Confessions of a Sociopath (6 page)

So, while it’s clear that people like me have existed throughout the many cultures of the world, our modern society likes to apply clear labels to people: Are you a sociopath, or something else? In the science fiction film
Blade Runner
, the sociopath analogues are the replicants, organic androids who have escaped to Earth and are hunted by Harrison Ford in his nuclear-dusty postapocalyptic world. So human-seeming are the replicants that they can be detected only through a set of emotionally provocative questions. In the movie, Harrison Ford can’t resist the charms of Sean Young’s porcelain skin and perfectly heart-shaped lips, even knowing she is a manufactured thing—that she can feel no empathy despite what he can see in her big, soulful eyes.

I remember watching the movie as a young girl, captivated by Sean Young’s quivering poise and futuristic office attire. Even then I felt sure I could survive pretty well in their harsh world, that all the scattered neon and miscellaneous steam would make it a hard enough place to live that all the weaklings would be relegated to subsistence living, and the strong ones like me would thrive. I imagined wheeling and dealing in pidgin Chinese, darting through alleyways in my dinged-up hovercraft. The irony, of course, is that in my adulthood I would willingly subject myself to very similar diagnostic questions—that I too would be clinically outed by tests designed to measure my lack of humanity.

The
Blade Runner
example is an interesting comparator because the emphasis is on identification, not diagnosis. The replicants are truly “other” and presumed to be subhuman; therefore there are no ethical constraints on what becomes of them, despite evidence that their internal worlds may have been just as rich as those of the humans. Similarly, even health professionals like Martha Stout, Harvard Medical School faculty member and author of
The Sociopath Next Door
, speak in terms of “identifying” sociopaths, as opposed to diagnosing. The message seems clear: These people
are
sociopaths, they aren’t people who have sociopathy. Diagnosis is for people for whom there is a treatment. Because there is no known effective treatment for sociopaths, there is just the question of what to do with the sociopath problem. In
Blade Runner
, society had come to a definitive decision of what fate would befall its empathy-free creations.

The sociopath problem for our society is, how do we keep sociopaths from acting in antisocial ways? Before society can even begin to discuss solutions to that problem, they need a reliable way to identify sociopaths. Before psychologists can
identify them, however, they must be able to understand them. And to be able to understand them, they must be able to identify them. One psychologist has illustrated the tautology in the following way: “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.”

It’s a classic chicken-and-egg dilemma that has prompted countless criticisms of the most popular diagnostic criteria. All diagnostic tools are based on the observable traits of people who have been diagnosed as sociopaths, which, apart from being rather circular, introduces the risk of biases that might skew which traits get included or not included. Of course there must be some starting place. Cleckley and others observed that some traits occurred more commonly in his patients than in the general populace. Once that recurring group of traits had a name, researchers could try to figure out if they all had a common cause, if they were related to other identifiable groups of traits, how many people had that group of traits, and what kinds of things those people got up to compared to the larger population. But Cleckley was well aware that his checklist was just his own poor approximation of the essence of sociopathy, and consequently was not infallible or even all-inclusive—a humility that I sometimes feel is lacking with researchers of sociopathy.

The current primary tool for identifying psychopaths (and, by association, sociopaths) is the PCL-R (Psychopathy Checklist–Revised), developed by Dr. Robert D. Hare, professor emeritus of forensic psychology at the University of British Columbia and generally considered the primary authority on criminal psychopathy. “Science cannot progress without reliable and accurate measurement of what it is you are trying to study,” Hare explains. With a research assistant he compiled a
list of twenty traits that he noticed recurring among the prison population he was studying: lack of empathy and remorse, megalomania, manipulation, charm, self-interestedness, impulsivity, proficiency at lying, along with criminal-specific traits such as juvenile delinquency, revocation of conditional release, and criminal versatility. He instructed other psychologists giving the assessment to award two points if a trait was present, one if they were unsure or it applied somewhat, and zero if it wasn’t. The test was reliable, in that repeat assessments resulted in approximately the same score, but its validity has been heavily criticized.

Validity is a measure of how well a diagnostic tests what it is meant to test—in this situation, how accurately the PCL-R identifies psychopaths. The PCL-R has been criticized for being exclusively based on the prison population. Hare himself has admitted that it was done solely for convenience: “Prisoners are easy. They like meeting researchers. It breaks up the monotony of their day. But CEOs, politicians …” In a widely publicized scandal, Hare threatened to sue two psychologists who warned in a paper that the checklist was increasingly being mistaken for a complete definition of psychopathy, which is a broader personality construct that includes deceitfulness, impulsivity, and recklessness, but not necessarily physical aggression or illegal acts. The authors contended that Dr. Hare’s checklist warps that concept by overemphasizing criminal behavior. Their article reflects the growing consensus that sociopathy does not equate to criminality. Nor has Hare defended why each trait on the checklist is scored exactly the same. It’s not immediately obvious why a trait like lack of empathy should earn exactly as many points as something seemingly less significant like superficial charm. There is also the question of what defines this (or
any) personality disorder, a person’s actions or her interior motivations. While a case history of bad decision-making is easy to evaluate, it’s harder to truly understand another person’s modes of thought.

There are significant differences of opinion among academics and clinicians about whether psychopathy and sociopathy are diagnosable conditions at all. The good folks at the American Psychiatric Association who put together the
DSM
have decided to exclude both terms, despite movements by researchers for revisions in favor of antisocial personality disorder, or ASPD, a diagnosis based on observed behavioral patterns. The World Health Organization’s
International Statistical Classification of Diseases and Related Health Problems
describes a similar diagnosis it calls dissocial personality disorder but also does not include sociopathy. ASPD and sociopathy do not share all of the same characteristics; ASPD focuses primarily on the criminality of behavior, rather than the internal thought processes of a sociopath, since thought processes are difficult to ascertain, particularly with unwilling, institutionalized subjects. For instance, although I consider myself a high-functioning sociopath because of my weak sense of empathy, my failure to conform to social norms, and my predilection to manipulate others, I could not be legitimately diagnosed with ASPD.

Further confusing the diagnostic problem of sociopathy is the overlap in behavioral characteristics between sociopathy and other personality disorders such as narcissism, like enhanced self-regard and diminished empathy, as well as some social developmental disorders like Asperger’s that are also seen on the autism spectrum.

In his book
Forensic Psychology: A Very Short Introduction
, David Canter, a psychology professor at the University
of Huddersfield, warns that “we should not be seduced into thinking that these diagnoses are anything other than summary descriptions of the people in question” and echoes the concern that they are “actually moral judgments masquerading as medical explanations.” The first line in the preface of Robert Hare’s book reads: “Psychopaths are social predators who charm, manipulate, and ruthlessly plow their way through life, leaving a road trail of broken hearts, shattered expectations, and empty wallets.” So you can imagine what side of the fence he’s on. Still, these diagnoses are being used, and important decisions like whether or not to deny someone parole are made primarily on the basis of them.

Unlike the problematic definitions of psychological diagnoses, neuroscience may offer some more clarity. Recent brain scan research and other studies suggest a link between these characteristics and something more “definitive” and unique about a sociopath’s brain. But it would be a mistake to conflate the list of characteristics of a sociopath with the definition of
sociopath
, just as it would be a mistake to assume that all Catholics would share the exact same traits—or that having a certain list of traits is what makes people Catholic. The diagnosis of sociopathy is useful, but only to the extent that people understand its limitations. The main limitation is that we cannot identify it by its root source; we know it only by its symptoms and characteristics. This is somewhat disappointing to people. It would be easy to think that I am bad because I was treated badly or raised badly, that I grew up in an environment devoid of love and filled with enmity. But I didn’t suffer the kind of outrageous abuses that so many people do. Mine were of the ordinary variety, maybe some benign neglect. When people ask me whether I had a bad childhood, I tell them that it was relatively unremarkable. We know from
twin studies that there is a strong genetic component to sociopathic traits, and we also know that sociopaths have different brains from most people. But just because they have different brains does not mean that their unusual brains are what makes them act differently. The fact that they act differently could actually be affecting their brain circuitry. Similarly, just because a sociopath’s brain is different does not mean that is what is causing the sociopathy—that could be, according to Hare, a “by-product of some other environmental or genetic factor commonly found among psychopaths.”

We don’t know the root cause, but we also know there isn’t a cure for this disorder, not that we would necessarily want one, for reasons that I hope will be clear upon finishing this book. Dr. Cleckley observed and counseled sociopaths as a psychologist and professor at the Medical College of Georgia. He wrestled with how to treat sociopathic patients and criminals, whom he believed to be deeply disturbed but essentially intractable. In the preface to his final revision of
The Mask of Sanity
, which he wrote at the very end of his life, Cleckley explained that he had been unable to discover an effective treatment but was heartened by the belief that he had contributed to the understanding of sociopathy—and especially that the relatives and loved ones of sociopaths could have some explanation for the unusual behavior of their beloveds. Indeed, he cited at length instances of incurable patients—individuals who had all the resources and support in the world to get better but ended up maiming significant others and committing other manner of misdeeds. To him we were a lost cause.

Cleckley was not alone in this belief. Recent estimates of the criminal recidivism rate for sociopaths is approximately double that of nonsociopathic criminals, and it is triple for violent crimes. Even the Yoruba and the Inuit tribes believed
that these antisocial individuals could not be changed. The only solution was to neutralize or marginalize them, or as one Inuit purportedly told Murphy, the anthropologist, “Somebody would have pushed him off the ice when nobody else was looking.”

Today psychologists and criminologists are occupied with the same conundrum with which the Inuit and Yoruba dealt through discreet homicide—what to do with sociopaths who simply cannot be trusted and who do not belong. In Great Britain, authorities have given sociopathic criminals life sentences solely on the basis of their sociopathy. In America, diagnosed sociopaths have been committed indefinitely in psychiatric facilities with no hope of release, since their doctors assume they cannot be cured. Take the story of Robert Dixon, who received a fifteen-years-to-life sentence for accessory to murder as the getaway driver to an armed robbery gone wrong. Twenty-six years into his sentence, he was up for parole. As part of the assessment of whether he was likely to reoffend, he was given a test that indicated that he was a sociopath. “I remember reading the report and feeling heartbroken,” Dixon’s lawyer recalls, “because I knew no matter how hard I worked from that day forward, that when I brought him back to the board, we were going to get denied.”

While in his first edition Cleckley asserted that sociopaths should be considered psychotics due to their deep inability to function in society, he revised his position in later editions when he realized that this characterization stood in the way of making them responsible for their criminal acts. He faced a crisis; he never believed that sociopaths were crazy, or “manic,” in the sense that others of his patients were. But he felt that they were just as troubled, just as deficient or wrongly equipped to live, and so should be kept apart from everyone
else. He was concerned that dangerous sociopaths were not committed in mental institutions often enough, because an overemphasis on verbal intelligence and rationality in determining whether a person was mentally competent for the purposes of confinement weighed in favor of sociopaths.

But depriving the sociopath of freedom purely on the basis of her psychiatric diagnosis is fraught with questions of moral significance. Social scientists worry about control and maintenance—how do we deal with these strange creatures, they ask themselves, in a manner that does not make monsters of the rest of us? Can a person’s lack of conscience justify a deprivation of his freedom? Society commits the insane to confinement by reasoning that they present harm to themselves and others. I’ve heard the argument that sociopaths cannot function in the outside world, so there is nothing that society can do but take the drastic step of separating the sociopaths from the rest of the world. But sociopaths
can
function; we just function differently. It’s not like we’re biting off our own hands or jumping off of buildings in the belief that we can fly. We’re not crazy. And the truth is that we are sometimes quite successful. It is just that we live, think, and make decisions in a way that some people find loathsome and most find disturbingly amoral. What do you do to people you simply don’t like?