Foreigner is pretty much spot on TBH and yes and I have a degree and work experience. Although there is some confusion on the personality disorder spectrum which is pretty much part and parcel with the diagnostic category itself. "I hate you, don't leave me", or
Stay Far Away/So Close is the cry of the borderline, if from a woman--which is a very problematic diagnosis as it is almost entirely gendered female (there is a lot of critique of this dx from a feminist perspective--but from a man it is the howl of a domestic abuser. So on from there antisocial personality disorder (the closest actual DSM category to psychopath/sociopath) is similarly gendered but in the other direction, to cover overall unpleasantness, defiance, and criminality. I don't know about that, having spent some of my wayward youth in the illicit drug business and other shadiness I can tell you that there were some legit psychopaths in the field but also some surprisingly well adjusted people. But as for the gender issue, I have seen the occasional male borderline who gets a
pro forma antisocial PD dx because stereotypes and first impressions. On to other issues schizophrenia also has been far more often with Blacks (and recent immigrants) to a degree that is hard to understand: there is probably a genetic/biological component such as elevated testosterone levels in Blacks, but so too certainly cultural alienation plays a role, especially with immigrant populations, but also historically the diagnosis of paranoid schizophrenia has been utilized as a tool of repression against Black activists and communities. One could go on, anorexia is pretty much a upper-middle-class and above White culture-bounded syndrome, etc. There's not a lot of universals. Different people could present different ways in different settings. Psychiatric assessment is not, or should not be, about fitting our patients and their characteristics into neat little diagnostic boxes. That shit is only for insurance companies and lazy doctors.
Now, in pop psychology there is a lot about sociopaths and narcissists going around these days and alot of it is crap and talking about stuff that is rather on the normal spectrum of personalities, i.e. the asshole. A true sociopath is categorically different. Since we were speaking of Steve Jobs, he certainly had the Machiavellian side but apparently from his interpersonal interactions he had the charisma/'glib and superficial charm' as it is stated in the DSM ASPD criteria and from afar, and diagnosis of historical or popular figures is a problematic thing, not to mention that sociopathy is not even a diagnosis, but yeah, I'd rate him one, probably. A psychopath is a more extreme version typically associated with criminal/forensic populations, there are rating scales for this, etc. and they involve some really troubling things like torturing animals as a little kid. Keep in mind that neither sociopath nor psychopath is a valid condition under the DSM, we have "antisocial PD," which is not really the same thing. But psychiatry does have rating scales and assessments for psychopathy which will play a role in the outcomes of psychiatrically incarcerated persons in a forensic context committed for "ongoing treatment" after prison. But the truth is that yes, this is taking clinical work into a somewhat more subjective area of morality. This is for all the Szaszian reasons troubling but as far as my own experience working with this population rather intimately, a necessity given that we don't really have anything better to do with this population.
Foreigner said:
I'd be interested to find out how traditional societies dealt with what we would call psychos. If I was in a society that was at war with another society, I might want a psycho on my side. I guess what I'm getting at is, in nature, such people would probably be strong survivors, otherwise these traits would not have survived evolution. To be unemotional, unempathizing, and ruthless even to the point of taking pleasure in it... that's pretty hardcore
Definitely. Violent men are and have been integral to the making of history and many of our great military, political, and even religious leaders especially in ages past might be considered sociopathic to a degree, or rather, had priorities at their level that are not the same as our ordinary interpersonal values. This is more Machiavellian than sociopathic, i.e. Machiavelli's distinciton between private morality and the obligations of the prince to protect his state, even by doing objectively evil acts. The same might be said for CEOs, etc. The sociopathy may not manifest itself in the person's ordinary interpersonal life but in the professional life. These are definitely the people who I would want to be with in a foxhole, to advise a political campaign, to plan an invasion, to traffic drugs, or whatever.
That's why the utility of clinical labels on stuff like this is limited. I'm of the opinion that labels are of at best secondary use in psychiatry anyway, psychopathology always exists on a continuum, and the psychiatric/biomedical/biopsychosocial model often winds up being about doing what works empirically. When faced with psychopathic, pedophilic, or dangerous forensic individuals, then our task is a little bit different (see: the lack of confidentiality in an NGRI assessment), more carceral (not just brief psychiatric holds on physician assessment but holds for many years until non-dangerousness can be proved which can come uncomfortably close to inverting 'innocent until proven guilty'), it is about
containment and yes, this is a blurry line to the clinician and the Hippocratic
primum ... all of these are difficult questions. But the reason we have the system that we do is that nobody comes up with better answers. Prison of course is the first answer, but what to do with them afterwards? Is there a hope in rehabilitation? Is it psychiatric, psychotherapeutic, spiritual? All of the above are important. But as a society we have to figure out how we can try to rehabilitate the most people, some of whom don't want to be rehabilitated or don't see anything wrong with themselves, these are often the real sociopaths, who can play the system very well and affect the appearance of rehabilitation only to get out and start offending again.
