Monday, November 25, 2013

Confessions of a Prosocial Psychopath

Many neuroscientists have been howling about the media coverage surrounding a new book written by UC Irvine Professor Emeritus, Dr. James H. Fallon. This is because unbeknownst to himself for 58 years (or apparently to anyone else, for that matter), he was secretly a psychopath. How did he finally discover this? Did he complete the Psychopathy Checklist and score over 30?


Instead, he diagnosed himself as a psychopath on the basis of his PET scan.

Compared to a control brain (top), neuroscientist James Fallon’s brain (bottom) shows significantly decreased activity in areas of the frontal lobe linked to empathy and morality—anatomical patterns that have been linked with psychopathic behavior. Image via James Fallon in The Smithsonian.

This is a case of reverse inference, assuming that a certain pattern of brain activity indicates a particular behavioral state (or in this case, a specific psychiatric diagnosis). While it may be true at the group level that activity in the ventromedial prefrontal cortex is decreased in psychopaths, it's not possible to diagnose an individual on this basis (at least not with our current state of knowledge).

In fact, Fallon himself initially doubted the ugly possibility that he's lacking in empathy, morality and self-control:
In [his book], Fallon seeks to reconcile how he—a happily married family man—could demonstrate the same anatomical patterns that marked the minds of serial killers.

“I’ve never killed anybody, or raped anyone,” he says. “So the first thing I thought was that maybe my hypothesis was wrong, and that these brain areas are not reflective of psychopathy or murderous behavior.”

Not with certainty, they're not. The Smithsonian article continues:
Eventually, based on further neurological and behavioral research into psychopathy, he decided he was indeed a psychopath—just a relatively good kind, what he and others call a “pro-social psychopath,” someone who has difficulty feeling true empathy for others but still keeps his behavior roughly within socially-acceptable bounds.

A "prosocial psychopath"? Isn't this an oxymoron? Aren't psychopaths antisocial by definition? Eventually, he came to doubt the classification scheme. Psychopathy doesn't appear in the DSM... part because it encompasses such a wide range of symptoms. Not all psychopaths kill; some, like Fallon, exhibit other sorts of psychopathic behavior.

“I’m obnoxiously competitive. I won’t let my grandchildren win games. I’m kind of an asshole, and I do jerky things that piss people off,” he says. “But while I’m aggressive, but my aggression is sublimated. I’d rather beat someone in an argument than beat them up.”

This is psychopathy??

(Perhaps) in response to a snarky query on Twitter ("There goes Hare's PCL" [to paraphrase]), Dr. Fallon noted:

But he looks like such a genial fellow!

Taking a quick look inside The Psychopath Inside (p. 26), we learn that Fallon viewed himself as a "nice, regular guy" who was popular and able to form close friendships with women.1 Should we rely on his brain scan, or on his behavior, when applying such a stigmatizing label?

Confessions of an Extremely Antisocial Female Psychopath

Another book published this year would make an interesting pairing with Fallon's personal discovery neuroscience / memoir: Confessions of a Sociopath, by the anonymous "M. E. Thomas". If you want narcissistic antisocial [but nonviolent] braggadocio, this is the book for you.2 For starters, the author is female, placing her in the minority of those with antisocial personality disorder. She's also a Mormon law professor in California.

"Ms. Thomas" wears the stigmatized behaviors as a badge of pride, although she erroneously calls herself a "sociopath" (which doesn't exist as a diagnostic label). But what do I know? She's SO brilliant – she passed the bar exam without even studying (while everyone else was crying):
I loved getting high marks in school; it meant I could get away with things other students couldn't. When I was young, what thrilled me was the risk of figuring out just how little I could study and still pull off the A. It was the same for being an attorney. During the California bar exam, people were crying from the stress. The convention center where the exam took place looked like a disaster relief center; people made desperate attempts to recall everything they had memorized over the prior eight weeks—weeks that I spent vacationing in Mexico. Despite being woefully ill-prepared by many standards, I was able to maintain calm and focus enough to maximize the knowledge I did have. I passed while others failed.

And she's oh so charming!
You would like me if you met me. I have the kind of smile that is common among television show characters and rare in real life, perfect in its sparkly teeth dimensions and ability to express pleasant invitation. I'm the sort of date you would love to take to your ex's wedding—fun, exciting, the perfect office escort. And I'm just the right amount of successful so that your parents would be thrilled if you brought me home.

But the best take on the book comes from Patrick Bateman, who reviews it for Slate:
I take the elevator up to my apartment and wash my hands and sit in my cream leather chair and chase an Adderall with a J&B and read the book in one sitting. It begins with a psychological evaluation that describes M.E. Thomas as a “prototypical psychopathic personality” manifesting “a ruthless and calculating attitude toward social and interpersonal relationships, and a relative immunity to experiencing negative emotions.” ...
. . .

...She’s into “the fine art of ruining people,” according to the title of Chapter 7. She seduces with charisma, and she cunningly covers her hollowness with superficial charm. She’s a “Nietzschean machine.”

And she violates social norms like it’s her job. Emotionally she takes no prisoners: The high school teacher she falsely accuses of harassment, the friends whose boyfriends she sleeps with just because she can, the colleagues she mind-fucks—they’re all just roadkill...

I'd much rather read Fallon's memoir. He sounds like an upstanding and sympathetic guy, despite the fact that he's related to Lizzy Borden.

Further Reading

The Disconnection of Psychopaths

Born This Way?

I Feel Your Pain... and I Enjoy It

Can Brain Activity Predict Criminal Reoffending?

Are Cognitive Factors Related to Criminal Reoffending?

"None of us are saints"

The Stylized Neuroscience of Psychopaths


1 Interestingly, on page 28 we learn that he developed OCD in junior high, in particular an obsession with Catholicism and morality.

2 Confessions of a Glib Blogger: I haven't read either book.

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At December 01, 2013 1:37 PM, Anonymous T. AKA Ricky Raw said...

Can you elaborate on the idea that sociopathy doesn't exist as a diagnostic label? I thought it was listed under the Cluster B category, at least in the DSM-4?


At December 01, 2013 2:29 PM, Blogger The Neurocritic said...

You're indeed correct that antisocial personality disorder is listed under Cluster B of DSM-IV-TR, but I don't think sociopathy is a synonymous term. Or maybe it is...? Many investigators and clinicians don't seem to use the term, and use psychopathy instead, which is diagnosed using a separate checklist.

But I'm not an expert...

At December 14, 2013 3:49 AM, Anonymous Anonymous said...

Nah, he's probably "just" your typical self-centered US academic jerk. He says he is not the kind of guy who would "beat somebody up". You don't need to beat somebody up in academia to hurt or kill them. How many tenure committees has he been on, just to mention one way in which power and psychopathic behavior manifest themselves in academia? Perhaps he talks about that in the book, no idea, but I suspect that the definition of psychopathy is contextual.

At December 27, 2013 1:25 PM, Anonymous Anonymous said...

I believe APD and BPD are highly correlated with FASD (Fetal Alcohol Syndrome Disorder). My ex wife was severely affected by an alcoholic mother and was basically born sloshed. She has never recovered from that neurological trauma.

At February 18, 2014 9:05 AM, Blogger Unknown said...

For T AKA Ricky Raw - Sociopath is found in the World Health Organization diagnostic manual (ICD-10) - mostly in the States the American Psychiatric Association DSM is used. In ICD-10 Sociopathy is found under Dissocial Personality Disorder, which is very close to DSM Antisocial Personality Disorder. (different book, same thing). Psychopathy is not in either; it is more common in a legal framework. Cleckly was the first to look for this (1941) and his framework is still important, added to by Hare, who came up with a checklist(mention in the main post)

At February 17, 2019 2:12 AM, Anonymous Anonymous said...

^^^^highly probable. M.E. Thomas may seem more unpleasant, but she's far more "real".

At September 30, 2019 10:33 PM, Anonymous Anonymous said...

Sorry if I'm necroing this thread, but I'm looking into my own condition and I'm learning about Personality Disorders.

"Psychopath" and "Sociopath" are two somewhat deprecated terms that describe a person more generally, as I understand. It also focuses more on how a person's condition specifically relates to people. Anti-Social Personality Disorder, on the other hand, is an actual Personality Disorder, and it focuses on roughly the opposite - a general focus on how relationships turn out, and then specifically WHY it happens.

It's possible to be Anti-Social, but not psychopathic (because you lack the ability to care enough about people that you care about manipulating them) - this would be the "sociopath" (as I understand).

In other words (if my understanding is correct), psychopaths are sociopaths with a far more anti-social behavior - one that involves far more conspiracy and manipulation. I could imagine some experts arguing that sociopath may better be described as "asocial personality disorder". But if it wasn't obvious already, I'm no expert and so don't take my word for it.

I myself have clear pro-social traits (as do we all), but with weird correlations of symptoms that could be related to psychopathy or similar. But I also fail psychopathy tests (when testing for my relationship to other people generally, as opposed to myself or people of specific personality types (e.g. narcissists), in which case I may score higher).

But whether I'm accurate here and whether I have psychopathy, or some kind of "Echoism" (opposite of Narcissism), or Dependent PD, or whatnot, one thing is certain:

This field of psychiatry is certainly not fully figured out.


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