The psychopath problem

The psychology world seems to be taking a fresh look at sociopathy. Apparently once people dared question the infallibility of Hare's diagnostic criteria, the Psychopathy Check List Revised ("PCL-R"), it opened the door for other heresies against established views.

In his new book "Forensic Psychology: A Very Short Introduction," David Canter, a psychology professor at the University of Hudderfield, briefly describes the psychopath problem:

Until you have met someone whom you know has committed horrific violent crimes but can be charming and helpful, it is difficult to believe in the Hollywood stereotype of the psychopath. Without doubt, there are people who can seem pleasant and plausible in one situation but can quickly turn to viciousness. There are also people who just never connect with others and are constantly, from an early age, at war with those with whom they come into contact. If we need a label for these people, we can distinguish them as type 1 and type 2 psychopaths. The former have superficial charm, are pathological liars, being callous and manipulative. The clearest fictional example of this sort of psychopath is Tom Ripley, who has the central role in many of Patricia Highsmith’s amoral novels. The type 2 psychopaths are more obviously criminal, impulsive, and irresponsible with a history of juvenile delinquency and early behavioural problems.

Another label that may be assigned to people who are habitually involved in illegal, reckless, and remorseless activities that has a much broader net than ‘psychopathy’ is ‘antisocial personality disorder’. But we should not be seduced into thinking that these diagnoses are anything other than summary descriptions of the people in question. They do not help us to understand the causes of people behaving in these unacceptable ways. Some experts have even commented that they are actually moral judgements masquerading as medical explanations. So although the labels ‘personality disorder’ and ‘psychopath’ do summarize useful descriptions of some rather difficult, and often nasty, people, we need to look elsewhere for explanations of how they come to be like that.

The psychopath problem for society is "how do we keep psychopaths from acting in antisocial ways?" The psychopath problem for psychologists is "what are we really dealing with here?" Before psychologists can even begin understanding psychopaths, they must be able to identify them. Before psychologists can identify psychopaths, they must be able to understand them. It's a classic chicken/egg dilemma that leads critics like our favorite narcissist Sam Vaknin to quip that "psychopathy seems to be merely what the PCL-R measures!" and probably led the good folks putting together the DSM to eventually exclude psychopathy as a diagnosis in favor of the more criminal-sentencing friendly ASPD.

Still, these tests are being used, and brains of people flagged by these tests are being scanned and studied, helping scientists to learn more about . . . the brains of people who would be flagged by these tests. Some of the new discoveries or theories about psychopathy jive with my own personal experiences, and some of them strike me as being less than accurate -- an attempt to add an epicycle to support some of the weaker premises that provide the basis for the modern study of psychopathy. Maybe it is true that we are on the verge of a breakthrough, as some psychologists think -- a unifying theory of the causes and explanations for psychopathic behavior. If we are, I think it will have to be a product of fresh thinking, rather than continuing to focus on the same "20 items designed to rate symptoms which are common among psychopaths in forensic populations (such as prison inmates or child molesters)."

Knowing the limits of our answers

I thought this was a very interesting Wired article about the limitations of the PCL-R.  The author begins with the anecdote of Alan Turing's attempt to answer the question of whether computers could think.  Realizing that the question framed that way was impossible to answer (what does it mean to think?), he reframed the question to be whether computers could pass as humans.  He set up an experiment where test subjects were asked to determine whether responses from an unidentified source came from another human or a computer.

Turing constructed the test in transparently trivial terms. If a computer could fool someone for five minutes 70 percent of the time, it was as good as intelligent. This is powerful not because of its implications for intelligence, but because of its insight into asking tough questions. When we don’t understand the underlying causes of a phenomenon, what scientists call its mechanism, we must resort to studying its effects. But it is crucial that we be aware of the limitations of this approach and remain humble in our inquiry.

He then goes on to compare the difficult misalignment between what we can test and what we hope to learn in terms of the PCL-R and other diagnostic tools for psychopathy:


In the next year, the American Psychological Association will put the finishing touches on the latest version of the Diagnostic Statistical Manual of Mental Disorders, its compendium of psychiatric illnesses. Psychiatry is up against a problem similar to the one Turing faced. The illnesses are complex and their causes hard to discern. Without a clear mechanism, psychiatrists must rely on their patients’ subjective symptoms. It’s a process that’s always fraught, but it works when psychiatrists are realistic about the constraints of their tests.

Things become more troubling when the stakes are high and the diagnoses are tough to change. This is the case in prisons throughout the Western world, where inmates are subjected to the revised Psychopathy Checklist, or PCL-R.

Like the Turing Test, the PCL-R is about effects and symptoms, not causes.

The problems with the PCL-R:


The PCL-R, unlike the Turing Test, is inflexible by design. The Turing Test merely relies on the ability of the machine to be convincing in the present. It doesn’t take into account the machine’s past track record. It leaves open the possibility for change and improvement. The PCL-R is not so forgiving. If a person with a history of psychopathic behaviour were to get better, testers would likely interpret this as deception. After all, deception is a key feature of psychopathy. The PCL-R tries to have it both ways. It relies on observing a set of behaviors, but it resists assigning significance to a change in those behaviors.

Leaving open the possibility of change isn’t about setting serial killers free. But for crimes on the margin, the batteries and assaults and armed robberies, we have to decide whether to deny people who score high on the PCL-R the same opportunities we would give those who score low.

The take away:

The checklist demands that we confront our values. For the possibility of a little more security, are we willing to risk denying a person a second chance? We have to understand the tradeoff and the uncertainty of the reward.

With the Turing Test, it’s pretty straightforward. Five minutes and 70 percent can only tell us so much. How much can the PCL-R tell us?

Alan Turing taught us that when the question is hard, we must know the limits of our answers. At stake here is redemption, the possibility that the wretched can make good. It is an aspiration worth more than a guess. It deserves our humility.


I like this issue about knowing the limits of our answers.  I have recently dipped more into the empirical side of my profession and it has been fascinating and eye-opening to see some of the common mistakes people make in terms of believing that they are "proving" things or that some things are capable of being "known."  There really is a great deal of hubris, and particularly when these pieces of "knowledge" leave the academic area of origin and are used by other people who are unaware of the inherent uncertainty (courts, parole boards, trolls, etc.).  I can understand why people would want to believe things are knowable, particularly when it comes to something as scary as psychopaths, but they just aren't -- at least not currently.

Ch-ch -changes

A reader informs me that aspies aren't the only ones getting reshuffled in the proposed new DSM.

Interestingly, the new DSM, or at least the draft presented online, (1) renames ASPD to "Antisocial/Psychopathic PD" and (2) completely removes NPD. Narcissists now have "a core personality impairment with prominent traits such as callousness, manipulativeness, histrionism and narcissism." Sociopaths on the other hand have "callousness, aggression, manipulativeness, hostility, deceitfulness, narcissism, irresponsibility, recklessness and impulsivity." It seems that under the new definitions sociopaths are just malicious, foolhardy narcissists with a diminished emotional repertoire. This is really a new perspective and one that might or might not be as absurd as it seems at first glance.

Again, this shows how the definitions (such as DSM) are completely misleading as to the depth of experience and as to the diversity of different wirings out there.