you gotta know you(')r(e) crazy

Music: Indian Wells: Night Drops (2012)

What a difference an apostrophe makes, as Freud might say, like "a running figure with his head conjured away . . . ."

I overheard a "journalist" describe James Holmes, the 24-year-old who killed twelve and injured 58 in Aurora, Colorado on July 20th, as a "psychopath" this morning. Days earlier I heard another journalist describe Holmes as a "sociopath." Clearly journalists are murky about what these terms mean and, frankly, so am I. That's perhaps because they're not used by the psychiatric and psychological community in the United States in clinical settings: these terms are intended to describe psychical structures in popular parlance, and in the U.S. the diagnostic terms are defined behaviorally. Both what journalists (and in some jurisdictions, lawyers) would dub psychopathic or sociopathic fall under the rubric of "antisocial personality disorder" in the current edition of the Diagnostic and Statistical Manual of Mental Disorders or DSM, published by the American Psychiatric Association.

The confusion between "psychopath" and "sociopath" unquestionably has to do with their interchangeable use (common definitions in dictionary use the one or the other term tautologically), and I'm not clear where one might locate the origin. The terms have become so popular that some countries use the term in legal proceedings (apparently including the US, although I plead ignorance here---I've gleaned some uses on the InterTubes). [ENTREATY: if any of my lawyer buddies reading this know how the terms are used in legal proceedings, please explain in the comments!] The term "psychopath" does have some footing in psychology because of a fairly well-known inventory that is used to predict criminal behavior (the PCL-R), however, this and related inventories are usually used in the US to diagnose (confusingly) antisocial personality disorder. Adding to the confusion, the popular use of "sociopath" and "psychopath" would use the former for individuals who violate the assumed rights of others in a given culture with the possibility of guilt and the latter not so much, however, the psychopath may not exhibit anything that the psychiatric community would recognize as "psychotic." The upshot of all of this is that, it seems to me, "sociopath" and "psychopath" are terms that are dispensed in the mainstream media to mean, simply, "crazy," where "crazy" refers to failure to recognize the rights or well-being of others and the possibility of the lack of guilt. (For example, a free-market capitalist.)

I started to recognize the problem of such terms recently when I referred to Holmes as "psychotic" here on Rosechron and on Facebook "status updates." Folks seemed to recognize "psychopath" or "sociopath" in my remarks, when I meant neither. When I use the term "psychotic," I confess I'm referencing the psychoanalytic tradition, and none of those terms used in the medical community today. In the nineteenth century, as Dylan Evans explains, "psychosis" was used as a synonym for "mental illness in general." Gradually it was distinguished from "neurosis," which referenced "less serious disorders." Freud relied on this distinction and it gradually became increasingly refined.

Lacan developed the distinction further: most of us are "neurotic" to some degree, while less of us are "psychotic" (and "phobic," and "perverse"). He insisted on "psychical structures," not behaviors (as all of us are capable of having neurotic, psychotic, phobic, and perverse behaviors). Adjective and noun, I guess.

Psychoanalysis is only useful for the neurotic, in general. The psychotic is generally believed out of reach (although not necessarily a lost cause) for "talking cures," or those that rely on symbolic inducement and working-through. I won't go into any detail here, but in the Lacanian psychoanalytic tradition, a psychotic has not fully accepted negation or "the no" (castration if you want), and thus is not beholden to the symbolic (say, law or rights or moral norms and what not) that structure the rest of us in some fundamental way (that's why the "talking cure" is sorta lost on them). So, when I say Holmes was psychotic, I simply mean to say he does not function in the same moral/normative universe as the rest of us---you cannot help him improve by pushing on the symbolic weak-spots. This is stronger than saying what he did was psychotic---because everyone is capable of psychotic behavior. It's possible he had a "one time" break, however, today it was reported he was seeing a shrink for mental issues for some time . . . .

I admit I'm drawn to the Lacanian categories for their elegance; these, however, are not the same categories our psychiatric/psychological system operate on. Like it or lump it, whether you identify Holmes as behaving psychotically or as a "sociopath" or "psychopath," the proper designation for the system we live in is antisocial personality disorder, which is among the second or "B cluster" of personality disorders listed in the DSM. The detail is extensive, but a key characteristic is a lack of empathy and persistent anti-social behavioral pattern. More specifically (since the DSM is sitting in front of me), here's the lowdown:

A. There is a pervasive pattern of disregard for a violation of the rights of others occurring since the age of 15 years, as indicated by three (or more) of the following:

1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
3. impulsivity or failure to plan ahead
4. irritability and aggressiveness, as indicated by repeated physical fights or assaults
5. reckless disregard for safety of self or others
6. consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

B. The individual is at least 18 years.
C. There is evidence of Conduct Disorder [repeated violation of the rights of others] with the onset before age 15 years.
D. The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode.

What is striking about such a definition (at least to the student of rhetoric) of antisocial personality disorder is basically it is anti-state behavior, premised as it is on "rights." What is antisocial in one culture is defined, here, as potentially appropriate in another. I've never read the entry for ASPD before tonight; I'm struck by how it is a behavioral definition guided by statist assumptions. Huh.

Incidentally, I've been totally obsessed with reading Star Wars comics over the past month. The Rebels and the Jedi Order are plagued by antisocial personality disorder. As are the Joker and Batman, alike.

Perhaps the reason I find psychoanalytic explanations of "psychotic behavior" compelling has something to do with the way in which they locate them in both affect and enduring structures---it's "essentialism without essentialism," as Zizek might say. Regardless, the more I follow the "news" of the Aurora massacre the more and more I find the terms "sociopath" and "psychopath" odious terms: they signify only one thing. They signify "not me" or "not like us." And I find that terribly problematic. There is an imperative here, a moral imperative, perhaps best intoned by Cibo Mato allegorically: