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.
EnnLondon,
I guess I agree with boths sides. You can’t miss the message if you read the whole thing yet people look for the message they want to hear.
Currently, I am reading The Art of Seduction by Robert Greene. I don’t remember if it was reviewed here but it has been recommended several times. I finally picked it up and though it is written more as a manual on how to seduce someone, psychologically, rather than as a book about psychopaths and sociopaths, it is still a great tool for understanding ourselves and how we got sucked down the black hole.
There is a section describing different kinds of victims as well and I surely see myself described there for sure.
Anyway, the above article will not induce any false hope for me as I am too far down the road. I hope that no one will “read” between the lines a message that is not there… which is… hey.. maybe I can get help for my S and then he will be the nice guy he promises he is… NOT NOT NOT!
:o)
The xs fits 19 of the 20. The only anomoly is #17- many short marital relationships… we were together/married for 7 and his previous marriage lasted about 7yrs. Of course only the WIFE half recognized the marriage either time… and I understand he was engaged a few times between when I threw him out and when we became divorced/he went to prison. He of course, had many gf’s and perhaps even fiancee’s during our marriage… so maybe the many short marital relationships does apply, just not in the traditional sense?
I think there is one drug that could “fix” the xs: sodium pentobarbital. But it’s probably not terribly charitable of me to suggest it. 😉
Dr. Leedom and All:
I am not even “out ” yet and I have found this very interesting and helpful. I knew “my” S was a player when I met him, a year before I became intimate with him. Six months into that, I knew something was not right with the guy I had fell for and through my own research discovered he was an S. Knowledge is power and the more we have, no matter how it pulls on our emotions, is good for the long haul. As EnnLondon stated, this blog was really illustrative. It made me wonder what “my” S would be like if he were drugged. I fell in love with some of these sociopathic traits.
“My” S. knows something is wrong with him and wants his life to be different. I don’t beleive his ego and/or anger would ever accept the fact that he could be a N/S/P though. So… I really look forwrd to the next blog by Dr. Leedom.
In the beginning I was in a mode to understand and ‘help.” If he knew…
maybe… he’d change. Getting over their lies, the disbelief and accepting that “unreality” is reality with a psychopath is monumental. I have a background in research and I had read this sort of stuff before….and unless you can give them a heart, sort of like the lesson from Wizard of Oz,
they don’t change.
This “therapy” only works if they are institutionalized and/or enjoy the drugs, if they don’t like the drugs ..forget it. And my God, why should any of us care? Really? This doesn’t change them, and is not in our domain at all…this stuff is for mental institutions and correctional facilities.
Life is so much more than a relationship with a psychopath in a stupor.
Lib….I hope you go NO Contact. You need to be thinking about you- really, your life is in danger.
Gillian:
Does NC mean losing all connection? You loved your husband very much, and as you stated about the photographs, being intense memorys you can almost touch, why do you have to get rid of all “emotional” connections. I may be totally wrong, but at this point for me, I want to move myself from the S, get back to who I was when I was healthy, but I don’t feel the need to get rid of all connection. I never want to forget this experience, because I never want to find myself in this place again.
Lib-
The goal is no contact …meaning email, text mess. , phone, in-person or through other people , some call that contact via proxy.
And I suspect if you do got no contact, one day you will not want any mementos, and that will be a very good day.
So what are doing to get yourself out of this abusive relationship?
I will have no contact.
I don’t beleive my life is in danger. My heart aches, my home and children have been neglected, but my children and I will be okay eventually.
I have kept mementos of good and bad in my life. It is all part of my life.
I had NC for aprox. three months last fall and then answered one of his calls and blew it. I know that I have to go longer or forever. I have shed no tears this time, I know that he will not change, I know I want a mutually loving, caring, partner. This is what I am doing for now.
Lib,
I want to get rid of all emotional connection to my S because I think he is evil, and I don’t want to have any evil in my life.
The more I let go of him, the freer I feel. I do not want his negative energy infecting my life anymore. He appeared to be a wonderful man, but he was not, and I grieve for the loss of that illusion. I hate like crazy that it was only an illusion, but it was, and that’s all it ever could be. He’s tried to convince me he wants to change, he has changed, he is changing (he recently told me he’s had a “white light” experience), but that’s all part of the illusion too. It’s ALL manipulation.
That’s not to say that I’ll ever forget him. How could I? However I do look forward to a time when I no longer wonder where he is, who he is with, or what he is doing. When I no longer wonder because I no longer care.
My first husband I will never stop wondering what he is up to. He’s the really dangerous kind of S, and like a rattlesnake, I want to keep half an eye on him to make sure he’s not sneaking into my garage or something. But I did go NC for my own sanity, even though I’ve given up 12 years of child support.
This is not always possible, though, if you have kids. The important thing is not to let him worm his way back into your life, your wallet, your self-esteem, etc.