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Shoshana, January 25, 2007 (view all comments by Shoshana)
+ Case studies illuminate the range of expressions of sociopathy

- Overgeneralizations abound, factual errors, contradictory interpretations of behavior

I rarely pan books. Even when I was reviewing for Publisher's Weekly, I tried to emphasize the good points of the books. It seems irresponsible to identify good points in The Sociopath Next Door without pairing them with their caveats. This is unfortunate, because Stout's case studies are vivid and, while not particularly complex, illustrate a range of expressions of sociopathy in familiar contexts (home, work, and relationships).

I also don't usually write giant question marks or rebuttals in the margins, or have cause to circle egregiously inaccurate statements. My copy of this book is highly marked up. In recent years, only Edward O. Wilson's Concilience: The Unity of Knowledge has evoked comparable frustration and disgust, and in fact I put it down after only a few chapters. Rather than go into exquisite detail about my many notes, exclamations, and Post-its, I will try to summarize the major flaws of Stout's book, with an example of each.

1. She casts doubt on her accuracy by using outdated references. While she has a few (mostly non-psychology) references from after 2001, the majority are references from the 1990's, and some hail from the 1960's. I'm all for an historical perspective, but research on cortical functioning from 1962, if still considered accurate, should be backed up by more contemporary studies. Most surprisingly, on page 6 she cites DSM-IV as the current edition of the Diagnostic and Statistical Manual. As a psychologist in practice, she ought to be well aware that the current edition of DSM, DSM-IV-TR (Text Revision) was published in 2000 (that's 5 years before her book was published). She is out of standard of practice. Further, the information she cites, apparently from the DSM, is incorrect. Stout asserts that the rate of antisocial personality disorder is 4% (p. 6, no citation given). She then moves into a discussion of the DSM criteria for this disorder. I don't have a DSM-IV handy at the moment, but as luck would have it, I do keep a DSM-IV-TR in the house. It reports the rate as "about 3% in males and about 1% in females" (DSM-IV-TR, p. 704). That would be a prevalence rate of 2%, or 50% lower than her assertion here and throughout. She also characterizes this disorder as "a noncorrectable disfigurement of character" (p. 6). DSM-IV-TR reports that it "has a chronic course but may become less evident or remit as the individual grows older.... there is likely to be a decrease in the full spectrum of antisocial behavior...." (DSM-IV-TR, p. 704). Even if she doesn't agree with this conceptualization, she needs to clarify the dispute, and take measures not to appear to suggest that DSM is the source of her information. Egregious errors like these immediately make me question the quality of her scholarship.

2. It is over-generalized and sensationalized. She uses the word "insane" to describe all sociopaths, including those who are parasites rather than aggressors. If her contention is that lack of conscience equals insanity, this ought to be a more central premise, and more clearly explored. Though she avoids exclamation points, at many points the book still reads as if she's shouting.

3. She poses rhetorical questions and then answers them with reference to how "we" all agree with her assertion. We don't.

4. Overgeneralization, part 2. She does not adequately differentiate between sociopathy and passivity plus entitlement. While she does describe some differences between sociopathy and narcissism, she does not explore many other reasons that a person might be construed to be sociopathic, but actually be something else. She glosses over the cycle of violence model in which being abused as a child may cause the person to abuse others as an adult, failing to delineate why a person with complex PTSD or Borderline Personality Disorder might engage in behavior that appears sociopathic, but isn't. She does not address autism spectrum disorders and their possible relationship to, or confound of, her definition of sociopathy. She notes the high rate of sociopaths in a prison population, but does not address the high rate of ADD in the same population, or explore whether these are alternative, overlapping, or coincidentally occurring characterizations of the same people.

5. She seems almost oblivious to the conscience-dulling, judgment-impairing effects of substance abuse, which she mentions only in passing (on p. 105, for example, she raises and then dismisses it out of hand). Stout seriously undermines her argument by citing statistics on sociopathy, then describing behaviors that may have varied etiologies, and ascribing the lion's share of distasteful interpersonal behavior to sociopathy.

6. Stout describes sociopaths' higher mean Pd scale scores on the MMPI, which is all well and good. She does not mention that psychologists and police also have higher means on this deviancy score on the MMPI than does the average person. So does a person with a history of illegal sunstance use, even if they've stopped. So does a gay person or anyone whose behavior does not toe the social line or has caused them to stand up to even unjust authority (more on this below).

7. She equates sociopathy with evil. This is problematic if, as she asserts, the research suggests a high heritability for sociopathy. Is evil genetic? Apparently she believes that it is.

8. Statements such as this make me want to hurl the book across the room: "...hundreds of thousands of brand-new Americans are now living the insecure existence of unwanted children simply because a physical appetite eclipsed their parents' consciences for just a few minutes in each case" (p. 54). Has she never heard of rape or coersion? Of failure to use adequate birth control for religious reasons? Of poverty and its effects on both birth control and the means to raise a child?

9. She castigates sociopaths for not following the rules, but one of her admonitions to people trying to resist sociopaths, whom she sees as gravitating to positions of power and control, is not to follow the rules. Not only is this contradictory as expressed, but failing to follow the rules of an authority, even if that authority is a sociopath, will earn you a higher score on the aforementioned Pd scale of the MMPI.

10. In her "Thirteen Rules for Dealing with Sociopaths in Everyday Life," she does not mention an important rule that, if followed, would have decreased much heartache an damage in her extended case studies: If you discover that you have been compromised by a sociopath, admit it. Nobody wants to admit their bad behavior, indiscretions, or blackmailable offenses, but be a mensch and take the rap. I would argue that covering for a sociopath (or your own bad judgment) keeps you vulnerable and perpetuates the offender's power to negatively affect others. I think, if pressed, Stout would say that people who allow themselves to be coerced in this way are not sociopaths because they feel shame. This is cold comfort to whomever the sociopath next compromises or harms.

I enjoyed Stout's philosophical musings and attempts at theory-building, though I don't agree with all of them. The weakest chapter by far is the Introduction. A good editor could have helped her make this tighter, though I would still disagree with some of her basic premises.

If you want a good book on personality disorders, you'd do better with the David Shapiro's classic text, Neurotic Styles. More empathic toward its subjects, this was the work that led to the codification of "personality disorders." It is well-written (though you may disagree with some of *its* basic premises) and substantially warmer, though more formal in tone.

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Product Details

ISBN:

9780767915823

Subtitle:

The Ruthless Versus the Rest of Us

Author:

Stout, Martha

Author:

Martha Stout, Ph.D.

Publisher:

Broadway Books

Subject:

Personality

Subject:

Mental Illness

Subject:

Psychopathology - General

Copyright:

2005

Publication Date:

March 2006

Binding:

Paperback

Language:

English

Pages:

241

Dimensions:

8.00x5.28x.56 in. .42 lbs.