by Oxford University Press
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. This is part one of a two part interview. Here is a link to the audio podcast.
Thanks to Don Caldarazzo for doing the transcript.
Rob Kall: And welcome to the Rob Kall Bottom Up Radio Show, WNJC 1360 AM out of Washington Township, New Jersey, reaching metro Philly and South Jersey, sponsored by Opednews.com . My guest tonight is Donald W. Black, MD. He's a Professor of Psychiatry at the University of Iowa, and he's the author of a book: Bad Boys, Bad Men: Confronting Anti-social Personality Disorder. Welcome to the show!
Donald Black: Well thanks for having me.
Rob Kall: This is a fascinating topic, and what is perhaps the most frightening are the statistics about this. Your book says it's about three percent (3%) of the population?
Donald Black: Well, it actually might be higher. There's some surveys that show that about four and a half percent (4.5%) of the general population may meet criteria for this disorder. In any event, I think all people would agree that it's more common than people think. When you think about the kind of people who get diagnosed with Anti-social Personality Disorder (or the other more common term people use in the general population is "Sociopathy," or "Sociopath") and where they end up, because a lot of them are in jails and prisons, those people are not counted in the surveys, so the figure could be higher than even 4.5%.
Rob Kall: So we're talking on a planet with seven billion people, we're talking about a quarter of a billion [250,000,000] people. Unbelievable.
Donald Black: Yeah. Potentially in the United States, over 8 million people.
Rob Kall: That's very frightening. I was having a conversation the other day with somebody who is a very positive person, really believes that the world can heal itself. And then I brought up sociopaths; and his face changed, and all of a sudden it went to, "Yeah. That's really a problem." There really aren't solutions -- and your book is very -- again, the book title is Bad Boys, Bad Men, and a revised edition of it just came out in February. Your book gives suggestions to people who live with sociopaths how to cope, and it gives suggestions to sociopaths and anti-social personality people how the can work on their problem; but there's no real cure, is there?
Donald Black: No, there isn't. This is a dirty little secret in the field of Psychiatry and Psychology, that here we have this disorder that I call major; it's widespread, it affects a lot of people, the consequences of it are enormous. Because just think of all the people who end up in the criminal justice system because of their recurrent criminal behavior, which is one of the main symptoms of this disorder. You think of how costly it is, and yet we're no better at taking care of these people than we were fifty years ago when most doctors were just writing them off as untreatable.
Now, I do make the point in the book that we don't know if it's untreatable, but the government and researchers have put so little effort into looking for treatments, that I could only identify a single randomized, controlled trial in the entire worlds' literature. Now, if you compare that to schizophrenia, bi-polar disorder, depression, where there are thousands of studies showing that various treatments work - I mean, it's just not a level playing field. So I maintain that we don't know if it's untreatable, because no one has adequately studied this.
Rob Kall: So what you're saying is: currently no treatment for it, but there's been only one study that you've been able to find that actually looked at it.
Donald Black: Absolutely. I find this very regrettable and disturbing that something as problematic as this doesn't get any/more attention. And yes, in the book I do provide advice to anti-social men as well as their family members about steps that they can take. I remember when the book originally came out in 1999 I had a series of letters from people - this is almost pre-email days -- telling me how naÃ¯ve I was to even suggest these things for anti-socials, since they wouldn't do anything about helping themselves anyway. In the meantime, I've met with anti-socials, I've discussed the book with anti-social individuals, and they tell me that they like that advice, and in fact that I'm on track.
Rob Kall: Before we go any further, why don't we do some definitions. What is an anti-social or a sociopath? What are the primary characteristic of someone that fits the -
Donald Black: Well, that's an excellent question, and I think that's a good starting point for the discussion. To me, in a nutshell, it's "Recurrent bad behavior over time." So what do I mean by that? Well, most of these people have an onset of their disorder in early childhood, or at least by late childhood. So as kids they're regularly getting into trouble: lying to parents and teachers, getting into fights, vandalism, hurting others, hurting animals; in the worst cases, maybe setting fires, that sort of thing. And then as they transition into adolescence, the kind of misbehaviors depends on opportunities: early sexual misconduct, maybe stealing and thievery, burglary; you know, escalating in terms of crimes. And then when they hit adulthood, being irresponsible, not paying child support, spousal abuse, criminal behavior. So again, bad behavior over time.
People with this condition tend not to benefit from punishments. They don't tend to learn how to control their behavior the way most non-- anti-social people would. If you or I do something bad - we get caught, there's a punishment - we learn from that. We say to ourselves, "I'm not going to do it again, because first of all it's not a good thing to hurt other people, and second of all, I don't want to get punished. I don't want to go through that." These people never seem to learn that lesson.