You’re basically correct. The best lay analogy I can think of is that psychopathy can be described as “Antisocial Personality Disorder on steroids.”
The current DSM model of Antisocial Personality Disorder decribes basically criminal behaviors, such that 80% of the prison population will meet the criteria just by committing crimes. A garden variety career criminal can meet the criteria for Antisocial Personality Disorder and still have some degree of remorse and empathy for other human beings - perhaps less empathy than the average noncriminal would express, but otherwise normal human thought processes. The current forensic model of psychopathy describes not just criminal behavior, but a mind very different from normal human thought processes. A psychopath has something like a completely alien reaction to empathy and remorse, not just a diminished capacity for empathy and remorse but more of a a complete lack of understanding of the concepts. “Sociopathy” is kind of a problematic term because it has been used to describe both Antisocial Personality Disorder and psychopathy. When Dr. Martha Stout uses the term “sociopathy” in her book The Sociopath Next Door, she’s very clearly referring to the current forensic Hare/Cleckly model of psychopathy.
If they are truly nuts and treatment doesn’t work then getting them committed before they’re 18 is the goal. After that, it takes an act of violence to force them.
I don’t see an easy solution to getting crazy adults off the streets. I would support a move to make people dependent on medication wards of the state so that medication schedules are maintained. What a can of worms that would be.
I can’t remember where I read it, but this might jar someone’s memory, but they’re supposedly not. Sociopaths are created in response to their environment whereas psychopaths are born that way. Someone correct me if I’m wrong.
Not exactly. Psychopathy appears to be more related to brain structure, while Antisocial Personality Disorder without psychopathy may be more related to environment and upbringing. “Sociopathy” is currently used interchangably with both psychopathy and Antisocial Personality Disorder, and may refer to either depending on how the speaker is using the term. Dr. Stout’s book talks about “sociopathy” but she explicitly states that when she uses that term she means the Hare/Cleckley model of psychopathy.
If the kid’s genuinely starving of thirst, and the parents deny his needs and call 5150 instead, then the parents are fully liable for any fallout (heh) that may occur.
If the kid’s just being a brat, a mere time out should suffice. Again, no 5150 necessary.
If the kid’s already had 10 Pepsi’s and screams for another, while smearing feces on the walls and threatening suicide and wearing a black trenchcoat, well – by then, it doesn’t matter who or what’s at fault, it’s far more important to contain the mess until it can all get sorted out. And that’s when you bring the psychiatrist on board – as long as you don’t get a really bad apple {…} you and the kid will hopefully work out a new, workable Pepsi Schedule.
Since it does not appear that there is an excess of zeal or anger liable to be resurrected, I am leaving the thread open.
I am not sure whether momto7 simply wished to continue an old discussion, vent, or seek help. As long as the thread does not jump the tracks, it is welcome to stay in Great Debates. If it turns into a rant or a plea, it will be closed with a suggestion that a new thread be opened in The BBQ Pit (rant) or MPSIMS (plea for suggestions).
As a person who works in the mental health field, and specifically in an locked inpatient setting for children, all I can say is “Good luck with that.” Getting children committed to long term, inpatient treatment is incredibly difficult, if not, in some jurisdictions, almost impossible (the average length of an inpatient stay on my unit is two weeks).
That is true. Long term commitment may be hard, getting the records out there to the relevent enforcement agencies (such as to enforce gun laws) shouldn’t be.
Well, they are supposed to be the same, clinically. Antisocial Personality Disorder is the newer name (with some modified diagnosis criteria) for what used to be called sociopathy and what used to be called psychopathy before that. All three derive from the same original root diagnosis. All the DSM did was try to make the diagnosis more scientific by adding things that were more directly measurable – acts of violence, problems with the law, etc.
This didn’t go over well with some people. Requiring that things be directly measurable and objectively quantifiable is something that people who believe in multiple personalities and other similar concepts have a real problem with. Also, focusing largely on problems with violence and breaking the law means looking at a lot of people in a society that has a significant percentage of incarcerated citizens and, let’s face it, missed the people with no conscience who are better able to follow the law or even use it to their own twisted ends.
This is the problem right here. Dr. Robert Hare, who is considered by himself and many others to be the leading expert on psychopathy from following Cleckley’s work, did not agree with the change of the name and diagnostic criteria that the APA made. The terms had already been confused in many people’s minds from the earlier name change, and the newest change provided him an opportunity to do a runaround on the DSM and the APA who created it. So he told people, especially police and prison officials, that the Antisocial Personality Disorder was mostly people who were just common criminals and that we need to single out actual psychopaths. He created his own checklist for determining what a psychopath was and then sold it to people and institutions. The DSM is the standard way to diagnose mental illness, but Hare was selling his very own product. The more people he could convince that these were different things, the more money he made and the more fame he received as being this expert on something that most people said did not even exist under that name any more.
So, basically, people used to be confused about this diagnosis either from not knowing much about psychology or from not realizing the name changed, but now they are confused because someone in the field created a competing product for sale and appropriated the name. This would be similar to someone who wanted to sell trips to Constantinople but not agreeing with what other tour groups marketed as the important sites to see so started marketing trips to Istanbul instead with different sites of interest so his customers would not have preconceived ideas about what to see there, and, indeed, not even cluing anyone in to the fact that they are the same place.
Now, if that were not confusing enough, the APA is releasing yet another version of the DSM soon (it will be version V), and they are changing things again!
And, to get back to the OP, the idea that psychopaths are completely without all emotion and conscience is just wrong. There are plenty of famous killers diagnosed as classic psychopaths who do express emotions, just not to the same extent or in the same way. And it’s really along a scale: some are worse than others. When we look at what psychopathic serial killers have done, some of the most notorious and awful cases were by people who did express emotion, just not at the times when it most mattered to the rest of society. I think the idea that psychopaths are completely broken and unreachable is just a way to try to put up an artificial barrier. That artificial barrier also trends to lead to what I consider to be hasty conclusions.
So, based upon the bizarre history of the diagnosis and confusion among laypersons and professionals alike, if a mental health professional were to diagnose a child of mine as a psychopath, I’d ignore it and focus on behaviors and behaviors alone. And I’d work on those behaviors, if there were any that needed fixing.
No, I think you misremembered that. Some psychotics do not know the difference between right and wrong. Psychotic and psychopathic are very different things.
People who are legally insane do not know right from wrong (or do but cannot prevent their actions), which can be a result of someone suffering a psychosis.
And, as covered before, psychopathy, sociopathy and Antisocial Personality Disorder were intended to be the same thing by the APA.
Your analysis of the history is dead on, but I think you’re being grossly unfair to Dr. Hare. His disagreement with the current DSM criteria is an honest one based on observation and research, not merely an calculated effort to sell a product. His model of psychopathy and his Psychopathy Checklist have both withstood peer reviewed scrutiny, and the DSM V revision is largely incorporating his work.
As you note, the DSM criteria for Antisocial Personality Disorder that was supposed to replace what was then being called sociopathy and psychopathy, but the consensus decision was made to focus more on behaviors it was thought could be more objectively measured, rather than focusing on the personality characteristic that underlie those behaviors as many working in the field urged, including Dr. Hare. The problem is that those “objectively measured behavior” by and large describe criminal behaviors in general that 80% of the prsion population will meet, and as a result the Antisocial Personality Disorder model has strayed from the original disorder it was intended to describe. It’s not so much a matter selling Istanbul and Constantinople separately, it’s more like clearing up a misconception that Manhattan and New York City refer to the exact same place. Dr. Hare explained it himself in the article Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion.
The DSM (as it states itself) isn’t a cookbook that you mess up by straying from, it’s intended to provide criteria for existing models to get clinicians on the same page when describing the same thing. If the DSM criteria don’t accurately reflect the model they were intended to describe or match up with the current research, that’s the fault of the DSM for not matching the current state of the research, not the research’s fault for not matching the DSM. As you also note, the DSM-V is changing it’s criteria again, and changing largely in favor of matching up more closely with Dr. Hare’s model and research. The proposed replacement for Antisocial Personality Disorder is “Antisocial/Psychopathic Personality Disorder Type.” The proposed criteria now focus more on underlying character traits, and track Dr. Hare’s model almost word for word.
Not as far as I know. The best you can do is crank the external restraints (fear of punishment) up to eleven to compensate for the absence of internal restraints.
As I mentioned on another thread, that’s my reasoning for supporting severe punishment for animal abuse (about the best diagnostic indicator we have for sociopathy and psychopathy).
