Sunday, January 28, 2007

Reading The Sociopath Next Door as a Mystery

I just read Martha Stout's 2005 book The Sociopath Next Door (SND). It's a very quick read -- I went through it in a couple of hours, although I admit that I was exercising my right to skim, particularly since it was not a book that I was reading for work or anything like that. It's not a good book in a conventional literary sense -- it's written in a breezy style that is common to pop books about psychiatric conditions and to books in which the author's name is followed by "Ph.D." on the title page. But it is a very interesting book, and one which seems (so far as I can tell) to be fairly careful in its description of the academic field it describes and which usually modulates its judgments with the sort of qualifiers one would want to keep it from getting overblown and silly.

SND is about sociopaths, people without conscience -- described as a condition affecting 1 in 25 people, or about 4% of the population. (The figure is given rather relentlessly and I wonder about its confidence -- its strikes me as a hard thing to measure accurately.) The sense one gets is that some people are born without conscience the way some people are born deaf or blind -- they lack the "seventh sense", as Stout terms conscience.* Of course, Stout talks about sociopathology as deriving from both nature and nurture -- but she does so entirely from analogy to other traits, admitting quite frankly that while all sorts of psychological problems are due to external factors such as abuse, no such links have been found with sociopathology. What links there are are to genetics, and to culture (as distinguished from individually varying nurture) -- Stout notes that sociopaths, while a universal phenomenon, are more common in some cultures than others: they are apparently rare in China and Japan, for example, while they are distressingly and increasingly common in the U.S. (and Stout talks about some of the ways in which U.S. culture might reward sociopathic traits in its emphasis on individuality, competition, cutthroat capitalism, etc.)

Obviously to write a book about something one must be a bit obsessed with it, and Stout does come across as someone who jumps at sociopaths in corners. This makes it all the more gratifying that she is careful not to attribute more to sociopathology than she ought, talking about other reasons for immoral acts such as obedience to immoral authority, desperation, momentary failings of existent consciences, and so forth. But she is trying to warn us about sociopaths; a key purpose of her book is to try and convince us that such people really do exist, that they are common enough that we'll all meet them, and that we have to be careful. (She does not, alas, deal with the social and psychological implications that would result from that idea being more widespread; it seems that the idea that 1 in 25 people were fundamentally untrustworthy, unable to love, without remorse, etc., while presumably perfectly true, would nevertheless be quite destructive if widely believed -- and for at least some individuals if they think upon it too deeply. Blindness to sociopaths may hurt us, but seeing them everywhere might, too.)

She paints the portraits of a number of sociopaths**, describing their varied courses of life -- of course sociopaths vary in every other way: some are smart, some aren't; some are energetic, some lazy; and so forth, so they take many different paths. (Very few turn out to be the Hannibal Lecterian-murderers that we associate with sociopaths; more are what we think of as garden-variety nasty people.)

At any rate, it's a fascinating book, and I recommend it to anyone interested in the subject. (There's another good review here.)

But concurrently with my normal 'what's-this-all-about-then' read, I read it in an entirely different way as well: as a mystery. All the way through, I kept wondering: Is George W. Bush a sociopath?

I should be very clear: Stout never raises the possibility. She does talk about sociopathic leaders, but always referring to people like Hitler or Mussolini -- uncontroversial examples. She says things which tantalizingly hint at her awareness of the issue -- always vague enough to give her full plausible deniability. Still, when she writes things like:
Do sociopaths understand what they are?... Sociopaths are infamous for their refusal to acknowledge responsibility for the decisions they make, or for the outcomes of their decisions. In fact, a refusal to see the results of one's bad behavior as having anything to do with oneself -- "consistent irresponsibility" in the language of the American Psychiatric Association -- is a cornerstone of the antisocial personality diagnosis. (SND, pp. 49 - 50)
or, to pick one of the most blatant examples, brought up in the context of the intimidation that sociopaths use as part of their manipulation of others:
The resolve to keep respect separate from fear is even more crucial for groups and nations. The politician, small or lofty, who menaces the people with frequent reminders of the possibility of crime, violence or terrorism, and who then uses their magnified fear to gain allegiance, is more likely to be a successful con artist than a legitimate leader. This too has been true throughout human history. (SND p. 159)
-- it's impossible to think that she's not making a coy reference to Bush. She is a Harvard-associated clinician; and while universities are not the swamps of liberal oppression that conservatives imply they are, they are certainly liberal in their culture to the extent that what she wrote must have screamed "Bush" to her and to all her readers. Indeed, I suspect that most conservatives would see this as a dig at Bush too -- although maybe not, since to do so would be to admit that Bush was illegitimately magnifying fear, whereas conservatives would probably believe he was simply confronting evil (not practicing it). -- And, of course, her last sentence gives her coy deniability -- nor is it simply deniability, since of course it is true that tyrants throughout history have used fear to gain allegiance.

Still, these passages (both as blatant as the latter and as merely slightly suggestive as the former) are common in the book, and I couldn't help but wonder what Stout thought of it. She might be a conservative who would bristle at the idea -- although, reading the book, I doubt it. I suspect that it was a coy acknowledgement of what many of her readers would think, which still allowed her to avoid the professionally irresponsible notion of diagnosing at a distance. -- Although she does seem willing enough to diagnose someone as a sociopath based on what one of her patients tells her; many of her examples are presented** as people in the lives of her patients. Inaccurate as psychiatry based on (manipulated, manufactured, partial and inevitably misleading) news depictions might be, I can't see why it's that much less reliable than a diagnosis based on patient interviews, particularly since the latter has a great many sources, which must mitigate their individual inaccuracies somewhat.

Anyway, even if one treats Bush's presentation in the media as an essentially fictional character, and discusses it as such, I was struck by how much the DSM-IV diagnosis list fits it. Stout writes:
According to the current bible of psychiatric labels, the Diagnostic and Statistical Manual of Mental Disorders IV of the American Psychiatric Association, the clinical diagnosis of “antisocial personality disorder” should be considered when an individual possesses at least three of the following seven characteristics: (1) failure to conform to social norms; (2) deceitfulness, manipulativeness; (3) impulsivity, failure to plan ahead; (4) irritability, aggressiveness; (5) reckless disregard for the safety of self or others; (6) consistent irresponsibility; (7) lack of remorse after having hurt, mistreated, or stolen from another person. The presence in an individual of any three of these “symptoms,” taken together, is enough to make many psychiatrists suspect the disorder. (SND, p.6)
By my personal count, Bush falls pretty clearly into six of those categories (the exception being #1). In some cases (e.g. #3) this is true for his policies, but not necessarily for his personal relations with people. But even in his personal life, #4, 6 and 7 are frequently documented. And in some cases (e.g. #5) the personal and the political are impossible to disentangle.

Again, this is Bush's media image. Who knows. But his protestations of his own certainty and lack of doubt about his leading the country into war on false premises is striking (compare the stories of Lyndon Johnson, having lead us into an equally unnecessary war, torturing himself with guilt about American deaths); indeed, he recently said that he slept better than most people would think.

Further, most -- not all, but most, probably around the 6/7 that he scores here -- of the other things that Stout says about sociopaths seem to fit Bush as well -- their frequent reliance on drugs and alcohol, for example. Reading the book, one is hit by it over and over and over. I find it impossible to think that Stout thought it, too, and repressed it as much as she needed to for professional integrity, while giving ample material for readers to draw their own conclusions. Since it seems so clear.

Or does it?

In her antepenultimate chapter, Stout considers people at the opposite end of the spectrum -- those who have stronger consciences than the rest of us. And she writes:
In a book that documents their findings entitled Some Do Care: Contemporary Lives of Moral Commitment, [Anne Colby and William Damon] report three striking commonalities among individuals of extreme conscience. The authors label these shared characteristics as (1) "certainty, (2) "positivity," and (3) "unity of self and moral goals." "Certainty" refers to an exceptional clarity concerning what the exemplars believe to be right, and also their sense of an unequivocal personal responsibility to act on those beliefs. "Positivity" expresses the exemplars' affirmative approach to life, their extraordinary enjoyment of their work, and their marked optimism, often despite hardship or even danger. And "unity of self and moral goals" describes the integration of the subjects' moral stance with their conception of their own identity, and the perceived sameness of their moral and personal goals. (SND, p. 194)
Just before I hit this passage, I had just about convinced myself that Stout was playing a coy game. But this gave me pause. I realized at once that it sounded a lot like the descriptions that conservatives tended to give to Bush. Where I, a liberal, saw Bush as having the features of those lacking conscience, conservatives see him as having the features of those with "extreme conscience"! To be sure, not everything here fits (does anyone really think that Bush shows "extraordinary enjoyment of [his] work"?), but a lot -- moral clarity, marked optimism despite danger -- seems to match conservative rhetoric quite powerfully.

So perhaps what I'm seeing is just a reflection of my own beliefs.

Now, I don't in fact believe that. I'm not a relativist. I think that one can distinguish the powerful fit of the sociopath description with the extremely shallow, only apparent fit of the extreme conscience description -- point out that despite Bush's purported moral clarity, there is hardly a principle he hasn't broken, for example, or the fact that his willingness to deal in Rovian dirty tricks to achieve his ends demolishes any notion of "a perceived sameness of their moral and personal goals."

I'm not even sure that Stout would see this; a few of the (few) other things she says about Colby and Damon's categories markedly don't fit, just as many of the other things she says about sociopaths do. For instance, she writes that "Colby and Damon report that most of their moral exemplars are insistent realists regarding the circumstances of human life and their own limited potential to alter those conditions" (SND p. 215). I would guess that while Stout saw the relevance of sociopathology to Bush and decided not to make it explicit (while fairly clearly teasing the idea), she never guessed that anyone would see Bush as a man of extreme conscience. (But of course I don't really know.)

Still, for all that I believe what I believe, and believe that my view is in fact defensible on the available evidence, it did give me pause -- an appropriate twist at the end of the mystery. I had been so sure. Perhaps that was not the conclusion after all.

Finally, I think I should note that, even if it turns out that Bush is, in fact, one of the 4% of the population to lack any sort of conscience, in a lot of ways it doesn't much matter. What's destructive about Bush isn't the fact that he's a sociopath. Sociopaths often do well, since they aren't inhibited from tactics that principled people would shun (such as bald-faced lying, say, or using racist appeals to demonize their opponent in a South Carolina primary. Or whatever.) Ruthlessness can serve people well -- particularly, as Stout points out, in our culture. (She is in fact rather optimistic on this point, suggesting that while sociopaths tend to get ahead, they also tend eventually to self-destruct; her examples fit this, but I wonder if this isn't wishful thinking.) So sociopaths will always be there, to try to charm us, manipulate us and lie to us to get ahead. The problem is if we let them.

The problem isn't Bush. It's the conservative movement that picked this incompetent failure and put him at its head; that wrote disastrous policies for him to implement; that served up incompetent hacks for him to appoint; and that designed an authoritarian cult around this natural-born used-car salesman,*** treating him as an infallible Leader instead of the proudly ignorant bully that he is. It is this last point -- the power of authorities, and the tendency of people to follow them -- that is the real crux of the matter. Indeed, Dr. Stout discusses it at the end of her third chapter, in one of her discussions other things that cause moral harm. Referring to the famous Milgram experiments, she combines Milgram's findings with the statistics on sociopathology and writes:
To illustrate, I propose an imaginary society of exactly one hundred adults, in a group that conforms precisely to known statistics. This means that of the one hundred people in my hypothetical society, four are sociopathic -- they have no conscience. Of the remaining ninety-six decent citizens, all of whom do have consciences, 62.5 percent will obey authority more or less without question, quite possibly the authority of one of the more aggressive and controlling sociopaths in the crowd. This leaves thirty-six people who have both conscience and the strength to bear the burdens of their actions, a little more than a third of the group. These are not impossible odds, but they are not easy ones, either. (SND pp. 68 - 69)
The problem is not Bush; it is those who blindly followed, and follow, him.

But I don't think the odds are as bad as Stout suggests. The Milgram experiments were a particular set-up, with a powerful and unitary authority. Other social structures can be created -- competing authorities to block an single evil from imposing its will. One attempt to do this was the constitution, with its checks and balances (which in turn is perhaps one reason why the Bush administration, and Cheney in particular, are so dedicated to the so-called unitary theory of executive power, which allows them to override those checks and balances). If we can offer competing authorities, then all people of good conscience -- which, according to Dr. Stout's book, is about 96% of us -- will at least have other options than following whichever sociopath' charm allows him to lie his way into a place where he can ply his love of risk and lack of concern for other's lives into disaster for us all.


I was going to leave matters there; but thinking it over, I wanted to return to this issue of the percentage of sociopaths in the population.

As I said, Stout gives the 4% figure rather relentlessly. The first time she mentions it, her notes cite it to four sources -- three journal articles and a book. I have neither the time nor, almost certainly, the technical ability to look these up and evaluate them. But I must admit to deep skepticism. There are all sorts of questions one might ask -- methodology, definitions, representativeness of samples, control for other variables, and so forth; and they should be asked. In particular one might ask about the applicability of the models: one needn't question either the interest of the results of the Milgram experiments, nor their applicability in certain historical and social circumstances, to doubt that the claim that, in ordinary circumstances, "62.5 percent will obey authority more or less without question" is a reasonable conclusion to draw from them. I wonder if a similar extrapolation is going on with the data used to support the 4% figure for sociopaths.

But I think the fundamental reason for my skepticism is that it just doesn't seem to match my experience. I don't feel like 1 in 25 people I know lack conscience; it doesn't sound right. It doesn't fit with the people I know (although as I lay in bed last night, after writing a draft of this entry, I ran through many of them, seeing who might fit -- a tiny example of the corrosive effect that the dissemination of this information might have which I mentioned above.)

Of course, it wouldn't sound right. One of the things that Dr. Stout talks about at length is our blindness to sociopathy -- our unwillingness to see it, the way that sociopaths prey on our consciences and compassion to hide their lack of them, the way that there is no marker or badge to see: that sociopaths often appear normal, even good, to many who know them. So my gut-level rejection of the idea is itself explained in the book.

But it still doesn't feel right. And of course gut-level skepticism is an important check on accepting data -- particularly data from only one source; given legitimate questions about the reliability of the data's determination, it seems odd to say that we should set it aside. (Besides, the second of Dr. Stout's 13 rules for dealing with sociopaths in everyday life is: "In a contest between your instincts and what is implied by the role a person has taken on -- educator, doctor, leader, animal lover, humanist, parent -- go with your instincts." (SND, p. 156.) She meant it about individuals, of course. Still.)

And it's hard to underestimate the importance of the figure for SND's impact -- one of the reason that Stout mentions it so frequently. It's not that what she says would be invalidated or less interesting if the percentage of sociopaths were only .4%, or .04%, of the population -- which is close to what the percentage has been found to be in Taiwan, incidentally. The book would still say a lot of interesting things about morality, psychology and many other things.

But it wouldn't have the same visceral impact -- the same gut-level, emotional punch. It would still be good advice for individual people. But what makes the intellectual content pack a punch above its weight would be gone. The book is so gripping because of its recurring suggestion not only that there are people like this -- in contrast to what Dr. Stout seems to think, I don't find that particularly hard to accept -- but that you know people like this, and more than you think. And it's precisely that that I find myself most skeptical about.

The book is worth reading in any event; it clearly describes a possible dimension of the human condition. But whether that is a dominant feature of our life, or a feature that is just an intellectual curiosity to most of us, is something I am still unconvinced about. Though perhaps, given the tendency of sociopaths to rise to power, even if the percentage is small it is still a phenomenon we should all know more about.

* The sixth sense is the colloquial "sixth sense" or intuition. I get the impulse behind the name -- if she called it the "sixth sense" it would be confusing given the colloquial usage -- but it's awkward in that it somehow takes the idea of the sixth sense too seriously (although I don't think Stout means to).

One might object that conscience isn't a sense, and of course strictly speaking that's true. But it can operate uncannily like a sense -- allow us the empathy that in turn gives us genuine information about the world. It's a sort of a priori sense, whose workings depend upon the reliability of the models we impose upon the world (as opposed to the data we draw from it, as in the other senses). That reliability is not bad, since our sense of other's minds is, after all, honed by evolution; but part of the oddity of dealing with sociopaths is that for them our sense of other's minds fail: they really don't think the way we do, and it's hard to get that through our heads. That's one of Stout's key points.

** Stout's case examples are composites, as well as altered in their details, in order to preserve the privacy of her patients. This is a typical move for popular psychiatry books, but a fascinating one; I may write more about this soon if I find the time.

*** My sincere apologies to any and all used-car salesmen for perpetuating this stereotype.

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