Bad Boys, Bad Men This page intentionally left blank Bad Boys, Bad Men CONFRONTING ANTISOCIAL PERSONALITY DISORDER Donald W. Black, M.D. with C. Lindon Larson New York Oxford OXFORD U N I V E R S I T Y PRESS 1999 Oxford University Press Oxford New York Athens Auckland Bangkok Bogota Buenos Aires Calcutta Cape Town Chennai Dar es Salaam Delhi Florence Hong Kong Istanbul Karachi Kuala Lumpur Madrid Melbourne Mexico City Mumbai Nairobi Paris Sao Paulo Singapore Taipei Tokyo Toronto and associated companies in Berlin Ibadan Copyright © 1999 by Oxford University Press, Inc. Published by Oxford University Press, Inc., 198 Madison Avenue, New York, New York 10016 http://www.oup-usa.org 1-800-334-4249 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. Library of Congress Cataloging-in-Publication Data Black, Donald W., 1956- Bad boys, bad men : confronting antisocial personality disorder / by Donald W. Black with C. Lindon Larson. p. cm. Includes bibliographical references and index. ISBN 0-19-512113-9 1. Antisocial personality disorders. 2. Men—Mental health. I. Larson, C. Lindon. II. Title. RC555.B53 1999 616.85'82-dc21 98-23579 9 8 7 6 5 4 3 2 1 Printed in the United States of America on acid-free paper To the memory of the late George Winokur, my friend and mentor. This page intentionally left blank Contents Acknowledgments, ix Introduction, xi 1. A Lurking Threat: Antisocial Personality Disorder and Society, 1 2. Searching for Answers: The Evolving Psychiatric View of Antisocial Personality Disorder, 15 3. Bad Boys to Bad Men: The Symptoms of Antisocial Personality Disorder, 33 4. Naming the Problem: The Diagnosis of Antisocial Personality Disorder, 57 5. Divergent Paths: The Natural History of Antisocial Personality Disorder, 77 6. Seeds of Despair: The Causes of Antisocial Personality Disorder, 101 7. Overcoming Antisocial Personality Disorder: Options for Treatment, 123 8. Power and Pretense: The Hidden Antisocials, 145 9. The Antisocial Murderer: Gacy and Others, 159 10. Antisocial Personality Disorder and Families: Finding Ways to Cope, 181 Epilogue: Dispelling the Myths, 199 Notes, 207 Recommended Readings, 229 Index, 232 This page intentionally left blank Acknowledgments he idea for this book came to me more than 10 years ago Arhen I began my research with antisocial men. None of the TIb ookso n antisocial personality disorder (ASP) was suitable for the general public except Hervey Cleckley's The Mask of Sanity, out of print since 1976. His book remains compelling reading, but much has happened since it was first published in 1941, including the seminal research that has defined ASP as we now know it. In studying antisocial men, my research team and I collected an enormous amount of data. As the project came to a close, I wrote several manuscripts for medical journals. After submitting them for review, I was told by one respected but now deceased editor of a major journal that the papers contained too many "chatty" anec- dotes and were not written in the "concise, bullet-like language" of scientific journals. I gave a spirited defense of my work and replied that scientific journals are typically dull, as well as inaccessible to the lay person. I would not apologize for writing interesting manu- scripts. The response backfired, as the editor felt I was overly defensive. A kind man, he suggested that I consider writing a book. The idea gelled, and I have since worked steadily to write down the thoughts and ideas that had been on my mind for many years. My goal has been to educate readers about a serious but underappreci- ated health problem and to help people with antisocial personality disorder and the millions of others whose lives are affected by them. I am grateful to the many people who helped me write this book. The late George Winokur, former head of psychiatry at the University of Iowa, provided enormous guidance from my initial conception of the book through the actual writing. I am indebted to my colleagues Remi Cadoret and Raymond Crowe for their pio- neering genetic research on ASP. My interactions with them over the years have been of tremendous influence. My colleague Bruce