Donald Black: Well,
again, those sorts of things occur in a cultural context. They're not acting alone, they're acting
within a large group of people - you know, other protestors that share their
particular worldview - and that's outside the scope of what sociopathy or
anti-social personality disorder is about.
Plus, if you examine these people and took their histories, most of them
would not have a history of childhood misbehavior, they wouldn't have a history
of adult criminality, they wouldn't be abusing their spouses, they wouldn't be
getting into trouble at work, and so forth.
So I think even in countries where these kinds of acts can get you
arrested, most people would be able to distinguish between the sociopath who
was regularly getting into trouble, and the person who is simply violating laws
that he and many other people just don't accept.
Rob Kall: Can you
talk a little bit about this diagnosis and disorder, and DSM-IV and DSM-V, the
diagnostic manuals for psychiatrists?
Donald Black: Yeah, well
let me just talk a little bit about the history of this concept. I remember an interview that I had years ago,
I can't remember who was interviewing me, but they said, "Doctor Black, so you
are describing a new condition called 'Anti-social Personality Disorder.'" I said, "I'm doing nothing of the sort." In fact, if you look at the history of
psychiatry over time, this concept has been around at least two hundred years
(if not longer), where psychiatrists, or doctors, or others were describing
people who were not psychotic (that is, they weren't hearing voices or seeing
things), and yet they were regularly getting into trouble and committing
criminal acts.
We've always had a segment of the population who
behaves this way, and this has been described in the literature for hundreds of
years, and in the late 19th century, doctors described it in more
detail. In the 20th century,
that tradition continued: there was a man writing in the 40s named Hervey
Cleckly, an American Psychologist. He
wrote a book called The Mask of Sanity that really brought these ideas
together, and it was very influential book.
By the way, he's also co-author of Three Faces of Eve; everyone
has heard of Three Faces of Eve, they haven't heard of Masks of
Sanity. Psychiatrists and
psychologists look at the Mask of Sanity as really pulling this concept
together.
The diagnostic and statistical manual of mental
disorders, and many listeners may not be familiar with that, but it is
essentially the diagnostic bible that psychiatrists and psychologists use. It's produced and published by the American
Psychiatric Association, and has been since 1952 when it first came out. Anti-social personality disorder, either
under that name or other names, has been there from the start. We have specific criteria to define it that
can be used by clinicians in practice, it can be used by researchers, and it is
a valid disorder. It's been shown to be
very reliable, that is, various psychiatrists around the world seeing the same
patient applying those criteria will diagnose that person anti-social.
So it's reliable, it's valid, meaning it's a
highly useful concept, in that it's predictive of what happens to an individual. When someone has that diagnosis, we know a
lot about that person, and we know what the possible outcome probably is. Currently, we're using the 4th
edition of the DSM, as it's called, and we're about to go into the 5th
edition, which will be released in late May at the American Psychiatric
Association meeting in San Francisco.
I'll be there. The criteria have
not changed; so what's in DSM-IV will be in DSM-V.
Rob Kall: And what
are the basic criteria to diagnose, the bare minimum criteria?
Donald Black: Well you
know, I always have to look it up, because even though I'm an expert in this
area, I can never remember exactly how things are worded; and I'll tell you,
because I have it right here next to me.
Basically, "A pervasive pattern of disregard for and violation of the
rights of others, occurring since age fifteen years." And the person has to have three of seven
different behaviors. That's how a lot of
our diagnoses work: there's a whole list of symptoms, and then we require for
diagnosis "x" that the person have a certain number of the criteria. I'm not going to read them all, but just for
example:
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