madli

OK - I'll bite. Just this one post and then I'm not playing anymore.

So I am a psychiatrist, and yes, you probably are a psychopath.

I am a mental health professional (Kramus' "reliable source"), but the only way for you to get a reliable diagnosis is through assessment by a forensic psychiatrist specially trained in administering the Hare PCL-R - a clinician-rated psychopathy checklist. Although I find the area fascinating, I am not trained in the PCL-R and I am far from a forensic psychiatrist. You'd have to commit a crime in order to see a forensic psychiatrist, so let's try not to go there, OK?

You don't need the label - antisocial personality disorder, sociopath, psychopath - they are all the same thing, just older and newer terms. You know what traits you have, you're trying to understand them and decide what to do with them. In some ways, that's commendable - in every way, this kind of self-reflection and evaluation is understandable. Sort of cool that you're turning to TFP to act as your mirror and scope out what the common denominator looks like. The internet is amazing - I wonder how many psychopaths have had that opportunity in the past?

You are more than a Narcissistic Personality Disorder. Narcissists lack empathy and are self-centred, but they do have a moral compass and are capable of guilt and narcissistic injury. Narcissism is more like a psychological defense, an overcompensation for profound and deep seated low self-worth. Psychopaths are something entirely different - it's not a psychological defense - there is some biological aberrant circuitry going on. Have a look through Barb Oakley's Evil Genes (a fun read actually) to see the evidence for the biological loading.

So here's my take. Most clinicians see the primary defect in psychopathy as a lack of capacity for empathy (fascinating topic - mirror neurons and empathy - there are other conditions associated with hyper-empathy which can lead to pathological altruism - but that's a whole other thread). I actually think the empathy circuits must be intact - theory of mind (the ability to imagine what another feels) and empathy (to feel what others feel) are very tightly linked neurologically - and are very necessary capacities for being a good manipulator. Maybe a psychopath knows what you feel, but doesn't care - but I suspect it's got more to do with a problem in moral judgment (ability to feel guilt). Secondarily, I think the moral defect may be socially acquired.

What if the psychopath is born with a defect in the emotional attachment system (ability to form emotional bonds, another whole separate topic) - and that difference ostracizes them from their loved ones from the get go. Children need to feel attached to their parents to care about behaving well, etc. The psychopathic child must be constantly reprimanded for not caring enough to correct their behaviour, constantly told they are selfish, wrong, bad - but unlike "normal" children, the inherent selfishness which is part of being human and must socialized out of us by our parents, doesn't get socialized out of psychopaths. I wonder if all that punitive conditioning fuels cruelty, distrust and a need for control, and the chronic absence of emotional bonds fuels feelings of emptiness, which can become almost painful. In order to feel something, to test if they can feel anything, the psychopathic child tortures animals to see if some feelings can be invoked (sort of like people with borderline personality disorder, who cut themselves in order to feel something). The pattern continues into adulthood, where peers also reject and malign them (as is illustrated by the perspective of many on this thread), further fueling anti-social desires.

In short, what I'm saying is that it's not really that psychopaths are untreatable - it's that we don't understand their biology and psychology well enough to know how to treat them. The psychotherapeutic approach we've taken so far is wrong, it is based on trying to establish a therapeutic relationship and providing empathy and that only makes for a better psychopath. It is also likely delivered too late - to criminals in prison. The key may be to catch the psychopathic child and provide that child with an informed, supportive and therapeutic relationship.

- or to catch early adult psychopaths, on the cusp of self-discovery like the OP, before he's done anything serious. There you go - my attempt at being supportive and empathic with you. What you do with it is up to you - become a better psychopath or a better person. You have no real control (or blame) for how you feel, you can only control (and be accountable for) your actions.