April, 2003, nearly four years ago, the police removed my then husband from my office in handcuffs. Following his arrest, the stories came rolling in. People called to say, “I never told you this but…” When the shock of it all wore off, I had to admit I had failed to make the most important diagnosis of my life, that of sociopathy in the man I married. I knew I had to understand, for the sake of my son and myself, why I missed this diagnosis. What did I not understand about sociopathy?
Sociopathic traits versus sociopathy
I have always been very well read in my field, so the problem was not that I was unfamiliar with DSM diagnostic criteria, The Mask of Sanity, or Without Conscience. I also encountered many sociopaths in my clinical practice. The problem was, even with all this knowledge and experience, I still did not understand the disorder. One of the reasons for this lack of understanding was the fact that one of my former mentors often made light of diagnostic criteria. He said, “We all have sociopathic traits.” Recently, this statement has been confirmed by research. Sociopaths represent a group of people with personality traits that are on a continuum with those of everyone else. Science has made a rather arbitrary decision as to where to draw the line between non-disordered and disordered. This continuum also means that it is possible to be “a little bit of a sociopath.”
The Inner Triangle
With all due respect to the real experts in the field, I had to come up with my own way to understand this disorder. I had to know how I would evaluate people in the future. Practically speaking, how would I draw the line in this continuum. I sat on my bed while my baby was asleep. I took the piles of references and diagnostic criteria I had assembled and asked myself, “How does this all add up?” That afternoon, I understood sociopathy for the first time. I realized that at the core of sociopathy is a problem with Ability to Love, Impulse Control and Moral Reasoning. I called these three “The Inner Triangle.” A sociopath is someone who has severe difficulty in each of these three areas. Most importantly, sociopaths lack Ability to Love. I also realized that one reason for the confusion about this disorder is that there are those who lack ability to love and are not sociopaths, namely narcissists and schizoids. Other people, like those with addiction, have impaired ability to love. Furthermore, mood disorders, like manic-depression, temporarily impair Ability to Love, Impulse Control and Moral Reasoning.
The developmental literature confirms The Inner Triangle
After putting together the construct of The Inner Triangle, I sought to read every paper ever written about how Ability to Love, Impulse Control and Moral Reasoning develop. When I studied the scientific literature in detail, I discovered something truly amazing: The Inner Triangle is indeed a triangle as opposed to three parallel lines. What I mean is that the development of Ability to Love depends on Impulse Control and Moral Reasoning. The development of Impulse Control depends on Ability to Love and Moral Reasoning, and the development of Moral Reasoning depends in Ability to Love and Impulse Control. All three grow together and connect.
The Inner Triangle helps us understand sociopathic traits
After being fooled by a sociopath, it can be a challenge to feel safe. I want to be as sure as I can be that I will not be fooled again. If I find myself feeling unsure about whether to trust someone, I think about what I have come to believe are the three things that define character, Ability to Love, Impulse Control and Moral Reasoning. In doing this, I find I expect more from those I am close to. Next time, I’ll discuss what it means to have Ability to Love, until then, follow this link for more on The Inner Triangle.