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delivery (and reimbursement).
    Psychiatric logic is that if it’s a disease, only a physician should treat it. This exact argument was used decades earlier, unsuccessfully, when psychiatrists tried to restrict non-M.D.’s from practicing psychotherapy. Today few psychiatrists would claim any primacy in the delivery of the “talking cure,” and in fact many psychiatrists denigrate psychotherapy as a lower-level service best relegated to paraprofessionals (under a psychiatrist’s supervision, of course).
    As part of the campaign to medicalize deviance, the American Psychiatric Association began producing a series of
Diagnostic and Statistical Manuals
, small-print, phone-directory-sized tomes chock-full of numerical diagnostic codes easily adaptable for computerized insurance billing. Known as DSMs—the current model is number IV—these volumes have become the billing bibles of the mental health industry.
    I am not dismissing the DSMs as mere political tools. Much of the research they’ve generated is excellent and has gone a long way toward getting mental health professionals to think scientifically about psychological disorders.
Any
systematic classification is certainly an improvement over the sloppy, often opinion-based diagnostic taxonomy of the past.
    The problem is one of overzealous application: Some disorders simply don’t lend themselves to the disease model, and nowhere is this truer than in the case of psychopathy/sociopathy, which, whether you view it as a dysfunction of the individual or as a reaction to societal oppression, or even as chemistry gone wrong, persists in sounding a lot more like nasty behavior than an illness.
    That, of course, creates tremendous cognitive dissonance among psychiatrists, psychologists, and other mental health workers. It’s an economic threat as well. Why pay clinicians of any stripe to treat meanness and viciousness, or acts of protest grounded in the struggle against oppression?
    Hence a new syndrome:
antisocial personality disorder
(DSM 301.70), or APD.
    Let’s examine the DSM description of APD: “A history of continuous and chronic antisocial behavior in which the rights of others are violated, persistence into adult life of a pattern of antisocial behavior that began before the age of 15, and failure to sustain good job performance over a period of several years (although this may not be evident in individuals who are self-employed or who have not been in a position to demonstrate this feature, e.g. students or housewives). The antisocial behavior is not due to either severe Mental Retardation, Schizophrenia, or manic episodes.
    â€œLying, stealing, fighting, truancy, and resisting authority are typical early childhood signs. In adolescence, unusually early or aggressive sexual behavior, excessive drinking, and use of illicit drugs are frequent. In adulthood, these kinds of behavior continue, with the addition of inability to sustain consistent work performance or to function as a responsible parent and failure to accept social norms with respect to lawful behavior. After age 30 the more flagrant aspects may diminish, particularly sexual promiscuity, fighting, criminality, and vagrancy.”
    Take two life sentences and call me in the morning.
    Call them psychopaths, sociopaths, or antisocial personalities—these are the people we think of as bad.
    I will continue to call them
psychopaths
, because the term
antisocial personality disorder
is unwieldy, bland, and lends no more insight than did
sociopathy
. And because
psychopathy
has a nice, novelistic ring to it. It’s a juicy term, connotative of evil, and this is a juicy, evil creature we’re dealing with.
    Let’s take a closer look at the beast.

VI
    Dissecting Evil
    Researchers have identified two distinct components of psychopathy: the
impulsive
aspect, featuring lack of self-control and delay of gratification, failure to respond to long-term punishment,