Sociopaths and depression

From a reader:

I am already sorry that my email has to begin with "my ex-boyfriend is a sociopath..." because I know this is something most women think has happened to them. My ex, however, is what he describes as "caught in the net"; a diagnosed sociopath, treated once in hospital and still in occupational care. Not that it helps, of course.

When we were together, he didn't act in a way that most women would describe their apparently sociopathic exes as acting, in fact he was very loving and caring, and always spoke of the huge amounts of respect he had for me, and how he took me seriously, and this is why he loved me. Before we were together we were friends and I would watch him systematically destroy the emotional lives of his exes, just for fun, just for kicks. My reasons for loving him were the normal ones; mainly, I was attracted to the sociopath in him.

I saw him just the other day, and we had this long conversation, where he told me about how much he feels he is suffering. I am adverse to all people who assume that sociopaths have no feelings whatsoever. Sure, he doesn't feel guilt, which sometimes makes me feel incredibly upset that he could - and has - hurt me spectacularly, and the only remorse he would feel would be the remorse would follow my excommunication of him, not the fact that he had upset me.

He has started to complain of feeling he has built himself a prison of his own behaviours, that his lack of impulse control is what's driving him to his own insanity. He doesn't feel guilty, his problem doesn't lie in his fear that he is hurting people, it is his basic fear that he will be lonely, that he is damaging himself. He has had a few scares that have nearly killed him, a few outbursts that have landed him in the Police Station or the psychiatric unit. He said something to me about his grip on reality; something about the fact that every time he does something "typically psychopathic", he is bored of himself, and he feels another barrier between him and the real world has gone up. I'm not entirely sure what he means by this.

I wouldn't assume that the reason he is saying this stuff to me is to appeal to my empathy, because I currently have nothing he wants. He is always relatively honest with me, in that if he wants something from me, he will ask for it. He respects me, still, so the mind games he plays with me are very minor and are usually just to keep himself on form.

My question is, is this feeling of suffering a common thing? Sociopaths I know only feel very primal emotions, and he has often told me that my downfall in life is that I am far too empathetic and this is slowing me down, that I could be like him if I wanted to but I'm too compassionate and he finds this quite sickening.

Occupational hazard?

Blood lust

In my experience, blood lust is very rare even in the sociopath community (and of course not exclusive to sociopaths). The difficult thing about it is you can never really tell who it will be: you can have some creepy co-worker who turns out to be fine, and another charming one who one day comes to work with a small arsenal. It's hard to tell what is going on there, but here is a reader's description of what it feels like to self-professedly have bloodlust:

Blood cravings or the craving of wanting to hurt someone is weird. I'm holding a fork or a knife or something sharp, and all I want to do is shove it in the throat of the person next to me. I'm curious, but, I know the hell that awaits me if I do it. So I don't. But, I feel the need, the force and thought that pulls me and is pushing me closer to the step where I actually do it. Sometimes, I'm not even angry. I'm fully in control of my emotions and body. But, I keep having images in my head where I step closer and jab and the persons throat. Who, it doesn't matter to me. I've had those images with my friends, people I don't know, even my own mother.

When I'm angry, I have no control. I have lost my temper and destroyed things I shouldn't. I'm more curious than afraid that one day, I'll lose my temper and hurt someone. It could be rather interesting actually. If I end up in a courtroom at least I can plea the "insanity"-plea. Or am I thinking of some other thing?

For me it's more like curiosity. Will the blood pour out of him/her like water? Will it splatter across the room? Will I have to use a lot of force to shove it all the way in? If I pull out the knife, will the blood gash out of her/him like in the movies? Will she scream?

All I know is that IF I do it, unprovoked, I will have one hell of a time explaining it to the police, my family, probably even the media. Who knows? Will my former therapist get an interview in the newspaper? That would actually be fun.

Will I one day give in to the urges? If I do, and I can control it, I will only do it towards those who I see fit to die. Those I hate. Not personally of course, but, to those who I deem evil.

Sociopath song of the day: liar

Ha.

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.

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”.