Sociopathy doesn't exist

This was actually a good description of the difference between personality disorders versus other mental disorders and the problematic features of personality disorders, cognitive versus affective empathy, how and why the PCL-R emphasizes criminality, how sociopathy is a spectrum, and why brain scans cannot actually diagnose you with sociopathy (but rather just show that your brain is prone to the typical sociopathic traits), with Jim Fallon:

Criminal vs. Successful Sociopaths

This was an interesting interview in the NZ Listener with Devon Polaschek, an associate professor in the Victoria University School of Psychology about the differences between criminal and successful sociopaths:

The downside is that the [PCL-R] was developed exclusively for use with criminals, so can’t be used to look at psycho­pathy in any other setting. “You can’t get a high score unless you are involved in criminal acts, so it mixes the two things together: psycho­pathy and criminality. So that limits the availability of a really well-validated instrument for a wider population,” says Polaschek.

Also, the checklists capture people who lack some of the core characteristics of psychopathy and over-pathologise people who have an extensive history of impulsive criminal behaviour that isn’t just distinctive to psychopaths. “The research on non-offender psychopathy could not be said to be an extensive scientific one at the moment, because it just hasn’t been done. The central personality characteristics, while always antisocial – they always have a negative impact on other people – do not necessarily predispose people to criminal behaviour.”

The idea of a lack of guilt or remorse is real. “But again, that’s typical of high-risk criminals, too,” Polaschek says. “In the community, in terms of so-called successful psychopaths, we would assume their core personality characteristics would still be there, the ones like lack of guilt, narcissism and irresponsibility. But we would also assume they have better impulse control because they are not getting themselves in trouble with criminal law.
***
“If you view psychopathy as I do, as a bigger construct that includes some aspects that could be adaptive and even useful, then certainly there will be CEOs and MPs and lawyers. Also, someone recently did a paper on US presidents – Clinton came up quite high. That’s important, because Clinton was an incredibly competent man, and it does show you that the combination of characteristics doesn’t always include only bad things.

“There are some positive characteristics – stress immunity is one of them – that the broader view of psychopathy would say are not a bad thing in themselves; it’s the fact that they are combined with other things. It isn’t necessarily about harming other people but it enables you to put yourself into novel and challenging situations in a way that other people can’t. Clearly that can go well or it can go badly, but it’s not necessarily a bad characteristic because it depends how the person develops.”

Am I... ?

From a reader:

First of all great blog. I really like that you don't talk about sociopathy, but through it. I find it similar to reading for example Nietzsche - nothing new, but if I find it HERE people must see it differently, it's funny how blind they are.

Moving to main part of this email I feel, that I will screw English terribly ;) If you want to publish it feel free to fix anything that sounds really bad.

I'd like to ask, what would you consider me to be. I tried tests – I always score full points on “lack of feelings and machiavelism” scale while having average score on aggression. On PCL-R I get about 17.
Where to start...
Maybe with what I'm not. I don't like killing animals and never did. Ants, some frogs etc, but not mammals. I don't commit crimes on daily basis and I'm not impulsive. I cheat in any way available and I find it enjoyable, but I didn't steal for fun or anything like it. When I had to fight few times in my life I just turned off anything but anger, so I could aim for eyes and veins, but I it was always a choice and I could stop at any point. I also wouldn’t say I’m fearless, I know that emotion pretty well. That will be it about being normal.

I’m narcissist, but I work on it. It’s like drug and I don’t like anything to control me. I guess you know that nice feeling, when people say how they think, that they know you really well, when they only know mask – or even better feeling, when they tell you, how they can see through your mask and describe another mask as “real you” ;) But the drug part is the only thing that I fight with. I feel better, I don’t think about “difficulty level” when I choose goals and so on.
I play with people. I see them like they were sets of algorithms. I read “Influence” by Cialdini when I was 8-10 year old and I never stopped learning psychology from that point (I’m 21 now). I always could easily imagine how to break someone or how to help him evolve and I find both ways enjoyable – what I care about is how good am I with it. And I am pretty good ;).
I don’t think there is any “real me” behind all that games.
I never felt remorse. I also didn’t feel love, attachment or friendship and I don’t think I fully believe these are real things like people describe them. I know it on cognitive level, that they exist but I just feel like it was some fake. I know happiness, anger, some lust, sorrow(and I think it’s nice),fear/anxiety and flow. Actually, I heard few times that people find it hard to imagine me in any other mood then happy.
I’m also pretty smart. I like math, physics or philosophy and can understand them as well as I can remember lots of biological stuff. At the moment I study three full courses and it’s just fine. I even prefer when I have more to do and I find time pressure fun.

Opinions?

P.S.
There is a book “Psychopaths among us” by Hare. Nothing spectacular, but read part about successful sociopaths. There is also “Time Paradox” by Zimbardo. Basing on what you wrote about your analogy-based world perception I think you will find connecting those ideas enjoyable 

White collar criminals

A reporter for a national TV outlet is looking to interview assessed sociopaths who have committed white collar crimes. Please email me if you or someone you know fits the bill and would like to talk to him.

I can share some of my own thoughts on this topic later (I don't want to taint anyone's opinions before he has a chance to talk to you), but I've explored the association between criminality and sociopaths many times before.

It's true that there is a higher proportion of sociopaths in prison than there are in the general population. However, the same could be said of males -- there is a higher proportion of men in prison than there is in the general population. There is a higher proportion of African Americans in prison than there is in the general population. No one really (legitimately?) makes the argument that African American men are inherently criminal or that there is something innate about a man or an African American that predisposes them to criminality. But you could. Men have higher levels of testosterone than women, a hormone associated with higher levels of impulsivity and aggression. Much junk science has been historically written about the inferiority of the African races (although it is true that everyone but Africans have Neanderthal DNA, who "possessed the gene for language and had sophisticated music, art and tool craftsmanship skills," so there's at least a difference in genetics), but most people seem to feel that the higher proportion of African Americans in prison is due to environmental factors like social disenfranchisement than a genetic predisposition to crime. Similarly, there could be multiple factors connecting sociopaths with criminality, including that most sociopaths who have been studied happen to have been criminals.  

Somewhat relatedly:

"Bridging the Gap Between Scientific Evidence and Public Policy"

To address some of the misconceptions I've been seeing recently about sociopaths, a peer-reviewed academic article on public policy implications of sociopaths. From the summary to: "Psychopathic Personality: Bridging the Gap Between Scientific Evidence and Public Policy" co-authored by Jennifer Skeem, among others:


Few psychological concepts evoke simultaneously as much fascination and misunderstanding as psychopathic personality, or psychopathy. Typically, individuals with psychopathy are misconceived as fundamentally different from the rest of humanity and as inalterably dangerous. Popular portrayals of “psychopaths” are diverse and conflicting, ranging from uncommonly impulsive and violent criminal offenders to corporate figures who callously and skillfully manuever their way to the highest rungs of the social ladder.


Despite this diversity of perspectives, a single well validated measure of psychopathy, the Psychopathy ChecklistRevised (PCL-R; Hare, 1991; 2003), has come to dominate clinical and legal practice over recent years. The items of the PCL-R cover two basic content domains—an interpersonalaffective domain that encompasses core traits such as callousness and manipulativeness and an antisocial domain that entails disinhibition and chronic antisocial behavior. In most Western countries, the PCL-R and its derivatives are routinely applied to inform legal decisions about criminal offenders that hinge upon issues of dangerousness and treatability. In fact, clinicians in many cases choose the PCL-R over other, purpose-built risk-assessment tools to inform their opinions about what sentence offenders should receive, whether they should be indefinitely incarcerated as a “dangerous offender” or “sexually violent predator,” or whether they should be transferred from juvenile to adult court.
***
Despite the predominance of the PCL-R measurement model in recent years, vigorous scientific debates have continued regarding what psychopathy is and what it is not. Should adaptive, positive-adjustment features (on one hand) and criminal and antisocial behaviors (on the other) be considered essential features of the construct? Are anxious and emotionally reactive people that are identified as psychopaths by the PCL-R and other measures truly psychopathic? More fundamentally, is psychopathy a unitary entity (i.e., a global syndrome with a discrete underlying cause), or is it rather a configuration of several distinguishable, but intersecting trait dimensions? 

Although these and other controversies remain unresolved, theory and research on the PCL-R and alternative measures have begun to clarify the scope and boundaries of the psychopathy construct. In the current comprehensive review, we provide an integrative descriptive framework—the triarchic model—to help the reader make sense of differing conceptualizations. The essence of this model is that alternative perspectives on psychopathy emphasize, to varying degrees, three distinct observable (phenotypic) characteristics: boldness (or fearless dominance), meanness, and disinhibition. The triarchic framework is helpful for clarifying and reconciling seemingly disparate historical conceptions, modern operationalizations, and contemporary research programs on psychopathy.

In many cases, the findings we review converge to challenge common assumptions that underpin modern applications of psychopathy measures and to call for cautions in their use. For example, contemporary measures of psychopathy, including the PCL-R, appear to evidence no special powers in predicting violence or other crime. Instead, they are about as predictive as purpose-built violence-risk-assessment tools, perhaps because they assess many of the same risk factors as those broader-band tools. Specifically, the PCL-R and other psychopathy measures derive most of their predictive utility from their “Factor 2” assessment of antisocial and disinhibitory tendencies; the “Factor 1” component of such measures, reflecting interpersonal and affective features more specific to psychopathy, play at best a small predictive role. Similarly, current measures of psychopathy do not appear to moderate the effects of treatment on violent and other criminal behavior. That is, an increasing number of studies suggest that psychopathic individuals are not uniquely “hopeless” cases who should be disqualified from treatment, but instead are general “high-risk” cases who need to be targeted for intensive treatment to maximize public safety.

Misunderstandings about the criminal propensities and treatability of individuals achieving high scores on measures like the PCL-R have been perpetuated by professionals who interpret such high scores in a stereotypic manner, without considering nuances or issues of heterogeneity. A key message of our review is that classical psychopathy, whether measured by the PCL-R or other measures, is not monolithic; instead, it represents a constellation of multiple traits that may include, in varying degrees, the phenotypic domains of boldness, meanness, and disinhibition. Measures such as the PCL-R that do not directly assess features of low anxiety, fearlessness, or boldness more broadly tend to identify heterogeneous subgroups of individuals as psychopathic. As a consequence, efforts to apply one-size-fits-all public policies to psychopathic individuals may be doomed to failure. In aggregrate, these conclusions may help to shed light on what psychopathy is, and what it is not, and to guide policy interventions directed toward improved public health and public safety.

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.

Knowing the limits of our answers

I thought this was a very interesting Wired article about the limitations of the PCL-R.  The author begins with the anecdote of Alan Turing's attempt to answer the question of whether computers could think.  Realizing that the question framed that way was impossible to answer (what does it mean to think?), he reframed the question to be whether computers could pass as humans.  He set up an experiment where test subjects were asked to determine whether responses from an unidentified source came from another human or a computer.

Turing constructed the test in transparently trivial terms. If a computer could fool someone for five minutes 70 percent of the time, it was as good as intelligent. This is powerful not because of its implications for intelligence, but because of its insight into asking tough questions. When we don’t understand the underlying causes of a phenomenon, what scientists call its mechanism, we must resort to studying its effects. But it is crucial that we be aware of the limitations of this approach and remain humble in our inquiry.

He then goes on to compare the difficult misalignment between what we can test and what we hope to learn in terms of the PCL-R and other diagnostic tools for psychopathy:


In the next year, the American Psychological Association will put the finishing touches on the latest version of the Diagnostic Statistical Manual of Mental Disorders, its compendium of psychiatric illnesses. Psychiatry is up against a problem similar to the one Turing faced. The illnesses are complex and their causes hard to discern. Without a clear mechanism, psychiatrists must rely on their patients’ subjective symptoms. It’s a process that’s always fraught, but it works when psychiatrists are realistic about the constraints of their tests.

Things become more troubling when the stakes are high and the diagnoses are tough to change. This is the case in prisons throughout the Western world, where inmates are subjected to the revised Psychopathy Checklist, or PCL-R.

Like the Turing Test, the PCL-R is about effects and symptoms, not causes.

The problems with the PCL-R:


The PCL-R, unlike the Turing Test, is inflexible by design. The Turing Test merely relies on the ability of the machine to be convincing in the present. It doesn’t take into account the machine’s past track record. It leaves open the possibility for change and improvement. The PCL-R is not so forgiving. If a person with a history of psychopathic behaviour were to get better, testers would likely interpret this as deception. After all, deception is a key feature of psychopathy. The PCL-R tries to have it both ways. It relies on observing a set of behaviors, but it resists assigning significance to a change in those behaviors.

Leaving open the possibility of change isn’t about setting serial killers free. But for crimes on the margin, the batteries and assaults and armed robberies, we have to decide whether to deny people who score high on the PCL-R the same opportunities we would give those who score low.

The take away:

The checklist demands that we confront our values. For the possibility of a little more security, are we willing to risk denying a person a second chance? We have to understand the tradeoff and the uncertainty of the reward.

With the Turing Test, it’s pretty straightforward. Five minutes and 70 percent can only tell us so much. How much can the PCL-R tell us?

Alan Turing taught us that when the question is hard, we must know the limits of our answers. At stake here is redemption, the possibility that the wretched can make good. It is an aspiration worth more than a guess. It deserves our humility.


I like this issue about knowing the limits of our answers.  I have recently dipped more into the empirical side of my profession and it has been fascinating and eye-opening to see some of the common mistakes people make in terms of believing that they are "proving" things or that some things are capable of being "known."  There really is a great deal of hubris, and particularly when these pieces of "knowledge" leave the academic area of origin and are used by other people who are unaware of the inherent uncertainty (courts, parole boards, trolls, etc.).  I can understand why people would want to believe things are knowable, particularly when it comes to something as scary as psychopaths, but they just aren't -- at least not currently.

Psychopath brains differ even from ASPD

Reuters reports on how the brains of psychopathic criminals show distinctly less grey matter in the areas of the brain important for understanding the emotions of others.  These differences in brain structure were different even from other criminals who were diagnosed with antisocial personality disorder (ASPD).  Other interesting selections from the article:

• Damage to these areas is linked with a lack of empathy, a poor response to fear and distress and a lack of self-conscious emotions such as guilt or embarrassment.
• Research shows that most violent crimes are committed by a small group of persistent male offenders with ASPD. . . . Such people typically react in an aggressive way to frustration or perceived threats, but most are not psychopaths, the researchers wrote in a summary of their study, which was published in the Archives of General Psychiatry journal.
• There are clear behavior differences among people with ASPD depending on whether they also have psychopathy. Their patterns of offending are different, suggesting the need for a separate approach to treatment.
• "We describe those without psychopathy as 'hot-headed' and those with psychopathy as 'cold-hearted'," Blackwood explained.

I love that distinction between "hot-headed" and "cold-hearted."  I'm going to have to start using those terms all of the time when explaining about how I don't quite consider myself to have ASPD.  And our buddy Bob Hare should be happy about this seeing as he is always going on about how the two are quite distinct.