Schizophrenia and sociopathy

From a reader:

I've been reading your blog for about 7 or 8 months now, and I've found it quite interesting reading the posts from fellow readers who have reached out to you to describe their lives and the unusual way they look at the world, often wondering and asking if they are sociopaths themselves. 
I've been reading your book and blog and have commented on a few blog entries myself, and I thought it would be interesting to gain your perspective on my current state. 

I'm a 23 year old female currently an undergraduate at university studying psychology. I'm not a sociopath, and I don't believe there is any chance I am one. I've been speaking to doctors, mental health assessment teams and a clinical psychologist for the last couple of months, and while I haven't yet received a clear diagnoses, my condition seems to lean towards some form of schizophrenia, possibly the paranoid or disorganized sub-type, or a combination of them. 
I write because I've been thinking a lot about what may be called "Abnormal Psychology", and I've been considering some of the similarities and differences between sociopathy and my own mental state (I'll refer to it as schizophrenia for simple convenience).  

You recently posted a blog entry from an interesting young woman who was wondering if she was a sociopath, and I commented on the post explaining that I could relate to some of her feelings of violence and murder. Like many sociopaths, I don't feel any guilt, empathy or remorse with the idea of killing another human being that deserves it, and I've been experiencing frequent strong impulses to murder certain individuals (ex-friends) who have made life more inconvenient for me by spreading around a lot of negative stigma, insults and rumours concerning my mental state and odd behaviour. The only thing that has stopped me from carrying out my plans of killing these persecutors is the threat of legal consequences and the cost to my freedom that a prison sentence would entail. The doctors I have spoken to seemed a little worried that empathy and guilt wasn't playing any role in deterring my violent impulses, only a practical argument was stopping me. 
One of your readers replied to my comment explaining that this risk vs reward reasoning was characteristic of many higher functioning sociopaths, which is probably one of the things that inspired my thoughts about sociopathy and my own possible schizophrenia. 
Empathy and understanding others in generally something I have a lot of trouble with, although I'm very fond of animals. 

I've had a fairly good fufilling childhood, with no neglect or abuse of any kind. My mental health issues only began to surface severely when I was round the age of 16, although I think I was always a bit odd and different throughout my life in ways I still can't explain. 
Unlike many sociopaths, I have suffered in the past from many depressive episodes and I currently suffer from a great deal of paranoia, anxiety and fear of other people, which I guess is where my condition differs from sociopathy a fair bit. I have had many thoughts of suicide, but the thought of hurting my family with my own death does not occur to me or really bother me. The reason I haven't killed myself is a functional one (like the ones holding me back from killing), I don't believe in an afterlife, so if I was dead I wouldn't be able to do things that I enjoy anymore, like going for enjoyable walks or eating nice food. That's all. 

Some other readers and commenters have mentioned things like fluid sexuality or gender identity with regards to sociopathy. Like them, gender often feels like a meaningless concept to me. People appear to me as if they walking around in "people suits" of flesh and skin and muscle, and it's only the person underneath the skin that has any real bearing. So therefore I guess I could be considered bisexual as Male and Female doesn't make much of a difference to me. People are either aesthetically pleasing, or they are not. 
I've had friends in the past, but they never last too long and I've became very anti-social at this point. Sexuality doesn't play an important role for me, and I've never had any romantic or sexual interactions with anyone in my life, nor do I have any deep desire or intention to do so. I still find some men and women physically attractive, hence the bisexuality instead of asexuality. 

I feel very detached from the people around me when I'm in public. I often feel detached from my own skin and body too. If I'm not feeling the effects of anxiety or paranoia, I can simply observe these masses of flesh and bone move around me and interact with each other as if I am watching a TV show. Some sociopaths seem to mention this kind of thing too, as it lets them observe things like power, influence and seduction from an objective viewpoint. I also view things objectively, but unlike sociopaths my understanding of human interactions is pretty poor. I find it very difficult to correctly pick up on social cues and facial expressions, so it's like I'm looking at a confusing puzzle with no answer when I observe people. Simply put, I struggle to understand people. 

Finally, you and others have commented on the sociopaths ability to blend into a crowd and copy the behaviours and customs of empaths in a very convincing way. I found this to be one of the most interesting aspects of your book (and sociopathy in general) becuase it's where the greatest difference lies between me and sociopaths. I can't blend in anywhere. As soon as I enter a room or a group conversation, everyone can immediately tell that I'm not normal. I stick out in ways I can't seem to fix. My mannerisms and social interactions seem off and unsettle people. Apparently I stare too much or too little, or the things I say in conversation are perceived as odd. I have no ability to charm others as sociopaths do. While sociopaths can be like a wolf in sheep's clothing hidden in the herd, I stand out immediately like a deformed goat with leprosy. There's nothing wrong with my appearance. I'm quite feminine and I believe I'm fairly or moderately attractive with regards to body shape and facial structure. I think it's all behaviour, mannerisms and social cues that give me away. 

Anyway I've rambled incoherently for far too long. I'll just finish by saying that I'm interested in the similarities and differences between mental conditions like schizophrenia and sociopathy and how it makes individuals feel like outsiders in a world they have to try and fit into, like playing a role for the sake of social convention. It's a hard topic to wrap my head around since schizophrenia can take many different shapes and forms, and sociopathy doesn't seem to be very well understood by most. 
I don't particularly expect a reply, but it was nice to try and put these thoughts down on paper, and if you do happen to have any thoughts on the subject, I'd love to hear it. 

Sorry for the essay and thank you for everything, 

Mind blame

Nobel Prize winning neuropsychiatrist writes an op-ed for the NY Times "The New Science of Mind" about the biology of mental disorders. He first uses the example of how psychotherapy and anti-depressant pharmaceuticals both change the structure and functioning of the brains of depressives, but one works better than the other depending on the neurological roots of the patients' depression. He also uses the genetic example of how an extra copy of genetic sequence means an increased risk of autism and its accompanying anti-social tendencies or a missing copy of the same sequence leads to Williams syndrome and its accompanying intense sociability.

Our understanding of the biology of mental disorders has been slow in coming, but recent advances like these have shown us that mental disorders are biological in nature, that people are not responsible for having schizophrenia or depression, and that individual biology and genetics make significant contributions.

The result of such work is a new, unified science of mind that uses the combined power of cognitive psychology and neuroscience to examine the great remaining mysteries of mind: how we think, feel and experience ourselves as conscious human beings.

This new science of mind is based on the principle that our mind and our brain are inseparable. The brain is a complex biological organ possessing immense computational capability: it constructs our sensory experience, regulates our thoughts and emotions, and controls our actions. It is responsible not only for relatively simple motor behaviors like running and eating, but also for complex acts that we consider quintessentially human, like thinking, speaking and creating works of art. Looked at from this perspective, our mind is a set of operations carried out by our brain. The same principle of unity applies to mental disorders.

In years to come, this increased understanding of the physical workings of our brain will provide us with important insight into brain disorders, whether psychiatric or neurological. But if we persevere, it will do even more: it will give us new insights into who we are as human beings.

Like most other mental disorders, sociopaths are characterized by both genetic and neurological differences that distinguish them from neurotypicals. I'm not saying that sociopaths aren't responsible for their actions, but they're certainly not responsible for being sociopaths. 

Dealing with mental illness

I really enjoyed this interview between schizophrenic and author Eleanor Longden and author of The Psychopath Test: A Journey Through the Madness Industry Jon Ronson, which is worth reading in its entirety. She talks about how the first voice in her head was just narrating what she happened to be doing, and in some ways she found it calming:

[W]hat research suggests is that voice-hearing (and other unusual experiences, including so-called delusional beliefs) are surprisingly common in the general population. This recognition has led to the popularity of 'continuum models' of mental health, which suggests different traits and experiences are all part of human variation – not strictly categorical in terms of "us and them", "sane and insane", "normal and abnormal". However, I do think life events play a vital role in determining who becomes distressed and overwhelmed and who doesn't. This might include experiences of abuse, trauma, inequality, powerlessness and so on, but it can also include the immediate reactions of the people around you. If you don't have people who will accommodate your experiences, support you, and help you make sense of what's happening, then you're probably much more likely to struggle.

And she wasn't supported or accommodated, instead her friend flipped out, followed by her psychiatrist, until she was institutionalized and the voices got much worse.

[My psychiatrist] really made me feel like a walking inventory of symptoms. This forensic-like scrutiny grew to feel very frightening and de-stabilizing, and was basically sending the message that the only relevant thing about me was my deficits. Not my strengths, not my abilities or resources, just my Bad Brain. I was eventually admitted to hospital (voluntarily), and the impact of that was disastrous because it sealed my perception of myself from someone who was confused, unhappy and frightened into someone with an uncontrollable, carnivorous mental illness. Eventually, I was diagnosed with schizophrenia. The voices (which by this time had multiplied and become much more aggressive) were witheringly contemptuous about this: "You can't even SPELL schizophrenia," one of them said, "So what the hell are you going to do about having it?!"

How did she find her way back?

I don't think there was a single, defining turning point, more an accumulation and fusion of positive changes. Primarily, I was very fortunate to have people who never gave up on me – relationships that really honoured my resilience, my worth and humanity, and my capacity to heal. I used to say that these people saved me, but what I now know is that they did something even more important: they empowered me to save myself. My mum, for example, had an unconditional belief that I was going to come back to her and was willing to wait for me for as long as it took. I also met an amazing psychiatrist, who absolutely didn't subscribe to the idea of me as 'schizophrenic' – or any other label for that matter. "Don't tell me what other people have told you about yourself," he would say, "Tell me about you." 

This led her to a period of profound self-acceptance:

For the first time, I had an opportunity to try and see my voices as meaningful – messages and metaphors about emotional problems in my life – and in turn begin to relate to them more peacefully and productively. I began to understand the voices (as well as my other experiences, like self-injury, anxiety, and paranoid beliefs) in a more compassionate way. Not as symptoms, rather as adaptations and survival strategies: sane reactions to insane circumstances. The voices took the place of overwhelming pain and gave words to it – memories of sexual trauma and abuse, rage, shame, loss, guilt and low self-worth. Probably the most important insight was when I realised that the most menacing, aggressive voices actually represented the parts of me that had been hurt the most – and as such, it was these voices that needed to be shown the greatest compassion and care. Which of course ultimately represented learning to show compassion, love, and acceptance towards myself.
***
But primarily it was when I stopped attacking and arguing with them, and began to try and understand them, and relate to them more peacefully. It was about putting an end to the internal civil war I mentioned earlier, because each of them was part of a whole – me! I would thank them for drawing my attention to conflicts I needed to deal with. I remember one very powerful moment, several years down the line, when I said something like, "You represent awful things that have happened to me, and have carried all the memories and emotion because I couldn't bear to acknowledge them myself. All I've done in return is criticize and attack you. It must have been really hard to be so vilified and misunderstood." There was an immensely long pause before one of them finally responded: "Yes. Thank you."

I found myself relating a lot to this last part -- part of learning to deal with any mental issues is a self-acceptance of yourself, your strengths, and your weaknesses. We all have what Carl Jung called the Shadow, parts of our personality that we would rather not acknowledge about ourselves. But in order for us to become whole, self-actualized human beings, we must not only acknowledge these aspects, but embrace them (see The Tools: 5 Tools to Help You Find Courage, Creativity, and Willpower--and Inspire You to Live Life in Forward Motion for some help on how).

Like most people, I used to ignore my shadow +90% of the time and the other part of the time I became the monster I was afraid I truly was. When I finally cared enough to get better, I knew I couldn't keep doing this, flipping back and forth between the projected-ideal-me and the indulging-every-bad-impulse me. The truth was that both those versions of myself were a distortion, and until I could acknowledge and accept the real me, any changes that I made would be superficial and not-lasting. I saw this same transition in the last season of Dexter, where he finally acknowledges that the "dark passenger" he always blamed for his killing impulse was really just a part of him that he had long ago alienated, and later personified as an external entity. People want me to feel shame for who I am, I can tell. But I'm not going to, because it would make me a much worse person (see also Ted Bundy).

Nobody chooses to be who they are. We make choices and we can define ourselves by our choices if we choose, but there will always be people defining us by other things, including things that we didn't ask for and cannot help. We can't do anything about that either. We just do the best we can and that has to be good enough. As Longden said:

I last heard voices yesterday. They were repeating something I'd read on the internet. The comment was: "I'm going to spoil the ending for you. The ending is – everything's going to be great!"

Successful and sociopathic

I thought this NY Times op ed, "Successful and Schizophrenic," had some interesting parallels. It tells the story of a law professor who was diagnosed as schizophrenic (I hope I'm doing the math right) in her early 20s. She was basically told that she would be living in a group home for the rest of her life. And she was actually hospitalized multiple times (apparently), but after her last stint at age 28 she was told that maybe she could get a job as a cashier making change part time. Instead she became a law professor and recipient of a MacArthur Foundation genius grant. Is she still schizophrenic?


Although I fought my diagnosis for many years, I came to accept that I have schizophrenia and will be in treatment the rest of my life. Indeed, excellent psychoanalytic treatment and medication have been critical to my success. What I refused to accept was my prognosis.

Conventional psychiatric thinking and its diagnostic categories say that people like me don’t exist. Either I don’t have schizophrenia (please tell that to the delusions crowding my mind), or I couldn’t have accomplished what I have (please tell that to [University of Southern California]’s committee on faculty affairs). But I do, and I have. And I have undertaken research with colleagues at U.S.C. and U.C.L.A. to show that I am not alone. There are others with schizophrenia and such active symptoms as delusions and hallucinations who have significant academic and professional achievements.


There were also really helpful suggestions about how each person came up with coping mechanisms specific to their individual issues:


How had these people with schizophrenia managed to succeed in their studies and at such high-level jobs? We learned that, in addition to medication and therapy, all the participants had developed techniques to keep their schizophrenia at bay. For some, these techniques were cognitive. An educator with a master’s degree said he had learned to face his hallucinations and ask, “What’s the evidence for that? Or is it just a perception problem?” Another participant said, “I hear derogatory voices all the time. ... You just gotta blow them off.”

Part of vigilance about symptoms was “identifying triggers” to “prevent a fuller blown experience of symptoms,” said a participant who works as a coordinator at a nonprofit group. For instance, if being with people in close quarters for too long can set off symptoms, build in some alone time when you travel with friends.

Other techniques that our participants cited included controlling sensory inputs. For some, this meant keeping their living space simple (bare walls, no TV, only quiet music), while for others, it meant distracting music. “I’ll listen to loud music if I don’t want to hear things,” said a participant who is a certified nurse’s assistant. Still others mentioned exercise, a healthy diet, avoiding alcohol and getting enough sleep. A belief in God and prayer also played a role for some.

Sound familiar to anyone? The advice to identify and avoid triggers by explicitly structuring your life to avoid or minimize them? Exercise and diet? Sleep and sensory inputs? Religion (which always what I fall back on when my brain is sick)?

She goes on to talk about how some people pour themselves into a rewarding career. She warns about the conflation of symptoms and diagnosis:


Far too often, the conventional psychiatric approach to mental illness is to see clusters of symptoms that characterize people. Accordingly, many psychiatrists hold the view that treating symptoms with medication is treating mental illness. But this fails to take into account individuals’ strengths and capabilities, leading mental health professionals to underestimate what their patients can hope to achieve in the world.


She mentions that some people with autism managed their symptoms, sometimes to the point of eliminating them. She then closes with these thoughts that could apply equally well to sociopathy:

I don’t want to sound like a Pollyanna about schizophrenia; mental illness imposes real limitations, and it’s important not to romanticize it. We can’t all be Nobel laureates like John Nash of the movie “A Beautiful Mind.” But the seeds of creative thinking may sometimes be found in mental illness, and people underestimate the power of the human brain to adapt and to create. 

An approach that looks for individual strengths, in addition to considering symptoms, could help dispel the pessimism surrounding mental illness. Finding “the wellness within the illness,” as one person with schizophrenia said, should be a therapeutic goal. . . . They should encourage patients to find their own repertory of techniques to manage their symptoms and aim for a quality of life as they define it. 

Pigeonhole diagnosis

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

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


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

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

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

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

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

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


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