Psychopathy

Psychopathy is derived from the Greek psych (mind) and pathos (suffering), and was once used to denote any form of mental illness. These days Psychopathy is defined in psychiatry as a personality disorder characterised by lack of empathy or conscience, poor impulse control and manipulative behaviors. Though in widespread use as a psychiatric term, psychopathy has no true equivalent in either DSM-IV-TR's, where it is most strongly correlated with antisocial personality disorder and the ICD-10 dissocial disorder. It is hoped that the projected DSM V will begin to address this anomaly.

Psychopathy is most commonly diagnosed using Robert D. Hare's Psychopathy Checklist-Revised (PCL-R). Hare describes psychopaths as, "intraspecies predators who use charm, manipulation, intimidation, and violence to control others and to satisfy their own selfish needs. Lacking in conscience and in feelings for others, they cold-bloodedly take what they want and do as they please, violating social norms and expectations without the slightest sense of guilt or regret."

Outside of that, in common parlance, the term psychopathy can take on broader meanings, often being confused with psychosis, particularly by the use of the abbreviation psycho. People sometimes take "psychopath" to be interchangeable with their perception of an evil person.

Psychopaths may be responsible for a disproportionately large amount of crime and general misery, but only a few become serial killers, rapists, or child molesters. In these cases there is generally at least one additional diagnosis.

Legal definitions
It is important to note that psychopathy also has various, quite separate legal and judicial definitions that should not be confused with the medical definition. Various states and nations have at various times enacted laws specific to dealing with psychopathic offenders, and many of these laws are active, on statute, today:


 * Washington State Legislature defines a "Psychopathic personality" to mean "the existence in any person of such hereditary, congenital or acquired condition affecting the emotional or volitional rather than the intellectual field and manifested by anomalies of such character as to render satisfactory social adjustment of such person difficult or impossible".


 * In 1939, California enacted a psychopathic offender law that defined a psychopath solely in terms of offenders with a predisposition "to the commission of sexual offenses against children." A 1941 law attempted to further clarify this to the point where anyone examined and found to be psychopathic was to be commited to a state hospital and anyone else was to be sentenced by the courts.


 * "Psychopathic Disorder" is legally defined in the The Mental Health Act (uk) as "a persistent disorder or disability of mind (whether or not including significant impairment of intelligence) which results in abnormally aggressive or seriously irresponsible conduct on the part of the person concerned".

What is a psychopath?
A psychopath is defined as having no concern for the feelings of others and a complete disregard for any sense of social obligation. They seem egocentric and lacking insight and any sense of responsibility or consequence. Their emotions are thought to be superficial and shallow, if they exist at all. They are considered callous, manipulative and incapable of forming lasting relationships, let alone of any kind of love. It is thought that any emotions which the true psychopath exhibits are the fruits of watching and mimicking other people's emotions. They show poor impulse control and a low tolerance for frustration and aggression. They show no empathy, remorse, anxiety or guilt in relation to their behavior. In short, they truly seem devoid of conscience.

Psychopaths have been shown to be unable to learn from punishment and behavior modification. They have been regularly observed to respond to both by becoming more cunning and hiding their behavior better. It has been suggested that traditional therapeutic approaches actually make them, if not worse, then far more adept at manipulating others and concealing their behavior. They are generally considered to be not only incurable but also untreatable.

Most studies of the psychopath have taken place among prison populations, though it has often been suggested that the psychopath is just as likely to sit on a Board of Directors as behind bars, concealing his true nature behind a well crafted "Mask of Sanity" (also the title of the one of the first definitive studies of psychopathy, written by Hervey M. Cleckley in 1941.)

Cleckley defined psychopathy thus:


 * 1) Superficial charm or intelligence.
 * 2) Absence of delusions and other signs of irrational thinking.
 * 3) Absence of nervousness or neurotic manifestations.
 * 4) Unreliability.
 * 5) Untruthfulness and insincerity.
 * 6) Lack of remorse or shame.
 * 7) Antisocial behavior without apparent compunction.
 * 8) Poor judgement and failure to learn from experience.
 * 9) Pathological egocentricity and incapacity to love.
 * 10) General poverty in major affective relations.
 * 11) Specific loss of insight.
 * 12) Unresponsiveness in general interpersonal relations.
 * 13) Fantastic and uninviting behavior with drink, and sometimes without.
 * 14) Suicide threats rarely carried out.
 * 15) Sex life impersonal, trivial, and poorly integrated.
 * 16) Failure to follow any life plan.

Childhood precursors
Psychopathic tendencies can be recognized young. It becomes apparent in childhood or early adolescence and continues into adulthood in the form of a conduct disorder. Children showing strong psychopathic precursors often appear immune to punishment; nothing seems to modify their undesirable behavior. Consequently parents usually give up, and the behavior worsens. It should be noted that psychopathy is not normally diagnosed in children or adolescents, and some jurisdictions explicitly forbid diagnosing psychopathy and similar personality disorders in minors.

Childhood indicators are (see conduct disorder for more indicators):
 * A longer-than-usual period of bedwetting
 * Cruelty to animals
 * Firesetting and other vandalism.
 * Lies
 * Truancy
 * Theft
 * Aggression to peers
 * Defiance of authority

The three indicators, bedwetting, cruelty to animals and firestarting, known as the MacDonald triad, were first described by J.M. MacDonald as indicators of psychopathy. Though the relevance of these indicators to serial murder etiology has since been called into question, they are considered relevant to psychopathy.

Obviously, not all children who exhibit one, or more, of these signs grow up to be psychopaths, but these childhood signs are found in significantly higher proportions in psychopaths than in the general population.

Many people are aware that a lack of conscience could indicate that they are dealing with a psychopath; fewer are aware that psychopaths also have a markedly distorted sense of the potential consequences of their actions—not only for others—but also for themselves. They do not, for example, deeply recognize the risk of being caught, disbelieved or injured as a result of their choices.

Psychopathy is frequently associated with drug abuse and alcoholism, which exacerbate psychopathic behavior.

Pseudopsychopathic personality disorder
There are many examples of people developing apparently psychopathic personality changes from lesions or damage of the brain's frontal lobe. This is sometimes called Pseudopsychopathic personality disorder or Frontal lobe disorder

One well-known and dramatic case was that of Phineas Gage, a railroad work supervisor. According to Dr. Renato Sabatini, an explosive charge was set. When it detonated, a steel rod was accidentally driven through Gage's skull from his left cheek to above the right brow.

Incredibly, he survived for many years. However his personality changed completely. He became, abusive, aggressive, deceitful, irresponsible and incapable of insight and planning (a poor sense of consequence). Computerised reconstruction of the possible brain damage suggest that, from his known injuries he seemed likely to have had a lesion on the ventromedial frontal cortex.

Fictional portrayals of psychopaths
Psychopaths in popular fiction and movies generally possess a number of standard characteristics which are not necessarily as common among real-life psychopaths. The traditional "Hollywood psychopath" is likely to exhibit some or all of the following traits which make them ideal villains.
 * High intelligence, and a preference for intellectual stimulation (music, fine art etc.)
 * A somewhat vain, stylish, almost "cat-like" demeanor
 * Prestige, or a successful career or position
 * A calm, calculating and always-in-control attitude

It is this last feature which is probably most at odds with the typical real-life psychopath: a psychopath is much more likely to be impulsive, disorganised and short-tempered rather than the smooth-talking, self-disciplined characters portrayed by Anthony Hopkins (Hannibal Lecter in The Silence of the Lambs), Christian Bale (Patrick Bateman in American Psycho), Jack Nicholson ( The Joker (comics) in 1989's Batman (film)), Rowan Atkinson (Edmund Blackadder in the Blackadder television series), Alec Baldwin ("The Teacher") in The Juror and Kiefer Sutherland (in Phone Booth), Matt Damon in The Talented Mr. Ripley.

Perhaps more accurate portrayals of psychopaths are Don Logan (Ben Kingsley in Sexy Beast), Doyle Hargrave (Dwight Yoakam in Sling Blade), Tommy DeVito (Joe Pesci in Goodfellas), Bob Rusk (Barry Foster in Frenzy), and Frank Booth (Dennis Hopper in Blue Velvet), all of whom are crude, impulsive characters who relentlessly torment other people. The Japanese novel "Battle Royale" features a character named Kazuo Kiriyama who appears to suffer from a form of Pseudopsychopathic Personality Disorder. In the movie Cry Wolf the character Dodger exhibits many characteristics of a psychopath, but the movie never states that she is one.

Angelina Jolie's character, Lisa, in the film Girl, Interrupted is diagnosed as a sociopath, but, in the end, we are left wondering just how valid that diagnosis might be.

The character Fred Frenger, played by Alec Baldwin in the film Miami Blues, fits the profile of a psychopath. He lies and steals habitually, attacks and kills people without provocation, makes and breaks promises to get what he wants, and does not show remorse. Roger Ebert described him as "a thief, con man and cheat. He also is incredibly reckless... He wanders through the world looking for suitcases to steal, wallets to lift, identification papers he can use." Leonard Maltin writes in his Movie Guide that Frenger is a "psychopathic thief and murderer." Other critics have simply dubbed the character a sociopath.

Diagnostic criteria (PCL-R test)
In contemporary research and clinical practice, psychopathy is most commonly assessed with the Hare Psychopathy Checklist-Revised (PCL-R), which is a clinical rating scale with 20 items. Each of the items in the PCL-R is scored on a three-point (0, 1, 2) scale according to specific criteria through file information and a semi-structured interview.

Psychopathy's relationship with other mental health disorders
Psychopathy, as measured on the PCL-R, is negatively correlated with all DSM-IV Axis I disorders except substance-abuse disorders. Psychopathy is most strongly correlated with DSM-IV antisocial personality disorder. PCL-R Factor 1 is correlated with narcissistic personality disorder and histrionic personality disorder. PCL-R Factor 2 is particularly strongly correlated to antisocial personality disorder and criminality.

PCL-R Factor 2 is associated with reactive anger, anxiety, increased risk of suicide, criminality, and impulsive violence. PCL-R Factor 1, in contrast, is associated with extroversion and positive affect. Factor 1, the so-called core personality traits of psychopathy, may even be beneficial for the psychopath (in terms of nondeviant social functioning).