I interviewed psychiatrist Donald Black, M.D., author of Bad Boys, Bad Men, on May 6, 2013, discussing anti-social personality disorder, sociopaths and psychopaths. He says there about 8.5 Million sociopaths in the USA-- about 4% of adults.
This is part two of a two part interview. Here is a link to the audio podcast. Links to other articles in the series, including part one of this interview.
Thanks to Don Caldarazzo for doing the transcript.
John Wayne Gacy art by Wikipedia
Rob Kall: OK. Next: you mention in your books on a couple occasions use of marijuana as a sign, potentially, of anti-social personality; yet several states have now made it legal, and it's available for use as a medicine in a growing number of states. Where does marijuana fit in with this?
Donald Black: Well that's a good question, and let me correct that, in that anti-socials in general tend to abuse substances. It could be marijuana, it could be methamphetamine, it could be cocaine, it could just be alcohol. Alcohol is probably the most widely used substance of anti-socials, and I think it just reflects on their inability to delay gratification. They tend to be into instant gratification, and drugs and alcohol can provide that. If they are alcohol or drug addicted, their anti-social personality is worse, because they are dis-inhibited; they're more like to be impulsive, they're more likely to act out. One of the thoughts about treating these people is that if they are drug addicted, you must get them off of drugs.
Now, we have seen this tendency in the U.S. in various states to legalize medical marijuana or just decriminalize marijuana. Whether or not that's a good thing or not I think society has to determine for itself. I personally don't agree that states should be legalizing marijuana as a medical indication, because as a doctor I can tell you that there are no hard and fast medical indications, and certainly none that have been well studied. But it's a question that society has to address for itself. There's no specific connection with anti-social personality disorder.
Rob Kall: OK. Next question: I want to observe that your book tends to focus on people who are in lower portions of our culture, and I think you make it clear in your book that sociopathy can keep people stuck in a /
Donald Black: Absolutely.
Rob Kall: - cycle where they're impoverished, where they're dependent, where they're using theft and drug dealing to survive, /
Donald Black: Yep.
Rob Kall: -b ut my understanding is that there are also people who are higher functioning sociopaths.
Donald Black: Absolutely.
Rob Kall: I'm very interested in those people who don't get arrested, people who don't function in a violent way, but they do it in a way that perhaps hurts a lot more people. What about wealthy people, what about powerful people, what about people who manage to navigate socially without being violent? And I assume that you don't have to be violent to be a sociopath. You could be a colluder.
Donald Black: That's a wonderful question, and you're absolutely correct. Not everyone who's anti-social is violent. But there is this issue of low socioeconomic status: low income, low educational level, and all of those things are highly correlated with anti-social personality disorder. Now, does low social status cause anti-social personality disorder? No, but in fact people who are anti-social tend not to finish their education, they have unstable personal lives, they get divorced, have many relationships, they get fired from jobs. So all of that reinforces low income positions.
Now, there are some people who rise above that. You'll find sociopaths at all levels of society. There's no reason why people at even the upper ends of the income level can't be sociopaths, and in fact there probably are many, proportionately less than at the lower ends of the income spectrum. For example, someone can grow up in a wealthy family, and despite their anti-social personality they get a good education, maybe through family connections get a good job so they have a decent income, and yet they are anti-social: regularly committing crimes (perhaps white-collar crimes and not violent crimes), abusing a spouse quietly at home so no one knows.