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.
Oxy:
I think it was Truthspeak who mentioned that about Hare.
I don’t see anything that would indicate Hare is a P at all – but I see PLENTY to indicate to me that he is very naive – and at minimum fairly often a PAWN (all you have to do is read his story about “Ray” in “Without Conscience” to see that).
What everyone seems to forget – since the PCL-R has been so popular that it seems to have eclipsed any test that may be more accurate – is that the PCL-R was never meant to be a diagnostic tool/test. It was developed to be a research tool – plain and simple – so that researchers could identify and quantify a particular group of criminals in order to conduct studies (of the impact of various treatment strategies on recidivism if I remember correctly). It was developed in a men’s maximum security prison, and pretty much doesn’t apply outside of that milieue. Hare admits to being spectacularly naive and therefore a prime target when he first started out (thus the “Ray” stories). Plus, I wish I could find the article where I first read this, I believe he is one of those men who was raised by a loving, caring mother, and just can’t conceive that there are evil, sadistic women in the world, and therefore his measurements didn’t bother to consider their existance, let alone the differnt ways that females offend/perpetrate. Exactly the same principle applies to “white collar” crime, except that society doesn’t have the same level of knee-jerk denial mechanisms in place to obscure and deny white collar crime as it does with female-perpetrated crime. But there is still a lot of societal denial going on re: white-collar crime. I find it fascinating that even though Hare has said that if he had it to do all over again he would have started out studying psychopaths in the Vancouver Stock Exchange rather than the local maximum security prison, and yet he hasn’t made ONE SINGLE modification to his PCL-R to accomodate the differences. Which means that, just like with women, his results are self-reinforcing (and self-skewing). It makes sense that the most violent male criminals (for which the PCL-R was designed and who primarily use physical force to commit crimes) would “mellow” with age. However, the rest of them who don’t rely on physical force, for instance white collar criminals and female perpetrators who don’t use physical force in the first place, don’t have the same impediments. Plus, I believe that by “mellow” Hare probably means only what he can measure, which is that their rate of “convictions” decrease with age.
But BBE’s point is very good: the mental health industry – particularly psychology and psychiatry researchers – is rife with narcississm. I attended some seminars at a conference for Sex Offender Treatment Researchers, and it was astounding to see the level of hostility and competition amongst them. More disturbingly, they also LOVED to gossip. And the very first person I heard gossip about (he wasn’t there, nor had I mentioned him in any way) was Robert Hare.
Wow, Annie.
I’d like to add, not knowing if it is of any value, that it is my understanding that Dr. Hare profits from his PCL-R. Based on what I have read, professionals need to buy something, perhaps a kit, regarding the PCL-R and maybe that’s where the missing parts are located that I asked about above.
I don’t think that it is necessarily wrong that Dr. Hare is making money off his scale. I believe the same holds true with certain intelligence and aptitude tests used in schools and elsewhere. I can see wanting to maintain some sort of control over something so it isn’t misapplied.
I wouldn’t know how these professional fields regard researchers making money off their theories. Would that be any different than an inventor making money off a medical device he or she designed? We certainly know about patents for pharmaceuticals and other things.
Dr. Hare and Dr. Paul Babiak co-wrote, Snakes in Suits-When Psychopaths Go to Work. That book contains information about women being Ps in a work environment. In fact, they point out that female Ps exploit societal expectations about “nice” female behavior to achieve their ends.
Dr. Hare is retired now. I doubt he’s going to be doing much more work.
I read somewhere that he lost a daughter to alcoholism. I’m sure that taught him a bit about how negative some females can get. The few clips that I have seen of him gave me the impression that he is a gentle and kind individual.
It was Truthspeak who first suggested that Hare is a sociopath. As I mentioned, I have no idea how anybody could conclude that.
If the mental health industry is rife with narcissism, that goes far in explaining why they wouldn’t be open to hearing what we, the victims, have to say or feel that we need.
G1S,
I too have read some pretty strong criticism (and charges of hypocrisy) leveled towards Hare for being more concerned about his financial returns than his research integrity. Particularly about how he laments that his tool is wrongly used to convict/sentence criminals – particularly in capital punishment cases in the U.S. – and yet lets in pretty much anyone into his courses. I read one pretty scathing criticism of his PCL-R training courses, that mentioned specifically how one of them included two (very bored) people associated with a prison (a southern U.S. prison if I remember correctly) who sat in the back and cracked jokes and doodled and didn’t pay attention at all. This person was bitterly complaining that these yokels received the exact same ‘certification’ for their attendance as the serious and committed researchers who attended. He was particularly bothered by the thought that these were the very people whose job description was to use the PCL-R in exactly the way that Hare warns against, and yet according to this person Hare said and did nothing about it.
BTW, I think truthspeak was probably making a joke about Hare being a P.
Well, Annie, whatever is the case with Hare, he isn’t the only researcher in this field nor will he be the last.
Let’s hope that current or future ones will correct whatever shortcomings Hare’s checklist has.
You sound like you work in the field, Annie. What would have been a better (more acceptable) way for this checklist to have been used? I have no clue how this sort of thing is usually done.
I do know one thing – we victims don’t need more obstacles to overcome to get help and have others understand what we go through and endure from and because of Ps.
I see your point, but blunting receptors is not the only way, or the best way. current research is lacking. I do remember when my anxiety was ‘cured’ for a few hours when i took small amounts of 5htp, yet was exacerbated a few hours later, so there is a cure for anxiety which is short term. 5htp regulates serotonin and it worked until I had an overload of it in my brain. I have also read that thyroid is involved in sociopathy and I believe that. I have also read that dilantin can cure it and also gabapentin can help. They modulate all neurotransmitters. More later. I also feel that there are other ways besides blunting the brain’s receptors. Are you suggesting we break away from a loved one or our grown children if they are sociopaths? Please elaborate. I can see your point, but is difficult, if not impossible. These are people who have no control over their brains. I know this because I have no control over my anxiety. For instance, I am not afraid of anything, I have a strong constitution, and have a low key demeanor, but I cannot change how I relate to my anxiety, and, believe me, I have tried. Because the 5htp worked for me, I know that there is something out there that may work for sociopathy. I also saw the gabapentin work on someone with sociopathy but it also made them very nervous. People do not want to do these out of control things or hurt others or lie or be destructive. They can’t help it. Nobody in their right mind would want to hurt anyone, so they obviously have no control over their behavior, but we do, and people seem to want to hurt them back. That is not right. Would you blame a retarded person for being that way? Of course, you wouldn’t!!!! Would you abandon them? Of course not. Would you abandon someone with cancer cause they could not cure themselves? NO. And at least people with cancer know they have it. People with sociopathy are not even aware so are more vulnerable and this is a mental illness and they destroy their own lives so it is not something that they are directing at us because they dont know and are not even aware of what they are doing. It is devastating for them. I am careful around them and cannot go around them but I would NEVER abandon them or leave them this way. I want to find a cure as much as I want to live. WE need a cure. It would help society in so many ways. Less or no crime. Etc. Less breakups less alienation. less homelessness less starvation better health care affordable housing less domestic violence better environment and government cause believe me there are lots of sociopaths who are drawn to jobs etc with power authority exploitive opportunities etc. Everything would be better and more fair and more accessible. But, thanks for being so intuitive and smart etc. We must have people like you in order to heal sociopaths. We need more. Also, we are all victims in this mind war. Especially the sociopathic person because they have a mental illness over which they have no control. I have been looking into this disorder for years now and Hare let us know what was going on, but now we know so checklists are not needed. The word is blasted all over the internet. I also dont think he is looking into any cures!!!!!!!!!!!! Hello!!!!!!!!! Forget why and concentrate on fixing it!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Lastly, for now I really really agree with and like what G1S said. ditto to what he or she said. I have family members who do these same things. I wish you would contact me and we could talk further. I agree with your whole post but mostly with this >So, how would you classify people who bad mouth you to others? Ruin your reputation? (Yes, there are laws against this, but good luck finding a lawyer who would take such a case and you having enough money to pursue it in the first place.) Got plenty of lawyers who told me that I had an excellent case of malicious prosecution. Is it criminal because they were never charged with that?
What classification would emotional abuse fall under? How about neglect?
sorry this is so sloppy. i am too tired to edit it just yet.
None, you asked:
Are you suggesting we break away from a loved one or our grown children if they are sociopaths? Please elaborate. I can see your point, but is difficult, if not impossible.
ABSOLUTELY I am not only suggesting that, but STRONGLY suggesting that, and I HAVE DONE JUST THAT. One of my sons is a card-carrying psychopath who hhas murdered a young woman and tried to kill me (actually have me killed) and I am NO CONTACT with him, my other biiological son was and is a “fence sitter” who KNEW that the man my son sent to kill me was taking over my credit cards and ruining my credit, and doing other things, and SAID NOTHING until that very man tried to kill lHIM. Then…he decided “mom is a prophet” but that wasn’t the first time second sonn had aided his P brother in illegal and immoral things…and he continues to lie to me, so I have gone NC with him as well.
My mother sends money to my P son in prison and hires him attorneys to try to help him get parole. I am also essentially NC wit her as well…except for the business things we must engage in due to a family trust in which we are co-trustees, but I do all communications with her by e mail (and keep a record of that)
So, yes, It IS DIFFICULT to cut off relationships with family members who are psychopaths and dysfunctional but it is WORTH IT FOR SURE IN PEACE OF MIND AND PEACE IN MY LIFE.
none,
you said, “These are people who have no control over their brains. I know this because I have no control over my anxiety.”
You are projecting your own experience on the spath. That is the mistake we all made. In fact, spaths have complete control over their brains and THAT is their exact problem.
They have chosen to not feel emotions other than envy and rage. They certainly don’t feel anxiety. Their willful refusal to feel creates havoc in their personalities. They accomplish this emotional control by splitting, projection and transference. In short, they refuse to feel pain but they make sure WE feel all of their pain. This abdicating of responsibility makes it impossible to have empathy for others.
And I will tell you something else, many of them KNOW that they are doing this. Those that don’t, you could explain it to them and they would understand completely. Their response would be, “so? and your point is?”
It is simply that they have made the decision that you suffer so that they don’t. Just like when we make the decision to eat a chicken, we know that it has to die so that we don’t. It’s just like that for a spath and YOU are the chicken.
Because the spath’s feelings of envy are triggered by our presence, the only “cure” for psychopathy is NC. Shunning them is the only “cure”. For us and for them.
I am not the type to project anything. You are right that they don’t have anxiety and that is a chemical imbalance. I understand to get safely away but to wish them harm is awful. Are you saying that you would not feed them if they were hungry? You sound like a reasonable person and I hardly think you could bring yourself to ignore them completely. I have to tell you that I assumed you would argue with me..someone would cause that is always the way. Either, I’m ignored on posts like these or they try and prove me wrong. I certainly can’t be wrong when so many others agree with me. I also have to tell you that I think there are way more sociopaths in the world and that they hide it.
Most families are dysfunctional in antisocial ways and that tells me most people are antisocial. You do the math.