74 Psychopathy

Dictionary.com Definition of Psychopath: “a mental disorder in which an individual manifests amoral and antisocial behavior, lack of ability to love or establish meaningful personal relationships, extreme egocentricity, failure to learn from experience, etc.”

Introduction to Psychopaths

Psychopaths are utterly fascinating to both scientists and non-scientists alike. The discovery of the existence of psychopaths has led to the creation of a vast number of books, TV shows, and movies. Some examples of these are the book and TV series Dexter, and the book and film The Silence of the Lambs. The more accurate versions of these entertainment sources (e.g., the novel and film American Psycho) depict psychopaths for what they really are: individuals that never feel genuine guilt or concern for others; cold, inhuman beings that lack the ability to empathize and whose main focus is always on themselves.

Psychopathy is a term that was created by Hervey Cleckley in 1941. This word was initially used to discuss individuals that possessed artificial charisma and intellect, and that were non-empathetic, deceitful in nature, careless, incapable of guilt or real concern for people, and fearless (Larsen & Buss, 2010). Psychopaths feel no compassion for other humans, which is why they frequently abuse (emotionally and/or physically), murder, manipulate, deceive, con, and abandon other people. They are able to do this because they are often masterful manipulators and actors, often times being able to keep up the appearance of being completely normal. Many of them are observant, charming, human chameleons that can easily blend in with their social environment (Hare, 1993). From an evolutionary standpoint, this makes plenty of sense. Humans that blatantly show zero concern for fellow humans, through such actions as murder and abandonment, are going to stick out in a negative manner. Of course, not all psychopaths avoid behaving in violent or conning ways that can get them put into prison. Certain serial killers that are currently incarcerated or were incarcerated prior to their death are prime examples of this. Prison is where many people assume that most psychopaths are located, but this is an inaccurate and dangerous belie (Hare, 1993).

The incarcerated psychopaths, however, are what a great deal of the available research on psychopathy has been conducted on. It can be very difficult to successfully identify psychopaths, even the ones that are in prison for violent crimes. This is so because the majority of them are exquisite liars, and a lot of them are smart enough to know what researchers are looking for on psychological tests and in one-on-one interviews. In fact, there are inmates that obtain books dealing with psychological testing and various other areas in the field of psychology. These inmates study the material and then, in return for payment, instruct fellow inmates how to answer psychological tests in a manner that will make them look good and possibly get them an early release from jail (Hare, 1993). So, this means that psychopaths can learn how to efficiently trick psychometric tests while they are in prison. Psychopaths have much better access to information about psychological testing and psychology in general when they are not imprisoned, obviously including research regarding psychopathy. It is possible that some of them receive actual training or college degrees in psychology, making them that much more adept at avoiding detection. In summary, it is not as simple to correctly recognize a psychopath as the media and Hollywood make it appear to be. Someone is not automatically a psychopath because they committed murder, rape, torture, etc. There are certain personality traits and socially undesirable behaviors that must be present before someone can be diagnosed as a psychopath (Hare, 1993).

Terminology

Psychopath, Sociopath, or Antisocial Personality Disorder: Which is the correct term?

It is quite common for the terms psychopath and sociopath to be used synonymously by scientists and non-scientists alike. Reading articles and other research writings in the areas of psychopathy and sociopathy can easily be confusing because different terms are preferred by different researchers. Adding to the confusion is the fact that antisocial personality disorder is frequently used as an equivalent of psychopath and sociopath (Hare, 1993). Sociopath is sometimes preferred by some individuals because, unlike psychopath, it does not indicate that someone is psychotic or insane. Some common misconceptions are that psychopaths are completely insane and unaware of what they are doing and why they are doing it. Psychopaths are actually fully aware of their behaviors and the motivations behind them; they are logical and live in reality. Psychopaths know what they are doing, and they make decisions out of their own free will. Unfortunately for those around them, these individuals are not acting in socially deviant or harmful ways because they are delusional or suffering from hallucinations. (Hare, 1993). Psychopaths choose to act in certain socially unacceptable ways, all the while cognizant of how they are acting; they know what they are doing and they do not care if it negatively affects the people around them.

Robert Hare (1993) believes that the preference for psychopath or sociopath is a clear indication of what that person’s causal theories are. Many different social scientists (e.g., psychologists, criminologists, and sociologists) like to use sociopathy because they think that this disorder is directly a result of social factors and experiences that an individual underwent while growing up. On the other hand, psychopathy is more preferable to scientists that believe that the disorder is caused by a mix of cognitive, physiological, social, and genetic elements. Hare (1993) goes on to say that antisocial personality disorder is a phrase that was intended to be almost synonymous with psychopath and sociopath, but that this was not quite accurate due to a difference in diagnostic requirements. The symptoms that are required in order for one to receive a diagnosis of antisocial personality disorder are numerous antisocial and illegal actions. As a result, most criminals meet the necessary qualifications for diagnosis of antisocial personality disorder (Hare, 1993). Psychopaths, however, are described as performing various antisocial and unlawful behaviors in addition to having a certain set of personality characteristics. It can easily be seen that the symptoms of antisocial personality disorder are quite similar to those of psychopathy (Lack, 2010), but symptoms are not present in the extreme form like they are in psychopathy.

David Lykken (1995) uses the phrase sociopath when he is discussing people with antisocial personality disorders that demonstrate negative behaviors that are caused by unhealthy social or family-related experiences. He uses the phrase psychopath when he is talking about humans that express socially undesirable behaviors that are likely a result of a physiological anomaly and not because of their socialization. Lykken (1995) views psychopaths and sociopaths as two distinctly separate types of individuals, even though there are some similarities between the two. Even though he sees psychopathy and sociopathy as not being one and the same, he provides the same reasoning for the causes of psychopathy/sociopathy that Robert Hare, probably the leading specialist in the area of psychopathy, does (Lykken,1995).

Something else that further confuses the nomenclature of psychopathy is the absence of psychopathy or sociopathy as a diagnosis in the DSM-IV-TR (American Psychiatric Association, 2000). It is no wonder so many scientists cannot agree on one term or usage of both terms in regards to antisocial personality disorders, i.e., psychopathy or sociopathy, when the so-called Bible of mental disorders does not contain either of them. The DSM-IV-TR only has a section discussing antisocial personality disorder. At the beginning of the section, it briefly mentions that antisocial personality disorder has previously been mentioned as “psychopathy, sociopathy, or dyssocial personality disorder” (American Psychiatric Association, 2000). A big problem with this is that research shows that there is only a small overlap of calculations (i.e., psychological measurements) of psychopathy and antisocial personality disorder (Lilienfeld & Arkowitz, 2007). It appears that the DSM-V will include psychopathy in the antisocial personality disorder section. The proposed idea is for the Antisocial Personality Disorder section to be changed to Antisocial/Psychopathic Type.

In conclusion, psychopath is a term used to describe people that exhibit antisocial behaviors and that were born with physiological differences that cause them to behave in socially unacceptable and often hurtful ways towards others. Sociopath is a term used to describe individuals that perform antisocial behaviors as a result of various social and environmental factors that they experienced earlier in life; there is no inherited brain abnormality that causes the behavior. Antisocial personality disorder and sociopathy do not come across as very different from each other in the current literature; it can argued that they are the same thing. Psychopathy, however, is quite different from these two other terms because it has a genetic component, and should not be referred to as antisocial personality disorder or sociopathy, as a result. The focus of this chapter is on psychopathy, so the terms antisocial personality disorder and sociopathy will not be further examined outside of this area of the chapter.

In case you want to read more about antisocial personality disorder, see the antisocial personality disorder portion of this online text. ASPD is located in the Cluster B of personality disorders.

Etiology

The amount and quality of research is still fairly limited on psychopaths since they are fairly difficult to find and get useful and valid data from. There are still, however, theories as to the cause of psychopathy. It appears that a mix of both environmental and genetic effects are to be blamed for the cause of this syndrome.

Genetics

In regards to genetic causes, one belief is that there is an inherited abnormality that causes unhealthy and abnormal emotional thinking. What this denotes is that it is not that psychopaths inherit bad behaviors, but that their acquired genes cause them to develop unnatural emotional processing, as compared to the emotional processing in the brains of normal people. The development of anomalous emotional processing in the brains of psychopaths is responsible for their antisocial behaviors and non-human-like cognitions (Blair, Mitchell, & Blair, 2005). This would explain why psychopaths do not have the cognitive abilities to accurately interpret, recognize, and feel typical human emotions. This unusual brain functioning prevents them from being able to empathize and care about other people’s feelings. A psychopath may be able to recognize what certain facial expressions represent (e.g., pain, sadness, anger), but they cannot put themselves in the other person’s shoes in order to determine what someone is feeling underneath a particular countenance. And since psychopaths primarily and often only worry about themselves, it is unlikely that they would even bother to take the time to try and figure out what someone else is feeling.

Socialization

The social upbringing is another area of focus for the causality of psychopathy. One causal theory is that psychopaths grow up in environments where their aggression and cruelty go unpunished and possibly even get reinforced by others. Parents may reinforce their child’s aggressive and violent behavior by giving in to what the child wants. For example, a kid may start threatening to punch or actually punching a sibling as a means to receive some type of desired object/event (e.g., candy). If the parents give in to their child’s demand(s), the violence/aggression is rewarded and the child learns that violence and aggressiveness are acceptable methods to get what they desire; the negative behavior is more likely to happen again in the future. This can easily lead to socially deviant and destructive actions, and may also prompt a person meeting the qualifications for other psychological disorders, such as conduct disorder or antisocial personality disorder (Hare, 1993).

It could also be possible that social environments that reinforce hostility and violence additionally involve modeling of said types of behavior by caretakers. A combination of positive reinforcement of a child’s violent behaviors and displays of violent behaviors by caretakers would make it highly likely that a child becomes violent. The child learns through instrumental conditioning that hostility can be a means to receive things that they want (reinforcement). An unhealthy environment like this would probably put a child at a greater risk to develop psychological disorders, like conduct disorder and antisocial personality disorder. Robert Hare (1993) found that psychopathic adults often were diagnosed or met criteria for diagnosis of these disorders earlier in their lives. Not all people diagnosed with conduct disorder or antisocial personality disorder become psychopaths, but it is very likely that they will become psychopaths if they do not receive some sort of treatment. Because of this, it is imperative that children displaying antisocial behavior and affect undergo treatment as soon as possible, as long as their symptoms are above the normal level of antisocial behavior that can be expected from children (e.g., insulting, fighting, etc.). The longer the antisocial behavior persists without being treated, the more difficult it will be to successfully treat the individual, and the greater the possibility there will be that they develop into a psychopath (Hare, 1993).

Symptoms

As previously mentioned, it is very difficult to identify actual psychopaths. There is, however, one research scale that has a lot of empirical results to back up its effectiveness at correctly diagnosing psychopaths, Robert Hare’s Psychopathy Checklist-Revised (PCL-R). The PLC-R is employed across the globe to help scientists attain accurate diagnoses of true psychopaths, differentiating them from people that are merely just somewhat socially deviant in their behavior (Hare, 1993). This method involves an in-person interview in addition to the researcher or clinician looking over the interviewee’s personal records, such as crimes carried out in the past. The scale is comprised of three different-labeled, but alike personality trait labels: interpersonal deficiencies (e.g., manipulation), affective deficiencies (e.g., inability to empathize), and rash/illegal behaviors (e.g., arson) (Lilienfeld & Arkowitz, 2007).

The PCL-R enabled Robert Hare to come up with a set of symptoms that are frequently seen in psychopaths.

Table of Psychopath’s Key Symptoms Taken From Without Conscience (Hare, 1993)

• The traits listed above in the table are commonly mentioned by researchers in the field of psychopathy.
• Sexual promiscuity: psychopaths tend to be sexually promiscuous, especially psychopathic men.
  • Male psychopaths often have more female sex partners, act more sexually aggressive, have more children out of wedlock, and have a higher number of marriages ending in divorce than males that are not psychopaths (Larsen & Buss, 2010).
  • Female psychopaths may measure up equally to their male psychopathic counterparts in terms of sexual behavior. Females frequently physically abuse and emotionally starve their offspring, sometimes just flat out abandoning them and going on to their next sexual adventure.
    • On a side note, something lacking in the current literature is research on the prevalence rates of sexually transmitted diseases (STDs) in both psychopathic males and females. It could be entirely possible that psychopaths have a higher rate of STDs for numerous reasons.
      • Psychopaths are primarily concerned about themselves and often have a hedonistic approach to life. Condoms are not as sexually pleasurable as unprotected sex and psychopaths frequently move on to new lovers quickly, which may result in psychopathic individuals often engaging in risky sexual behaviors.
      • Large numbers of sexual partners makes knowledge about partners’ sexual histories and diseases/infections close to or actually nonexistent. Even if psychopaths religiously use condoms, they are still probably more likely to get an STD than average individuals, due to their elevated number of sexual partners. Condoms break, get used improperly, and sometimes fail to prevent the transmission of sexual diseases even when used properly.
        • It is frightening to think about psychopaths having higher rates of STDs when one factors in their disregard for others and inability to empathize. They may be fully aware that they have a sexual disease but not have a care in the world about infecting their lovers.
        • One thing that would make it difficult to perform useful research in this area would be the issue of the prison population being the main focus of research on psychopathy. It is almost a sure thing to say that safe sex is never performed in prisons. Incarcerated psychopaths may have entered prison with no STDs, had sex with a fellow inmate and gotten a disease/virus from them, and then test positive during a study of STD prevalence rates amongst psychopaths. This is something to factor in on any future research done to link STD rates with psychopathy.

Treatments

Not Much Hope for Now

• The lack of agreement on terminology and etiology makes it difficult to formulate effective treatment programs. It could also be argued that therapists that only support social causes for psychopathy are wasting their time. As previously mentioned, it appears that psychopathy is caused by both genetic and environmental influences. Treatment of a biologically-caused disorder is unlikely to be very effective if the therapist is unaware of the biological component or just flat-out disagrees that it exists.
• Psychopaths usually do not try to get treatment even when they know they are not normal (Lilienfeld & Arkowitz, 2007).
• The intensity and rate of antisocial behavior typically decreases in people as they get older. Because of this, it has been suggested that the most effective treatment for psychopaths is to age while they are in jail. Older, imprisoned psychopaths still exhibit indifference about other people’s emotions and other people in general, but they do not behave as antisocially or violently as they did when they were younger (Larsen & Buss, 2010).
• If treatment is to have any chance of preventing the development of a full psychopath, it must be performed in the early years of child; there is little hope of preventing the development of a full-fledged psychopath if treatment starts in adolescence or any time there after. The most treatment strategies can do, at best, is produce some short-lived behavioral improvements when they are used on people with firmly-ingrained antisocial tendencies and attitudes (Hare, 1993).
• Many therapists attempt to use strategies that target specific antisocial behavioral patterns, such as stealing, physical violence, and manipulation of others. This is ineffective because these therapists are failing to treat what is a personality disorder that has a biological component (Hare, 1993).
• Psychopaths are difficult to therapeutically alter because they tend to just go through the actions and not really try to get better. They may do or pretend to do what the clinician asks but they do not really care about changing or fixing their relationships. Also, a psychopath cannot be taught or conditioned to empathize; it simply is not a possibility with the way that their brains are wired (Hare, 1993).
• Treating psychopaths may actually make them worse than better, more dangerous to be specific (Hare, 1993). This unfortunate concept can be true for several reasons.
  • Teaching psychopaths which of their behaviors are socially unacceptable and which behaviors they should display instead gives new ideas to the antisocial patient of how to better disguise their true nature. Informing them about the social undesirability of certain cognitions that they share aloud can help with this too. They will continue to have the thoughts but be wiser and not tell them to other people.
  • Learning more about proper ways to act and what behaviors are approved by others can just provide psychopaths with better tools to manipulate and use people (Hare, 1993).
• The current outlook on treating psychopaths is not a very pleasant one, but much more research is needed in this relatively young field.

Prevalence

• It is difficult to come to an representative prevalence rate for a few reasons.
  • Psychopaths tend to avoid coming in for treatment (Lilienfeld & Arkowitz, 2007), preventing clinicians and researchers from being able to garner representative statistics of the psychopathic population.
    • Even if people with this disorder come in for or are forced to take therapy for some reason (other than them being a psychopath, e.g., a boss requiring an employee get treatment after the death of a spouse), most of them are charming and intelligent enough to keep their true nature hidden.
  • It is difficult for researchers and clinicians to get a gauge of how many psychopaths exist when there is not even a mostly-agreed-upon term for these antisocial types of people, and when there is debate over the causes of this disorder. Some people may give prevalence rates for antisocial personality disorder (when it is really psychopathy), and others may provide prevalence rates for psychopathy (when it is really ASPD, or something else like conduct disorder).
• Psychopaths are usually males, but it is unknown why this is the case (Lilienfeld & Arkowitz, 2007).
• The disorder is not isolated in Western cultures, and has even been found in cultures in very isolated parts of the world (e.g., Inuits that lived near the Bering Strait) (Lilienfeld & Arkowitz, 2007).
• Robert Hare (1993) gave a conservative estimate that 2 million psychopaths lived in the United States in 1993.

Examples of Psychopaths From Movies and Television

Hannibal Lecter

• Hannibal is one of the main characters in the movie, The Silence of the Lambs.

• Commits violent murders, even killing people that have demonstrated kindness towards him during the film.
• Is imprisoned for murder, cannibalism, and serving cooked human body parts to unknowing dinner guests (the cannibalism and human entree part are only mentioned and not shown in the film).
• Highly intelligent and can be very charming and sophisticated when he wants to be. He managed to obtain a medical degree and work as a psychiatrist prior to his capture, so he was effective at blending in for a long while.
• Asks very personal questions, insults people, and makes vulgar remarks without any concern for the discomfort he causes others. In fact, it actually appears that he enjoys making people upset and uncomfortable.
  • This is visible in the following clip from The Silence of the Lambs. The clip shows an interaction between Hannibal and a senator that wants his help to save her kidnapped daughter from a vicious serial killer. Hannibal makes crude comments about the senator’s anatomy and how she will feel when she sees her dead daughter’s body. The comments seem to be made solely to upset the senator, and Hannibal appears to be pleased with how upset his comments make her. There is zero concern exhibited by Hannibal for how he affects another person.
    • Scene From The Silence of the Lambs

Patrick Bateman

• Patrick is the main character of the movie, American Psycho.

• Commits numerous, extremely violent murders, cannibalism, snorts cocaine, tortures people, and kills a dog for no reason.
• Repeatedly uses other people for his gain, without caring about inconveniencing them or repaying them in some way.
• Cruelly insults people, even those he knows well, for no reason except that it possibly entertains him.
• Very charming, intelligent, and well-spoken. Admits at one point during the movie that he only keeps his job in order to “fit in.” This shows that he knows what he is doing; knows he is different from other people; and that he must hide his actions because society would not look kindly upon it.
  • In the following clip from American Psycho, Patrick is extremely upset because he thinks he is going to get caught for his violent crimes, not because of what he did to the victims. He also acknowledges that what he does is not normal human behavior by saying, “I mean I guess I’m a pretty sick guy.”

Dexter Morgan

• Dexter is the main character from the Showtime TV series Dexter.

• Commits a massive number of murders that are almost always extremely bloody.
• Is very sarcastic (not that this alone is an indication of psychopathy) and often laughs at and mocks his victims right before he ends their lives.
• Exceptionally charming and fairly good at fitting into society, as shown by his ability to have a sister that loves him and also by him finding a person to love and marry him. Knows how to use his charm to get things he wants from people, even though he has no understanding of why people respond as they do to his faked charm.
• His inner monologue, that is heard by the viewing audience, is a frequent reminder that he is not entirely human. He often internally comments that he cannot fully understand the meaning of concepts like “love” and has difficulty understanding other people’s emotions and behaviors. Admits that he is a monster and must follow a code of behavior so that his dark deeds are not discovered.
• Different from Hannibal and Patrick Bateman is that there are reasons and hints given as to why Dexter is a “monster” (psychopath). The show implies that the brutal death of his mother set in motion the monster that he would become, thus socialization played a part in his becoming a psychopathic serial killer. The show also repeatedly indicates that Dexter was born the way he is. The death of his mother may have accelerated the process, but he was going to become what he is regardless of any socialization factors.
• Something that makes Dexter different from other psychopaths is that he has a moral code, albeit a very twisted one. He strives to only kill bad people (e.g., pedophiles or murderers). This makes one wonder, are there psychopathic serial killers at large, similar to the fictional Dexter, that believe they are making the world a better place by eliminating people that do bad things?
  • There is a quote at the end of the following clip that perfectly illustrates that Dexter has something physiologically different about him than most people: “I see their pain…I just can’t feel their pain.” He can recognize pain in others, but he cannot mentally experience what they are going through; he is unable to empathize. The video briefly shows and describes some of the things that exhibit that Dexter is a psychopath.
    • Dexter Trailer

Real-life Example of a Psychopath

John Wayne Gacy

• Effectively charmed people in a superficial manner (Lilienfeld & Arkowitz, 2007). Gacy effectively blended in for awhile by serving as a chaplain, being helpful towards his neighbors, entertaining youths by dressing up as a clown named “Pogo,” and even managing to get married and have children (Chua-Eoan,1979).
• Extreme lack of remorse and presence of empathy (Lilienfeld & Arkowitz, 2007).
• Gacy took the lives of between 28-32 (28 confirmed) young males. Twenty-eight of them that he killed he buried in the crawl space beneath his home. Claimed to have tossed the four other bodies into a river (Chua-Eoan,1979).
• Enjoyed toying with his victims by teasing them by handcuffing them and not letting them get out of the cuffs (Chua-Eoan,1979).
• It is probably fair to assume that he had a high need for excitement since he killed such a large number of people.
  • In the following clip, Gacy discusses his knowledge of how to tie a tourniquet knot in a rope. He discusses this calmly and even jokes with the interviewer. Gacy appears to be a reasonably normal person in the video, seemingly just discussing his knowledge about tying a type of knot in a rope. As the video points out at the end, the knot type he discusses is the same type of knot found in ropes tied around his victims’ necks; he did not even bother to remove the ropes he used for strangulation before he buried the bodies. This video is a small sample of a psychopath speaking and behaving, but it shows that they can quite easily present as a normal human being.
    • John Wayne Gacy Interview