Wednesday, April 7, 2010

Sociopathy: The Loss of Humanity

About all he said was, "I'm seeing a patient for medication management and I'd like you to do some therapy with him. He's had some legal entanglements, but I don't think he'll try to hurt you. I'm eager to get your impressions."

My usual glad-to-be-of-help expression must have turned slightly pale because he quickly added, "Don't worry, if you get in trouble, just shout and we'll all come running."

Oh, that's very comforting, I thought, and just how am I supposed to do that with his hands around my neck? "Thanks, I'll be sure to call your name loudest," I said, irony dangling around the rim of my smile. They call this supervision?

Legal entanglements was putting it mildly. He had a record that went back to high school and was currently awaiting arraignment on charges of assault and battery. Of course, my patient said, it was all trumped up, he'd done nothing of the sort, and besides, the police didn't like him because he was Irish. I refrained from mentioning that, in Boston, being Irish could almost be considered a prerequisite for a position on the force.

Suggesting we assume for the moment, that the charges were genuine, I asked what might be the reason for them. He explained a fellow car salesman had cheated him out of a deal and then waved the contract in his face, daring him to do something about it. "I tried to reason with him," he said, "but he laughed and called me a coward. It was his own fault, he shouldn't have provoked me."

"So, you did assault him, is that right?"

"No, I didn't touch him," he replied, conspiratorially. "He stumbled and hit his face on a car. I was trying to help him when someone called the police. They said they saw me hit him, but they lied -- they were all in on it."

Later that afternoon, my supervisor informed me that my patient had been diagnosed with antisocial personality disorder. "He's sociopathic, has essentially little or no conscience, and refuses to accept responsibility for his actions. He's charming, narcissistic, and he'll have you believing the moon is made of green cheese if you're not careful." Over the coming months, our "therapy," if you want to call it that, involved a weekly recounting of the offenses other people had committed against him, thereby justifying any retribution he may have exacted. Our final session ended much like the first one had begun, with him denying he'd harmed his coworker in any way.

I never felt I was in danger, but neither did I ever feel completely comfortable. The normal feeling sense you get with another person was absent with him, as though he had little emotion to begin with. He denied having been abused as a child but when he talked about his parents, he might have been describing strangers. Working with him was a learning experience without question, and one that I'm generally disinclined to repeat. It was too much like trying to help someone who'd lost his humanity and had no interest in going to look for it.

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