It turns out that Sandy Brown, M.A. is quite correct in stating that any talk of treatment of sociopathy makes people (particularly women) reluctant to give up on a dangerous relationship. We received a note this week from a woman asking for more info about treatment and wanting to know if there was any hope for her man. He was the only man she had ever loved and she was actually still grappling with the meaning of his diagnosis.
This week, I will discuss medications that can be used to treat sociopathy. But before I do I want to make it clear that I encourage people to break away from sociopaths. Remember that the sociopath’s doctor and therapist will want you to stay with the sociopath to assist in the treatment. Sociopaths “do better” with treatment and when they stay married. So let me explain what “do better” means. Also this discussion will help you if you are still grappling with the meaning of your sociopath’s diagnosis.
One of the ways to assess sociopathy is with the Psychopathy Check List-Revised, developed by Dr. Robert Hare (PCL-R). The PCL-R is a 20 item psychological evaluation that professionals with training complete on a person using an interview and a review of criminal/ psychiatric records. When someone scores above 30 on the PCL-R that person is “a psychopath.” Most people who psychiatrists would consider “sociopaths” score above 20 on the PCL-R.
Researchers have used the PCL-R to evaluate large numbers of people. They have found that some items of the 20 item test are correlated with each other. That means that say a person who scores high on item 1 is also likely to score high on items 2, 4, 5, but not necessarily item 20. On the basis of these item correlations, researchers have grouped the items into two “factors” each having two “facets.” I will use these factors and facets to discuss with you what aspects may respond to medication. Two items of the PCL-R do not belong to either Factor 1 or 2. These are Item 11, Sexual Promiscuity and Item 17, Many short term marital relationships. These items stay part of the PCL-R because they are so integral to psychopathy as you already know!
| Factor 1 Interpersonal/Affective |
Factor 2 Lifestyle/Criminality |
| Facet 1 Interpersonal Symptoms | Facet 3 Lifestyle |
| 1. Glibness/superficial charm
2. Grandiose sense of self worth 4. Pathological Lying 5. Conning/manipulative |
3. Need for Stimulation
9. Parasitic Lifestyle 13. Lack of realistic long term goals 14. Impulsivity 15. Irresponsible Behavior |
| Facet 2 Affective (emotional) symptoms | Facet 4 Criminal Behavior |
| 6. Lack of Remorse/Guilt
7. Shallow Affect 8. Callous/Lack of Empathy 16. Failure to accept responsibility for actions |
10. Poor behavior controls
12. Early Behavior Problems 18. Juvenile Delinquency 19. Revocation of conditional release 20. Criminal versatility |
Look at the Table above and consider that you are interested in the two items that are not part of either factor and Factor 1. These are the symptoms that are most concerning to family members. The criminal justice system and professionals are most interested in Factor 2.
Look at the list again and imagine a person with a great deal of energy either because he or she is manic or because he or she is on speed. In that case Items 1, 2, 5, 3, 13, 14, 15, 10, 19, 20 and 11 would be most affected. In fact this is why there is overlap between bipolar disorder and psychopathy.
Anything that increases a sociopath’s energy level makes him or her worse. Anything that reduces his or her drive leads to “improvement.” That is why, medications for mania like lithium, anticonvulsants and antipsychotic drugs have been used “successfully” to treat sociopathy. In this case success is defined in terms of fewer arrests and aggressive acts.
Also look at the list and notice that Items 3, 14 , 15, 10, 19 and 11 are related to poor impulse control. These symptoms may respond to antidepressants that work on the serotonin system. Defects in the serotonin system are thought to underlie impulsivity. The problem is that many people become manic when they take antidepressants so these can also make a sociopath worse.
Okay, now see what was left off the list, and you will conclude with me that medication will not turn your sociopath into someone you want to spend your life with. Many people say that the sociopath’s energy and spontaneity are what they find attractive. If that is the case for you, then medication which reduces a sociopath’s energy level will make him or her less attractive to you. All the “fun” part of the sociopath may disappear, leaving you with a boring parasite.
Nothing will make a sociopath loving and empathetic or build a conscience. A loving person takes care of his/her family, is trustworthy and doesn’t lie. Medication cannot make a person loving; it can only reduce dangerousness. Focus on the use of the term reduce, as I did not say eliminate dangerousness. In a hypothetical research study, a 50% reduction in the battering of family members and a 50% reduction in arrests would be considered “improvement.” That does not mean sociopaths are turned into people you want to share your life with.
So why do I even discuss treatment? Only to keep you informed and for those who for whatever reason choose to share life with a sociopath.
Next week psychotherapy for sociopathy.
VERY interesting. Thank you so much for this. It’s a good reminder, one to read again and again. I just wish this list, factor 1, didn’t call to mind most politicians so strongly. “A loving person takes care of his/her family”–makes me think of how, when John McCain’s first wife was in a horrible car accident, he threw her over and took up with a much younger heiress. And let’s not even discuss Elliot Spitzer.
The hardest thing is giving up that hope. Yesterday I met with my one therapist who has never met or seen my husband (my other therapist has; so I don’t have to convince her that we were, or appeared to be anyway, as she put it, “a great couple”).
Anyway, the therapist yesterday, having heard over the past year the entire horror story of what my husband has done, and never having experienced or witnessed in any way his “love” herself, has apparently had a hard time understanding why I can’t just get on with my life and why I’m having a hard time letting the S go. I told her how my other therapist has had me working, via imagery, on letting the S go (taking the hook out of my heart) and how, in that process, I realized I did not want–and/or was not quite ready–to let go of him completely.
When I told her this, the therapist yesterday just looked at me quizzically and said, “Why *wouldn’t* you want to let him go?” (because to her this solution seems obvious).
Tears came to my eyes and as much as I hated to admit it, I said, “Because I don’t want to lose that connection; I loved him; I completely believed in this man.”
And I think she finally realized how much I did love him. Although to her he sounds completely unlovable, to me, the deception was complete and the memory is so vivid of how much I loved him and how much I believed he loved me.
It’s like looking at a photograph, or thinking back on any memory for that matter. No matter how many years go by, some memories are so intense, it’s as if you can reach out and touch them. Part of you asks, “Did this really happen? Was there really a time?” but another part of you can practically step right into the memory.
And I think that’s why it is hard. So painful. To lose someone you love and who is still alive is so difficult. The one we love don’t want us, we want what we had, we can’t have it, we want it, it is real, it seemed real, we can reach out and touch it is so real and we are so astonished that anyone could deceive us so cruelly–was none of it real?–just so they could pursue their evil, selfish desires.
And no amount of calming medication or serotonin adjustment will negate that dark place that exists within the sociopath. Hard as it is to let go, and I’m still hanging on to my S by a few slender threads, it is our only hope. Then we can move forward, toward love and light, acknowledging the pain and grieving are as real and piercing as if we lost our loved one to death.
I find these studies interesting abstracty–BUT again…I do not know why these posting are here. Men and women just leaving and still entrenched with psychos do not need any tips on helping psychos.
In this pst it states psychos do better when they remain married…most women and men want a reason to hang on…and this gives it to them.
Yes, with drugs psycho are dull conscienceless lumps….but “theire there” and t”their mine” that’s the way a victim’s mind works.
I would really reconsider posting these scientific findings.
correction: “the one we love DOESN’T want us,”
i would have just let it be, but it sounded so awful with “don’t”
My personal opinion is that to be in any higher level political position the person would almost have to be a Narcissist of at least a lower level, but a psychopath who had plenty of charm (when they wanted to use it) like Elliot Spritzer are those that advance to “higher” places in politics.
Dr. Leedom also pointed out in a previous post that people with “power” even if they weren’t Ns or Ps to start with sometimes start to act like Ns or Ps.
I am totally in agreement that “success” in treatment of Ps doesn’t produce a “viable human with a conscience” but only a “less dangerous P” and while that may be a benefit to society in keeping them out of prison it certainly wouldn’t make them an “ideal family member” by any stretch of the imagination.
My previous husband was mentally ill, and I would have stayed with him in spite of that because he was not abusive to me, because I loved him. I didn’t have the choice as he left me. Just as if he had been injured in a car wreck and left paralyzed I would have stayed with him. I would have continued to love him.
Psychopathic abuse, and I don’t know of any that aren’t abusers in one form or another to those that are “nearest and dearest” to them, is another ball of string. There comes a point that no matter how much you love a person and how much you would “sacrifice” your own needs for that person, that the “price” is “too high to pay.”
I loved my P-son as much as any mother could love her own child, but when it finally became clear to me that my son was a psychopath, that nothing I could do for him would change that, and if I kept interfacing with him that it would lead to my own death, I had to quit risking my own life and sanity in order to live, much less live a good and healthy life.
I had held on to the MALIGNANT HOPE that he could at least “go straight” when he got out, that the words he had said might actually be true, that he had gained some insight into his behavior, etc etc. all delusions on my part because I wanted so badly for them to be true. When I quit listening to his WORDS and started observing his ACTIONS I saw the truth.
The Trojan Horse psychopath was also bi-polar and the bi-polar treatment helped stabilize his behavior enough that he could “function” in a social setting, it did nothing for his impulse control or his evil intentions to get what he wanted at any price. Incarceration is no deterrent to their grandiose dreams of “the big score” it is only viewed as a temporary set back, an inconvenience. They still view themselves as “successes” and only temporarily inconvenienced by the betrayal of others.
If more states would enact laws, in my opinions, with the “three (felony) strikes and you are out” laws, so that these habitual criminals (mostly all Ps) are incarcerated for life without parole, at least the streets would be safer for the rest of us. I think something like 70% of the violent crime is committed by the 20% of criminals who are scored 30 on the PCL-R. The people who just “score high” but don’t go over 30 I would estimate cause a tremendous amount of other kinds of damage in society as well. Maybe the 3-strikes laws would catch an incarcerate a few of them as well.
While I would like to see medicine find a treatment that worked, and would like to see research continue, I think in the meantime, the criminal justice system is the best avenue we have to get the really dangerous ones like my son and the Trojan Horse P off the street and keep them off the street.
In the meantime, it behooves the rest of us to protect ourselves from the less violent, but still disruptive and harmful ones that are still out there, by learning about the red flags, disseminating this knowledge as broadly as possible, and work on healing our own wounds.
Thank you Dr. Leedom for another great piece of information to add to the arsenal.
excellent points…i wonder if we took the dollars out of politicking and hence the attractiveness to the n/p s/ of the world we might provide/return to a more conscious America….yes i am aware that many of our forefather leaders may have been as well…..but it seems today that we have more of an acceptance of this than in “the olden days”
yes i have lost my best friend because power can corrupt and make n/p/s type behavior out of someone who doesnt stay humble in view of newfound power……and i hired her for the power role because i felt she wouldnt let it run away with her….oh well many other variable at play here as well…..guess the environment helped to nurture her
i also feel that current treatment cant make them more human…just less inhumane
gillian:
“And no amount of calming medication or serotonin adjustment will negate that dark place that exists within the sociopath”
no kiddint, it wont fix them or us……what a bummer….if only……
i understand this post was in answer to anothers quest for info….i also understand the posters DO NOT advocate staying with such a disordered person
such a bummer on such a beautiful saturday that i am finding solace in such information…………..i wish i was snorkeling ciao for now
HolyWaterSalt,
With all due respect to Dr. Leedom, I am with you on your opinion. I think these posts are dangerous for people that are “just out.”
People only hear what they want to hear. Somewhere out there is a person who is thinking maybe they could stay with the Sociopath if he was just a little less abusive.
It seems we were all posting almost at the same time, I was composing my post (after the first post) and when I happened to go back I see that several came in “ahead” of mine which I thought was the second. Some good points in those that I hadn’t read when I posted mine.
It IS I think worse to love a loved one to psychopathic behavior than to death. In Death you know that they didn’t “purposely” quit loving you and die, and you know it is FINAL, that no amount of wanting, or doing anything else will revive them, bring them back to life and you go through the grief process and heal. You get to where you can think about the good times, and not dwell on their loss. I know that even with the terrible, sudden and horrible way I lost my husband, I think it was easier than the way I “lost” my son. I KNEW FOR A FACT my husband LOVED me. I knew for a FACT finally at least, that my son DID NOT ONLY NOT LOVE ME, HE HATED ME, he WANTED ME DEAD so he could have what I had worked for and he felt he deserved to have.
Wow! What a difference in the RESPONSES to my love. One person I lost had loved me back, and one person I lost had wanted to kill me.
I have watched throughout my career families with their loved on on a ventilator, being artifically maintained in that space between “life” and “death” and holding on to malignant hope that by some miracle their loved one will LIVE AGAIN. Will wake up and love them back. I have seen the grief that those families experienced, hoping against hope that some miracle will bring their loved one back to them.
I don’t know exactly how they must have felt, but I think I have some idea because while my psychopathic son was not on a MACHINE holding him between life and death, I was using delusion, my delusion, to keep on hoping that something, some miracle, some act of God, some prayer would be answered and the lovely boy that I loved, had nurtured would reappear in the body of this MAN that I didn’t know. This stranger. This man who could “talk repentence”—but I finally saw, that without a doubt the “boy” I loved would not return to the body of the “man” who was so EVIL.
NO CONTACT was my way of “pulling the plug” on the loved one that I knew was NO MORE, was NOT INSIDE that Body on “emotional life support” that I had kept on maintaining at great cost to myself, just as those families at the hospital kept on hoping against hope that their loved one, long brain dead, would wake up and return to them.
I rememeber the day my husband died, when I got to the hospital where they had taken him, I knew he could not live, but yet the physician there held out HOPE TO ME. I remember being so ANGRY at that physician for holding out a hope to me that I KNEW WAS UNREALISTIC, and I kept thinking, what if I didn’t KNOW the truth, how would I have suffered more because the physician didn’t have the courtesy or guts, or compassion to be “straight forward” and say to me “Your husband is too badly burned to live, but we will keep him comfortable, I am so sorry.”
I asked the doctor “Why are you transferring him 200 miles to another burn center?” He looked at me like I was crazy and said “Because it is the best burn center in the nation” and I said again “WHY? He’s too badly burned to live, I am an APN,I was there at the crash. He inhaled the flames he can’t live with third degree burns over his entire body”
All my career it seems that I fought against phsyicians who held out unreasonable HOPE to patients, which increased the suffering of both family and patient in HOPELESS situations, and this man holding out “hope” to me when there was none to this day makes me angry. But not for myself, as I was at least informed, but for the patients and families he will treat in the future.
Yet, I had done the same thing as that physician, holding out HOPE TO MYSELF over my son. Maybe it is myself I am angry at over this malignant hope, this delusional hope that I too held out.
One of our “family jokes” is the ELEVENTH COMMANDMENT, you know, just like the other ten commandments given by God, but violated more often and with worse results–
“Thou shalt not fool thy self.”
I think I have violated the “eleventh commandment” as much as anyone, and more frequently. Realizing this and stopping my “sinning” in this aspect has been difficult for me.
I had no problem in recognizing that my husband was going to die, and that there was nothing I could do to prevent it. I didn’t accept the physician’s unrealistic offer of “treatment” for something that there was NO treatment for except to keep the patient comfortable and to let God heal them with death. But I did keep up my OWN malignant optimisim and my mantra “where there’s life there’s hope” which is NOT TRUE. There is no more chance for my son, though his body is breathing, to come back to me “whole” (with a conscience) than there was for my husband to get up off the gurney and run into my arms.
But because we don’t have a “ritual” like a memorial service for those that are “lost” but not dead—unless it happens to be a divorce–maybe that is a ritual for their loss—but not having a “ceremony” that marks the total loss may be one of the things that keeps it gnawing at our hearts.
I did my own little “memorial service” for my P-son, the chld that I loved, and laid him to rest, covered the memory with the soil. The MAN that is inside what used to be the body of my little boy is a stranger to me. Just like I had “donated” the organs to someone else after my son died. The heart beating inside another’s body, or the kidney, or the lungs, they are NOT the chld I loved, only pieces of tissue. And if I had literally donated his organs, the person who had his heart might not be a good person, or the person who got his eyes might not be a nice person, etc. so just the “tissue” being there would not make those people my “son”—any more than a “total body” donation, as in this case makes that criminal, that EVIL psychopath “my son.” My son is dead. The relationship is dead. I can’t bring back my husband, I can’t bring back the little boy, but I CAN MOVE FORWARD with the rest of my life.
I think this is another brilliant piece of information – you can’t miss the message if you read it all.
I suppose the problem is that the people who are ‘just out’ might not read every posting and so the title of this might convince them more if it was ‘Why Treatment Doesn’t Make the Sociopath a Better Partner.’ (Though I must say that when I was ‘just out’ I read EVERY inch of EVERY posting EVERYWHERE!)
All I know is that I found this bit:
‘Many people say that the sociopath’s energy and spontaneity are what they find attractive. If that is the case for you, then medication which reduces a sociopath’s energy level will make him or her less attractive to you. All the “fun” part of the sociopath may disappear, leaving you with a boring parasite.’
…really illustrative.
I’m still at the stage (though well past my own sociopath) where I find this whole subject massively interesting and this has answered a question I’ve wondered about for some time.
This also makes me think of why my sociopathic ex blamed Prozac for his terrible behaviour – it DID just ‘enhance’ factors 3, 14 , 15, 10, 19 (poor impulse control). When he wasn’t on it he was slightly better at concealing his true nature. Which to him will have been the important bit – the bit that stopped things unravelling for him.
Someone was saying.. I think it was Wini.. that the only hope for a real sociopath is with God. I think this is true to an extent. IF, and it’s a big IF, the person really turns to God and fights his old natural inclinations, I think he or she could change. But too many times they end up just using the church and new group of friends as yet another support system for their abusive ways.