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"Aren't you struck by how much action occurred simply because something went wrong in one man's brain?" (p. 31)

"If people like you, you can manipulate them to do whatever you want them to do... I don't feel empathy... you select the kind of emotions you want." (p. 134)

"Kids with extreme irritability and moodiness and temper tantrums are being called bipolar. The drug companies and the advocacy groups have a tremendous influence in propagating the epidemic." (p. 244)

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Everybody's Fool Lyrics: Perfect by nature / Icons of self-indulgence / Just what we all need / More lies about a world that / Never was and never will be / Have you no shame, don't you see me? / You know

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Hide and Seek (2005)

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As World Mental Health Day approaches, has the drive to identify all illnesses created a 'fiction' of psychiatry?

In his riveting tale of how psychiatrists "medicalise" human suffering, Gary Greenberg recounts that, in 1850, a physician called Samuel Cartwright reported a new disease in the highly respected New Orleans Medical and Surgical Journal. Cartwright named it drapetomania, from the ancient Greek drapetes for a runaway slave; in other words, here was a disease that "caused Negroes to run away". It had one primary diagnostic symptom - "absconding from service" - and a few secondary ones, including "sulkiness and dissatisfaction just prior to flight".

Drapetomania was, of course, consigned to the dustbin of medical history. It never made it into the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), the leading authority on mental health diagnosis and research. But, Greenberg suggests in his scathing critique of the DSM, it might well have done - had the manual existed at the time.

After all, he notes, homosexuality was listed as a "sociopathic personality disorder" when the DSM was first published in 1952, and remained so until 1973. "Doctors were paid to treat it, scientists to search for its causes and cures," he writes in The Book of Woe: The DSM and the Unmaking of Psychiatry. "Gay people themselves underwent countless therapies including electric shocks, years on the couch, behaviour modification and surrogate sex."

Greenberg, 56, is a US psychotherapist of 30 years' experience and a prolific writer on mental illness (including his own depression after the collapse of his first marriage). But the target of his latest book is the DSM itself, the so-called "psychiatrist's bible", which aims to provide a definitive list of all mental health conditions, along with their diagnostic criteria.

Updated at regular intervals - DSM-5, the fifth edition, was published in May - it has considerable influence worldwide, including in the UK, where it underpins several clinical guidelines on mental health. Yet Greenberg holds that by imposing a pseudoscientific model on our "hopelessly complex" inner world, it creates a "charade" of non-existent disorders.

As World Mental Health Day approaches this week, he argues that, thanks to the DSM, "countless millions" are hooked on powerful antidepressants to cure a mythical "chemical imbalance", while rates of mental disorders in children, including autism, bipolar illness and ADHD, have rocketed. The DSM is, he says, a "fiction" which medicalises human experience and allows psychiatrists "dominion over the landscape of mental suffering".

Greenberg's language may at times sound overblown but he isn't alone. DSM-5, 14 years in the writing, has been criticised by many for the unhealthy influence of the pharmaceutical industry and its tendency to medicalise behaviours and moods that many would argue fall within the normal range.

"Few professionals are happy with the DSM," Greenberg says on the phone from his home in Connecticut, where he lives with his wife, teenage son, cat, dog and "a dozen or so" hens. "We are forced to engage with a charade of diagnostic disorders that we don't believe our patients have for the crassest of reasons - money." (In the US, people have to have their diagnosis confirmed by the DSM to access insurance funds for treatment.) "It's not just psychotherapists - even psychiatrists admit this is a deeply flawed document."

The rot set in during the 19th century, he says, when expectations of medicine changed dramatically after the discovery of micro-organisms. "It created a desire for all mental suffering to be understood in the same way as physical suffering, such as smallpox or cholera. To consider craziness as another treatable disease which originates in biology had tremendous appeal."

Playing into this is another factor, the influence of the pharmaceutical industry. Despite an attempted clean-up in recent years by the American Psychiatric Association, 67 per cent of the "task force" members responsible for DSM-5 are reported to have industry links.

Yet Greenberg believes that many psychiatrists - and even drug reps - are well-meaning. "It is intellectual rather than financial corruption. The idea that human suffering can be reduced to a biochemical imbalance - this is about ideology rather than money."

Greenberg's book tracks in painstaking detail how the DSM's decisions have created "false epidemics" of over-diagnosis and over-treatment. In 1994, for example, the diagnostic threshold for bipolar disorder was lowered to cover people without full-blown mania (instead, they have elevated moods that doctors call hypomania, but which Greenberg describes as exuberance). As a result, bipolar diagnoses soared, as did prescriptions for mood stabilisers and antipsychotic drugs, which in the US were for the first time being advertised directly to the public. "Suddenly, everyone and his brother was bipolar," says Greenberg. About six million people are now diagnosed as bipolar in the US, and in the UK, it's one in 100.

He also describes how a loophole in the DSM criteria was exploited "by one of the few real bad guys in psychiatry" to establish a juvenile version of the disorder, without any solid evidence. This was at a time, coincidentally, when powerful antipsychotics were being rebranded as mood stabilisers. As a result, diagnoses of child bipolar illness increased 40-fold over a decade. "In 2007 alone half a million children, 20,000 of them under six, were prescribed drugs that a decade before would have been prescribed only in the most dire circumstances," says Greenberg.

The side effects of some of the drug cocktails children were prescribed included obesity, diabetes and suicidal thoughts.

In an attempt to reduce bipolar diagnoses in children, DSM-5 has introduced a new illness, called Disruptive Mood Dysregulation Disorder (DMDD), to cover intensive temper tantrums. But this too is proving controversial, with fears that it may capture some children who may be volatile, but who are not ill. "Clinical trials of treatments for DMDD are probably already under way and may well lead to another treatment epidemic," he says.

A different tale concerns Asperger's syndrome, which was first included by the DSM in 1994. Greenberg explains that this had some beneficial effects. "It may not have been a disease but calling it one gave a hitherto neglected group of children access to support and educational services, as well as a sense of identity and community." The result though, was that from a worldwide prevalence of four in 10,000 for autism disorders (including Asperger's) in 1988, 20 years later this was one in 88. Alarmed at diagnostic rates "getting out of hand", DSM-5 has removed Asperger's, replacing it with the umbrella term Autistic Spectrum Disorders. This means a "higher threshold for diagnosis", according to Greenberg, and possibly less access to educational benefits for future generations.

He is unimpressed with the DSM-5's new Hoarding Disorder - "Is an eccentric old man living amid his junk sicker than a billionaire who is always thinking of the next way to make a buck?" - and argues that anyone over the age of 50, including himself, would qualify for another new entry: Mild Cognitive Disorder.

Greenberg is particularly dismissive about DSM-5's changes to the criteria for Major Depressive Disorder. Until now, this diagnosis was specifically excluded in cases of recent bereavement, on the grounds that grief is normal. That exemption has been removed in DSM-5, leading critics to argue that grief has been medicalised.

"The exemption clause was an embarrassment because it challenged the idea that depression is caused by biology and led critics to demand that other external factors, such as divorce and redundancy, be exempt too," he says. "So they got rid of it, which means that if you are depressed while bereaved you can be classified as mentally ill." Not that bereaved people who are depressed shouldn't be helped, he adds. "But is it really a medical problem?"

So what needs to happen? Psychiatrists, he believes, must narrow their scope - to make a "reasonable claim" for certain mental illnesses falling within their domain. "When the DSM was published there were 14 mental disorders and now there are 250 - it needs to scale back."

There is a place for drug treatments, he says, although "you only have to look at the clinical trials to see they help some people but not all."

Above all, psychiatrists need to be more honest with their patients, he believes. "They shouldn't tell people their illness is caused by a chemical imbalance when there is no evidence this exists. Psychiatry has little knowledge of the underlying processes governing mental health and it should not pretend otherwise."

The Book of Woe: The DSM and the Unmaking of Psychiatry' by Gary Greenberg (Scribe Publications, RRP £20) is available to order from Telegraph Books at £18 + £1.35p&p. Call 0844 871 1514 or visit books.telegraph.co.uk

World Mental Health Day is on Thursday, October 10. See mentalhealth.org.uk

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‘Dozens of mental disorders don’t exist’

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As World Mental Health Day approaches, has the drive to identify all illnesses created a 'fiction' of psychiatry?

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Master Manipulators

Serial Killers

Psychopaths

What makes someone go off the deep end? What is going on in the mind of a serial killer? Are master manipulators crazy?

In this post I want to answer all of these questions and more because we are going to dig into the psychology of psychopaths.

Before we get too far into the science, the term 'psychopath' should not be used lightly.

According to researchers, psychopaths make up about 1 percent of the general population and as much as 25 percent of male offenders in federal correctional settings.

The Mayo Clinic describes psychopathy as a personality disorder where, the person "typically has no regard for right and wrong. They may often violate the law and the rights of others." Often, psychopaths have little empathy, antisocial behavior and lack inhibitions.

1. Psychopathic Tendencies

This is very disturbing footage of a psychopathic child from the 1990 documentary Child of Rage:

Beth shows what are called 'psychopathic tendencies,' which psychologists believe is due to the mistreatment she received at the hands of her parents. Beth is NOT a psychopath; after therapy and strong, loving relationships, Beth is now a fully functioning adult. Luckily, her psychopathic tendencies never grew into true psychopathy.

Psychopathic researchers found that psychopaths often have these common traits:

Lack of empathy, guilt, conscience or remorse
Do you think you know a psychopath? Tell me.
Shallow experiences of feelings or emotions

Impulsivity and a weak ability to defer gratification and control behavior

Superficial charm and glibness
This suggests that there is a relationship between how the brain functions and the behavior of a psychopath.
Irresponsibility and a failure to accept responsibility for their actions

A grandiose sense of their own worth

2. The Warning Signs

Psychopaths are typically highly impulsive and highly emotional. They are at high risk of substance abuse and incarceration. According to Joseph Newman at the University of Wisconsin, "Criminal psychopaths are about three times more likely to commit violence than other offenders and about two-and-a-half times more likely to commit other antisocial acts such as lying and sexual exploitation." They are very difficult to have relationships with because they lack social kindness and empathy. Researchers believe that psychopathy has roots in early childhood. Children who show an early lack of fear, indifference towards peers and appear callous in the face of emotion are at the greatest risk.

3. The Brain of a Psychopath

Researchers believe that psychopaths have different brain activity patterns, specifically less activity in the amygdala where fear is processed and in the orbital frontal cortex or regions where decision making happens. One study found that people with antisocial personality disorder (often linked with psychopathic behavior) have an average of 18% less volume in the brain's frontal gyrus. In another study from the Archives of General Psychiatry, researchers compared 27 psychopaths to 32 non-psychopaths and found the psychopaths had less volume in their amygdala-where empathy, fear processing and emotional regulation happens. This study also found that psychopaths have less activity in the area of the brain that processes empathy.

4. How About Adolf Hitler, Fidel Castro, Saddam Hussein?

The CIA has released all kinds of interesting personality reports of historical figures. Read some of the findings below. See any similarities?

Adolf Hitler:

Henry A. Murray was tasked with putting together a personality evaluation of Adolf Hitler in 1943. The report concludes that Hitler was a masochist and a suicidal neurotic narcissist.

Fidel Castro:

In 1961, the CIA's psychiatric staff put together a report stating Fidel Castro was "so highly neurotic and unstable a personality as to be quite vulnerable to certain kinds of psychological pressure. The outstanding neurotic elements in his personality are his hunger for power and his need for the recognition and adulation of the masses."

Results: "Over 300 subjects who were treated at MJTC were matched with similar subjects not treated at MJTC and followed over a 5 year period. 98% of the non-MJTC youth were arrested again within four years, while only 64% of MJTC youth were. This is a 34 percent reduction in recidivism!

MJTC youth were 50% less likely to commit a violent crime, and while non-MJTC youth killed 16 people after their release, MJTC youth didn't commit a single homicide! Furthermore, detailed economic analysis revealed that "for every $10,000 spent at MJTC, the state of Wisconsin saved $70,000 by reducing the future costs of incarceration."

Saddam Hussein:

Jerrold Post, the founder of the CIA's Center for the Analysis of Personality and Political Behavior, found that Saddam's pursuit of power is tied with messianic dreams and "there is no evidence he is constrained by conscience; his only loyalty is to Saddam Hussein. In pursuing his goals, Saddam uses aggression instrumentally. He uses whatever force is necessary, and will, if he deems it expedient, go to extremes of violence, including the use of weapons of mass destruction...While Hussein is not psychotic, he has a strong paranoid orientation."

We can't say conclusively if Hitler, Castro or Hussein were 'psychopaths' but we can spot some of their tendencies.

5. Can Psychopaths be Cured?

There is no 'cure' for psychopaths, but the earlier psychopathic tendencies are spotted, the more help can be given. It is incredibly difficult to teach empathy, but loving relationships and therapy can help reengage healthy, social behaviors. The discussion on treating psychopaths is not that different from the conversation about lowering recidivism and helping criminal rehabilitation. Since researchers estimate that 25% of criminals in state facilities show psychopathic tendencies, we know that the treatment could be one in the same. One model that has had some success is called the Decompression Model. This was developed by staff at the Mendota Juvenile Treatment Center (MJTC) and is based on the fact that psychopaths don't think about or respond to punishment the same way as non-psychopaths (due to brain differences). In this way, punishment doesn't discourage bad behavior-in fact, criminal psychopaths are six times more likely than other criminals to commit new crimes following release from prison.

The Decompression Model is all about positive reinforcement. Whenever good behavior is spotted, staff members at the MJTC immediately offer some kind of reward. This is because even though psychopathic brains don't respond to punishment, they do respond to rewards. This increases and reinforces learning a new behavior.

6. The BIG Take-Away

Maybe there is someone in your life who you are thinking shows psychopathic tendencies. If so, this last study with MJTC criminal youth is crucial for you.

With psychopaths, punishments do not work.

Trying to give consequences, punish or shame for behavior will only make them worse-remember, their brain doesn't respond to punishment and fear in the same way as ours. Positive reinforcement is the kindest and most effective thing you can do. Most importantly, I think this is a better way to interact in general. Always look for good behavior to reward instead of bad behavior to punish.

Always reward the good, and you will see more of it.

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The Psychology of a Psychopath | Science of People

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Master Manipulators Serial Killers Psychopaths What makes someone go off the deep end? What is going on in the mind of a serial killer? Are master manipulators crazy? In this post I want to answer all of these questions and more because we are going to dig into the psychology of psychopaths.

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Experts from Emory University discuss theory of 'successful psychopathy'

Estimates suggest psychopathy is found in 1% of the general population

This includes powerful and successful people such as CEOs and lawyers

Traits include charm, being good in a crisis, intervening in emergencies and being persuasive

Despite the popular perception, most psychopaths aren't coldblooded or psychotic killers.

Research suggests many of them live successfully among the rest of us, using their personality traits to get what they want in life.

It has even been claimed that some of the world's most powerful and successful people, including American presidents, exhibit traits of the behavioural disorder.

Here, writing for The Conversation , Scott Lilienfeld, professor of psychology at Emory University and student Ashley Watts reveal the theory behind 'successful psychopathy'.

Psychopathy is not easily defined, but most psychologists view it as a personality disorder characterised by superficial charm with profound dishonesty, callousness, and poor impulse control.

According to some estimates, psychopathy is found in about one per cent of the general population, and for reasons that are poorly understood, most psychopaths are male.

That number likely doesn't capture the full number of people with some degree of psychopathy.

Data suggest that psychopathic traits lie on a continuum, so some individuals possess marked psychopathic traits but don't fulfill the criteria for full-blown psychopathy.

Not surprisingly, fully psychopathic individuals are more likely than other people to commit crimes.

Contrary to popular belief, only a minority are violent.

But because researchers tend to seek out psychopaths where they can locate them in plentiful numbers, much research on the condition has taken place in prisons and jails.

That's why until fairly recently the lion's share of theory and research on psychopathy focused on decidedly unsuccessful individuals, such as convicted criminals.

But a lot of people on the psychopathic continuum aren't in jail or prison.

In fact, some individuals may be able to use psychopathic traits, like boldness, to achieve professional success.

Successful psychopathy is a controversial idea, but it's not a new one.

In 1941, American psychiatrist Hervey Cleckley was among the first to highlight this paradoxical condition in his book The Mask of Sanity.

According to Cleckley, the psychopath is a hybrid creature, donning an engaging veil of normalcy that conceals an emotionally impoverished and profoundly disturbed core.

In Cleckley's eyes, psychopaths are charming, self-centered, dishonest, guiltless and callous people who lead aimless lives devoid of deep interpersonal attachments.

But Cleckley also alluded to the possibility that some psychopathic individuals are successful interpersonally and occupationally, at least in the short term.

But what's the difference between the psychopaths who get arrested and the ones who don't?

Research from Adrian Raine, now at the University of Pennsylvania, conducted in the 1990s sheds some light.

Raine and his colleagues recruited men from temporary employment agencies in the Los Angeles area.

After first identifying those who met the criteria for psychopathy, they compared the 13 participants who had been convicted of one or more crimes with the 26 who had not.

Raine provisionally regarded these 26 men as successful psychopaths.

Each man gave a videotaped speech about his personal flaws.

Raine and his colleagues found that the men they considered successful psychopaths displayed significantly greater heart rate increases, suggesting an increase in social anxiety.

These men also performed better on a task requiring them to modulate their impulses.

The bottom line was having a modicum of social anxiety and impulse control may explain why some psychopathic people manage to stay out of trouble.

More recently, researchers have speculated that people with pronounced psychopathic traits may be found disproportionately in certain professional niches, such as politics, business, law enforcement, firefighting, special operations military services and high-risk sports.

Most of those with psychopathic traits probably aren't classic 'psychopaths,' but nonetheless exhibit many features of the condition.

Perhaps their social poise, charisma, audacity, adventurousness and emotional resilience lends them a performance edge over the rest of us when it comes to high-stakes settings.

The lab at Emory University, and that of collaborators at Florida State University, are investigating whether some psychopathic traits, such as boldness, predispose to certain successful behaviours.

Boldness encompasses poise and charm, physical risk-taking and emotional resilience, and it is a trait that is well-represented in many widely used psychopathy measures.

For instance, in studies on college students and people in the general community, the study found that boldness is modestly tied to impulsive heroic behaviors, such as intervening in emergencies.

It's also linked to a higher likelihood of assuming leadership and management positions, and to certain professions, such as law enforcement, firefighting and dangerous sports.

There's one job in particular in which boldness may make a difference - president of the United States.

In a study of the 42 American presidents up to and including George W. Bush, the researchers asked biographers and other experts to complete a detailed set of personality items - including items assessing boldness - about the president of their expertise.

Then, they connected these data with independent surveys of presidential performance by prominent historians.

They found that boldness was positively, although modestly, associated with better overall presidential performance.

And several specific facets of such performance, such as crisis management, agenda setting and public persuasiveness, were associated with boldness too.

The boldest presidents were not necessarily extreme or pathological on this dimension, but boldness was markedly elevated relative to the average person.

Although boldness was tied to some successful actions, the study generally found that other psychopathic features, such as callousness and poor impulse control, were unrelated or negatively related to professional success.

Boldness may be associated with certain positive life outcomes, but full-fledged psychopathy generally is not.

Could psychopathic traits be adaptive? Few investigators have explored the 'Goldilocks' hypothesis. Moreover, we know surprisingly little about how psychopathic traits forecast real-world behaviour over extended stretches of time.

The charm of the psychopath is shallow and superficial.

With that in mind, we would argue that boldness and allied traits may be linked to successful behaviours in the short term, but that their effectiveness almost always fizzles out in the long term.

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Scott Lilienfeld And Ashley Watts For The Conversation

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Do YOU work with a psychopath? Traits are found in successful people

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Experts from Emory University discuss theory of 'successful psychopathy' Estimates suggest psychopathy is found in 1% of the general population This includes powerful and successful people such as CEOs and lawyers Traits include charm, being good in a crisis, intervening in emergencies and being persuasive Despite the popular perception, most psychopaths aren't coldblooded or psychotic killers.

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The Myth of Sanity: Divided Consciousness and the Promise of Awareness

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The Science of Evil: On Empathy and the Origins of Cruelty

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Anchor Text:

The Psychopath Test: A Journey Through the Madness Industry  by Jon Ronson

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Does society create mental illnesses that don't exist as way to control and cope with imperfections of society?