 Okay, some of you have written to ask me for a longer video. Talk about masochistic personality disorder. But being who I am, I'm going to oblige you. I'm gonna give you an extra long video because I'm the nicest ever former visiting professor of psychology and visiting I am right now. I'm also the author of Malignan self-love narcissism Revisited. And today we're going to discuss antisocial personality disorder psychopathy. Are they real? Is there such a thing? And if they are real, how to become one? You can't say you're not having fun with some Vakni. Okay, Don't ask. The list is way too long even for my 190 minimum IQ. The problem with antisocial personality disorder as it is defined in the diagnostic and statistical manual edition four text revision edition five text revision is that the diagnosis relies on criteria which are behavioral. In other words to qualify to to receive a diagnosis of antisocial personality disorder. You must behave in certain ways. The criteria are not based on anything intrinsic. They're not even based on any clinical observations. They're based on behavior, personal history, autobiography, and this raises the question. If you behave in a certain way, does that make you mentally ill? For example, if you hate authority, aka contumatious, if you are defined, if you're reckless, if you don't care for the consequences of your actions, if you reject your life, if you're violent and aggressive, if you are pathological something, pathological liar, pathological gambler, if you lack impulse control and behave in ways which are deleterious and detrimental to other people. It's all bad, of course. But does that make a mental illness? Shouldn't a mental illness be a clinical entity? Shouldn't it be almost medical? Shouldn't we be able to diagnose mental illness regardless of specific socially rejected behaviors? Aren't we pathologizing socially unacceptable behavior? Aren't we pathologizing a refusal to sublimate? A refusal to play by the rules of society? Aren't we encouraging conformism, sheeple mentality? In short, isn't the diagnosis of anti-social personality disorder, isn't it a form of social control? Isn't it an instrument to subdue and subjugate the wayward? Those who don't play by the rules, those who don't obey the law, those who reject and resent authority, those who undermine the pillars of our civilization, those who challenge social mores and conventions, those who are mavericks and even entrepreneurial in many ways? Why do we pathologize them? Isn't it a tool of society rather than a proper clinical entity? I personally happen to think that anti-social personality disorder is BS. It's not a mental illness. It's not a diagnosis. It should not be a diagnosis. It should vanish. In my view, it's completely wrong. I think it's what we call a culture-bound syndrome. In other words, a set of traits and behaviors that we find reprehensible, that society frowns upon, that we would like to eliminate and eradicate because people get hurt or damaged or broken. But the proper place for this isn't criminal courts, not in diagnostic manuals. And when we start to mix the two, confuse the two or to mix the two, to conflate the two, the criminal system and the psychological system, what we get is dictatorship. In Soviet times in the USSR, dissidents, people who opposed the regime, they were diagnosed as mentally ill and they were placed in mental asylum for the rest of their lives. We are going that way. There are hundreds of thousands, if not millions of people, in prison just because they don't agree with the rules and the laws of society. Not many of them spend time in prison only to find out they were right. For example, homosexuals were incarcerated. Homosexuality was a crime for well over 300 years in multiple locations, including very civilized places like the United Kingdom. It's not a crime now. It's not even a mental illness. It used to be a mental defa... It used to be... Homosexuality used to be defined as a mental illness until 1973. The DSM-3 removed it. So people who, for example, smoked cannabis or marijuana, they went to prison only for the laws to change. Laws are not written or not cast in stone. Laws don't come from high up. Laws are human inventions. Laws reflect ever-shifting consensus. So to create a mental health diagnosis based on behaviors that are today unacceptable and tomorrow mainstream, that's crazy and undermines the objectivity and foundation of psychology. Still, I'm going to review the literature for you today. I'm going to try to make sense of some of the aspects of antisocial personality disorder and psychopathy. And before we proceed, there's not such a thing as sociopathy in proper rigorous clinical literature. Media figures use it. It's media hype. And some scholars from time to time devolve or degenerate into using the term. It's meaningless. It's not a clinical thing. It's like empath, nonsense, nonsensical or emotional flashback. These are nonsensical things. So I'm going to limit myself to psychopathy and antisocial personality disorder. Mind you, even psychopathy is not considered a clinical entity by the vast majority of practitioners in the United States or in North America. Successive committees of the diagnostic and statistical manual refuse to incorporate the diagnosis of psychopathy in the DSM. So it's not there. There's no such thing in the DSM. There's only antisocial personality disorder. Robert Hare, Babyak and quite a few others, Dutton, quite a few others, they are the proponents and the advocates of the psychopathy diagnosis as distinct from antisocial personality disorder. But the debate is still raging. I think they're right. I think the research of thing is a psychopath. But that's only my personal unqualified opinion. And as I said, the majority of the profession disagree. They think there's no such thing, no such thing. So let's delve right in. Antisocial personality disorder is a pattern, a pattern of socially irresponsible, exploitative and guiltless behavior. All three elements must exist. Irresponsibility, recklessness, damaging others and so on. Exploitiveness, goal orientation, and a lack of remorse or guilt or shame. Non-negative affectivity associated with negative actions, actions that are socially perceived as negative. Antisocial personality disorder usually occurs, is comorbid with other issues, addictions for example. And so it's very difficult to disentangle the impacts and effects of substance abuse from the impacts and effects of the alleged clinical entity, antisocial personality disorder. Also, contrary to what many self-styled experts would tell you online, the rates of suicide, homicide and accidents among psychopaths, collectively known as unnatural deaths, these rates are excessive. Antisocial personality disorder is an excellent predictor of poor treatment outcomes. They're impossible to treat. And the reason that ASPD is, and I'm going to use ASPD from now, make the video shorter, antisocial personality disorder equal ASPD. Got it pigeons? Okay. So ASPD and the reason that it's very difficult to treat ASPD is that ASPD is actually a childhood disorder. It starts very, very early in life, usually around ages six to eight. And at these ages it's not called psychopathy, it's called conduct disorder. If it persists until age 18, you graduate from conduct disorder to ASPD if the antisocial behaviors persist. So, how do you treat someone that has been an integral feature of one's life from age six or eight? It's very difficult to disentangle or break apart the identity of the person from these dysfunctional or at the very least antisocial behaviors. Yeah, I heard some noise. So, it's entrenched. It's entrenched, it's chronic, it's lifelong, but exactly like borderline personality disorder, it improves with age. The earlier the onset, the poorer the diagnosis. I mentioned this identical pattern of lifespan development, both antisocial, both ASPD and BPD, borderline personality disorder, remit with age to the point that we can no longer diagnose in people usually above the age of 45. This leads many scholars to speculate that both disorders, BPD and ASPD are actually brain abnormalities, forms of brain malfunction, dysfunctions, structural and functional. And so, there is a body of literature that tends to support this. The brains of people diagnosed with antisocial personality disorder are very different to the brains of normal, shall we say, healthy people. And the functioning of these brains is different. And the physiology of people with ASPD is different. For example, perspiration patterns, reactions to fear, amygdala and so on. And skin conductance, they're all very different. That's why psychopaths can defeat a polygraph test, can defeat a lie detector. And so, as the person with ASPD grows older, usually the antisocial aspects, because there are others which we will deal with later, but the antisocial behaviors and aspects of the disorder tend to ameliorate. Psychopaths who get married, find a steady job, are incarcerated early on, end up in prison at an early age, or adjudicated if they're children, socialize. These psychopaths are likely to recover, to lose the psychopathy, to lose the antisocial features earlier. The symptoms of antisocial personality disorder, as I said, are very society-oriented. I mean, just listen to the word, antisocial. So, who is defining the disorder? Society does. Do you conform to the law? Do you observe the law? No. You're a psychopath. Do you fail to sustain consistent employment? You're a psychopath. Do you manipulate other for personal gain? Do you deceive other people? Do you fail to develop stable interpersonal relationships? You're a psychopath. Now, the lifetime prevalence of ASPD is anywhere between 2 to 4% in men and 0.5% and 0.5% to 1% in women. So, it's a men's thing. Psychopathy is definitely a men's thing, as opposed to narcissism and borderline, which are equally represented among men and women, psychopaths are overwhelmingly men. And the prevalence peaks between 24 and 44 and drops precipitously between 45 and 64. Male to female ratio is anywhere between 2 to 1 and 6 to 1, depending on the assessment method and sample characteristics. And the prevalence of ASPD varies with the setting. But in prisons, for example, there have been studies that the prevalence of psychopathy among prisoners is about 80%. As I mentioned before, ASPD is associated with addictions, major depressive disorders, bipolar disorder, anxiety disorder, somatic symptom disorders, somatization, substance use disorders, gambling disorder, sexual disorders. So, it's a rainbow coalition of disorders which renders the ASPD diagnosis even more suspicious. It seems that ASPD borrows elements from these comorbidities and makes it exceedingly difficult to tell them apart. People with ASPD are at risk for traumatic injuries, accidents, suicide attempts, hepatitis, and HIV. People with ASPD use disproportionate, a disproportionate share of medical and mental health services. And they have been identified, as I said, as a predictor of poor treatment response, only in certain populations, by the way. So, ASPDs die early and the rates of mortality among them, among people with ASPD, the rates are much higher. But we're beginning to discover connections between ASPD and other surprising chronic illnesses. For example, there's a strong connection between ASPD and diabetes. What we don't know is whether this is the outcome of neglect. Psychopaths don't pay attention to their own health. They fail to comply with medical regimens. They neglect their own medical problems. This could be one explanation. But there may be other explanations. We're just starting to explore this exciting field of the medical background, the physiological and physiopathological background, for antisocial personality disorder, antisocial behavior in general, and psychopathy. Nearly 80% of people diagnosed later in life with antisocial personality disorder, 80%, that's 8-0, display their first symptoms no later than age 11, usually age 8, but no later than age 11. Boys develop symptoms earlier than girls, and girls usually don't develop symptoms until puberty. Studies by Robbins that a child who makes it to age 15 without exhibiting antisocial behaviors will not develop psychopathy. So children who do not develop contact disorder by age 15 are exceedingly unlikely, vanishingly unlikely to develop ASPD. ASPD, therefore, is a childhood disorder, exactly like pathological narcissism, exactly like borderline develops at age 12 among girls. Narcissism is a reaction to early childhood abuse. These are all childhood disorders. You could generalize and say that cluster B is not an adult disorder, but a childhood set. These are not adult disorders, but childhood disorders. And this is one of the philosophical pillars of my work when I suggested that the treatment of people with cluster B personality disorders should be founded on child psychology. They should not be treated as adults because they are not. The presence of contact disorder in childhood is a robust predictor of ASPD in adulthood. The DSM-5 definition of ASPD actually requires a history of childhood contact disorder. The diagnosis is used for persistent and serious childhood behavior problems, including cruelty and sadistic cruelty. Once a child passes age 18, if the behavioral problems are persistent, then it's ASPD. The numbers are staggering. About 25% of girls and 40% of boys with contact disorder will later meet the criteria for antisocial personality disorder. A subset of antisocial adults have no history of childhood contact disorder. They do meet the criteria for antisocial personality disorder, but their symptoms are so mild that it's debatable whether they should at all be diagnosed. Let's discuss a bit the history of antisocial personality disorder. I have another video on this channel where I discuss the history of personality disorders in general. Psychopathy was actually the first personality disorder ever to have been described. And so this video that I have here on the history of personality disorder, disorders is actually a video which deals with the history of the very concept of psychopathy. Today we are going to deal with the history of the diagnosis antisocial personality disorder. In the 40s and in the 50s, there were people like Leckley, Harvey Leckley and others, Robbins, Gluck, Gluck and Gluck. These scholars at Harvard, Washington University in St. Louis and other places, these scholars independently, by the way, demonstrated that there is a continuity between adult and childhood behavioral problems. The work of these researchers influenced the diagnostic criteria which were first incorporated in the DSM-3, 1918. The Gluck's, for example, they followed 500 boys between the ages of 10 and 17. And these were boys who were judged officially delinquent by the Massachusetts Correctional System. The boys were interviewed at ages 25, 32 and 45. It's a longitudinal study, one of the largest. In the 1990s, Samson and Laub reanalyzed the Gluck's data and they were able to confirm their findings. Those of you who want to follow this amazing study was published in a book called Unraveling Juvenile Delinquency. So severe antisocial behavior in childhood, problems which are serious enough to constitute legal delinquency. This was strongly linked to adult criminality and or deviant behavior. Arrests between the ages of 17 and 32 years were three to four times more likely to occur in men with a history of delinquent behavior than in their non-delinquent peers. Childhood antisocial behavior also predicted many other things. Educational attainment, economic status, employment, family life in adulthood. Samson and Laub concluded that varied outcomes correlated with childhood behavior are all expression of the same underlying trait, although they didn't exactly identify the trait. Robin's work was much more influential. He studied 524 subjects in a child guidance clinic between 1922 and 1932 and he followed up on them in the 1950s. That's a long period of that's a long difference in time. She described the study in a book called Deviant Children Grow Up. The children were an average 13 year old when they were seen at the clinic. About three quarters of them were boys and most of them were referred by juvenile courts. Robin's concluded that ASPD is chronic persistent and seldom remits. We now know this to not be true. And so this was a background in the 1950s. We had Clackley's Masterpiece, Musk of Sanity, amazing book but very very literary, not exactly a rigorous clinical study and we had rigorous studies by Robbins, Gluck's and many others. The problem was then and is now that many prospective studies involve non-representative samples. People who have been hospitalized, prisoners, people who have been adjudicated, these are non-representative samples. They don't represent the general population. These are self-selecting samples in many ways and the definition of antisocial personality disorder has evolved and so it makes it very very difficult to interpret findings earlier findings. Many prospective studies use a limited number of predictive variables for example. And so let's go back to Robin's studies. Among the 524 subjects, 94 qualified for an ASPD diagnosis in Adalton. 82 of whom were interviewed 30 years later. These people were in their 30s, they were in their 40s. Robbins concluded that 12% have remitted, only 12%. There was no evidence of antisocial behavior. Another 27% have improved but have not remitted. 61% were unapproved or even became worse. The antisocial behavior became much more egregious. The average median age actually of improvement was 35 years old but Robbins noted that there was no age, I'm quoting her, no age beyond which improvement seemed impossible. And that the subject had improved did not mean that the disorder was no longer a problem. She wrote the following and I'm quoting her. Definding that more than one third of the sociopathic group had given up much of the antisocial behavior does not mean that at present they are strikingly well adjusted and agreeable persons. Many of them report interpersonal difficulties, irritability, hostility toward wives, neighbors and organized religion. They are in many cases no longer either a threat to the life and property of others nor a financial drain on society. But still not people you would like in your life or to cross swords with. Let's progress a bit, the Iowa antisocial follower. Black and his associates followed up on 71 men who had been psychiatrically hospitalized at the University of Iowa between 1945 and 1970. These men met the criteria for antisocial personality disorder in the DSM-3. The criteria were applied retrospectively but still there was a good match. The researchers were able to trace over 90% of the men and they had sufficient information about 45 of them regarding the outcomes of the hospitalization 29 years earlier. The men were there was a the mean age of the men was 56 years in the follower. So with ratings similar to those used by Robes, Black and his associates concluded that 27% of the subjects had remitted, 31% had improved but not remitted and 42% were unimproved or even worse. Subjects that were most likely to improve were the least symptomatic at baseline and had achieved an older age by the time of the follower. Black concluded that many of the antisocial behaviors present were still present at follow up. Allow me to quote a paragraph from the study. Although most of our subjects were no longer having frequent confrontations with the police, they continued to have enduring problems with poor occupational performance, social isolation, marital discord, poor family relations and substance abuse. The kind of person you would like to marry or have as a neighbor, joking. Black compared the course of the antisocial men to people with schizophrenia or depression as well as to healthy control subjects. Because there was a study called IOR 500 and it took it took the data from there. Okay so all the subjects were hospitalized in the same facilities so there was no treatment variability. You couldn't say well it's they're different because they they've spent time in a different hospital and you know each hospital has its own procedures and level of quality and so on so forth. No they're all in the same unit they're all in the same facility so that eliminated a lot of bias. So antisocial men fared less well than depressed subjects and not to mention healthy control subjects. When when you reviewed the marital situation of psychopaths, occupational, psychiatric adjustment they they were the worst. They were even worse than depressive people. They function people with antisocial personality disorder function better than people with schizophrenia in their marital status and housing but not when it came to occupational status and aggregate psychiatric symptoms. This is shocking. It means that people with antisocial personalities or psychopaths are worse off worse off psychiatrically than schizophrenics and the schizophrenics can hold the job much better. They're much more stable occupationally than psychopaths. It's the pits. It's even much worse than not the narcissists. I have a video on this channel how to tell a narcissist apart from a psychopath, how to tell them apart and I coined the phrase island of stability. Narcissists have an island of stability, a stable marriage but many careers a stable career but many marriages. One part of their lives, the life of the life of the narcissist, one part is always stable. It grounds him. It's an anchor and all the other parts are in chaos. The psychopath everything is in chaos. Everything is in chaos. The psychopath chaoticizes his life time and again. He can persist for 10 years in doing something and he would look like the most stable reasonable rational wise man and then he would destroy everything in an orgy explosive orgy of of rage and envy and hatred and just pure simple self destructiveness which clearly called a called a rejection of life. So that's a psychopath for you. Even people with psychosis don't behave this way. Psychopath is like a tornado that consumes the entire neighborhood and then consumes itself. It's really bad in terms of functioning. It doesn't mean that it's a mental illness. Mind you that you don't function well in any given society in a different values maybe or that doesn't make you mentally ill but still there's no debate that people with antisocial personality disorder malfunction that their functionality is much reduced that they have a problem being self efficacious pursuing their own goals successfully. Their goal oriented, their goal obsessed. They are sometimes invested emotionally in the very process of pursuing goals but they are losers. Their failures even when they're exceedingly successful they end up ruining everything look at Adolf Hitler and to some extent no comparison Donald Trump who is possibly a psychopathic narcissist possibly. So by the way everything I'm saying everything I'm saying about psychopaths applies to psychopathic narcissists. Psychopathic narcissists and narcissists who use leverage psychopathic methods and techniques and survival strategies and trades to obtain supply. So they are essentially outwardly psychopaths for all intents and purposes. Both Black and Robbins found that a sizable percentage of people with antisocial personalities or the improve or remit with advancing age about half according to them today we know the number is higher and this finding was consistent with crime statistics. Crime statistics show that arrests peak among people in in their late teens and then decline. Few arrests occur in older adults. When arrests occur they're due to conduct offenses such as public drunkenness not usually owing to violent crimes. While the aging antisocial person is not as problematic community-wise many remain troublesome in their families among their neighbors and co-workers so it's not antisocial behavior doesn't disappear it's just like the target group becomes much smaller while the teenage psychopath and the young adult psychopath they're likely to target society as a whole. The aging psychopath will target his wife or a neighbor a pesky neighbor or a hated boss or a co-worker okay so it's like a constriction of life. The psychopath's life is constricted because he keeps suffering losses he keeps getting punished it's like a Pavlovian reaction it's like a dog that's being bitten on the nose struck on the nose and the dog learns to not pee on the carpet psychopaths learn that all of life is a huge carpet and peeing on the carpet has its consequences when you pee on society society gets wet when society pees on you you drown so many of these people end up being indigent and they draw on public resources for survival those who do improve are still unable to regain lost opportunities in education employment domestic life it's too late when these people wake up when they have lost the antisocial behavior when they want to integrate and to conform they discover it's too late they don't have the proper education they've never been gainfully employed or consistently employed the domestic life is ruptured and ruined and there numerous angry people after them they they create horrors and and hurts of enemies everywhere so some people for these people improvement in the psychopathic condition simply means somehow subsisting or living in society's margins until they die this is a sad picture of the aging psychopath what about young people the developmental trends study began in 1987 it involved 177 boys in pennsylvania georgia these boys were aged 7 to 12 and they were followed up at regular intervals into early adulthood the purpose of the study was to document the course of disruptive behavior over time and the interaction with other mental health disorders or even other physical physiological disorder the boys were recruited from university clinics they have been referred to these clinics because of some disruptive behavior disorder often they were misdiagnosed with attention deficit hyperactivity disorder or contact disorder so this study showed that boys with early onset of symptoms had a faster progression to more serious problems than boys whose problems emerge at a later age the earlier the behaviors torturing animals exploiting others stealing petty petty thievery lying the earlier these behaviors start the worse the prognosis the worse the outcome in later life early onset is the number one two and three predictor of how you're going to end your life as a psychopath and so physical fighting for example predicted the onset of conduct disorder more than any other symptom oppositional defined disorder was a developmental precursor to conduct disorder in some boys and conduct disorder as i repeatedly said predicts is a is a great predictor as predictive value when it comes to later diagnosis of ASPD in in other order the Pittsburgh youth study was a longitudinal study of inner city boys it began it began also in 1987 the aim was to trace the development of antisocial and delinquent behavior from childhood to early adulthood among boys in the first fourth and seventh year in the Pittsburgh public schools 1,517 were screened and the 30 percent most antisocial were selected for follow-up along with 30 percent of the remainder as a control group in effect the boys ranged in age again from 7 to 13 at intake in this study the researchers show demonstrated that problem behaviors occurred along a developmental trajectory from childhood to adolescence the onset of minor covert acts such as lying or shoplifting these tended to occur before the onset before the onset of more serious transgressions such as property damage and property damage in turn occurred before the onset of moderate to serious forms of delinquents including sexual offenses Moffitt and colleagues Moffitt Hodges and others they suggested that ASPD is actually highly stable in a small percentage of men and women and their behavior problems are extreme they said that this kind of ASPD does not remit does not heal spontaneously and they called it life course persistent ASPD and there was a study called the Duneadine longitudinal study in New Zealand and Moffitt and his colleagues traced the outcome of 1,037 children from age three to age 32 so this is the first study or the only study that I'm aware of where they've examined children younger than 70 or six years old so most antisocial youth with behavior problems were categorized as having an adolescence limited form of antisocial behavior this is a type of less severe antisocial behavior it arises in the context of teenage peer group pressure it's important it's not it's not internal it's brought from the outside and these things typically have little or no history of earlier antisocial behavior they improve on their own and most children about 60 percent of children with this type of conduct behavior they do not develop adult ASPD for both men and women the life course persistent group the group that is hopeless incorrigible they showed an early onset of antisocial behavior they developed more severe behavioral problems and they had a greater variety of problems than the adolescent limited group so what are the outcome predictors for antisocial personalities? Robbins found that most of the children improved as they grew older and did not become adults with antisocial personality disorder she concluded that variety and severity of childhood behavior problems are the single best predictors of adult antisocial behavior she wrote this no patient without moderately severe antisocial behavior as measured by having six or more kinds of antisocial behavior so no patient without these moderately severe antisocial behavior let's let's regress a bit she defined moderately severe antisocial behavior as behavior that has six or more kinds of antisocial behavior four or more episodes of antisocial behavior or an episode of such behavior serious enough that it might have led to a court appearance she says no patient without these was diagnosed sociopathic personality as adult so you need to be really really bad as a child and even worse as an adolescent you need to be cruel and sadistic and exploitative and criminalized and you need to be disempathic and reckless and defined and authority rejecting consummations you need to be all these in childhood and adult to become a lifelong psychopath otherwise your chances to not develop antisocial personality disorder is an adult the chances are pretty good among the few variables predictable long-term adjustment robins at the time said that greater improvement occurred in people over 40 years at the time of follow-up so age is somehow a critical factor which is a strong indication that antisocial personality disorder let alone psychopathy are somehow bodily issues they may not be psychological at all may not be a psychological problem but a medical problem the same way today we consider depression psychotic disorders schizophrenia bipolar disorder is essentially medical conditions i have no idea why they still find their place in the dsm except for money and insurance so there's other data by black and others it shows that men with aspd improved with increasing age another variable by the way is prison incarceration robins found that men incarcerated for less than a year had a higher rate of remission than men who were never incarcerated and men who were incarcerated spent time in prison did time for less than a year had a higher rate of remission than men who were incarcerated for longer than a year since the year is a crucial critical factor so these findings suggest that a brief incarceration acts as a deterrent to antisocial behavior but a limited time deterrent it wears off memory somehow evaporates and the deterrence is gone but if you spend a longer period of time in prison this deterrence lasts and could be even lifelong prison does reform even if there's no rehabilitation the very act in fact of limiting freedom seems to have a curative effect seems to have a curing effect a healing effect or a remitting effect at least when it comes to antisocial personality disorder psychopathy actually prison has adverse outcomes in borderline personality disorder but and to some extent in narcissistic personality disorder but with psychopaths psychopaths it works especially as they grow older what about relationships marriage is a moderating variable believe it or not married psychopaths are much less antisocial but it's a chicken and egg situation maybe psychopaths who are less psychopathic simply get married marriage is a social institution it's a ritual it's a ceremony it's a procedure and psychopaths hate hate all these things they're non-conformists they're rebellious they're defined in contumations so maybe the more psychopathic you are the less likely you are to get married and so it's not that the marriage affected the antisocial behavior it's that if the antisocial behavior is low level low key you're more likely to get married possibility I'm not sure I'm just delineating the possibilities but it's a fact that being married is positively and highly correlated with a reduced incidence of severity of antisocial behavior in robin's study over one half of married people with ASPD improved but very few unmarried spouses partners other people close to the to the ASPD they play an important role in regulating the ASPD urging therapy and the improvement often comes when one has a source of personal support motivation you know sometimes just not wanting to hurt the other is sufficient motivation to not engage in antisocial behavior people with ASPD who are admitted they had stronger family ties they were more involved in their communities and they were more likely to live with their spouses these findings are largely consistent with the GLUG's findings which linked job stability and marital attachment with improvement each of these situations from brief incarceration to relative success with marriage and family life could easily be the result of improvement rather than the course of improvement as I just said so we can expect people with ASPD who stay happily married or didn't face lengthy period of incarceration to have probably to have had a milder case of ASPD to start with maybe they were predisposed to getting better somehow you see even psychopaths are embedded in culture and society and maybe they're upbringing or their education or a chance opportunity or something it's it's very difficult to tell the chicken from the egg there is some evidence regarding marriage so there was a study of male twins and it followed them from 17 to 29 years and the researchers discovered that men with less severe forms of antisocial behavior these men were more likely to marry than the more antisocial twin so there was one twin who had ASPD but it was less severe than the twins ASPD and so the one with a less severe form got married it's a severe antisocial symptoms hinder marriage because they interfere with forming intimate relationships psychopaths don't do intimacy can't do intimacy another factor that moderates eventual outcomes is the degree of childhood socialization the child's tendency to form relationships in the child's proclivity to internalize social norms whether the socialization process was disrupted Jenkins and Glickman identified two types of children with contact disorder socialized children and the under socialized children Glickman said that the ability to develop group loyalty group loyalty is crucial it marks fundamentally fundamental division between the socialized and the under socialized children in the contact disorder group socialized children regardless of their wayward behavior naughty behavior socialized children form strong ties to a familiar group of friends under socialized tend to be loners in a 10-year follow-up Hen H E H H E N Hen and his colleagues found that socialized delinquents were less likely to have been convicted of crimes or imprisoned as adults under socialized children under socialized delinquents went on to a life of crime and imprisonment there are quite a few studies about psychopaths it's a thought-button topic similar to narcissism and so three additional studies that I may just mention is the follow-up studies of Maddox Gibbons and the partners and the work done by Tong all these were conducted in the United Kingdom in the 90s and 50s and 60s 1950s and 60s the subjects of the studies were considered psychopaths which is today the rough equivalent of ASPD Maddox reported a five-year follow-up study of patients seen in an outpatient department between 1961 and 1963 the men were considered psychopaths and the inclusion criteria included impulsivity, trouble with the law, several spouses or sexual partners, trouble at school and unreliability Maddox traced 52 of the 59 men 10 of them 19 percent have settled down 39 75 percent have not settled down and had not settled down and three percent and three of them I'm sorry six percent died by suicide that's not very far from borderline by the way corresponding number number for borderline is 10 percent 10 to 11 but what does it mean to settle down in the 1960s Maddox defined settling down as having shown a reduction of impulsiveness and enabling the patient to stay in the same job stay with the same partner and generally a reduction in symptoms that placed him in the category in the first place it's a good enough definition even today it was not clear distinction between the men who had settled and those who had not but 15 of them 38 percent of those who had not settled drank excessively or were frank alcoholics Gibbons and his associates reported on an eight-year follow-up of 72 incarcerated criminal psychopaths whose courses life development autobiographies were compared with those of 59 ordinary criminals so 72 psychopathic criminals 59 non-psychopathic criminals the psychopaths were psychopaths were considered as having severe cases and they were selected with the assistance of experienced prison medical officers the psychopaths had a greater number of subsequent convictions and the controlling subjects and yet 24 percent of them had only one or no conviction the psychopaths were more likely than the controlled subjects to have an abnormal EEG that is true to this very day Gibbons concluded that psychopathic personality as he said I'm quoting does not inevitably portend as hopeless prognosis as is usually implied he was a malignant optimist psychopaths considered aggressive had the worst prognosis violence externalized aggression externalization this is the extreme form of psychopath and it's compared to what we call the inadequate psychopath so aggressive psychopaths externalizing psychopaths had more convictions were committed for aggressive offenses willful damage drunk and assault etc Gibbons wrote it seems probable that the aggressive psychopath is so crippled in all his social relations that he is only able to live by crime and his record therefore consists very largely of acquisitive offenses told reported on also on outcomes in criminal psychopaths these criminal psychopaths have been legally classified as psychopaths in the United Kingdom and they were incarcerated between 1954 and 1961 the year I was born at Rampton Hospital it's a special closed security psychiatric hospital that at the time catered to offenders considered dangerous or have violent propensities Tong define psychopathic behavior in a bit of a special way he I'm quoting psychopathic behavior he defined it as criminal behavior characterized by extreme callousness brutality disregard for others on the one hand and or criminal behavior which is not necessarily violent or serious but it's repeated over and over again recidivism the men in his study were aged they had a mean age of 29 at follow-up and they had been incarcerated nearly nine years by that time among the 587 men 171 29% relapsed Tom concluded that the prognosis is far from hopeless because only 29 relapse the few that were admitted at much later ages they did not relapse so late age at at the moment of incarceration predicts good outcomes no relapse and no recidivism and as Tong said both age on discharge and length of stay in hospital correlated positively with success the findings are similar to blacks in their follow-up study so we have no reason to doubt okay that's the overview what are what are my conclusions what am I trying to to tell you anti-social personality disorder is a childhood disorder it's behavioral it's defined by society and for society it's very well studied possibly it's the most well studied disorder because it started 150 years ago at least definitely in the past 80 years or even 100 years it was a linchpin of mainstream psychological research and we have a lot of data on cycles or people with anti-social personality disorder it's a chronic disorder it begins in early childhood continues through adulthood it's associated with other mental health and addictive disorders mortality rates are very high people with ASPD improve with age the problems continue even though they improve but they continue on a lesser scale and they are more benign and the target group is much smaller so poor job performance domestic problems abuse the improvement can occur at any age but most likely between the mid 30s and the mid 40s people with more severe symptoms uh at onset appear to be the ones with the most severe anti-social personality disorder at follow-up there's no way to predict outcomes in ASPD but people with earlier onset tend to have a worse outcome and moderating factors include marriage family and community ties early incarceration adjudication in childhood the length of incarceration degree of socialization there's a lot of work to be done first and foremost to determine whether we should establish a whole class of social relational mental disorders narcissism for example is a relational disorder socio uh psychopathy and anti-social personality disorder these are societal disorders it's not a shame it's not shameful to say it's a group of disorders which have to do with brain abnormalities for example bipolar psychosis schizophrenia there's a group of disorders which are innate and reflect mental illness and there is a group of disorders which are which erupt and occur only when other people are present only in interpersonal and societal settings these group of mental illnesses should be separated even in the dsm under the heading of societal cultural and interpersonal relational mental health disorders until about 100 years ago this was the case many mental health disorders were described as character disorders we need to determine the full extent of this alleged disorder in various sub-populations for example we need to determine the clinical picture in women for example cooperative course outcome we don't know any of any of this and there's a small percentage of people with ASPD that have no precursor have no history of contact disorder how come we need to characterize this subset we need to use much bigger samples we say that the disorder is is chronic but why why do some people improve while others do not even though we know the predictors we don't know the process so we don't know if therapy therapeutic interventions for example incarceration how do they change the course of ASPD if at all outcome predictors are important of course clinical illness variables potential biomarkers everything yeah sure but we if this is a if this is a disorder of childhood we must focus on troubled children they are at the greatest risk of developing ASPD and children go through the process of socialization there they are in the throes of becoming so these are disorders of becoming it's something goes awry in transitioning from tabula rasa to individual something again is not as it should be in the process of individuation we need to focus on this we don't need to pay so much attention to criminals in prison populations there was a wrong orientation it led us astray we wasted decades of course some people got rich in the process names withheld but it led us astray we need to realize that disorders like ASPD reflect a child's inability to internalize socialization and a child is unable to internalize society and its signals and messages and values and core and conventions and more rates child is unable to internalize all this because there's something wrong with the socialization agents his parents his peers his teachers his role models something's wrong with them something goes awry the acculturation and socialization processes in these children they just don't learn how to be social beings it's not so much as anti-social personality disorder it's like non-social personality disorder these children become adults who go through life doing whatever the hell they want they don't realize the interplay between society and individual this is what we need to focus on not on measuring all kinds of nonsense in prison populations or mentally or people hospitalized in mental asylum it's we won't get we won't get anywhere with this because these people are finished they're ready made they're made they're not going to reverse they're not going to regress they're not going to change that so why why study the unfortunate outcomes and not the process that leads to the outcomes and give us hope of treatment and yes of course there is hope of treatment if we care to find out what causes this disorder including the possibility that their brain abnormalities and so on again it's a chicken and egg was the brain abnormality caused by the disruptive disrupted process of socialization or did it cause the disrupted process i opt for the first i think the brain abnormality is a secondary not primary but this also needs to be proven or at least investigate we have a lot of work to do eight years later shame on us