Tuesday, August 6, 2013

Medicated sociopath

A sociopathic reader recently wrote to me telling me about how he spent the past year being heavily medicated. First he was given stimulants and amphetamines, including Ritalin, which made him hallucinate as well as making him more callous. After he stopped those he was left taking antidepressants and tranquilizers, which dulled his experience, but he said that the drugs helped him reset his mind towards a more pro-social way of viewing the world. He asked me my thoughts on the possibility of sociopaths benefiting from medication:

I have never really been on any medication.  I’m curious what tranquilizers you have been taking.  Do you think some of the mellowing out is also just due to age and/or acquiring enough in your personal life that you are a little more hesitant to risk it on risk-seeking impulses?

To answer your questions, my impulse has traditionally been that it would be that it is better to be a loose cannon then to be a dumbed down version of myself, although if I were faced with ultimatums from loved ones or started to feel a little out of control, I wouldn’t hesitate to mellow out through the use of drugs.  I don't know if it is necessarily a self image issue, but depending on what I'm doing, I feel like I am barely smart enough to keep one step ahead in my exploits.  I already don’t do a lot of things I would like to do (boxing, other violent activities that involve possible head injuries) because of that, and I would have a similar reluctance to take meds because it might make me lose that part of my personality that helps me fulfill the role that I often choose in my life.  Plus I guess I am comfortable being me and it would be weird to feel like something else besides me is my puppetmaster.  So I guess the feeling of a loss of control would bother me a bit.

On the other hand, sometimes I feel like being a lot more passive, taking a break. I am sort of feeling like that right now, actually. And I go through cycles of being this way, on and off. Maybe several years on, one year off? It's sort of like sleep to me, and I like to take meds to sleep that deep restorative sleep. So maybe when I'm off I should be on meds too, just to give my mind a break. And I really like trying new things, so maybe I will try this.

I understand what you mean about the medication "resetting" your brain. The mind gets in habits of thinking and it's hard to break those habits, but I can see how being on meds would by their very nature be a disruptive force in your mental patterns. Once a pattern is disrupted, I think it is much easier to start a different pattern. That's why it's hard for me to get too sad about my life falling apart.

Your question “Is it weaker to latch on to one's emotions as a source of identity and meaning, or to accept them as a liability and turn them off?” is a really interesting one.  I have a shadow of a memory of choosing the latter and I don't really think it’s reversible, but I don’t really have opinions anymore about which is better.  I guess the answer is that it is better for the world to have some of each.  And for each individual, it probably depends on your circumstances, like choosing which airport security line you think is going to be best for your particular needs. The default for sociopaths is to not identify with their emotions as a source of identity and meaning, and the default for empaths is to see their emotions as a reflection of the truth about themselves and the world around them. Both of them are incomplete approaches to discerning reality, probably. Both would do well to learn something from the other.

Has anyone else had good experience with meds? It would actually be great if there was a medication that worked with sociopaths. Then we could be like schizophrenics -- as long as we were thought to be taking medication, people would likely not discriminate against us. It's sad, really, because I think a lot of sociopaths have found non-medicated ways to achieve the same ends (e.g. resetting out mindsets towards more pro-social ends through mindfulness, meditation, found spirituality, etc.). And we know that this can also change brain chemistry -- as my friend's doctor told her regarding postpartum depression, you can treat it either with medication or with therapy and both work to the same goal. But would people trust that a sociopath had made this sort of internal change sans meds? Would the sociopath eventually be able to be given the same benefit of that doubt, that although he remained a sociopath, he had it "managed"? The problem with figuring out a non-medicated way of resetting your mindset or controlling your thoughts/behavior is that people put way more trust in the power of medications than they do the power of the mind to change. Or am I wrong? 

Monday, August 5, 2013

Can we eliminate evil?

A reader suggested this Morgan Freeman narrated special "Through the Wormhole: Can We Eliminate Evil?" Not surprisingly, it features sociopaths and studies on the brain that give interesting insight to how we decide what to do and what constitutes evil.

The first clip is about empathy, and illustrates well the recent study that found that sociopaths feel empathy when directed to put themselves in the shoes of others.




If you have the genetics of a killer and the brain anatomy of a killer, are you destined to become a killer? James Fallon.




And finally this was an illustration of this experiment regarding the moral lives of babies.





Sunday, August 4, 2013

Training the low-functioning sociopath

A reader asks how she can better interact with her lower-functioning sociopath ex for the benefit of their child:
Growing up with an extremely high functioning sociopath for a best friend, I perhaps not understand but appreciate the logical thinking that comes along with not having to consider others' emotions. I've seen the game well played, but my soon to be husband keeps shooting himself in the foot. He is now destitute, living without so much as a car and is about to lose everything he will ever make in the divorce settlement. Have you met any sociopaths who completely sabotage themselves to this degree? Is this a challenge to him, an insult to me, or a result of a game gone horribly wrong? Or am I missing the point entirely? Is there a way to encourage him to use his advantages for more productive means or am I dealing with a real chump and should call it a day?
My response:
Sociopaths are allegedly slow learners, particularly experiential learning, which I'm sure is a large part of why sociopathic criminals are very likely to re-offend. Sociopaths don't respond effectively to punishment because they don't fear punishment in the same way that neurotypicals do. Dr. Hare illustrated this in a study where participants watched a timer ticking down to a painful electric shock. Normal people would get increasingly anxious as the time for the shock approached, but psychopaths did not. Because sociopaths do not fear consequences in the same way empaths do, they are prone to making the same mistakes over and over again. Even mice can be trained to stop pushing particular buttons that lead to certain negative consequences, but sociopaths struggle. Because sociopaths are risk takers, they also tend to be overly optimistic about their chances. Finally, sociopaths are largely emotionally empty -- their lives do not have much meaning beyond the power they can acquire and gratification in which they can indulge, so they don't have much to lose.

Still, if sociopaths seem oblivious to punishments, at least the more successful ones are surprisingly sensitive to incentive systems. My personal theory is that the lowest functioning sociopath is only sensitive to immediate rewards, while the highest functioning sociopath has learned to also feel pleasure in accumulating delayed rewards. For example, low functioning sociopaths might be enticed to do an honest day's work for a honest day's pay, but are less likely to save money for retirement. For whatever reason, I am able to experience part of the pleasure today of anticipated rewards, which is probably why I managed to fund my retirement by age 30?

How would i use this knowledge to train a low functioning sociopath? I think the same way that you might train a small child or a pet -- break up rewards into small, frequent, easy to achieve increments. For instance, if he does a small task, you will let him have more time with his daughter, you will let him borrow your car, you will let him be late with support payments, whatever the small reward you want to provide is. He probably won't like thinking that you are messing with him or manipulating him, which to him will smack of a power struggle or paternalism, so try to find some natural connection between his actions and your responses to his behavior. For example, if he picks up your daughter on time, you won't have to pay the babysitter extra money to stay, so you are willing to send her out with spending money. Or his calling ahead when he cannot make his appointed visitation allows you to make other arrangements so you do not need to miss work. In economic-speak, sociopaths are rational actors, perhaps the purest form of rational actor, as that term is defined. You can always count on them to look out for their best interest, and as long as what you want is also something they want, they can act in your best interest as well.

Saturday, August 3, 2013

Free won't

In doing some research on the sociopath's supposed lack of impulse control, I stumbled upon this article from Scientific American (found in full here), which questions the popular conception that we make a conscious choice then act on that choice (i.e. free will). The abstract:
Most of us have a sense that our everyday actions are controlled by an intention that precedes the action: I decide to turn on the light, then flip the switch. But experiments don't consistently support this notion. Some psychologists believe that our sense of intention and purpose is constructed by the brain after the action takes place. Others disagree. The authors discuss ingenious experiments that probe this question, along with bizarre phenomena, such as "alien-hand syndrome," where brain damage leaves patients struggling with actions they cannot control.
The experiments:



Another experiment suggests even more strongly that our sensation of control is largely imaginary:
In one such experiment . . . two participants worked together to move a cursor over objects on a computer screen. One of the participants served as a confederate of the experimenter, but the experimental subject never knew this. The genuine subject heard words over a set of headphones that related to particular objects on the screen. For example, a subject might hear the word "swan" while moving the cursor over a picture of a swan. Unbeknownst to the subject, all of the movement of the cursor came from the confederate. The results showed that, when the relevant word was presented 1 to 5 seconds prior to the action, subjects reported feeling that they had acted intentionally to make the movement. In other words, they had experienced will. When the word was presented 30 seconds prior to the action or 1 second after it, however, there was no false feeling of willing the action. The authors argued that this experiment provided clear evidence that the human brain constructs feelings of causal agency after an action has taken place. It could be that a proper temporal order between intentions, actions and consequences triggers the brain—after the fact—to feel a sense of control.
This type of self deception is perhaps seen best in sufferers of alien hand syndrome, who often rationalize the behavior after the fact, "fool[ing] themselves that the actions they performed were indeed intentional" although "patients are not aware of what they are going to do until after the action has been made." Interestingly, schizophrenics, who frequently "describe an external agent as causing their actions, thoughts, speech or emotions," may largely suffer from an inability to delude themselves into believing that they are acting on their own intentions like "normal" people do.

We are not slaves to impulse, however. The literature suggests that rather than experience free will, we instead experience "free won't," or the ability to avoid acting on the impulse, possibly with the aid of the dorsal fronto-medial cortex, as explained in this article.

The idea of decisions being unconscious impulses that we either reject or make our own raises interesting issues for sociopaths with alleged impulse control problems, but raises even more issues for neurotypicals and the role that a sense of control plays in how they define themselves:
More than a matter of simply turning on a switch, this feeling of control over actions might even contribute to a conscious sense of self. In other words, I am because I control my actions. The question is: How do we go from mundane, everyday actions—like turning on a light—to developing a sense of self as a causal agent?

Friday, August 2, 2013

Criminal sentencing for sociopaths

The role that a diagnosis of psychopathy should play in criminal sentencing is an admittedly thorny issue. The legal standard for an insanity plea is that the perpetrator must not be able to distinguish between right and wrong. Sociopaths actually know the difference between right and wrong most of the time, they just don't care (enough to conform their behavior to societal standards). The debate is whether this faulty wiring makes them more culpable, less culpable, or equally culpable to a similarly offending non-sociopath. A prominent researcher who specializes in scanning the brains of sociopaths in prisons, Kent Kiehl, suggests in an interview with NPR that we should cut them some slack:
Brian Dugan . . . is serving two life sentences for rape and murder in Chicago. Last July, Dugan pleaded guilty to raping and murdering 10-year-old Jeanine Nicarico in 1983, and he was put on trial to determine whether he should be executed. Kiehl was hired by the defense to do a psychiatric evaluation.

In a videotaped interview with Kiehl, Dugan describes how he only meant to rob the Nicaricos' home. But then he saw the little girl inside.

"She came to the door and ... I clicked," Dugan says in a flat, emotionless voice. "I turned into Mr. Hyde from Dr. Jekyll."
***
"And I have empathy, too — but it's like it just stops," he says. "I mean, I start to feel, but something just blocks it. I don't know what it is."

Kiehl says he's heard all this before: All psychopaths claim they feel terrible about their crimes for the benefit of the parole board.

"But then you ask them, 'What do you mean, you feel really bad?' And Brian will look at you and go, 'What do you mean, what does it mean?' They look at you like, 'Can you give me some help? A hint? Can I call a friend?' They have no way of really getting at that at all," Kiehl says.

Kiehl says the reason people like Dugan cannot access their emotions is that their physical brains are different. And he believes he has the brain scans to prove it.
***
Psychopaths' brains behave differently from that of a nonpsychopathic person. When a normal person sees a morally objectionable photo, his limbic system lights up. This is what Kiehl calls the "emotional circuit," involving the orbital cortex above the eyes and the amygdala deep in the brain. But Kiehl says when psychopaths like Dugan see the KKK picture, their emotional circuit does not engage in the same way.
***
Kiehl says the emotional circuit may be what stops a person from breaking into that house or killing that girl. But in psychopaths like Dugan, the brakes don't work. Kiehl says psychopaths are a little like people with very low IQs who are not fully responsible for their actions. The courts treat people with low IQs differently. For example, they can't get the death penalty.

"What if I told you that a psychopath has an emotional IQ that's like a 5-year-old?" Kiehl asks. "Well, if that was the case, we'd make the same argument for individuals with low emotional IQ — that maybe they're not as deserving of punishment, not as deserving of culpability, etc."
***
This argument troubles Steven Erickson, a forensic psychologist and legal scholar at Widener University School of Law. He notes that alcoholics have brain abnormalities. Do we give them a pass if they kill someone while driving drunk?
***
At trial, Jonathan Brodie, a psychiatrist at NYU Medical School who was the prosecution's expert witness, went further. Even if Dugan's brain is abnormal, he testified, the brain does not dictate behavior.

"There may be many, many people who also have psychopathic tendencies and have similar scans, who don't do antisocial behavior, who don't rape and kill," Brodie says.

The jury seemed to zero in on the science, asking to reread all the testimony about the neuroscience during 10 hours of deliberation. But in the end, they sentenced Dugan to death. Dugan is appealing the sentence.
With this and the U.S. Supreme Court case allowing governments to indefinitely detain pedophiles, the halcyon days of believing in rehabilitation for criminals seem to be over. If there was one piece of advice I could give this upcoming generation of sociopaths, it would be to master the ability to authentically mimic the empath's exaggerated remorse and self-hate, a performance that is quickly becoming necessary to keep the lynch mobs at bay.
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