What is a psychopath?

Antisocial. Sociopath. Psychopath. These terms are often used loosely and interchangeably. While those who describe themselves as "antisocial" because they don't like to be around others, they are really describing themselves as "asocial." Antisocial is a personality disorder that begins in childhood, usually before or about the teen years, where a series of bad behaviors including truancy, lying, cheating and fighting are key elements. Cleckley was a psychiatrist who described while the superficial appearance of one may seem normal, it serves only as a "mask" for mental illness. The most modern term, based on an older DSM (Diagnostic Statistical Manual) popularized by Robert Hare, PhD, a Canadian psychologist, describes a particularly type of evil person, on a scaled rating for their behaviors on a deeper level. Dr. Hare created a scale utilizing symptomatology common among particular criminals. My step-father could score between a 36 and 39 on the scale, by my assumption if I were to rate him. Through my training as a physician, I have found others very much like my step-father. I couldn't make much sense of my childhood. It was filled with trauma, blame, guilt and shame. But in medical school, learning about psychiatry, I was able to suture my life as I recovered. While I had already been learning about grooming behaviors in regards to pedophiles, the epiphany about my step-father didn't come to me until my third year during an interview with a particularly vile "patient." I was rotating through an inpatient psychiatry ward in an inner city when we met "Mr. Smith." Mr. Smith was a diabetic patient married to a nurse. He had an addiction problem and when out of funds, would either sabotage his blood sugars to gain admission or become "suicidal" to hang out in the inpatient unit where he would be protected from outside bill collectors. He openly admitted this and boasted proudly of how he could play the doctors and his wife. He answered affirmatively to questions regarding fire setting as a kid, numerous fights, thefts and harming animals. Accusatorily, he remarked, "What are you going to do now? Analyze me?" As a young student, I looked to my attending for guidance. I explained that I would discuss his case with my attending and we would formulate a treatment plan there after. "What do you think!" he demanded. Again, as I looked to my attending, my superior nodded his approval to offer my opinion. "I think you have antisocial personality disorder." "What is that?" "Well, it is where you do a lot of criminal behaviors and have no remorse for it. You use people to your advantage, and you don't feel guilty." "Is she right?" he asked my attending. "Hand me that book over there." My attending opened the pages of the then DSM-IIIR and read aloud the criteria. I studied every word and one by one, I was taken back to the braggadocio manner in which my step-father would boast about what he did "as a kid" and what he continued to do up until the day I left home: "repeatedly performing acts that are grounds for arrest...conning others for personal profit...repeated physical fights...reckless disregard for safety...failure to honor financial obligations...lack of remorse." The last one hit me hard. I remember that is what he said to me when I left; that I had no remorse for what I had done. What I had done? What did I do? I left home for my own safety. But I remembered that he had been seeing a psychiatrist just before I left. Projection is a common coping strategy that I witness my patients utilize. He was projecting what the psychiatrist had told him onto me. He had accused me of being the "antisocial." This was an eye opening experience. One that I would encounter many times later in my profession.