing. There was no evidence of what is now considered psychosis, and their reasoning abilities did not appear to be impaired. He described these men as suffering from manie sans délire (insanity without delirium). As Pinel explained, “I was not a little surprised to find many maniacs who at no period gave evidence of any lesion of understanding, but who were under the dominion of instinctive and abstract fury, as if the faculties of affect alone had sustained injury” (p. 9). His observations were very controversial during this era, especially because a low intellect and symptoms of psychosis were the typical criteria for identifying mental illness (Stevens, 1993).

In the early 1800s, Benjamin Rush, an American psychiatrist, also documented confusing cases that were described by clarity of thought along with moral depravity in behavior. However, Rush (1812) went beyond Pinel’s more affectively based description and maintained that moral derangement was either a birth defect or was caused by disease. Rush believed this condition was primarily congenital. As he stated, “There is probably an original defective organization in those parts of the body which are preoccupied by the moral faculties of the mind”. In addition, Rush held that “it is the business of medicine to aid both religion and law, in preventing and curing their moral alienation of the mind”. The American psychiatrist maintained that the lack of morality was primarily hereditary, yet unstable environments were largely responsible for fostering its growth. Rush further claimed that offenders with mental defects were best treated in medical rather than custodial institutions. Benjamin Rush is recognized as one of the first to begin what has since become a long-standing practice of social condemnation toward individuals labeled psychopathic.

Monday, April 19, 2010

Diagnosis sociopath: overview

This week I want to talk about the origin of and continuing confusion over sociopathy as a psychiatric diagnosis. Unless otherwise indicated, the material/information is taken (edited for length) from "The Confusion Over Psychopathy (I): Historical Considerations," a paper by Bruce A. Arrigo and Stacey Shipley, printed in International Journal of Offender Therapy and Comparative Criminology, 45(3), 2001 325-344.
Notwithstanding its extensive heritage, psychopathy has been plagued by changing and uncertain diagnostic nomenclature. For example, a great deal of confusion currently exists regarding the relationship between Antisocial Personality Disorder (ASPD), as identified by the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM–IV), and the modern construct of psychopathy as explained by Cleckley (1941) and further refined and empirically validated by Hare (1985, 1991). Although contemporary research supporting the diagnosis of psychopathy is at its strongest, mental health professionals remain perplexed when diagnosing, treating, or making recommendations to the court system about these individuals.

In general, we note that the psychopathic label (i.e., explanation) has changed from the morally neutral view of Pinel (1801/1962) to the more truculent and disparaging characterization described by Kraepelin (1915). In addition, the designation itself has evolved from the unpopular term insanity, to the controversial expression moral, to the present moniker psychopathic. The elusiveness of the psychopathic construct and its meaning is further confounded by the theoretical basis out of which social scientists approach and investigate this mental disorder. Indeed, some researchers invoke descriptors for psychopathy, implying that the individual experiences morality problems that are solely personality based, exclusively congenitally or biologically derived (Ellard, 1988; Schneider, 1958; Smith, 1978), or principally behaviorally grounded (American Psychiatric Association, 1994). Moreover, notwithstanding these interpretations, Hare’s (1996) empirical and qualitative findings consistently demonstrate that the psychopath has distinctive affective, interpersonal, and behavioral attributes.

Psychopathic individuals historically and at present are almost uniformly considered difficult, if not impossible, to treat. We submit that the diagnostic confusion surrounding psychopathy (i.e., the label and its meaning) and the adverse consequences persons in the mental health and criminal justice systems (potentially) experience in the wake of such a determination, warrant closer scrutiny. Although clearly not exhaustive, this overview will provide an important backdrop, making it possible to assess provisionally how psychopathy evolved into a mental disorder and a pejorative label.

In particular, we will consider the logic of linking psychopathy, as applied to forensic clients, with the behavioral diagnosis of ASPD. This notwithstanding, the progression of thought contained within each of the components or categories demonstrates the course of psychopathy’s development and demonstrates how each has ostensibly functioned along a continuum (e.g., social condemnation as morally neutral to morally reprehensible, the disorder’s description based on personality to behavioral traits, and the locus of treatment from asylums to prisons).

Tuesday, September 1, 2009

Raising a sociopath child (part 2)

My response:
This is a very interesting question and I'm glad you came to me because I sense disaster already. First the positive: having a sociopath child can be just as good, if not better than having a neurotypical child. There is nothing keeping your child from being a great, high achieving, functional member of society. I excel at many things, I have meaningful relationships with people, I have a very full life. I also suffered a lot to get where I am, and most sociopaths have similar stories. Luckily for me, my parents managed to do a lot of things right, and I love them for that. It could have gone very badly, I think, and I appreciate the fact that it didn't.

I think the biggest thing that parents of sociopaths need to learn is to realize when you are helping and when you are hurting. For instance, you should not tell other people (including school officials or anyone else) that your child may be a sociopath. I understand the impulse. I have a little relative who has had significant hearing loss, which is immediately obvious to anyone. Even if it wasn't, though, the parents are more than willing to make it known, particularly if it would affect the child's schooling. Nowadays we expect schools and teachers to be understanding of children's individual strengths and weaknesses. This "legitimately" includes autism and asperger's, but does not include sociopathy. People talk (even on this site) about the forced execution of sociopaths and how they would kill a sociopath baby if they could. Sociopathy (even if applicable) is a label that could forever inhibit your child's life and development. If everyone knows your child is a sociopath, they will treat him differently. He will not be given the benefit of the doubt like other children will be. Once he knows that every anonymous bad thing will be blamed on him, he will do only bad things because at least that way he will get the pleasure of the thing before he gets punished for it. Sociopath children are very very sensitive to perceived fairness and incentive structures (more on that later). If I were you, depending on what you have told the school official, I would play it off as much as possible. I don't know what you could do, but maybe tell the counselor you were just trying to warn him about the sociopath family member you mentioned, or even better trying to warn him of the evils of trying to diagnose someone before 18 (the "official" age for diagnosing a sociopath), e.g., don't make the mistake of doing that with my child, otherwise I will pursue legal action. You could suggest your family history includes asperger's, and you're concerned about your son. I would also do some research to try find a doctor who will readily diagnose your son as having asperger's. Unlike sociopathy, asperger's is an "acceptable" diagnosis that can be used to explain your sons other antisocial symptoms without fear of reprisal.

Tuesday, May 19, 2009

Not Chris Brown, another one

I have been corresponding with one reader who (atypically) does not want to remain anonymous. The first i heard from Chris was this comment on a post:
I was diagnosed with ASPD (sociopathy) although I think it's more likely I have NPD (Narcissistic Personality Disorder). I've hurt a lot of people, but never intentionally (as with a plan), and always it's been due to feelings of powerlessness, fear or being taken advantage of. My emotional core is more comprised of feelings of inadequacy than of maliciousness. In fact, I care a lot about other people and do a lot of good things for my community. I also feel remorse and empathy. But at the same time I think in very selfish ways sometimes and have hurt a lot of people.
When I read the comment, I was struck with what an accurate and sympathetic description of a narcissist it was, or at least the narcissists I know well. Chris later emailed me about how he had been diagnosed as a sociopath after he punched his then girlfriend in a violent outburst, for which he served a year in jail. To read about his experience, check out ablessingindisguise.org. I replied:
Interesting blog. I particularly thought this post was interesting. Even before I read that post, though, I didn't think you were a sociopath. Before I read your self-assessment of NPD, I actually thought that maybe you might be on the autism spectrum, particularly because of your lack of conforming to social norms in odd ways, e.g. making eye contact with strangers and picking your nose. Those with sociopathy and NPD also have difficulties with social norms, but usually the big stuff, if that makes any sense -- stealing, lying, cheating. They (sociopaths at least) may also have difficulty with the smaller social norms at first because they don't have a natural instinct for them, but they are usually able to overcome those difficulties and be very adept socially, some say charming. I would look into asperger's and autism in addition to your research on personality disorders. The type of bursts of anger/rage you describe seem to be more typical of the sometimes violent symptoms of autism. I wrote about it here.

Unfortunately for you, if you were on the autism spectrum and the condition manifested itself as violence, I don't think there are very good treatments for it. If the violence is truly an uncontrollable impulse, then it seems like the only options available to you would be to condition the subconscious to react differently, perhaps via shock therapy? I assume you are already being treated for the basic anger management stuff, without much progress.
Cont.

Wednesday, April 1, 2009

Sociopaths, Psychopaths, and Narcissists, oh my!

Here's a comment from a reader about the value of professional psychological diagnoses:
As you have diagnosed yourself as such I am not too worried however much your attempts at diagnoses you should have already figured out diagnoses are there for the pathetic people who cant understand what these things are. So they make up these diagnoses and things that should be corrected but if you think about it there is a DSM but no manual for whats normal no manual to counter it. Normalcy is what is socially acceptable and what is "Right" to these people. However there is no real right and no real wrong the only right there is is what us as an individual decide is best for ourselves. There maybe sociopaths in psychology but in reality its just another type of person their is no real disorder its a way of being.
I agree. Some people comment on this blog saying things like "sociopaths would never do/say x," which i figure are probably just arguments over semantics. For instance, one writer described the confusion over the terms sociopath and psychopath thusly:
Without getting into the politics surrounding the different diagnostic systems, people who were unaware of the need for precision and accuracy for research and assessment adopted a preference for using either ‘psychopath’ or ‘sociopath’ and came up with their own workable definitions. In other words, things got a little sloppy. I’ve even seen professionals use the term 'sociopath' but rely on the criteria specific to the concept of a psychopath. However, for researchers in psychopathy, ‘sociopath’ has a different connotation.

Which brings me back to the original question: the difference between a psychopath and sociopath. If you subscribe to the Hare criteria for a psychopath, then you see the conning, manipulative narcissistic liar and user as a psychopath, as long as he or she is completely lacking in remorse or empathy. The sociopath, however, is capable of guilt, caring, building relationships, etc., but only within a certain context. He or she will have loyalties to a specific group but not to society at large. They care nothing for social norms and will break them with impunity if it serves their purpose. So, on the surface, they may resemble psychopaths. However, they might genuinely feel remorse over harming someone within their group or family. They will have a moral code specific to that context: they might not lie, exploit, or manipulate within the group. Thus, they exhibit psychopathic behaviors in certain contexts but not all.
If these distinctions are accurate then maybe I am more sociopath, not psychopath. Or maybe we follow the DSM and say i have APD. Or maybe I'm a malignant narcissist? The labels are fuzzy, and ultimately they don't matter. I am who I am. I think what I think, feel what I feel, do what I do. I know I'm not typical. I don't care to debate the nuances of particular definitions or diagnoses, I just want people to know that they live in a world with people like me.
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