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May 15, 2012

Thoughts about the NYT’s ‘Can You Call a 9-Year-Old a Psychopath?’

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When I read Jennifer Kahn’s well-written, draining piece in the NYT about the plight of a family whose child is exhibiting all the signs of a sociopath at the tender age of 9, all sorts of questions ran through my mind. Science often just uncovers the tip of the iceberg when it comes to mental illness/conditions we don’t understand very well, and it’s true in this case.

I urge you to read the entire lengthy piece before commenting, because Kahn spends a good deal of time looking at the issue of labeling, research and the social impact of exploring sociopathy in children and the potential to rehab them. We’re not talking about tantrums, general aggressive normal behavior; we’re talking about kids without empathy, kids that learn how to lie and manipulate at very early ages with the intent on harming others. You know, the stereotypical horror of a child that kills small animals for curiosity and pleasure.  The term for it is Callous-Unemotional Trait (CU), since only adults can be clinically labeled as psychopaths. We’re talking about this kind of behavior:

In some children, C.U. traits manifest in obvious ways. Paul Frick, a psychologist at the University of New Orleans who has studied risk factors for psychopathy in children for two decades, described one boy who used a knife to cut off the tail of the family cat bit by bit, over a period of weeks. The boy was proud of the serial amputations, which his parents initially failed to notice. “When we talked about it, he was very straightforward,” Frick recalls. “He said: ‘I want to be a scientist, and I was experimenting. I wanted to see how the cat would react.’ ”

In another famous case, a 9-year-old boy named Jeffrey Bailey pushed a toddler into the deep end of a motel swimming pool in Florida. As the boy struggled and sank to the bottom, Bailey pulled up a chair to watch. Questioned by the police afterward, Bailey explained that he was curious to see someone drown. When he was taken into custody, he seemed untroubled by the prospect of jail but was pleased to be the center of attention.

The parents of Michael, the child profiled in the piece, are well-educated, caring people who are existing in a living hell with him; they have two other boys who are the focus of Michael’s ire and aggressive actions, and have tried myriad paths to find help for him — psychologists, behavioral programs, research programs — to no avail. One of the major issues and frustrations is that CU kids apparently thrive in these programs — at learning how to lie and feign empathy.

In another study, the researcher Mark Dadds found that as C.U. children matured, they developed the ability to simulate interest in people’s feelings. “We called the paper ‘Learning to Talk the Talk,’ ” Dadds said. “They have no emotional empathy, but they have cognitive empathy; they can say what other people feel, they just don’t care or feel it.” When Anne worried that Michael might have begun manipulating his therapists — faking certain feelings to score points — she might have been more right than she knew.

The article doesn’t come to a conclusion about what to do – they don’t want to label the kids, but the science shows sociopathy is hereditary, like many conditions, and in about 50% of the cases the behavior resolves at adulthood. The point is that to do the research to find a way to help the other 50%; it means assigning a label. Until we walk in those parents’ shoes, I certainly cannot fathom what can help this family situation. This is the conundrum:

“Others fear that even if such a diagnosis can be made accurately, the social cost of branding a young child a psychopath is simply too high. (The disorder has historically been considered untreatable.) John Edens, a clinical psychologist at Texas A&M University, has cautioned against spending money on research to identify children at risk of psychopathy. “This isn’t like autism, where the child and parents will find support,” Edens observes. “Even if accurate, it’s a ruinous diagnosis. No one is sympathetic to the mother of a psychopath.”

The article seeks to find a path other than “there’s nothing that can be done” precisely because we’re talking about kids. But to ignore the condition because of the label is a big roadblock and mistake. We already have parents in denial about their child’s autism, or major depression until they cannot avoid it — for good reason — because of societal stigma that will follow their child for a lifetime. At least in those conditions there are behavioral approaches combined with medications that can maximize a child’s potential and health. In generations past, kids with autism, schizophrenia and sociopathy were institutionalized as throwaways. At least today they are looking at what can be done for kids like Michael instead of throwing up their hands and blaming the victim.

While the chance of inheriting a predisposition to psychopathy is high, Lynam noted, it is no higher than the heritability for anxiety and depression, which also have large genetic risk factors, but which have still proved responsive to treatment. Waschbusch agreed. “In my view, these kids need intensive intervention to get them back to normal — to the place where other strategies can even have an effect. But to take the attitude that psychopathy is untreatable because it’s genetic” — he shook his head — “that’s not accurate. There’s a stigma that psychopaths are the hardest of the hardened criminals. My fear is that if we call these kids ‘prepsychopathic,’ people are going to draw that inference: that this is a quality that can’t be changed, that it’s immutable. I don’t believe that. Physiology isn’t destiny.”

The problem is that the science has only led at this point to identify commonalities in these behaviors. It sounds horrifically like knowing a freight train is barreling down upon you but you have no way to stop it or divert it from its path. How can you not feel for the mom who has tried everything to help her son who can only come to the conclusion “I’ve always said that Michael will grow up to be either a Nobel Prize winner or a serial killer.”

An interesting companion piece to read in the NYT is “Capitalists and Other Psychopaths.”

There is an ongoing debate in this country about the rich: who they are, what their social role may be, whether they are good or bad. Well, consider the following. A recent study found that 10 percent of people who work on Wall Street are “clinical psychopaths,” exhibiting a lack of interest in and empathy for others and an “unparalleled capacity for lying, fabrication, and manipulation.” (The proportion at large is 1 percent.) Another study concluded that the rich are more likely to lie, cheat and break the law.

The only thing that puzzles me about these claims is that anyone would find them surprising.

It comes down to accepting some humans come out of the womb “broken” in some way — hey, given all of my auto-immune conditions, I would have already been dead without modern medicine. With mental illnesses, society has always blamed the victim because it is “invisible” and manifests itself in behavioral anomolies that society often finds unacceptable. Pharmaceutical advances have made it possible for people who would have been cast out to live relatively normal lives. However, this particular issue — sociopathy — is so loaded because we all know that they exist among us, have no empathy and wreak havoc when they attain positions of immense power. We do owe it to these kids to try to find ways to “fix” them before it’s too late. But the conversation about it is so loaded; it wouldn’t be as touchy if it were only about figuring out gene therapy/meds/behavioral mods for a less-severe mental condition or a purely physical hereditary one.

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