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Dear Dr. Robert Saltzman,

I have recently ordered the book "The psychopathy of everyday life" by Dr. Martin Kantor and while I have not received it yet, I have already started doing some initial research and read some reviews.

Pretty much this author's professional opinion states that the the car salesman who knows the cars he sells are lemons, the ruthless businessman who dupes the public and barely skirts the law, a surgeon who performs unnecessary surgery, etc are essentially "mild psychopaths"

So my question to you is, can some mild psychopaths have a conscience, love others, and be empathetic?

Based on what Dr. Martin Kantor wrote, I seem to have some mild psychopathic tendencies. Before I learned about his book, I felt that my tactics were Machiavellian at worst and pretty normal in a business environment.

I am a successful businessman based in California that is involved in Internet advertising and marketing. I have founded my own successful business and employ about 250 employees

Unfortunately, our business practices are pretty ruthless and we were never established to serve the consumer, but rather to satisfy the advertisers who pay us to run their campaigns.

We offer a lot of "unique" services that our business associates requested, and I will not detail these services because this email may be potentially publicly viewable. However a more generic service we offer is adware distribution. One division of our company assists our associates in developing "Ad supported software" that comes bundled with adware.

Part of our responsibility is to develop the software in such a way where it complies with all laws, but is still pretty misleading. One job we did in particular for a client involved us integrating our adware solution into their online game. There were terms and conditions that described everything in detail, but all the user was required to do was check a box that said "I have read and understood the terms and conditions". A link was offered to the terms and conditions, but how many people do you honestly think actually took the time to read the terms?

The fact that consumers are willing to be ignorant and will blindly click or check "I accept" presents the opportunity to fleece them without breaking any laws.

We're not the first company to do this type of stuff of course. Plenty of check cashing businesses do the same thing, and it's much worse because consumers are sent deep into debt rather than simply being mildly annoyed.

Another good example of questionable things that my company does under my watch and approval are the advertising campaigns we run with Ringtone companies. The ringtone companies know they can't market their useless ringtones as free and charge money for it. That would be fraudulent. However they can do the next best thing: Be vague about the price.

A typical ringtone ad campaign will target users aged 13 to 30 and will heavily play up the fact that no credit card is required, that the user can obtain instant access, and that they can choose ringtones offering music clips from top artists. We are never allowed to mention the price, and always have to play up the fact that the user is "eligible" for 10 complimentary ringtones.

The above doesn't sound TOO bad, until the user actually goes to sign up. All they need to do is type in their cell phone number and press confirm. After that they will receive a special pin code to their cell phone and can begin downloading tones.

Most users think that you have to use a credit card to be charged for anything online, and that is simply not true. What most users signing up for the ringtones didn't realize is that the service costs $10 per month billed directly to their cell phone bill. The cost for the service was outlined in the terms and conditions which is viewable on the same web page without scrolling, but the design is done in such a fashion where the user's eyes will be focusing on flashy graphics and not the fine print.

Many adult sites also pull such stunts, and we have provided support for them as well.

So as you can see, a lot of my businesses tactics are very questionable and seem to indicate that I could be a mild psychopath based on the above author's opinions. I feel no remorse at all because ironically I'm not the guy being impulsive here--the users using the products and services from my clients are! However these are still pretty deceptive practices that comply with the law but still burden users.

On the other hand, when it comes to interacting with my wife, family, friends, and employees I never do anything that could be considered "psychopathic". Plus on top of it, I know myself better than anyone else. I feel love, anxiety, stress, fear, happiness, sadness, pleasure, pain, guilt, shame, and remorse. Furthermore, I can empathize with others.

I genuinely love my wife, and care about my friends and family. They aren't objects for me to manipulate, they are people with feelings.

I find "true" psychopaths like Ted Bundy or Kim Jong-Il repulsive monsters with no redeeming values. I am aware that "true" psychopaths don't have to be like Ted Bundy, and can be extremely successful in the corporate world. I also find "mild" psychopaths who are in positions of great responsibility to be disturbing. Manipulating someone into signing up for a service that costs $10 per month is completely different from manipulating someone into allowing an unnecessary invasive procedure. There is always a risk with any surgery, and doctors with such disregard for human life should really be ashamed of themselves.

Do you offer therapy over the phone? Can I request therapy over the phone? If so, what are your rates? I would like give further detail to you, but it needs to be in a more confidential setting.

Looking forward to your thoughts, because I am pretty confused about this.

Very Truly Yours,

[name withheld]

Dear [name withheld]--

Before being able to reply to your question, "Can some mild psychopaths have a conscience, love others, and be empathic?" I must tell you that the old diagnosis of psychopathy has been replaced, in the Diagnostic and Statistical Manual (DSM) of the American Psychological Association (APA), by a newly created diagnosis called Antisocial Personality Disorder (in the World Health Organization's ICD-10, this is called Dissocial Personality Disorder). In other words, according to the APA, there are no psychopaths—mild or severe--only antisocial personalities, and, as I will try to explain, this is much more than a mere change in terminology.

In the previous diagnostic nomenclature, psychopaths were people who lacked all compassion, and had no ability to love or even to care at all about others. In other words, the psychopath saw others merely as pawns on a chessboard to be moved around only for the benefit of the psychopath, regardless of how much the "pawn" might be hurt or suffer. And so, the diagnosis of psychopathy was based not on evaluating outward behavior, but on determining how such people saw the world and the people around them. Simply stated, a psychopath was someone who not only lacked empathy and the ability to love, but also felt no guilt and very little anxiety, both of which are present in the vast majority of human beings.

That was how a psychopath was diagnosed: by looking into the inner, psychological world of the person in question, not by evaluating actions, for students of this personality type generally understood two things about psychopathy:

1. that two people could engage in the same bad behavior, and that one might be psychopathic and the other not according to whether or not such a person felt guilt and anxiety while carrying out the action.

2. that someone could be psychopathic without seeming to do much real harm at all, or even be seen as doing "good." A common example might be the kind of clergyman who becomes rich at the trade of priestcraft by manipulating his flock (what a rich metaphor) to pay for his lavish lifestyle, and who meanwhile feels nothing--no guilt, no anxiety--about bilking people in this holy con-game--even when some believers are going without necessities in order to throw money into the collection plate.

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By the way, number 2 demonstrates how the "antisocial personality" label, which requires evaluating only how the person's behavior impacts others, and says nothing about the inner experience of that person, discourages the process of hearing, seeing, and understanding someone, which is the very essence and sine qua non of psychotherapy. The DSM-style perspective regards such human beings as little more than defective cogs in the social machine. As long as the psychopathic preacher cannot be charged with theft, child abuse, getting into too many barroom brawls, or the like, he will never qualify for the antisocial personality diagnosis. In fact, unless he had begun to show antisocial behaviors before the age of fifteen--another part of the criteria set for APD--he cannot ever be diagnosed with APD at all, no matter what he is like or what he does as an adult. Clearly he is psychopathic--he feels no compassion, and only pretends to care about others, while actually bilking them, using them, and manipulating them without anxiety or guilt, but the correct diagnosis--psychopathy--no longer exists according to the DSM.

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Unfortunately, the American Psychological Association seems not just uninterested, but actively hostile to the approach of depth psychology which attempts to investigate not only behavior, but also motivation and inner experience. The APA definitions of personality disorders promulgated in the DSM are based almost entirely on observation of external behaviors, showing little or no interest in the inner, emotional world of the person to be diagnosed. For example, the criteria set for a diagnosis of APD includes such phrases as "failure to conform to social norms," "repeatedly performing acts that are grounds for arrest," and "irritability and aggressiveness, as indicated by repeated physical fights or assaults," while including only one mention of an intrapsychic characteristic--"lack of remorse"--and this one item, which is a central feature of psychopathy, is not even required to make the diagnosis. And so we now have conduct disorder and antisocial personality disorder, but no psychopathy.

By the way, as a depth psychologist who is profoundly interested in human motivation and inner experience, and who considers that a diagnosis demands an understanding of the psychodynamics of the patient as well as his or her behavior, I rarely use the DSM in my own practice—the last time I consulted it I had, literally, to wipe away the dust first. Regrettably, because almost all insurance companies demand a DSM diagnosis before they will pay for services, the DSM has become hugely influential, and distorts terribly, in my experience, the way that many psychologists and psychiatrists understand and treat their patients.

When the diagnostic protocol emphasizes external behavior, then the treatment will be based on changing that external behavior instead of trying to grasp the meaning of the behavior and what that behavior may indicate about the inner world of the patient. For example, if a child has, according to the DSM, a "conduct disorder" (which means basically that he or she gets into trouble at school or with other authorities), the kind of psychologist for whom the DSM is a bible will try to find a medication to prescribe aimed at altering the child's "conduct," and perhaps not spend even a moment trying to enter, empathically, the inner world of that troubled child in order to find out where the pain is. That kind of approach, which tends to reduce troubled human beings to erratically running machines in need of adjustment, is, in my opinion, unconscionable, and tantamount to malpractice, but these days mine is a minority view I fear.

Now I am not saying that there is no room for a diagnosis called Antisocial Personality Disorder; perhaps there is. I merely mean to say that a diagnosis of APD is no substitute for one of psychopathy, and so the two must be distinguished from one another--separated, not conflated, as the APA has done. As the APA now has things, Antisocial Personality Disorder includes both people who are and who are not psychopathic, but leaves out many who are psychopathic, and psychopathy, as a separate diagnosis, does not even exist.

"Antisocial behavior" and psychopathy are simply not the same. I believe that much antisocial behavior is largely a manifestation of poor impulse control, or being somehow out of control, whereas the psychopathic personality type may have excellent self-control, but simply lacks very much feeling at all for others, allowing him or her to act with total ruthlessness. Some people manifesting antisocial behavior may not choose that behavior, but instead simply are not able to resist the impulses and desires which lead to the behavior. But later, recognizing that others have been hurt by the behavior, such a person might feel guilt or remorse about the harm caused, whereas the psychopath never feels guilt, and if he or she appears to feel guilt, that is simply role-playing, a feigning of a normal human emotional state, a false character assumed for the purposes of deceit. In other words, psychopaths can and do express feelings of remorse, empathy, and guilt without actually going through the associated feelings.

To give an example of this vital distinction, two men may both rob liquor stores at gunpoint and end up killing the clerk (I have spoken at length with such people). One may feel sorry that the clerk is dead, may feel guilty, may even pray to God for forgiveness, but will rationalize the crime to himself by saying, for example, "I had to have more crack, and the liquor store was my only source of money. I had to rob it. I never meant to kill anyone." But the psychopath will experience no need for rationalization of his actions, except, perhaps, as window dressing. "I kill when I need to," will be his private feeling regardless of what public face he may assume. I am simplifying a set of very complex issues here, but you get the idea, I hope: two people may behave in similar antisocial ways, and may cause equal amounts of harm by their actions, but the psychodynamics behind the behavior may be quite different, requiring different treatment, and if this is not seen, how can the treatment really be appropriate?

That said, let me try to respond to your question. After receiving your letter, I took a look at Dr. Kantor's book. Apparently his idea was to create a new diagnostic category to cover people who cannot receive a diagnosis of antisocial personality disorder because their behaviors are not harmful enough to meet the DSM criteria. As Kantor put it, "Patients with antisocial personality disorder resemble hardened criminals. Their crimes often involve direct aggressive acts toward individuals and may even go beyond committing mayhem to committing murder. In contrast, mild psychopaths are more like ordinary schemers and conners. . . [such as ad writers who speak partial truths]. . . ." (p. 24).

In other words, Kantor seems to agree with the APA in looking at antisocial personality disorder as a diagnostic replacement for psychopathy, so that mild psychopaths are simply less psychopathic than people with antisocial personality disorder who he imagines must be more severe psychopaths, like "hardened criminals." Since I have just explained my opposition to replacing the diagnosis of psychopathic personality with one of antisocial personality (because someone's behavior can be severely antisocial and terribly harmful without being in any way psychopathic), I cannot agree at all with this idea which, in my opinion, adds nothing, leads nowhere, and simply compounds the American Psychological Association's original error by creating yet another diagnosis which is judgmental instead of explanatory, and which obscures the inner world--the psychodynamics, that is--of the person in question.

The utter uselessness of Kantor's new diagnostic idea--or was it really just an idea to sell books?--can be seen in a later chapter called "The Psychopathy of Everyday Life" (which, by the way, is a rather clever lift of the title of a book by Sigmund Freud—probably his most famous—The Psychopathology of Everyday Life, leading me to wonder if Dr. Kantor is perhaps himself a mildly psychopathic plagiarist). In this chapter, Kantor attempts to give examples of what he calls mild psychopathic behavior. But most of the examples cite behaviors which, in my view, have nothing whatsoever to do with psychopathy. Here are some examples of "mild psychopathy," according to Kantor (pp. 57-71):

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  1. a patient who sees more than one doctor in order to get more than one prescription for a medicine they like and want.

  2. lawyers who can argue both sides of a case using two opposite arguments.

  3. an author who garnered media publicity by handing out free copies of his book in places where the TV cameras were running.

  4. people who invite friends for dinner, buy prepared food, add a little spice, and pretend that they cooked the meal from scratch.

  5. amateur body builders who use steroids in order to show off at a gym.

  6. workers who call in sick when they are not.

  7. a "pseudoactivist" who is more motivated by a need to battle the establishment than by the real need for reform.

  8. people who drink not so much to get high as to disinhibit themselves so that they can behave wildly and have fun.

  9. some who puts personal trash in a construction site's dumpster.

  10. the composer, John Cage, because his works are little more than instructions to the players to play anything they like.

  11. a publisher who puts the more famous author's name first on the book cover although the less famous author did more of the work.

  12. editorial writers who first form a conclusion and then form their argument around it instead of weighing both sides of the issue.

  13. an art dealer who told Dr. Kantor that a painting he wanted to buy cost $4800. while the dealer's partner told him it cost only $4000.

  14. Bill Clinton because he claimed that since he did not inhale he really had not smoked marijuana.

  15. a person who adopted cats and then let them run free.

  16. etc.

To my mind, the absurdity of this list is apparent and does not even require comment. But I will comment. The patient who goes prescription shopping may be a drug addict, but that does not make her a psychopath. A lawyer who can argue either side of a case is simply doing her job which is to represent her client's interests, not to seek the "truth," which is the job of the court, not the lawyer. An author who gets publicity by handing out free books is clever, not psychopathic—or, to be more accurate, such a person may be a psychopath, but simply handing out free books is not indicative of psychopathy in any way. I fail to see any difference between drinking to "get high," and drinking to "disinhibit" oneself; perhaps Dr. Kantor can explain. If someone who ever put personal trash in a construction site dumpster is, by definition, a psychopath, the world is awash with psychopaths.

Enough said about his examples—Kantor's "mild psychopath" diagnosis is nonsense, and illustrates the damage done to psychological insight when behavior, in lieu of psychodynamics, becomes the focus of diagnostic scrutiny. Kantor wants a "mild psychopath" to be a person who calls in sick when he or she is not, or someone who pretends that a store-bought dinner is really a personal creation. Balderdash! Those behaviors seem normal, and, along with the other items on the list, have nothing to do with psychopathy. In fact, his use of that term, "psychopathy," in such inappropriate ways seems to raise the question of whether Kantor, notwithstanding his authorship of a book with the word "psychopathy" in the title, has much first-hand knowledge of what an actual psychopath--one of the countless millions of them around our planet--is like or how such a person experiences the world.

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Now, a bit about your situation. Without knowing you personally, I cannot make a firm diagnosis. However, judging from what you have said about loving your wife, friends, and family, I doubt very much that you are any kind of psychopath, "mild" (what nonsense!) or not. I agree that your business practices are, as you yourself have evaluated them, "pretty ruthless," but as I understand things, your customers are not the consumers of the software, but the advertisers who pay you to run their campaigns. Those with an absolute obligation to treat the consumers fairly, are, in my view, the sellers of the software who ought to alert their customers that their software may contain unwanted code; you, technically speaking, do not have that obligation, at least as I understood your letter.

Nevertheless, the tone and content of your letter indicate that you are not comfortable ethically with your business methods. That discomfort is part of the price you pay for the money you earn. If you were in a different business, or if you conducted your business with more attention to scrupulous principles, you might earn less, but be happier with your own conduct. This kind of thing might be a good topic for some psychotherapy, but that therapy would not be aimed a treating psychopathy, but simply at broadening your understanding of a "good life," and of giving you more power and more scope to live one.

I sometimes do telephone therapy, but usually with clients whom I have seen personally earlier and who are away temporarily or who are now living elsewhere. However, if you would like to speak in further detail—and perhaps a bit more openly and honestly—about what really is hanging you up, send me another email, and perhaps we can arrange something.

Be well.

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