"I don't know what I've done wrong," the patient told me.
She was an intelligent and articulate woman in her early 40s who came to see me for depression and anxiety. In discussing the stresses she faced, it was clear that her teenage son had been front and center for many years.
When he was growing up, she explained, he fought frequently with other children, had few close friends, and had a reputation for being mean. She always hoped he would change, but now that he was almost 17, she had a sinking feeling.
I asked her what she meant by mean. "I hate to admit it, but he is unkind and unsympathetic to people," she said, as I recall. He was rude and defiant at home, and often verbally abusive to family members.
Along the way, she had him evaluated by many child psychiatrists, with several extensive neuropsychological tests. The results were always the same: he tested in the intellectually superior range, with no evidence of any learning disability or mental illness. Naturally, she wondered if she and her husband were somehow remiss as parents.
Here, it seems, they did not fare as well as their son under psychiatric scrutiny. One therapist noted that they were not entirely consistent around their son, especially when it came to discipline; she was generally more permissive than her husband. Another therapist suggested that the father was not around enough and hinted that he was not a strong role model for his son.
But there was one small problem with these explanations: this supposedly suboptimal couple had managed to raise two other well-adjusted and perfectly nice boys. How could they have pulled that off if they were such bad parents?
To be sure, they had a fundamentally different relationship with their difficult child. My patient would be the first to admit that she was often angry with him, something she rarely experienced with his brothers.
But that left open a fundamental question: If the young man did not suffer from any demonstrable psychiatric disorder, just what was his problem?
My answer may sound heretical, coming from a psychiatrist. After all, our bent is to see misbehavior as psychopathology that needs treatment; there is no such thing as a bad person, just a sick one.
But maybe this young man was just not a nice person.
For years, mental health professionals were trained to see children as mere products of their environment who were intrinsically good until influenced otherwise; where there is chronic bad behavior, there must be a bad parent behind it.
But while I do not mean to let bad parents off the hook - sadly, there are all too many of them, from malignant to merely apathetic - the fact remains that perfectly decent parents can produce toxic children.
When I say "toxic," I don't mean psychopathic....I often tell readers that not every asshole ex of theirs is a sociopath, and the same applies for misbehaving children. In this situation, though, I actually think it is foolish to discount the potential role of sociopathy. There is a strong genetic but weak environmental link to sociopathy, which is consistent with having two normal sons and one sociopathic one. Furthermore, although inconsistent discipline may not be enough to cause anyone to become a sociopath, it could trigger sociopathy in someone who was genetically predisposed to it, as sociopath children are particularly sensitive to incentive structures and perceived fairness (i.e. consistency and reciprocity). I obviously don't know the full story, but just based on the article, the description fits sociopathy, at least for this kid.
After spending time with my family recently, I am more convinced that nurture had a significant role to play in my development into a sociopath. When people ask me whether I had a bad childhood, I tell them that it was actually relatively unremarkable, however I can see how the antisocial behaviors and mental posturing that now define me were incentivized when I was growing up -- how my independent emotional world was stifled and how understanding and respect for the emotional world of others died away. Still I don't think I was "made" into a sociopath, nor was I born one. I feel like I was born with that predisposition, that I made a relatively conscious decision to rely on those skills instead of developing others, and that the decision was made in direct response to my environment and how I could best survive and even thrive in that environment. It's a bit similar to this author's description of her own survivalist adaptations:
If you've read much about writers, you know that many of us grew up with an alcoholic parent or in some otherwise dysfunctional home. Me, too. Kids who are raised in households where feelings of safety and predictability are up for grabs might be more likely to turn into storytellers. We spend a lot of emotional energy trying to guess what might happen next, and mentally drawing up different contingency plans. It puts us in the "what if" habit early.Genetics are important for sociopathy, but environment plays a crucial role as well. Although the NY Times article notes that "[f]or better or worse, parents have limited power to influence their children," such that they should be reluctant "to take all the blame - or credit - for everything that their children become," unfortunately (or luckily?) they can still take quite a bit of blame (or credit) for sociopathic children, particularly with new "studies suggesting that such antisocial behavior can be modified with parental coaching." Knowledge is power.
