Customer Reviews

Bad Boys, Bad Men: Confronting Antisocial Personality Disorder

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I have a shelf full of books that have bits and pieces of information on conduct disorder and the like on young men. Bad Boys, Bad Men takes all of that information, blends it together, adds to it, and spits it out in a very readable, comprehensive book that is like a dream come true to me. I mean it. And the advice to family members is so valid and honest. And the advice to the ASP person is so straight-forward. Reading this book has filled in many pieces for me in my search to understand the nature of a loved one. Bravo to Dr. Black and his writer friend. May this book be read by all the probation officers, juvenile judges, social workers and counselors alive. I truly believe that ASP is the basis for so much pain and suffering in our society.

Clearly influenced by Hervey Cleckley's classic work, "The Mask of Sanity", Donald Black's brief overview of the enigma of the antisocial personality disorder in its several guises serves as a welcome introduction to the subject for anyone interested in its recognition. Those looking for a "cure" or even a practical form of treatment for sociopathy will have to search beyond this book, for its management remains just as evasive as it was when Cleckley sat down to write his landmark description in 1941.

The book provides excellent useful documentation through its careful chapter notes, and Dr. Black wisely avoids the theorizing and speculation, so often characteristic of the authors of books of this genre. The style is adult breezy, with strict avoidance of the turgid jargon of the typical psychiatric or psychologic journal article.

Even though I was admittedly somewhat put off by the fact that a man with Dr. Black's professional background required the services of a ghost writer (C.Lindon Larson), this doesn't appear to have adversely perverted the end-product, a highly readable and helpful introduction for the general public on the pervasive influence of sociopathic behavior on all our lives.

Are there some people who simply make it their mission to be bad? The psychiatric circle is now beginning to believe so. In this groundbreaking look at Anti-social Personality Disorder (ASP) psychiatrist Donald Black charts the process and problems of men (for they are primarily men) who know no conscience and simply refuse to obey the rules. Typically, these men are white and working class, who go through jobs, money, homes, prisons, and family with a virtual disgregard for those around them. They may have come from poor families and broken homes, they are likely to have been juvenile delinquents, their parents may have been antisocials as well. But the Antisocial is a very dangerous person who comes in any size, shape, or form.

At the risk of seeming like another attempt to plead pity for criminals, Donald Black insists that these men be held responsible for their actions, and avoids placing blame on anyone but them for the destruction they seem to willfully cause. He discusses various causes for the disorder (ie: genetics, brain trauma, abuse, poverty), the history of its discovery, and gives us case studies of men who he has tracked down more than twenty years after their initial hospitalization and diagnosis with ASP, often with unsettling results.

I liked this book for its scholarly treatment of this psychiatric subject. It was complex and in-depth, but at the same time, still accessible to me as a non-psychiatrist. I was fascinated with the descriptions of personalities that he gave, and riveted by the petrifying account he gave of the sociopath John Wayne Gacy. At the same time, I did have some problems with this book. At times, it did not hold my attention and would read like a textbook. I also found that Dr. Black's treatment of the antisocial was rather contemptuous and seemed to emphasize the fact that these people are virtually impossible to treat, rather than trying to show optimism or enthusiasm. I don't think you can help somebody (no matter how unlikeable they may seem at face value) recover if you attack them. There is a difference between holding someone responsible and beating them up over their bad choices. (Or perhaps this shows I didn't get as much out of this book as I should have.) Along the same lines, Dr. Black did not support his descriptions of antisocial behavior with the responses of the patients. He told us antisocials have no remorse, but I don't feel he really articulated that in telling the stories of follow-up interviews.

Overall, I felt that this was a pretty good book, and an important introduction to a disorder which has extreme ill-effects on society (poverty, crime, etc.). Hopefully, over the years, their can be more research to define a way to treat these individuals.

I'm still recovering from my 5-year marriage to a man with ASP that ended in 1982. When I left him, I'd never heard of ASP or sociopathy and I thought I was losing my mind. Reading "The Mask of Sanity" was the best tool available to help me. "Bad Boys, Bad Men" was the book I wish had been available back then. This book isn't "pop" psychology. It is an engaging discussion of a long-term study of ASP by a respected researcher and professor of psychiatry. The financial and emotional costs of antisocial behavior are incalculable. But I hear commentators on TV and radio every day who simply don't know what they are talking about. I am so grateful to now have the facts at my fingertips.

If you are looking for a book about psychopathy, look elsewhere. While a couple of true psychopathic types do make an appearance in Black's book, most of them are simply APD types, and the two are NOT equal.

The problems have to do with the fact that there is a mass of confusion among the professionals as to what, exactly, IS psychopathy, and how to "test" for it. The DSM-III changed the name of the disorder from psychopathy to "antisocial personality disorder, and the criteria for diagnosis consisted almost entirely of persistent violations of social norms, including lying, stealing, truancy, inconsistent work behavior and traffic arrests! The main reasons given for this shift were that it was too difficult to assess personality traits and it was much easier to measure "facts," such as recorded violations. This meant that there was a constellation of "behaviors" but no differentiation as to WHY those behaviors occurred. This meant that many individuals who behaved a certain way due to varied stresses and or nurturing failures were categorized right along with individuals who behaved the same way, but never had experienced familial or social stresses or lack of nurturing.

The result was, of course, a diagnostic category with good "reliability," but very questionable validity as to what was REALLY wrong with the individuals thus categorized. It also failed completely to categorize those psychopaths who do not ever break the law, yet cause untold damage to their families and to society.

This issue is not simply academic. The fact is, individuals who are APD due to "nurture" issues may have a better prognosis than those who are "APD" due to genetic factors.

Robert Hare developed the Psychopathy Checklist based largely upon the work of Hervey Cleckley. Black doesn't think much of Cleckley because the only patients that Black seems to have encountered are the APD type, and not the "ambulatory psychopath," or the "compensated psychopath," those who never break the law or who do so in such a way that they never get caught. Curiously, when Black quotes Cleckley, he removes the term psychopath and inserts APD.

Hare's checklist measures TWO factors: 1) affective/interpersonal items such as egocentricity, manipulativeness, callousness, lack of remorse - the features that are CENTRAL to psychopathy; and 2) "sometimes" features of psychopathy that are also features of other disorders, including APD, such as antisocial, unstable lifestyle, social deviance. The two factors are correlated, but there are different patterns of correlation with the external variables.

Another important point is that Black relies on the MMPI, but it has been shown that a good psychopath can completely skew the results of this test.

Hare's Psychopathy Check List played a role in the field trials for revisions to the DSM-IV. These trials showed that scores on Hare's checklist are significantly correlated with APD in criminal populations, but not symmetrically. This is because most psychopaths in prisons meet the criteria for APD, but most of those with APD do NOT meet the criteria for psychopathy.

Again, APD is defined largely by antisocial behaviors and is simply not adequate to measure the core issues of psychopathy: the affective/interpersonal components. APD leaves out the trait assessments that are necessary to differentiate between psychopathic and other criminals.

These field trials didn't help the APD or psychopathy diagnostic criteria of the DSM-IV, nor did so only slightly. The term psychopathy was entirely absent from DSM-III-R and the DSM-IV text now says that "antisocial personality disorder has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder." The text DOES make many references to the personality traits traditionally associated with psychopathy, however, the diagnostic criteria for APD tends to identify antisocials that are NOT psychopathic.

But Black seems to be perfectly happy with all the confusion, even adding to it himself with some considerable self-satisfaction.

Interestingly, the "showcase" case of Black's book actually contradicts everything he has asserted about APD: John Wayne Gacy. He even writes, (without getting a clue himself, it seems):

"In some ways, Gacy's story contradicts much of what we know about the natural history of ASP. ... Gacy, however, demonstrates that no predictive theory is flawless when confronting a disorder as complex and mysterious as ASP. Though he grew up feeling afraid and different, John Gacy was moderately well behaved and exhibited only a few characteristics of delinquency, with no juvenile arrest record or early history of violence."

He wouldn't be so confused if he could just get straightened out in his own mind the difference between APD, Psychopathy, and other disorders that he seems to lump all together. His writing is also very bad as the other reviewer noted.

If you want to read about APD, criminal types almost exclusively, nasty, dirty, vulgar and repellant, then this is the book for you. If you want to learn about psychopaths, the real predators that live and move among us almost undetected, those that are suave, smooth, and deadly, try Martha Stout's "The Sociopath Next Door," or Cleckley's "Without Conscience," or the classic: Cleckley's "The Mask of Sanity."

Genetic determinism has been with us since the bible. Recent advances in genome and proteome studies debunk both radical claims: "people are born bad" (bad seeds hypothesis) and "people are corrupted by bad parents and society" (the tabula rasa approach). It seems that genes and environment interact, recursively influencing each other. So are crime and moral dissolution hereditary mental disorders - or learned behavior patterns? The author votes for the former in this impressive but accessible introductory text, replete with dozens of case studies and recent scientific data. Still, social and domestic ills such as abuse and poverty, admits Black, a psychiatrist, play a role, at least in unlocking the criminal "potential". One should applaud the author's honesty in admitting his own profession's helplessness in the face of these depraved and largely untreatable personality disorders. Sam Vaknin, author of "Malignant Self Love - Narcissism Revisited".

This is perhaps one of the best reviews I have read on any mental illness. Antisocial Personality Disorder is biologically based, but tragically often discarded as the result of poor parenting, movies, TV, video games, or a decline in social morals. It is none of these. It is a biological disorder with devasting effects on family members and far reaching costs to society. This book will take the reader on a review of what is currently known about this disorder and challange society to make a commitment to research and understand this illness. The author offers no excuses for the behavior of individuals with Antisocial Personality Disorder, but points out its costs to society and the need to understand, diagnose and develop treatments for it.

After many paper and journal searches in the library on Antisocial Personality Disorder, I was attempting to put it all together..... then I discovered this Book! From the family member to the Mental Health Professional this book gives the reader a look into what is and who has Antisocial Personality Disorder. A very easy read into a very complex disorder!

After I read this book, I began my research on psychopaths, sociopaths, serial killers and how it all gets started. I feel that they are drawn to positions of power because perhaps somewhere at some point in their lives, maybe after being dominated or abused at a very young age, they decide that as soon as they are able, they will never let anyone else tell them what to do. And the profession they come up with that will allow them to accomplish their objective would be one of power, often law enforcement. Scary. I just found out that my neighbor also escaped, but not with her children, as I did. Turns out that her ex husband, also violent, and also a psychopath, was also highly educated. A court appointed psychiatrist, even. So, it wasn't until five years ago when he finally landed in prison, did anyone start listening to her about this charming man. Who had of course had everyone convinced she was crazy. Invalidation, I find, is one of the most insidious forms of abuse that they use. Pretty soon, you start beginning to doubt your own thoughts and feelings, and eventually you stop having them altogether.

When I was a psychiatric resident at the University of Iowa Dr Black was my residency director. Occasionally during my training someone would make an unkind remark about the muddleheadeness thought to be pervasive in mental health circles in places like Cambridge MA and other sites on the East Coast.

As an easterner myself I dismissed these remarks as bedtime stories meant to scare our residents into staying in the midwest. However after reading one reviewer of Dr Blacks book wringing his hands over Dr Black appearing exploitative and sarcastic toward a convicted serial killer I now realize there may have been a grain of truth to what my elders were attempting to teach me.

It is clear that this book is needed more now than ever before. Our mental health system in part is suffering because evil is masquerading as disease. The result is increased stigmatization of the mentally ill and misallocation of resources. As the Jewish religious tradition teaches in Midrash Rabbah "Kindness to the wicked ends in cruelty to the righteous".