Stout's 'Sociopath' lacks even a shred of credibility

February 13, 2005|By Paul McHugh | Paul McHugh,Special to the Sun

The Sociopath Next Door: The Ruthless Versus the Rest of Us

By Martha Stout. Broadway Books. 256 pages. $24.95.

The cover of this book blares out its alarmist message. "1 in 25 ordinary Americans secretly has no conscience and can do anything at all without feeling guilty. Who is the devil you know?" The psychotherapist author claims that 4 percent of Americans, by psychiatric criteria, have anti-social personality disorder (also known as sociopathy). She wants to warn us about them because, so she says, they are difficult to identify and, lacking an innate conscience, are dangerous to all.

After my surprise beholding a therapist literally demonizing people who by her own definition are mentally ill, I noticed three telling credibility problems. By misquoting a paper (on which I'm an author) she reaches the 4 percent figure, more than double the actual 1.5 percent prevalence for anti-social personality (thus any concerns involve fewer than 2 in 100 Americans not 1 in 25). These patients are not "difficult to identify" (after all, we did count them). But her knowledge of them (including their lack of "conscience") comes indirectly from reports of "hundreds of survivors" who say they were hurt by "typically sociopathic parents." Exaggerated numbers, mystifying assertions and unassessed claims shake one's confidence at the start.

Author Martha Stout previously promoted the multiple-personality craze and knows how psychological notions evoking paranoid suspicions sell with the public. She builds this book around a set of dramatic vignettes -- mostly fictionalized, some wholly, others partially -- from unpleasant encounters with workmates. These stories contrast the good guys (the author and her patients) who act responsibly and suffer, with the bad guys ("sociopathic" parents) who act selfishly and vindictively -- sometimes to even a score, sometimes for sheer malicious, sadistic pleasure.

These vivid "villain and victim" stories play up how we innocents have been entertaining monsters unawares. Their charm and plausibility hide their nature from us, their unsuspecting victims. But our author knows how to strip away their masks -- so she says -- and promises to arm us for the future.

With those promises, you might expect the book to convey some genuine descriptive and analytic information -- something, at least, that could count as observational data. You'll find none. No tables, no surveyed populations, no methods of study, no error rates for her diagnoses. Only more vignettes. But, trust doctor. She knows those devils and is never wrong.

Similarly. there are no data to explain the causes of sociopathy, again because the author has not studied the condition directly. She gestures at behavioral and social science where she often uses terms incorrectly. She does though, eventually and predictably, turn to blame that bane of the chattering class -- America -- where "individualism as a central value, tends to foster the development of anti-social behavior, and also to disguise it."

This scare-mongering book emerges from a vulnerability of psychotherapists -- the impulse to believe that, as initiates to certain 'secrets of the mind,' they know the wicked ways some use to have their will with others. Surrendering to this 'Gnostic' impulse subverts them as therapists. They will cease encouraging patients to identify and surmount their own psychological frailties -- teaching instead that 'the sociopaths' in their lives provoked their emotional and behavioral difficulties. And, along the way, the therapist will, as does our author, defame the patients' relatives with sinister unverified psychiatric diagnoses.

This book displays what misguided psychotherapists can do when they get down to name-calling. Their accusations sound so professional and compelling, they could launch a lynch mob or a witch trial. There is no grandeur and little kindness in their view of life.

Paul McHugh was Psychiatrist-in-chief at Johns Hopkins Hospital from 1975-2001, and is the university Distinguished Service Professor of Psychiatry at Johns Hopkins University.

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