9 ms·

Psychopathy: A new clinical approach offers hope

98 points by kposehn 9y ago

gorbachev 9y ago
This made me shiver. As a parent that's more or less my worst nightmare, to raise kids who are like that.
- thatwebdude 9y ago
  +1, I couldn't even finish reading. The scary part is the consistent fear of "raising" that behavior; that somehow it's your fault. It would be very hard to live with that idea.
  - stevenwoo 9y ago
    They made it clear that parenting doesn't matter for these cases as far as they can tell, they focused on a juvenile treatment facility in the main part, not the family in the introductory paragraphs, and the facility tries to mold behavior with high reward/low punishment system ( with the juveniles behind bars to protect everyone else )
    - thatwebdude 9y ago
      A professional could tell me it wasn't my fault over and over again; but it'd honestly take years (at least) to get over that fact. That's just something I'd be hard to un-program from myself.
droithomme 9y ago
Diagnosing a child as a psychopath is pretty questionable. In addition, diagnoses of psychopathy in adults is difficult and expert psychiatrists have admitted even they are fooled. I was not surprised then when the article admitted that the parents diagnosed the disorder themselves, and then shopped around for therapists until they found one in another state willing to agree with their diagnosis. I bet it made them feel good when they finally found a doctor willing to support their amateur diagnostic efforts.
- mjfl 9y ago
  Exactly. Psychology is not totally exact... think of the false positive rate (it's going to be big!) and the toll a false positive would take on a child's life. Think of a mentally ill parent doing exactly what you say. That is terrifying to me.
  - falcolas 9y ago
    Imagine the toll on a parent if the child remains undiagnosed and untreated. Imagine constantly viewing yourself as a failure for 18+ years because you are unable to control your child's behavior - as they go from hurting pets for fun to hurting siblings and school peers... Not to mention the toll on their victims.
    - mjfl 9y ago
      All children have empathy problems. It's a capacity you develop as you get older (some kids develop it faster or slower). If you diagnose your child with that kind of mental illness in the early stages of development you are completely insane and probably need to have your custody taken away.
      - dkarl 9y ago
        It definitely can't be left to the parents, but of course a determined parent is going to shop around for a diagnosis, and of course some people are really hungry for a diagnosis. On the other hand it can be tragic when parents deny a problem and prevent their kid from getting treatment. It sucks that so many parents let their own wishes interfere with their kids' medical needs, from inventing food allergies to denying mental illness. Some people just looooove a diagnosis (for themselves or their kid) because they love using it to give a certain context to their lives, and some people will live in denial for years because they don't trust doctors or fear stigma.
    - wu-ikkyu 9y ago
      >Imagine constantly viewing yourself as a failure for 18+ years because you are unable to control your child's behavior I understand this sentiment, but looking at it from another angle, this sentiment suggests control/blame issues on the part of the parent. Which itself can be classified as a "mental illness". This highlights how often the macro social environment is ignored in the production of mental issues, and how the blunt of the blame is placed on the individual.
spangry 9y ago
I'm not sure how to bring this to the attention of a mod, but is it possible to merge this post with this other one: https://news.ycombinator.com/item?id=14355964 https://news.ycombinator.com/item?id=14355964 EDIT: maybe if someone flags this commment... don't worry I won't mind :)
dsacco 9y ago
The article is kind of all over the place. It's a bit grating to me, because it's a long form piece attempting to grapple with a complex subject, but it's overly sensationalized and doesn't meaningfully differentiate itself from the media representation. Consider that the article insists on using the colloquial, imprecise and emotionally charged term "psychopath" - the clinical diagnosis, antisocial personality disorder, is not mentioned once in the entire article, despite the fact that the author acknowledges the stigma inherent in the disorder. The title itself is clearly sensationalized. Furthermore, it has passages like this one: Like the guy standing 20 feet away from me in the North Hall of Mendota Juvenile Treatment Center, in Madison, Wisconsin. The tall, lanky teenager has just emerged from his cell. Two staff members cuff his wrists, shackle his feet, and begin to lead him away. Suddenly he swivels to face me and laughs—a menacing laugh that gives me chills. As young men yell expletives, banging on the metal doors of their cells, and others stare silently through their narrow plexiglass windows, I think, This is as close as I get to Lord of the Flies. That's a laughably sensationalized and stereotypical depiction of someone with antisocial personality disorder, even one given to criminal behavior. On the one hand it's trying to evoke images of children who are wildly remorseless, on the other hand it talks about the "chills" you get from interacting with these people. It feels like the article decided to play up the angle of, "What if your child was a psychopath?" instead of realistically tackling the subject in a new way. It's just perpetuating the stigma that already exists - "psychopaths" are either remorseless killers with an insatiable thirst for violence, or they're hyper-efficient captains of their fields. I honestly expect much more nuance and integrity in a long form piece approaching this subject.
- scott_s 9y ago
  The article does mention the clinical diagnosis, but the one for children: "Samantha was diagnosed with conduct disorder with callous and unemotional traits. She had all the characteristics of a budding psychopath." Antisocial personality disorder is, as far as I know, used for adults.
  - UnpossibleJim 9y ago
    I think the youngest diagnoses was 12 (I need to double check) but it, generally, begins to manifest at puberty to mid-twenties, barring some jarring event. Even then, that is usually diagnosed as PTSD with Atypical symptoms, displaying in antisocial behavior. It's been a while since I was in school, so categorization may have (and has, since a new DSM has been published) changed, but they rarely make huge changes. It's, generally, language to accord to the societal language.
SCAQTony 9y ago
The brain is so complicated that circa 2017 A neurologist, let alone a psychiatrist, can't explain why we can look at a cup of coffee, know that it is hot, know how to to pick it up and balance the cup to your lips and swallow the hot fluid without burning yourself while reading a suspenseful book all at the same time. If science can't fully explain how and why that process can happen, how can psychiatry or psychology be so confident that they can determine how to cure or treat psychopathy at 3-or-4 years old?. Even take it further, there is no process, procedure, or prescription you can write or execute to immediately mend a broken heart other than time and personal consideration.
- maxmcd 9y ago
  If I can't explain where the wind comes from, why there are tides, or what the sun is, I can still sail a ship. Complete understanding of all the components of a subject or system doesn't typically seem to be a requirement to do work within that system.
  - wu-ikkyu 9y ago
    The wind, tides, and sun are all real, objective physical phenomenon. The mind is not so
    - ferentchak 9y ago
      It can be debated that the wind, tides and sun are not real and only the mind is. This viewpoint usually doesn't result in computers and spaceships being created though.
      - wu-ikkyu 9y ago
        Very good! This reminds me of an old zen tale: >Two men were arguing about a flag flapping in the wind. "It's the wind that is really moving," stated the first one. "No, it is the flag that is moving," contended the second. A Zen master, who happened to be walking by, overheard the debate and interrupted them. "Neither the flag nor the wind is moving," he said, "It is MIND that moves."
projektir 9y ago
> Indeed, certain psychopathic traits have survived because they’re useful in small doses: the cool dispassion of a surgeon, the tunnel vision of an Olympic athlete, the ambitious narcissism of many a politician. But when these attributes exist in the wrong combination or in extreme forms, they can produce a dangerously antisocial individual, or even a cold-blooded killer. Certain politicians are responsible for far more suffering than cold-blooded killers... funny what we value.
- timthelion 9y ago
  You were being down voted. By whom? People who love Hitler and Pol Pot? Or just people who are tired of politics on HN?
  - DKnoll 9y ago
    Because it's a platitude. By the same criteria, the following statement is true: some scientists are responsible for far more suffering than cold-blooded killers.
- wu-ikkyu 9y ago
  "It is forbidden to kill; therefore all murderers are punished unless they kill in large numbers and to the sound of trumpets."
- pmiller2 9y ago
  Indeed, even if we had a good therapy for psychopaths in general, the ones who don't get in trouble with the law are the ones who are most dangerous. Why would a successful psychopath ever seek help?
zeroer 9y ago
Were I in charge, I'd put these kids down. It'd be a mercy.
- sctb 9y ago
  Please post more thoughtfully than this. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
  - zeroer 9y ago
    Thank you. I appreciate the guidance, but I'm not attempting to troll, and this is something that I would say in an in person conversation and have. I really honestly believe that you'd do these kids a favor by euthanizing them. It'd be a relief to their parents and the future people who wouldn't be victimized, too.
socrates1998 9y ago
What's scary is that these people are actually released into the world. 36% of them do violent crimes again. And that's considered a GOOD stat. That's insane. I don't know what the answer is, but this article makes me more aware (and maybe scared) of how many violent people are out there.
deleted 9y ago
[deleted]
5ourpu55 9y ago
I wonder if psychopathy has anything to do with the phenomenon of "cute aggression", and being unable to restrain yourself from urges that everyone has.
VladimirGolovin 9y ago
I was wondering recently what Dr. Kiehl is up to these days, and the article gives the answer: Kiehl and the staff at Mendota are now asking some 300 young men to slide into a mobile brain scanner. The scanner records the shape and size of key areas of the boys’ brains, as well as how their brains react to tests of decision-making ability, impulsivity, and other qualities that go to the core of psychopathy. Each boy’s brain will be scanned before, during, and at the end of their time in the program, offering researchers insights into whether his improved behavior reflects better functioning inside his brain. Also, "while adult psychopaths constitute only a tiny fraction of the general population, studies suggest that they commit half of all violent crimes.". This is beyond scary. I wonder how we, as a civilization, can get psychopathy under control? We have 1 percent of the population that places enormous burden on the society, and we still act as if they are normal people. Why there's no requirement for psychopathy assessment for jobs like police officers or civil servants? Should we apply mandatory psychopathy testing to all convicted criminals and divert the positives into a specially-designed life track - and what would that life track even look like?
- atemerev 9y ago
  Quite a lot of psychopaths are well-adjusted and trained themselves to fake empathy and other social traits they don't innately have. You probably have a psychopath among your friends, it is not that rare. Unfortunately, this mental adaptation might never happen or happen too late.
  - raarts 9y ago
    According to most sources 1 in hundred people are psychopaths. Most people don't have that many friends. I for example have just one.
  - deleted 9y ago
    [deleted]
laughfactory 9y ago
Yikes. This was a horrifying read. Mostly because my five year old daughter displays some of these characteristics. Like not seeming bothered by others' distress. Or like sometimes maybe enjoying terrorizing her siblings. I think sometimes when she acts concerned it's just because she wants to get her sister to stop crying, not because she cares about her sister, but because the sound annoys her. Does this mean she's wired for psychopathy? That we need to sleep with one eye open? Man, I hope not! Or is this fairly typical of children of this age?
gt_ 9y ago
So, a configured abstract reward system can make psychopaths look like regular narcissists. And then? Did they find a cure or become mutual accomplices? They learned that if they maintain without showing emotion long enough that they can earn a form of respect by playing the patient's own game. Not surprisingly, the respect sustains when nourished with rewards. The doctors and patients are now comrads. The patient shows improvement during the state of success, diplomatic accomplishment, overcoming their peers, winning, etc. and while it is nice they can reproduce the system, they are still misunderstanding it. By their logic, we would elect the patients into office, process their confidence as wellness, and maybe one day they can become so cured they will be president! Maybe there is some valuable stuff being researched here but this essay doesn't confirm that. There is a comparison opportunity in the two origins discussed that might offer actual insight but I guess that was just a narrative decoration?
RScholar 9y ago
I find myself stuck on a single data point from this article, the one that reports 16 people lost their lives due to the release of just 248 incarcerated kids. Now my rational mind is able to grasp that this is only 6.5% of the group they were tracking, but I can't help but feel like we owe those 16 people a greater standard of care than to release these deeply disturbed individuals. The recidivism rate for that same group was 97%...so a virtual certainty. They don't break that down into violent crimes vs property crimes, but seat of the pants wisdom suggests that even if it is property crime initially, that it is similarly likely to progress to more sinister deeds later on. If that's not enough to justify a life sentence in perhaps a minimum security facility, I don't know what is.

98 points by kposehn 9y ago

gorbachev 9y ago

This made me shiver. As a parent that's more or less my worst nightmare, to raise kids who are like that.

thatwebdude 9y ago
+1, I couldn't even finish reading. The scary part is the consistent fear of "raising" that behavior; that somehow it's your fault. It would be very hard to live with that idea.
- stevenwoo 9y ago
  They made it clear that parenting doesn't matter for these cases as far as they can tell, they focused on a juvenile treatment facility in the main part, not the family in the introductory paragraphs, and the facility tries to mold behavior with high reward/low punishment system ( with the juveniles behind bars to protect everyone else )
  - thatwebdude 9y ago
    A professional could tell me it wasn't my fault over and over again; but it'd honestly take years (at least) to get over that fact. That's just something I'd be hard to un-program from myself.

droithomme 9y ago

Diagnosing a child as a psychopath is pretty questionable. In addition, diagnoses of psychopathy in adults is difficult and expert psychiatrists have admitted even they are fooled. I was not surprised then when the article admitted that the parents diagnosed the disorder themselves, and then shopped around for therapists until they found one in another state willing to agree with their diagnosis. I bet it made them feel good when they finally found a doctor willing to support their amateur diagnostic efforts.

mjfl 9y ago
Exactly. Psychology is not totally exact... think of the false positive rate (it's going to be big!) and the toll a false positive would take on a child's life. Think of a mentally ill parent doing exactly what you say. That is terrifying to me.
- falcolas 9y ago
  Imagine the toll on a parent if the child remains undiagnosed and untreated. Imagine constantly viewing yourself as a failure for 18+ years because you are unable to control your child's behavior - as they go from hurting pets for fun to hurting siblings and school peers... Not to mention the toll on their victims.
  - mjfl 9y ago
    All children have empathy problems. It's a capacity you develop as you get older (some kids develop it faster or slower). If you diagnose your child with that kind of mental illness in the early stages of development you are completely insane and probably need to have your custody taken away.
    - dkarl 9y ago
      It definitely can't be left to the parents, but of course a determined parent is going to shop around for a diagnosis, and of course some people are really hungry for a diagnosis. On the other hand it can be tragic when parents deny a problem and prevent their kid from getting treatment. It sucks that so many parents let their own wishes interfere with their kids' medical needs, from inventing food allergies to denying mental illness. Some people just looooove a diagnosis (for themselves or their kid) because they love using it to give a certain context to their lives, and some people will live in denial for years because they don't trust doctors or fear stigma.
  - wu-ikkyu 9y ago
    >Imagine constantly viewing yourself as a failure for 18+ years because you are unable to control your child's behavior I understand this sentiment, but looking at it from another angle, this sentiment suggests control/blame issues on the part of the parent. Which itself can be classified as a "mental illness". This highlights how often the macro social environment is ignored in the production of mental issues, and how the blunt of the blame is placed on the individual.

spangry 9y ago

I'm not sure how to bring this to the attention of a mod, but is it possible to merge this post with this other one: https://news.ycombinator.com/item?id=14355964 https://news.ycombinator.com/item?id=14355964 EDIT: maybe if someone flags this commment... don't worry I won't mind :)

dsacco 9y ago

The article is kind of all over the place. It's a bit grating to me, because it's a long form piece attempting to grapple with a complex subject, but it's overly sensationalized and doesn't meaningfully differentiate itself from the media representation. Consider that the article insists on using the colloquial, imprecise and emotionally charged term "psychopath" - the clinical diagnosis, antisocial personality disorder, is not mentioned once in the entire article, despite the fact that the author acknowledges the stigma inherent in the disorder. The title itself is clearly sensationalized. Furthermore, it has passages like this one: Like the guy standing 20 feet away from me in the North Hall of Mendota Juvenile Treatment Center, in Madison, Wisconsin. The tall, lanky teenager has just emerged from his cell. Two staff members cuff his wrists, shackle his feet, and begin to lead him away. Suddenly he swivels to face me and laughs—a menacing laugh that gives me chills. As young men yell expletives, banging on the metal doors of their cells, and others stare silently through their narrow plexiglass windows, I think, This is as close as I get to Lord of the Flies. That's a laughably sensationalized and stereotypical depiction of someone with antisocial personality disorder, even one given to criminal behavior. On the one hand it's trying to evoke images of children who are wildly remorseless, on the other hand it talks about the "chills" you get from interacting with these people. It feels like the article decided to play up the angle of, "What if your child was a psychopath?" instead of realistically tackling the subject in a new way. It's just perpetuating the stigma that already exists - "psychopaths" are either remorseless killers with an insatiable thirst for violence, or they're hyper-efficient captains of their fields. I honestly expect much more nuance and integrity in a long form piece approaching this subject.

scott_s 9y ago
The article does mention the clinical diagnosis, but the one for children: "Samantha was diagnosed with conduct disorder with callous and unemotional traits. She had all the characteristics of a budding psychopath." Antisocial personality disorder is, as far as I know, used for adults.
- UnpossibleJim 9y ago
  I think the youngest diagnoses was 12 (I need to double check) but it, generally, begins to manifest at puberty to mid-twenties, barring some jarring event. Even then, that is usually diagnosed as PTSD with Atypical symptoms, displaying in antisocial behavior. It's been a while since I was in school, so categorization may have (and has, since a new DSM has been published) changed, but they rarely make huge changes. It's, generally, language to accord to the societal language.

SCAQTony 9y ago

The brain is so complicated that circa 2017 A neurologist, let alone a psychiatrist, can't explain why we can look at a cup of coffee, know that it is hot, know how to to pick it up and balance the cup to your lips and swallow the hot fluid without burning yourself while reading a suspenseful book all at the same time. If science can't fully explain how and why that process can happen, how can psychiatry or psychology be so confident that they can determine how to cure or treat psychopathy at 3-or-4 years old?. Even take it further, there is no process, procedure, or prescription you can write or execute to immediately mend a broken heart other than time and personal consideration.

maxmcd 9y ago
If I can't explain where the wind comes from, why there are tides, or what the sun is, I can still sail a ship. Complete understanding of all the components of a subject or system doesn't typically seem to be a requirement to do work within that system.
- wu-ikkyu 9y ago
  The wind, tides, and sun are all real, objective physical phenomenon. The mind is not so
  - ferentchak 9y ago
    It can be debated that the wind, tides and sun are not real and only the mind is. This viewpoint usually doesn't result in computers and spaceships being created though.
    - wu-ikkyu 9y ago
      Very good! This reminds me of an old zen tale: >Two men were arguing about a flag flapping in the wind. "It's the wind that is really moving," stated the first one. "No, it is the flag that is moving," contended the second. A Zen master, who happened to be walking by, overheard the debate and interrupted them. "Neither the flag nor the wind is moving," he said, "It is MIND that moves."

projektir 9y ago

> Indeed, certain psychopathic traits have survived because they’re useful in small doses: the cool dispassion of a surgeon, the tunnel vision of an Olympic athlete, the ambitious narcissism of many a politician. But when these attributes exist in the wrong combination or in extreme forms, they can produce a dangerously antisocial individual, or even a cold-blooded killer. Certain politicians are responsible for far more suffering than cold-blooded killers... funny what we value.

timthelion 9y ago
You were being down voted. By whom? People who love Hitler and Pol Pot? Or just people who are tired of politics on HN?
- DKnoll 9y ago
  Because it's a platitude. By the same criteria, the following statement is true: some scientists are responsible for far more suffering than cold-blooded killers.
wu-ikkyu 9y ago
"It is forbidden to kill; therefore all murderers are punished unless they kill in large numbers and to the sound of trumpets."
pmiller2 9y ago
Indeed, even if we had a good therapy for psychopaths in general, the ones who don't get in trouble with the law are the ones who are most dangerous. Why would a successful psychopath ever seek help?

zeroer 9y ago

Were I in charge, I'd put these kids down. It'd be a mercy.

sctb 9y ago
Please post more thoughtfully than this. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
- zeroer 9y ago
  Thank you. I appreciate the guidance, but I'm not attempting to troll, and this is something that I would say in an in person conversation and have. I really honestly believe that you'd do these kids a favor by euthanizing them. It'd be a relief to their parents and the future people who wouldn't be victimized, too.

socrates1998 9y ago

What's scary is that these people are actually released into the world. 36% of them do violent crimes again. And that's considered a GOOD stat. That's insane. I don't know what the answer is, but this article makes me more aware (and maybe scared) of how many violent people are out there.

deleted 9y ago

[deleted]

5ourpu55 9y ago

I wonder if psychopathy has anything to do with the phenomenon of "cute aggression", and being unable to restrain yourself from urges that everyone has.

VladimirGolovin 9y ago

I was wondering recently what Dr. Kiehl is up to these days, and the article gives the answer: Kiehl and the staff at Mendota are now asking some 300 young men to slide into a mobile brain scanner. The scanner records the shape and size of key areas of the boys’ brains, as well as how their brains react to tests of decision-making ability, impulsivity, and other qualities that go to the core of psychopathy. Each boy’s brain will be scanned before, during, and at the end of their time in the program, offering researchers insights into whether his improved behavior reflects better functioning inside his brain. Also, "while adult psychopaths constitute only a tiny fraction of the general population, studies suggest that they commit half of all violent crimes.". This is beyond scary. I wonder how we, as a civilization, can get psychopathy under control? We have 1 percent of the population that places enormous burden on the society, and we still act as if they are normal people. Why there's no requirement for psychopathy assessment for jobs like police officers or civil servants? Should we apply mandatory psychopathy testing to all convicted criminals and divert the positives into a specially-designed life track - and what would that life track even look like?

atemerev 9y ago
Quite a lot of psychopaths are well-adjusted and trained themselves to fake empathy and other social traits they don't innately have. You probably have a psychopath among your friends, it is not that rare. Unfortunately, this mental adaptation might never happen or happen too late.
- raarts 9y ago
  According to most sources 1 in hundred people are psychopaths. Most people don't have that many friends. I for example have just one.
- deleted 9y ago
  [deleted]

laughfactory 9y ago

Yikes. This was a horrifying read. Mostly because my five year old daughter displays some of these characteristics. Like not seeming bothered by others' distress. Or like sometimes maybe enjoying terrorizing her siblings. I think sometimes when she acts concerned it's just because she wants to get her sister to stop crying, not because she cares about her sister, but because the sound annoys her. Does this mean she's wired for psychopathy? That we need to sleep with one eye open? Man, I hope not! Or is this fairly typical of children of this age?

gt_ 9y ago

So, a configured abstract reward system can make psychopaths look like regular narcissists. And then? Did they find a cure or become mutual accomplices? They learned that if they maintain without showing emotion long enough that they can earn a form of respect by playing the patient's own game. Not surprisingly, the respect sustains when nourished with rewards. The doctors and patients are now comrads. The patient shows improvement during the state of success, diplomatic accomplishment, overcoming their peers, winning, etc. and while it is nice they can reproduce the system, they are still misunderstanding it. By their logic, we would elect the patients into office, process their confidence as wellness, and maybe one day they can become so cured they will be president! Maybe there is some valuable stuff being researched here but this essay doesn't confirm that. There is a comparison opportunity in the two origins discussed that might offer actual insight but I guess that was just a narrative decoration?

RScholar 9y ago

I find myself stuck on a single data point from this article, the one that reports 16 people lost their lives due to the release of just 248 incarcerated kids. Now my rational mind is able to grasp that this is only 6.5% of the group they were tracking, but I can't help but feel like we owe those 16 people a greater standard of care than to release these deeply disturbed individuals. The recidivism rate for that same group was 97%...so a virtual certainty. They don't break that down into violent crimes vs property crimes, but seat of the pants wisdom suggests that even if it is property crime initially, that it is similarly likely to progress to more sinister deeds later on. If that's not enough to justify a life sentence in perhaps a minimum security facility, I don't know what is.