Here’s the prologue to The Other Side of Charm.
I’m going to start you off by talking about psychopaths. Why not? I can’t think of a better way to start off a story about how a charming, apparently caring man can maintain a sparkling smile as he devastates you. Maybe you’ll recognize some of these tendencies in people you know. Maybe you’ll be surprised.
So let’s talk about it.
Psychopath. Sociopath. Antisocial Personality Disorder. The labels are muddled and confusing because the field is equally so. The terms “psychopath” and “sociopath” are used interchangeably in the literature and by professionals. The exception to this is while establishing a formal diagnosis, because then it’s most proper (at least in 2013) to use the label “Antisocial Personality Disorder.” But to keep it basic, all of these words refer to a specific diagnosis that research has indicated can be applied to 1 out of every 25 people in our general population.*
1 out of 25.
That’s a pretty prolific diagnosis.
But it’s also a confusing diagnosis. What’s it called? Why all these different labels? What does it look like? What does it mean? How does a sociopath behave and how can I tell?
Most people can’t.
Most people get confused. And not just by the niceness of many sociopaths, but by the messy complexity of properly applying the established diagnostic code. For example, it’s easy to confuse and misread the behaviors of a person with an Attachment Disorder with the characteristic sociopathic tendencies. But you have to be careful. Because while a sociopath may be incapable of forming attachments, the criteria for diagnosis are broader. They’re different disorders. The issue is that it’s apparently difficult for clinicians to see, experience, and identify the differences accurately. A clinician may look at the sometimes cruel or violent behavior of a traumatized and neglected individual who is suffering from Attachment Disorder and think “psychopath” and pursue the diagnosis of Antisocial Personality Disorder. The same clinician may feel the warmth behind the smile of a hand-shaking client who talks incessantly about family values and how his daughter may need a bit of help because she’s been hearing voices lately and is saying things that just don’t make sense. This clinician will not likely think “psychopath” and will not immediately suspect that the daughter is starting to speak the truth about family incest and that her sociopathic father is simply ensuring that no one will believe her. She may be hospitalized. Institutionalized. Her father may run your local Rotary Club and coach your son’s team. He may show up for everything. He may be the most likable person you ever met. He may be a sociopath.
If he is, he will never feel remorse. That’s the key. He may fully believe that his daughter brought it on herself, and he won’t care, anyway, as long as he wins.
He has no conscience.
He will hug her and may even cry over her declining mental health when the camera’s pointed at him.
You will never see him for who he is. What’s scary is that most clinicians won’t, either.
I’m not an expert, I’m not a researcher, and I’m not leading the field. I’m an average clinician with limited experience—as are most mental health professionals that any of us will encounter in our lives. I simply have enough knowledge and personal experience to understand that any human being who is involved in the prevention, diagnosis, or treatment of any form of abuse in any vulnerable population needs more training in the assessment of sociopaths, psychopaths, or individuals with Antisocial Personality Disorder. The fact that we don’t have a clear and consistent way to talk about these individuals is a small indication of a huge, confusing mess.
Who can see us through it? Research shows that untrained college students are as accurate in detecting deception as CIA and FBI agents.** That none of us—no one, anywhere, at any level of training—can detect a liar as well as we think we can. You know what that means?
It means we’re all vulnerable.
Even the professionals. But we’d all like to know who’s out to get us. So let’s talk just a bit more about identifying these individuals and labeling them through diagnoses. The fields of psychiatry, counseling, psychology, social work, psychotherapy, and so on generally utilize a manual for establishing diagnoses that is called the Diagnostic and Statistical Manual, or DSM. I was trained in the fourth edition, the DSM-IV. In 2013, clinical professionals are in the process of being trained to use the fifth edition, the DSM-V. Essentially, this manual standardizes mental illness and provides clinicians with a common language and code for diagnosis along with a uniform system for obtaining payments from health insurance companies. Choosing a diagnosis is not an option—if a clinician wants to be paid through health insurance or if a client needs or wants to continue in therapy in a way that is supported and reimbursed by an insurance company, then a diagnostic code is mandatory. You get a label.
That being said, the creation and use of the DSM is controversial. Who wrote the book? Who defines mental illness for our society? Who is diagnosing who and for what benefit? Who is it that benefits? Those questions are not the overarching topic of this book. My point is simply to educate—to make unfamiliar readers aware of issues that do exist in the field. It’s always important to question whether a certain group of professionals or body of work are benefiting humanity—and ask how they might do better.
I’m a licensed mental health professional. Today, I can pick up the DSM-IV and eventually the DSM-V, and I can legally use it under supervision to assign diagnoses to my clients. Not only can I do this, but I am impelled to do this by the system that manages our health care and well-being. Using the DSM-IV, I can diagnose a psychopathic or a sociopathic individual as having “Antisocial Personality Disorder.”
My issue with this power that I have is that I have absolutely zero training—nothing—nada—to guide me in this specific type of assessment.
But that doesn’t necessarily stop other untrained clinicians from jumping right in. In fact, we’re encouraged and even pressured (under supervision) to do so. If you work for a practice or a clinic or an agency, they want paid. The way to get paid is to get their clinicians to assign a label.
Diagnoses are tied to paychecks. But I’m cautious.
I don’t want to give the diagnosis of Antisocial Personality Disorder and be wrong. Yes, I’m supervised. And yes, I have to admit that at this point in my life, I probably have a better ability to detect these traits than probably 90% of the professionals in my field. The number may be higher. But I’m not bragging. It’s the reverse—I’m simply pointing out that the number of professionals who can accurately diagnose another human being with Antisocial Personality Disorder (a psychopath or sociopath, remember) is so small that most of us will not get it right.
And that’s scary.
And if this “disorder” affects 1 in 25 people,* then it seems to me that we all need further training in assessment—stat. Especially when you realize that this disorder is incurable and potentially has a physiological basis.*** Especially when you realize that a troubled teen who is acting out his or her own abuse and neglect may be labeled “Antisocial” and have to share that mislabel with “true” psychopaths both internally and on record for the rest of his or her life. Especially when you realize that the presence of an unidentified sociopath in group therapy or family therapy or any other type of therapy will completely change the success rates of that therapeutic process for everyone involved. How can a family heal in therapy when a sociopath is dropping bombs on their progress and no one, not even the clinician, can see what’s happening behind the smoke and mirrors of an incredibly charming and manipulative human being? In individual therapy, I would venture to guess that every therapist I know has been fooled into thinking that their undiagnosed sociopathic client was making big progress and really embracing the work.
It’s a fool’s game.
Even further, the failure to identify sociopathic individuals extends far beyond the mental health field. I’ve witnessed and experienced enormously devastating systemic failures in the legal, justice, and law enforcement systems to date, and I’ve also experienced the gaps between these institutions. It’s even bigger than confusion and a lack of education. Court-approved (admissible) forensic psychiatric evaluations cost thousands and thousands of dollars each, and their success depends entirely on the training and capabilities of the administering clinician. These assessments are reserved for the rich and can potentially be used as a weapon to hurt and label the victim of a better-funded (potentially sociopathic) individual. It’s easy to label people who are suffering. It’s sometimes impossible to label a perpetrator. I’ve watched for years as very clear sociopathic behaviors have been missed entirely by mental health professionals and educators and advocates who are trained to see but remain blind—sometimes by charm, sometimes by choice. And I’ve watched my children suffer trauma and degradation almost daily for the past ten years as a result of these ineptitudes—in a system that not only fails to protect them, but prevents parents and caregivers like me from doing it as well.
I believe there are millions living out this story in the United States.
That belief makes this story not only mine, but yours.
*The Sociopath Next Door, Martha Stout, Ph.D.
**Predators: Pedophiles, Rapists, and Other Sex Offenders, Anna Salter, Ph.D.
***Without Conscience: The Disturbing World of the Psychopaths Among Us, Robert Hare, Ph.D.