Guise of Humanity

Educating Ourselves on Dangerous Personality Disorders Can Help Our Protection

(A longer version of this article can be found here.)

Diagnoses of sociopathy or psychopathy are made cautiously and sparingly in order not to stigmatize persons, but we must counterbalance this with the need to warn potential victims and the public, so that they might better protect themselves.  Above all, society needs to be better informed more generally, so that it does not fall easy prey to well-disguised, dangerous personalities who increasingly inhabit our midst.

At the onset of my quarter-century career, I encountered sociopaths and psychopaths mostly in jails and prisons, my main settings for clinical work.  Very disturbingly, over time, I found them increasingly in leadership positions, as chief executive officers, legal professionals, or political leaders—and less in correctional settings.  This means that society is not doing a good job at containing them, and they are escaping detection more and more.

Those with these conditions overwhelmingly crave power, so that they can exploit the trust and privileges accorded them to bolster their fantasies of unlimited domination and their drive to harm others.  Distinguishing them from true aspirants with real capabilities is crucial: they may masterfully disguise themselves as ideal candidates for a job, for example, but once given the task, they will only destroy whatever they are put in charge of—be it a family, a company, or a nation.

What is psychopathy?  Briefly, it can be defined as a personality disorder characterized by an absence of compassion or conscience, constant engagement in emotional manipulation as a way of navigating the world, and a propensity for destructiveness and cruelty.  Afflicted individuals are impaired in almost every human emotion, except envy of other human beings, rage, and revenge.  It is arguably the most debilitating disorder known to humankind, for there is no cure—and the masterful guise of sympathy, humanity, and competence is all deception intended for predatory purposes.  It is certainly the most dangerous disorder known to psychiatry, as it wreaks more havoc on individuals and society than all other psychiatric disorders combined.

What is sociopathy?  Briefly, I call this a “societal disorder” rather than an individual one, since society is the cause for this affliction.  It is a disorder characterized by a disregard for and violation of others’ rights since age fifteen, and can be diagnosed through observation of the following behavior:

1.  Failure to conform to social norms concerning lawful behaviors, such as performing acts that are grounds for arrest

2.  Deceitfulness, repeated lying, use of aliases, or conning others for pleasure or personal profit

3.  Impulsivity or failure to plan

4.  Irritability and aggressiveness, often with physical fights or assaults

5.  Reckless disregard for the safety of self or others

6.  Consistent irresponsibility, failure to sustain consistent work behavior, or honor monetary obligations

7.  Lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another person (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition).

Approximately 4 percent of the U.S.  population have sociopathy (6 percent of adult men and 2 percent of adult women).  Approximately 25 percent of those with sociopathy have psychopathy: in other words, about 1 percent of the U.S.  population (1.2 percent of adult men and 0.3 to 0.7 percent of adult women).

Psychopathy, while the least recognizable among psychiatric disorders, is the most dangerous.

Qualifications for diagnosing psychopathy usually include a doctorate in psychology or psychiatry, forensic training, and clinical experience with dangerous individuals, as well as specific training in administering the Hare Psychopathy Checklist–Revised (PCL-R).  This is a well-researched and highly-reliable diagnostic tool, which Canadian psychologist Dr.  Robert Hare and colleagues developed in the 1990’s.

Here are the items we score, based mostly on collateral interviews:

1.  Glibness/superficial charm

2.  Egocentricity/grandiose sense of self-worth

3.  Proneness to boredom/low frustration tolerance

4.  Pathological lying and deception

5.  Conning/lack of sincerity

6.  Lack of remorse or guilt

7.  Lack of affect and emotional depth

8.  Callous/lack of empathy

9.  Parasitic lifestyle

10.  Short-tempered/poor behavioral controls

11.  History of promiscuous sexual relations

12.  History of early behavior problems

13.  Lack of realistic, long-term plans

14.  Impulsivity

15.  Irresponsible behavior

16.  Frequent marital relationships

17.  History of juvenile delinquency

18.  Revocation of conditional release

19.  Failure to accept responsibility for own actions

20.  Many types of offense (PCL-R).

Contrary to the popular perception that psychiatric diagnoses always require a personal interview, they have not since 1980—and psychopathy is one of a handful of diagnoses for which studies show that a personal interview can even be detrimental to the accuracy of an evaluation (since psychopaths are prone to lying, deceiving, and beguiling whoever is in their presence).  Collateral interviews with victims or close contacts, review of written records, and objective observations of interactions with others are far more valuable. 

Corruption in institutions becomes a magnet for psychopaths, who, in turn, further corrupt the institutions of which they become part: this is how they are coming to occupy positions of power at dangerously high rates.

Whether occurring at the level of families, institutions, or government, the psychological dynamics are the same, and so is the involvement of psychopathic personalities.  Whereas diagnosis is not necessary to assess dangerousness, and I avoid diagnosing public figures, I believe it is important to educate the public on existing conditions so as to help protect public health and safety.

A lack of cure for the most dangerous personality disorders does not mean a lack of treatment: there is always something we can do for improvement—such as first protecting ourselves, limiting power in the wrong hands, prosecuting when warranted to set boundaries, and behaviorally directing afflicted individuals toward more realistic goals, so that they can use their actual gifts (rather than rely on cheating, conniving, harming, and covering up).  Cure is at the level of society: if we truly created a just and equitable society, we would see sociopathy, and much psychopathy, disappear.