Psychopathy

[Lord J]

So I recently finished reading Jon Ronson's "The Psychopath Test", which is about the history of modern psychiatry in general, but focuses very closely on Robert Hare's psychopathy inventory. I had read "The Men Who Stare at Goats" (and I kinda want to reread it now), and picked this up mostly because of the author's name. Anyway, long story short, loved it, am a little worried that i've started grading everyone I meet (including myself) on the psychopath index, and interested in what you guys have to say on the topic (not to call anyone out, but) particularly you, Flibble. Can psychopathy be treated? Are they really different from us? Does psychopathy serve evolutionary/social purposes? How useful is the Hare inventory?

[Anathema]

Never heard about those authors, or the psychopathy index. I did follow a couple of psychiatry-related courses during college, though. Anti-social personality disorder (which is more or less the same) is considered uncurable and untreatable, as much stems from a complete lack of empathy, wich is not something that can be corrected through medicine or therapy.

[MrFlibble]

I must also say that I'm not familiar with psychiatric theories, but it seems to me that one should be very careful when defining the norm and the deviations from it when dealing with mental health issues.

Speaking of empathy, I remember reading somewhere that it was observed in both human societies and those of primates and other social animals that members can be roughly divided into three more or less equal groups according to their place on the empathy scale: those who show moderate empathy, those who have excessive empathy towards others, and those who have little or no empathy at all. Not sure though if this is backed up by some very serious research, or is just a simplified account of the real state of affairs, or just a scientific myth. But there should probably be no doubt that empathy is a valuable adaptive trait from the evolutionary standpoint.

[TMA_1]

functioning sociopaths I believe can become very successful, though generally close interpersonal relationships tend to suffer because of the specific behavior that is noted in sociopaths/psychopaths. I believe that there is a spectrum of those who are born sociopaths. It can range from cold blooded killers, to serial liars.

Ever read any Oliver Sacks? If you are interested in the neurological aspects of human behavior, you should check him out.

[Wolf]

I thought "The Men Who Stare at Goats" was incredible. J: have you researched how much of the book/film is true? The movie-version is right, it really is more than you would believe.

In that vein, I have no doubt that psychopathy can be treated, either medically or therapeutically. But, out of curiosity, what did you mean by "grading?" In what sense? How so? If you wouldn't mind, would you care to provide some examples of how/why you handed out certain grades?

[Mihail]

Lord J, I vaguely remember that article. It was disconcerting and, for lack of a better word, spooky. The story of the patient who claimed he faked craziness to avoid going to jail, but was then put in a psychiatric hospital for 12 years really had me torn. Who was telling the truth? Of course, if there was a "truth" at all, which I'm not inclined to believe. In the comments of that article, somebody mentioned a frankly scary study where sane people faked symptoms to get into a psychiatric hospital. All of them were diagnosed with one disorder or another, and some were confined for several months. Another aspect of the study was to ask staff in psychiatric hospitals to detect patients who were supposedly "fake", sane people who had been planted into the institution. The catch was that there weren't any such patients. Nevertheless, the staff did pick several patients who they thought were "fakes".

Ah, found it now. The Rosenhan Study. http://en.wikipedia.org/wiki/Rosenhan_experiment

Things like this bother me, if only for the sole reason that I don't like the idea of a person either being mentally ill or normal. I'm not convinced that we can just divide it up like that. Of course, if it looks at issues that take place at a genetic level, then a diagnosis like that holds more weight. But scientists still don't know much more than they know about the human brain, emotions, etc. Maybe I'm being overly optimistic, in the case of psychopathy at least. But in regards to the wider issue of mental problems in general, I'm very wary of those who attempt to arbitrarily impose a certain "answer".

As a disclaimer, maybe I should add that there is certainly a personal investment in this issue. My ex-girlfriend wants to be a psychiatrist. In school, she excels - top marks for most subjects. But there is something definitely... off with her. I wouldn't call her crazy, since that implies a mania of sorts. 'Messed up' sounds milder to me, so I'll go with that. She is certainly a bit messed up, and it's not only me(as I might) that sees that in her. I wouldn't want her treating me, being my psychiatrist. It's a very queer world, that. Was it in the same article that it's mentioned that psychiatrists have the highest suicide rate of any profession?

My two cents.

EDIT: Sorry, I should mention that I didn't read the book but the article by Jon Ronson on the Guardian website. Less exhaustive perhaps, but I'm pretty sure the idea is the same.

[Lord J]

Quickly, since my iPod is rapidly losing battery power:

Flibble: I should chech that out. I wonder how closely empathy is related to spontaneous emulation of behavior.

TMA: No, I have not read any Sacks. I'll be sure to add that to my list :)

Wolf: I was a long time listener to Art Bell on Coast to Coast AM until college (I stopped having time, and I don't like Noory's voice as much. As an adult I find most of the topics on CtoC uninteresting; I've learned the importance of empirical evidence) so I'm familiar with some of the ideas, but I haven't looked much farther. I think I did know about MKULTRA before.

As for the "grading" I meant more, "assessing". I have friends/relatives that are charismatic, impulsive, etc. and I've just considered the possibility of which of those criteria they fit. I mean, throughout my life, I'm pretty sure I've met a psychopath or two, but I only think I know one, offhand, and part of me feels like I'm giving him too much credit (he's not very bright, just manipulative, charismatic, impulsive, and lacking realistic long term goals).

Mihail: excellent points. He actually addressed those studies in the book. I think it's a real problem with (especially older, psychoanalytic) psychiatry, is that there is little formal diagnosis and treatment planning. Psychoanalysis has a lot of surface validity, it makes the analyst feel good, and it fits the theory, but there's nothing systematic.

I feel like certain types of people (myself included) tend to be attracted to psychology, and I feel like it takes a very "special" type of person to complete an advanced degree in psychology. Obviously, the exceptions may just be more visible than the rule. Anyway, I agree that people are very quick to latch onto "mental illness" as a brand for behavior that may be adaptive in certain situations. Are temper tantrums really problem behavior if they remove a child from an unwanted situation?

[Anathema]

Speaking of Sacks:

http://en.wikipedia.org/wiki/Awakenings

Amazing film. True story, even.

How "popular" is psychoanalysis in the USA? In most European countries it's not generally seen as a valid form of psychiatry anymore.

[Lord J]

Anathema: I don't think psychoanalysis is very popular in the US anymore, though you have Melfi on The Sopranos who, from what I've seen, was a traditional Freudian in every way. It's actually quite funny to me that she was in the process of referring Tony to a "behaviorist" at some point, because clearly she was good at helping Tony "open up" and "make breakthroughs" but actually changing the behavior that he was paying her for... well....

I believe that Carl Rogers' approach, and various offshoots, is probably the most popular among modern therapists, though an alternative seems to be gaining acceptance within the field.

It would be interesting to me to see whether psychopaths could be treated by some form of neurological surgery. On the other hand, the application of behavior modification could be interesting. It would be like the approach for children with Autism, but it would have to be constructed in a way that generalizes over the rest of the client's life. It reminds me of Spike on Buffy the Vampire Slayer, actually. If we could implant a chip that detects intention (?) to engage in socially maladaptive behavior, and produces pain, it could be a long term fix. Of course, as far as I know, there's no systematic research showing that "intention" exists, so that's a minor hurtle ;)

EDIT: Added a few qualifiers.