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Authors: Martha Stout PhD

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These similarities have been noticed in many parts of the world. In Scandinavian child psychiatry, for example, a condition called “early emotional frustration” is thought to be caused by a lack of mutual bonding between mother and child, and in Scandinavia, this diagnostic term (
early emotional frustration
) is used to flag a child's greater than average chance of developing a sociopathic character disorder by adulthood. Early emotional frustration is statistically linked to factors that may make mother-infant attachment more difficult, such as preterm birth, extremely low birth weight, and maternal substance abuse during pregnancy.

There are some minor design problems in this kind of research. For instance, certain factors, such as maternal substance abuse during pregnancy, could easily implicate sociopathic mothers, and therefore a return to the genetic explanation. But the major problem with the equation of attachment disorder and sociopathy, despite the scientifically tempting commonalities of the two, is their persistent and undeniable
dissimilarity
with respect to the trademark features of sociopathy. Quite unlike sociopaths, children and adults afflicted with attachment disorders are seldom charming or interpersonally clever. On the contrary, these unfortunate individuals are typically somewhat off-putting, nor do they make any great efforts to “fake” being normal. Many are isolates. Their emotional presentation is flat and uninviting, or sometimes directly hostile, and they tend to swing between the distinctly nonseductive extremes of belligerent indifference and unmeetable neediness. None of this allows in any way for the chameleonlike manipulations and con games of the sociopath, with his smiling deceptions and disarming charisma, or for the intermittent success in the material world that the rather sociable sociopath often achieves.

Many clinicians and parents have reported that sociopathic children refuse to form warm relationships with family members. They tend to pull away, both emotionally and physically. And, of course, so do children with attachment disorders. But very unlike the situation with the sad attachment disorder child, detachment from family is much more likely to be a
result
of the young sociopath's way of being in the world than it is to be the cause of it.

And so, in summary, we have some idea of what one of the underlying neurobiological deficits in sociopathy may be. The sociopaths who have been studied reveal a significant aberration in their ability to process emotional information at the level of the cerebral cortex. And from examining heritability studies, we can speculate that the neurobiological underpinnings of the core personality features of sociopathy are as much as 50 percent heritable. The remaining causes, the other 50 percent, are much foggier. Neither childhood maltreatment nor attachment disorder seems to account for the environmental contribution to the loveless, manipulative, and guiltless existence that psychologists call sociopathy. How nongenetic factors affect the development of this profound condition, and they almost certainly do have an effect, is still mainly a puzzle. The question remains: Once a child is born with this limiting neurological glitch, what are the environmental factors that determine whether or not he will go on to display the full-fledged symptoms of sociopathy? And at present, we simply do not know.

Culture

It is entirely possible that the environmental influences on sociopathy are more reliably linked with broad cultural characteristics than with any particular child-rearing factors. Indeed, relating the occurrence of sociopathy to cultures has so far been more fruitful for researchers than looking for the answer in specific child-rearing variables. Instead of being the product of childhood abuse within the family, or of attachment disorder, maybe sociopathy involves some interaction between the innate neurological wiring of individuals and the larger society in which they end up spending their lives.

This hypothesis is bound to be disappointing to some people, because though altering the conditions of pregnancy, childbirth, and child treatment on a massive scale would be no small project, changing the values and belief systems of an entire culture is an even more gigantic undertaking, with a time horizon that seems distant and discouraging. We might feel a little less daunted if we were to identify a set of child-rearing practices that we could try to correct in our lifetimes. But perhaps society is the true parent of certain things, and we will eventually find that, as William Ralph Inge said in the early twentieth century, “The proper time to influence the character of a child is about 100 years before he is born.”

From recorded observations, we do know that sociopaths, by various names, have existed in all kinds of societies, worldwide and throughout history. As an illustration, psychiatric anthropologist Jane M. Murphy describes the Inuit concept of
kunlangeta,
which refers to a person whose “mind knows what to do but does not do it.” Murphy writes that in northwest Alaska,
kunlangeta
“might be applied to a man who, for example, repeatedly lies and cheats and steals things and does not go hunting, and, when the other men are out of the village, takes sexual advantage of many women.” The Inuits tacitly assume that
kunlangeta
is irremediable. And so, according to Murphy, the traditional Inuit approach to such a man was to insist that he go hunting, and then, in the absence of witnesses, push him off the edge of the ice.

Though sociopathy seems to be universal and timeless, there is credible evidence that some cultures contain fewer sociopaths than do other cultures. Intriguingly, sociopathy would appear to be relatively rare in certain East Asian countries, notably Japan and China. Studies conducted in both rural and urban areas of Taiwan have found a remarkably low prevalence of antisocial personality disorder, ranging from 0.03 percent to 0.14 percent, which is not none but is impressively less than the Western world's approximate average of 4 percent, which translates to one in twenty-five people. And disturbingly, the prevalence of sociopathy in the United States seems to be increasing. The 1991 Epidemiologic Catchment Area study, sponsored by the National Institute of Mental Health, reported that in the fifteen years preceding the study, the prevalence of antisocial personality disorder had nearly doubled among the young in America. It would be difficult, closing in on impossible, to explain such a dramatically rapid shift in terms of genetics or neurobiology. Apparently, cultural influences play a very important role in the development (or not) of sociopathy in any given population.

Few people would disagree that, from the Wild West of the past to the corporate outlaws of the present, American society seems to allow and even encourage me-first attitudes devoted to the pursuit of domination. Robert Hare writes that he believes “our society is moving in the direction of permitting, reinforcing, and in some instances actually valuing some of the traits listed in the
Psychopathy Checklist
—traits such as impulsivity, irresponsibility, lack of remorse.” In this opinion he is joined by theorists who propose that North American culture, which holds individualism as a central value, tends to foster the development of antisocial behavior, and also to disguise it. In other words, in America, the guiltless manipulation of other people “blends” with social expectations to a much greater degree than it would in China or other more group-centered societies.

I believe there is a shinier side of this coin, too, one that begs the question of why certain cultures seem to encourage prosocial behavior. So much against the odds, how is it that some societies have a positive impact on incipient sociopaths, who are born with an inability to process interpersonal emotions in the usual way? I would like to suggest that the overriding belief systems of certain cultures encourage born sociopaths to compensate cognitively for what they are missing emotionally. In contrast with our extreme emphasis on individualism and personal control, certain cultures, many in East Asia, dwell theologically on the interrelatedness of all living things. Interestingly, this value is also the basis of conscience, which is an intervening sense of obligation rooted in a sense of connectedness. If an individual does not, or if neurologically he cannot, experience his connection to others in an emotional way, perhaps a culture that insists on connectedness as a matter of belief can instill a strictly cognitive understanding of interpersonal obligation.

An intellectual grasp of one's duties to others is not the same attribute as the powerfully directive emotion we call conscience, but perhaps it is enough to extract prosocial
behavior
from at least some individuals who would have behaved only in antisocial ways had they been living in a society that emphasized individualism rather than interrelatedness. Though they lack an internal mechanism that tells them they are connected to others, the larger culture insists to them that they are so connected—as opposed to our culture, which informs them resoundingly that their ability to act guiltlessly on their own behalf is the ultimate advantage. This would explain why a Western family by itself cannot redeem a born sociopath. There are too many other voices in the larger society implying that his approach to the world is correct.

As a tiny example, had Skip the American been born into a strongly Buddhist culture, or Shinto, would he have killed all those frogs? Perhaps, or perhaps not. His brain would have been the same, but all the people around him would have maintained that respect for life was necessary. Everyone in his world would have been of the same mind, including his wealthy parents, his teachers, his playmates, and maybe even the celebrities he saw on television. Skip would still have been Skip. He would have felt no honor for the frogs, no guilt if he murdered them, no repugnance, but he might have refrained from doing so because his culture had unanimously taught him a lesson, something on the order of proper table manners, about how to fit in—a lesson that his perfectly good intellect had mastered. Sociopaths do not care about their social world, but they do want, and need, to blend in with it.

Of course, I am implying that our own culture would teach a child like Skip that he could torture small animals and still be passably disguised among us, and regretfully, I think this reflects a fair assessment of our current plight.

Warriors

Within the context of human society as a whole, across all cultures, is there anything about the lack of caring and the absence of conscience that could be considered positive, or at least useful? As it happens, from a certain point of view, there is one such thing. Whether the victim be a frog or a person, sociopaths can kill without experiencing anguish; thus, people who have no conscience make excellent, unambivalent warriors. And nearly all societies—Buddhist, Shinto, Christian, or purely capitalist—make war.

To some extent, we can think of sociopaths as being shaped and maintained by society because nations so often require cold-blooded killers, from anonymous foot soldiers to the conquerors who have made, and continue to make, human history. Sociopaths are fearless and superior warriors, snipers, undercover assassins, special operatives, vigilantes, and hand-to-hand specialists, because they experience no horror while killing (or while ordering killing) and no guilt after the deed is done. By far most people—the bulk of our armies—cannot be so emotionless, and if they are not carefully conditioned, most normal people make fourth-rate killers at best, even when taking the lives of other people is deemed to be necessary. A person who can look another person in the eye and calmly shoot him dead is unusual, and in war, valuable.

Strangely, some acts are so emotionally bankrupt that they
require
the absence of conscience, just as astrophysics requires intelligence and art requires talent. Of warriors who can operate without conscience, Lt. Col. Dave Grossman writes, in
On Killing
, “Whether called sociopaths, sheepdogs, warriors, or heroes, they are there, they are a distinct minority, and in times of danger a nation needs them desperately.”

But these same nations pay a concealed price within their borders for the glory they bestow on their steel-cold killers in the field. The path to such glory does not go unnoticed by others for whom guiltless killing is a special aptitude, others who will never find themselves working behind enemy lines. The self-appointed remain at home, among the rest of us, and mainly invisible. From Rambo to Baghdad, the glorification of killing—the glamorizing of the deepest infraction of normal conscience—has been a lasting feature of our mainstream culture, and may well be the most pernicious environmental influence of all on the vulnerable sociopathic minds in our midst. The owner of such a mind does not necessarily kill, but as we are about to find in the next chapter, when he does, he is not always the person one would have suspected.

EIGHT

the sociopath next door

It may be that we are puppets—puppets controlled by the strings of society. But at least we are puppets with perception, with awareness. And perhaps our awareness is the first step to our liberation.

—Stanley Milgram

I
wanted to talk to someone, and I think it's because my father's in prison.” Hannah, the pretty, thin-lipped twenty-two-year-old who was my new patient, directed this barely audible remark to her right, toward one of my bookshelves. After a moment, she looked at me directly, shyly, and repeated herself: “I need someone to talk to. My father's in prison.”

She made a tiny gasp, as if the effort of this much speech had exhausted her lungs, and then she was silent.

Especially when people are very frightened, a certain amount of doing therapy is simply knowing how to paraphrase the comments of the person seated before you without sounding judgmental, or patronizing. I bent forward slightly, my fingers laced around my knee, and tried to recapture Hannah's gaze, which had now dropped to the rust-colored Oriental rug between our chairs.

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