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Posts Tagged ‘Anti-social Personality Disorder’

trump12This blog entry is presented less as a political opinion than a medical opinion, but the political implications are staggering. I believe America has elected a sociopath as its next President, and, as a “mental health professional” that concerns me – in fact, it terrifies me.

What is a sociopath?

The current diagnostic term (per the new DSM-5) for the condition I’m referring to is “anti-social personality disorder” and, if you care to, you can go to the manual and read a long description of the symptoms. It all sounds like Donald Trump, almost comically so, from “inflated and arrogant self-appraisal” to “glib, superficial charm.”

I’m the first to admit there’s a worrisome aspect to mental health diagnoses, which is that they appear subjective. There’s no blood test, no pathogen you can stick under a microscope or obvious physiological indicator of disease. There’s just a description of human behavior and emotions. That hardly seems medical.

Nonetheless, the irregular human behaviors and troubling emotions that define mental illness – including sociopathy – are real and, they exist on a spectrum, so when they are severe, they can be very serious indeed. We all feel down once in a while, but if you witnessed the effects of catatonia in someone suffering from major depression, its severity might startle you. Likewise, knowing someone slightly “kooky” is different from encountering someone suffering from the hallucinations and delusions produced by severe schizophrenia.

Sociopathy is unique and troubling in part because of a peculiar paradox: the more severe the condition, the more difficult it can be to detect. It’s hard to see what isn’t there, and sociopathy, unlike schizophrenia or depression, is about the absence of normal controls on a person’s behavior. It’s easier to notice something new, that doesn’t belong in someone’s psyche, than something we take for granted that’s missing. And what’s missing in a sociopath is the very humanity that might make it hard for him to hide his condition.

So what is sociopathy, really? In brief, it amounts to the absence of a conscience. Whatever it is within us that we call empathy or caring or concern or connection to others, doesn’t exist in a sociopath.

My father, a psychiatrist who ran a secure ward at a state mental hospital, used to quip: “You know the true sociopath because he’s the one you lend money.”

What Dad meant was that the most severe sociopath is the one who can even fool a psychiatrist. And it really happened sometimes – my father used to recount in amazement stories about sociopaths talking their way right out of secure mental wards.

How do they do it? A sociopath has the amazing ability to tell you exactly what you want to hear. It’s as though they possessed empathy – astonishing powers of empathy – in the sense that they can intuit your desires, and sense what it is that you need to hear them say in order to produce a predictable emotional response. This creates a frightening ability to control others simply through insincere words and the inauthentic play-acting of emotions.

A moment after they tell you something – and this is the truly chilling aspect of sociopathy – a sociopath might be with someone else and say precisely the opposite of what they just said to you, with appropriate emotions displayed, simply because they sense that other person needs to hear something else and the sociopath wishes to control them, as well.

A sociopath will tell anyone whatever it takes, complete with apparently sincere emotions, to create the desired response in them, and thus influence their actions.

This phenomenon is sometimes called being a “pathological liar” and I’ve run into examples where the lying itself becomes the end goal – sociopaths who concoct stories to see how long they can fool people, then revel in being found out, as if that heightened the pleasure of the entire enterprise of deceit.

It’s been said that all criminals – at least, criminals with the intent to commit their crimes, perhaps not criminals who had to steal from necessity, due to poverty or desperation – are sociopaths. That’s because it is our consciences that keep us from doing things we know to be wrong. As members of a community, we sign on to a social compact, an understanding with other people, to care for one another, at least to the minimal extent that we agree not to commit acts we define as crimes because they hurt others.

The most dangerous sociopaths are the ones who are less concerned with fooling people or even stealing from people than they are with controlling people. They don’t want to be found out. They want the lies to go on forever so they can continue controlling those around them….

Which brings us to Donald Trump, our next President, and why I believe he’s a sociopath, and thus very dangerous, especially in his new role leading our nation.

First observation: Donald Trump tells lies without the least hesitation.

The lies are near-constant, and on their face, many are absurd. The lie about President Obama not being born in the United States could be disproven in a moment by posing the simple thought problem: Where would Obama’s mother, the teenage daughter of middle-class Midwesterners scraping by on modest salaries in Honolulu, fly to in order to give birth outside her own home country? Fiji? Japan? The Philippines? Chile? Any alternative, non-US locale she could have chosen (ignoring the question of why would she would go to all the trouble of choosing one in the first place and then somehow faking a US birth certificate) would involve an expensive, lengthy flight across thousands of miles of ocean just to place her near-penniless, American, teenage self for no particular purpose, outside the US. Likewise, the endlessly repeated lie that Obama is Muslim (particularly offensive, because it implies there is something wrong with being Muslim) is also flatly absurd, since Obama was raised by his Christian mother and grandparents and barely met, let alone knew, his Muslim father, a visiting graduate student from Kenya. It is absurd to imagine Trump actually believes such nonsense.

However, Trump knew those lies would produce the desired response in an audience of racist, anti-Muslim extremists who hated Obama, and so Trump told those lies. And these are only two of dozens and dozens of outrageous, hateful mistruths he initiated or perpetuated before, during and even after the campaign. Trump knew he could control people, excite them, fire them up, by telling them exactly what he sensed they wanted to hear. He continues to lie, and lie and lie and lie, in order to give whoever is listening to him a chance to hear whatever it was they want to hear and thus fall under his control.

Second observation: Donald Trump has no fixed values, morals or ethical precepts.

(more…)

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Gerald Lucas, a psychotherapist who runs an institute in New York City, used to tell his patients he regretted he couldn’t make the world a better place – he could only make them better able to handle it the way it is.

Sometimes the key to happiness is a little like the key to Weight Watchers – learning to stay away from things that are bad for you.

Luck certainly plays a role.  My relatives fled to the United States from Poland and Lithuania because the Czar and other nasties were oppressive, violent rulers.  Forty years later, Hitler rolled in and committed the worst crimes in human history.  It could have been my relatives in those Nazis death camps, but for dumb luck and the determination to leave the bad behind and seek something better.

The world can seem like an unpleasant place sometimes.  If you need evidence, open this morning’s paper and take a look.

As a psychotherapist, patients bring plenty more proof that evil exists.  It’s a good wake up to some harsh realities.  As with everything else in psychotherapy, awareness is all.

One of my patients was violently raped in her early twenties.  Working with a rape survivor taught me a lot about human dignity and the process of recovery from trauma.  It also taught me about rape.  Knowing someone who has been victimized by violence introduces you the fact that it really happens, to real people, all too often.

This woman gave me a book to read about rape, “Lucky,” by Alice Sebold, the author of “The Lovely Bones.”  It is a memoir of Sebold’s own experience of rape, and a book I shall never forget.  My patient taught me another important lesson:  if something like that happens to you, you will do everything in your power to avoid letting it happen again.  She took a self-defense class, carried a can of mace, and never again walked home alone late at night.  There are predators out there, and at very least, you can take all available precautions.

So this week, when a beautiful young female patient complained to me about what she’d been through recently, I wasn’t surprised.  In the past year she’d had a guy slip a drug into her drink, an older man – a professor, no less – approach her inappropriately for sex, countless construction workers whistle at her, and a best friend fall victim to domestic violence, then return to the boyfriend who beat her up.  It was quite a list, but I believed every word.  We talked about how she could be careful – and stay away from people who mean her no good.

Another patient I saw recently had a run in with a sociopath, a person who lacks a conscience.  A sociopath will tell you whatever you want to hear, take pleasure in lying to you and generally not give your feelings a thought as he pursues his own agenda.  “Sociopath,” or the technical term, “Anti-social Personality Disorder,” are arguably just mental health lingo for a criminal.  Many of the people who populate our prisons – the hard-core law-breakers – are socipaths.

The sort of run-in that happened to my patient could happen to anyone, and all too often it does.  It’s not a nice experience.  This guy was very charming, and appeared to have a successful career.  He moved in with her and said he wanted to marry her and have a child.  What he didn’t mention was that he already had a family – a wife and children – who knew nothing about this other relationship.  The “business trips” were spent with this family, 20 blocks away.

My patient asked what she could do now that she’d discovered the truth.  I gave her my blanket advice for dealing with sociopaths:  stay far away.  She moved somewhere else, and hasn’t seen him since.

Obviously, women aren’t the only people who are victimized by evil deeds – although they do seem to receive more than their fair share.  Children are victimized in terrible ways each and every day, and  I’ve worked with adult men who have survived domestic violence, sexual abuse and other ills.  Bad things can happen to anyone.

My point here isn’t that the world and everyone and everything in it are bad.  There is plenty of good out there, too.  It’s just that you need to keep what is bad far away – and, at the same time, pull the good nice and close.

In everyday life, that means more than just staying away from predators and sociopaths.

It also means:

Don’t date someone if he doesn’t treat you with kindness, consideration and respect.  He should be grateful and appreciative to have you in his life – or you can find someone who will be.

Don’t work in a setting that is hostile or toxic.  Your workplace should make you feel appreciated for the work you do.  You should look forward to coming in to work each day – or you should work someplace else.

Don’t consider someone a friend unless he’s got your back.  “Friend” is a powerful term – it means someone you can say anything to and who can say anything to you.  It implies loyalty, caring, trust and respect.  Anything less is an “acquaintance.”

Breathe in the good.  Breathe out the bad.

Sometimes it’s that simple.

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