DSM-IV

Finishing up my degree in psychology I had to look into the publishing policies of the APA. They disturbed me at the time, and they still do. My opinion has usually been that science is a search for truth and that truth is rarely comfortable. I don't need to get into the details. Suffice it to say that sometimes things change between editions of the DSM and sometimes those changes are not based on research.

There are some old classifications that I really like because they make quick useful distinctions. One example is neurosis, psychosis and schizophrenia. The first two no longer exist as discrete diagnoses and the third has become very specific. Everybody has problems or unusual habits. When the habits were only noticed by you and didn't effect the rest of your life, you were healthy. When they did effect your life, it was a neurosis. When it started affecting other people's lifes it was a psychosis and when you were no longer playing in the community sandbox, when the world you responded to wasn't the same as everyone else sees, it was schizophrenia. Scientifically robust? Maybe not. Useful shorthand? Definitely.

Setting up the latest training for crisis communication with the mentally ill I had to look up some stuff in the DSM-IV and saw something that really disturbed me- the sociopath has been tacked on as an alternate name for the Anti-Social Personality Disorder. In earlier editions, there was a distinction and there was a physiological test to show the distinction, a negative GSR (galvanic skin response). GSR is part of the "lie detector test"- your skin's conductivity to electricity changes under stress. Lying is stressful. A true sociopath didn't even have a GSR response to pain. Pain was not stressful.

Personally, I see the difference in action and it is an important and a qualitative difference. It is not quantitative, it is not a matter of a sociopath being more antisocial that an APD. An APD cares more about himself than you. We all do this, but the APD takes it to extremes, and there are gradations of it. An APD who decides that what he wants is more important than what you want will take your stuff and feel no guilt. An APD who feels that what he wants is more important than your life is more severe and will rob and kill. An APD who feels not being bored is more important than your life will kill you for fun. More extreme yet.

The true sociopath doesn't think any of this (you, me, the world) is real. I'm split on whether they think of themselves as real. They are essentially playing the biggest, most complex video game ever.

If you've played video games (I'm thinking GTA: San Andreas here) they are fun, exciting, you might get a little trickle of adrenaline- but there is no remorse, not even to your own characters death. Slaughtering is a technical skill, not an act of will or desperation. To live life this way can be powerful, even liberating- but it is very alien.

Probably the only saving grace is that the world is so complex that there are many ways to win, so few sociopaths become serial killers by deciding that the points are in the body count. Instead they may shoot for business or political success... or suspecting that there is an emptiness inside try to fill it with the artificial emotion of drugs and destroy themselves.