Contextualizing Sociopath: A Memoir, by Patric Gagne, PhD
I’m posting twice in a row about literature. In this case, the book being discussed is not fictional, but autobiographical. As the title, Sociopath: A Memoir, suggests, the book has a specific aim in mind. Dr. Gagne hopes her story will connect with other people one might refer to as sociopaths. And perhaps, dispel some myths and biases about what that actually means.
Given my own focus on psychological misinformation, this immediately drew me to read the book. It lent an immediate feeling of kinship to her effort, which her writing did not disappoint.
“You’ve got to be taught”: What “sociopathy” has to say about how we understand each other
Dr. Gagne’s intentions are very specific. She describes her thoughts, feelings, and actions throughout her life (as of yet), with the hope that readers will recognize their own struggles. This can help ‘normalize,’ or tell people that they are not broken. It also helps people feel connected and seen. Sending the message that I see your struggle, and there are people out there who will work through it with you.
These are laudable intentions. They are certainly fundamental to my work as a psychotherapist.
My intention here, however, is somewhat different. Dr. Gagne’s story poignantly demonstrates some of the challenges we have in listening to and understanding each other as a community.
My (clinical) interactions with sociopathy and psychopathy
Definitions
First off, what is a sociopath? As Dr. Gagne points out, definitions are somewhat limited. Sociopathy is often thought of as ‘psychopathy-light,’ while psychopathy is taken as shallow or disconnected emotions and relations, and antisocial traits (such as in Cleckley’s 1941 list that she references). Antisocial is defined in its diagnosis as “a pervasive pattern of disregard for and violation of the rights of others” (APA, 2022, p. 748). Keep in mind that this is different from how some people use ‘antisocial’ colloquially, which is as a desire to isolate from others. Psychology calls this latter meaning ‘asocial.’
Dr. Gagne then suggests, though this is from clinical wisdom, and not found in any diagnostic manual, that people view psychopaths as incapable of learning to connect to others, but sociopaths as challenged but potentially capable.
Interactions from a student to present
I have to admit, and shamefully so, that my interactions and awareness of this topic as a psychologist is very lacking. I can think of only two interactions.
First, as a student at my graduate school’s in-house clinic, I was responsible for conducting intakes. One of the people requesting services was a young man who unabashedly declared multiple actions he had taken, out of revenge or for stimulation, that could have caused major harm to others. At the time, I was unsure whether his description was meant as gloating or simply stating the facts. He did not express any remorse or recognition that these were not appropriate ways to act.
I got through perhaps one minute of presenting my intake write-up to my supervisor, before he had decided next steps. This young man was ineligible for our clinic, and would be given other referral options. He was a potential legal liability for any clinician, and certainly for trainees. This liability falls under what gets called the “duty to warn,” coming from the influential Tarasoff trial. Clinicians are obligated to take action to warn law enforcement/specified targets about any specific and foreseeable dangers to others.
And so, my knowledge of this man ends there.
Hard to connect but still suffering
Later, while leading my OnTrackNY team, we worked for two years with a young man and his family who demonstrated many sociopathic traits. We struggled with how to help him throughout. He bounced back and forth between myself and the other therapist during his enrollment; despite our earnest efforts, we found it hard to create a connection with him. He was clearly suffering – frequently in pain, both physically and emotionally – but often viewed us as threats for further suffering, or even at times as the authors of the suffering. When he left our program, he and his family were still in difficult shape.
Meeting people where they are at
If, as Dr. Gagne cites in her book, sociopaths represent ~5% of the population, I should have encountered way more than 2. What’s going on here?
I wonder how much it comes from the same reason that in the US, people who experience psychosis take 1.5 years to connect to treatment, or if they can help it, never connect at all: we pathologize (i.e., see as diseased or unhealthy). And through pathologizing, we can use people by fitting them into our preconceived boxes. Dr. Gagne described, over and over, how different people, through praise or criticism, used the “sociopath” label to exert power over her, or siphon her power for themselves.
There are two levels to this pathologizing.
South Pacific and the label “sociopath”
First and foremost is the general categorizing of people. As Hammerstein wrote, “You’ve got to be taught, to hate and fear.” Technically, the fear of things and people that differ from our experience comes naturally to us, but how we understand and handle that fear does not. This is what Hammerstein was getting at in South Pacific. In western culture, we are trained to categorize and other what we don’t understand. Generally, the othering is not helpful. If you do not respond to how I am feeling in the way I expect or want, that can be scary and intimidating. I may then categorize this as sociopathic. You now have/are the problem. These beliefs and judgments about the person are referred to as stigma. Yet what comes before the stigma – the response to fear by putting people into clinical boxes – is just as important to recognize.
Self-stigma and the (re)interpretation of intention
The second pathologizing is a bit more subtle. As a psychologist, perhaps particularly as a behaviorist, one theme called out to me repeatedly across the memoir. I didn’t anticipate this, so it was rather a surprise: how much Dr. Gagne felt and was controlled by emotions.
Lack of emotional response is all over Cleckley’s list: directly a part of #3 (absence of nervous or psychoneurotic manifestations), #5 (insincerity), #6 (lack of remorse or shame), #9 (incapacity for love), and #10 (general poverty in major affective reactions), and implicitly a part of numbers 1, 7, 12, 14, and 15. And Dr. Gagne agrees with this, for herself: she repeatedly does not notice herself responding emotionally as other people are, or as she expects herself to. Even to major events, like deaths or dangers.
And yet, time and time again, the reaction was there. She would ruminate about it, berate herself about it, hide it, force herself to try to feel. These situations were often cues for her “stuck stress” and perceived apathy. The pattern struck me as very familiar: it was an inverse of what happens to many people with obsessions. In OCD, the person interprets the presence of a thought as characterizing the person. For example, if I see a knife and have a thought or image of picking it up and stabbing someone, that says something about me. For Dr. Gagne, she took her absence of perceived emotion as about her: I didn’t cry when my ferret died, therefore I’m uncaring.
Pathologizing variation in reactions
I didn’t buy it. Not only does the presence or absence of feeling say very little about her values and morality (a point she was quick to recognize, and has spent many years trying to demonstrate to those around her), the signs of the feeling all over. For example, she became furious when her mother and sister buried the ferret without her.
We are a feeling-focused culture, constantly trying to supply ourselves with endless happiness and eliminate any signs of fear, anger, or sadness. We forget that emotions are simply messengers. They let us know about what is happening, but are not the event itself.
Throughout the memoir, I saw repeated evidence of this push and pull for Dr. Gagne, and realized that she is just as controlled by emotion/its equivalent as the rest of us. Over and over, she took her ‘sociopathic’ actions either as a response to what for some might come as an emotion but for her was not perceived this way; or, a response to recognized emotion (what she called “stuck stress.”). This is how she came to find herself, in her self-treatment journey, doing exposure work. Exposures are a key tool to separate intense emotional responses from how we act.
You’ve got to be taught: Interpreting intention
My reframing of emotions and the role of emotions brings me to the broader theme: how we interpret intention. For many years, Dr. Gagne fought herself and others over how to interpret her own intentions. She became caught up in a battle over is she a “good person,” because her reactions did not conform to general societal expectations. She gradually disconnected these reactions from judgments of herself as a person, and appreciated her rather well-developed sense of ethics. In this process, I think she revealed an important lesson about intentions: we construct them. Intentions are not the actions themselves, but the stories we tell about those actions, and there is no “right” story. These stories change across people, across time, across cultures. We reassess our own stories, even about actions that have already happened, and tell new ones.
When I was a teenager, I got stuck analyzing my own intentions, perceiving selfish aims in all of them. These were not silly or illogical stories, but well-reasoned and coherent. And impactful: they affected my mood, what I chose to focus on, how I treated others. It wasn’t until years later that I began to recognize them as just stories. And that what I did with them – the actions I took, how I treated myself and others – was more important, and enabled me to tell many other stories.
I appreciate that Dr. Gagne openly shares her own story. She points out many themes that can be told of her actions. Rather than suggest that any of these perspectives are the right ones, she lets us in on her ongoing journey to improve her story.
There’s nothing more universal to connect with than that.
Literature – Sociopath: A Memoir
Post-script: Lying
Speaking of stories: some of you might be thinking, how can we trust what she writes? Isn’t she crafting a story that fits her experiences to the message she wants us to take? Isn’t this what a sociopath does?
Well – isn’t this what we all do?
As a psychologist, I don’t pin my expectations on truth. Truths are something we don’t get access to. Remember, communication is persuasion. What I care about is what type of world are we creating together. Dr. Gagne chose to share her story – what can I learn? How can I better understand people going through what she has?
I learn what I can, but I don’t take those messages as truths, either. They are simply hypotheses. They are perspectives I can try out, and see if they make things work better.