Science Break: Sociopathy

If life was a sport, sociopaths / psychopaths would be the players repeatedly cheating. In real life they flagrantly flout fundamental human social rules, such as ‘Do unto others as you would do unto yourself,’ and ‘Scratch my back and I’ll scratch yours.’ If a sociopath had written these rules they would be, ‘Do unto others,’ and ‘Scratch my back.’ The classic hallmarks of sociopaths include a lack of empathy and remorse, and a tendency to manipulate others. Many difficult people we encounter in life are in fact sociopaths, and I believe once one learns what the telltale signs are, it becomes possible to identify them and hopefully understand their condition and avoid being overly impacted by them.

It is estimated that about 1% of the population are sociopaths (depending on how you define sociopath – more on that later). Presumably the condition has been around since time immemorial, and as anyone who has ever been manipulated by one knows, it’s not hard to identify a sociopath as being flawed, the difficulty lies in determining just exactly what is wrong with them and how to deal with them. The way sociopaths have been viewed and treated over the centuries has changed considerably, and obviously varies greatly between cultures. During more superstitious times sociopaths were seen as evil and affected by the devil, witchcraft or whatever the current agent of evil was. I’ve always been struck by the historical use of the term “remittance man” and believe that in many cases it referred to sociopaths whose families could afford to pay the family “black sheep” (another term probably applied to sociopaths) to stay far away in the colonies.

The current perspective on sociopathy has been largely shaped by the forces of rationalism, which I suppose started to come into vogue during the age of enlightenment in the 1600’s and which have really pervaded every aspect of life in the last 150 years or so. The term psychopath was coined by early German psychologists in the mid to late 1800’s, but it was a very general term applied to anyone who violated legal and/or social “laws” due to some underlying psychological flaw, whether understood or not. In the early 1900’s the term sociopathy was created to describe people who violated societal rules in a way that could harm others. Since then there has been an ongoing effort to better define sociopathy and its many expressions.

A landmark work in the field was Hervey M. Cleckley’s “Mask of Sanity” (Cleckley, 1988) which first came out in 1941. Cleckley conducted interviews with psychopaths and documented them in a unique style that is highly descriptive, accurate, and yet readable at the same time. His extensive clinical experience informed his theories on psychopathy that are still well respected today, and this book was and continues to be extremely influential, partly because of its down to earth accessibility. I highly recommend it. Mask of Sanity has been put in the public domain by Cleckley’s second wife Emily for educational purposes, and pdfs are easy to find on the Internet.

Retired UBC professor Robert D. Hare has played an important role in the definition, understanding, and diagnosis of psychopathy. His 20-point checklist, the Hare Psychopathy Checklist (PCL) or Psychopathy Checklist-Revised (PCL-R) has been become the most commonly used tool for these purposes, although it is certainly not perfect and is subject to several criticisms. Each point is given a score (0 if it does not apply, 1 if it applies somewhat, and 2 if it fits perfectly), and if the score is above a certain threshold (30 in the US, 25 in England) the subject is deemed a psychopath. I’ve scored my deceased younger brother, certainly a sociopath, and come up with 29; interestingly I gave him a 2 in almost all categories, but mostly 1’s and 0’s for Factor 4 facets, so maybe that made him a social sociopath…

Having been forced to learn about sociopathy by my brother’s condition and its effects on our family, I now observe and hear about situations in other families that almost certainly involve sociopaths. At times friends or acquaintances will tell me about their problematic child or sibling, and identifying the common traits of the sociopath, I am struck by how the other family members blame themselves or other external factors, and speak as if the sociopath will grow out of it. You’ll see families treating mature adults as if they are troubled teens on the verge of growing up. Tragically, sociopathy is something that is not treatable in any permanent sense, and people do not grow out of it. We’re so hardwired as socially empathic creatures that we find it almost impossible to believe that the love and support we shower on these sociopaths won’t eventually bring them around and be reciprocated.

Antisocial Personality Disorders (ASPD)

My choice of title for this article is actually a poor one, as it propagates confusion related to terminology. Sociopathy is just one type of personality disorder that falls into the broader category of Antisocial Personality Disorders (ASPD). About 4% of the population has ASPD, and three quarters of these are male. The problem with psychological disorders is that their symptoms tend to be behavioral and fall along a broad spectrum, making it difficult to come up with sharp, clearly understood definitions. Physical conditions are clear, such as diabetes, cancer, heart attack, psoriasis and so on, but mental afflictions are vaguer. For the personality disorders that are the topic of this article, different organizations have come up with lists of standard symptoms, but these are not in complete agreement, and in some cases different meanings are assigned to particular words, such as ‘psychopath’, ‘sociopath’, etc.

The American Psychiatric Association (APA) maintains what is known as its DSM – the Diagnostic and Statistical Manual of Mental Disorders. Each new version of this manual contains new disorders, and updated definitions for older ones. The details it contains pertaining to ASPD have changed considerably over the years, as prevailing wisdom has changed and presumably become better informed. In the current version (DSM-5) ASPD is defined by these following terms:

A) A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three or more of the following:

• failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;
• deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure;
• impulsivity or failure to plan ahead;
• irritability and aggressiveness, as indicated by repeated physical fights or assaults;
• reckless disregard for safety of self or others;
• consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
• lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

B) The individual is at least age 18 years.

C) There is evidence of conduct disorder with onset before age 15 years.

D) The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or a manic episode.

As you can see, in certain respects these terms are rather broad, and one can imagine that if a person displays some of the behaviours within the section A) bullets more than others, perhaps more narrowly defined disorders could be identified. This is indeed what psychologists have done. For example, Theodore Millon has proposed five sub-types (covetous, malevolent, nomadic, reputation-defending, risk-taking). There are numerous disorders that either overlap with ASPD or are contained within ASPD; the Wikipedia entry on ASPD lists ten disorders that coexist with ASPD:

• Anxiety disorders
• Depressive disorder
• Impulse control disorders
• Substance-related disorders
• Somatization disorder
• Attention deficit hyperactivity disorder
• Borderline personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder
• Sadistic personality disorder

Looking at the above list I can roughly divide them up into disorders that just happen to have overlapping symptoms and whose root causes are likely to lie elsewhere from those of ASPD (e.g. depression), those that may actually be symptoms of ASPD (e.g. substance abuse), and those that may be subsets of ASPD (e.g. narcissism). A key observation is that there is a group of disorders whose central feature is a lack of empathy, or at least it’s a major component. Regarding substance abuse – it is commonly found among people with ASPD, and the thinking is that missing the natural endorphin highs most of us get from rewarding relationships with other people, sociopaths fill that void with artificial substances that trigger similar neurochemical rewards.

I think an attempt to distinguish between the terms psychopath and sociopath would be valuable here. I certainly find it frustrating that the terms are used interchangeably by some, and not by others. Scott Bonn (2014) outlines the characteristics that distinguish the two (but note that he also acknowledges the many traits they share):

• Sociopaths can form emotional attachments with other humans, psychopaths generally cannot
• Sociopaths are emotional / irrational / disorganized, crazy, psychopaths are cold / rational crazy (my choice to insert the word “crazy”)
• Sociopaths are often identifiably crazy, while psychopaths are good at hiding it, especially through mimicry
• Sociopaths are often social outcasts, whereas society is generally unaware of the psychopaths within it
• Psychopaths are good at manipulating others, sociopaths not normally
• Psychopathy generally has a genetic origin, sociopathy is usually the result of environmental factors such as childhood abuse or other trauma

Neurobiology of Psychopathy

Given that it is generally believed that psychopathy is caused by genetics, what more can be said about this? In a 2013 study using prison inmates (it is estimated that almost one quarter of prisoners in the USA are affected by ASPD) that involved functional magnetic resonance imaging of brain activity, an interesting observation was made. While the non-psychopaths showed neural activity in the region of the brain known to play a role in feelings of empathy when imagining both themselves or others feeling pain, the psychopaths showed activity only when imagining themselves feeling pain. When imagining others feeling pain the psychopaths exhibited none of the brain activity associated with empathy, and in fact showed some activity associated with pleasure. That in itself is not very surprising as it represents neurological confirmation of observed behaviour. But are there neurological explanations for these differences in brain response, and can these be linked to genetics?

My cursory research has been unable to find any clear neurological fingerprint that defines a psychopath. The closest I’ve found is that abnormalities in certain proteins involved in neurotransmission, the synaptosomal-associated proteins or SNAP, have been implicated in psychopathy. There does seem to be a general consensus that psychopathy is caused by an overlap of environmental and genetic factors. For this knowledge we have that most studied segment of society – identical and fraternal twins separated at birth – to thank. Studies on twins seeking to identify factors leading to psychopathy suggest about a 50% correlation to genetics, leaving the other 50% to be explained by environmental factors. This rate of correlation is consistent with other mental disorders, as discussed in Fire in the Mind (June 2014 RECORDER). So a predisposition to ASPD would be inherited, and then life experiences, especially during formative childhood years, would trigger or not trigger the condition.

Evolutionary Basis for Sociopathy

Any trait that is inherited begs the question whether it serves some advantage and thus has an evolutionary basis, or whether it’s just a random trait. In the case of ASPD there is some evidence that it can provide an advantage in an evolutionary sense, as long as the proportion of carriers in society is small enough. In other words, if there’s just a few of these people floating around, they can catch the general population by surprise with their behaviours, and manipulate us for their own good.

Neuropsychologists employ sophisticated game theory experiments to come up with these kinds of theories. I won’t go into much detail on this, but a simple version of the prisoner’s dilemma applied to ASPD will illustrate the methodology. In this experiment we have two types of people, honest ones and cheats. In social interactions, which are essentially indications of cooperation and then the expected follow through, there are 4 possible scenarios – both people follow through on their promise to cooperate, both cheat and fail to follow through, and finally there are the two ‘one person cheats / one does not’ possibilities. Values are assigned to outcomes, and the assumption is that individuals will adopt behaviours that result in the highest value outcomes for themselves over time. The highest possible payoff for the first round comes with cheating, but of course things get more complicated with successive rounds as players get more wary, having been cheated before. Add to this the sophisticated ways humans intuitively detect whether they can trust someone or not, and the role emotions such as shame, guilt, happiness, gratitude and so on play in the behaviours of normal (i.e. non-psychopathic) people.

Plug all these variables into iterative computer modeling, and scientists can try to simulate whether or not psychopathy will evolve through natural selection. Apparently many of these studies suggest that psychopathy as a heritable trait can provide enough advantages to drive natural selection, as long as the percentage of psychopaths remains at observed levels (~1% of population psychopaths, ~4% ASPD). This is remarkable or not, depending how you look at it – skeptics would attribute this correlation to experimental bias. After all, when scientists know what the answer is supposed to be and have enough knobs to twiddle, it’s just a matter of time before they get the “right answer”. (Did someone say PSDM with anisotropy?) But I’m not a skeptic on this one, and can see that as long as there aren’t too many psychopaths / sociopaths around, they can carry on their guiltless, manipulative ways with relative impunity, especially in today’s relatively anonymous urban societies, and in many cases reproduce in abundant numbers given that the majority are males and they have a tendency towards promiscuity.

ASPD and Business Leaders

I recently finished Walter Isaacson’s biography of Steven Jobs. Part way through I started wondering whether Jobs suffered from narcissistic personality disorder (NPD), and it turns out many psychologists feel that he did, especially after reading the same book. For example, Gregg Henriques, a Professor of Psychology at James Madison University says on his blog, “[T]here is no doubt in my professional judgment that Jobs met criteria for a Narcissistic Personality Disorder (NPD). He was preoccupied with his sense of importance and his brilliance, he consistently damaged others by exploiting and bullying them and could be completely unempathetic to their feelings, he was envious of other’s attention, he was arrogant and haughty, and he was controlling and manipulative. (Henriques, 2012)”

It seems to be a commonly held opinion that many business leaders have ASPD, especially CEO’s. Is this a fair belief or not? Well, unfortunately yes – it is estimated that about 4% of CEO’s are psychopaths, four times the normal rate (Ronson, 2011). Many traits that are held up as executive level management virtues come directly from Hare’s PCL-R checklist. I can see that being without remorse might make decision making in certain situations more straightforward, but I personally don’t ascribe to the thinking that psychopaths make better CEO’s. Ultimately a business operates best when employees are at their most productive and creative, and that tends to happen when they feel safe (along with other conditions such as being challenged, motivated, etc.) But getting back to arguments for an evolutionary basis for psychopathy, perhaps humanity as a whole benefits when we have a small number of psychopaths around who can act as short term leaders when ruthless decisions are needed. For more on this topic, check out the book Snakes in Suits (Babiak & Hare, 2006).

Follow-Up on ‘Prions’ Article

In response to the article on prion disease (January 2015 RECORDER), Andrew Boland emailed me with a sad story. His friend since childhood, Shane O’Neill, passed away in 2012 at the age of 50, cutting short a happy family life and successful career as a business leader in the European telecom sector. He died from variant Creutzfeldt-Jakob disease (vCJD). As a young child Shane was administered growth hormones because he wasn’t physically developing at a normal rate. Tragically, the growth hormones were derived from cows, and these hormones were unknowingly contaminated with Bovine Spongiform Encephalitis (BSE) prions, which morphed into vCJD and killed him after an almost 50-year incubation period.