Most Psychologists are Equipped to Diagnose Psychopathy...
Except... they're not, and in many cases, not equipped to diagnose many things that they do anyway
This post has been inspired by a comment that I got over on Quora, and it made it obvious that there is still a need to make it clear how poorly people, even professionals, are educated about psychopathy.
We have discussed in the past how ridiculous some of the statements made by so-called “professionals” about psychopathy are, but there is still a belief that they have been educated regarding it. They aren’t. Psychologists themselves have told me that they received one day of education on abnormal psychology in general while they were getting their degree.
One day. Can you imagine getting one day of training in structural engineering, and then being expected, or worse, believing that you are qualified, to build a bridge? I understand that there is a difference between a hard science and a soft science, however, something with more nebulous terms seems to me that it should be studied with the same amount of rigor as a hard science like math. You are dealing with a person’s life after all.
It seems easy to diagnose people. You just rely on the checklist of the DSM, but that seems to me to be more a part of the problem, and definitely not a solution. Have you ever noticed the clusters of diagnosis that happen as the years go by? For a time, almost kids it seemed, had some degree of ADHD. So many were scripted out ritalin unnecessarily, and then later on it was discovered that ritalin had dramatically negative effects on the developing brain.
What about Bipolar? More recently it appears to be DID, and PTSD. These things are being diagnosed at record numbers, much to the detriment of those that actually have these conditions. I know that all of these things are real. They exist, and people deal with them every single day. However, I find it amusing when someone is diagnosed with PTSD because apparently having a totally normal and structured childhood, is the same as being chained to a toilet by your parents for years as a permanent punching bag that can’t get away.
That seems like a ridiculous comparison, I know, but I have had people tell me that they have nothing unusual about their lives, and they are still diagnosed with PTSD, when in reality what they are describing is mild anxiety. I have dealt with young men that have PTSD so severely that if you hit a trigger, they can break for days because of their unending trauma from things like the second example. Seems like an overreach in example number one, and I am not blaming the person that received the diagnosis in example number one, I am holding that clinician to account for over diagnosing things.
There are a number of places where there is a gross misunderstanding of things, and yet the diagnoses are being handed out like candy on Halloween. I think that the overreliance on the DSM has a lot to do with this. Many people have no idea how the DSM is constructed, and the process is not nearly as involved as you might imagine that it is. I spoke about it here:
so that way I don’t have to bore those of you that have already read it with a repeat. Checklists are great, if they can be followed up with testing that can confirm the suspicion, but that is not often the case. Someone that I know was diagnosed with bipolar in a single evening in an emergency room. I will say that there was certainly something going on with that person in general, but it was a very quick diagnosis without confirmatory follow up, instead it was straight in line to medication.
The DSM has become a crutch I think. I can understand the reasoning for its creation, but I think that it plays into a human trait of letting the work be done by someone else, while relying on the idea that the person that came before knew what they were doing.
What if they didn’t? What if they were wrong to begin with? Then what?
I will speak more about this in the next post, delving deeper into the work of Robert Hare in regards to psychopathy, to illustrate that sometimes, the tools left behind by someone else needs to be reevaluated as the science progresses. If they aren’t, and in the case of the PCL-R there have been massive roadblocks in that reevaluation, then you end up with a quagmire of misinformation that can’t be sorted.
Getting back to the training that psychologists receive in terms of diagnostics of anything abnormal. This is important because of the effects that it has on people’s lives. There are many people that get caught up in these diagnostic trends. How many people that have something totally different, but display somewhat similar characteristics that just so happen to be on that psychologist's mind, that they manage to fit what their client is telling them in that moment?
Training is imperative, and it is lacking. I don’t think that a person that is looking down a checklist of symptoms and assigning a label is doing any favors for their client, but it appears that this is what happens in a lot of cases. This is made worse when they are given powerful, mind altering drugs that significantly change how their brain is functioning, but also creates an environment in the brain that if you just stop taking these medications, it can induce life threatening situations.
I have come across this problem in multiple venues of my life, be it through people that I know personally, comments sections, or even stories around celebrities. There is something to be said for being at the mercy of people that are supposed to be more engaged than using an insurance repayment manual for identifying what is going on in a patient.
What does “abnormal psychology” cover? Among other things it covers:
Anxiety disorders, such as social anxiety disorder, panic disorder, and generalized anxiety disorder
Mood disorders, such as depression and bipolar disorder
Neurodevelopmental disorders, such as an intellectual disability or autism spectrum disorder
Neurocognitive disorders including delirium
Personality disorders, such as borderline personality disorder, avoidant personality disorder, and obsessive-compulsive personality disorder
This list seems like it should require more than a single day of study for understanding, let alone diagnosis. How many people are being underserved, or entirely unserved when it comes to wellbeing?
There is, of course, a mental health problem in this country, and addiction is another serious problem. Perhaps addiction is easy to diagnose, but what about the underlying factors? Are they so simple to identify, let alone treat? If our homeless population is any indication, no, they are not. Many people tell me that the homelessness crisis is about there not being enough affordable housing. To which I ask:
“Have you ever dealt with the homeless?”
I don’t mean giving them a dollar, but rather volunteering at a shelter? Mind you, in this question I am specifically delineating between the actual homeless population, and those that panhandle for a living, and then go home to their very nice house paid for off your bucks collected at the off ramp of the freeway. You can suss out those types often by looking at their shoes, and their clothing, however, some of them are very committed to the bit, even if they aren’t actually homeless.
I am speaking about the real homeless population where mental health problems, and addiction are a huge part of the problem. Deinstitutionalization contributed to this significantly, and the institutions themselves didn’t help their case. My point is that addiction often stems from self medication, and self medication arises from mental health issues that are not being successfully addressed. It becomes a near assembly line of diagnostics, and “problem solving” that does little to address the underlying issues.
There is a culture of laziness, and overreliance on a book that was never meant for the purpose that it is being used for, and the people that are reaping the black harvest that this environment is sowing, are the patients. Be them homeless, or not. Adults or teenagers. Males or females. There is a problem when you have people that are completely undereducated assigning diagnoses to clients that they aren’t assessing in a thorough manner. Where does this leave people?
Up a creek. Really, that’s what it comes down to, a very expensive creek I might add, and people more or less know that this is the case. What do we get partially because of this? People that would prefer to self diagnose. They create definitions for labels that they believe describes who they are, and a lot of times this is going to be based on misinformation that they glean from places like Tumblr, or Reddit.
I had a conversation recently that was about this very thing. A distinct lack of faith in the mental health system led a person to self identify as a psychopath, and that self identification was based on myths, not reality. No matter how much they were presented with information that countered what they wanted to believe, they were adamant that I was wrong, and they were correct.
How do you argue with a person that makes this statement about themselves:
“i’m a psychopath and i want to be happy. i am a victim of narcissistic abuse, institutional abuse at the hands of very sick monsters. i don't want to be a bad person even though i have suicidal and homicidal tendencies as i fantasize about murder. this is me, this is real, gonna let the light shine out of me.”
I explained that this is not what psychopathy is, and that they were misinformed, but that did nothing to sway their opinions. They had been previously diagnosed in an institution that they claim they were committed to for an attempted murder:
i’ve been admitted to an asylum once where they diagnosed me as schizophrenic because i had a phantasmagorical episode whereby i thought my abusive family was planning to kill me
Of course I know they are not psychopathic, but I don’t know, nor would I ever attempt to give them a diagnosis of any kind. As much as I might speak about having a single day of training in abnormal psychology is inadequate, it is one day more than I have. Add to that, most people that work at actual asylums are going to be forensic psychologists that do have much more education in such things.
However, this person is obviously not convinced. They lack faith in the professional clinicians, and the assembly line type diagnostics that we are seeing, relying on checklists instead of interaction with the patients, presents a strong argument for that lack of faith.
What can be done? I think that the first thing to do is to reeducate not only psychologists, but the general public as to what the DSM actually is. It is an insurance repayment manual, not a bible, but that doesn’t stop people from having really uninformed opinions about it’s value:
Courtesy of people's abject refusal to inform themselves, many people believe psychopathy is an actual disorder. It is not.
THERE IS NO OFFICIAL DISORDER OR DIAGNOSIS CALLED PSYCHOPATH.
This disorder is not recognized by the American psychiatric association, the DSM-5, the ICD-10 or any medical psychological organization. There are speculative personality inventories which claim to label individuals with certain types of psychopathy.
Nonetheless you cannot be diagnosed with a condition called Psychopath: it does not exist.
The closest approximation to psychopathy is found in the personality disorder called ASPD-- Antisocial Personality Disorder.
Do yourself and everyone else a favor who shares this falsehood:
Go to the DSM-5 site online
Look up the disorder called psychopath
You will note there is no such disorder.
There are many things not in the DSM, and that does nothing to outline whether or not they exist, but people believe it to be inherently valuable, and rely on it to do their thinking. This is creating a lot of issues in the mental health world. The person above claims a “BA, Dev Psych, 2019”. A bachelor's degree in developmental psychology definitely does not provide a better education in abnormal psychology than a masters degree in psychology. However, what this does do is give you a reading on the education system, and what they are teaching about the DSM’s importance.
In a recent post in which I made similar statements regarding the DSM, Elinor Greenberg, a PhD level psychologist with specializations in specific personality disorders had this to say:
Very accurate about the DSM5 and what it is intended to do. It is not even pretending to be useful to therapy or therapists. See page 646 where it explains it is not validated and unlikely to be useful to clinicians doing psychotherapy. It says it might be useful for research or educational purposes, but does not explain how.
She is someone with the added training, and who has made it a point to undertake even greater training in terms of her practice’s focus. The more training a person receives, the more they will understand how inadequate the DSM is, and how poorly it is utilized.
All of this is detrimental to patients. Not only their mental health, but often their physical as well, when they are scripted doses of medications that may not be helpful to them. When properly scripted, psychiatric medication can be lifesaving. Intervening in the suicidal ideations of a patient, or allowing them to be able to function while dealing with schizophrenia. It cannot be stressed enough that I think that they certainly have their place and value.
What doesn’t, is undereducated clinicians that are assigning diagnoses, who then ship that patient off to a psychiatrist that doesn’t work to confirm the diagnosis, and instead readily scripts out whatever the newest drug rep has said is a powerful treatment for whatever has been assigned. It’s a rather incestuous relationship in which many people are doing a tenth of the work that they should.
When you find a competent or even excellent mental health practitioner, that’s pretty cool. However, there needs to be a light shone on those that are allowing others to do their thinking for them, and are just on autopilot. It is causing problems, not solving them.
Thanks Athena! There’s so much interesting information and aspects of what you write about within the field of psychopathy - that I think it needs to be shared with as many people as possible!
Most, but not all insights you share about your cognitive outlook and perceptions in general - I can totally identify with. And tbh some of the ones I think I don’t identify with - are due to myself obscuring these from myself, because I’ve learned to believe I feel certain things I don’t - which I don’t actually know anyway!
Regardless of before any drug consumption, I had to frequently emulate emotional responses to events - which would appear to shock other people, so as not to stand out as being callous! (Much like how I learned to pretend to pay attention, by nodding and repeating certain words back - this being due to my ADHD inattentiveness). Obviously this is a completely separate, but potentially coexisting condition. However dealing with the required acting skills, in order to deal with the attentive mask - was something I had learned to put in place already - making its application in other areas more natural for me.
However, hearing news which would dismay others; this would (more often than not ) result in a mounting, sense of dreaded boredom - knowing I had to produce the verbal and visual responses required of me. I recall wondering why everybody else had to pretend to have them - this being my assumption at the time.
Personally, I’ve refrained from further self-reflection on this, and what it may, or may not mean for myself - but I continue to find the whole topic of psychopathy, as well as the more environmentally acquired PD in general to be of immense fascination!
Thanks for writing such fascinating articles Athena!
Spending time interacting with those on the psychopath spectrum, you may pick up poker tells
They are tells that have a similar feel as high functioning aspergers do.
The individual tells by themselves don’t lend to conclusions, but a pattern of tells emerges eventually.
Everyone perceives the tells, but they are just low level noise until you can sense the pattern.
That’s what psychologists should be taught.
And then what about it?
Regarding the self diagnosed psychopath.
His identity is hooked into his belief structures, so direct evidence against this will just cause cognitive dissonance
One can meet them where they are (pace) and nudge them to where they aren’t (lead)
Find a few things to agree with them with.
Then I might ask “ you know I’m curious, how would you know if you weren’t a real psychopath, but maybe something like that, what evidence would you need to see hear have?