Rage (13 page)

Instead, she described these children as “hyperactive” because they carried out “activities at a higher rate of speed than the average child, or [were] constantly in motion, or both.” Chess theorized that hyperactivity could be the result of any number of factors and that brain injury is just one of them. Although her ideas were quickly accepted in the United States, European doctors held on to the older idea that hyperkinesis (as they called hyperactivity) was always the result of injury or defect until the late 1980s.

Chess spent the rest of her life trying to help what she called “difficult” children. She wrote books with titles like
Know Your Child
,
Your Child Is a Person
and
How to Help Your Child Get the Most Out of School
. She continued the Longitudinal Study, maintained a private practice and worked as a professor at New York University’s Child Study Center. When her husband and partner died in 2001, the university offered her emeritus status. She refused so that she could continue her daily work. Chess died March 14, 2007, aged 93. Her colleagues suspected as much because it was the first day in decades she didn’t show up for work on time.

But while Chess and her colleagues did much to illuminate the dark world of hyperactivity, they couldn’t figure out exactly what caused it. And, since nobody was sure what caused hyperactivity, there was little anybody could do about it.

At the time, the standard treatment was therapy. It wasn’t all that effective, but there was little else they could do. Help came, ironically enough, from a stimulant.

Chemical stimulants were in high demand in World War II—every one of the major armies fed their soldiers amphetamine, methamphetamine or even cocaine to keep them alert and confident in the face of combat. Nobody denied that the drugs worked and, in the heat of battle, side effects were not considered important.

In 1944, a Swiss company called Ciba—later Ciba-Geigy, now part of the enormous Novartis firm—developed a new, easy-to-produce stimulant called methylphenidate (MPH).

Working on the same process as cocaine—preventing the brain’s natural dopamine re-uptake hormones from doing their job, allowing the user to enjoy greater and longer amounts of dopamine, a hormone that increases energy and confidence—MPH was considered just one of the era’s many wonder drugs. It lacked cocaine’s immediate rush of euphoria, took longer to take effect, stayed in the body longer and was nowhere near as habit-forming.

After the war ended in 1945, many of these stockpiled stimulants were put to work in civilian markets, treating everything from narcolepsy and depression to impotence and the sniffles. MPH was put on the market under the name Ritalin in 1957.

Just like cocaine a few generations earlier, Ritalin was specifically prescribed to treat chronic fatigue, depression, psychosis associated with depression, and narcolepsy. Though effective for all of those purposes, Ritalin wasn’t an immediate commercial success, largely because of the existence of cheaper and better-established amphetamine-based drugs serving the same purposes. Ritalin did find a niche in hospitals and rehab centers because of its ability to offset the sedating effects of other medications. It was especially effective and in demand for reviving the victims of barbiturate overdose—a significant concern as “downers” were a prominent recreational drug at the time.

But as Chess’s theories about hyperactivity gained increasing acceptance, researchers looking for a treatment experimented with all kinds of drugs. Ironically, the only one that seemed to calm and slow hyperactive children was Ritalin, which they knew was a potent stimulant. Nobody knows for sure why Ritalin helps ADHD patients, but the prevailing theory now is that people with ADHD have more dopamine transporters than other people and that the excess of transporters starves the brain of dopamine by spreading it too thin. While the increase of dopamine may stimulate those without ADHD, it basically brings those with the disorder up to a place we might consider “normal.”

Despite the side effects (which can include stunted growth and hallucinations) and the potential for addiction, Ritalin almost immediately became a popular prescription for children with ADHD. Doctors began prescribing Ritalin in the 1970s and usage steadily increased. As media attention portrayed Ritalin as the latest wonder drug, and as parents statistically spent less and less time with their children, usage exploded. From 1991 until 1999, sales of Ritalin rose by 500 percent, mostly in the United States.

While few deny that Ritalin works to control the symptoms of ADHD, a significant number of people (including many in the media and some medical professionals) have opposed what they feel is the rampant overprescription of the drug. And, since Ritalin acts as a powerful and admittedly enjoyable stimulant for those without ADHD, its prevalence has created an illicit market for the drug where none existed before.

I spoke with a psychiatrist I know from New York and asked him what he thought of Jason. He told me he wasn’t stupid enough to try to pass a diagnosis on a child he’d never met; but that he would tell me a little bit about mental illness if I didn’t use his name. He told me he had run into a lot of “problem children,” especially when he was working in the emergency room of a busy urban hospital. “All children are a little self-centered, especially when they are stressed,” he said. “But you can tell which ones don’t care about anyone other than themselves.”

He told me that kids who show many of the same symptoms Jason did may be lucky if all they have is ADHD, as it generally fades as the child gets older and they always have the Ritalin option. The same symptoms, the doctor told me, could be a reflection of something worse—something potentially much more dangerous and even less likely to respond to any form of treatment. And sadly, something statistically just as likely to occur as ADHD. The doctor from New York began to tell me about Antisocial Personality Disorder, or APD.

As the name obliquely implies, sufferers of APD have a problem with other people. While the existential philosopher Jean-Paul Sartre once famously wrote, echoing the frustrations of millions, that “hell is other people,” people with APD don’t occasionally get fed up with society; they just don’t get it at all.

But it’s more than that; specifically, APD is defined as a disregard for social rules, norms and cultural codes, along with impulsive behavior and an overall indifference to the rights and feelings of others.
The Diagnostic and Statistical Manual of Mental Disorders
(
DSMMD
), the bible of modern clinical psychiatry, indicates that a diagnosis of APD may be safely made if a patient shows just three of the following seven symptoms:

Basically, a person with APD lacks empathy—the ability to care for or identify with others. He or she feels no guilt, no pangs of conscience after he or she has caused harm to others. Of course, if a person feels no guilt, it’s much easier for them to commit crimes. And, not surprisingly, many serial killers and others who have profoundly offended society have been diagnosed with APD. But the
DSMMD
makes it perfectly clear that APD can not legally be diagnosed in patients younger than 18. Of course, this is to prevent confusing APD with ADHD, and to keep a child’s life from being unfairly stigmatized by an incorrect diagnosis.

But that doesn’t mean that children can’t have APD, or show signs they’ll develop it later in life. Back in 1963, a psychiatrist named John MacDonald published an article in the
American Journal of Psychiatry
called “The Threat to Kill.” In it, he wrote about the data from his studies that showed that the overwhelming majority of murderers—and the frequency was higher among the more sadistic killers, the ones most likely to exhibit the traits of APD—shared three particular and peculiar traits. MacDonald found that the people who later exhibited severe criminal behavior and/or APD often wet their beds, set fires and exhibited significant cruelty to animals as children. While many children may experiment with animals—say, pull the wings off a fly to impress or repulse their peers—MacDonald made it clear that what he was talking about was real zoosadism, acts of cruelty to larger, more human-like animals such as cats and dogs, often alone and with the intent of pleasing the self and not others.

While any of these behaviors by themselves could be attributes to a lack of self-discipline or an excess of curiosity, when the three are seen together, they set off red flags among psychiatrists. They should; such notorious killers as Albert “The Boston Strangler” DeSalvo, John Wayne Gacy, Jeffrey Dahmer and others exhibited all of them.

But not everybody with APD exhibits the symptoms of the MacDonald triad, admits to them or is caught at them. The condition can be much stealthier than that. And those affected can be great liars. Often, a person with APD can blend into the rest of society seamlessly—or almost so. It can take the form of the overaggressive, nitpicking manager; the constantly interrupting and one-upping aunt; the co-worker who blames everyone else for his mistakes; or the housemate who raids the communal fridge at night. Since recent studies show that about 5.3 per cent of men and 1.8 per cent of women show the symptoms that indicate APD, it’s not out of the question to surmise that we all know at least one, and most of us have one or even some in our family.

Traditionally, our culture has recognized two types of people with APD. The medical community, which nowadays shies away from calling people names, has largely abandoned these titles, but they are familiar to most people—sociopath and psychopath.

The difference is in presentation. A sociopath is someone who—often unashamedly—makes it clear that he or she has APD. We’ve all seen them. While lots of people will adopt outward signs of rebellion such as piercings, tattoos or a mode of dress, sociopaths usually make it pretty obvious they’re not interested in your opinion of them, so much as they are interested in their own opinion of themselves. Our society has built up some collective and tacit knowledge of sociopaths—while there’s no guarantee that a guy with a swastika tattooed between his eyebrows is dangerous, pretty well everyone is going to give him a little extra room on the subway.

But not all sociopaths are obvious by appearance. Some look very much like everyone else, but have clear behavioral cues. The doctor from New York acknowledges the difference between sociopaths and psychopaths, even if he doesn’t use the names professionally any more. He tells me that if I want to see the difference between the two types, I should research the histories of two killers—Seung-Hui Cho and Ted Bundy.

If you hadn’t known him, Cho would have appeared at first glance to be a fairly ordinary guy—a bit intense and aggressively nerdy, but within the bounds of what most people would call normal. But it became abundantly clear to Julian Poole, who encountered Cho in September 2005 when they were both juniors at Virginia Tech University, that Cho was anything but “normal.” It was the first day of an American literature class and the prof was trying to break the ice and get to know his students by asking them to introduce themselves. Some were nervous, especially at first, and tried to get it over as quickly as possible. But most tried to get a laugh or sincerely offered some insight into their personality. When it came to be Cho’s turn, he merely stared angrily at the prof. It was a horrible, awkward silence that seemed to last for a very, very long time. Finally, with a nervous chuckle and a long-forgotten disarming comment, the prof moved on to the next person. Later in the same class, the students were obliged to write their names on a seating assignment map. Poole, curious to learn the name of his silent and defiant student, noticed that Cho put a question mark where his name should have been. It apparently didn’t escape the prof ’s notice, either. According to published reports, the school’s faculty started referring to Cho as the “Question Mark Kid.”

And he wasn’t just that way in class. Karan Grewal, an accounting student who lived in the same undergrad suite as Cho in Harper Hall, knew him for months before he realized Cho could speak English. “It was weird that he never spoke, but we’d all got used to it,” said Grewal, who only finally found out Cho spoke English when he peeked over his shoulder while he was furiously typing away on his laptop. “If you talked to him, he would stare down at his lap.”