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: