Bob Schwartz

Category: Psychology

DSM-5: Antisocial Personality Disorder (Sociopathy)

Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
Impulsivity or failure to plan ahead.
Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

Individuals with antisocial personality disorder frequently lack empathy and tend to be callous, cynical, and contemptuous of the feelings, rights, and sufferings of others.

These individuals may also be irresponsible and exploitative in their sexual relationships. They may have a history of many sexual partners and may never have sustained a monogamous relationship.

This post about Antisocial Personality Disorder (Sociopathy) is a sequel to one of my most popular posts, published more than a year ago: DSM-5: Antagonism and Narcissistic Personality Disorder.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the “bible” of the mental health profession—“a classification of mental disorders with associated criteria designed to facilitate more reliable diagnoses of these disorders.” It is worth repeating here that mental health diagnosis should ultimately be left to trained clinicians. Nevertheless, intelligent non-professionals may gain important insights by reviewing the literature about significant personality disorders.


Antisocial Personality Disorder

Diagnostic Criteria

A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following:

  1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
  2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
  3. Impulsivity or failure to plan ahead.
  4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
  5. Reckless disregard for safety of self or others.
  6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
  7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

Diagnostic Features

The essential feature of antisocial personality disorder is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. This pattern has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder. Because deceit and manipulation are central features of antisocial personality disorder, it may be especially helpful to integrate information acquired from systematic clinical assessment with information collected from collateral sources.

Individuals with antisocial personality disorder fail to conform to social norms with respect to lawful behavior. They may repeatedly perform acts that are grounds for arrest (whether they are arrested or not), such as destroying property, harassing others, stealing, or pursuing illegal occupations. Persons with this disorder disregard the wishes, rights, or feelings of others. They are frequently deceitful and manipulative in order to gain personal profit or pleasure (e.g., to obtain money, sex, or power). They may repeatedly lie, use an alias, con others, or malinger. A pattern of impulsivity may be manifested by a failure to plan ahead. Decisions are made on the spur of the moment, without forethought and without consideration for the consequences to self or others; this may lead to sudden changes of jobs, residences, or relationships.

Financial irresponsibility is indicated by acts such as defaulting on debts, failing to provide child support, or failing to support other dependents on a regular basis. Individuals with antisocial personality disorder show little remorse for the consequences of their acts. They may be indifferent to, or provide a superficial rationalization for, having hurt, mistreated, or stolen from someone (e.g., ‘Tife’s unfair,” “losers deserve to lose”). These individuals may blame the victims for being foolish, helpless, or deserving their fate (e.g., “he had it coming anyway”); they may minimize the harmful consequences of their actions; or they may simply indicate complete indifference. They generally fail to compensate or make amends for their behavior. They may believe that everyone is out to “help number one” and that one should stop at nothing to avoid being pushed around.

Associated Features Supporting Diagnosis

Individuals with antisocial personality disorder frequently lack empathy and tend to be callous, cynical, and contemptuous of the feelings, rights, and sufferings of others. They may have an inflated and arrogant self-appraisal (e.g., feel that ordinary work is beneath them or lack a realistic concern about their current problems or their future) and may be excessively opinionated, self-assured, or cocky. They may display a glib, superficial charm and can be quite voluble and verbally facile (e.g., using technical terms or jargon that might impress someone who is unfamiliar with the topic).

These individuals may also be irresponsible and exploitative in their sexual relationships. They may have a history of many sexual partners and may never have sustained a monogamous relationship.

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The I Ching on Hardship

The ancient sages experienced the hardship of climbing a mountain as well as crossing a river. They also experienced all kinds of hardship in their life journey. Some hardships were avoidable, but others were unavoidable. If one has the right attitude, no matter what kind of hardships there are, they can be overcome….If it is not the right time to overcome hardship, one should keep still. Keeping still does not mean giving up. It is just yielding to the situation and waiting for a more auspicious time.
Alfred Huang, The Complete I Ching, Hexagram 39

There are so many sincere, good-hearted and helpful messages being generated at this sad moment of some very public suicides. There is no need for me to add my own thoughts.

But I did wonder if the I Ching, that trusted well of wisdom, might have something to say. It never fails; it didn’t this time.

In answer to the question of suicide, the answer was Hexagram 39—Jian/Hardship.


39
Jian/Hardship

NAME AND STRUCTURE

Originally, Jian meant lame or a lame person. From lame, its meaning extends to encompass difficulty in walking or hardship. Wilhelm translates Jian as obstruction; Blofeld translates it as Trouble. In this book I use Hardship.

Sequence of the Gua: If there is misunderstanding and diversity in a household, surely hardship will result. Thus, after Diversity, Hardship follows.

The ideograph of the gua shows its original meaning—a lame person having difficulty walking. At the top of the ideograph is the roof of a house with a chimney. Below it there is an ideograph of a person, ren. Between the roof and the person, there are two bundles of grass, representing bedding. These images form the upper part of the ideograph: a picture of a person under the roof of a house covered with two pieces of thick bedding to resist the cold. At the bottom, there is an ideograph of a foot. On each side of the foot and underneath the person a pair of crutches is drawn. One can visualize the crutches under the armpits of the person with a lame leg. The blood circulation of a lame leg is poor, thus the image of a cold foot was used to demonstrate a lame person’s difficulty with walking.

The structure of the gua is Water above, Mountain below. It represents a situation of hardship following hardship. Climbing a mountain and crossing a river are arduous undertakings. The attribute of Water is darkness and of Mountain is keeping still. If it is not the right time to overcome hardship, one should keep still. Keeping still does not mean giving up. It is just yielding to the situation and waiting for a more auspicious time. If the proper time comes, it is favorable to seek union or to consult a noble person for constructive advice. Any premature advance will entail risk. Overcoming hardship depends on the correct time, situation, and companions—in Chinese terms Heaven, earth, and human beings, the three primary elements….

Decision

Hardship.
Favorable to the southwest.
Unfavorable to the northeast.
Favorable to see a great person. Being steadfast and upright: good fortune.

Commentary on the Decision

Jian is Hardship.
Danger in front.
Seeing the danger and knowing to stand still,
Being conscious and wise.

Hardship.
Favorable in the southwest.
Going forward obtains the central place.
Unfavorable in the northeast.
There is no way out.

Favorable to see a great person;
Going forward, there is achievement.

Proper position,
Being steadfast and upright,
Good fortune,
Rectifying the country.
Great indeed is the function and time of hardship!

Commentary on the Symbol

Water on the Mountain.
An image of Hardship.
In correspondence with this,
The superior person is introspective to cultivate his virtue.

SIGNIFICANCE

Water above Mountain is an image of hardship following hardship. There is no way to totally avoid hardship in one’s life. Hardship should be overcome; calamity can be prevented. One should not always let things take their own course and resign oneself to one’s fate. This gua tells us how to deal with hardship. The ancient sages experienced the hardship of climbing a mountain as well as crossing a river. They also experienced all kinds of hardship in their life journey. Some hardships were avoidable, but others were unavoidable. If one has the right attitude, no matter what kind of hardships there are, they can be overcome.

Trump’s Ties: The Tragic Comic Idiosyncrasies of Dictators

“The general contemporary rule of thumb is that your tie should fall right at the top of your belt buckle, regardless of tie length, style of the tie, or how tall you are.”

Sometimes, as the Freudian cliche goes, a cigar is just a cigar. And a tie is just a tie.

In the case of Trump’s ludicrously long ties, which point at his crotch, it’s obvious something else is going on.

Dictators are often known for their idiosyncrasies. Sometimes there is a psychological basis. Sometimes it is a signature, part of a brand. Sometimes it is just a personal preference. Fidel Castro, for example, was associated with his cigar, which he obviously liked, which is Cuba’s best-known product, and which, well, is more than a cigar.

Trump is the first president to regularly refer to the size of his “hands”, his “button”, and once in a while, almost directly, his “penis”. The only evidence we have so far about this is from Stormy Daniels, who has only said that Trump is “average.” God willing, that is the only detail we ever have to deal with. But absent evidence, we only have Trump’s word for it. We all know what that’s worth. So most people don’t believe him. Or his ties.

Proof of Dreams

Proof of Dreams

The dreams of last night’s sleep
Are as real and present
As this morning’s coffee.
Otherwise how could they
Poke and tug and shake
As we move on and say
They are over.

©

The Essential James Hillman: A Blue Fire

I cannot fully explain James Hillman in this space, not briefly, not at all. If there is a badge, it might say psychologist, or Jungian psychologist, but that would be misleading, limiting and wrong. Thomas Moore, in his Prologue to The Essential James Hillman: A Blue Fire, begins with this:

James Hillman is an artist of psychology. If it sounds odd to call a psychologist an artist, then you, the reader, know your task as you take up this anthology. You will be challenged all along the way to rethink, to re-vision, and to reimagine. The difficulty in reading Hillman is not to learn a new bag of techniques or a new conceptual system. Hillman demands nothing short of a new way of thinking. He takes psychoanalysis out of the context of medicine and health, not only in the obvious ways, rejecting the medical model, but in subtle ways: asking us to give up fantasies of cure, repair, growth, self-improvement, understanding, and well-being as primary motives for psychological work. He is more a painter than a physician, more a musician than a social scientist, and more an alchemist than a traditional philosopher.

Hillman has written many books and articles, but A Blue Fire, made up of short passages from many works, is what to read to get the essence. Choosing a representative excerpt is impossible, since it is bound to miss most other points Hillman makes. But the excerpt below, covering the nature of illiteracy, silence and imagination, is close to my heart, and to some of our life in 2018: “An education that in any way neglects imagination is an education into psychopathy. It is an education that results in a sociopathic society of manipulations. We learn how to deal with others and become a society of dealers.”


Why have we as a nation become more and more illiterate? We blame television and the computer, but they are not causes. They are results of a prior condition that invited them in. They arrived to fill a gap. When imaginative ability declines, other ways to communicate appear. These ways work even though they too are dyslexic in structure: simultaneity of bits, odd juxtapositions, messages that do not move linearly from left to right. Yet television and personal computers communicate.

Evidently, reading does not depend solely on the ordering of words or the ordering of letters in the words. Indeed, poets use dyslexic structures deliberately. Reading depends on the psyche’s capacity to enter imagination. Reading is more like dreaming, which, too, goes on in silence. Our illiteracy reflects our educative process away from the silent grounds of reading: silent study halls and quiet periods, solitary homework, learning by heart, listening through a whole class without interruptions, writing an essay exam in longhand, drawing from nature instead of lab experiments. This long neglect of imaginational conditions that foster reading—Sputnik and the new math; social problems and social relatedness; mecentered motivation; the confusion of information with knowledge, of opinion with judgment, and trivia with sources; communications as messages by telephone calls and answering machines rather than as letter writing in silence; learning to speak up without first having something learned to say; multiple choice and scoring as a test of comprehension—has produced illiteracy.

The human person as a data bank does not need to read more than functionally. A data bank deciding yes or no on the basis of feedback (i.e., reinforcement) need not imagine beyond getting, storing, and spending. Just get the instructions right; never mind the content. Learn the how rather than the what with its qualities, values, and subtleties. Then the human agent becomes an incarnated credit card performing the religious rituals of consumerism. You need only be able to sign your name in the space marked Xy like an immigrant, like a slave, or a …

Or a psychopath. Descriptions of psychopathy, or sociopathic personalities, speak of their inability to imagine the other. Psychopaths are well able to size up situations and charm people. They perceive, assess, and relate, making use of any opportunity. Hence their successful manipulations of others. But the psychopath is far less able to imagine the other beyond a fantasy of usefulness, the other as a true interiority with his or her own needs, intentions, and feelings. An education that in any way neglects imagination is an education into psychopathy. It is an education that results in a sociopathic society of manipulations. We learn how to deal with others and become a society of dealers.

James Hillman
“Right to Remain Silent”
Journal of Humanistic Education and Development (1988)

Crazy Like a Fox and Friends: After the Laughter It Is Not At All Funny

Discomfort and despair has led to dark laughter as we listen to Trump’s half-hour unraveling/meltdown in his call-in monologue on Fox and Friends yesterday. Of course it is not actually funny.

Except for willfully oblivious Republicans, Trump’s instability is obvious to everyone. There is wide agreement not only that the thirty minutes of nearly uninterrupted chatter was often nonsensical and non-sequitur, but that if the Fox and Friends hosts—who were clearly aghast—had not intervened (“you have a million things to do, Mr. President”), Trump might have gone on blathering for hours.

Why Republicans ignore, excuse and put up with just about anything Trump dishes out, including rants that beg for a psychological evaluation, is best told by an old and wise joke:

Guy walks into a psychiatrist’s office. “Doc,” he says, “my brother thinks he’s a chicken.” Doctor says, “Bring him in and I’m sure I can help him.” Guy says, “I would Doc, but we need the eggs.”

Is Trump Experiencing a Break With Reality?

“Trump suggested to a senator earlier this year that [the “Access Hollywood” tape] was not authentic, and repeated that claim to an adviser more recently.”

The New York Times reports:

But something deeper has been consuming Mr. Trump. He sees the calls for Mr. Moore to step aside as a version of the response to the now-famous “Access Hollywood” tape, in which he boasted about grabbing women’s genitalia, and the flood of groping accusations against him that followed soon after. He suggested to a senator earlier this year that it was not authentic, and repeated that claim to an adviser more recently. (In the hours after it was revealed in October 2016, Mr. Trump acknowledged that the voice was his, and he apologized.)

The least controversial interpretation is that Trump is doing what he frequently does: saying something untrue in the face of incontrovertible evidence to the contrary to escape an inconvenient situation. Or, as even Republicans admit, he lies.

But sometimes you wonder, as when candidate Trump said he saw people cheering the attacks on 9/11:

Republican presidential candidate Donald Trump says he saw people cheering the Sept. 11 attacks across the river in New Jersey — a claim officials strongly deny.

Trump first told the story Saturday at a rally in Birmingham, Alabama, as he pressed the need for greater surveillance, including monitoring certain mosques, in the wake of the Paris attacks.

“I watched when the World Trade Center came tumbling down. And I watched in Jersey City, New Jersey, where thousands and thousands of people were cheering as that building was coming down. Thousands of people were cheering,” Trump said Saturday at a rally in Birmingham, Alabama.

Trump repeated the assertion Sunday in an interview with George Stephanopoulos on ABC’s “This Week,” as Stephanopoulos explained to Trump that police had refuted any such rumors at the time.

“It did happen. I saw it,” said Trump. “It was on television. I saw it.”

It was simple to dismiss this as political prevarication. But the sincerity with which he said it might indicate he really did see it, or thought he did. In the current revision of history, he says he no longer believes that he spoke the words that appear to be coming out of his mouth—even though he previously acknowledged it.

So maybe Trump really does now believe he never said the words he is shown saying and admits saying. If that is the case, it is evidence that somehow he is experiencing a break with reality. There is no clinical definition of the term “mental breakdown”, but the clinical conditions related to this sort of break can be exacerbated or triggered by extreme stress. However Trump got himself into his current situation, and whether or not he was predisposed to mental problems before he took office, he is now in a situation that offers little opportunity for a clean escape. It would not be surprising if anyone under that kind of pressure might no longer know the difference between the real and unreal, the true and untrue. If the person is president, the stakes are immeasurably high.

Don’t Play the Madman’s Game (Heart of Darkness)

In the face of current events in America, it is easy to say something heartfelt, progressive, outraged, rational and clever. I am tempted, but decline and leave that to other more articulate voices.

Instead, what I want to say right now is this: don’t play the madman’s game. Social and political situations are real and affect the lives of many, and we want to make things better, for ourselves and others. But loud and powerful lunatics can quickly draw us into their craziness, even as we think we are doing the right thing by criticizing, resisting and opposing. Before you venture into the heart of darkness, try to be sure of your own light.

Note: Some literary and film folks may recognize the reference to “heart of darkness.” It is the title of a Joseph Conrad novella, which was the inspiration for Francis Ford Coppola’s Vietnam War movie Apocalypse Now. In unsettled times, in strange lands, charismatic and crazy leaders may emerge, not so much products of the environment as reflections of it, or at least part of it. Read or reread Heart of Darkness, watch or rewatch Apocalypse Now. “Mistah Kurtz—he dead.”

Brain Fiction: Self-Deception and the Riddle of Confabulation

What if someone lies in the face of overwhelming contrary evidence? What if that person really believes what he is saying?

Confabulation is the construction of false answers to a question while genuinely believing that you are telling the truth.

This mysterious phenomenon usually accompanies neurological or cognitive disorders, and the puzzle of it has been the subject of some study among researchers. In his book Brain Fiction: Self-Deception and the Riddle of Confabulation, William Hirstein takes this study further than it has gone before:

“Both a neuroscientist and a philosopher, William Hirstein writes from his unique vantage point with great scholarship, precision, and clarity to tackle some of the deeper mysteries of the human mind. Brain Fiction is full of profound insights, and I recommend it to all who wish to better understand our human nature.”

—Fredric Schiffer, M.D., Harvard Medical School, author of Of Two Minds

Here is a description of the book:

Some neurological patients exhibit a striking tendency to confabulate—to construct false answers to a question while genuinely believing that they are telling the truth. A stroke victim, for example, will describe in detail a conference he attended over the weekend when in fact he has not left the hospital. Normal people, too, sometimes have a tendency to confabulate; rather than admitting “I don’t know,” some people will make up an answer or an explanation and express it with complete conviction. In Brain Fiction, William Hirstein examines confabulation and argues that its causes are not merely technical issues in neurology or cognitive science but deeply revealing about the structure of the human intellect.

Hirstein describes confabulation as the failure of a normal checking or censoring process in the brain—the failure to recognize that a false answer is fantasy, not reality. Thus, he argues, the creative ability to construct a plausible-sounding response and some ability to check that response are separate in the human brain. Hirstein sees the dialectic between the creative and checking processes—”the inner dialogue”—as an important part of our mental life. In constructing a theory of confabulation, Hirstein integrates perspectives from different fields, including philosophy, neuroscience, and psychology to achieve a natural mix of conceptual issues usually treated by philosophers with purely empirical issues; information about the distribution of certain blood vessels in the prefrontal lobes of the brain, for example, or the behavior of split-brain patients can shed light on the classic questions of philosophy of mind, including questions about the function of consciousness. This first book-length study of confabulation breaks ground in both philosophy and cognitive science.

A sample chapter can be read here. A couple of brief excerpts:

Why then does confabulation happen? Confabulation seems to involve two sorts of errors. First, a false response is created. Second, having thought of or spoken the false response, the patient fails to check, examine it and recognize its falsity. A normal person, we want to say, would notice the falsity or absurdity of such claims. The patient should have either not created the false response or, having created it, should have censored or corrected it. We do this sort of censoring in our normal lives. If I ask you whether you have ever been to Siberia, for instance, an image might appear in your mind of you wearing a thick fur coat and hat and braving a snowy storm, but you know that this is fantasy, not reality. In very general terms, the confabulating patient lacks the ability to assess his or her situation, and to either answer correctly, or respond that he or she does not know. Apparently, admitting ignorance in response to a question, rather than being an indication of glibness and a low level of function, is a high-level cognitive ability, one that confabulators have lost. ‘‘I don’t know,’’ can be an intelligent answer to a question, or at least an answer indicative of good cognitive health….

Young children sometimes confabulate when asked to recall events. Ackil and Zaragoza (1998) showed first-graders a segment of a film depicting a boy and his experiences at summer camp. Afterward the children were asked questions about it, including questions about events that did not happen in the film. One such question was, ‘‘What did the boy say Sullivan had stolen?’’ when in fact no thefts had taken place in the film. The children were pressed to give some sort of answer, and the experimenters often suggested an answer. When the children were interviewed a week later, the false events as well as the suggested answers had been incorporated into their recollections of the movie.

DSM-5: Paranoia

DSM-5

I did not think that I would be returning to the DSM quite so soon after my recent post.

The caveat in my last post about the DSM bears repeating. Mental health is a serious issue. Using diagnostic tools and terminology merely for entertainment and “pop psychology” can be careless. On the other hand, these tools can help provide insights that may be useful, particularly when the subject and the subject matter are very important or even critical.

Non-professionals talk loosely and colloquially about paranoia. The DSM approaches this clinically and scientifically:

Paranoid Personality Disorder

Diagnostic Criteria

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

  1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
  2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
  3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
  4. Reads hidden demeaning or threatening meanings into benign remarks or events.
  5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
  6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
  7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

Diagnostic Features [selected]

They suspect on the basis of little or no evidence that others are plotting against them and may attack them suddenly, at any time and without reason.

They are preoccupied with unjustified doubts about the loyalty or trustworthiness of their friends and associates, whose actions are minutely scrutinized for evidence of hostile intentions.

They may refuse to answer personal questions, saying that the information is “nobody’s business.”

They read hidden meanings that are demeaning and threatening into benign remarks or events. For example, an individual with this disorder may misinterpret an honest mistake by a store clerk as a deliberate attempt to shortchange, or view a casual humorous remark by a co-worker as a serious character attack.

They may view an offer of help as a criticism that they are not doing well enough on their own.

Individuals with this disorder persistently bear grudges and are unwilling to forgive the insults, injuries, or slights that they think they have received.

Minor slights arouse major hostility, and the hostile feelings persist for a long time.

Because they are constantly vigilant to the harmful intentions of others, they very often feel that their character or reputation has been attacked or that they have been slighted in some other way.

They are quick to counterattack and react with anger to perceived insults.