Confessions of a Sociopath: A Life Spent Hiding in Plain Sight

Chapter 2 DIAGNOSIS: SOCIOPATH

How did I eventually come to think I was a sociopath? With all of the benefits of hindsight I can see that there were plenty of signs. But it took a professional and personal collapse in my late twenties to make me care enough to investigate.

My family likes to joke about my inability to stick to one thing for longer than a few years. High school was a little bit of a farce but I tested well enough to become a National Merit Scholar. In college I majored in music on a whim. I chose percussion because the core requirements were split to cover four instruments, and I didn’t have the attention span to focus on just one. I chose to go to law school because it was one of the few graduate programs without prerequisites and I needed something to do. I tested well on the LSAT and got into a top law school, despite having the GPA of someone who, though clearly intelligent, is easily bored.

After law school I was hired as an attorney at a self-described “elite” law firm. All of my colleagues were recruited from the top of their classes at their top ten schools. I barely made the firm’s grade cutoffs, and I had graduated with honors. We were supposed to be the best of the best, and the firm charged a premium. Just two years out of law school, my base salary was $170,000 with a double bonus totaling $90,000 and I was in a lockstep pattern of significant raises every year I stayed. But I was a terrible employee.

I have never been able to work well unless it directly benefited my mind or my résumé, no matter how lucrative the work was. I spent most of my effort in dodging projects and scheduling my day around lunch appointments and coffee breaks. Still, when I got my first bad review I was surprised. I was even more surprised when I eventually got called into my supervising partner’s office and told to shape up or ship out.

I didn’t shape up. I interviewed with other firms and got an offer from a similarly prestigious firm that paid more, but I wasn’t interested in continuing to be a well-paid paper pusher. I was meant for greater things than being a junior legal associate; I was sure of it. A couple months later I was out on the street with a banker’s box of personal belongings, waiting for a friend to pick me up.

Around this same time, a close friend’s father was diagnosed with cancer. Whereas she had once been a pleasure to be around—intelligent, wise, independent, and insightful—she was suddenly emotionally fragile and beset by family obligations. I was exhausted by trying to accommodate her, and I felt that I was suddenly putting more effort into the relationship than I was getting out of it. I decided to cut off all contact with her. At first all I felt was relief. Eventually I missed her, but I had expected that, and I tried not to let it bother me too much.

I spent the next couple of years receiving unemployment insurance checks. My family was worried for me. They wondered what I was planning on doing with my life. But I never had those sorts of existential crises. I always live in two-year increments. I figure anything beyond that is just so uncertain that it can basically be disregarded as a possibility.

This compounding of losses was unusual for me, though—even my two-year plan seemed bleak. I found myself at loose ends, directionless and, I had to admit, fairly mindless. I had squandered a prestigious and lucrative job in my chosen field. I considered going to business school, but for what? To repeat a cycle of success and devastation for the duration of my life? I had heartlessly put aside a friend in her time of need. How many more relationships did I have to destroy? I knew these were not the actions of a normal person, and I began to admit that my life was not sustainable. If I wasn’t normal, what was I?

With a ruthlessness I usually reserved for other people, I stripped away my own artifices to discover who I really was. I realized that all my life I had been trying to be like the chameleons I had learned about as a child in my big book of small reptiles. The social part of me had evaporated, making it apparent that all of my efforts to entertain were designed to sit on the very outer surfaces of me, separate and apart from what existed inside. And those insides—they were impenetrable. I had never liked people to look at me; I wanted to be the only one doing the looking. But now I realized that I never bothered to look closely at myself.

I had grown accustomed to believing my own lies. I would fixate on moments that made me feel normal. A monster would not cry at a sad movie. Her heart would not break from a lover’s departure. So my tears were proof that I was normal, as was the pain in my chest, about which so many songs have been written. How could my heart be broken if there was no heart to break? It had been easy to convince myself that I was not the one with the problem.

It is one thing to lie to others, but I had been lying to myself for years. I had become reliant on self-deception and forgotten who I was. And now I didn’t really understand myself at all. I wanted to stop being a stranger to myself; for the first time in my life, that bothered me enough to want to do something about it.

Though it would prove to be a turning point, this was not my first period of deep introspection. During college, I got myself into an awkward social mess (I’ll relate the details in chapter 5), and my life went completely to hell. I didn’t have any label to identify with, but after a long period of unflinching honesty and self-analysis I recognized that I was a very manipulative, cunning person who was unable to connect to anyone on more than a superficial level, obsessed with power, and willing to do anything to get ahead, among other things. To the extent that those things were negatively impacting my life, I tried to tame and control them—or to at least divert them to situations where the stakes were lowest.

I didn’t know then what a “sociopath” was nor did I have any inkling that I might be one until a few years later during law school, when a coworker raised the possibility. We were working together as summer interns, largely busywork that didn’t matter. I was bored, so when I learned that she was an openly gay woman who had been adopted as a child, I started to pry into her personal life, hunting for insecurities. Slightly overweight, cheerful, and gregarious, she appeared to be a treasure trove of plush emotional vulnerabilities. It turned out that she was much more than that—she was intellectually curious and wide open to the possibilities of how to live in the world. We shared offices and spent hours talking about politics, religion, philosophy, fashion, or anything else that would distract us from the drudge work. From the very beginning, she felt compelled to mother me, giving me advice on how to dress appropriately at work and feeding me quinoa salads she had prepared for me to keep me from dining on cheeseburgers every day. I noticed and began to analyze how she made everyone feel comfortable around her. I hoped to replicate little nuggets of her charm, and I told her so. Whereas I viewed the world through the lens of bloodless rationality, she could not have been more touchy-feely; though she was an intelligent woman who valued rationality, she made a deliberate choice to abandon it occasionally in favor of soft intangibles like “compassion” and “mercy.” Even though I don’t naturally value those things, I respect that they are legitimate interests that people have, the same way that I acknowledge that not everyone will have my exact taste in, say, music or automobiles.

She had a master’s degree in theology, and I loved to probe her beliefs, first about whether God made her gay, but later about anything that seemed important to her. I remember specifically questioning her about altruism, with which I had little personal experience. I explained to her that, to my mind, to have the ability to measure with such stark precision the utility of a person—just as any other thing—made it senseless to regard that person in any other way. At that time, I had yet to abandon my friend whose dad had cancer, but there were plenty of other ruined relationships that I could have been referencing—I routinely disposed of people once their burden to me exceeded their utility. I told my coworker that one of these disposed-of people had accused me of lacking altruism. Perhaps, I had conceded. But perhaps this thing that I allegedly lacked—altruism—was nothing more than garbled thinking that did no more than freeze people in a moment of indecision, whereas I was free to cut off entanglements at will. My coworker nodded sympathetically.

One day, not long after our altruism conversation, we were discussing how to behave appropriately in situations in which I was expected to comfort anguished loved ones. Perhaps she could see that I seemed clueless, because she asked me then if I thought I might be a sociopath. I remember not knowing how to answer and having to look the word up, not sure exactly what a sociopath was or why she would think I was one. Socio-for social or society, -pathy for a morbid affliction or disease: a disorder of social conscience. That did sound familiar.

I was not offended. I was already well accustomed to the idea that there was something pointedly different about me that could not be altered. I realized early on that other people did not treat their lives as if it were a complicated game in which all events, things, and people could be measured with mathematical precision toward achieving their own personal satisfaction and pleasure. Somewhat more recently, I also noticed that other people felt guilt, a special kind of regret that did not arise from negative consequences but from some amorphous moral dictate that had taken root in them from consciousness. They felt bad in a way that I never felt when they hurt others, as if the hurt they had caused was so cosmically connected to the goodness of the universe as to reverberate back to them. These things I had pretended to feel for many years, had attempted assiduously to mimic the manifestations of, but had never actually felt in my life. I was more curious than anything. If there was a label for who I was, then maybe I could learn something more about myself. In fact, I had no trouble recognizing myself in the descriptions I found in my research.

It turned out that my officemate had been acquainted with a man she discovered was a sociopath. Rather than live out the sob story of the con artist’s innocent victim, she had maintained a deep and enduring friendship with him. In retrospect, her willingness to regard me as a human being despite her firm belief that I was a sociopath offered me the possibility that I could be understood and accepted as I was. She was proof that not all people with consciences and empathy were appalled by the existence of people like me.

I was actually glad that there was a word for it, that I wasn’t the only one like this. It must be a similar feeling to that of people who discover for themselves that they are gay or transgendered: in their bones, they’d known it all along.

Years had passed from that tentative self-diagnosis to my period of introspection after being fired. Once the word sociopath had entered my consciousness and my initial satisfaction with finding a label had faded, I had treated it as an unimportant oddity, like an interesting but irrelevant quirk, until eventually I forgot it. But as my life crumbled around me, I knew that I couldn’t keep living like I had been before, acknowledging that I was different but ignoring the differences. I was so desperate for answers that I had begun seeing a therapist, but she was nothing more than a thing for me to toy with, and even then, she was too expensive for the limited satisfaction our sessions gave me. But through those therapy sessions, I had remembered that summer internship and that casual diagnosis of “sociopath.” I sensed there were answers about myself there, so I started reading a book that just happened to be available in its entirety online, written by the father of the modern concept of psychopathy, Dr. Hervey Cleckley.

Cleckley, in his groundbreaking book The Mask of Sanity, first published in 1941, presented the profile of the personality he called the psychopath, but which we now commonly refer to as the sociopath. Cleckley explained that a psychopath was extremely difficult to diagnose, because his mental faculties were fully intact, as was his ability to function in society as a seemingly normal human being, even a particularly successful one. Cleckley wrote:

Not only is the psychopath rational and his thinking free of delusions, but he also appears to react with normal emotions. His ambitions are discussed with what appears to be healthy enthusiasm. His convictions impress even the skeptical observer as firm and binding. He seems to respond with adequate feelings to another’s interest in him and, as he discusses his wife, his children, or his parents, he is likely to be judged a man of warm human responses, capable of full devotion and loyalty.

According to Cleckley, psychopaths are antisocials who excel at seeming social—seeming to feel, desire, hope, and love like everyone else. They exist virtually indistinguishable among society. In fact, the psychopath excels in many ways that others do not. Cleckley’s psychopath is uncommonly charming and witty. He is unflappable and eloquent, keeping his cool under pressure. Under this “mask of sanity,” however, is a liar, a manipulator, a person who disregards his obligations with little to no sense of responsibility. He is exciting because he is impulsive, whimsical, and prone to making the same mistake multiple times. His narcissism keeps him from forming any real emotional bonds, and he tends to be promiscuous. His own emotional world is mostly a poor imitation of natural emotions. Cleckley acknowledged that this unique suite of personality traits could suit the psychopath equally well to a career in business as to one in crime.

Nowhere else have I recognized the sociopath inside me more than in Cleckley’s clinical profiles, more than half a century old. From his observations of hundreds of patients, Cleckley distilled what he believed to be sixteen key behavioral characteristics that defined psychopathy. Most of these factors are still used today to diagnose sociopaths/psychopaths and others with antisocial disorders. They include the following:

• Superficial charm and good intelligence

• Absence of delusions and other signs of irrational thinking

• Absence of nervousness or psychoneurotic manifestations

• Unreliability

• Untruthfulness and insincerity

• Lack of remorse and shame

• Inadequately motivated antisocial behavior

• Poor judgment and failure to learn by experience

• Pathologic egocentricity and incapacity for love

• General poverty in major affective reactions

• Specific loss of insight

• Unresponsiveness in general interpersonal relations

• Fantastic and uninviting behavior with drink and sometimes without

• Suicide threats rarely carried out

• Sex life impersonal, trivial, and poorly integrated

• Failure to follow any life plan

If you’ve ever recognized yourself in a horoscope and thought, “Hey, maybe there is something to this astrology business,” then you understand my encounter with Cleckley’s book. Not everything is quite right, but many things are spot-on, and in general, it’s frighteningly accurate. My lack of life direction, my cold treatment of friends, my inability to focus on my job—the psychological pattern underpinning many of my problems was laid bare. I was particularly amazed by his descriptions of his patients, some of whom I shared so much in common with that I felt he could have been writing about me. There was one woman in particular, Anna, whose description seemed like a fictionalized version of myself:

It’s clear that Cleckley was taken by her. I love the way he describes her idiosyncrasies: the accent, her artlessness, her eternal youthfulness, her attractiveness that seems to be something more than mere beauty, her intelligence, and her charm. These describe me as well. She loves The Brothers Karamazov, but Cleckley later discusses how Anna does not have the highbrow tastes and prejudices that accompany the typical “intellectual” of her education and breeding, treating gossip magazines with the same interest as the music of Russian composers. Again, he could have been writing about me. Cleckley goes on to tell about how Anna quite sincerely taught Sunday school, volunteered for the Red Cross, and engaged in haphazard same-sex liaisons, one time with a nurse after being universally adored during a hospital stay. There were incredible parallels to my own life, from such seemingly insignificant ones like teaching Sunday school or being a model hospital patient to relatively more prominent ones like fluid sexuality. I was floored.

Cleckley does clearly lay out why he believes that Anna fits his criteria, primarily because of her lack of remorse about her lascivious lifestyle, but it’s clear that she is not just a sum of points on a checklist to him. She is a person. And it wasn’t the checklist that I identified so strongly with upon reading Cleckley’s book; it was the people. Even Cleckley acknowledged that the checklist was just a gross generalization of why these people seemed so similar to each other—despite their vast differences in education, background, socioeconomic status, criminal history, etc.—and yet so different from the rest of the world. I could quibble with whether or not I met a criterion like “unreliability,” but I could not deny the remarkable similarities that I shared with Cleckley’s patients.

Cleckley’s book was widely popular, circulating beyond a purely academic or medical audience. He edited the volume several times, making efforts to create as exhaustive a profile as possible of the modern-day psychopath. Cleckley understood that psychopaths and sociopaths, while sometimes or even often engaged in extremely antisocial acts, could also live lives completely undetected, adapting to their surroundings well enough to pass as normal, even to become contributing members of society.

Because Cleckley realized that there were sociopaths in the world who either do not engage in criminal behavior or are too clever to ever get caught, what began as a study of solely male patients in mental institutions became a much larger volume that included women, adolescents, and people who had never been institutionalized. Many of his later subjects, like Anna, had learned to live relatively normal lives within the general populace. From my own experience, I was sure that, had Cleckley peered into the classrooms of today’s law schools and offices of mega law firms, he would have found plenty of viable test subjects.

Now that I knew that I was not alone, that there were people out there much like me, I wanted to find out more about us.

In 1819, John William Polidori wrote a novella called The Vampyre, inspired by a fragment by Lord Byron, which would spark a vampire craze across nineteenth-century Europe and influence Bram Stoker and the modern vampire genre. The title character of Polidori’s novella was based on the wayward Byron himself. The vampire enters London high society and beguiles all who cross his path with his mysterious and contrary manners. Accompanying a young gentleman companion southward through Rome and Greece, he seduces and murders young women, unbeknownst to his companion, only to die himself from an apparent murder. A year later, however, the vampire reappears in London, where he seduces and marries his companion’s sister, leaving her drained of blood on her wedding bed.

At once beautiful and treacherous, the vampire occupies the unique position of the appealing monster. He is far from deranged or wild and, in fact, his manners are superior to those of the people he meets. His demeanor is uncanny and yet beguiling, his eyes hollow but intoxicating. His apparent deficits attract his victims and his peculiarities engage them, while he views them as nothing more than objects. The vampire does not seek his lonely existence; he merely lives it out to its fullest measure, unable to function any other way. He drinks blood because it fulfills him; he toys with people because it amuses him. His soul cannot rest.

The gothic vampire is the sociopath writ large, charismatic and sophisticated, a predator walking among us undetected. His myth dates back to the medieval period and is rooted in Slavic spirituality, based on a clear distinction between the body and the soul. An unclean soul gave rise to the vampire, whose continuing existence was both unnatural and interminable.

Sociopaths have been around for a long time, always at the margins. We exist in every culture. According to a 1976 anthropological study by Jane Murphy, members of the Yoruba tribe in Africa called cold souls arankan, “which means a person who always goes his own way regardless of others, who is uncooperative, full of malice, and bullheaded.” The Yupik-speaking Inuit knew antisocial members of their tribe as kunlangeta, of whom it was said “his mind knows what to do but he does not do it”; he is someone who “repeatedly lies and cheats and steals things and … takes sexual advantage of many women—someone who does not pay attention to reprimands and who is always being brought to the elders for punishment.” This concept of an individual who has the mental capacity to understand social norms but refuses to follow them is the key to the clinical diagnosis for modern-day sociopathy.

So, while it’s clear that people like me have existed throughout the many cultures of the world, our modern society likes to apply clear labels to people: Are you a sociopath, or something else? In the science fiction film Blade Runner, the sociopath analogues are the replicants, organic androids who have escaped to Earth and are hunted by Harrison Ford in his nuclear-dusty postapocalyptic world. So human-seeming are the replicants that they can be detected only through a set of emotionally provocative questions. In the movie, Harrison Ford can’t resist the charms of Sean Young’s porcelain skin and perfectly heart-shaped lips, even knowing she is a manufactured thing—that she can feel no empathy despite what he can see in her big, soulful eyes.

I remember watching the movie as a young girl, captivated by Sean Young’s quivering poise and futuristic office attire. Even then I felt sure I could survive pretty well in their harsh world, that all the scattered neon and miscellaneous steam would make it a hard enough place to live that all the weaklings would be relegated to subsistence living, and the strong ones like me would thrive. I imagined wheeling and dealing in pidgin Chinese, darting through alleyways in my dinged-up hovercraft. The irony, of course, is that in my adulthood I would willingly subject myself to very similar diagnostic questions—that I too would be clinically outed by tests designed to measure my lack of humanity.

The Blade Runner example is an interesting comparator because the emphasis is on identification, not diagnosis. The replicants are truly “other” and presumed to be subhuman; therefore there are no ethical constraints on what becomes of them, despite evidence that their internal worlds may have been just as rich as those of the humans. Similarly, even health professionals like Martha Stout, Harvard Medical School faculty member and author of The Sociopath Next Door, speak in terms of “identifying” sociopaths, as opposed to diagnosing. The message seems clear: These people are sociopaths, they aren’t people who have sociopathy. Diagnosis is for people for whom there is a treatment. Because there is no known effective treatment for sociopaths, there is just the question of what to do with the sociopath problem. In Blade Runner, society had come to a definitive decision of what fate would befall its empathy-free creations.

The sociopath problem for our society is, how do we keep sociopaths from acting in antisocial ways? Before society can even begin to discuss solutions to that problem, they need a reliable way to identify sociopaths. Before psychologists can identify them, however, they must be able to understand them. And to be able to understand them, they must be able to identify them. One psychologist has illustrated the tautology in the following way: “Why has this man done these terrible things? Because he is a psychopath. And how do you know that he is a psychopath? Because he has done these terrible things.”

It’s a classic chicken-and-egg dilemma that has prompted countless criticisms of the most popular diagnostic criteria. All diagnostic tools are based on the observable traits of people who have been diagnosed as sociopaths, which, apart from being rather circular, introduces the risk of biases that might skew which traits get included or not included. Of course there must be some starting place. Cleckley and others observed that some traits occurred more commonly in his patients than in the general populace. Once that recurring group of traits had a name, researchers could try to figure out if they all had a common cause, if they were related to other identifiable groups of traits, how many people had that group of traits, and what kinds of things those people got up to compared to the larger population. But Cleckley was well aware that his checklist was just his own poor approximation of the essence of sociopathy, and consequently was not infallible or even all-inclusive—a humility that I sometimes feel is lacking with researchers of sociopathy.

The current primary tool for identifying psychopaths (and, by association, sociopaths) is the PCL-R (Psychopathy Checklist–Revised), developed by Dr. Robert D. Hare, professor emeritus of forensic psychology at the University of British Columbia and generally considered the primary authority on criminal psychopathy. “Science cannot progress without reliable and accurate measurement of what it is you are trying to study,” Hare explains. With a research assistant he compiled a list of twenty traits that he noticed recurring among the prison population he was studying: lack of empathy and remorse, megalomania, manipulation, charm, self-interestedness, impulsivity, proficiency at lying, along with criminal-specific traits such as juvenile delinquency, revocation of conditional release, and criminal versatility. He instructed other psychologists giving the assessment to award two points if a trait was present, one if they were unsure or it applied somewhat, and zero if it wasn’t. The test was reliable, in that repeat assessments resulted in approximately the same score, but its validity has been heavily criticized.

Validity is a measure of how well a diagnostic tests what it is meant to test—in this situation, how accurately the PCL-R identifies psychopaths. The PCL-R has been criticized for being exclusively based on the prison population. Hare himself has admitted that it was done solely for convenience: “Prisoners are easy. They like meeting researchers. It breaks up the monotony of their day. But CEOs, politicians …” In a widely publicized scandal, Hare threatened to sue two psychologists who warned in a paper that the checklist was increasingly being mistaken for a complete definition of psychopathy, which is a broader personality construct that includes deceitfulness, impulsivity, and recklessness, but not necessarily physical aggression or illegal acts. The authors contended that Dr. Hare’s checklist warps that concept by overemphasizing criminal behavior. Their article reflects the growing consensus that sociopathy does not equate to criminality. Nor has Hare defended why each trait on the checklist is scored exactly the same. It’s not immediately obvious why a trait like lack of empathy should earn exactly as many points as something seemingly less significant like superficial charm. There is also the question of what defines this (or any) personality disorder, a person’s actions or her interior motivations. While a case history of bad decision-making is easy to evaluate, it’s harder to truly understand another person’s modes of thought.

There are significant differences of opinion among academics and clinicians about whether psychopathy and sociopathy are diagnosable conditions at all. The good folks at the American Psychiatric Association who put together the DSM have decided to exclude both terms, despite movements by researchers for revisions in favor of antisocial personality disorder, or ASPD, a diagnosis based on observed behavioral patterns. The World Health Organization’s International Statistical Classification of Diseases and Related Health Problems describes a similar diagnosis it calls dissocial personality disorder but also does not include sociopathy. ASPD and sociopathy do not share all of the same characteristics; ASPD focuses primarily on the criminality of behavior, rather than the internal thought processes of a sociopath, since thought processes are difficult to ascertain, particularly with unwilling, institutionalized subjects. For instance, although I consider myself a high-functioning sociopath because of my weak sense of empathy, my failure to conform to social norms, and my predilection to manipulate others, I could not be legitimately diagnosed with ASPD.

Further confusing the diagnostic problem of sociopathy is the overlap in behavioral characteristics between sociopathy and other personality disorders such as narcissism, like enhanced self-regard and diminished empathy, as well as some social developmental disorders like Asperger’s that are also seen on the autism spectrum.

In his book Forensic Psychology: A Very Short Introduction, David Canter, a psychology professor at the University of Huddersfield, warns that “we should not be seduced into thinking that these diagnoses are anything other than summary descriptions of the people in question” and echoes the concern that they are “actually moral judgments masquerading as medical explanations.” The first line in the preface of Robert Hare’s book reads: “Psychopaths are social predators who charm, manipulate, and ruthlessly plow their way through life, leaving a road trail of broken hearts, shattered expectations, and empty wallets.” So you can imagine what side of the fence he’s on. Still, these diagnoses are being used, and important decisions like whether or not to deny someone parole are made primarily on the basis of them.

Unlike the problematic definitions of psychological diagnoses, neuroscience may offer some more clarity. Recent brain scan research and other studies suggest a link between these characteristics and something more “definitive” and unique about a sociopath’s brain. But it would be a mistake to conflate the list of characteristics of a sociopath with the definition of sociopath, just as it would be a mistake to assume that all Catholics would share the exact same traits—or that having a certain list of traits is what makes people Catholic. The diagnosis of sociopathy is useful, but only to the extent that people understand its limitations. The main limitation is that we cannot identify it by its root source; we know it only by its symptoms and characteristics. This is somewhat disappointing to people. It would be easy to think that I am bad because I was treated badly or raised badly, that I grew up in an environment devoid of love and filled with enmity. But I didn’t suffer the kind of outrageous abuses that so many people do. Mine were of the ordinary variety, maybe some benign neglect. When people ask me whether I had a bad childhood, I tell them that it was relatively unremarkable. We know from twin studies that there is a strong genetic component to sociopathic traits, and we also know that sociopaths have different brains from most people. But just because they have different brains does not mean that their unusual brains are what makes them act differently. The fact that they act differently could actually be affecting their brain circuitry. Similarly, just because a sociopath’s brain is different does not mean that is what is causing the sociopathy—that could be, according to Hare, a “by-product of some other environmental or genetic factor commonly found among psychopaths.”

We don’t know the root cause, but we also know there isn’t a cure for this disorder, not that we would necessarily want one, for reasons that I hope will be clear upon finishing this book. Dr. Cleckley observed and counseled sociopaths as a psychologist and professor at the Medical College of Georgia. He wrestled with how to treat sociopathic patients and criminals, whom he believed to be deeply disturbed but essentially intractable. In the preface to his final revision of The Mask of Sanity, which he wrote at the very end of his life, Cleckley explained that he had been unable to discover an effective treatment but was heartened by the belief that he had contributed to the understanding of sociopathy—and especially that the relatives and loved ones of sociopaths could have some explanation for the unusual behavior of their beloveds. Indeed, he cited at length instances of incurable patients—individuals who had all the resources and support in the world to get better but ended up maiming significant others and committing other manner of misdeeds. To him we were a lost cause.

Cleckley was not alone in this belief. Recent estimates of the criminal recidivism rate for sociopaths is approximately double that of nonsociopathic criminals, and it is triple for violent crimes. Even the Yoruba and the Inuit tribes believed that these antisocial individuals could not be changed. The only solution was to neutralize or marginalize them, or as one Inuit purportedly told Murphy, the anthropologist, “Somebody would have pushed him off the ice when nobody else was looking.”

Today psychologists and criminologists are occupied with the same conundrum with which the Inuit and Yoruba dealt through discreet homicide—what to do with sociopaths who simply cannot be trusted and who do not belong. In Great Britain, authorities have given sociopathic criminals life sentences solely on the basis of their sociopathy. In America, diagnosed sociopaths have been committed indefinitely in psychiatric facilities with no hope of release, since their doctors assume they cannot be cured. Take the story of Robert Dixon, who received a fifteen-years-to-life sentence for accessory to murder as the getaway driver to an armed robbery gone wrong. Twenty-six years into his sentence, he was up for parole. As part of the assessment of whether he was likely to reoffend, he was given a test that indicated that he was a sociopath. “I remember reading the report and feeling heartbroken,” Dixon’s lawyer recalls, “because I knew no matter how hard I worked from that day forward, that when I brought him back to the board, we were going to get denied.”

While in his first edition Cleckley asserted that sociopaths should be considered psychotics due to their deep inability to function in society, he revised his position in later editions when he realized that this characterization stood in the way of making them responsible for their criminal acts. He faced a crisis; he never believed that sociopaths were crazy, or “manic,” in the sense that others of his patients were. But he felt that they were just as troubled, just as deficient or wrongly equipped to live, and so should be kept apart from everyone else. He was concerned that dangerous sociopaths were not committed in mental institutions often enough, because an overemphasis on verbal intelligence and rationality in determining whether a person was mentally competent for the purposes of confinement weighed in favor of sociopaths.

But depriving the sociopath of freedom purely on the basis of her psychiatric diagnosis is fraught with questions of moral significance. Social scientists worry about control and maintenance—how do we deal with these strange creatures, they ask themselves, in a manner that does not make monsters of the rest of us? Can a person’s lack of conscience justify a deprivation of his freedom? Society commits the insane to confinement by reasoning that they present harm to themselves and others. I’ve heard the argument that sociopaths cannot function in the outside world, so there is nothing that society can do but take the drastic step of separating the sociopaths from the rest of the world. But sociopaths can function; we just function differently. It’s not like we’re biting off our own hands or jumping off of buildings in the belief that we can fly. We’re not crazy. And the truth is that we are sometimes quite successful. It is just that we live, think, and make decisions in a way that some people find loathsome and most find disturbingly amoral. What do you do to people you simply don’t like?

The role that a diagnosis of sociopathy should play in criminal sentencing is an admittedly thorny issue. The legal standard for an insanity plea is that the perpetrator must not be able to distinguish between right and wrong. Sociopaths actually know what society considers right and wrong most of the time, they just don’t feel an emotional compulsion to conform their behavior to societal standards. The debate is whether this faulty wiring makes them more culpable, less culpable, or equally culpable compared to a similarly offending nonsociopath. Kent Kiehl, a prominent researcher who specializes in scanning the brains of sociopaths in prisons, suggested treating them the same as people with low IQs, who may know that their actions are wrong but lack sufficient “brakes” on their violent impulses.

Furthermore, there is the question of effectiveness of punishment. Cleckley asserted that treating sociopaths as ordinary criminals—and simply imprisoning them when they had committed a wrong—did not work, since punishment does little to deter them. Of course, the deterring effect of imprisonment on anyone is questionable. I doubt that empathetic people who commit crimes of passion are deterred by the thought of imprisonment, and I wonder how much it works on lifelong drug dealers born into gangs and poverty who thus have few alternatives. However, scientific research has been conducted to show that sociopaths are particularly nonresponsive to negative consequences, and I have found this to be true in my own life. The threat of punishment at home or school only served as a challenge to figure out how to circumvent the consequences when I did what I wanted to do anyway. I didn’t fear the punishment, I just saw it as an inconvenience to work around.

Cleckley’s intuition that sociopaths do not respond normally to negative consequences was validated by a famous study by Hare in which he administered mild electrical shocks to both psychopaths and a normal control group. A timer ticking down preceded the shock. Normal people would show signs of anxiety as the timer got closer to the shock, anticipating the slight pain. Psychopaths were remarkably unfazed by the shock and did not express a comparable increase in anxiety as the timer ticked down.

This blithe reaction to negative events may be due to the excessive dopamine that characterizes the sociopathic brain. Vanderbilt University researchers have linked the excess dopamine in sociopaths to a hypersensitive reward system in the brain that releases as much as four times the normal amount of dopamine in response to either a perceived gain of money upon the successful completion of a task, or chemical stimulants. These researchers suggested that the overactive reward system is to blame for a sociopath’s impulsive, risk-seeking behavior because “these individuals appear to have such a strong draw to reward—to the carrot—that it overwhelms the sense of risk or concern about the stick.”

I have my own doubts about this hypothesis, though. A hypersensitive reward system could explain why sociopaths are allegedly sex fiends, at least compared to the rest of the population. It could also explain why you’ll see them at the top of their field, professionally speaking. Sociopaths are probably contributing to society in all sorts of random ways in order to trigger an enormous amount of dopamine flooding through their brains. Risk takers, though? Maybe we are, but I don’t think it’s because of excess dopamine, particularly because an earlier study at Vanderbilt showed that low amounts of dopamine were highly correlated with risk taking and drug abuse. From personal experience, I feel like my risk-seeking behavior stems from a low fear response or a lack of natural anxiety in potentially dangerous, traumatic, or stressful situations.

I do all sorts of risky and often stupid activities, particularly when you consider that I am a financially secure white-collar professional with a brilliant IQ who was raised devoutly religious in a stable middle-class home. When I was young, I did the usual reckless teenage stuff: mosh pits, hitchhiking in developing countries, being towed in a shopping cart from the back of a truck, fistfights, etc. I might have grown out of some of the more childish thrill-seeking activities, but I never quite grew out of the inability to learn from experiences.

One summer I lost all of my savings trading high-risk options. Not only were the options risky, I took an incredibly risky approach to them—holding when I should have sold and putting all of my eggs in one basket. Even after many failed trades, I still took unnecessary gambles. I knew objectively that I was losing a lot of money, but I couldn’t make myself feel the pain of it in a way that seemed to matter. Though it doesn’t seem related, I don’t use knives. The risk of injury never sinks in, even with such a mundane tool. I’ve cut myself many times, lopping off chunks of skin or cutting down to the bone and requiring stitches, but I can never force myself to be more careful, so now I just don’t use them.

I’ve always loved to bike in cities, partly because it’s so dangerous. If a car starts creeping into my lane, I will punch at it or use my portable tire pump to swing at it. If a car cuts me off, I will follow it until I catch up, then dart in front and come to a skidding halt, forcing them to slam on their brakes. I’m sure it’s incredibly dangerous for me to do this, and really only for me, but it also freaks the hell out of them. And I don’t really care for my safety enough to change my behavior. It’s not that I’m being irrational. It’s that suffering the consequences of something rarely involves actual “suffering.” Maybe there is a small thrill in taunting drivers or risking my life savings, but mainly it’s that I just don’t feel sufficient anxiety in these situations warning me to be more careful.

I can’t tell you how many times I have gotten food poisoning from eating rotten and questionable food, but I never seem to learn my lesson. A few years ago I woke up naked on the floor of a YMCA shower. I couldn’t remember how I had gotten there, but I am sure it was something stupid. People who know their limits don’t end up passed out naked in a YMCA. I don’t have the off switch in my brain telling me when to stop—no natural sense of boundaries alerting me to when I am on the verge of taking something too far. When I do these things, it doesn’t feel as if I’m so overwhelmed by the carrot; it’s more like I am so unimpressed by the stick.

I have always lived in the worst neighborhoods. Rent is cheap and I figure there’s no need for me to pay a safety premium if I have health insurance. It drives my friends and family crazy, but it makes me easy to shop for when it comes to birthdays and Christmas: pepper spray, dead bolts, automobile theft deterrents, etc. Just after college I lived next door to a drug-infested Chicago housing project, taking night jogs through the neighborhood with headphones blaring loud enough to cover the sounds of gunshots, which were pretty loud. Recently I walked in on my apartment getting burglarized for the second time—the first time was just a few days after I had moved in. When it’s not getting burglarized, I get visitors banging on my door at all hours of the night. (I think one of my neighbors might be a drug dealer and these people are mistaking my apartment for his. Just idle conjecture.)

Perhaps my risk taking can be best seen in terms of my affection for and mishaps with motor vehicles. I love cars. I feel invincible behind the wheel, and I often put myself and others at risk because I didn’t think through the consequences of my decisions. Once when my brakes started going out, I opted to drive the car into the mechanic’s rather than pay for a tow, even though I had driven much too long on the brakes, until they were all but useless. It was rainy that day and I had to drive several miles on a steady decline. Making matters worse, when I got close to the shop, I saw that I would have to cross a bridge over train tracks, which rose and fell dramatically over the distance of about a block on a busy four-lane main thoroughfare. By the time I was at the bottom of the bridge without brakes, I was going at least forty-five miles an hour, much too fast for traffic that was slowing at a red stoplight up ahead. Making a split-section decision, I jerked the wheel to the left and power-slid across two lanes of opposing traffic, across both lanes of a parallel frontage road, and finally jolted to a stop when the right rear and then front wheel made contact with the curb on the far side of the street. I looked up at the addresses on the buildings and noticed that I was just south of the driveway to the mechanic’s, so I crawled into the parking lot and used the parking brake to come to a full stop, all to the gaping stares of onlookers.

Of course I was pretty pleased with myself at the time. It’s nice to have proof of your seeming invincibility. But if it had gone horribly wrong—had my car slid off the bridge and exploded on impact—I would have felt much the same about it. As long as I keep surviving, I seem okay. It’s not that bad things don’t happen to me; they do. But I just don’t feel that bad about them. Maybe in the moment I feel some regret or anxiety, but it’s quickly forgotten and the world seems ripe with promise again. I’m not superhuman, not entirely immune to sorrow or pain. I just have an extremely robust sense of optimism and self-worth that keeps me looking at the world through rose-colored glasses.

Although I am largely immune to misery, my siblings and friends aren’t. They sometimes hate me for my recklessness and the third-party externalities it causes. I vividly remember trying to coax my frozen hands to operate a tire jack in a snowdrift on the side of the road, replacing the tire that I had “fixed” myself a couple days earlier while my oldest brother spat epithets in my direction. After one burglary too many, my friend begged me to move to a different neighborhood—for peace of mind. When I assured her I was not bothered by the experience, she pressed on, saying, “Peace of mind for your loved ones, then.” It’s hard to find any incentive to change, though. I have always managed to get out of scrapes, whether that meant begging for money from strangers, pleading for mercy from police, or spinning webs of lies to cover my tracks. Because I was always willing to go double or nothing and because my unlucky streaks never lasted for long, I always managed to come out okay. And precautions are expensive, either in terms of actual costs for safety or opportunity costs for risks that you could have taken but didn’t. I understand that for a lot of people precautions are worth the money for, as my friend put it, “peace of mind.” But my mind is almost always at peace no matter what I do. Which is why I never bothered to be more careful.

After a number of years of living as a self-diagnosed sociopath, even running a blog for sociopaths, I decided to get formally assessed. At first I wasn’t inclined to seek a professional diagnosis. I had read all of the criticisms of the diagnostic criteria. I trusted my own self-assessment as much as I would anybody who happened to have a degree in psychology. However, eventually I decided that the lack of formal diagnosis might lead some readers to discount my point of view. Without a formal diagnosis, how could they know that I was an actual sociopath? I figured that if I was going to risk outing myself as a member of one of the most hated subclasses of humans, I might as well ensure that people believed me.

My diagnostician was Dr. John Edens, PhD, a professor at Texas A & M and a leading researcher in the field of sociopathy, whose opinions have recently been solicited for articles in the New York Times and on NPR, among other media outlets. Dr. Edens worried that the test he intended to give me was strongly wedded to Hare’s criminal-oriented model of sociopathy. Given that I had no documented criminal record, Dr. Edens felt that the test score in my case might be somewhat questionable and might in fact understate my true level of sociopathic traits.

I underwent a form of the PCL-R, the PCL:SV (Psychopathy Checklist: Screening Version), among other tests. The PCL:SV, as the name implies, is a checklist of criteria historically associated with Hare’s conceptualization of psychopathy. It was developed to assess for psychopathic features while relying less on the extensive file and criminal-history data required to complete the PCL-R. The PCL:SV is comprised of twelve individual criteria scored from 0 to 2 points, which are summed to form a total score from 0 to 24. The test is divided equally into two parts. Part 1 includes the personality traits typically associated with sociopathy, including lack of remorse and empathy for others, and interpersonal behaviors, including deceitfulness and grandiosity. Part 2 taps more socially deviant behaviors and activities, including irresponsibility, impulsivity, and adult antisocial behavior.

During the interview, I was asked about my significant history of impulsive, aggressive, and generally irresponsible conduct—things like fistfights and theft—that, while perhaps not having resulted in criminal charges, easily could have led to various encounters with the criminal justice system under different life circumstances. Dr. Edens noted in my report that these actions appear to have been almost entirely for thrill-seeking purposes rather than for any type of economic gain or other instrumental purpose. He noted: “Whether Ms. Thomas’s lack of police contact has been due to her successfully manipulating her way out of ‘jams,’ various protective factors evident in her life (e.g., high intelligence and educational success, generally supportive family structure, and other socioeconomic advantages), random luck, or some combination of all of the above is unclear at this time.” I talked about my family, my reckless teenage years, my inability to stick with my jobs after law school, and my subsequent self-analysis that had led me to his office, telling Dr. Edens stories that I had all but forgotten.

I scored a total of 19 out of 24 on the PCL:SV. There are no sharp diagnostic cutoffs, but according to the manual, scores of 18 and higher “offer a strong indication of psychopathy.” I got a 12 for part 1 (personality) and a 7 for part 2 (antisocial behavior). Dr. Edens remarked: “Notably, 12 is the maximum score one can obtain on Part 1 of this rating scale and indicates the presence of pronounced affective and interpersonal characteristics typically evidenced by highly psychopathic individuals.”

This linear grading system is in line with recent evidence that, in Robert Hare’s words, “psychopathy is dimensional (i.e., more or less), not categorical (i.e., either or).” Those with higher scores are more outwardly antisocial, but even those with lower scores “may present significant problems for those around them, just as those with blood pressure readings below an accepted threshold for hypertension may be at medical risk.” So Dr. Edens also had me take several other personality tests designed to look for sociopathic personalities. The most specific to sociopathy was probably the Psychopathic Personality Inventory–Revised (PPI-R), a self-report questionnaire developed to tap various personality characteristics historically thought to be indicative of psychopathic personality. This scale provides both a total score indicative of a global index of psychopathic traits as well as eight subscales that assess more specific traits. Dr. Edens reported: “Perhaps more notably, Ms. Thomas’s results were beyond the 99th percentile for any sub-sample within the PPI-R’s normative database, regardless of age or gender. Needless to say, these findings are highly consistent with a psychopathic personality structure.”

Other tests included the revised NEO Personality Inventory, also a self-report questionnaire, for which Dr. Edens noted that my profile mirrored that of “the prototypical psychopathic personality among females.” Finally, I took the Personality Assessment Inventory, for which I scored very high for traits like egocentrism and sensation-seeking characteristics, interpersonal dominance, verbal aggression, and excessive self-esteem, as well as very low scores on measures tapping negative affective experiences (e.g., phobias, traumatic stressors, depressive symptoms), interpersonal nurturance, and stressful life events.

I liked Dr. Edens. He seemed like a reasonable person—a genuinely caring person. At one point during our interview I thought that he might cry, he seemed so distressed on my behalf. I don’t remember what we were discussing, perhaps some story about my father beating me. I think if anything he was worried for me—worried about what a diagnosis like “sociopath” would mean for me in my life. Of course it’s hard for me to worry about things like that. If I can’t manage to care about my own health and safety, I’m not likely to care about the potential fallout in my professional and personal life from being officially diagnosed a sociopath. He must have realized that too. Maybe that’s why he seemed troubled.

We talked about how none of the tests are designed for someone like me, who seeks the diagnosis of her own free will and choice. Criminals have an incentive in an institutional setting to lie and distort their self-assessments, particularly in situations like a parole hearing. The diagnostic tests were designed to be administered with a healthy dose of skepticism. But what to do with an individual who seems to have an incentive to be diagnosed a sociopath? Several times he noted how I could possibly be tricking him by lying to him to make myself seem more sociopathic than I was, but he had to admit that lying for the purpose of self-aggrandizement was also consistent with sociopathy. Still, I wasn’t really tempted to lie. It would have seemed silly to lie. I was genuinely looking for answers and insight—as much as you can get from a three-hour appointment with a stranger.

Whenever suspected sociopaths write to me and ask whether they should get tested, I almost always tell them no. It’s just too risky. Because there is no real treatment, the only upside to a formal diagnosis is peace of mind, that you know who you are. The downside is having a major blemish on your record that could affect every aspect of your life, should it fall into the wrong hands. Even Dr. Edens showed an overabundance of caution in sanitizing the e-mailed version of the report, lest the “Internet gremlins” intercept it.

At the end of our several hourlong sessions Dr. Edens asked me, “What would you think if I told you that you are not a sociopath?” It was a question I had asked myself many times before. What if I just stopped the blog? What if I stopped trying to find answers in new psychological research? “I don’t know, I guess I would be annoyed that I spent all day traveling and talking to you for nothing?” I replied. He laughed. When it was time to leave he told me how much I owed him for his time. I had forgotten my checkbook. We both joked at how that was a likely story from a sociopath.

I left his office having no clue what he would put in the report. But I knew we shared a perception that sociopathy was understudied, overvillainized, and an important issue to get right. When I got the report back a couple weeks later it confirmed what I had suspected for a while—both in terms of my own diagnosis and also understanding better the inconclusiveness and subjectivity of the modern psychiatric diagnostic process.

A final question regarding detection is, why do we need to detect sociopaths? When I was growing up, my grandfather raised chickens and other animals on his ranch. Each chicken laid approximately one egg a day, so if he had seven chickens at the time, we would expect to see seven eggs. My grandfather was always very careful to feed the chickens and collect the eggs every day and taught me to be equally diligent when I stayed with him. If not, he said, the chickens might turn to eating their own eggs, and once a chicken has a taste for egg, it will continue eating eggs and have to be killed. I don’t know if it is really true that there is no cure for a cannibalistic chicken, but that is what he told me to scare me into feeding the chickens and collecting their eggs regularly. One time while I was gone, he got sick and couldn’t visit the chicken coop every day to feed them and collect their eggs. When he finally did get out there, he saw broken eggshells everywhere, the evidence of egg eating. Ever after, there were always one or two eggs missing from or pecked over in the daily collections. At least one chicken had gotten a taste for egg and wasn’t willing to give it up, even with the renewed ample food source.

“How are we going to find out which one of them it is?” I asked.

“What do you mean?”

“We need to kill the chicken that is eating the other eggs.”

He just laughed.

“No, seriously, Grandpa. One of these chickens is eating our food, taking up room in our coop, and ruining our eggs. We have to find out which one it is and kill it, right?”

“I don’t have time to sit watching chickens. Plus that chicken actually helps. It helps to remind me to stay vigilant about caring for the other chickens and collecting the eggs. It also reminds me that nature is cutthroat, and that human nature is just that.”

I wasn’t satisfied with my grandfather’s reasoning. The next day I woke up early and kept watch over the chicken coop. I saw the chickens go into the nesting area and lay their eggs, one by one. I also saw one of the chickens begin toying with an egg with its claws and pecking at it with its beak. I thought about killing the chicken. I had learned how to slaughter a chicken by hanging it up by its feet, securing its head in my weak hand, and with my strong hand locating the jugular vein with a knife and slitting it open, spilling the blood on the ground while the chicken flapped itself to death. The whole process took no longer than five minutes. Instead I yelled at the chicken, causing it to scurry away. I gathered the remaining viable eggs and walked back into the house.

I wondered if the chickens knew which one was the egg eater, and if they didn’t, what they would do if they found out.