Clinically a high-functioning sociopath? A case study on BBC’s Sherlock Holmes

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Character Overview:

Sherlock Holmes is a fictional private detective created by Arthur Conan Doyle, and this character is played by Benedict Cumberbatch in the BBC television series Sherlock (Gatiss & Moffat, 2011). As a consulting detective widely reputable for solving crimes, Sherlock is portrayed as smart, attentive to detail, intuitively clever, and consequentially often condescending and arrogant. That said, albeit a great reputation for intelligence and problem-solving, Sherlock tends to be emotionally cold, distant, insensitive, and tremendously unempathetic when it comes to interpersonal relationships or social interactions. In fact, throughout Sherlock, various characters comment that he is “a bloody psychopath”, an “insensitive prat” and “without a heart” (Gatiss & Moffat, 2011-2014). However, given the buzz about Sherlock’s notorious reputation of being “a high functioning sociopath”, does this character really meet diagnostic criteria for such a statement? This case study will closely analyze whether Sherlock clinically meets the criteria for an antisocial personality disorder as compared to an autism spectrum disorder, followed by a detailed analysis of Sherlock’s interpersonal tendencies through an attachment theory lens. Implications for relevance to modern mental health diagnosis and practice will be discussed. 

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Autism or Sociopathy?

Though many fans jokingly subscribe to Sherlock’s self-proclamation of being “a high-functioning sociopath”, I personally do not believe that Sherlock’s character meets the criteria for an antisocial personality disorder, and I think his behavior and tendencies more closely match that of an individual with autism spectrum disorder (ASD). Throughout the show, Sherlock meets various descriptors for autism such as being particularly knowledgeable about topics of interest, lacking general social cues but without malicious intent, preferring familiarity and orderly consistency for certain things, and other such related criteria. Given this, seeing as ASD encompasses many of these tendencies (American Psychiatric Association, 2013), I would argue that Sherlock more closely meets the criteria for autism rather than any form of sociopathy. Briefly, the DSM-5 describes criteria for ASD as follows:

  • Persistent deficits in social communication and social interaction across multiple contexts (i.e. deficits in social-emotional reciprocity, deficits in nonverbal communicative behaviors used for social interaction, deficits in developing/maintaining/understanding relationships).
  • Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following:
    • Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal/nonverbal behavior (e.g. rigid thinking patterns, difficulties with transitions, extreme distress at small changes)
    • Highly restricted, fixated interests that are abnormal in intensity or focus (e.g. strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests)
    • Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment (American Psychiatric Association, 2013)

These criteria must be present along with clinically significant impairment to social, occupational, or other important areas of current functioning. They also cannot be better explained by an intellectual disability, which Sherlock definitely would not meet.

Lestrade: “I suppose he likes having the same faces back together. It appeals to his… his…”
John: “Aspergers?”
-Hounds of Baskerville (2012)

Notably, John also mentions Asperger’s in an episode of the show. Clinically, Asperger’s syndrome has since been integrated into the general description of autism spectrum disorder.

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Contrarily, the DSM-5 criteria for antisocial personality disorder (which is now the umbrella category for both psychopathy and sociopathy) are as follows:

  • A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three or more of the following:
    • Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest
    • Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
    • Impulsivity or failure to plan ahead
    • Irritability and aggressiveness as indicated by repeated physical fights or assaults
    • Reckless disregard for safety of self or others
    • Consistent irresponsibility (repeated failure to sustain consistent work behavior or honor financial obligations)
    • Lack of remorse (i.e. indifference to or rationalizing having hurt, mistreated or stolen from another) (American Psychiatric Association, 2013)

That said, though Sherlock may seem to meet a few of the criteria for antisocial personality disorder, I would argue that his lack of remorse and general unorthodox approach towards social relationships can more closely be attributed to unawareness rather than malicious intent. It is discussed in Essentials of Psychiatric Diagnosis that a common indicator of antisocial personality disorder in earlier childhood would be injuring animals without remorse (Frances, 2013). Contrarily, Sherlock throughout the first three seasons of the show shows a great attachment to the insinuated pet dog from his childhood, Redbeard. In addition, it is arguable that his friendship with John and his devotion to protecting his loved ones from Moriarty—such as faking his death to protect Mrs. Hudson, Mycroft, and Lestrade in “The Final Problem”— also disproves prevailing traits typical of someone with antisocial personality disorder.

“So if I didn’t understand I was being asked to be best man, it is because I never expected to be anybody’s best friend. and certainly not the best friend of the bravest and kindest and wisest human being I have ever had the good fortune of knowing. John, I am a ridiculous man. Redeemed only by the warmth and constancy of your friendship.”
-Sherlock to John, The Sign of Three (2014)

From an Attachment Perspective:

The linked scene above is from Sherlock episode “The Hounds of Baskerville” (Gatiss & McGuigan, 2012). Sherlock and John have been investigating a rumored gigantic hound, which later transpires to be a projected hallucination based on chemicals in a synthetic fog. However, in this particular scene, Sherlock had just stood in the synthetic fog, and believes that he had actually scene a gigantic hound, which defies all scientific reason and is thereby severely unsettling to him. Contrarily, John did not see the hallucination, and attempts to have a regular conversation with Sherlock about next steps in the investigation.

 “I’ve always been able to keep myself distant. Divorce myself from feelings. But you see? Body’s betraying me. Interesting, yes? Emotions. The grease on the lenses. The fly in the ointment.”
-Sherlock to John, Hounds of Baskerville (2012)

In this scene, one principal aspect of Sherlock’s response to his emotional distress is that he is determinedly suppressing his visceral reactions and focusing exclusively on his rational mind, trying to cognitively explain his thinking and why it is reasonable to be distressed. Though the rational mind indubitably plays an important role in emotional tolerance (Wallin, 2007; Howe, 2013), it is noteworthy how Sherlock seems to, in turn, neglect his emotional mind, and does not allow himself to sit with vulnerable discomfort without intellectualizing his experience. This is a tendency that is very central to Sherlock’s character, and arguably intimately related with Sherlock’s attachment style.

John: “Now, why would you listen to me? I’m just your friend.”
Sherlock: “I don’t have…friends.
Hounds of Baskerville (2012)

It is notable to observe Sherlock’s relational coping mechanisms when he is feeling unsafe. As overviewed in Attachment in Therapeutic Practice, individuals can develop ways to regulate their affect through what best works for achieving their needs (Slade, 2014). Throughout the show, John is Sherlock’s closest friend, given that Sherlock has few friends, intimate connections, or family relations. In this scene, we can see Sherlock emotionally disconnecting from John, nonverbally avoiding eye contact and positioning himself away, while John is leaning forward and prompting him. It is also later revealed in the show that Sherlock’s childhood comprised of him always being second best to his older brother, Mycroft, and always being alienated at school due to being “the eccentric kid”. Given this background, it is illuminating to employ an attachment lens on Sherlock’s response to John, because part of Sherlock’s learned reflexes from his childhood seem to have been to avoid social connections since he was so frequently belittled or alienated by other people.

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Additionally, it can be observed that Sherlock’s cognitive tendencies are to deflect emotional experiences and rely heavily instead on intellectual reason. For instance, when experiencing fear and uncertainty in this scene, Sherlock avoids opening up about his experience of vulnerability, choosing instead to rely heavily on logical explanations for his distress and also suppressing his clear fear from seeing a gigantic hound. At the end of the scene, he compulsively analyzes a nearby family, capitalizing on his affinity for detail so as to avoid coping with his true emotional and visceral feelings. During all of this, as well, Sherlock is deliberately pushing John away, and at the end of the scene, he also abrasively says “I don’t have…friends”, further distancing himself emotionally from his closest social connection in this situation.

Given this discourse, I would suggest that Sherlock has a dismissive attachment style. As overviewed in Attachment in Psychotherapy, dismissive attachment tendencies include turning away from relational opportunities, seemingly discounting the importance of social support, and superficially minimizing social relationships (Wallin, 2007). It is also important to note how individuals with dismissive attachment styles are not necessarily truly indifferent towards relationships, but that many times their seeming indifference is stemming from unmet needs in childhood, with resulting dismissive tendencies as an adaptive defense mechanism (Howe, 2013).

Moreover, as described in Attachment Across the Lifecourse, “psychological independence feels more comfortable than emotional closeness” for individuals with dismissive attachments in adulthood (Howe, 2013, p. 106). Key characteristics of avoidant attachment types include downplaying the importance of attachments and minimizing feelings of vulnerability or emotional need (Wallin, 2007). As exhibited in this scene, Sherlock intuitively distances himself from John, denying the need for social support and verbally expressing that he does not have friends.

In addition, cognitive tendencies for dismissive attachment styles include presenting oneself in inflated or grandiose terms, and heavily relying on talents, successes and achievements to measure contentment as a form of defensive self-enhancement (Shaver & Mikulincer, 2004). These propensities can be observed in Sherlock’s behavior as well. Consistent throughout the show, Sherlock is repeatedly shown to gloat in his successes, feeling very self-confident, often to the point where characters speculate that if he believed in a higher power, it would be in himself (Gatiss & Moffat, 2012). It can also be noted, therefore, that Sherlock uses his intellectual prowess to measure his own sense of worth. In this scene, when faced with a problem in the investigation, Sherlock turns to analyzing the table next to them in the restaurant, capitalizing on his logical and inferential abilities which have brought him so much reputable fame in the past. He is likely turning to this because he does not want to face his emotions of fear and vulnerability, or expressively explore such feelings with his closest friend.

Furthermore, it is also interesting to notice how Sherlock feels the need to prove himself during this scene, contradicting John’s suggestions that he may simply need support. Notably, he forcibly analyzes the table next to them, saying “See, John, like I said, I am fine” (Gatiss & Moffat, 2012).

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Discussion:

I close this case study instigating discussion around how autism and other related developmental disorders could play a role in attachment and mental health treatment. If Sherlock genetically lacks social inclinations compared to the general population, and neurologically does not process relationships the same way that other people in society might, how could this have influenced the development of his dismissive tendencies and general attachment inclinations? What is more, how would therapeutic treatment plans change if this additional information is provided about a client presenting similar to Sherlock?

Distinguishing between autism and antisocial personality disorder is another important point of discussion from this case that relates importantly to clinical challenges of differential diagnosis and recognizing key discrepancies that define an individual’s presenting context. It also notions how oftentimes media can promote inaccurate representations of mental illness, given that Sherlock himself jokingly refers to himself as a “sociopath”, automatically perpetuating stigma and presumptions that accompany such a label. I therefore want to highlight the importance of seeing beyond a diagnosis and recognizing the individual differences and unique life circumstances of every client and patient presenting for mental health treatment. Labels and misdiagnoses are far too common today, and approaching clinical diagnosis with a grain of salt can make a world of difference for a mental health practitioner.

In conclusion, Sherlock Holmes is among the most portrayed and reenacted fictional characters to date, and the BBC TV series Sherlock arguably portrays this famed character with dismissive and avoidant attachment tendencies. Attachment-related approaches for this client would be very interpersonally focused, and such a clinician could find ways to explore familial backgrounds, developmental history, and emotional underpinnings behind Sherlock’s tendencies to downplay social connection and shut down his emotional mind in the face of vulnerability. Sherlock’s character is thus a great illumination regarding attachment tendencies and cognitive defensive strategies, as well an example of the compelling and complex layers behind clinical diagnosis in the mental health field.

As a disclaimer, this case study focuses exclusively on the character of Sherlock Holmes as portrayed by Benedict Cumberbatch in BBC’s Sherlock series. I am not analyzing any content from Doyle’s books or any other portrayed versions of the character.

Have any reactions, comments or questions regarding my opinion on autism vs. antisocial or want to discuss further? Please message me, as I would love to hear your thoughts on this case study.

References:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. (DSM-5) Washington: American Psychiatric Association, 2013.

Bennett, S., & Nelson, J. K. (Eds.). (2010). Adult attachment in clinical social work: Practice, research, and policy. Springer Science & Business Media.

Bettmann, J. E., & Jasperson, R. A. (2010). Anxiety in adolescence: The integration of attachment and neurobiological research into clinical practice. Clinical Social Work Journal, 38(1), 98-106.

Farber, B. A., & Metzger, J. A. (2009). The therapist as secure base. Attachment theory and research in clinical work with adults, 46-70.

Fonagy, P. (1998). Attachment theory approach to treatment of the difficult patient. Bulletin of the Menninger Clinic, 62(2), 147.

Frances, A. (2013). Essentials of psychiatric diagnosis, revised edition: Responding to the challenge of DSM-5®. Guilford Publications.

Gatiss, M. (Writer), & Lovering, J. (Director). (2014). The Empty Hearse (Television series episode). In S. Vertue (Producer), Sherlock. London: BBC Worldwide.

Howe, D. (2011). Attachment across the lifecourse: A brief introduction. Macmillan International Higher Education.

Jacobs, J., & Mollborn, S. (2012). Early motherhood and the disruption in significant attachments: Autonomy and reconnection as a response to separation and loss among African American and Latina teen mothers. Gender & Society, 26(6), 922-944.

Love, K. M. (2008). Parental attachments and psychological distress among African American college students. Journal of College Student Development, 49(1), 31-40.

Mohr, J. J. (2008). Same-sex romantic attachment. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 482-502). New York, NY, US: The Guilford Press.

Simpson, J. A., Collins, W. A., & Salvatore, J. E. (2011). The impact of early interpersonal experience on adult romantic relationship functioning: Recent findings from the Minnesota longitudinal study of risk and adaptation. Current Directions in Psychological Science, 20(6), 355-359.

Vertue, S. (Producer). (2010). Sherlock [Television series]. London: BBC Worldwide.

Wallin, D. J. (2007). Attachment in psychotherapy. Guilford press.

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Disclaimer: This character, their photos, and storyline references are all copyright by BBC One and Arthur Conan Doyle. All information and content presented in this assessment are solely analyzed for general information and reference purposes. 

© Post material by Juliann Li and The Character Clinic, 2019.
All rights reserved.