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 na????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.
A subset of these individuals lack a conscience;
that is, they can commit all kinds of heinous, criminal acts and not care about
it, not care about what the victim goes through. They lack empathy, and that's what can make
some people really dangerous: that they can commit some kind of criminal act
and just not care about how it impacts other people. This is what's frightening about the
disorder.
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