Lists and drugs (2012)

Book Review from the October 2012 issue of the Socialist Standard

The Psychopath Test. By Jon Ronson, Picador. £8.99.

This is a very funny book, but also a very sad and disturbing one. Its subtitle is ‘A journey through the madness industry’, which gives a good idea of how mental illness is a source of status and profit for some who claim to treat it.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association (which makes $5m a year from its sales), and supposedly provides a list of disorders and how to identify and classify them. But in the case of psychopathy (or sociopathy or anti-social personality disorder) nobody has any real idea as to what this condition comprises. A widely-used psychopathy checklist, provided by Bob Hare, contains points such as grandiose sense of self-worth, proneness to boredom, impulsivity and lack of remorse. Using these and similar tests, maybe half the population can be viewed as having some mental illness, which is good news for the pharmaceutical companies that make the drugs which are claimed to treat such illnesses. And to illustrate the kind of nonsense found in such circles, one nineteenth-century American doctor identified a mental disorder called drapetomania in some slaves (meaning a desire to escape from slavery).

As for actually treating psychopathy, nobody really seems to have a clue, though there have been many attempts (including Nude Psychotherapy), and many criminal psychopaths re-offend quite soon after being released. Too often ‘treatment’ just consists of detaining people.

But is it really just a matter of a few anti-social individuals? Hare claims that psychopaths are responsible for much of what is wrong with society, with many being in top positions in business. For what some see as psychopathic traits, others will view as being distinctive of good leadership. Some chief executives of companies genuinely seem to enjoy sacking workers, especially if it leads to the share price going up. Nobody is arguing that more than a few percent of bosses are psychopaths but, as Ronson says, ‘I wondered if sometimes the difference between a psychopath in Broadmoor and a psychopath on Wall Street was the luck of being born into a stable, rich family.’

And if psychiatrists find it hard to diagnose psychopathy and other mental illnesses, it can be very difficult to convince people that you are actually sane. Ronson recounts an experiment run by an American psychologist called David Rosenhan: eight people presented themselves to mental hospitals, saying they had a voice in their head but otherwise acting completely normally. All were diagnosed with schizophrenia or manic depression, were admitted and were kept in for an average of nineteen days, despite their behaviour from their time of admission being completely normal. But then psychiatrists have little idea as to how to distinguish ‘normal’ from ‘ill’.

We should make it clear that, while capitalism may benefit from having executives who are psychopathic, the problem lies not with the dysfunctional bosses but with a sick system.

Paul Bennett