Psychopath or Sociopath What You Need to Know

We've covered how to spot a psychopath or sociopath before, but we've never gone this in depth, on the clinical diagnosis behind them.

Antisocial personality disorder.

Welcome to the MedCircle series.

Antisocial personality disorder.

Psychopaths, sociopaths, and how to spot them.

It's just so great to sit down with you.

I love talking with you.

Sometimes we talk about some topics that I think are really, really dreadful and hurtful.

Yeah.

And I think, this series is going to be more in that lane.

Yes, it is.

It is.

Yeah.

you brought up the cluster B.

Yeah.

Personality disorders.

I think it's so, I'm so glad we're doing this, having this conversation, because a lot of folks out there are trying to make sense of these difficult patterns, and they put in all kinds of words into search engines online.

Cluster B is something that comes out and a lot of people don't know how to make sense of it.

So let me give you some historical background.

This word, cluster B comes from how the personality disorders were traditionally organized in the diagnostic manual of psychiatry and psychology called the DSM.

The DSM organized the personality disorders, there were 10 of them, into three groups.

Cluster A, Cluster B and cluster C.

And they organized the disorders based on their manifestations.

Now, back in graduate school, we would remember these three clusters by calling them, mad, bad and sad.

That's how we sort of memorize them.

And by mad, it was sort of that traditional, like, madman.

Like, you know, a person who's just really off and almost like, you know, very disturbed.

Bad meant almost badly behaved.

And that's our cluster Bs.

And sad were people who are more anxious and avoidant.

The cluster B disorders are also termed dramatic and erratic.

Now, these disorders, again, are grouped by sort of how they affect a person.

And today we're going to focus on cluster B.

The cluster B disorders are the difficulties disorders.

They're antagonistic.

They're interpersonally challenging.

these are folks who, as a rule, almost always lack empathy.

They tend to be, entitled.

So it's almost like narcissism becomes a nice sort of like the midpoint of a lot of these disorders.

Like most of them have qualities of narcissism in different ways.

And as you said, the four disorders that hang out in cluster B are antisocial personality disorder, borderline personality disorder, narcissistic personality disorder, and something called histrionic personality disorder.

These are probably the most clinically vexing patterns we see in psychology and psychiatry because they can make for very Difficult clients.

These patterns can interfere with us treating other issues the person may have, like substance abuse, bipolar disorder, major depression, anxiety disorders, eating disorders, the list goes on.

If you have a cluster B disorder and these other things, you're constantly sort of like, it's like you're trying to fight two different battles at the same time.

And it's really one big kind of war, if you will.

So it is a challenge.

And it's a challenge for people not only living with the cluster B patterns, but also a challenge for the people living with those people who have cluster B patterns.

So that's what cluster B is.

Dramatic, erratic, emotional, antagonistic, combative, lacking empathy, oftentimes internally very chaotic.

They can't regulate their emotions very easily.

And some of these are really clinically demanding.

Borderline personality, for example, is very clinically challenging condition.

Narcissistic, histrionic clients, they don't even tend to end up in therapy that often.

and antisocial personality disorder, those folks often end up in prison.

We've talked about specific personality disorders, but what is a personality disorder in general?

A personality disorder is a maladaptive pattern of behavior and relating that cuts across all situations in the person's life, Relationships, work, social functioning, and even their sense of self.

It's the long standing stability that makes these be called personality disorders.

Because personality is considered to be a stable trait.

But their personality styles cause the person problems in all areas of their life.

But it's the maladaptive, consistent and stable nature of these problematic personality patterns that lead to them being called personality disorders.

Can someone be diagnosed as having cluster B disorder?

No, you just have one of them and then that's.

Yeah.

What would end up happening is like, for example, as you know, I do research on, psychopathology and mental illness and mental health.

So when we analyze our data, because these disorders are common, sometimes we'll combine these patterns to see if we see any patterns there.

So partly it serves as sort of a research kind of an approach.

It becomes a shorthand for clinicians.

But we as clinicians have to be really, really careful about using that term because cluster B is code for difficult patient.

And there's a wait, that's really big.

Yeah, Cluster B is code for difficult patient.

Now I can already hear people though saying, well, I'm watching that.

My therapist said I have cluster B.

Now that's rude.

Why would you say I can feel, I can feel weird.

That's why I'm saying we have to be very careful with these labels.

It's really meant.

It's almost like, again, it's an organizational scheme if we see.

Because what may happen, Kyle, is a person may not meet the full diagnostic criteria for any one pattern of those disorders.

We chose four disorders.

They may have a little bit of this, a little bit of that.

And we might call it this sort of has a cluster B pattern to it.

It means that we might use very specific kinds of therapeutic techniques or realize that these patterns may interfere with, the treatment of other disorders, if you will.

But it does imply, typically, somebody who's interpersonally difficult.

I'll be honest with you.

I mean, those of us in mental health will sometimes even use that as shorthand in our own lives.

Like, I'm going to Thanksgiving.

It's going to be difficult.

I have cluster B relatives there, you know, anyone in the business will know, like, uh-huh.

She's got some really difficult family members.

But it's beyond difficult.

It's antagonistic and almost like they often don't get it.

Is it almost often that they don't want the help?

Not necessarily, I think, you know, because cluster B disorders take in so much territory.

I work with many clients who have borderline personality disorder.

They desperately want help.

They desperately want help.

In fact sometimes need more help than even they can get in sort of like one or two weekly therapy sessions.

And many clients with borderline personalities sort of are very invested in getting that help, but it's difficult for them.

They feel so internally chaotic and frightened that therapy can be challenging, not only for them, but for the therapist who's trying to sort of soothe this patient.

Obviously, when you're dealing with somebody with narcissistic personality, they don't think anything's wrong.

So they're often going to think, I don't even need help.

And then, you know, histrionic personality disorder.

Actually, they're thinking of removing that from the diagnostic manual.

These are people who are dramatic and attention seeking and seductive, and look at me.

How come I'm not getting all the attention kind of thing.

They almost also never end up seeking out treatment for that particular pattern.

The folks with antisocial personality disorder also almost never seek out treatment.

They get in trouble for something, and then they're sometimes forced into treatment.

briefly describe what antisocial personality disorder is, because that name is so misleading.

Antisocial personality disorder is one of the most important and one of the most unfortunate, unfortunately named diagnoses out there.

It throws my students off, it throws off trainees, it throws off lay people.

Antisocial personality disorder is actually quite dangerous.

It can be quite dangerous.

It doesn't mean what we think.

A lot of people take the antisocial to mean.

these are people who don't want to be with other people, almost as though they're socially anxious.

Not at all.

The unfortunate term historically came from this idea that these were people who were anti society.

They were anti the norms of society.

They would break the rules of society.

That was where the antisocial came from.

Like I said, such an unfortunate name because we use antisocial to mean someone who doesn't want to socialize.

What would you call it?

I would call it psychopathic personality disorder.

That's what I would term it.

And antisocial personality disorder is the diagnostic term for things that are called psychopathy and sociopathy in, the popular literature in the media at large, in all kinds of other writing, in criminology writing.

but not.

It's not a diagnostic.

Those are not diagnostic terms.

But those two terms definitely ascribe more to antisocial personality disorder.

Now what is it?

Antisocial personality disorder is a pattern whereby a person not only lacks empathy, but they think the rules do not apply to them.

They do not adhere to them.

They break moral codes, social codes, legal codes.

They have a, failure to take any kind of responsibility.

They're very deceitful.

They exploit other people to achieve their ends.

They will take risks that will put other people in danger.

So they're dangerous.

They're dangerous.

And here's the ringer.

Here's the ringer.

I personally think that to really, to really call it antisocial personality disorder, you're talking about someone who lacks remorse for the bad things they do.

And that's where it gets scary.

Can they fake it?

That's where it gets scary.

I'm sorry, can they fake it?

Can a person fake.

Can they fake remorse?

absolutely.

You can fake anything.

You can fake empathy, you can fake remorse.

You can fake anything.

And they do.

They will.

When they're finally hauled in front of the press conference, they'll cry crocodile tears and a year later they'll do it again.

That's antisocial personality disorder.

Which clusters of disorders do you think are most common?

In terms of the personality disorders overall, I actually think that the cluster B disorders may be more common.

And the only reason I think I'm going to say that is because when we do research on these disorders, they're the ones that are more clinically compelling.

So we may see more clients with these patterns because especially in the case of borderline personality, they're more likely to get help.

That's right.

In the case of antisocial personality disorder, they're more likely to end up in prison.

So there are these two groups of folks we study a lot because of the distress we see in borderline personality and the danger that can be created by antisocial personality.

And there's four disorders in that group too.

So it's going to up your number up a little bit.

I think that the cluster B disorders probably are the ones that have the highest prevalence rates across the three groups overall.

Yeah, well, you have more disorders and people are having to go get help.

They're more disruptive.

That's who you're going to see.

I'd say, if you were working in the mental health business, you'll see that a lot.

In cluster C, there's things like avoidant personality disorder, which is, it almost looks like a social anxiety disorder.

So you will see that sometimes, but sometimes we don't even know which variant we're seeing.

Social anxiety or avoidant personality.

And with the, cluster A disorders, the schizoid, the schizotypal, the paranoid personalities, these are people who actually look quite severely mentally ill.

They're incredibly either socially withdrawn or they appear as so odd, they almost look psychotic.

They're sometimes overrepresented in residentially unstable, like homeless populations or people who are in and out of long term psychiatric facilities.

Is there hope for people who are in the cluster B camp in terms of hope for cluster B clients?

It varies.

It varies.

We don't hear that answer a lot.

it varies, yeah.

And that's the problem that speaks to how heterogeneous the disorders that make up this cluster.

If I talk about bipolar disorder, if I talk about anxiety, depression, adhd, the doctor across from me will say there's so much hope.

No, very variable.

I would say that the most good research on treatment outcomes and best practices can be found for borderline personality disorder.

I believe firmly that if you have a client with borderline personality disorder and you can give them trauma focused care, dialectical behavioral therapy, whatever psychiatric medications they may need to manage other sorts of conditions, they have, and other kinds of adjunctive therapies that will help them with their symptoms, the treatment literature can really show some good long term outcomes, but the treatment has to be consistent and long term.

And that's often passed beyond the financial ability of a lot of people.

That's what's so unfortunate because I think there is tremendous hope for people with borderline personality, if they get the kinds of treatment and if the client won't cooperate with the treatment, then all bets are off.

With narcissistic personality disorder, you know what I say about that?

You're not going to see much change.

And when you do, it's glacial.

And the amount of change you see is often not enough for the people around them to feel like things are better.

but with antisocial personality disorder, that disorder might be the most hopeless of all.

these are folks who will try to outwit and outfox a therapist who will fake it and are often court ordered to go to therapy as a condition of parole or probation or something like that.

And so they'll sit there for 10 sessions and say, I don't need to say anything, I just need you to sign that document said, I came here for 10 sessions.

So you can get a lot of resistance.

And they can often try to intimidate a therapist.

You have to be a very specially trained therapist to work with that population, particularly those who have very, very difficult criminal histories.

And if you're dealing with sort of the more neat and tied up antisocial personalities, sort of like the CEO variant, they're very manipulative, they can be very exploitative.

Again, they will often try to outwit the therapist.

They're really not motivated to change because they really, truly don't think there's anything to change.

So, if anything, they're just really out to game the system.

That's not progress.

So I would say definitely for them, of all groups, they'll have the worst outcomes.

What percentage of your clients do you think fall in the cluster B category?

with some cluster B, symptomatology?

Well, I mean, well over 50%, maybe.

Yeah, maybe even a little less.

actually, I thought you were going to say 5%.

heck, no.

No, no, no.

And actually that's what I choose to focus in.

But maybe 40%.

40%.

That is good though, because now at least people are getting help or, in the space to get help.

And there are people out there who specialize in this, people who specialize in dialectical behavioral therapy.

This is called DBT.

I'd say they see 90% because they're working with clients who have a lot of borderline personality sorts of symptoms.

People who work in prisons are probably seeing antisocial personality at the level of 60, 70%, but I'd say almost half of the, the clients I work with, I choose to do that though, because like, I Said, although I would say, maybe even, alright, I'll be 35%.

Because the majority of clients I work with are trying to negotiate a family or other relationship with a person with a cluster B disorder.

A solid third of them are struggling with these issues.

Well, that leads perfectly into my next question.

Knowing that if somebody has watched this video this far, they have been likely given a, diagnosis of a disorder in the cluster B family or they know somebody knows somebody who has.

What.

What could I ask them on their behalf that you would think would be most beneficial for them to hear?

I would.

You know, I think that the big question people have is from the person, there's two sides of it.

From the side of the person who's experiencing it is what do I do?

I'm not only always miserable, I feel like I'm making people miserable.

You know.

And then from the other side, I think the question would be, what do I do?

I feel like nothing I say to this person ever makes things better.

In fact, all I do is feel like things get worse and I feel like I'm always walking on eggshells.

What do I do?

So think, what do I do?

Yeah, what's the answer to that?

I mean, for the people who are experiencing this symptomatology, you got to get therapy.

You're not going to think your way out of this this one.

You're not going to meditate your way out of this one.

You got to get therapy with somebody who is trained in things like DBT and working with these kinds of patterns.

Okay, that's have to.

Yes.

You know, Dr.

Yip, is one of the nation's leading experts on ocd and I interviewed her for our OCD series.

She really drove home the point of, don't just go get therapy because the therapist said, yeah, I treat ocd.

Go find the person who.

That's what they do.

That's what they do.

They are ocd.

Right.

So with these people, you know, I feel bad for someone who might have gone to a therapist who said they could treat it, but they did it once 10 years ago and they had a bad experience.

Yeah, yeah.

I think that you, especially with now again with something like narcissistic personality disorder, if you actually do get them to therapy, you can use a combination of some DBT techniques, but also some cognitive behavioral work, some humanistic work, rapport building.

It's a lot of it's relationship building.

You need a strong therapist to work with those clients because they will try to outfox you and so you've got to be.

You almost have to be one step ahead of them.

Like, you can't fall for the charm.

You have to be almost charm immune or charm proof to work with the narcissistic clients, with the anti, you know, so it's all about expertise.

But the borderline clients are the ones who are most likely to actually seek out therapy.

And for them to say, like I said, you do it right, what do you do?

You need to get help from somebody who knows what they're doing.

And it might even be a team of people who know what they're doing.

In fact, DBT is best delivered in a team approach with a combination of group therapy and individual therapy and some medication management.

On the other side of it, if somebody in your life is experiencing these cluster B, patterns, it's going to be difficult.

I'm telling you that right now.

And you're not a bad person for thinking it's difficult.

Because a lot of people, I feel guilty there's actually something happening to them.

How dare I think that this is difficult?

Because it is.

Because the nature of these patterns is somewhat antagonistic.

That, again, it may be that they're feeling insecure or chaotic inside and that's why they're lashing out.

At the end of the day, it doesn't matter when somebody lashes out.

It doesn't feel good, regardless of the reason.

And so I will tell people, if you are with somebody who is experiencing cluster B patterns, definitely seek out individual therapy.

You may need to manage your expectations of that person and then ask yourself what would the landscape of a relationship look like with this person if things don't change?

Because in many cases, yeah, it may not change.

Those are really good.

Three takeaways.

real quick, for people watching, explain briefly what DBT is.

Yeah, DBT is dialectical Behavioral therapy.

Dialectical behavioral therapy was, developed by someone named Dr.

Marsha Linehan, and she, developed DBT actually specifically to address the crisis of suicidality in people who had borderline personality disorder, because that's the dangerous issue.

People with borderline personality are experiencing so much inner pain and turmoil that they want to silence that pain.

They truly do believe often they're a burden to others that they don't or they're not worthy to live.

It's really agonizing for them and for the people around them who care for them.

And so DBT was initially really developed as a way for the person living with borderline Personality disorder to see how life always feels like a crisis to Them how everything is black or white.

And so the dialectic is really to bring those two sides, those two perspectives together and find that gray in the middle.

The other thing that Dr.

Linehan brought into this work, it was a real focus on mindfulness.

People with borderline personality disorder tend to react instead of responding.

Responding is a more thoughtful approach.

Reacting is like you jump right in through DBT using mindfulness and sort of catching yourself.

You help people construct more responsive rather than reactive kinds of approaches when they're faced with a stressor because the reacting often means people's faces, feelings get hurt, people get angry.

But to help them deal with that crisis and the fears that overtake a person with borderline personality disorder, such as things like that they're going to be left, that they're going to be alone, that they can't take care of themselves.

Many people with borderline personality disorder engage in a lot of negative self talk.

Dialectical behavioral therapy also draws from cognitive behavioral therapy where you push back and say it's interesting you say all these terrible things about yourself because my experience and you really do point out to them the good things and the strengths and you do some resilience building with them and you have them do homework assignments between sessions so they do a lot more monitoring so they can start seeing their own patterns.

DBT has been shown to reduce, the rate of suicidal thoughts, suicidal actions in people with borderline personality disorder.

And it's really the only evidence based treatment we know of right now that has any consistently good outcomes in person with persons with borderline personality.

I just want to touch on two things you said that really struck a chord with me.

The first one is mindfulness.

It is becoming a reoccurring theme in all of my conversations about mental health.

Yes.

Which makes me think if there's one thing we all could do to make our lives better, it would be to be conscious of what we're doing, mindful of what we're doing.

And then the second thing is that difference between reacting and responding.

Yeah, that's huge.

We live in a very reactive world.

Especially when you think about tweeting and texting and responding to those tweets and texts.

But that's reacting to tweets and texts.

Responding means you stop, you think what's meaningful, what would make sure, how do I write this so I don't hurt people?

You know that it's actually beneficial to either the receiver or other people who will be seeing this message.

You go through a series of cognitive steps, but unfortunately Technology doesn't.

I mean, I wish all technology made you like, are you sure?

Are you sure?

Are you sure?

Like, you know, that's an app idea.

And honestly, they made you like 60 seconds and then another are you sure?

And then another 60 seconds and then, are you sure?

Because by then a lot of reacting would have come down and you're like, forget about it, it's not that important.

Give me.

Think about those emails that you write in a range and hopefully you don't send them and you save it.

And the next morning you read it and go, thank goodness I didn't send that email.

Never ever put a name in a subject line of an email until you're ready to send it.

That's sort of a bit of advice, but it's that, react, respond and mindfulness are linked.

And because everything these days is so quick, quick, quick, and we're judged on speed and everything's designed not only for speed, but not to catch ourselves before we go off the edge that we can send things without.

You know, back in the day, you'd have to like write the letter, fold the letter, put the letter in the envelope, find the stamp, write the address, go to the mailbox.

That was nine times.

You could have said, maybe I shouldn't send this.

And so that's where that mindful mindfulness is a stop.

It's a feel, it's a think.

But that does mean awareness of other people.

And if you don't have empathy, all the mindfulness in the world may not necessarily pay out.

Let's get into it.

What is antisocial personality disorder?

So antisocial personality disorder is a long standing pattern of inability to comply with moral, legal, ethical or social codes, or really an unwillingness to do so.

These are people that are characterized by lying, deceit, malice, lack of empathy.

They exploit other people, they break the law, they, lack responsibility, they, don't follow through on things.

They have very, checkered work histories, that kind of thing.

they'll use aliases, they'll put other people at risk, and they lack remorse or guilt or shame for the bad things that they do.

So that's what antisocial personality disorder is.

Now there's a little interesting wrinkle in this diagnosis.

In order for a person to be diagnosed with antisocial personality disorder, we also have to establish they had a diagnosis of something called conduct disorder prior to the age of 15.

Conduct disorder probably best sort of ascribes to what we might call juvenile delinquency.

These are kids who were, who've either engaged in illegal activities like theft or assault, but also things like torturing animals, setting fires, bullying peers, abusing, taking advantage of peers.

And that could even include like, sexually exploiting younger peers.

there's sort of almost a willful cruelty, even though they're children.

And they often won't show remorse or even recognition of what the ramifications of these actions are.

So these are kids who may end up in juvenile detention, who will have trouble with educational systems, may drop out of school.

So you have to establish this track record that they were a kid who.

Who would have these kinds of problematic behaviors prior to the age of 15.

And then after the age of 18.

We diagnose antisocial personality disorder.

So they don't have to get the diagnosis before the age of 15.

Because someone could skip it.

Someone could skip it.

In fact, they often do.

Right.

But you would go back and tell me about in your teenage years and then go, you probably had Covid.

Yeah.

And they'll say, yeah, I skipped school all the time and I got expelled, or I assaulted a kid, or I assaulted a teacher, I stole my dad's money, that kind of thing.

You know, it doesn't have to all be big ticket stuff.

It could be the, if you will, the kind of bad childhood behavior like bullying or stealing candy a lot or stealing other kids lunch money, that sort of thing.

Those kinds of patterns.

Yeah.

To play devil's advocate, though, couldn't that just be a symptom of bad parenting?

Sure it could.

Absolutely.

But you could absolutely still get the disorder diagnosis.

you could, yeah.

Because even.

But still, that bad parenting is the predictor of lots of psychiatric disorders.

You know what I'm saying?

So at the end of the day, parenting has a lot to do with what gets shaped.

Is it a guarantee?

So if a person has a traumatic, neglectful, or invalidating childhood, is that a guarantee that things will go wrong for them in adulthood?

Absolutely not.

But is it a vulnerability?

Absolutely.

What does it mean to be a psychopath?

so here's where things start getting into.

We get into sort of interesting sort of semantic territory here.

To be a psychopath.

It's a term that probably ascribes best to this thing we're calling antisocial personality disorder.

So psychopath is not a diagnostic term.

It's a descriptive term.

It's a sociological term, but it's definitely not a diagnostic term.

Okay.

But researchers will use it and that sort of thing.

So a psychopath is Somebody who tends to be very calculating, manipulative, cunning, smart, Malevolent, dangerous, exploitative.

They have very little empathy.

They don't really think through the consequences of their actions.

They really don't care about the consequences of their actions.

They break rules, ethics, laws, they violate moral codes, they're deceitful.

A real picnic.

Yeah, love to meet one of those.

but it's not actually.

You can't be diagnosed as a psychopath.

Yeah.

So if a person met those criteria, and this is a long standing pattern for them since childhood, we call it antisocial personality disorder.

Yeah, I understood.

What about a sociopath?

So sociopath, this is where people get very confused.

Okay, so psychopathy and sociopathy are very like, you know, they're like the Venn diagrams.

There's a lot of overlap, but there's definitely.

There are distinct end entities.

The sociopath in many ways is not as glib, socially skilled, successful, and manifest as well put together in the way the psychopath does.

The psychopath in some ways is more chilling because they have an absolute lack of empathy.

And if they have a relationship with someone, it is solely exploitative.

It's to get something from them.

Sex, money, power, connections, you name it.

The sociopath, in their very unskilled way, might get into a human relationship, but they still don't have any empathy.

And in that relationship they still remain very cold and still somewhat calculating, but really more cold.

And rejecting.

The psychopath makes a better criminal.

The sociopath tends to be messy, sloppy and reactive.

Your sociopath is your bar fighter.

The psychopath is a person who, who will kill that person three days later methodically.

You see what I'm saying?

So it's like the sociopath tends to be more reactive, they tend to be more sloppy, they tend, don't tend to be as planful, they're not as sophisticated as the psychopath who tends to be coolly efficient and in that way almost more dangerous.

Because there was a book, that was written called the Mask of Sanity and that's where they were describing, he was describing psychopaths in that book.

And it was this idea that the psychopath can look sane because they actually there was some research that estimates that corporate heads, like heads of major corporations of all kinds, the rates of psychopathy in those folks is 5 to 21%.

to 21.

So depending on how you measure psychopathy, so it could be one out of five major CEOs as a head.

Yeah.

Because those are, there's all the stuff that, that the Power drive.

the willingness to have that sort of take no prisoners attitude to power in this absolutely, almost scarily, surgically precise, focused way.

That's very profitable.

In preparing for this interview, I was researching the term psychopath and it was almost, I would say 80% of the time correlated with serial killers.

almost like it was an interchangeable term.

Like almost all serial killers are psychopaths.

Probably Almost all of them are.

Because there's a precision to being a serial killer.

Right.

Because in order to be a serial killer you have to have killed two or more people.

So you got away with one.

Right.

So you got away with one.

And there tends to be some very stereotyped.

There tends to be some very stereotyped stuff around serial killings.

The keeping of trophies, the taunting of law enforcement, almost getting some pride out of like getting everyone in the world rattled and paying attention to what you're doing.

If you even think of folks like the Son of Sam or the Zodiac killer, they were actually writing letters to the newspapers, and to journalists and even to the police, to, you know, even Jack the Ripper did that.

And so it's this sense that there's something again, very methodical and there's almost a sadistic pleasure that they're deriving from committing these crimes.

That's very much the psychopath's game because it's very planful.

They think about it.

I just can't believe that those people who are likely a psychopath and perhaps one out of every five CEOs are also a psychopath, are in the same category.

Well, think about where the overlaps are.

The utter lack of empathy, the precision, the singular focus.

Yeah.

Very similar in those two ways.

So could you have.

No, because you have to have utter lack of empathy.

I was thinking, could you have a psychopath who uses his make up for good?

But it's not that way.

No.

Because ultimately it's self serving.

So I guess maybe the only way you might see that is let's say you have a psychopath out there who is running this incredibly successful corporation, but in order to sort of launder money or to distract people, raises tens and tens of millions of dollars for charitable causes.

And that money really does go to protecting people, feeding people, giving them health care or something like that.

So it's dirty money, but people get helped.

And let's face it, that does happen more than psychopathic philanthropic psychopathy.

So it's money laundering to them.

People benefit.

I mean, I guess viewers out there could think about, is it worth it, if somebody gets helped that they wouldn't have gotten helped otherwise, but the money came from a really manipulative place.

Out of curiosity, if you're watching this, do you feel like your boss is one of Those who are 5% or 21% likely to be a psychopath?

I've never worked for a psychopath.

I can say that in all terms.

I don't think I have worked for a psychopath.

I've worked for people who are deeply, deeply, deeply narcissistic, but a full on psychopath.

You tend to see them in more competitive industries.

Media, business, law, maybe even sometimes medicine.

Like high stakes, athletics, that kind of military.

High stakes, high visibility kinds of spaces where the profit lines are high and the stakes are high.

I mean, let's face it, when you hire people to do a job, you're not doing a personality test.

You're looking at what they can do.

And if they're making money and you're hiring for a company, then you're going to look at the person who hires money.

And you may not ask questions about how they're getting that done until after the fact.

When does someone cross, going back to antisocial, personality disorder.

When does someone cross the line between or from suave confidence to antisocial personality disorder?

I mean, obviously someone being suave and confident is not a diagnosis or an indictment.

It is to me actually.

When I meet suave people, I actually get, I get really put off.

Like to me now, charming people are terrifying.

Is that a Ramany tip?

Yeah, it's a Ramany tip.

That's a personal Rami tip.

When I meet charming people, I tend to excuse myself to the restroom and I, will often join another table or something.

It terrify.

Okay, so if we didn't know each other and we're at a party and I go, Dr.

Rowdy, I've seen your videos on med circle.

Let me get you a drink.

You look fantastic tonight.

I love your shoes.

Wow.

You're so smart, intelligent.

You would go, my gosh, thank you.

I got you.

You would have lost me at I love your shoes.

I gotta probably start watching how I act around these mental health professionals because I tend to be very complimentary.

Yeah, but complimentary.

But then there's a point to which, like, I don't watch your anger, you know, so that's the struggle there.

So this idea then, where's the line?

Right?

Suave and charming and sophisticated and all of that.

What you're looking though too is to see is there Empathy.

Is there a meaningful give and take in the conversation?

Are they looking through you or are they looking at you?

Are they actually interested in what you're saying?

And if you continue to spend time with them, are they present?

are they reciprocal?

Are they warm?

how do they treat other people?

So, obviously, if they're not mistreating other people, if they don't have a track record of having done bad things, that kind of thing, then they're not.

Then they're suave and charming, and they're not a psychopath.

Now, obviously, not all most charming people are not psychopathic.

but again, when you do what I do, charm gets scary.

Well, let's dive deeper into that.

What does the average person who has antisocial personality disorder look like?

What do they physically look like?

How do they dress?

How do they carry themselves?

That's a tricky question, because there is no average person with antisocial personality disorder.

You can find people with antisocial personality disorder everywhere, from death row to the best table at the best restaurant in Los Angeles.

So it's, that might be how they got there.

And both instances.

Yeah, absolutely.

That their personality disorder is likely what got them there.

So they look very different.

They can be in a $5,000 suit or a $10 prison jumpsuit.

They can be in a, They can be in any number of professions.

they could be any race, definitely proportionally more men.

Many, many more men.

How many more, do you think?

I would say it's.

Gosh, if I were to spitball, because I don't know the numbers off the top of my head, I.

I would hazard a guess.

It's probably five to one, eight to one.

Men versus women, five to one, eight to one, eight to one.

Yeah, something like that.

Yeah.

It's quite a few.

Many more men.

Are there women with antisocial personalities who are out there?

Of course there are.

Of course.

but, for sure, you would see, the only thing I could say in common is, this would be a man.

That's the best I got for you.

But beyond that, like I said, they could be successful.

They may not be successful.

They could be living in the streets.

They could be living in a mansion.

that's where it's interesting.

Whereas with other mental illnesses, we might actually see sort of a truncation.

But even there, we look at substance abusers.

They can be fabulously wealthy, or they could be living in the streets.

You know, they can be any race or ethnicity.

They could be, you know, you know, any gender.

It Doesn't.

It doesn't matter.

You are the country's leading expert on narcissism, perhaps the world's leading expert on narcissism at this point.

That would be very narcissistic for them to believe that.

That's why you're the expert.

You already cut it out.

how is this different, though, than narcissism?

It's a very good question.

What?

I view them.

I view them on a continuum.

And here's a good rule of thumb.

All people with psychopathy are narcissistic.

Not all narcissistic people are psychopathic.

Okay?

And in that way, I would say nearly all people with antisocial personality disorder are narcissistic, but not the other way.

Not all people narcissistic.

Narcissistic personality disorder have antisocial personality disorder.

I would never diagnose both.

If you have antisocial personality disorder, it's a built in that you have many, many traits of narcissistic personality.

so it's a continuum of sorts.

It really is.

And so narcissism, sort of.

There's a form of narcissism we sort of term malignant or toxic narcissism.

These are people who have all the stuff associated with narcissism, like the lack of empathy, entitlement, et cetera, et cetera.

But there's also a really hard, manipulative, exploitative edge to them.

And, they tend to be the more deceitful, interpersonally brutal narcissists.

And then when you look at what a psychopath or a person with antisocial personality disorder, now you jump the rails into a space where a person does not feel remorse for the bad things they do.

People with narcissism actually do feel guilty or shameful when they do a bad thing.

more shame than guilt, because shame's a very public emotion.

But they will definitely, they'll definitely feel bad about it, whereas a person with antisocial personality disorder or psychopathy in general won't.

As a technical matter, and this is a.

It's a fine point, but I want to make it the way DSM allows us to diagnose antisocial personality disorder.

Symptom number seven is the one that's called lack of remorse.

Okay?

There's a specific symptom called lack of remorse.

You can get the diagnosis, though, even if you do feel remorse.

And I struggle with that because I have interviewed, and in my research we've interviewed many people who will say, I did a bunch of really bad stuff.

And I did this bad stuff because I was living in a very dangerous neighborhood in Los Angeles.

I came up with the wrong kids.

I get that.

I had an abusive family.

I was gang involved.

We stole, we assaulted.

I did time.

And I feel awful about the lives I ruined.

And they're very.

And they're genuine.

They've done their time, and they're actually now devoting their lives to better work.

They're participating in research like they feel bad.

And the remorse rang true.

So they didn't get.

In our research.

They didn't get that.

But they still got the diagnosis.

I get that.

Do you see what I'm saying?

Whereas psychology requires that lack of remorse.

That's right.

Well, Dr.

Ramani, and I sat down for an entire series on narcissism.

And if you would like to watch that, here is a little preview.

So when we talk about narcissistic personality disorder, there's a long list of patterns, and they have to have five of the nine on that list.

It has to be something we call pervasive, meaning it cuts across situations with a variety of patterns.

People at work, at home.

It's not just like they're narcissistic to only you and they're nice to everyone in the world.

It tends to be pervasive.

But here's the rub.

It has to involve what we call social and occupational impairment and subjective distress.

That's a fancy way of saying it is messing up that person's life.

They're aware it's messing up their life, and they're uncomfortable with it.

And that's where you don't see as many people with narcissistic.

Narcissistic personality disorder.

Dr.

Ramani, can sociopathic or can someone have sociopathic and psychopathic traits without having antisocial personality disorder?

Yes, they can, actually.

You can see that now.

Here's Rob.

It's like, again, antisocial personality disorder has such a sort of specific diagnostic set of criteria, you know, in terms of this, the early life experience and all of that, that, you know, you may have that person who is coolly efficient and manipulative and, singularly focused on success and lacks empathy and exploits other people.

Maybe they'll come in right under the threshold.

At this point, we're sort of really.

We're splitting hairs.

Does that make sense?

Like, who cares what the word is?

Thank you.

You know, I mean, it is.

It's dangerous, it's problematic.

You know, my work in this area is very much focused on.

On how people with These patterns affect people in relationships.

I can tell you this now.

People with psychopathy and sociopathy 100% are not built for close intimate relationships.

They just don't, they cannot put the roots down deep.

And I think what ends up happening is cause they're so smooth and charm and glib and successful.

They absolutely draw partners in many times with a psychopathy.

It's like a, it's like big game hunting.

They just want the trophy, they want the prize of it all or they value that partner.

They're very attractive, they're very wealthy, they're very successful.

They may be a bridge to something they want or they just want sex.

I mean it can literally be that simple.

And in fact you do see that when we look at the Hair Psychopathy checklist, which is a very famous frequently used checklist, research the hair like hair, but hair like a bunny.

The Hair Psychopathy checklist.

in that checklist one of the things actually one of the items gets at their inability to be in long term relationships.

Like they have very short term marriages kind of thing because oftentimes they're exploitative.

They want something and they get out or they just have very brief sexual unions.

They're very sexually exploitative.

They'll use people for sex and then just sort of spit them up and chew them out and leave them, you know, leave them out.

And so people are very hurt by that and they'll say gosh, he was so charming, you seem so into me.

But that's cause they're so charming.

And that's why you avoid.

It's why I avoid charming people because really their damage comes from the fact that if you don't know what you're dealing with, it's so easy to get drawn in because it feels like a fairy tale.

You know.

Little do we know that like many fairy tale princes probably are psychopaths.

It's a new Disney fairy tale.

Princes are mostly likely a psychopath.

They're just a little too charming.

I mean I think, you know, we don't their name.

Prince Charming.

Yeah, Prince Charming.

Yeah, Prince Charming.

It's more Prince Psychopathy to me.

Yeah.

by the way, when people meet you now, they're not going to be very nice to you.

I feel like cuz you're, they're going to be like hey, I love you on that circle.

Not a lot, just an appropriate amount.

Well, I get like there's the narcissism woman.

I'm like no, no, no, not really.

In fact I actually be successful.

But Instead actually stop and make sure everyone's okay.

Very funny.

this does come with a lot of co occurring disorders.

Yes.

What are the most common in antisocial personality disorder?

The co occurring disorders we most often see are substance use disorders.

Interestingly, you might actually see depression.

But it's probably woefully under diagnosed because they'll probably present more as irritability, what we call impulse control disorders.

But the impulse control might be like they lash out at people.

Road rage, intermittent explosive disorder.

But we may not diagnose both because it's likely that their rage and stuff is subsumed under the antisocial personality disorder.

But really the most common comorbid diagnosis is gonna be substance use.

Are there different forms of antisocial personality disorder in the diagnostic manual?

There's antisocial personality disorder and it doesn't have different kinds of, it doesn't have different kinds of descriptors, if you will.

in my research we've actually sometimes split them out by people who report having remorse versus those who don't.

so it's not really differentiated in that way.

In fact, the research on psychopathy actually takes the time to distinguish between psychopathy and sociopathy or between primary and secondary psychopathy.

There's different ways you can slice and dice that pie.

And a lot of it has to do with the forward facing characteristics of how intelligent, well put together, articulate, smart, charming, glib.

All that stuff we associate with success and that precision.

That's sort of different than what I call kind of like the sloppy bar fight.

Psychopathy or sociopathy.

Yes.

Why?

Or rather what would not be considered antisocial personality disorder, but often is, what type of behavior?

I would say that, I mean again, many people mistakenly have called narcissists.

As having antisocial personality disorder.

But if indeed that narcissist is like, I can't believe I did this, I'm so sorry.

And they're apologizing and they go do it again.

That's probably more of the narcissism piece.

bipolar disorder.

Bipolar disorder could be mistakenly diagnosed as antisocial personality disorder because it's very possible that during a manic phase a person's behavior may drift into the illegal.

They may use a lot of drugs, they may solicit the services of prostitutes and behave very badly with them.

They may gamble a lot of money and engage in illegal activity to get more money to gamble.

So they may actually behave in a way that is, risky and in violation of the law.

So we'd have to be very, very careful to ensure that when there were these sorts of upticks of illegal behavior that it occurred only during a manic episode.

You got to remember, in antisocial personality, the behavior is consistent.

It's not like six days a week.

They're a nice guy, and only on day seven do they go out and put their serial killer mask on.

They tend to not work well in society.

Even when they're charming and glib.

They don't tend to have high quality, deep personal relationships.

Are people diagnosed with border or antisocial personality of sort or when in fact they're bipolar?

they could be, but it's gonna be.

Somebody should catch that pretty quick.

Okay?

You know what I'm saying?

Because then they should recognize that that person is in an episode of mania.

And this has not been their typical pattern of behavior.

But since one of the biggest errors we can make is make a diagnosis on the basis of a snapshot, if all you did was focus on one day of one person's manic episode, you could easily then completely call it something it's not.

So that's why we have to look at psychiatric patterns over time.

And so also in some substance abuse disorders, I could see how somebody who has a diagnosis of certain forms of substance abuse, particularly activating drugs like cocaine or methamphetamine, people who use those drugs are more likely to engage in risky behavior.

They may engage in illegal activities to procure the drug, they may sell the drug.

they may engage in high risk sexual activities while they use the drug.

And if they're an addict and they're using regularly, that may contribute to the likelihood that they're engaging in these high risk illegal behaviors, which over time could look like antisocial personality disorder.

What would have to happen is get that person off the drugs, get them clean, see if the behavior changes or not.

I make a point to say this in almost every series because for me, it is the difference between mental health therapy working or not.

And that is people must, must, must get the right diagnosis.

Absolutely.

And do not take that as a new label or a new terrible thing that's wrong with you.

Only take it as that that's the next step to get the right treatment.

Well, and in effect, we don't have to call it a diagnosis.

We can call it a pattern.

This is the pattern.

I love that I'm very.

I've been really, we're talking about depression person.

I'm sad.

I'm more irritable than usual.

Da Da da da da da.

You know, so it's.

So we're looking at patterns, and these are patterns that make a person uncomfortable and make it so that they're not achieving at their fullest potential.

Because really, my goal as a therapist is to get a person to achieve at their fullest potential, to be the best version of themselves.

Dr.

Sue Varma in New York, we did a series with her on depression.

She goes, my job is to give people, what you just said, an optimal life.

That's what I do.

People go, yeah, but I can deal with it.

I go, you could, but why don't we work hard to make it even better?

Right?

I love that.

Yes, that's good.

I want people to, understand what we're doing here is providing the education so that they can get into the right people, get the right diagnosis and get the right treatment.

And, you know, Kyle, I want to say something to that, because I know many people who watch MedCircle have lived with an experience or may even currently be experienced experiencing mental health or mental illness issues.

I always say to people, this is part of your story, and if you've come through this and you will come through this, that that's part of your strength and resilience, and it's not a piece of you to be forgotten.

Because I work with clients, for example, who are healthcare practitioners, who are teachers, and we, can use this as a way to say you have an empathy that someone else may not.

And you may be gentler with a patient or you may be kinder to a student.

And to me, I think that many times that people who've walked through the fires that can be harnessed in a way that actually could not only bring you to a fuller potential, but benefit the people around you.

It's really like spinning straw into gold.

So I think that that's what's absolutely critical.

People don't view this as there's something wrong with you.

There's absolutely nothing wrong with you.

Everything's right.

We just want to keep.

Get you to a better place, but that you can use this part of your story to enhance the lives of others.

that's so beautiful.

I would love to leave it right there, but I have more questions for you.

Good, great.

Let's keep going.

Let's keep going.

So I can't leave it on that perfect note that you just gave me.

when it comes to antisocial personality disorder.

What am I not asking you, that I need to be asking you?

Antisocial personality disorder, the big question Is, what if I.

You know, the big question around antisocial personality disorder really is, can it be treated?

You know, to which I'm typically going to say the answer is no.

In most cases, no.

we do know that over time, people with antisocial personality disorder kind of get tired out.

They kind of.

It gets exhausting to be a person who keeps breaking the rules at 90 or 75.

Like, you get tired.

It's exhausting.

Right.

But, these are patterns that are very, very, very, very resistant to change.

these are folks that many therapists don't have the training to work with, nor do all therapists even want to work with this population.

They feel threatened or intimidated, and nobody should ever work with a patient population they don't feel comfortable with.

but there's typically no motivation for change because these folks don't think anything's wrong.

You know, they really.

And it's also, the question is, how does a person become this way?

let's dive into that.

Explain first the born part.

Yeah, so there is, you know, particularly in the area of psychopathy and antisocial personality disorder, there's actually been a lot of research done on sort of brain function in people with antisocial personality disorder.

And there are various brain areas that have been implicated.

The ventromedial prefrontal corp cortex, the, anterior cingulate cortex, the amygdala.

All these fancy names are really simply boiled down to something's wrong upstairs.

You know, their brains aren't the same as everybody else's.

However, what these researchers have found is that those brain differences in structure and chemistry colliding with childhoods that may be characterized by abuse, neglect, violence, being the victim or witnessing violence, frankly, invalidation, emotional abuse, those things might potentiate any of those sorts of structural issues in the brain.

We also know that there are areas in the brain that subserve empathy and that one research, empathy.

So research has been done actually with people who qualify sort of stuff, psychopaths or as antisocial personality disorder.

I think they had been in prison.

what they found was when they were able to tell the subjects in this research to think about something and force them into empathy.

Like, they told them a story and say, can you really stop and think how that person in that story felt?

And the person concentrated on how that person felt, that area of the brain lit up.

But it wouldn't have happened naturally for.

So they don't naturally find themselves to empathy.

So they're capable of what we might call cognitive empathy.

They're like, yeah, I can get that.

And that area of the brain will light up, but it doesn't happen spontaneously.

So a relationship isn't really possible with them, but it's not entirely broken.

You can turn the system on.

Wow.

Now, if I always take my glasses off when I get excited.

If, a child is born with something not functioning correctly upstairs, and it is a psychopathic or sociopathic temperature, and they don't have an environment that is violent, they actually live in a very supportive environment, can you raise somebody not to be that way?

I have read case literature of exactly what you're describing.

A kid who was actually from the loving home, parents who loved them, you know, nurturing environment, plenty of resources.

It wasn't an impoverished or dangerous community or anything.

And that child started displaying antisocial tendencies, and it kept unraveling, and they became, you know, violent or predatory or poorly behaved adults, if you will.

And, you know, those are case reports.

That's not normative.

That's definitely a very low probability event, if you will.

but it's interesting when you read some of the work being done by some of the really great researchers in this area.

Adrian Rain, for example, is a guy at the University of Pennsylvania, and he's done some really great research on psychopathy.

And I was reading something, an interview done with him, and he had said, listen, we're going to get to the point where we may be able to identify some of these patterns in children.

And if that's the case, we really should work with parents to help them identify some of these patterns early on to see if we can do some intervention with them.

We're not quite there yet, but I must say that when we see kids who are engaging in patterns of behavior like bullying or acting out, we have to spend the time to do the necessary assessments to determine what might be going on for that child, both at home and in school, and what behaviors are manifesting.

Because it is possible in some of these cases, if we could get ahead of some of this, then sure, we might be able to engage in some prevention work.

But that's difficult to do.

You can only mandate so much, that I understand.

When we had the behavior, we tried to fix it.

You're saying, just on the basis of the brain.

Yeah, because that's the mental health landscape.

Is so gray.

And what's so frustrating to a lot of people is that it's just an expert's opinion whether or not their kid has ADHD or their kid has bipolar disorder or that Their cousin is depressed.

It's just somebody's opinion.

So when we can have something more definitive that can be tested, that's so exciting to me.

That's what the hope has been.

And of all the personality disorders, really, antisocial personality disorder is the area where a lot of this work on the central nervous system and the activity of the central nervous system is being conducted.

And you know, the challenge is, what do you do?

You give everyone in America a brain scan.

No, can't do that.

You see what I'm saying?

So it's sort of like, where do we go with that?

And the findings right now are very subtle.

A lot of them happen after the fact.

So a person goes and does bad things and then we do the scan.

What other things happen in their life?

That's right.

You know, and some of the research hasn't been as good at sort of describing how much, abuse or deprivation or all those other kinds of conditions are present.

How much of that shaped their brains.

And that's the thing.

The brain is shaped by its environment.

So you have a bit.

We're kind of playing a chicken egg chase game here.

But definitely both things are at play.

There are vulnerable brains out there.

And when that vulnerable brain meets an invalidating environment, that's sadly where the issues arise.

Do you think we would ever get to a point where we would do a scan on kids for.

Scan their brain and we could say, yes, they are likely to be a sociopath or psychopath?

Not in our lifetimes.

I don't think so.

I think that I wouldn't be surprised if slowly we get there.

Remember, the brain is a very complicated.

It's a very complicated system.

It's not so simple as like, there's like a little.

It's other organ systems.

We've created an entire business around the brain.

Other organ systems are a lot more straightforward.

But the brain, the brain hides for secrets.

And you could have four scans that look similar.

And yet the behavioral manifestations could be quite different because it's an intersection of so many things.

The person's.

Everything from the person's gender to their ethnicity, to where they live, to what their parents did, to what kinds of early environment they had.

It's not that simple.

Would that it were.

Would that it were.

But we're not there.

That this extraordinary thing called the brain is, you know, that allows us to do everything from, you know, write poetry, to fall in love, to, you know, drive a car.

It's not that simple.

And I don't think we're gonna get it.

We want it to be that simple.

We want to be able to predict these patterns.

I think it's a pretty high order.

It feels like a science fiction film to me.

But who knows, Maybe, maybe neuroscience will prove me wrong.

Do you think or is there any proof that any of this is hereditary?

There is some evidence showing that it runs in families now, particularly father to son.

and as we talked about, these rates are higher in men.

When we talk about antisocial personality disorder from a more biological model, one of the things we talk about is something called the autonomic nervous system.

The autonomic nervous system has an arm of it called the sympathetic nervous system that we popularly referred to as the fight or flight system.

But the autonomic nervous system is associated with arousal.

So when we get worked up about anything, when we're frightened, when we're anxious, you know, anything that is threatening to us, we get aroused, our heart rate increases, we sweat, our eyes become wide, we become short of breath.

Those are sort of, we get our skin, you know, they put a hair stand up on edge kind of thing.

All of those are autonomic signs.

The belief is that people with antisocial personality disorder have lower autonomic arousal, meaning that under conditions of fear or threat, they don't get as aroused, which is why they're willing to take risks and they don't have the same anxiety.

We avoid things that make us anxious, right?

They don't get anxious, so they don't avoid those same things that are really high risk.

And in fact, there's research that shows that people with psychopathy have lower resting heart rates.

They just are, more under aroused.

So sometimes that manifests in them getting into really dangerous thrill seeking types of sports because they almost want to feel the arousal the rest of us feel on a regular basis, day after day.

And that lower.

It's believed that that autonomic nervous system under arousal could be inherited.

In our first video you and I ever made, I think it was our first one, you told a story saying that they could be in a car with a dead body in the trunk, get pulled over by the police and be.

They won't break the car.

Totally cool.

Totally cool.

Absolutely.

They wouldn't be fledged.

Are those the one that's a sociopath, That's a psychopath or a psychopath.

And they are born psychopaths tend to be more born sociopaths are probably a little bit more made.

And I mean, that's a rule of thumb.

That's not Perfect science.

But definitely you see that that sociopathy tends to be a bit more a byproduct of the chaotic or negligent early environment.

whereas psychopathy, you can have that.

You can definitely have the negligent early environment.

It's probably likely, but there's likely also that biological sort of piece.

Again, the sociopaths tend to be a bit more sloppy, messy, reactive.

What age, in your personal experience, do you find psychopaths or sociopaths being diagnosed?

You can't diagnose them until they're over 18.

I don't think it's a reliable diagnosis.

None of the personality disorders are diagnosed in adolescents except for the conduct disorder.

Conduct disorder is not a personality disorder.

It's a childhood disorder.

So you could diagnose a kid with conduct disorder because they keep breaking the rules.

It's possible that kid will not go on to develop antisocial personality disorder.

If you're really, really, really, really lucky, they'd be put into some, perhaps a juvenile center where they really get good rehabilitative care, and they don't commit crime again.

I mean, the odds are not in your favor, but it could happen that way.

So conduct disorder is a disorder of childhood.

Personality disorders are only diagnosed in adulthood.

We're making room for the fact that the personality continues to evolve, shape, and grow during the adolescent years into emerging adulthood.

I actually really wouldn't feel comfortable giving a definitive diagnosis of a personality disorder in anyone who's much younger than 20 or 21.

That's so fascinating.

That was my next question, too.

Where you would feel comfortable.

I mean, I would talk about patterns.

I'd say you definitely have the traits here, but you also have a teenager.

And I can tell you, as the parent of teenagers, I think I've probably seen what's, feels like every personality disorder's symptoms in them.

You know, I'm like, wow, they're being really nice.

She still loves and unstable.

I love them.

But I was like, my gosh.

You know, and that's where I really learned that teenagers are up, down and all around.

And, you know, again, that's a developmental issue.

And that's why we want to be very careful.

Because the last thing you want to do is toss a label on an adolescent who's coming into their own and make them pathologize this process of them trying to find themselves.

And if we look at any of ourselves, when we were teenagers, we were anything but graceful.

goodness.

That is the truth.

In regards to antisocial personality disorders.

What demographic Besides men do you find more affected?

This is where it gets a little tricky sociopolitically.

Unfortunately what we see, and this is something that, as I've reviewed the literature from my research, that these patterns tend to be over diagnosed and people from lower income groups and ethnic minority groups.

And the belief is that's because those groups are also disproportionately incarcerated and the target of law enforcement.

So the belief is that it's almost like this sense of pathologizing people who are different than the norm.

And that's why those statistics I think we have to be very, very, very careful with.

So, again, these disorders don't know to describe, discriminate per se.

But since they're based on moral, social, ethical and legal codes and those codes are enforced by other entities, now you're bringing politics in.

You see, that's where it gets tricky and that those things don't belong in mental health, but we have to be mindful of them.

In fact, what we do sometimes see is that sometimes women who probably have antisocial personality disorder will get misdiagnosed with another syndrome such as borderline personality disorder, because we don't think of women as having antisocial personality disorder.

And so, and there are men out there who might very well have borderline personality disorder who get diagnosed with antisocial personality disorder.

So things like gender, race, social class is there, when a therapist or psychiatrist brings their own personal, you know, prejudices into their practice.

Bias, Bias.

Bias.

Just the normal term, bias.

It's bias.

And that's why that ideally you have multiple pairs of eyes on case data, which you don't always have.

Because I've been surprised when I do every so often get to see past diagnostic systems laid on a client.

I'm like really?

I gotta say I'm not seeing it this way.

So it's not a precise science.

That's why these labels don't tell us much.

I think we're better off focusing on patterns.

Yeah, on patterns.

Patterns, patterns, patterns.

In our lifetime, what do you hope or think that we could develop when it comes to the causes of antisocial personality disorder?

You know, this is actually, I mean a lot of what is being done in, you know, in personality disorder research very much focuses on antisocial personality because we do know it's dangerous to society.

So what do I think we'll learn?

I do think that newer and newer tools, neuroimaging tools that look at, namely functional neuroimaging tools that really look in real time at brain function, those are going to shed some really important light on how these brains work differently.

And then once, therapies or treatments are applied to folks to see if you actually see any frank shift in functioning and whether that's also associated with a behavioral change.

Again, these are not patterns that are that amenable to change.

I think that we might be able to isolate what the snapshot of what this looks like in the brain, whether we can then act on it.

There the jury is out.

Would it then become something that's more medical?

Is there medication that could be given?

Is it surgical?

But you face bigger ticket issues like consent to treatment.

In the United States of America, an adult has to consent to treatment.

You can't just crack open a person's skull and start fiddling around in there.

It's not how it works.

And so I think that as much as we think, well, there could be all these magical solutions, people have to agree to uptake therapy.

And there's reasons for that, obviously.

But if a person doesn't think something's wrong, whether it's psychotherapy, whether it's medication, whether it's newer therapies, newer sorts of, brain stimulation techniques, whether it's psychosurgery, a person has to consent to that and it has to be really medically indicated.

So we have to be careful in how we think about those things.

Dr.

Remini, someone comes to you, a patient, and they say, my husband is a sociopath.

I am convinced.

What's your first reaction?

First of all, I hear this regularly and I get heartbroken for them because what it means that they've been enduring is somebody who is likely verbally abusive or ignoring them, neglectful, lacks empathy, is cruel, is cold, is distant, is manipulative, like they use that one word.

And it gives me some real insight into what they've been enduring.

And by the time they pick up the phone and call me, it often means they've been enduring it for a while.

How severe do the symptoms of a sociopath become?

I mean, I mean, like all disorders, it's on a range, right?

You know, I mean, it's not like there's one version, obviously in the milder levels, you're often talking about someone who's cold, angry, brooding, resentful, mean spirited.

You know, at the more extreme levels, you'll see violence manifested.

So obviously at the more extreme levels, you're often talking about victims of more physical domestic violence.

Violence.

But I think even at the mild levels, it can look like emotional abuse.

What if Somebody comes to you and they say, I heard this word sociopath.

And I don't.

I'm not really sure what it is, but I think my husband might be one.

How can I tell?

I break it down for them because I think a lot of people use the word sociopath interchangeably with narcissistic.

Yeah.

And like I said, these are labels.

I'm interested in the pattern.

I'll say, don't use the word.

Tell me what it's like.

Don't show me a bucket.

Dump it out and tell them, show me what's in it.

Yes.

Okay.

Great metaphor.

And so I say, tell me what the patterns are.

And then once they start laying it out, I say, okay, here's what the pattern is.

It makes you feel better to have a word, because I know sometimes they want to keep doing digging and doing research, but then we break down that pattern.

So when somebody is experiencing that, like I said, they're experiencing all those things.

Coldness, distance, manipulation, lying.

All those things.

And it almost doesn't matter whether it's a sociopath or a narcissist.

Neither pattern is that amenable to change, and neither pattern feels good.

So they dump out the bucket and they're pulling out.

Uh-huh.

Verbal abuse, coldness, all of those things that you mentioned.

Yeah.

Who cares what we call it?

This type of person is unlikely to change.

No, they're not going to change.

They're not going to change.

So that leaves that person with two options.

Yeah.

Stay with it and deal with it or get out.

And when I say they're not going to change, I say that very.

As you can see, reflexively.

Let's say.

Let's say you get that person who's like, okay, I never thought it would get to this point.

You're leaving.

Let me give this a shot.

And they want to make a good faith attempt in therapy, and they're really owning it, and they get in there and they maybe make some minor changes in some small, small, small, small, small, small, small percentage of cases.

You might see that since most people out there and most people watching are not going to be the exception to the rule, I'm going with the idea.

If their partner is not endorsing any issues on their end that they're responsible for any of this, then the likelihood of change is zero.

You know, they have to be that acknowledgement of change.

So assuming that that's what this person's like, they won't change.

And when I bring it to their attention, they look at me like, you know, that's great.

There's nothing wrong with me.

This is you.

And they'll often blame the person.

So, they'll say, you're an idiot, you're a fool.

Maybe you're the one with the problem.

Then they'll undergo a whole new litany of emotional abuse.

So you're right.

Their two options are to either get out or stay.

And if they stay, to understand they're staying under conditions that really aren't going to shift that much.

But how able are we to unbiasedly tell a therapist how our significant other is.

No, I get it every day, 10 times a day.

So people are.

By the time.

Listen, you go into a therapist's office and you're paying good money.

Why would you lie?

I know.

I'm not saying that they're lying.

I'm saying if I say, all right, my name's Jennifer and I have a husband named Paul.

And I'm saying Paul is manipulative and cold and blah, blah, blah.

How accurate is that?

Because maybe I'm just angry.

Okay?

Then.

In which case, you're gonna get your guidance from that perspective.

And that's why it's great to work with couples, right?

Because if you get to work with a couple, then you get to see both sides.

Unfortunately, if Paul, in fact, is a sociopath, he's gonna be manipulative, you know, so you have to be a really skilled therapist to sort of suss that out and smell that out.

you'd be amazed how many clients pull out their phone and show me the text messages, and that's when I get a real sense of it.

I see the emails.

This is so good.

Yeah.

I bet you people don't realize that they can even do that with a therapist.

They can't always.

Some therapists listen, when my clients come in, they might bring in old photo albums.

I welcome all that.

They show me the text messages.

It helps your therapist, though.

Any of our viewers, your therapist may say no.

And I don't ever want to impugn how another therapist works.

So I'm not saying all of us will do that.

I certainly will, because I am very.

Because of the sheer number of clients I work with who have been in narcissistic or sociopathic or psychopathic relationships.

It's really important to me to never gaslight my patients.

Maybe you're not telling me the truth.

That's what the world has been telling this person for a while.

Like, well, maybe it's not that bad.

And they've been gaslighted by the world.

And I refuse to be someone who does that.

there's a reason this person picked up the phone, came to my office, spent the money to see me.

And if it's to come in and say, I'm gonna give you this sort of mythological version.

And do I think sometimes clients do that?

Absolutely.

Absolutely.

And so then what's happening is probably nothing is changing at home because I'm working in good faith.

So At some point they're either gonna stop coming.

Cause saying nothing you're doing is helping me.

but I have to say that it is important for me to honor their truth.

I'm a humanistic therapist and that's my orientation, to be humanistic, existential.

And a big part of that is that your truth is what matters to me.

And for some reason you're coming in here and saying, this is your experience of this person.

And it's not my place to doubt that.

I just want to understand it.

That is so good.

I love the permission to bring evidence as well to a therapist who's open for that.

You know why they do that though, Kyle?

sometimes people bring that in because they've been doubted by everyone and they feel like they're losing their grip on reality.

That's what gaslighting does to people.

It tests your reality.

And it could be going on for 20 years.

And sometimes to them, they've stopped trusting their own reality so much that they hand over the text messages because they don't think anyone will believe them.

It's actually a rather heartbreaking gesture.

I am not kidding you.

I've had clients come in with boxes of stuff and you know, and I mean, it's heartbreaking because I think, God, no one has been listening to this person.

And they literally feel like they're losing their grip on reality.

And that to me is devastating.

So I.

Jennifer comes in.

And she's irritated with her husband Paul because he's a sociopath.

And you tell her, look, the evidence which suggests that he's a sociopath, but I would assume Jennifer didn't marry him when he was doing all those things Jennifer did.

Here's the thing with these patterns.

Narcissism, sociopathy, psychopathy, these are long standing patterns.

Now, because of the charm particularly we see in psychopathy and narcissism, they can often keep a lid on it long enough to get a ring on it.

Okay.

Sociopathy tends to be a bit more sloppy.

I'm not quite sure why people fall for that, but they do.

Some people just Desperately want to get married.

And they're just sort of taking whatever person is in front of them.

They're like, okay, I guess I can work with this.

And sometimes if that, sociopaths don't tend to be as successful as psychopaths.

But if that person maybe brings enough practical characteristics they can live with, they may be willing initially to overlook the rest.

So no, this person, these red flags were here from the jump.

Going back to a conversation we had previously in this series about being mindful and being aware and conscious.

Because when you're mindful, aware and conscious, you can hopefully see that Paul is exhibiting characteristics that are maybe won't be good in a marriage.

but people so easily go into denial and then get married thinking it'll get better.

Well, that's the biggest mistake a person can make.

Nothing's going to get better once you're married.

If anything, I put my good bet on things are probably going to get a little worse.

Yeah, you know, I'll quote my father, who's not a therapist.

He said, look, it better be so good by the time you get married because it's only going to a little bit.

I mean, it's possible some things could get better with time, you know, but I have to say that it is.

you're absolutely right.

And every single client I have ever worked with, man or woman, gay or straight, you name it, any culture, they have said they owned it.

These signs were there all along.

And if anything, they feel angry at themselves.

They feel ashamed and embarrassed, humiliated.

Why didn't I see this sooner?

And they'll own it.

Family tradition.

They wanted to get married.

they wanted to be a parent.

They thought this person could take care of them.

They felt bad for them because they had a bad childhood.

Those are the reasons they get all the way in and like, we'll fix this.

It's almost like we'll get the house and it's like a fixer upper.

We'll get the house and then we'll fix it.

Yeah, not a good idea.

I'll share a personal story.

I had a six year relationship.

Broke up in therapy about it.

We didn't break up in therapy, but I'm in my therapist's office reviewing the relationship and I brought something up that happened in our first few weeks of dating.

And that event occurred throughout our relationship.

And I told my therapist, yeah, but I didn't know it was happening.

He goes, yes, you did.

You were in denial.

I wasn't in denial.

I saw it happen in the beginning.

He said, that wasn't, that's not going to happen anymore.

And I just didn't know it was happening.

He goes, kyle, you knew.

You just chose not to see it.

And I left his office angry.

Because I go, who are you to tell me that I'm denial?

But then after a few weeks, I came back.

I go, you were right.

I was in denial.

I saw it all along.

I just chose to pretend like it wasn't there or make rationalizations.

I mean, the other pattern I see folks make is like, he's having a bad day at work.

The, kids are really noisy, his father's been really sick.

Wait until we move by the new house.

I mean, it never ends, right?

Anyone can write those rationalizations.

And while those things may be true, as they're causes of stress, that kind of bad behavior is unacceptable.

Emotional abuse is unacceptable any day of the week.

Perfect.

I want to stop it right there.

That was so many great takeaways.

And my big one was going to the therapist with evidence.

Yeah, I've never done that, and I probably should have.

Yeah, I mean, like I said.

But I warn folks that, you know, like before they show up to the therapist's office with like, people are gonna be bringing a file cabinet with five boxes of records.

And they end up, and they, to open their phone, their therapist may say, you know, I only want to hear about your reality.

They don't want the therapy to be punctured by outside realities.

Like I said, I respect how other therapists work.

Given the nature of the populations I work with, that I must say it sometimes elucidates something.

and it allows them to almost feel heard.

And it normalizes things for them because they'll sometimes say, I have to show you this because otherwise I feel like no one could believe something is outlandish.

I say, I believe you.

If this helps you, by all means.

I'm just trying to give them a sense that I'm trying to help them feel sane and whole again by whatever path possible.

Yes.

What's the first sign someone needs to look at as if they think somebody they know is a psychopath?

I mean, if you come to find out that they're breaking major rules, moral codes, ethical codes, or laws.

Now, obviously, on a first date, a person doesn't.

I mean, unless they've got their, like they're, I've just broke the law bracelet around their ankle.

You know, most people, they broke the law bracelet, they're not going to, I don't think that Most people are gonna, like, put their rap sheet in front of you on a first date.

So, you know, but pay attention even to look at how they might handle rule breaking in a relationship.

I don't know, they might take something that doesn't belong to them.

If you're, you know, from a, like, I don't know, a place of business or a hotel or something, it may feel like a small transgression, but.

But it'll be enough to make you uneasy.

They may share something that they did at work that feels like it's on the wrong side of shady.

Enough of those little things start to accumulate, and the danger is that you're like, wow, they're really slick.

They're a hustler, they're a player.

You think you're in some sort of cool movie with them, but it's not cool.

It's actually they're breaking rules and they're doing it over and over again.

And that might be a sign or a signal.

They just are.

It's.

And it may end up culminating in more and more stuff, and you may find it out.

I think one of the most devastating things that people have said to me when they've been in relationships with psychopaths is what they learn down the road.

They come to find out that this person had a history of incarceration, that they may actually be married to someone else at the same time, that they lied about their occupational history, that they lied about, bills that went unpaid and which now are ruining their credit.

You might go try to buy a house and find out, they had two bankruptcies in their past or something.

So it's a.

It may be something you don't learn early on.

Nowadays with Google, you might be able to look into people.

Psychopaths have a tendency to use aliases.

They may not be who you think they are.

Wow.

Does it look.

Do psychopaths look different depending on the role they take in your life?

For example, a significant other versus a co worker versus, family.

Absolutely.

You got to remember, a psychopath's front game is the best game in town.

Smooth, glib, charming, intelligent, articulate, perfectly put together.

I mean, you really need to know what you're looking at to be able to catch them in what they're doing.

So they're going to be.

If they're trying to attract you as a new partner, they're going to bring their A game.

If they're trying to impress somebody in the workplace, they're going to bring their A game.

However, if you're someone who's disposable or dispensable to them or someone they view as you're in their service, God help you is all I have to say.

If you find yourself in a relationship with a psychopath or you believe that your husband or boyfriend, let's say, is a psychopath, are there any questions you could ask them to maybe find out if you're right?

I would say that what you want to do is look for inconsistencies in their story and find out, talk to people who know them.

Now, I'm not saying that you need to go CSI on this and start this interrogation of everyone who's ever known them, but try to see if there's continuity, if the dates line up, If their life story lines up.

If, you know, he might have said he went to college in one place and another person's like, yeah, when they graduated, they were working at this job.

And you're like, something's not adding up.

Psychopaths often go out of their way to isolate their partner from other people who know their histories.

Look for that pattern too.

Why aren't you being introduced to anyone in their past?

They'll often say, I was done wrong.

And they'll make up some dramatic story about how everyone did this to them.

So they have nothing to do with anyone from their past.

That's pretty rare that somebody would cut off everyone.

All friends, all family, all except extended family.

It may be that they're on a fresh start path and they're sort of reinventing themselves and that you're in the, in the.

You're in the eye line of a grifter kind of person at this point.

So look for inconsistencies.

Psychopathy is not a diagnosable term.

No.

But can someone have psychopathic tendencies but not be a psychopath?

You know, I mean, there you.

Then again, you're splitting hairs.

You're splitting hairs because, like psychology, because there's no diagnosis.

It's not like if you have five psychopathic tendencies, then you're a psychopath.

Right.

You know, the people who have, like, really are breaking rules in this consistent way, and they're cold and they're, and they fail to take responsibility and they're deceitful and they're manipulative and they're exploitative.

I mean, these things tend to hang together.

It's very rare that a person exploits other people.

But then they're really sweet and they do bake sales and they run a Girl Scout troop.

Like, you're not going to tend to see those things kind of hanging out together.

These things cluster together.

So the more of them you have, the more likely you are to dealing with somebody who is truly a psychopath.

I like the takeaway of looking for inconsistencies in this person.

And if you're in a relationship with them, you do have the option to leave.

But if you have a co worker, for example, you can, you can't necessarily leave them.

So how do you adapt to working with a psychopath?

If you suspect you're working with a psychopath, that what you want to do is you really, really, really want to cover your bases.

Remember, HR is not going to help you unless you have documentation.

You can't walk into HR and say, hey, the person in the next cubicle is a psychopath.

They'll be like, okay, that's.

Yeah, I watched a Med Circle video and I just want to let you know.

So, I mean, I always tell people anytime you start on a new job, you almost have to be kind of paranoid.

You start, you save every email, you make folders, you get that stuff off the server, you print it off.

Like there's all these steps that you really should engage in if you think you're working with a psychopath.

but you want to make sure you document things.

You want to avoid having meetings with them one on one.

You want to ensure that there's a third party present.

You want to ensure minutes are being taken of meetings.

You want to, you know, most times people scan minutes and don't really pay attention.

Pay attention to those minutes because that might be the only documentation you have.

and then you want to make sure you have alliances at work, people that you can trust.

But what you don't want to do is gossip about the psychopath because they're better at that than you are.

They're already stabbing you in the back and numerous other places you can't see.

way ahead of you.

They're going to play this game better than you.

So you're best off playing a clean game than trying to beat them at their own game.

Yeah, really good advice.

What about for family members?

How do you tell.

How do you know if your mom or your dad is a psychopath?

I mean, that's incredibly painful.

Because I gotta tell you, one thing I've seen in more than a few family systems is some people won't refuse to believe it.

Like I refuse to believe that we're just being dramatic.

And they'll say they're not a psychopath and so you'll have these families that'll be schismed and split.

Like people will say, I think you're exaggerating.

I think that, you know, they'll actually gaslight the person who's making the accusation.

So it can be very painful if you come into the realization that one or, God forbid, both of your parents is a psychopath.

That's a very painful revelation.

But I gotta tell you, you probably figured that out as a child.

Psychopathic parents tend to be abusive, neglectful, manipulative.

one of the more famous psychopaths out there is Bernie Madoff.

Okay?

He uses a classical example of a psychopath.

When you look.

And he was very wealthy and he raised his children up with tremendous comfort.

He certainly wasn't beating them with a stick or, you know, locking them in the basement or depriving them.

But there was a cruel edge to him.

And his kids would acknowledge that.

And if you watch any retelling of that story, well, it's definitely not a comfortable relationship.

Some people will have high functioning psychopathic parents, a dad who's a CEO or a mom who's really, really, you know, successful at whatever it is she's done.

And they'll report, like, having two parents, the public person and this really cruel, invalidating, malevolent, horrible person that would come home and they'd note the dichotomy, how seamlessly their parent would go between those two worlds, and put their child through unrealistic kinds of expectations.

So people, it's not like a person wakes up at 30 and says, dad was a psychopath.

You knew.

Is there such thing as a self aware psychopath?

You know, the funny thing about psychopaths is I don't even think they'd get mad if you called them psychopaths.

Because they don't care what anybody thinks of them.

So if you go up, they'll laugh it off.

You wouldn't be like.

Even a narcissist would get super defensive.

But a psychopath's like, you want to call me a psychopath?

Call me a psychopath.

Okay, so that's how they respond.

But do they think, yeah, I am a psychopath?

Yeah.

No, they're not affected by the evaluations or labels placed on them by other people.

What they don't like, I know they're not affected by it, but do they recognize that they are a psychopath?

Maybe.

Yeah, maybe.

Yeah, they might.

In some cases they might.

And if anything, it's like there's a sadistic glee.

You see what I'm saying they may recognize it.

Like, how cool that I got.

Like, how cool.

Like, I'm a psychopath and I'm getting away with it.

Or I'm a psychopath and look how much money I'm making.

Or, you know, it's almost like if you.

I don't know, it's like finding a bag of money on the street, dropped by a armored truck, and you're like, no one's around, and I'm picking this up and I'm walking down the street and I'm getting away with this.

Like, they're holding.

Life is about getting away with stuff.

So if anything, that psychopath might even be like a badge of honor.

but I don't.

Again, I think they're impervious to the criticisms of other people.

That's where they're different than the narcissists.

The narcissists hate being criticized.

The psychopaths don't mind.

Yes.

What are we not talking about when it comes to identifying a psychopath at.

People need to know.

I think that with a psychopath, it is really about looking for inconsistencies.

Inconsistency in mood, inconsistency in life history, inconsistency in their stories.

The problem is we so want to believe when we meet someone new that their stories are real.

And I've just met this super cool person that we make the puzzle pieces fit even when they don't.

I tell people, be a cynic.

When the dates don't line up, recreate it.

Listen, Google's making some of this stuff possible too.

And I'm not.

I mean, it's not like I want everyone to, like I said, go out there and play like junior detective.

But if you're being isolated from anybody who knows anything about this person, pay attention to that.

You know, before you entirely buy their recreation of the events, look for things that don't add up.

They have this huge job.

Like, they're so successful, but they don't have enough money to get through the month.

But can you help me out this month?

Like, next month the big payout's gonna come out.

so I've got everything covered from then on in.

You know, anything that feels like a hustle is probably a hustle.

We are seeing that there are certain.

There are programs, like, for example, prison transition programs and, other programs working with more like incarcerated, antisocial personality disordered groups that have found some utility in some forms of Social Security skills training, group therapies, some luck with cognitive behavioral therapies There has been some good work there.

You know, listen, at the end of the day, it's like the old joke of how many psychologists does it take to change a light bulb?

one, but needs to want to change.

It's the same thing with antisocial personality disorder.

You know, the person has to need to want to change.

And you know, you may or may not have that.

I have to be honest with you, it's more of those same slick, glib, charming almost, if you want to call them, white collar psychopaths that are, you're going to get absolutely nowhere there.

I mean, I think there's absolutely no chance of change there.

I think actually in the criminal populations you may be able to do some level of, job training, social skills training, meaning and purpose focused work.

And I actually would put my bet on the incarcerated population more than I would on the sort of the slightest, the slick, sophisticated, successful group of psychopaths, quite frankly, because there's almost no motivation for change.

They're getting rewarded for their behavior.

That's right.

In their world, they're killing it.

They're killing it, they're killing it.

And the world is telling them they're killing it too.

Right?

So maybe cured is the wrong word.

Could, a person who's psychopathic, could they at least get to a point where they're not breaking the rules?

I mean, that's obviously the goal and that's the goal of, you know, rehabilitation after prison.

And you know, that kind of thing is that there is no recidivism.

When we try to avoid recidivism is where we're trying to prevent a person from committing crimes again.

But, you know, criminal behavior or illegal behavior is just only one part of what we see in antisocial personality disorder.

We're also seeing violation of ethics or morality or social norms.

So for example, somebody who is antisocial personality or psychopathy is very likely to cheat on a romantic partner if they have one.

They're going to probably keep doing that because they really are, they're really almost immune to any sense of morality.

And so, that's not going to change, which can make it very difficult to maintain any kind of trusting relationship with somebody like that.

So I think that some of the treatment targets, maybe in terms of illegal behavior, they may be willing to bring some of that hustle, if you will, to more legal behavior.

But even then you'll sort of see that their tendency is going to want to take, moral and ethical shortcuts.

What does the treatment actually look like for these people, you know, a lot of it is, again, it's cognitive, behavioral.

It's challenging their beliefs and changing them, their beliefs and thoughts in a hope of changing their behavior.

That's really what you're trying to do, right?

And so that's where you're sort of pushing back on their cognitions, pushing back on their schemas, on their sense of how the world works, trying to enhance their sense of empathy, to really help them focus on this is how people are being hurt.

Especially if it's a kind of.

It's not like person on person crime, like violent crime, something that feels more remote to help them sort of see that this is hurting somebody else and the people around them.

Now, in a person who's really a cold, stone cold psychopath, they don't care.

So, like, I don't care if I'm hurting someone.

It doesn't matter to me.

And so if that's the case, how are you gonna make change there?

If I don't think something I'm doing is wrong, like if some.

If I'm.

If somebody tells me tomorrow, like, it's wrong to turn off my bedroom light when I sleep, I'll be like, what?

Yeah, we're just gonna do that?

Why is that a problem?

That's a really good way to put that.

That's how far it is.

Yeah, yeah, yeah.

What do you mean?

I got to make $100 million.

So this is what I'm doing to do it, you know, this is how I'm going to do it, and no one's going to stop me.

Or it's a game again.

I'm going to bring up the Bernie Madoff case because he's sort of like a real textbook kind of a psychopathic, antisocial personality sort of person.

In some ways, it's almost like it was gamesmanship to him at some point.

How much money does one person need?

Well, isn't that the proof that's the truth?

Yeah, that's all it was.

And it felt like that's what it was.

Despite literally so many people's lives being destroyed by his decisions.

It absolutely didn't even seem to.

It was the game was more important than the other people, and that's what it is.

They are players who really only care about the game.

So someone's watching this.

I doubt they're psychopathic.

They probably are in a relationship with somebody.

Is, somebody who.

Or a family member.

Or a family member.

Or work with them.

Or work with them.

Yeah.

They are likely going to be advised to go seek therapy for themselves.

In that therapy session, what do they ask the therapist?

Because what I want to have happen for them is that they don't have to go to five therapy sessions to figure out what is a psychopath and what all these things that you're educating them on and giving them the tools to ask the therapist so that maybe in the first session they can make a ton of a gain.

It depends on the relationship with the psychopath.

Is this your child?

Is this your co worker?

Is this your husband?

You know, because obviously the nature of the relationship is going to have a lot of bearing on what you need to know.

For example, if it's your child, the question a lot of parents are going to have is, am I responsible for this?

Well, we'll go into the whole child thing in our next video.

So let's assume that this is for a loved one.

So you mean like a partner?

A romantic partner.

A romantic partner.

is it possible he can change?

Because he keeps telling me he will.

We have kids together.

can I expect that he is going to be a decent co parent if we have kids?

should I be scared?

you know, I keep giving him second chances but it never works out.

Why not?

you know, is it possible he'll change?

Those are the kinds of questions you're going to, you know, that somebody should probably ask.

And you know, by and large, if that person has any expertise whatsoever in psychopathy or antisocial personality, they're going to be able to give you some straight answers on that.

Like I said, these people are not made for long term intimate relationships.

They're not.

And what if somebody says, what if somebody's in the position where their partner makes all the money, they have nothing in common scenario and they have five kids and they come to a therapist and they say, you're telling me he's not going to change and you're telling me to leave before all these reasons.

Therapist won't tell her to leave.

I wouldn't tell her.

Okay then.

But they're saying this is going to be really tough and that person says, I want to stay in the relationship.

Now what's your response to that?

Then I'll say, look at the history of what it's been like so far.

That's how it's going to keep being.

Okay.

He has not been listening to you.

He's not going to start.

He has been cheating on you.

He's going to continue.

He's been disrespecting you that's going to keep going, like everything you're seeing.

I said at least you already have the roadmap.

Expect nothing, you know, expect nothing.

Do you help them with coping strategies?

Mm.

things like continuing, if they can continue to stay in therapy, group therapy.

I do ensure that people, women in particular, who are in relationships with men who have antisocial personality disorder or psychopathy have access to domestic violence resources because that's not an uncommon pattern in these relationships.

Encourage them to cultivate some of their own interests, encourage them to cultivate friendships, and their partner will probably try to isolate them from those friendships.

But, you know, even if it's online communities, you know, and I do want to tell med circle listeners the guidance we're giving right now is not meant to be to serve a person who is in a violent relationship.

If you are in a relationship where you or other children or other dependent adults in your environment are in danger, you must seek help immediately.

You must seek domestic violence services, law enforcement, and keep in mind, if you're researching those resources online on a computer, make sure you clear out your cash every time.

Because it's not unusual in those relationships for a partner to go through and search everything you've searched.

It's that level of, of control.

So I mean, I do want listeners to understand that what we're talking about is situations where it has not escalated to violence, financial abuse, things that are putting you at abject risk.

This is not a substitute for the guidance somebody needs in that kind of a situation.

And it can go there.

And with psychopaths, not uncommon.

Is creating an exit strategy for the relationship ever part of therapy?

It is a part of it.

Now, unfortunately, this, this is where you start sadly getting sometimes into the world of restraining orders and really painful custody hearings.

If the antisocial personality pattern has more financial resources than you, they may try to crush you in court.

They will be able to charm the judge, they will be able to charm the attorneys, they'll be able to charm the custody evaluators.

I have seen these things go really, really badly for people.

People losing custody of their children, people getting limited custody.

Sometimes the psychopathic parent wants custody of that child, not because they're interested in the child, but to stick it to the other parent, which is not good for anyone in this situation.

So I do tell people, you need a plan, you need a strategy, you need supports, and after all that, it still may not go your way.

And I wish I could give people like a really sugar coated version of this.

But people say, well, the judge is going to see right through him.

Not necessarily.

Well, I'm glad you're not giving a sugar coated lotion because what we're doing here is giving the reality of mental health and the reality on this topic is what you have just described.

And let's not move away from reality because it makes us feel good in the moment.

Right.

Let's lean into it so we can work within the realms of what's real and make as the best decisions as we possibly can.

And I think you've given a lot our viewers actionable steps to take.

Absolutely.

But you have to, I mean these relationships can become dangerous.

Yes.

You know, and it's also, listen, I'll tell you this.

If a person's psychopathic or antisocial personality partner is really high functioning, they are like the head of a company or some sort of like really high up in a political structure or something like that, the world may not believe them.

And that's made, that's even more horrifying.

And in fact, women who have Who are more wealthy are often less likely to seek out domestic violence resources, which is not an uncommon situation in these relationships.

I mean this is a dark space.

And again, I think some, some people may be watching now and scratching their head and saying, how did a person not see this?

How did they get in in the first place?

Listen, you know, a lot of flash, a lot of sizzle.

Everyone around you saying, my gosh, he's so generous, he's so nice.

my God, he's, he's taking, he's flying all of us on the screen, great vacation.

Or you know, he's taking care of you or he's actually, you know, let's say you have a child and he's offering to take care of the child too.

That all looks really good to the world.

And a lot of people don't stop under those circumstances to ask the right questions.

Well, that's a really good takeaway for people who know somebody who's in a relationship with a psychopath to make sure you ask and check in.

Yeah.

And when I sat down with Kevin Hines, who survived a what normally would be fatal jump off the Golden Gate Bridge, he really drove home the point of checking in with people asking how are you?

But meaning it not the hi there, how are you?

Good.

That's surface.

No one's ever listening to that.

But really going, hey, you're in a relationship with this person, but how is it?

How are you feeling when you're in a relationship with people don't often like to pull back that curtain.

I don't know whether it's because they don't want to know the answer or whether they feel like they're prying, that it feels impertinent or something like that.

Especially if you, I mean, I think even if you don't know someone well, it's okay to say you've met them.

How are you?

Like, is it good?

Is it a good relationship?

I think people are often like, what?

Why would you even ask me that?

I think it's an interesting question.

Because if it's a great relationship and it's healthy, you'd say, I'm so fortunate.

Like, it's a really, really happy relationship.

At a minimum, it would make anyone stop and think.

Dr.

Ramani, explain why.

First a child cannot be diagnosed as a psychopath because it is a pattern.

A, diagnostic kind of a label that saved for people over the age of 18.

Antisocial personality disorder is not diagnosed until somebody is over 18.

But in children we can look for patterns that really conform to delinquency.

these can be milder patterns like truancy, cheating on school assignments to more severe ones like, physically or sexually assaulting peers.

it could be things like torturing animals, setting fires.

All of these behaviors.

If you have, I think three or more these kinds of behaviors, they qualify a child to be, diagnosed with something called conduct disorder.

Now these kids typically get handled through school and juvenile justice systems.

they may be placed in special school settings.

They may be sent to sort of special boarding school settings if the family has the money.

Sadly, some of them may end up in juvenile detention settings as well, where we know they're grouped in with other kids doing these things.

So sometimes they actually learn more criminality in those settings.

so if you're noticing these patterns in a child, they're bullying any of those things, you want to act so swiftly.

Early intention, early and intensively.

I think part of the reason this is always so tricky is that sometimes it's kids being kids.

It's that childhood play and all those childhood fights.

That's just kids being kids.

That's boys being boys.

And that's often used as in a defense of something that people could get ahead of.

But it's also not that simple nowadays.

We have a new issue to look at with kids and that's their online activity.

You may not have a kid who's going to school and making trouble there.

But what you might have is a child who's really getting into some dark online spaces, whether through social media or even websites and sort of social networks that aren't that as commonly used.

You want to watch their video game play.

While the research associating violent video gameplay or video gameplay and violent behavior is equivocal at best, we're not so seeing consistent patterns there.

Is your child locked up in a room all day playing those video games by themselves?

Are they socially isolated?

How do they treat their siblings?

Are they interactive at family gatherings?

Or are they distant and remote?

So there's a lot of places you can witness this child, and there's a lot of ways it's not just the acting out.

Some of it is also that extreme social withdrawal.

You're their parent.

They don't get cybersecurity.

You get to go through their stuff.

And that's a good thing.

Yes, it is a good thing.

If you're at the position as a parent where you feel like your kid is exhibiting some of these signs and symptoms, be happy that at least they're not 18, so that you can, you might be able to get at.

You can take control.

And a lot of parents listen.

A lot of these kids are more savvy in the electronic spaces than their parents are, so they're able to really bury things.

And they might be on websites and extreme website that parents don't even know exist.

so it's getting more, and sometimes more and more challenging to monitor all of these kinds of situations where kids could be going down some really perilous places.

at that point, you can really only engage in early intervention, like I said, in part through the schools, in part through people who have this as a specialization and at that point, hope for the best.

I talk to so many of our viewers, and so it helps me learn what helps them.

And one of the things that they've shared with me is that when they're watching videos like this and you just, you just said, look at if they're isolating, if they, interact with people at family functions, and you went through this list, go back in this video, play those responses again that Dr.

Ramanay just gave, and write down those questions.

And over the next week, two weeks, a month, write down what you're observing.

Because we get so caught up in getting the kids to school, getting to work, packing lunches, we miss the parenting process.

We do.

We don't always pay attention.

And so if you write that down and you actually take the Time to look and write out.

Then you can take something to a therapist and say, this is what I've been observing.

Right.

So we have some track record here.

And we start to expedite the process of therapy so that they get as much correct information as possible.

And one thing that's also tricky, Kyle, is, and as a parent, I can understand this is some parents just are in a place of denial.

They don't want to even let themselves go there.

Like, it's terrifying to think not only could something be wrong, but your child potentially could be dangerous to other people.

And parents think, well, maybe it'll be different in the new school.

Maybe it'll be different next year.

Maybe this is a phase.

maybe this is a phase.

Exactly.

Maybe it is.

But better that you do explore it instead of saying two years later.

I wish I had started something back then and started trying to get to the bottom of this.

It's hard.

If the child is oppositional enough, even getting them into a mental health practitioner may get you nowhere.

But I think for parents to at least know that you gave it a shot, the more resources you throw at something early, the more likely you are to have a good outcome.

Yes.

What do you wish more parents would be doing?

You know, I think I wish more parents would be willing to have emotional conversations with their kids early.

I have to say that we're having a real crisis of emotional expression in our culture.

And I think, sadly, it's concentrated in men and boys where we're not giving them permission to talk about their feelings.

We view vulnerability as weakness.

We view talking about feelings as weakness.

We feminize it.

And that's supposed to make it weak too.

And I think a lot of some of the bubble ups we see in men are just an inability to talk about their feelings, their fears, their anxieties, their vulnerabilities.

And I think sometimes parents are even afraid to go there to open those Pandora's boxes.

And with technology, kids have become sort of almost like they're speaking, we're talking, speaking two different languages in a household.

And, it's just to give permission to those conversations and you don't.

And I think parents often feel they have to give solutions to their kids.

Sometimes all you need to do is let them talk, let them talk and listen, listen.

I have to catch myself on, that all the time.

I happen to have a very long commute to school for my daughter.

I used to try to say, well, let's fix it.

And it took me a while to say, I'm going to let her talk.

I'm going to let her talk and talk and talk and not try to bring a solution to it every time.

Which is hard when you're a psychologist.

Well, I find that funny that it's hard.

I would think it'd be so easy for you to just listen because you are a psychologist.

But it's your kid, it's your kid, you want to fix it.

And I think many parents even well intentioned, it's time.

Like you said, you come home, you're making dinner, you're running around, you're doing homework.

This whole sort of like, let's just sort of climb under the covers and have an emotional conversation.

When does that happen?

Gotta make it happen.

Make the time, make the time.

You just caused a light bulb to go off in my head.

I've shared in our depression series with Dr.

Sue Varma that at nine years old I was diagnosed with clinical depression.

Completely suicidal, was put on Prozac.

and I shared more of my depression story throughout that.

But during or throughout my life.

But during that time, I remember I'd have episodes of like, I would say panic or anxiety or just really emotional outbursts and I would end up in my room in bed and I would be just wishing, wishing that my mom would come in and talk to me.

I wouldn't, I wouldn't go.

You would go ask her ever?

No, I would never go talk to her.

That's such an important thing.

I will share.

gosh, I hope so.

And when I would hear that knock on that door, door or that door open, it was just like relief came.

because I go, she's going to let me talk now.

And it was such a, I didn't realize it then until you just said that.

Of letting them talk, giving me that outlet to be like, here's what I'm feeling, here's what I'm talking about.

Because for whatever reason I couldn't manage it in a healthy way.

I think as parents it's not we don't wait for our child to come get us.

We do have to be, we have to be the early warning mechanisms.

We have to check in on our children.

That balance will shift one day.

That won't forever be our responsibility.

But it really is about paying attention.

And again it's something I've been rueful about myself as a parent, very busy and there have been times I wanted to give advice when all she needed was an ear, you know.

And I guess we learn and we evolve and we keep trying to get it right.

If a parent does take their kid to a therapist and they are diagnosed with I always forget the conduct disorder.

Conduct disorder.

What are the chances with the right intervention that this kid will not develop psychopathic tendencies as an adult?

You know, my knowledge base in the area isn't good enough for me to give you a specific probability.

I would be uncomfortable doing that because this is such a high stakes game.

Let me put it this way.

Your stakes are much, much better if you do take them to a therapist than if you don't.

Yes, you're improving your odds.

I think a lot of it's going to depend on the child's pattern of behavior, the environments they find themselves in, the resources to help the child.

There will be other adjunctive programs around that child.

For example, there are some programs that use things like martial arts and those kinds of physical kinds of programs to actually channel some of the strong feelings these kids have into the discipline of martial arts.

So you'll see some of those kinds of programs, somebody I know works on those kinds of programs with gang affiliated youth.

So there's different kinds of innovative programs out there that meet kids where they are at, using art, using music, using physicality, that you want to use as many of these resources as possible to give that child a chance to express themselves.

Where they may not be able to find the words, they may be able to find another outlet.

Give us a few tips for parents on that, on those initial therapy visits with that child.

You know, when you bring a child in for therapy initially.

Now, while different therapists who work with kids under 18 work differently, most of them, almost all of them are going to want to meet with the parents once, and sit with you.

Because many times a child won't be able to relate their own developmental history.

Like were there any birth complications or their milestones or all of that.

So they'll need the parents to do that.

And then you'll have to work out with the therapist sort of how you're going to communicate about it.

With a child who's well into adolescence.

That child might want a private space.

And then you agree with the therapist on when she will contact you or he will contact you.

If the child's in danger, if there's symptomatology they're concerned about, you want to make sure that the adolescent feels fine with that.

With younger children it's less of an issue.

That tends to be more of an open book and more open concept conversation.

you as a Parent should ask them questions on how they work, you know, with your child and what kinds of things that they're going to be expecting of a child.

Will they expect your child to do anything between sessions?

so I think that it ends up becoming collaborative.

I also have to say, Kyle, it can be useful for families to enter family therapy where everybody's in the room, mom, dad or whoever, the caregivers, whether it's two caregivers, whether it's a single parent, siblings and the child.

Because these tend to be systemic issues.

I think there's a real risk of sort of labeling that one child as the problem child, which that child is probably already experiencing that sense of identity within the family, especially if their other siblings are playing by the rules and they're not.

That by having family therapy, there could be a chance for everyone to kind of get a little bit more aware of the dynamics.

But it's early intervention, it's regular intervention, it's multimodal intervention, meaning we're using different techniques to help them out.

It's monitoring, and then it's a leap of faith.

The stakes are never higher when it comes to a child.

Yeah.

No, I agree.

And what are we not telling parents about psychopathic tendencies in their kids that we need to be telling them?

You know, we're.

We're learning more and more about this.

I mean, I think it's something that movies sometimes show in this kind of scary horror film kind of sequence.

it's an area where there are some specialists who are doing work in this area.

it is hard because there's so many moving parts here.

Listen.

For the child who's coming from a really abusive, deprived, violent home, I'm not so sure that they're going to be watching this.

If the parents are abusing them.

I don't know that they're watching videos to figure out how to help their kid.

So those kids are likely potentially to have poorer outcomes because there's nobody looking out for the aunt who got custody of the kid or something who's now trying to fix that.

Yeah, but in that kind of scenario.

Exactly.

Now that the child has a consistent caregiver to that family member or someone else who may have stepped in in this child's life.

Regular intervention, and that child may be really diffident and have their arms curved, you know, they're going to do that.

They're going to stonewall and they're a child and you're going to keep trying to find that way to get in.

And that's why Therapists use all kinds of techniques, even playing games with a child.

I mean, therapists who work with children tend to be very, very creative and very gifted.

It's very difficult work to do.

And there are people out there who specialize in this.

And there are also experts who sort of cross that line between sort of the justice system and psychology who sort of are working, you know, know about the cutting edge programs for young people who are vulnerable to ongoing, to either developing criminal behavior or are you engaging in it?

I want to thank you first for sharing that.

Because this is hopefully and I believe will change the path of so many kids.

I hope so.

I don't think that people understand.

And I think for me, especially on a day I'm, you know, clinically working with clients is the devastation that's wrought when somebody abuses a child.

For me, it's a passion, it's a fight, it's, an absolute.

There's something about it that.

The sheer innocence of a child, that they place their trust in the adults around them and that trust is betrayed.

That ramification is lifelong.

It is self doubt.

It is sometimes self harm.

It can be mental illness.

On the bright side, yes, we often can see resistance, resilience and growth and empathy and lots of other things.

And we can also see darker patterns like psychopathy and sociopathy.

But I think that I cannot stress enough how important it is to safeguard our children.

They are our children.

Not your children or my children.

They are our children.

These are the people who will be taking care of the world as we get older.

And, and our complete disregard sometimes for the welfare of children is concerning.

For me, this is why I want people to listen to this and really get that sense that pay attention to the kids around you.

Pay close attention.

Because for many folks I've worked with over the years, even students I've talked to, if one person, one person had listened to them and paid attention to them when they were children, things could have turned out quite differently.

Yes.

You mentioned in previous videos that people know once they become an adult, if their parent has an antisocial personality disorder.

They may not know the label for it, but I mean, the odds are if they had a psychopathic parent or a sociopathic parent or, you know, antisocial personality patient, I mean, a parent, I should say, they would have either had a parent who abandoned the family, that would have been very common, like disappeared, or who physically harmed either themselves or their mother or, or, you know, or other people in the family or who might have gone to jail.

You know, for really committing some sort of heinous crime.

so something there's going to be some sort of ringer.

They just may not know what it's called, but they'll know they know something.

yeah, they'll know.

Yeah.

It's not subtle.

It's not subtle.

How many of these, how many of these kids who are now adults have relationships with their parents who are psychopathic or sociopathic?

You know, it depends.

You know, it really depends on the nature of the parents transgressions.

Obviously somebody abandoned the child.

Some people, out of curiosity, as an adult may circle back and want to try to have a relationship with that parent.

if they were horribly abused by that parent, they often won't.

But you know, listen, it's amazing how many people who had abusive parents still stay in the game with their parents.

I don't know, maybe it's just.

It's almost like a loop they get stuck, stuck in still trying to think they can win them over or something would change their behavior.

So some do, certainly many don't because of the parents.

Transgressions were either so awful or just pulled them out of the child's life and never to come back again.

Well, I think out of all the categories, children and parents are the most difficult because I do have the choice.

Even though it might be very difficult to leave a partner, I do have a choice to quit my job.

If my, my boss has antisocial personality disorder.

But I can't go get a new biological mother and I can't go have, I guess I could have another kid, but I still got the one that I have.

Yeah, well, I mean, if you're talking about it being your parent, can you quit a parent?

Sure.

You're right.

You're right.

I think that the heartbreak I see in folks is when they realize their parent just did a bad job.

They were neglectful, they were abusive, they just were not.

They should not have been a parent.

Bottom line, that awareness is devastating because you're right, you do only get one set of parents.

Now.

They may not always be biological parents, Kyle.

Sometimes adoptive parents come into the scene in that person's life and that's the only parent they know.

it may be a slightly more.

It could be a more complex dynamic if that adoptive parent abused them, making them wonder, could this have gone a different way way.

But ultimately it's the sense of loss of.

I don't, I feel like I've been robbed.

I could have had a healthy parental relationship, which is Such an important relationship not only for a child, obviously critically important for a child, but also even in adulthood.

Person feels something's been stolen from them.

However, I think then that's getting caught up in somebody being given a job they probably weren't good at, which is namely your parent.

Some people who are good at this actually seek out mentoring figures and other adults.

It may be a grandparent, it could be an aunt or an uncle.

It could be some other trusted adult in the family system, or it could even be a mentor they meet along the way as a university, at the university at high school in a job that they find someone who becomes that fathering or mothering figure to them, and they have that relationship.

There's still a yearning.

Gosh, there.

Darn it.

I only wish this had been my.

The parent I had been born to.

Life doesn't always look the way we want it to, you know.

And by fighting, say, this is my parent, it needs to be right.

And fighting a, fighting for something that's completely futile, that you're never going to get, that feels like a waste of time.

So I want to break this into two categories then.

The first category is for the people who are in the position where, look, I go to Thanksgiving every year and I see my.

My parent, and I have to know how to deal with that.

And the second one is for the people who say, you know what?

I've moved on from them.

I've separated.

But I do need to recover from what I went through.

That's fair.

And perhaps both people need to recover.

So let's start with the first one.

What do you tell the people who still want or feel like they need to have a relationship with their parent?

You know, when people feel like they need that, then I say to, them, you got to manage your expectations.

You got to get realistic about this.

They're never going to be your cheerleader.

They may be downright jealous of you.

They may try to undermine you.

They may try to take money or resource from you.

They may try to manipulate you, because these are all the things they've already done.

So they're not going to stop.

Yeah.

So can you go instead of waiting for something, you're waiting for that I love you, that may never come, or that I'm proud of you, that may never come.

And so you're waiting for something that may not arrive, that can be heartbreaking.

But if you can say, listen, I want to know, I, like the idea that I have a parent out there somewhere, and I know they're always going to get it wrong.

If you can get down with that and really manage your expectations, then go ahead, have your relationship with them.

But to keep being surprised that they're acting badly after a lifetime of acting badly, it actually feels illogical.

It is illogical.

And this is illogical because it's a matter of the heart.

But you have to be realistic about the expectations you bring into the situation.

That is, first of all, so simple.

My favorite things are the simple ones though, because they're often underrated and the most powerful.

Yes.

This has been going on your entire life.

Just because you're an adult now and can point at what it is, doesn't mean it's now going to be different.

Nope.

And if you could just let it go, put it down, realize this is the hand you were dealt.

Yeah.

And just like in a casino, sometimes you're gonna have to fold the hand and say, I'm done fighting this table.

I'm good.

You know, you say, let it go and meet for me.

For me, it translates to forgive.

And, you're getting that, Jake.

And I'm gonna.

I wanna hear all about that response because my definition of forgiveness is giving up hope that the past could have been any different.

It doesn't mean I say what you did was okay.

No, it was terrible.

But I'm going to give up the idea that my childhood could have gone any differently because it couldn't have.

I mean, that's fair.

I actually, what you're describing, I tend to use the word accept.

Acceptance.

Acceptance.

I use the word acceptance.

forgiveness to me is a.

This happened and I no longer resent you for it.

There are not many people I know who reached that bar.

Like, I forgive people who might cancel dinner plans.

I can live with that.

I don't know that I would forgive someone who fundamentally betrayed my trust.

Depends.

It depends.

But only.

Yeah.

We could have a whole conversation about the forgiveness.

But you know, it's about forgiveness.

Here's the problem with forgiveness.

Okay.

When we hand it over to another person, we expect them to treasure it and to treat it as the really almost divine gift that it is.

Which is, thank you so much for this because it feels almost like absolution.

Right.

I'm going to honor this and I'm gonna get it right.

And I am so sorry for the hurt I caused you.

Thank you for.

Thank you for seeing through to this better part of me.

And they make real change.

That's an example of forgiveness working out.

But where forgiveness can be devastating is when you go out of your way to forgive someone and they turn around and they do it right back to you again.

Which they would do.

Which they would do.

Yeah.

For me, forgiveness is not even about that other person.

For me, it is all about me.

Okay?

It's me really taking the moment with myself to go, you know what that is?

That's something that happened.

It's out of my control.

Now.

I am either gonna dwell on this and get angry and, you know, ruminate on it, or I'm gonna go.

And you're okay with them of doing it again if I'm not okay with it.

But I.

I accept that.

That's their behavior.

Okay?

Accept.

Accept, yes.

That's why I call it.

And if I've made the choice to have them in my life, then I have to know it's coming because.

So if you forgive them.

Because forgiveness to me is very much a.

And many people argue what you do philosophically.

Forgiveness is an act to the self.

Okay?

It's for the self.

So I can.

But to me, that's letting go.

Like, I can say, let go of something.

When you let go of something, it doesn't necessarily mean you've let go of the resentment.

Does that make sense?

Like, I've let this go.

I'm going to tell you, though, it's changed this relationship.

Yeah.

That's not forgiveness.

Forgiveness is really kind of like a bit of.

A little bit more of a reset now.

If you read, Desmond Tutu's work on this, he was Nobel Prize winner from South Africa.

If you read his work, he gives a much more nuanced take on, forgiveness.

And actually, his work is some of my favorite work on forgiveness.

Because he really does say, like, this has changed the DNA of this relationship forever.

There's no getting past that.

But, I mean, I think we're talking about that.

So we're circling around that drain of forgiveness, letting go and acceptance.

But people use the word acceptance, but they don't really mean it.