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:
Your post about your p son is so good for me. When I finally realised (with your help), that my daughter, ” for a FACT ..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”. It was like an epiphany! I did not want to believe it and I still have days where I feel guilt (FOG) but the truth is in my heart, that I have to let her go. That in fact – SHE HAS ALREADY GONE MANY MANY YEARS AGO! I cannot deny it because it is so obvious. And I will have a ceremony eventually. I have got rid of her pictures around the room and her “stuff”, which helped me enormously.
My daughter died, in fact, with this daughter, in retrospect I believe she was born a psychopath. Like her father. He is a murdering criminal psychopath that NO-ONE would suspect. He LOOKS like one, but his charm and wit and humour is so disarming you would never know. He still roams free like a crocodile.
My daughter looks like an angel from heaven and can cry at a seconds notice. Her smile lights up the world . She has the charm and manners and wit and intelligence of a fantsy princess. She is too good to be true.
She told my youngest gentle son a few weeks ago that ALL SHE HAD EVER FELT TOWARDS ME IN HER WHOLE LIFE WAS GUILT AND JEALOUSY.
ErinBrockvich,
A very scary ref flag that just send chivers to my spine. On an occasion of extreme abuse (not physical abuse) I was so hurt that I sat outside and took a bottle of Tia maria ( I do not drink ever) and start stargazing in despair. Without thinking of what I was doing I started drink the Tia Maria with empty stomach. Offcouse after a few hours I was sick. I hardly could walk. I sat at the shower and shivering talking to myself ‘do not fall asleep
Billancy, yes whenever someone has that strong of a negative effect on us it is a clear sign to run as far away from them as you can.
Dear Tilly,
Even at the time in 1991 when he murdered that girl, and I was in such grief and pain (even though eh denied it I “knew” it was so) that his life was permanently ruined, I kept feeling I wanted to change places with that girl’s mother because it would have been easier for ME. At least when your kid is murdered the friends, church, neighbors, etc. come and mourn with you, but with me, I was BLAMED by the cops (oh, I wish you could have heard how they talked to me! Like I had done it by giving birth to him!) My husband’s niece who had taken him in (against my advice) to protect th epoor dear from his harsh mother, blamed me….he blamed me! the only one who didn’t blame me was my husband, God rest his soul!
Tilly, I know it is difficult to “give up” on someone you gave birth to, and so many people will tell you in all sincerity “oh, s/he’s your son/daughter hhow could you ever stop loving them (and putting up with their crap!)” But I can tell you I have NO love for the MAN my baby became, and my baby is GONE, DEAD, BURIED.
It sort of happened suddenly I was blogging here and I just got up went to the photos and took out everything of him over about age 12 and cut him out of our photo album, then I had my little “memorial service” for my dead baby, and I cried and grieved, and it was like a GREAT WEIGHT was off my shoulders.
Like you, tilly, I’ve had run ins with multiple Ps and when you are grieving for the losses of multiple situations and traumas, you think you have one “handled” but another pops up, and then the first one pops up again too, it takes TIME and thought and “processing” of these thoughts and emotions. it isn’t just like building say a house, where you lay a foundation then the walls and floor and then the roof, you build the foundation, someone blows it up, you rebuild it, then put the floor on and the wind knocks it down, the you start over again, etc. etc. It is more, I think, like planting a garden, and sometimes the weather or winds blow your crops down, but you cant start over cause it is too late in the year, or you cant find more seed, or the weeds take over cause your tractor breaks down, so your plot of ground goes back to weeds and brush, and you have to reclear the ground again, but this time with a hoe instead of a tractor, but then you fall and break your arm….it just seems never ending.
I think we must just take each day as we find it, work the best we can, and then put our heads on the pillows and say “I did all I can do”
We may never see the ‘reasons’ for the things that have happened, our why, or why we didn’t take action sooner, and all I can say is “i wasn’t ready yet THEN” but “I AM READY NOW!”
IN my own little garden plot this year I have not spent as much time taking care of it as I could have (should? have?) so some of the weeds are there, but in spite of the weeds we have had more squash than we could ‘say grace over” and fresh herbs and spices and garlic, and a few tomotoes…so rather than castigating myself for the weeds, I am grateful for the produce in spite of them. Today I made yogurt and cheese from the goat milk and ate it on some of the nicest rye melba toast with herbs and a fresh slice of tomato, and I felt so RICH and SATISFIED as I shared this treat with a friend and with my sons. It is the little things in life that make it RICH and SATISFYING.
Tonight I am tired, but in a good way, from doing something creative (cheese making is as much an art as a science) and life affirming, something that people have done in log cabins, brick mansions, palaces and mud huts for tens of thousands of years…those small comforts and creative efforts are my life and my pleasure.
Now to bed a tired old lady, satisfied and happy and grateful to God that my son’s biopsy came back OK. Thanks fo rall your prayers Tilly, it hellps me to know you are there rooting for me and cheering me on!@....... Love oxy
justabouthealed, ErinBrockvich,
Ups…. had a computer problem. the mssage was sent without me finishing it.
A very scary red flag that just sent chivers to my spine. On an occasion of extreme abuse (not physical abuse) I was so hurt that I sat outside and took a bottle of Tia maria ( I do not drink ever) and start stargazing in despair. Without thinking of what I was doing I started drink the Tia Maria with empty stomach. Offcouse after a few hours I was sick. I hardly could walk. I sat at the shower and shivering talking to myself ’do not fall asleep, continuing…….keep your eyes open. The S by then came to the shower and set there smiling…..brummmmmmm
After a while he took me to my bed..wet clothes and all and set there beside me…..I hardly could talk…he even did not boder to give me a pair of dry clothes. He sat there holding my pulse and I saying to myself…do not fall sleep…
Anyway…I was so stupid that I though his gesture was nice…after all he is not that bad…
This same man would rush to hospital for the most simple thing in the past…the kids could not have a cut in there fingers that there he was most concerned.
How come he did not boder to take me to hospital? Instead sitting in there holding my pulse..
Now remember, the only bill he never forgot to pay was a life insurence on me. and early on he sad: the best thing that could happen to him was if I die because he would get money from my Life Insurance.
Well…..that night when he was holding my pulse and I thought it was a nice gesture from him…I now know that he was hopping that I die….
The next day he said to the kids: Mum was really drunk last night…and the kids What?
Bastard he was hopping that I die and made those comments for the kids to think really bad about me..offcourse never told the reasons why I was so sick…and what his done afterwards…
How could I not see that by then….my God he was quitly doing everything for me to die….pushing me to the limits ..
For jis disapointment I AM VERY WELL AND VERY ALIVE…
Dear Oxy,
WHOOP!
That’s great news about your son! I’m so happy for you guys! (It’s really hard to do the Happy Dance and type at the same time!)
I love it that you make cheese! I’ve tried it, with disasterous (and smelly) results, and I buy all mine now because I choose life, but it is very cool to be able to make it yourself!
Brilhancy,
Nobody should ever have to go through something that awful — but you did come through it, and you even figured out what he was up to!
And you’re here, safe and sound. That is brilliant!
BIGhugs!
Betty
Oxy:
I am over the moon about your sons biopsy!
I can’t tell you……I just never ever wish to hear about another person having melanoma.
Just 2 months ago….I had a VERY dear friend pass away. It’s a nasty, horrible disease…..and the treatment is dreadful……and usually unsuccessful!
My friend fought like a banshee…..for 16 months…..every step bad news……treatments after treatment and on to 3 different trials in Bethesda.
He died like he lived….in control of his destiny.
He was heli skiing just two months prior to passing. I still laugh at him telling me as he was 3 days prior to departure to Canada for heli sk…. He was waiting for a call from the Dr’s…..he said he needed to have a quick Brain surgery before he left to go Heliskiing…..UH
Eeekks….
whats going on here? It’s not posting the whole post>!!??
Anyways…..
My friend went heli skiing and came home and immediately had the surgery….he never really was the same from the surgery…..
BUT>…..he lived and did what he wanted. accepted the cards he was dealt with wisdom and a tenaciious fight.
He is my ispiration and I will always feel him close……I will always hear him chuckle when I overcome an asshole move from the S…..He loved hearing about what I was up to on my counter attacks…..he loved it, it inspired me to keep going.
He gave me fight! He gave me strength. I gave him a diversion from his own fight…..
I am so grateful I got to share the end result with him……he saw it full circle……from planning the wedding, child bearing, investments, houses, jobs, questioning and becoming aware of these behaviors….He gave me strength my whole adult life.
He was thrilled to hear about the last court date, he laughed at every statement. He said “good for you Erin, I knew you could do it, I am proud of how far you have come’.
Those words meant so much coming from him!
He was a GEM!!!! He knew the S and he “GOT IT”, he stuck up for me, he was there when I needed someone to be there, he was ther when I was sick, I was there when he got sick…..we shared a lot of life, love and laughter….sadness, strength and tears……
He was a man of honor, integrity and faithfullness.
He is my friend.
Hug your son close, I am so glad he will not experience that ugly journey!
XXOO
Dear Erin,
Thank you for the story about your friend! That is wonderful, you know, I think the “shared experience” of someone we love’s death can be some of the most meaningful time to them and to us. My beloved stepfatehr and I shared his 18 month journey and he and I had some wonderful and close times. I still laugh about his jokes and his dry sense of humor and one-lines off the top of his head! It sounds like you share those same kinds of memories with your wonderful friend. those are memories that will comfort and warm you the rest of your life, and I know that having you there with him was benefical adn comforting fo rhim as well as for you.
Yes, I am glad lmy son’s biopsy turned out negative, I could see the relief in his eyes when he got the results. he was being stoic about it outwardly but I know he must have been worried about it inside. (He’s too much like me!!! LOL)
Thank all of you for your prayers, concerns and good wishes for my son about his biopsy. I am so fortunate to have him back alive and well from that nearly 8 yr. marriage-from-hell with his P X-wife. Not only back physically but emotionally as well.
Erin, I have been blessed by having several really CLOSE friends that have never never let me down, not many, I think a person is fortunate to have one or two of this kind of friend. these friends are there for you in good times and bad, and the more you share the stronger the bond grows. My best friend lives 7 hours from me, but we have mantained a CLOSE friendship in spite of that and visit and e mail and phone often and keep our friendship intact. We’ve been through the bad times for each other and the shared the good as well. there is nothing I wouldn’t do for her that was within my power. I KNOW that she had already done the same for me. Even though your friend is gone from your sight, he remains in your heart. My step father is as close to me now as he was when he was living and I can actually “ask him questions” about “what would you advise, daddy?” and if I sit quietly and LISTEN I can almost hear him telling me what to do. He was sharp and intuitive about people, and his advise was kind and firm and never bad. Sometimes I will dream about a problem and he will come to the dream and tell me the answer as if we had a visit in teh flesh. Those we love and who loved us are always with us. (((hugs)))) and God bless