The Psychopath Inside (17 page)

My personal concern, however, focused on the bipolar disorder that was mentioned in passing over the years by close friends of mine who are also clinical psychiatrists and neurologists. I always discounted such suggestions for the simple fact that I never considered myself capable of the normal depressed feelings the average person experiences, other than perhaps the sense of dread I experienced at times starting in my youth, and the wildly disorienting and bizarre emotions accompanying the regular panic attacks I experienced starting when I was eighteen. Instead, my adult life had been replete with a riot of positive feelings, pleasurable
mayhem, ecstatic bouts of whimsy and creativity, and a rollicking good time on almost a daily basis. The extent and intensity of my positive moods throughout adulthood after graduating from college were either a buzz to those around me, or annoying to others since I always seemed to be having a good time. And I was and still am.

This assumption that my almost chronic, overly positive mood was not indicative of bipolar disorder was, perhaps, a form of denial on my part. I saw depression as a form of weakness and didn't want to admit that I may be a victim. Meanwhile, who in their right mind would ever want to cure hypomania? It feels great, even if one does appear to be, as an eloquent neurologist friend put it, a “fart on a skillet”—volatile and unpredictable.

Bipolar disorder is now considered a spectrum disorder, which means in part that we don't yet fully understand what it is. The two principal types are bipolar I, which features extended periods of mania, and bipolar II, which is characterized by hypomania, a less intense version of mania. There are also minor forms III, IV, V, and VI. Bipolar I is more serious and debilitating, since the highly aroused, aggressive, and agitated state of mania can include psychotic delusions and hallucinations, paranoia, and behaviors highly damaging to one's relationships, job, and bank account.

My biologist colleague Rob and I once compared his clinical mania with my hypomania. I told him that my days- to weeks-long bouts of hypomania were associated with little sleep, bursts of productive creativity, and a desire to party hard
.
He contrasted
this with his manic episodes. He said a typical one would last a week and involve him walking out of his lab and jetting to Vegas, where he, too, would spend all day and night gambling and partying, but he would also buy thirty TV sets, jewelry, and expensive household items he didn't need. Such a week would set him back more than fifty thousand dollars. This behavior also led to divorces and a severe disruption of his career numerous times. He also said that although the manic phase felt wonderful, his creative output was large but not of high quality, something that contrasted with my hypomanic experiences.

During some of my episodes, I would end a late drunken Jacuzzi party at my house and drive off to Vegas with one of my three like-minded buddies, and spend the weekend there drinking and gambling like there was no tomorrow. Diane found my disappearing acts incredibly inconsiderate, and worried about drinking and driving and other dangerous behaviors. (The kids never complained; they just thought their dad was different and did crazy things.) In the end these shenanigans also threatened my friends' marriages, and I eventually lost my comrades. Basically, their wives told them they couldn't play with me anymore. One wife of a colleague, a Nobel laureate, pulled me aside at a party and pleaded with me to not hang out with her husband anymore. Another wife told me I reminded her of the scene in
The Great Gatsby
in which Nick narrates his final feelings about the Buchanans: “They were careless people, Tom and Daisy—they smashed up things and creatures and then retreated back into their . . . vast carelessness . . . and let other people clean up the mess they had
made.” It was never clear to me whether my friend's wife was referring to my hypomania, or to something a bit more sinister. After some tricky times, all my playmates have gotten over the marital rifts I played a part in causing.

Psychiatric conditions often carry with them a phenomenon called comorbidity. This refers to the presence of other disorders in addition to the primary one in question. So a patient diagnosed, for example, with bipolar disorder or schizophrenia will often have other diagnoses, too, such as borderline personality disorder. I don't know anyone who is just a psychopath and nothing else. There's wide overlap between disorders, in the symptoms displayed, the brain areas responsible, and the transmitters involved. And my psychopathic traits can't be discussed in isolation because other problems shape how they're expressed. I'm attractive to people in part because I'm bouncy and glib and I can bullshit my way around. Well, that energy and fluidity comes from my hypomania. So all my behaviors are tied together.

Doron Sagman and Mauricio Tohen of the Lilly Research Laboratories in Indianapolis have written that people with bipolar disorder are at higher risk for panic disorder, OCD, and substance abuse. In addition, about one-third of bipolar disorder patients, but not major depressive disorder patients, also exhibit antisocial, borderline, histrionic, or narcissistic personality disorders. These people are also more likely to commit suicide, be obese, develop type II diabetes, and smoke.

This list of bipolar comorbid ailments recently gave me pause. This was a familiar “who's who” of friends throughout my life,
starting in my childhood and continuing, alternately, through my teen and young adult years. I had the full load of the symptoms associated with these disorders, and each one of them dominated some phase of my life, with one peaking, say, in my early teens, only to be replaced by another full set of symptoms. In each case, I had displayed long bouts, up to years, of at least 80 percent of the symptoms for each disorder. Another curious thing was obvious in the clinical symptom reports and comments told to me by senior family members and clinicians. Most of these disorders were strongly impacted by the serotonin system, and to a lesser degree to the other monoamines, including the dopamine, norepinephrine, and histamine neurotransmitters. But serotonin and the temporal lobes jumped off the pages. My life, however hypomanic and wonderful, was a serotonin catastrophe, and one that screamed of a lower temporal lobe in distress. And if the lower, or inferior, temporal lobe (including the amygdala) was in distress, then the inferior frontal lobe and its connection in the insula would be a bit out of whack, too. This wackiness was evident in my PET scans—as Amy Arnsten had suggested after seeing my TED talk. My psychological world was starting to make sense.

After Oslo I continued to think about other ways my funky monoamine system explained my experiences. In a panel event titled “Madness Redefined” at the 2012 World Science Festival, the depression expert and author Kay Redfield Jamison, the psychiatric and legal expert Elyn Saks, and I talked about why so many people with bipolar disorder display such bursts of
creativity, and how they are overrepresented in the arts, music, theater, and sciences.

During the hypomanic stage, monoamine transmission increases, and these neurotransmitters put you in a positive mood, so you want to create something, and they can also boost connectivity between different areas of the cortex, allowing for novel associations. The creative impulse is one reason mental illness can sometimes be viewed as a blessing, especially in cases of mild bipolar disorder like mine, in which one benefits from the joys of hypomania without the devastation of full-on mania or depression.

The temporal lobe, and the orchestrations of its perceptual and emotional memory function, is also heavily influenced by monoamine neurotransmitter systems such as norepinephrine, dopamine, and, especially, serotonin, which all modulate the circuits to enhance and diminish sensory inputs. My own genetics show an unusual mix of high-risk alleles that code for enzymes and proteins involved in the monoamine pathways. But high risk for one type of malfunction can also confer low risk for another function. For example, one allele that codes for the growth factor BDNF (brain-derived neurotrophic factor) is associated with excellent memory but high anxiety. This is the combination I have, and it fits with my actual behavior. The other allele of BDNF codes for lower memory function but also low anxiety. So what would I rather have, a great memory and high anxiety or a poorer memory and a mellow disposition? Tough call.

The lower temporal lobe, beyond its role in emotional
memory, fear, anger, rage, and anxiety, also has a role in insight, a sense of the supernatural and God, and the feeling that one is experiencing extrasensory perception (ESP). These purported “psi” abilities include precognition, clairvoyance, presentiment, psychokinesis, and similar such silliness. Patients with temporal lobe epilepsy report ESP experiences before epileptic episodes. The sense of the supernatural and the reporting of experiences beyond this spatio-temporal plane are common in these patients, in schizophrenics, and in hallucinogenic drug users. These supposed psi experiences are treated by clinicians and researchers as subjective symptoms of a disorder, as opposed to objective signs of real capabilities.

Belief in such far-out experiences such as ESP is called “magical thinking” in psychiatry and is considered a symptom of some underlying disorder such as schizophrenia, irrational fears, or obsessive-compulsive disorder. Beyond the serious psychiatric stigma associated with magical thinking are common taboos and superstitions and generally accepted practices such as prayer. One person's magical thinking may be another's deeply held religious belief system. But when a psychotic person, perhaps one experiencing a psychotic break associated with bipolar disorder, MDD, or schizophrenia, starts hearing voices that tell him to murder someone, the temporal lobe issues can transform from personal belief to extremely serious public menace. Delusion-driven murder is not typically seen in primary psychopaths, who carry out their predatory behavior without such hallucinations or emotional involvement. There may be some psychopathic killers who do
experience violence-inducing hallucinations, but this type of motivation and behavior would most likely be due to a psychopath having a comorbid psychotic, rather than psychopathic, condition.

I have clear memories of a perception, perhaps one that could be classified as temporal-lobe-based, serotonin-induced, and almost spiritual. The perception started when I was about three years old, although they may have begun even earlier. Each night as I lay on my back while starting to doze off with my eyes closed, I would sense, and then see, a vast black-silver sheet forming in the periphery of my vision. This sheet would start to fill inward toward the center of my visual field, and then contract to a bright point as it rushed toward me. The point of light would accelerate toward the center of my forehead just above the brow line, and when that point of light energy struck me, it simultaneously felt as if it were of infinite mass and infinitesimal size. That point would hit me with a “ping,” as light as a feather, but containing what seemed to be the entire mass of the universe. The experience was weird and wild and I always thoroughly enjoyed the near-mystical sensation it imparted.

Once in the late 1960s, while driving back to college in the middle of the night with a friend of mine, I saw some strange silver-green light pulses reflecting off the windshield molding of my VW bug. It was so strange that I pulled over to the edge of a cow pasture and got out of the car, strolling into the black winter night. My friend and I looked up and witnessed the most intense display of the aurora borealis, or northern lights, seen in that area in decades. I felt like an ant standing on the stage of a vast theater,
looking up at a stage curtain that would shimmer intensely, then shoot and disappear into a single point, seemingly to the deepest reaches of the universe. This was much like the nightly childhood experience.

Later that year in my college physics class, I first learned of John Wheeler's description of a black hole, and I realized that what I was sensing as a toddler was like falling into a black hole. That was a satisfying and tangible explanation for that wonderful feeling created by the chemicals in my head.

T
he experience in Oslo motivated me to try to put this whole psychopath business to bed once and for all. The Oslo psychiatrists and geneticists had convinced me that I had a type of bipolar disorder characterized primarily by hypomania rather than depression, and the full genetic workup I'd had done before the meeting provided overwhelming evidence that something was wrong with my empathy hormones and monoamine systems. It was time to take a closer look at my personality.

Personality and character are different. We all have a common sense of both, with “personality” being the repertoire of traits such as emotionality (e.g., neuroticism, anxiety, avoidance), extraversion, agreeableness, openness to new ideas and experiences, and conscientiousness (carefulness, diligence, self-discipline, and a drive for achievement). “Character,” on the other hand, is less obvious than personality. A person's true character can only be determined when he is placed in a quandary, a stressful situation that forces him to make a hard decision.

Scientists tend to think of personality as more genetically driven and immutable, with the character more malleable to
stressors, experience, choice, and belief. The character arc of heroes in novels and film is one such example of deep character change for the better. Our beliefs in religion, government, family, and civilization are, in part, based on this hope that an errant person's character can be saved from the “dark forces of evil.”

Humans are inherently interested in figuring out who they are. Just look at the size of the self-help section of your local bookstore. In trying, as individuals, to come to grips with our own personality and character, we might try to assess our own emotions, actions, and desires through introspection. Though, since we are biased—in some cases favorably, in others less so (as the saying goes, we are our own worst critics)—we might not get such a reliable picture, and suddenly we're off trying to become president when, in reality, we have terrible judgment and no sense for diplomacy. Consider one study of the million students who took the SAT in 1976: 60 percent said they were a better-than-average athlete (a statistical impossibility), 70 percent said their leadership abilities were above average, and 85 percent said they were better than most of their peers at getting along with others. A quarter of them thought they were in the top 1 percent of getting-along ability. So it would be no surprise if I saw myself as more likable than I really was.

When I returned to Irvine, I started to ask everyone I knew—friends, family, colleagues—exactly what they thought of me and of how I treat people. I told them to hold nothing back, to tell me the truth, and to pull no punches. About half of the people responded. The others chose to say nothing or just laughed.

In the opinion of my friends, was my behavior really all that bad? Two of my closest friends are Susannah, my first postdoc research partner at UC Irvine, and Mark, her husband. They've known me intimately since 1977, and Diane and I still have dinner at their house. Mark told me, “Jim, I love you, I really do, and I have a great time with you, but I can't trust you. I know I could never count on you if things get really bad.” I asked him if he could be specific. As was the case for most of the other fifteen friends who gave me answers, he was disappointingly vague. He said that if given a choice between staying with him in a tight situation and having a good time doing something else, I'd go for the good time. He knew this because he had seen me do it over the years. He would invite me to a party at his house and I would always give him the runaround, refusing to commit to his party until the afternoon of the event to see if another, more exciting opportunity would crop up.

I approached a number of psychiatrists, psychologists, and neurologists who have known me well for years, some going back several decades, and posited the same queries. As I mentioned earlier, several of my colleagues had questioned my behavior on various occasions, sometimes calling me a psychopath. But I'd brushed them off, preferring to attribute their comments to jealousy or anger rather than consider that these behavioral specialists may have a point. I had worked closely with these people, broken bread with them, traveled with them, and I felt I was close with all of them. Every one of them told me the same thing. They said they had been telling me for years what they thought of me: that
I was a nice and interesting fellow and great fun to work with, but that I was a “sociopath.” I told them I was sure they'd been kidding. They said they had been dead serious with me all along.

What everyone seemed to be telling me was that I was Psychopath Lite, or a prosocial psychopath, someone who has many of the traits of psychopathy other than the violent criminality, a type of psychopathy in which one finds socially acceptable outlets for one's aggression and which is manifested in a cold, narcissistic manipulation of people. On the Hare Checklist, I have three of the four factors—the superficiality, the coldness, and the unreliability—but not the antisocial tendencies.

I continued to ask my close friends what they thought of me. The bottom line was that I seem to be a nice guy, usually, but that I occasionally do things to suggest I don't really care about other people. Consider the words and phrases they used to describe me: “manipulative,” “charming but devious,” “an intellectual bully,” “untrustworthy when it comes down to you or me,” “narcissistic,” “superficial,” “unreliable when you're needed,” “egocentric,” “unable to love deeply,” “shameless,” “completely lacking scruples,” “cunning liar,” “no respect for laws or authority or rules of society,” “live by a selective moral code,” “irresponsible,” “completely unfeeling,” “cold,” “unempathetic,” “emotionally shallow,” “The Great I Am,” “pathological liar,” “blame others,” “completely overblown sense of self-importance,” “constantly bored,” “looking for a buzz,” “a need for constant stimulation,” “fearless,” “irresponsibly puts others at great risk with yourself,” “very popular but with many shallow relationships,”
“no sense of guilt whatsoever.” Good grief, Mrs. O'Leary, other than that, how's your cow?

In hindsight, I shouldn't have been surprised. Throughout my career I have often been asked to participate in psychological tests, generally to help colleagues gather research for their own studies. Between my twenties and forties, I took three formal psychological tests, the results of which align with one another. The most comprehensive one was conducted in 1994 by my colleague Stanley, a professor finishing his second doctoral degree in clinical psychology. The test report is nearly fifty pages in length and is actually made up of a number of different tests that examined my intelligence, personality, and mental health. I took them over a three-day period at my home, through interviews, paper forms, and various tasks measuring reaction time and short-term memory.

Much of the report is in psychometric jargon, but some of the summaries give a pretty clear picture of what I look like from a professional angle:

James F. is a fun loving person with a very active social life and numerous close friends. He often organizes trips, dinners, and parties that include his friends and relatives. He enjoys dining well, is a wine connoisseur and an excellent cook. He is well liked by his students and highly regarded by his peers. He is an avid world traveler and readily adapts to new situations. James F. claims he has never been deeply depressed and hates to go to sleep because he is
“afraid he is going to miss something.” As a result he sleeps only 4–5 hours per night, often partying and drinking until 1 or 2 in the morning and rising at 6AM. He states that his childhood asthma problem gave him a sense of his own mortality and, at a young age, he decided to live life to the fullest. This was enhanced by decades of over 700 panic attacks that started when he was 18 years old. I should point out that he has run one of the largest amateur NFL football betting pools in the nation, something he does for pleasure rather than money. Although he has been going to the racetrack since he was three years old and to Las Vegas to gamble and party for decades, he bets only small sums of money, is not a compulsive gambler. He writes screenplays for fun, and all in all, he and his family live a comfortable life style . . .

James F.'s IQ scores are in the very superior range, similar to his scores in different tests in the past (IQ scores in the 150s). He showed very balanced verbal and performance cerebral functioning. (Notes—L and K [lie scale and defensiveness scale] values suggest he wants to present himself in an idealized manner, shows good ego strength, emotional defensiveness, good contact with reality, a perfectionist, excellent coping skills, but potentially poor introspection.) His clinical scores suggest a pattern of 1) adaptability, 2) decisiveness, 3) a secure self image, 4) a good natured optimistic disposition with low psychological stress, 5) independence, 6) assertiveness, 7) robust energy
levels, 8) alertness, 9) an outgoing personality, 10) a high degree of self confidence, 11) sociability, and 12) spontaneity. The scores also indicate that he approaches the world in a balanced, if somewhat “Marlboro Man” type manner. His scores also intimate verbal fluency, a high level of gregariousness with a degree of hyperactivity. This may also reflect a concern for power, recognition, and status. All of these putative personal qualities have been corroborated by a decade of close personal observation of the subject by one of the interviewers as well as by the results of the other tests . . . He is a very ambitious hard working academician who has had a fulfilling, successful career while enjoying a hedonistic life style. Thus, in spite of a hypothetical lack of true insight, he has developed a high degree of coping skills necessary to achieve his career goals, although his scores hint at self-centeredness and possible difficulty in getting close to others.

Possible impulsivity, self-reliance, women not always shown in a sympathetic light, MMPI [Minnesota Multiphasic Personality Inventory] indicates James F. reveals little of his inner self, TAT [Thematic Apperception Test] scores suggest strong father figure but lack of mother image in stories, no response to homosexuality, sexually normal definitely not a prude. HTP [House-Tree-Person test] drawings suggest infantile egocentrism and body narcissism. Easily adapts, is an extratensive social butterfly, interacts well in other cultures, extensive social and professional network.
Suggests narcissistic tendencies of grandiosity and self-preoccupation, human responses pure to others perhaps at a superficial level, highly positive estimate of self worth, could strive beyond his capabilities. Some tests show superficial relationships to others, and manipulative, but not in a destructive way. He lives a very high stress life style but appears to have sufficient psychological resources to deal with it. He did exhibit some grandiosity and narcissism as well as some unmet dependency needs but these may not be significant.

I didn't disagree with the findings but laughed off the negative aspects, as I do with everything.

None of the psychological tests I took prior to 2006 addressed the issue of psychopathy directly. And since there is no formal definition of a psychopath, no formal test was going to be able to determine whether I was one. In retrospect, however, the assessments did point out several traits that are common in psychopaths—grandiosity, narcissism, egocentricity, thrill-seeking, dependency, a potential for poor self-assessment, and superficiality in relationships—a point I had never considered in the context of psychopathy. These somewhat egotistical, “blowhard,” devil-may-care traits were of no real matter to me, because I wasn't antisocial.

Soon after Oslo I also remembered two long and emotionally charged letters that I had received within the same year, 2000, from people very near and dear to me. The letters were from two
of the most important women in my life—my sister, Carol, and my daughter Shannon. They had not talked to each other about these letters before sending them and only found out about the other's in late 2012, after I told them. Both letters expressed extreme disappointment in the way I treated them over the years. Both intimated that I was shallow and, too often, untrustworthy. At the heart of these letters was their feeling that they had given me all their trust, emotion, support, and love over our lifetimes, but that I gave almost nothing back. I returned nothing to them in terms of deep connection or real, interpersonal, emotional empathy, the kind of empathy people cherish and need most.

My sister and I had been close growing up, and I protected her, but I'd been drifting off over the years without realizing it. Carol didn't mention any specific episode but said she always has to ask for affection. Imagine being a friend with someone for thirty years and realizing you always initiate contact, asking, “How are you? Is everything all right?” without the favor being returned. My sister always initiated the contact and caring, and the sum total finally got to her.

Unlike my sister's, I think my daughter's letter was triggered by one incident, although it was backed by years of pain. The whole family was planning to go out to a holiday dinner. I had been up partying the night before, so when they were leaving the house, I told them I'd meet them at the restaurant a little later. Shannon opted to leave her youngest son at home with me, and I said I'd bring him with me when I came. But I forgot my grandson was there in bed and showed up at the restaurant without him. My
daughter felt like I didn't care enough to worry about him or remember him—my own grandson.

When I received the letters, I thought, “What did I do to deserve this?” I didn't get it. With my sister I thought, “What am I supposed to do? I'm busy. I've got a family. If I can't give you enough, that's just too bad. I'll be supportive, but I'm not going to be someone who gives you that call.” I figured it's unfortunate if I can't give people enough of what they want, but that's just who I am. In the end I just concluded that my sister and daughter must be unhappy about something else in their lives, and that they were taking out that unhappiness on me.