This summer I read a helpful book, The Sociopath Next Door by Martha Stout. It describes a certain type of “difficult” patient, colleague or public figure. Sociopathic behaviors also remind us of the pro-social values necessary for healthy relations.
Persons with “antisocial personality disorder” (sociopathy) are present in the workplace and in medical practices. Estimates of prevalence vary: 3.6% in psychiatric outpatients, 2% (women) to 8% (men) in primary care clinics, very common in males with substance use disorder. A rule of thumb might be that they are 1-4% of the general population. We all have encountered someone sociopathic.
The sociopath lacks Conscience – “a sense of obligation based on emotional attachments to others.” A default that is hard-wired into normal human relationships is that people care about one another, and will follow the rules of their group. Sociopaths also know there is a Golden Rule – but they don’t feel any need to honor it. They have no norms to obey, and no compunctions about consequences to others. Their only concern is what their self-interest dictates.
Sociopaths thrive on manipulation: they regard other persons as parts of their games of power and control. Lying is not morally disturbing, because morals imply shared values and mutual obligations. Personal responsibility is irrelevant, because circumstances beyond one’s control can always be blamed. Shame and guilt are not hindrances, because those feelings also depend on obligations beyond self-interest.
The first step in dealing with sociopathic persons is to be able to recognize them. Lying is a red flag of sociopathic behavior. A first lie and even a second might be related to misunderstanding; repeated lying reveals deceitfulness, and a lack of conscience. When confronted or revealed, sociopaths will often play the pity card: a second red flag. Sociopaths will manipulate the pro-social good will of others, even though they do not reciprocate. Thirdly, one can feel danger and creepiness in the presence of sociopaths – as if, or because, one senses the sociopath really may not have norms, boundaries or limits.
Dealing with persons with antisocial personality disorder requires diligent efforts to protect oneself and others. No one within sociopaths’ reach is immune, and sociopathic behaviors are not amenable to medications or insight therapy. But sociopaths can be avoided. It is important to watch for their manipulative methods: charm, flattery, secrets, threats, power-plays and/or pity-plays.
Sociopathic behaviors also remind us of what is normal and valuable in human interactions – “a sense of obligation based on emotional attachments to others.” Love, sacrifice, pity, courage, forgiveness and compassion all relate to these attachments and obligations. We can honor these virtues in others; we can model them in ourselves.