From The Wall Street Journal:
‘I’m a liar. I’m a thief. I’m emotionally shallow. I’m mostly immune to remorse and guilt. I’m highly manipulative. I don’t care what other people think.” Thus opens “Sociopath: A Memoir,” by Patric (short for Patricia) Gagne, psychologist, former therapist, happily married mother of two—and, she would say, an “advocate” for others like her.
In grade school, Ms. Gagne tells us, she jammed a pencil into the head of another little girl and took money from the collection tray at church. As a college undergraduate, she drove stolen cars around Los Angeles. “Sociopath” is the story of Ms. Gagne’s obsessional effort to understand these impulses—to understand herself. Her divorced parents were loving, and her home was nice, defying the stereotypical origin story of family dysfunction. In the author’s case, the problem seemed innate. “I was simply different,” she writes, and it “often felt like a life sentence in emotional solitary confinement.”
As a teen, Ms. Gagne conducted little experiments on herself: “Wouldn’t it make more sense to engage in smaller acts of ‘bad’ behavior more frequently,” she surmised, “than larger acts less frequently?” She concluded that apathy was the culprit—a lack of engagement and interest that led her to misbehave and thus elicit an experience of colorful emotion. So she put herself “on a diet,” she writes. “I did exactly what I needed to give myself necessary ‘jolts’ of feeling. I never took it any further—even when I was tempted, which was often. I scheduled my mischief like I would have a doctor’s prescription.”
Eventually she understood that people like her—people, that is, who are sociopathic—“just had a harder time with feelings. We act out to fill a void.” Today she knows how much she has to lose if she acts on desires to violate social norms or harm people. The guiltless possibility of doing harm to others points to another key aspect of her condition: an inability to imagine the experience of others.
In a way, Ms. Gagne was lucky. Many people with her condition—most are men—would have landed in prison for committing some of the same trespasses. And few recover or cope as well as she has. Her life, in aerial view, has followed a fairly standard trajectory of education, employment and then doctoral training to become a therapist.
. . . .
But “Sociopath” does present an arresting story of a person who had to build an intelligible moral code from scratch—psychiatrists, apparently, were of little help. Ms. Gagne says that she wrote the book for the other estimated 15 million sociopaths in America. “Who has empathy and compassion for them?” she once asked her husband. She does, and she wants to “allow people like me to see themselves in healthy, everyday situations, and provide the single thing I knew they needed most: hope.” If she can truly help others like herself, then she will have accomplished what the psychiatric profession has largely failed to do.
. . . .
While borderline pathology and sociopathy differ—sociopaths suffer emotional numbness whereas borderlines are often flooded with inchoate anxiety and rage—psychiatry regards both conditions as very difficult to treat.
Borderlines are manipulative people who are apt to violate personal and professional boundaries. They experience panicky feelings of emptiness and engage in “splitting” (judging others as all good or all bad, appraisals that can change over the course of a day); they commit impulsive, often self-destructive acts when faced with overwhelming emotion and harbor an erratic sense of self.
To be fair, most borderlines don’t harm animals. It is just that kind of operatic portrayal, in fact, that Alexander Kriss decries in “Borderline: The Biography of a Personality Disorder,” a well-researched and compelling account of an often baffling condition. As an assistant clinical professor of psychology at Fordham University, Mr. Kriss seems to have immense empathy for borderline patients, putting him in a select group of therapists.
In “Borderline,” he charts the six-year (and counting) treatment of Ana, a young woman who—true to form—introduced herself to him out of the blue, via email, by demanding: “Call me ASAP.” Chapters alternate between sessions with Ana and scholarly excursions into the history of the concept of borderline. Experts, from the ancients to Freud to today’s trauma gurus, have tried to explain the pathology. The answers have ranged from hysteria, disruptions of the pre-Oedipal stage, parental neglect, biologically driven mood and impulse dysregulation, and child abuse. At its core, the problem seems to be one of continuity—in emotional control, identity and relatedness. Borderlines are overwhelmingly women who have been abused in childhood, and their clinical prognosis is guarded. Although most people do age out of the condition eventually, their mature years can be marked by depression, drug abuse and rocky relationships.
Thus far, Ana has made progress. Her treatment, Mr. Kriss says, is a continuing story “of how one moves from chaos to stability; from a black-and-white worldview to a more complex one; from a life defined by desperation to one defined by a sense of who we are.” It is clear from Mr. Kriss’s chronicle that Ana has made these moves but also backtracked at times. Mr. Kriss acknowledges that he must make concerted efforts to handle the emotions that Ana’s provocations stir within him.
But what of other people with character pathology who do not have the financial means to afford several sessions a week? (Mr. Kriss treats Ana for a steeply reduced fee.) Today a shorter-term therapy conducted in a group-therapy format, called Dialectical Behavior Therapy, is the most common treatment for borderline personality disorder. It helps people regulate strong emotions by, for example, getting them to think about whether a particular emotion is justified by circumstances and by improving their communication skills so that they can defuse tense situations.
Link to the rest at The Wall Street Journal (Sorry if you encounter a paywall)