Friday, April 20, 2007

What to do with a sociopath?

Tragedies like Virginia Tech invariably bring out ideas for what to do differently. Here is one I got from a reader, with my comments interspersed.

1% of all humans born – no matter where, no matter what race, gender, group, etc. are psychopaths (meaning, at heart, they have no conscience). No technique, not psychotherapy, not medicine, not anything except two things work on them. The two things are: 1) scaring them and 2) avoiding them.


Where do you get the 1% figure? That means in my neighborhood of 40 houses, there are 2 or 3 born psychopaths. I'm not convinced. Also, I'm not convinced that all psychopaths, or sociopaths, which is the more accurate term, are born. I can believe that some are born, but it is possible to turn perfectly normal infants into sociopaths, if you neglect them profoundly enough. I have written about this in my books, especially Love and Economics
Also, there is an important distinction between the child without a conscience, who is the real sociopath, and the kind of delusional mentally ill person we saw at Virginia Tech. You are painting with too broad a brush here.
I see this problem at the root of wars, Virginia tech massacres, Enron, you name it. I advocate we monitor these people from children, and to be honest limit their constitutional rights, for our safety. That is preferable to numerous laws that limit behaviors for everyone (like Sarbanes Oxley for example).

There is something to this. A free society needs to be populated by people who can use their freedom without bothering other people too much. Again, that was the whole point of Love and Economics, whose subtitle is "Why the Laissez-Faire Family Doesn't Work." My libertarian friends never forgave me for that subtitle, I guess.
My solution has problems – such as false diagnosis of psychopaths, misdiagnosis (these people can fool others easily), since psychopaths break laws we have now, they will break these as well. Also, amending the constitution is not something you do in a four paragraph email, and we will have to have a different constitution for psychos, what a discussion that will bring. But we ought to think about some way to monitor them, limit the harm they can do, and protect others from them. We do a lot already – it could be worse, but acknowledging this problem might help us improve.

No kidding, your solution has problems. But, in effect, that is what we are now trying to do with sex offenders: monitor them for life, since we are so pessimistic about ever really changing them. And you are absolutely right that we have to acknowledge that we have a problem. That is where we are falling down on the job with the mentally ill. We keep trying to redefine them as a special case of something else, which they are not. We are treating them as if their civil liberties were more important to them and to us, than their sanity. See Carol Hawkins post below about how her mother, now in her right mind, sincerely wishes someone had honored her sanity more than her "freedom."
The only other advice is to follow the example of Jesus – do not be afraid of the devil (psychopaths)! Know what to look for, Face them, pushback from their nonsense when you see them in real life, and yes we all do see them.

Once again, you are painting with too broad a brush. We are dealing with multiple problems here. We can "push back" as you say, in the case of the person without a conscience, because they are extremely manipulative and go in for the juggular at the first display of weakness. But the families who are writing to me are dealing with something quite different.
There is one teaching of Jesus that we really have to be careful about applying correctly: turn the other cheek. We have no right to turn someone else's cheek: if we have any responsibility for protecting the public, we have no right to ask that someone else turn their cheek. And, in many cases, we aren't doing the person any favor by overlooking their behavior. For the truly mentally ill person, we need to confront their illness on its terms and deal with it. For the person without a conscience, we need to confront their behavior, set extremetly tight limits on it, with no excuses.
And you are right about this: we need to not be afraid.

1 comment:

matthew veal said...

Feom an article by robert hercz (see website hare.org):


Psychopathy research is raising more questions than it can answer, and many of them are leading to moral and ethical quagmires. For example: the PCL-R has turned out to be the best single predictor of recidivism that has ever existed; an offender with a high PCL-R score is three or four times more likely to reoffend than someone with a low score. Should a high PCL-R score, then, be sufficient grounds for denying parole? Or perhaps a psychopathy test could be used to prevent crime by screening individuals or groups at high risk -- for example, when police get a frantic "My boyfriend says he'll kill me" call, or when a teacher reports a student threatening to commit violence. Should society institutionalize psychopaths, even if they haven't broken the law?

The United Kingdom, partly in response to the 1993 abduction and murder of two-year-old James Bulger by two ten-year-olds, and partly in response to PCL-R data, is in the process of creating a new legal classification called Dangerous and Severe Personality Disorder (DSPD). As it stands, the government proposes to allow authorities to detain people declared DSPD, even if they have not committed a crime. (Sample text from one of the Web sites that have sprung up in response: "I was diagnosed with an untreatable personality disorder by a doctor who saw me for ten minutes, he later claimed I was a psychopath. . . . Please don't let them do this to me; don't let them do it to anybody. I'm not a danger to the public, nor are most mentally ill people.")

Hare is a consultant on the DSPD project, and finds the potential for abuse of power horrifying. So do scientists such as Dr. Richard Tees, head of psychology at UBC, a colleague of Hare's since 1965. "I am concerned about our political masters deciding that the PCL-R is the silver bullet that's going to fix everything," he says. "We'll let people out [of prison] on the basis of scores on this, and we'll put them in. And we'll take children who do badly on some version of this and segregate them or something. It wasn't designed to do any of these things. The problems that politicians are trying to solve are fundamentally more complicated than the one that Bob has solved."

So many of these awkward questions would vanish if only there were a functioning treatment program for psychopathy. But there isn't. In fact, several studies have shown that existing treatment makes criminal psychopaths worse. In one, psychopaths who underwent social-skills and anger-management training before release had an 82 percent reconviction rate. Psychopaths who didn't take the program had a 59 percent reconviction rate. Conventional psychotherapy starts with the assumption that a patient wants to change, but psychopaths are usually perfectly happy as they are. They enrol in such programs to improve their chances of parole. "These guys learn the words but not the music," Hare says. "They can repeat all the psychiatric jargon -- 'I feel remorse,' they talk about the offence cycle -- but these are words, hollow words."

Hare has co-developed a new treatment program specifically for violent psychopaths, using what he knows about the psychopathic personality. The idea is to encourage them to be better by appealing not to their (non-existent) altruism but to their (abundant) self-interest.

"It's not designed to change personality, but to modify behaviour by, among other things, convincing them that there are ways they can get what they want without harming others," Hare explains. The program will try to make them understand that violence is bad, not for society, but for the psychopath himself. (Look where it got you: jail.) A similar program will soon be put in place for psychopathic offenders in the UK.