
Psychopathy: A new clinical approach offers hope - kposehn
https://www.theatlantic.com/magazine/archive/2017/06/when-your-child-is-a-psychopath/524502/?utm_source=atlfb&amp;single_page=true
======
dsacco
The article is kind of all over the place. It's a bit grating to me, because
it's a long form piece attempting to grapple with a complex subject, but it's
overly sensationalized and doesn't meaningfully differentiate itself from the
media representation. Consider that the article insists on using the
colloquial, imprecise and emotionally charged term "psychopath" \- the
clinical diagnosis, antisocial personality disorder, is not mentioned once in
the entire article, despite the fact that the author acknowledges the _stigma
inherent in the disorder._ The title itself is clearly sensationalized.
Furthermore, it has passages like this one:

 _Like the guy standing 20 feet away from me in the North Hall of Mendota
Juvenile Treatment Center, in Madison, Wisconsin. The tall, lanky teenager has
just emerged from his cell. Two staff members cuff his wrists, shackle his
feet, and begin to lead him away. Suddenly he swivels to face me and laughs—a
menacing laugh that gives me chills. As young men yell expletives, banging on
the metal doors of their cells, and others stare silently through their narrow
plexiglass windows, I think, This is as close as I get to Lord of the Flies._

That's a laughably sensationalized and stereotypical depiction of someone with
antisocial personality disorder, even one given to criminal behavior. On the
one hand it's trying to evoke images of children who are wildly remorseless,
on the other hand it talks about the "chills" you get from interacting with
these people.

It feels like the article decided to play up the angle of, "What if _your_
child was a psychopath?" instead of realistically tackling the subject in a
new way. It's just perpetuating the stigma that already exists - "psychopaths"
are either remorseless killers with an insatiable thirst for violence, or
they're hyper-efficient captains of their fields. I honestly expect much more
nuance and integrity in a long form piece approaching this subject.

~~~
scott_s
The article _does_ mention the clinical diagnosis, but the one for children:

 _" Samantha was diagnosed with conduct disorder with callous and unemotional
traits. She had all the characteristics of a budding psychopath."_

Antisocial personality disorder is, as far as I know, used for adults.

~~~
UnpossibleJim
I think the youngest diagnoses was 12 (I need to double check) but it,
generally, begins to manifest at puberty to mid-twenties, barring some jarring
event. Even then, that is usually diagnosed as PTSD with Atypical symptoms,
displaying in antisocial behavior. It's been a while since I was in school, so
categorization may have (and has, since a new DSM has been published) changed,
but they rarely make huge changes. It's, generally, language to accord to the
societal language.

~~~
scott_s
The point of this article, and one I mention in another comment
([https://news.ycombinator.com/item?id=14359033](https://news.ycombinator.com/item?id=14359033)),
is that some of the behavior associated with antisocial personality disorder
appear to manifest much earlier than puberty. In that case, they use the
diagnoses of callous and unemotional traits.

~~~
mtdewcmu
The really broad, overarching point of the article is that a treatment
facility was getting good results in children previously considered hopeless.
The novel technique is using positive, rather than negative, reinforcement. It
seems kind of ironic that the one technique nobody thought to try was being
positive.

------
projektir
> Indeed, certain psychopathic traits have survived because they’re useful in
> small doses: the cool dispassion of a surgeon, the tunnel vision of an
> Olympic athlete, the ambitious narcissism of many a politician. But when
> these attributes exist in the wrong combination or in extreme forms, they
> can produce a dangerously antisocial individual, or even a cold-blooded
> killer.

Certain politicians are responsible for far more suffering than cold-blooded
killers... funny what we value.

~~~
timthelion
You were being down voted. By whom? People who love Hitler and Pol Pot? Or
just people who are tired of politics on HN?

~~~
DKnoll
Because it's a platitude. By the same criteria, the following statement is
true: some scientists are responsible for far more suffering than cold-blooded
killers.

------
SCAQTony
The brain is so complicated that circa 2017 A neurologist, let alone a
psychiatrist, can't explain why we can look at a cup of coffee, know that it
is hot, know how to to pick it up and balance the cup to your lips and swallow
the hot fluid without burning yourself while reading a suspenseful book all at
the same time.

If science can't fully explain how and why that process can happen, how can
psychiatry or psychology be so confident that they can determine how to cure
or treat psychopathy at 3-or-4 years old?.

Even take it further, there is no process, procedure, or prescription you can
write or execute to immediately mend a broken heart other than time and
personal consideration.

~~~
jerf
Along with my strong agreement with maxmcd's post, let me also point out that
this _isn 't_ science. It's doctoring, which, when you really get down to it,
is a form of engineering, not science. We measure success by whether the
treatment works, and whether we understand the side effects and such, not
whether we understand the mechanisms of the supposed cure or side effects.
There is no requirement that we understand something for it to work.

~~~
thatcat
For an engineer to create something that works reliably and that they can't
understand would rely heavily on luck. Usually, an engineer will start with
proven science and work towards a design.

~~~
jerf
That is a common myth, but it's complete bunk. There is no clean flow of
"science -> knowledge -> engineering". The flow goes every which way, and
there's plenty of engineering that we do without a particular knowledge of the
"science".

Heck, we can barely get half of Hacker News to agree that programming is a
mathematical endeavor, a close equivalent to the idea. How many programmers
are out there just bashing away on engineering despite not knowing the science
of what they're doing? How many "cloud" developers don't understand the
science papers on consensus algorithms? Yeah, their code hurts for that lack,
but it still works to some extent. How many programmers are reading papers
with any routineness in their field? Non-zero, but nowhere near 100%. Or even
50%.

~~~
TheOtherHobbes
No, that's a feature of software engineering, not of other kinds of
engineering.

No one seriously believes that airliners, bridges, and the electrical grid
stay up because of luck, hope, and positive thinking.

The last time the flow went "every which way" was during the industrial
revolution, when it was still possible to build useful things with a certain
amount of guesswork.

Sometimes they didn't even explode.

CS is roughly in that state now - lots of opinion and proselytising, plenty of
cut-and-paste cookbook programming, far too little empirical testing of
various beliefs and propositions, and even less interest in the continued
refinement of formal methods that have proven to be useful.

------
spangry
I'm not sure how to bring this to the attention of a mod, but is it possible
to merge this post with this other one:
[https://news.ycombinator.com/item?id=14355964](https://news.ycombinator.com/item?id=14355964)

EDIT: maybe if someone flags this commment... don't worry I won't mind :)

------
VladimirGolovin
I was wondering recently what Dr. Kiehl is up to these days, and the article
gives the answer:

 _Kiehl and the staff at Mendota are now asking some 300 young men to slide
into a mobile brain scanner. The scanner records the shape and size of key
areas of the boys’ brains, as well as how their brains react to tests of
decision-making ability, impulsivity, and other qualities that go to the core
of psychopathy. Each boy’s brain will be scanned before, during, and at the
end of their time in the program, offering researchers insights into whether
his improved behavior reflects better functioning inside his brain._

Also, _" while adult psychopaths constitute only a tiny fraction of the
general population, studies suggest that they commit half of all violent
crimes."_. This is beyond scary. I wonder how we, as a civilization, can get
psychopathy under control? We have 1 percent of the population that places
enormous burden on the society, and we still act as if they are normal people.
Why there's no requirement for psychopathy assessment for jobs like police
officers or civil servants? Should we apply mandatory psychopathy testing to
all convicted criminals and divert the positives into a specially-designed
life track - and what would that life track even look like?

~~~
atemerev
Quite a lot of psychopaths are well-adjusted and trained themselves to fake
empathy and other social traits they don't innately have. You probably have a
psychopath among your friends, it is not that rare.

Unfortunately, this mental adaptation might never happen or happen too late.

~~~
raarts
According to most sources 1 in hundred people are psychopaths. Most people
don't have that many friends. I for example have just one.

------
gorbachev
This made me shiver. As a parent that's more or less my worst nightmare, to
raise kids who are like that.

~~~
thatwebdude
+1, I couldn't even finish reading. The scary part is the consistent fear of
"raising" that behavior; that somehow it's your fault. It would be very hard
to live with that idea.

~~~
stevenwoo
They made it clear that parenting doesn't matter for these cases as far as
they can tell, they focused on a juvenile treatment facility in the main part,
not the family in the introductory paragraphs, and the facility tries to mold
behavior with high reward/low punishment system ( with the juveniles behind
bars to protect everyone else )

~~~
thatwebdude
A professional could tell me it wasn't my fault over and over again; but it'd
honestly take years (at least) to get over that fact. That's just something
I'd be hard to un-program from myself.

------
gt_
So, a configured abstract reward system can make psychopaths look like regular
narcissists. And then?

Did they find a cure or become mutual accomplices? They learned that if they
maintain without showing emotion long enough that they can earn a form of
respect by playing the patient's own game. Not surprisingly, the respect
sustains when nourished with rewards. The doctors and patients are now
comrads. The patient shows improvement during the state of success, diplomatic
accomplishment, overcoming their peers, winning, etc. and while it is nice
they can reproduce the system, they are still misunderstanding it.

By their logic, we would elect the patients into office, process their
confidence as wellness, and maybe one day they can become so cured they will
be president!

Maybe there is some valuable stuff being researched here but this essay
doesn't confirm that. There is a comparison opportunity in the two origins
discussed that might offer actual insight but I guess that was just a
narrative decoration?

------
RScholar
I find myself stuck on a single data point from this article, the one that
reports 16 people lost their lives due to the release of just 248 incarcerated
kids. Now my rational mind is able to grasp that this is only 6.5% of the
group they were tracking, but I can't help but feel like we owe those 16
people a greater standard of care than to release these deeply disturbed
individuals. The recidivism rate for that same group was 97%...so a virtual
certainty. They don't break that down into violent crimes vs property crimes,
but seat of the pants wisdom suggests that even if it is property crime
initially, that it is similarly likely to progress to more sinister deeds
later on. If that's not enough to justify a life sentence in perhaps a minimum
security facility, I don't know what is.

------
laughfactory
Yikes. This was a horrifying read. Mostly because my five year old daughter
displays some of these characteristics. Like not seeming bothered by others'
distress. Or like sometimes maybe enjoying terrorizing her siblings. I think
sometimes when she acts concerned it's just because she wants to get her
sister to stop crying, not because she cares about her sister, but because the
sound annoys her. Does this mean she's wired for psychopathy? That we need to
sleep with one eye open? Man, I hope not! Or is this fairly typical of
children of this age?

------
droithomme
Diagnosing a child as a psychopath is pretty questionable. In addition,
diagnoses of psychopathy in adults is difficult and expert psychiatrists have
admitted even they are fooled.

I was not surprised then when the article admitted that the parents diagnosed
the disorder themselves, and then shopped around for therapists until they
found one in another state willing to agree with their diagnosis. I bet it
made them feel good when they finally found a doctor willing to support their
amateur diagnostic efforts.

~~~
stevenwoo
I think the article could have been clearer but it sounds like they described
the recommended treatments in the previous paragraphs. None of them worked and
the child did not "outgrow" her condition as predicted by everyone that they
saw. Considering they have seven other children that are not particularly
troublesome, the most common diagnosis that it was the parenting to blame
might drive the most reasonable parent to seek other options, especially after
the horror movie-esque “I want to kill all of you.” and "Four months later,
Samantha tried to strangle her baby brother, who was just two months old."
Someone might consider it reasonable for the safety of the other children to
give up at that point but they continued to seek treatment options.

~~~
zeroer
There's another factor at play in Samantha's case - she was adopted. The
article mentions that no evidence of abuse was ever uncovered by previous
parents (both biological and foster), but who knows?

~~~
stevenwoo
You're right, they did adopt a half sister who may have not shared any family
home with Samantha at all or was cohabiting a home, could have used some more
info on that.

------
socrates1998
What's scary is that these people are actually released into the world. 36% of
them do violent crimes again. And that's considered a GOOD stat.

That's insane. I don't know what the answer is, but this article makes me more
aware (and maybe scared) of how many violent people are out there.

