Going for the Dopamine High: The Dynamics of Psychopathy
Art imitated life in an episode of one of my favorite medical shows called New Amsterdam. In it, a team of health care professionals tackle challenging issues in the lives of the patients who pass through the doors of an inner city hospital and by the end of the show, sometimes the solutions are found, but not all are tied up in nice neat little packages with a pretty bow on top.
One was the heart-wrenching dynamic in a family that included two parents, a young brother and slightly older sister, both under age 12. The little boy was brought in by ambulance after a near strangulation. The parents tell the ER doc that he got caught in a cord from a window shade. It unravels when she sees finger-prints on his neck that tell her that was not the cause. She immediately asks for a consult with the staff psychiatrist, Dr. Iggy Frome, and for a call to be put in to Child Protective Services.
Dr. Frome speaks with the father and the CPS caseworker interviews the mother. Both of their stories are debunked, and it is determined that neither of them is the perpetrator, but each initially takes the blame. What is discovered is that it is the girl who attacked her brother when he wouldn’t turn over his phone to her. She felt entitled to it, simply because she wanted it. She had no compunction about stealing it by assaulting him. Turns out, per evidence of her behaviors, that she would receive the diagnosis of psychopathy.
In two sessions with the doctor, she exhibits a shocking lack of conscience. He asks her telling questions about her perception about her family and her desire to hurt them. He inquires why she thinks she should. Her chilling response? “Because I can.” In further interactions, he puts her to a test by playing a winner-take-all game. She masterfully brings him to his emotional knees by insulting his intelligence, his lack of composure and appearance and a macaroni sculpture made by one of his children.
Dr. Frome refers to her as a “callous unemotional child.” The flat affect she exhibited with the brief exception of when she knew she had people in her life on hyper-alert, often accompanies this presentation. All of these put her at risk for a life of escalating criminal behaviors, hospitalization and incarceration. Although he had never successfully treated a child with that condition, he held out hope that with persistence, he could ameliorate the effects. It might include incorporating emotional literacy techniques to instill a sense of connection with other living beings.
This fictional interaction was well researched and scripted since it mirrors the standard beliefs about the diagnosis.
- An absence of empathy or compassion for others
- Lack of remorse for actions that harm others
- A sense of entitlement that they should have what they want simply because they want it
- High risk behaviors to see what they can get away with
- Desire for dopamine rush that comes with the aforementioned attitudes and behaviors
- Concocting elaborate stories about their activities
- Dismissing the concerns of others
- Believing that the ends justify the means
- Objectifying others
A quiz that may identify traits, but is not meant to be a diagnostic tool is available. A more nuanced tool is called the Robert Hare Psychopathy Checklist, which is considered “the gold standard” to determine if someone is exhibiting signs of this insidious condition. In his book called Without Conscience, Robert Hare, Ph.D., describes the symptoms and dynamics and harm done by those afflicted.
Can psychopathy be successfully treated? It is debatable that a “cure” is possible.