Shaili Jain, MD, is a Stanford/Veterans Affairs Palo Alto Health Care System psychiatrist and a fan of the television show "House of Cards." These two worlds come together in a recent blog entry she wrote on Kevin Spacey's sociopathic character and the psychiatric diagnosis of antisocial personality disorder. Jain, an affiliated faculty member of Stanford’s Program on Arts, Humanities, and Medicine commented to me that the show represents a compelling example of the intersection of entertainment and medicine.
Noting in her Mind the Brain blog post that she always likes to "explain misunderstood psychiatric concepts or diagnoses, and to clarify when a psychiatric term is used incorrectly or prone to misinterpretation," Jain writes:
While enjoying the second season of House of Cards, I could not help but notice how Kevin Spacey’s character, Frank Underwood, meets a textbook definition of Antisocial Personality Disorder (ASPD). Inspired by Spacey’s tremendous performance, I thought I would venture forth and use this example of a central character in a drama to illustrate this misunderstood and, often, underestimated psychiatric disorder. Individuals with antisocial personality disorder (or sociopaths) are difficult and dangerous; they deny, lie, and contribute to all manner of mayhem in our communities and societies. They know full well what is going on around them and know the difference between right and wrong (and hence are fully responsible for their own behaviors) yet are simply unconcerned about such moral dilemmas.
When Frank wants something or needs to manipulate someone, he is able to “switch on” the charm in an instant. He conveys to others that he cares deeply about them by flashing an infectious smile and being gracious and attentive.
And, as season 2 showed, there were many who fell prey to his deceit…not least of all the President of the free world. Perhaps nowhere is his charisma more evident that in the perverse loyalty of those in his inner circle; all turn a blind eye to what he is capable of and appear to be utterly captivated by his personality and presence.