
Life as a Nonviolent Psychopath - winstonsmith
http://www.theatlantic.com/health/print/2014/01/life-as-a-nonviolent-psychopath/282271/
======
mcguire
In this article, I learned,

* that the "warrior gene" thing == psychopathy,

* that your genes determine your personality, except when they don't,

* that your behavior is determined by your biology, except when it isn't,

* that lack of affect == Buddhism,

* that "looking at brainscans" is a valid step in judicial sentencing,

* that you can claim to be a person who suffers from an impairment of empathy, who at the extreme, might well not see the difference between a person and a block of wood, and _still_ be taken seriously when you say "that genetics were very, very dominant in who people are—that your genes would tell you who you were going to be",

* that neuroscientists aren't all that spectacular about keeping their data sets neat and orderly; in particular, they don't see a big deal mingling the results of several different experiments, and

* that claiming to have a Big Evil background, that you have to struggle with every day, is _still_ a great way to get publicity.

I laughed, I cried, it changed my life. Two thumbs up.

By the way, have I mentioned that I am of somewhat Nordic descent; every day,
I have to fight off the urge to raid the coastlines of Europe, to pillage and
plunder the tender and peaceful farmsteads and towns?

~~~
pavanky
The raiding and pillaging was probably more to do with societal factors than
genetics.

~~~
theorique
No, it's all genetic.

~~~
trenchwarfare
EXCEPT when its not

~~~
charlieflowers
Reminds me of the bureaucrat from Hitchiker's Guide that was instructed to
tear down Arthur Dent's house. He never knew why he had all those visions of
thousands of angry horse riding warriors shouting at him (he was descended
from Genghis Kahn).

------
lutusp
An interesting but scientifically useless account. Psychiatry and psychology
will become useful to science only when such stories are validated by an
effort to connect effects with causes -- to try to _explain_ what has only
been _described_. To date, these fields have gotten by with descriptions of
things they cannot explain. Once explanations are proposed, they can be
validated or falsified using empirical evidence, but until that happens, it's
not science, it's anecdote.

Interestingly, the director of the NIMH has recently taken the same position,
ruling that that DSM (psychiatry and psychology's "bible") can no longer be
used as the basis for scientific research proposals, for the simple reason
that it has no scientific content:

[http://www.nimh.nih.gov/about/director/2013/transforming-
dia...](http://www.nimh.nih.gov/about/director/2013/transforming-
diagnosis.shtml)

Quote: "... each edition [of the DSM] has ensured that clinicians use the same
terms in the same ways. The weakness is its lack of validity."

~~~
chimeracoder
To expand upon your point, biology lucked out with Carl Linnaeus. It so
happened that Linnaeus's methods of classifying and naming biological
organisms _happened_ to correspond very well to other scientifically relevant
concepts (genetics, etc.)[0]. We have no similar guarantee that the same
applies to classifications of behaviors.

That said - and let me qualify this by saying I have _many_ complaints with
the DSM (particularly the DSM V) - the fact that the DSM classifications may
not be helpful for research purposes does _not_ mean that they are not helpful
for clinical treatment. Clinicians who use it properly (a big caveat) use it
to ensure that they are all using a common vocabulary, though with an
understanding that the vocabulary is imperfect.

This is why I get very frustrated when I see online discussions about mental
disorders devolve into recitations of the DSM diagnostic criteria as if they
were checklists. The DSM provides a convenient library, but the clinician
still has to identify which portions are relevant and which are not, and to
write the "code" that glues those relevant portions together.

[0] Not that they weren't without fault, but they were an important early
effort that has been revised in modern day.

~~~
lutusp
> We have no similar guarantee that the same applies to classifications of
> behaviors.

Not yet, anyway. In the long term, there's hope that neuroscience will uncover
root causes in genetics and other objective disciplines, thus moving beyond
psychology entirely. This is a future goal, not at all something just around
the corner. On the other hand, psychology has been trying to crack this egg
since before the Civil War and has gotten nowhere.

Notice that, when President Obama launched his new research program, he called
it the "brain initiative", not the "mind initiative". This was a not-so-subtle
signal that psychology is no longer looked on as the cutting edge of mental
research.

> That said - and let me qualify this by saying I have many complaints with
> the DSM (particularly the DSM V) - the fact that the DSM classifications may
> not be helpful for research purposes does not mean that they are not helpful
> for clinical treatment.

That's true, but clinical treatment can't go anywhere without knowing causes,
which the DSM -- and psychiatry and psychology -- don't address. This issue is
discussed in the NIMH link I provided in my prior post, where the NIMH
director provides much detail on the problems caused by addressing only
symptoms, not causes.

> The DSM provides a convenient library, but the clinician still has to
> identify which portions are relevant and which are not, and to write the
> "code" that glues those relevant portions together.

But whenever a clinician goes beyond the DSM, s/he enters uncharted territory.
This subjective territory led Tom Widiger, who served as head of research for
DSM-IV, to say, "There are lots of studies which show that clinicians diagnose
most of their patients with one particular disorder and really don't
systematically assess for other disorders. They have a bias in reference to
the disorder that they are especially interested in treating and believe that
most of their patients have."

~~~
dragonwriter
> In the long term, there's hope that neuroscience will uncover root causes in
> genetics and other objective disciplines, thus moving beyond psychology
> entirely.

The idea that understanding the biological/physiological basis of behavior is
part of psychology has been part of the field since the 19th century.
Establishing those things -- whether under the comparatively new label of
neuroscience or any of the older labels under which such exploration have been
done (e.g., "psychobiology") -- isn't "moving beyond psychology", its just
grounding psychology in the same way that physics grounds chemistry, and
establishing that grounding has always been understood to be part of
chemistry.

> That's true, but clinical treatment can't go anywhere without knowing
> causes, which the DSM -- and psychiatry and psychology -- don't address.

This is simply false: psychology and psychiatry do address causes, and even
the DSM does in some cases.

~~~
lutusp
> The idea that understanding the biological/physiological basis of behavior
> is part of psychology has been part of the field since the 19th century.

Yes, but as an _unrealized goal_. William James stated that it was an
unrealized goal in the late 19th century, and the director of the NIMH
mentioned the same issue a few months ago as he ruled that the DSM would no
longer be accepted as the basis for scientific research proposals, for the
simple reason that it has no scientific content:

[http://www.nimh.nih.gov/about/director/2013/transforming-
dia...](http://www.nimh.nih.gov/about/director/2013/transforming-
diagnosis.shtml)

>> ... clinical treatment can't go anywhere without knowing causes, which the
DSM -- and psychiatry and psychology -- don't address.

> This is simply false: psychology and psychiatry do address causes, and even
> the DSM does in some cases.

Tell that to the NIMH, which has ruled against use of the DSM for the best of
reasons -- the claim is false. A quote from the above link:

"The goal of this new manual, as with all previous editions, is to provide a
common language for describing psychopathology. While DSM has been described
as a “Bible” for the field, it is, at best, a dictionary, creating a set of
labels and defining each. The strength of each of the editions of DSM has been
“reliability” – each edition has ensured that clinicians use the same terms in
the same ways. _The weakness is its lack of validity_."

"Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM
diagnoses are based on a consensus about clusters of clinical symptoms, not
any objective laboratory measure. In the rest of medicine, this would be
equivalent to creating diagnostic systems based on the nature of chest pain or
the quality of fever. Indeed, symptom-based diagnosis, once common in other
areas of medicine, has been largely replaced in the past half century as we
have understood that symptoms alone rarely indicate the best choice of
treatment."

So tell me -- which word didn't you understand?

~~~
dragonwriter
> Yes, but as an unrealized goal.

Right. So what? You are falsely asserting that this is a separate domain,
rather than just an area in which results have been incomplete. This is false
-- neuroscience is a new _name_ for something that has always been part of the
domain of exploration of psychology, and in which important results have been
made -- though not broad and deep enough to be widely useful across the field
-- for a long time, even before the name "neuroscience" was applied to them.

> and the director of the NIMH mentioned the same issue a few months ago as he
> ruled that the DSM would no longer be accepted as the basis for scientific
> research proposals, for the simple reason that it has no scientific content

The "no scientific content" claim you make is not, in fact, contained anywhere
in Director Insel's announcement regarding RDoC that you link.

A better description of Insel's position (and the one that is consistent with
his later statement on the relation between DSM and RDoC [1]) would be that
RDoC was announced because the tools for the investigation of the physical
causes of mental illness have progressed to the point where it seems likely
that we can productively move toward a better model of diagnosis with a fresh
look unconstrained by symptom-based descriptive categories, which have always
(as is the case with syndrome-based diagnoses elsewhere in health where causes
are not well-established) been recognized as troublesome but have been the
best that the science to date has been able to support.

> > his is simply false: psychology and psychiatry do address causes, and even
> the DSM does in some cases.

> Tell that to the NIMH, which has ruled against use of the DSM for the best
> of reasons -- the claim is false.

You can keep saying that, but its not going to make it true; psychology and
psychiatry do address causes, as does, in certain cases, the DSM. For
instance, the different neurocognitive disorders identified in the DSM-5 are
differentiated by causes. You can pick up a copy and look it up, or you keep
repeating the same ignorant statements you make in every discussion which
touches on psychology on HN.

[1] [http://www.nimh.nih.gov/news/science-news/2013/dsm-5-and-
rdo...](http://www.nimh.nih.gov/news/science-news/2013/dsm-5-and-rdoc-shared-
interests.shtml)

~~~
lutusp
>> Tell that to the NIMH, which has ruled against use of the DSM for the best
of reasons -- the claim is false.

> You can keep saying that, but its not going to make it true ...

Which part of this are you not getting? I'm not saying it, the NIMH is saying
it. The NIMH has ruled that the DSM can no longer be used as the basis of
scientific research proposals because it only lists symptoms, not causes.

> ... psychology and psychiatry do address causes ...

You need to locate some evidence for this claim. Psychiatry and psychology
deal in symptoms, not root causes. Don't bother to tell me how wrong you think
this is, just write directly to the director of the NIMH, whose recent ruling
is based on this uncontroversial fact.

In the 1950s, schizophrenia was blamed on refrigerator moms (among other
things). Now it's thought to have roots in genetics, but no one knows for
certain. All that is certain is that _its root cause is unknown_. I choose
schizophrenia for this example because, among the many disorders listed in the
DSM, it's one of the better-understood. But its actual cause is unknown, as is
true for all the other disorders listed there.

In his recent book "Book of Woe", psychoanalyst Gary Greenwood reports that
melancholia was proposed for DSM-5 but was turned down because its cause
really is known, and the committee members realized this would represent the
single exception to the rule that none of the listed conditions include a
cause, and this would undermine the editorial scheme. So they voted it out,
leaving the new DSM in a pure state -- all symptoms, no causes.

I ask that you think a bit more deeply about this. Why did the DSM committees
vote disorders into and out of the text? Why didn't they instead use
scientific results that prove an association between causes and symptoms? The
answer is that no such results exist.

> ... you keep repeating the same ignorant statements ...

Nice argument. Do you have any idea how this makes psychiatry and psychology
look? Are you familiar with the term _argumentum ad hominem?_

------
tokenadult
Since several of the comments here revolve around what we know now and could
possibly know now about brain differences related to behavior, I'll link to a
book, _Brainwashed: The Seductive Appeal of Mindless Neuroscience,_ [1] that
examines for a popular audience how much science is behind the latest
"neuroscience" and how much of it is just hype. Just because brain scans are
involved doesn't mean the explanation is any more valid. I think you will find
this book interesting and helpful for understanding yourself and understanding
the world.

I heard about the NIMH director's letter on research priorities[2] first from
behavior-genetics-informed research and clinical psychologists whom I meet in
a "journal club" weekly during the school year. The DSM framework involves a
lot of log-rolling among various kinds of psychologists and psychiatrists,
several of whom depend for their living on being known as "experts" on
"disorders" that may not have any real existence. That said, there is an
active research program all over the world based on a variety of different
paradigms, with very widely followed journals, trying better to understand
healthy human behavior and debilitating human behavior that results from brain
abnormalities, diseases, psychological stress, and other causes. Straight-up
psychology still has a lot to contribute to this study. The psychologists I
know best are very aware of critiques of their own discipline[3] through the
readings we discuss in the journal club, and more generally aware of the
general critique of the current conduct of science,[4] so they redouble their
efforts to do their science better, and to check their methodology as they try
to tease out the complex web of causes of human behavior.

[1] [http://www.amazon.com/Brainwashed-Seductive-Appeal-
Mindless-...](http://www.amazon.com/Brainwashed-Seductive-Appeal-Mindless-
Neuroscience/dp/0465018777)

[2] [http://www.nimh.nih.gov/about/director/2013/transforming-
dia...](http://www.nimh.nih.gov/about/director/2013/transforming-
diagnosis.shtml)

[3] [http://opim.wharton.upenn.edu/~uws/](http://opim.wharton.upenn.edu/~uws/)

[4] [https://med.stanford.edu/profiles/john-
ioannidis?tab=publica...](https://med.stanford.edu/profiles/john-
ioannidis?tab=publications)

~~~
debt
_A Skeptics Guide to the Mind_ by Robert Burton touches on the same subject;
the gulf between modern neuroscience and what we actually understand about the
mind. Burton points that we still are in many circumstances unable to
differentiate between conscious from unconscious thought. A brain scan can
only tell us about the brain but not necessarily about the mind.

------
wololo
> This is a classic example of poor scientific journalism and I believe it
> became so popular due to widespread deficits in scientific literacy. You
> don’t have to be a neuroscientist to see that there are huge problems with
> his story. You simply have view this story objectively have a healthy dose
> of skepticism without quickly deferring to the authority figure. There are
> simple questions which are never addressed here. What experiment was being
> done during each PET scan? If the psychopaths and Dr. Fallon were both
> completing a morality task and they both had low activity in certain
> regions, THEN that would be something more tangible. This is simply showing
> a brain picture and not asking questions. We know that people are much more
> likely to believe something if there is a brain picture associated with it
> and this is further proof.

\--
[http://www.skepticalraptor.com/skepticalraptorblog.php/pseud...](http://www.skepticalraptor.com/skepticalraptorblog.php/pseudoscience-
psychopathy/)

~~~
coldtea
I've never read a more poorly written piece in my life.

The first half is 5 variations of "he doesn't give us the full medical data
for his diagnosis" [in a magazine article or a tv interview, no less].

The second part is some lame assumptioms on what Dr. Fallon did.

And the conclusion builds up on the first part: "I am arguing that the news
articles covering his story do not provide enough details to support his
claims.".

No shit Sherlock. It's a news article, not a paper.

------
Tycho
Whenever I read about diagnosed psychopaths in the mainstream press, they
always seem to be married (with kids). I find this interesting. What were
their spouses thinking? Wouldn't 'total lack of empathy' rather preclude
starting a family with someone? Were they that good at faking romance, or were
they different when they were young? Or is the 'cold as steel' personally
attractive? Were they just willing to marry anyone who asked them? Actually, a
general study of 'why people decide to get married' would probably be even
more interesting than studies about psychopathy...

~~~
mtdewcmu
Psychopaths are known for being very good at getting people to agree to
things; they are described as very glib and superficially charming, which is
why they excel at being con men. So it doesn't seem hard to explain how they
manage to get married. What is peculiar, though, is how their spouses manage
to stay married to them even after they find out the truth. There has to be
some denial involved. If something like one partner belatedly coming out as
homosexual is considered an obvious reason to invalidate a marriage,
discovering that you married a psychopath can only be even more obvious.

~~~
Tycho
I know they are good at manipulating, but you would think manipulating someone
into getting married is a bit far fetched. Conning their way to a sale, an
investment, a favour, a promotion, sure... but that's because they are willing
to circumvent the social norms that govern shallow relationships. Marriage is
supposed to be a very deep relationship so I'm not sure that manipulation is
the explanation.

~~~
mtdewcmu
A psychopath doesn't experience normal emotions, so they can't have a deep
relationship, and they don't know what one is supposed to feel like. When I
read _Without Conscience,_ I was surprised to learn that psychopathy is a
brain disorder that causes a well-defined set of impairments and is possible
to diagnose fairly reliably.

------
altero
This is just bullshit. A few decades ago psychiatrists were deducing personal
traits from shape of skull. This imaginary is kind of similar.

There are 100 000 000 000 neurons in brain, we can not even count number of
connections. We are very very far from understanding it.

~~~
shanusmagnus
Sometime in the recent past people have started substituting a reasonable
skepticism about what is known and knowable for a kind of blatant dismissal of
everything that is not rendered absolutely elementary and deterministic. This
is especially true of the cognitive sciences and the double standard becomes
especially clear when the field is contrasted with, say, physics, the most
sciencey of all sciences. For instance, go ahead and take a quarter out of our
your pocket, flip it into the air and see how it lands on the floor. It's
pretty easy to predict whether it comes up heads or tails, right? Except no,
it isn't, not outside of a cleanroom with a known atmosphere and a robot
flipping the coin.

In my experience it's usually the people who know the least about psychology
or cognitive science claiming that the least can be known about psychology and
cognitive science. The people who know the most about psychology and cognitive
science will also tell you how little we currently know, but the context is
very different, sort of like when you're at a party and get cornered by a
Shakespeare scholar who for the next three hours tells you in explicit detail
how little is known about Shakespeare.

Of course the brain is complicated, and of course we're a long way from
understanding it, and yet I could look at a scan that showed hypometablism in
your anterior temporal lobes and be able to tell you with great specificity
about the symptoms I would expect you to manifest, a diagnosis which would be
drawn from a mountain of data that is often, admittedly, observational; and
yet using a confluence of imaging methods and single cell recordings and
anatomical studies and animal homologies, which collectively have given rise
to theoretical models, the predictions are as scientific as those that arise
in any other kinds of science. Doesn't mean they're always right, but there's
rigorous and principled methodology at work, results shift belief in the
explanatory power of this model or that, and the field moves forward.

So yeah, there are bad practitioners and bad papers and overbroad
explanations, but that doesn't mean that nobody knows anything.

~~~
lutusp
> In my experience it's usually the people who know the least about psychology
> or cognitive science claiming that the least can be known about psychology
> and cognitive science.

Perhaps, but in this specific example, the people who know the most about the
topic agree that we don't know anything, and that a new approach is required.
As one example, the director of the NIMH recently ruled that the DSM can no
longer be used as the basis for scientific research proposals, for the simple
reason that it has no scientific content.

[http://www.nimh.nih.gov/about/director/2013/transforming-
dia...](http://www.nimh.nih.gov/about/director/2013/transforming-
diagnosis.shtml)

Quote: "... each edition [of the DSM] has ensured that clinicians use the same
terms in the same ways. The weakness is its lack of validity."

> Of course the brain is complicated, and of course we're a long way from
> understanding it, and yet I could look at a scan that showed hypometablism
> in your anterior temporal lobes and be able to tell you with great
> specificity about the symptoms I would expect you to manifest ...

This is exactly the problem that the NIMH's new ruling is meant to address --
a focus on symptoms rather than causes. Until we can _explain_ these symptoms,
until we can move beyond simple description, mental research will remain a
subjective dead end.

> So yeah, there are bad practitioners and bad papers and overbroad
> explanations, but that doesn't mean that nobody knows anything.

As long as vestal virgins can claim to have been raped and destroy their
families without anyone asking some obvious questions, yes, no one knows
anything:
[http://arachnoid.com/trouble_with_psychology](http://arachnoid.com/trouble_with_psychology)

> For instance, go ahead and take a quarter out of our your pocket, flip it
> into the air and see how it lands on the floor. It's pretty easy to predict
> whether it comes up heads or tails, right? Except no, it isn't ...

Of course it is, the outcome is perfectly reliable if the coin is fair -- the
probably is 1/2 that the result will be heads. No clean room or robot are
required. I mention this to emphasize the difference between observation and
theory -- the theory is perfectly reliable.

------
xivzgrev
Karen Franklin had an interesting critique of his book, as well:
[http://www.amazon.com/review/R28SZH62Q6Y6AD/ref=cm_cr_dp_cmt...](http://www.amazon.com/review/R28SZH62Q6Y6AD/ref=cm_cr_dp_cmt?ie=UTF8&ASIN=1591846005&nodeID=133140011&store=digital-
text#wasThisHelpful)

------
mtdewcmu
I'm curious to get some people's reactions to this guy: he mentioned his
dangerous actions more than once; do you think he's truly dangerous, or just
exaggerating?

After he kept mentioning it, I was curious and a bit skeptical as to what
horrible things he could have admitted to and yet still be free and employed.
The incident with the Marburg virus is pretty chilling, though, if you think
it through. It's the sort of thing only a brilliant psychopath could come up
with or be proud of. I'd keep my distance, frankly.

------
j_baker
I'm not convinced that the brainscan patterns uniquely identify psychopaths.
There are lots of things that frontal lobe dysfunction is also correlated
with: ADHD, Bipolar disorder, and psychopathy. I suspect comorbidity (meaning:
how likely you are to have the other diseases given you have one) is quite
high, but I'm not convinced that frontal lobe dysfunction implies any or all
of these disorders.

------
dinkumthinkum
Is anyone else nonplussed by this? I'm not saying its wrong or I don't believe
the brain scans mean anything, but without a lot more details particularly
from people not invested in this research program being a success, I find this
hard to take seriously and it seems very naive.

------
sleepyK
I think this one's a repost.

------
poolpool
Look at any CEO. Many are very successful.

