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:

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.

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.”

The psychopath problem

The psychology world seems to be taking a fresh look at sociopathy. Apparently once people dared question the infallibility of Hare's diagnostic criteria, the Psychopathy Check List Revised ("PCL-R"), it opened the door for other heresies against established views.

In his new book "Forensic Psychology: A Very Short Introduction," David Canter, a psychology professor at the University of Hudderfield, briefly describes the psychopath problem:

Until you have met someone whom you know has committed horrific violent crimes but can be charming and helpful, it is difficult to believe in the Hollywood stereotype of the psychopath. Without doubt, there are people who can seem pleasant and plausible in one situation but can quickly turn to viciousness. There are also people who just never connect with others and are constantly, from an early age, at war with those with whom they come into contact. If we need a label for these people, we can distinguish them as type 1 and type 2 psychopaths. The former have superficial charm, are pathological liars, being callous and manipulative. The clearest fictional example of this sort of psychopath is Tom Ripley, who has the central role in many of Patricia Highsmith’s amoral novels. The type 2 psychopaths are more obviously criminal, impulsive, and irresponsible with a history of juvenile delinquency and early behavioural problems.

Another label that may be assigned to people who are habitually involved in illegal, reckless, and remorseless activities that has a much broader net than ‘psychopathy’ is ‘antisocial personality disorder’. But we should not be seduced into thinking that these diagnoses are anything other than summary descriptions of the people in question. They do not help us to understand the causes of people behaving in these unacceptable ways. Some experts have even commented that they are actually moral judgements masquerading as medical explanations. So although the labels ‘personality disorder’ and ‘psychopath’ do summarize useful descriptions of some rather difficult, and often nasty, people, we need to look elsewhere for explanations of how they come to be like that.

The psychopath problem for society is "how do we keep psychopaths from acting in antisocial ways?" The psychopath problem for psychologists is "what are we really dealing with here?" Before psychologists can even begin understanding psychopaths, they must be able to identify them. Before psychologists can identify psychopaths, they must be able to understand them. It's a classic chicken/egg dilemma that leads critics like our favorite narcissist Sam Vaknin to quip that "psychopathy seems to be merely what the PCL-R measures!" and probably led the good folks putting together the DSM to eventually exclude psychopathy as a diagnosis in favor of the more criminal-sentencing friendly ASPD.

Still, these tests are being used, and brains of people flagged by these tests are being scanned and studied, helping scientists to learn more about . . . the brains of people who would be flagged by these tests. Some of the new discoveries or theories about psychopathy jive with my own personal experiences, and some of them strike me as being less than accurate -- an attempt to add an epicycle to support some of the weaker premises that provide the basis for the modern study of psychopathy. Maybe it is true that we are on the verge of a breakthrough, as some psychologists think -- a unifying theory of the causes and explanations for psychopathic behavior. If we are, I think it will have to be a product of fresh thinking, rather than continuing to focus on the same "20 items designed to rate symptoms which are common among psychopaths in forensic populations (such as prison inmates or child molesters)."

Freudian look at psychopaths?

This was a sort of interesting, Freudian influenced approach to explaining psychopaths that may resonate with some of you, J. Reid Meloy (author of "The Psychopathic Mind: Origins, Dynamics, and Treatment") with subsequent commentary by Donald Carveth. He is a little bit more on the Hare side of his understanding (i.e. not too sympathetic), but it is a pretty decent overview of some of the more famous studies of sociopaths.

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."

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.

Chicken and egg

More research on the difference between sociopath, this time it's a lower number of connections from the prefontal cortex and amygdala. From Scientific American:

The study’s most important finding centered on impairments in the link between the ventromedial prefrontal cortex (a control node for regulating emotion, threats, decision-making and social behavior) and the amygdala, a locus of emotional processing. . . . In theory, the faulty interaction between the amygdala and the prefrontal cortex could fail to provide the proper negative emotional cue that robbing a bank or a ripping off a friend is just not kosher. Further tests are needed to confirm the implications of this breakdown in communication in the brain’s internal social network.

This finding, though, could also extend work by Newman that indicates that psychopathy may result from what he calls an “attention bottleneck.” Psychopaths may focus fixedly on one goal and ignore all other social cues, perhaps even signals sent over the prefrontal-to-amygdala pathway.

Good friend Hare warns:

Hare cautions that identifying what’s different in the brains of psychopaths isn’t the same thing as figuring out the cause of psychopathy. The weakened connections seen in the Wisconsin study could be a by-product of some other environmental or genetic factor commonly found among psychopaths.

“We have a chicken and an egg, in a sense,” he says. “There’s a tendency, certainly among people in the criminal justice system, to take any of these deficits and say, ‘Wow, we have a psychopath who has all these behavioral problems, and now we have this brain anomaly or dysfunction that seems to match, therefore one caused the other.’”

Defining conscience

I've been thinking recently about the definition and imagery behind the concept "conscience." Martha Stout in The Sociopath Next Door defines conscience as necessarily having an emotional component:

Psychologically speaking, conscience is a sense of obligation ultimately based in an emotional attachment to another living creature (often but not always a human being), or to a group of human beings, or even in some cases to humanity as a whole. Conscience does not exist without an emotional bond to someone or something, and in this way conscience is closely allied with the spectrum of emotions we call "love." This alliance is what gives true conscience its resilience and its astonishing authority over those who have it, and probably also its confusing and frustrating quality.

I don't know if I agree with that definition, but maybe my opinion doesn't count for much. I do find it interesting that there are basically two types of imagery used to portray conscience: (1) the devil and the angel on the shoulder and (2) a separate entity telling you to do the right thing, e.g. Jiminy Cricket. The origin of the devil and angel is obvious -- Judeo Christian beliefs include the concept of the "holy spirit" and guardian angels, and even God telling you what to do, and there is also a fallen angel, the devil, tempting you to do wrong things. The origin of Jiminy is less clear, but I would imagine that most non religious people would associate their conscience with this type instead of the angel/devil. When I asked my friend which he thought was most accurate, he said:

Friend: Jiminy Cricket

M.E.: Yeah, interesting. So it is a separate person? eparate little part of you?

Friend: I don't know, you can "tap into" your conscience, or suspend it, push it aside...

M.E.: So sort of separate, right?

Friend: I guess so, right?

M.E.: Hard to know. I guess it has to feel separate from us, otherwise we wouldn't come up with a separate name for him.

Friend: I feel like it doesn't feel separate most of the time until you feel fractured about it, when something disturbs it.

M.E.: Like a bone or your kidney?

Friend: Yeah, exactly.

Is a conscience like other organs in our body? We never notice it until we hurt it? And if so, is it more like the heart? The lungs? Or the appendix? The gall bladder? Is it something else? If we're defining sociopaths based partially on a lack of conscience (e.g. Robert Hare's book, Without Conscience), what is it that other people have that sociopaths lack?

Economic disaster = sociopaths' fault?

So says the good Doctor Robert Hare:

Robert Hare, from the University of British Columbia, Canada, said in a seminar on psychopathy that people with a certain degree of psychopathy sometimes have their own place in a society.

"They tend to be important to society sometimes," he said.

"These are people who take risks, tend to not be afraid."

He pointed out the example of a white-collar psychopath, viewed as "a good leader, good person and charismatic", but who secretly did harm to their surroundings.

Hare added such psychopaths were behind last year's global economic downturn.

"They engage in all sorts of illegal behavior. Half of the financial crisis we had throughout the world in the last few years, who's behind it all? Warm, loving people? No, people who want all they can get, they don't care about millions of people who lost their life savings," he said.

I'd like to think that sociopaths collectively have the power to send the world spinning out of control, but I wonder if that could possibly be accurate. Sociopaths take risks, and with risk comes higher return. But risk is still risk and there certainly aren't enough greedy sociopaths to have tipped the scales of excessive risk without empath help, no? Let's hope his comment made more sense in context.

Why Sociopathworld?

Some have wondered where the title "SociopathWorld" comes from. It comes indirectly from a book by Dr. Robert Hare, recognized expert on psychopaths and psychopathy: Without Conscience: The Disturbing World of the Psychopaths Among Us. Even though I doubt Dr. Hare added the subtitle, I thought it was an interesting visual image. What if there really was a world of the sociopaths, like some sort of planet of the apes. Would it be at all like a Disney theme park?

The reason I doubt Dr. Hare chose that subtitle (or possibly even the main title) is that he doesn't seem to make any normative judgments regarding sociopaths in his book. If anything, as I mentioned in another post, he seems to be pro sociopath:

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.

What do you all think? Is it a disease? Is it disturbing? Now that you have accessed a window into the soul of a sociopath, is your heart troubled? If not, what do you think would be a better or more accurate subtitle for Dr. Hare's book about the world of the psychopath?