I can't describe the mood I'm in today. Got pulled over for Reckless Driving last night on the way back from a charity show in Richmond. Quite serious. So here is something i was reading today. Enjoy and I'll talk to you guys tomorrow....
Sociopathy is classed as an anti-social personality disorder (APD). As a consequence of their behaviour the sociopath has the image of a cold, heartless, inhuman being. But do all sociopaths show a complete lack of normal emotional capacities and empathy? Like healthy people, many sociopaths love their parents, spouse, children and pets in their own way, but have difficulty loving and trusting the rest of the world. Furthermore, sociopaths do suffer emotionally as a consequence of separation, divorce, death of a beloved person or dissatisfaction with their own deviant behaviour.
Sources of Sadness
Sociopaths can suffer emotional pain for a variety of reasons. Like anyone else, sociopaths have a deep wish to be loved and cared for. This desire remains frequently unfulfilled, however, as it is obviously not easy for another person to get close to someone with such repellent personality characteristics. Sociopaths are at least periodically aware of the effects of their behaviour on others and can be genuinely saddened by their inability to control it. The lives of most sociopaths are devoid of a stable social network or warm, close bonds.
The life histories of sociopaths are often characterized by a chaotic family life, lack of parental attention and guidance, parental substance abuse and antisocial behaviour, poor relationships, divorce, and adverse neighbourhoods. They may feel that they are prisoners of their own etiological determination and believe that they had, in comparison with normal people, fewer opportunities or advantages in life.
Despite their outward arrogance, inside sociopaths feel inferior to others and know they are stigmatized by their own behaviour. Although some sociopaths are superficially adapted to their environment and are even popular, they feel they must carefully hide their true nature because it will not be accepted by others. This leaves sociopaths with a difficult choice: adapt and participate in an empty, unreal life, or do not adapt and live a lonely life isolated from the social community. They see the love and friendship others share and feel dejected knowing they will never take part in it.
Sociopaths are known for needing excessive stimulation, but most foolhardy adventures only end in disillusionment due to conflicts with others and unrealistic expectations. Furthermore, many sociopaths are disheartened by their inability to control their sensation-seeking and are repeatedly confronted with their weaknesses. Although they may attempt to change, low fear response and associated inability to learn from experiences lead to repeated negative, frustrating and depressing confrontations, including trouble with the justice system.
As sociopaths age they are not able to continue their energy-consuming lifestyle and become burned-out and depressed, while they look back on their restless life full of interpersonal discontentment. Their health deteriorates as the effects of their recklessness accumulate.
Emotional Pain and Violence
Social isolation, loneliness and associated emotional pain in sociopaths may precede violent criminal acts. They believe that the whole world is against them, eventually becoming convinced that they deserve special privileges or rights to satisfy their desires. For the rest of us it is unimaginable that sociopaths are so lonely -- yet they describe their loneliness and social failures as unbearably painful. They each created their own sadistic universe to avenge their experiences of rejection, abuse, humiliation, neglect and emotional suffering.
Self-Destruction
Violent sociopaths are at high risk for targeting their aggression toward themselves as much as toward others. A considerable number of sociopaths die a violent death a relatively short time after discharge from forensic psychiatric treatment due to their own behaviour (for instance as a consequence of risky driving or involvement in dangerous situations). Sociopaths may feel that all life is worthless, including their own.
Treatment Developments
In the last decade, neurobiological explanations have become available for many of the traits of sociopathy. For example, impulsivity, recklessness/irresponsibility, hostility and aggressiveness may be determined by abnormal levels of neurochemicals including monoamine oxidase (MAO), serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA), triiodothyronine (T3), free-thyroxine (T4), testosterone, cortisol, adrenocorticotropic hormone (ACTH), and hormones of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes. Other features like sensation-seeking and an incapacity to learn from experiences might be linked to cortical underarousal. Sensation-seeking could also be related to low levels of MAO and cortisol and high concentrations of gonadal hormones, as well as reduced prefrontal grey matter volume. Many sociopaths can thus be considered, at least to some degree, victims of neurobiologically determined behavioural abnormalities that, in turn, create a fixed gulf between them and the rest of the world.
It may be possible to diminish traits like sensation-seeking, impulsivity, aggression and related emotional pain with the help of psychotherapeutic, psychopharmacological and/or neurofeedback treatment. Long-term psychotherapeutic treatment (at least five years) seems effective in some categories of sociopaths.
Psychotherapeutic treatment alone may be insufficient to improve symptoms. Psychopharmacological treatment methods may help normalize neurobiological functions and related behaviour/personality traits. Lithium is impressive in treating antisocial, aggressive and assaultive behaviour. It is found that mood stabilizers such as divalproex (Depakote), selective serotonin reuptake inhibitors, monoamine oxidase inhibitors (MAOIs) and neuroleptics have documented efficacy in treating aggression and affective instability in impulsive patients. To date there have been no controlled studies of the psychopharmacological treatment of other core features of sociopathy. Cortical underarousal and low autonomic activity-reactivity can be substantially reduced with the help of adaptive neurofeedback techniques.
Case Study
"Ben" was raised by his aunt, as his parents were divorced and neither were capable of or interested in caring for him. As a child and adolescent, he had numerous encounters with law enforcement for joyriding, theft, burglary, fraud, assault and battery. He was sent to reform school twice. When he was 21 years old, he was convicted of armed robbery and served a year and a half in jail. His only close friend was another violent criminal; he had many short-term relationships with girlfriends. At 29, he killed two strangers in a bar who had insulted him and was sentenced to forensic psychiatric treatment. Norman was diagnosed as a sociopath.
Ben showed little improvement over the course of seven years of behavioural psychotherapy and became less and less motivated. The staff of the forensic psychiatric hospital considered him untreatable and intended to stop all treatment attempts. Ben's lawyer arranged for an examination by a forensic neurologist, who subsequently found that Ben suffered from severe cortical underarousal, 5-HT and MAO abnormalities, and concentration problems.
Ben was started on d,l-fenfluramine (Pondimin), a serotonin-releasing drug. Acute challenge doses (0.2 mg/kg to 0.4 mg/kg) produced significant dose-dependent decreases in impulsive and aggressive responses. After one month, an MAOI (pargyline [Eutonyl], 10 mg/kg) and psychodynamic psychotherapy were added. Pargyline produced some normalization of his electroencephalogram (EEG) pattern and was titrated up to 20 mg/kg over five months. Neurofeedback was started after two months and continued for 15 months. His EEG pattern gradually normalized, and his capacities for concentration and attention increased.
Ben continued to receive d,l-fenfluramine and psychotherapy for two years, at which point he was discharged from forensic treatment. He voluntarily continued psychotherapy for an additional three years and, in the four years since his release, has not re-offended.
Conclusions
It is extremely important to recognize hidden suffering, loneliness and lack of self-esteem as risk factors for violent, criminal behaviour in sociopaths. Studying the statements of violent criminal sociopaths sheds light on their striking and specific vulnerability and emotional pain. More experimental psychopharmacological, neurofeedback and combined psychotherapeutic research is needed to prevent and treat sociopathic behaviour.
The current picture of the sociopath, which is reflected in the leading diagnostic criteria of sociopathy is incomplete because emotional suffering and loneliness are ignored. When these aspects are considered, our conception of the sociopath goes beyond the heartless and becomes more human.
Sociopathy is classed as an anti-social personality disorder (APD). As a consequence of their behaviour the sociopath has the image of a cold, heartless, inhuman being. But do all sociopaths show a complete lack of normal emotional capacities and empathy? Like healthy people, many sociopaths love their parents, spouse, children and pets in their own way, but have difficulty loving and trusting the rest of the world. Furthermore, sociopaths do suffer emotionally as a consequence of separation, divorce, death of a beloved person or dissatisfaction with their own deviant behaviour.
Sources of Sadness
Sociopaths can suffer emotional pain for a variety of reasons. Like anyone else, sociopaths have a deep wish to be loved and cared for. This desire remains frequently unfulfilled, however, as it is obviously not easy for another person to get close to someone with such repellent personality characteristics. Sociopaths are at least periodically aware of the effects of their behaviour on others and can be genuinely saddened by their inability to control it. The lives of most sociopaths are devoid of a stable social network or warm, close bonds.
The life histories of sociopaths are often characterized by a chaotic family life, lack of parental attention and guidance, parental substance abuse and antisocial behaviour, poor relationships, divorce, and adverse neighbourhoods. They may feel that they are prisoners of their own etiological determination and believe that they had, in comparison with normal people, fewer opportunities or advantages in life.
Despite their outward arrogance, inside sociopaths feel inferior to others and know they are stigmatized by their own behaviour. Although some sociopaths are superficially adapted to their environment and are even popular, they feel they must carefully hide their true nature because it will not be accepted by others. This leaves sociopaths with a difficult choice: adapt and participate in an empty, unreal life, or do not adapt and live a lonely life isolated from the social community. They see the love and friendship others share and feel dejected knowing they will never take part in it.
Sociopaths are known for needing excessive stimulation, but most foolhardy adventures only end in disillusionment due to conflicts with others and unrealistic expectations. Furthermore, many sociopaths are disheartened by their inability to control their sensation-seeking and are repeatedly confronted with their weaknesses. Although they may attempt to change, low fear response and associated inability to learn from experiences lead to repeated negative, frustrating and depressing confrontations, including trouble with the justice system.
As sociopaths age they are not able to continue their energy-consuming lifestyle and become burned-out and depressed, while they look back on their restless life full of interpersonal discontentment. Their health deteriorates as the effects of their recklessness accumulate.
Emotional Pain and Violence
Social isolation, loneliness and associated emotional pain in sociopaths may precede violent criminal acts. They believe that the whole world is against them, eventually becoming convinced that they deserve special privileges or rights to satisfy their desires. For the rest of us it is unimaginable that sociopaths are so lonely -- yet they describe their loneliness and social failures as unbearably painful. They each created their own sadistic universe to avenge their experiences of rejection, abuse, humiliation, neglect and emotional suffering.
Self-Destruction
Violent sociopaths are at high risk for targeting their aggression toward themselves as much as toward others. A considerable number of sociopaths die a violent death a relatively short time after discharge from forensic psychiatric treatment due to their own behaviour (for instance as a consequence of risky driving or involvement in dangerous situations). Sociopaths may feel that all life is worthless, including their own.
Treatment Developments
In the last decade, neurobiological explanations have become available for many of the traits of sociopathy. For example, impulsivity, recklessness/irresponsibility, hostility and aggressiveness may be determined by abnormal levels of neurochemicals including monoamine oxidase (MAO), serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA), triiodothyronine (T3), free-thyroxine (T4), testosterone, cortisol, adrenocorticotropic hormone (ACTH), and hormones of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes. Other features like sensation-seeking and an incapacity to learn from experiences might be linked to cortical underarousal. Sensation-seeking could also be related to low levels of MAO and cortisol and high concentrations of gonadal hormones, as well as reduced prefrontal grey matter volume. Many sociopaths can thus be considered, at least to some degree, victims of neurobiologically determined behavioural abnormalities that, in turn, create a fixed gulf between them and the rest of the world.
It may be possible to diminish traits like sensation-seeking, impulsivity, aggression and related emotional pain with the help of psychotherapeutic, psychopharmacological and/or neurofeedback treatment. Long-term psychotherapeutic treatment (at least five years) seems effective in some categories of sociopaths.
Psychotherapeutic treatment alone may be insufficient to improve symptoms. Psychopharmacological treatment methods may help normalize neurobiological functions and related behaviour/personality traits. Lithium is impressive in treating antisocial, aggressive and assaultive behaviour. It is found that mood stabilizers such as divalproex (Depakote), selective serotonin reuptake inhibitors, monoamine oxidase inhibitors (MAOIs) and neuroleptics have documented efficacy in treating aggression and affective instability in impulsive patients. To date there have been no controlled studies of the psychopharmacological treatment of other core features of sociopathy. Cortical underarousal and low autonomic activity-reactivity can be substantially reduced with the help of adaptive neurofeedback techniques.
Case Study
"Ben" was raised by his aunt, as his parents were divorced and neither were capable of or interested in caring for him. As a child and adolescent, he had numerous encounters with law enforcement for joyriding, theft, burglary, fraud, assault and battery. He was sent to reform school twice. When he was 21 years old, he was convicted of armed robbery and served a year and a half in jail. His only close friend was another violent criminal; he had many short-term relationships with girlfriends. At 29, he killed two strangers in a bar who had insulted him and was sentenced to forensic psychiatric treatment. Norman was diagnosed as a sociopath.
Ben showed little improvement over the course of seven years of behavioural psychotherapy and became less and less motivated. The staff of the forensic psychiatric hospital considered him untreatable and intended to stop all treatment attempts. Ben's lawyer arranged for an examination by a forensic neurologist, who subsequently found that Ben suffered from severe cortical underarousal, 5-HT and MAO abnormalities, and concentration problems.
Ben was started on d,l-fenfluramine (Pondimin), a serotonin-releasing drug. Acute challenge doses (0.2 mg/kg to 0.4 mg/kg) produced significant dose-dependent decreases in impulsive and aggressive responses. After one month, an MAOI (pargyline [Eutonyl], 10 mg/kg) and psychodynamic psychotherapy were added. Pargyline produced some normalization of his electroencephalogram (EEG) pattern and was titrated up to 20 mg/kg over five months. Neurofeedback was started after two months and continued for 15 months. His EEG pattern gradually normalized, and his capacities for concentration and attention increased.
Ben continued to receive d,l-fenfluramine and psychotherapy for two years, at which point he was discharged from forensic treatment. He voluntarily continued psychotherapy for an additional three years and, in the four years since his release, has not re-offended.
Conclusions
It is extremely important to recognize hidden suffering, loneliness and lack of self-esteem as risk factors for violent, criminal behaviour in sociopaths. Studying the statements of violent criminal sociopaths sheds light on their striking and specific vulnerability and emotional pain. More experimental psychopharmacological, neurofeedback and combined psychotherapeutic research is needed to prevent and treat sociopathic behaviour.
The current picture of the sociopath, which is reflected in the leading diagnostic criteria of sociopathy is incomplete because emotional suffering and loneliness are ignored. When these aspects are considered, our conception of the sociopath goes beyond the heartless and becomes more human.
1 comment:
I hope this doesn't leave you in a slump, as I was really looking forward to your blog. Chin up, everybody loves a happy face!
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