"Psychopath"

From a reader regarding Jennifer Skeem's most recent article debunking sociopath myths:


I think she's much closer to the mark, ironically by not really trying too hard to pin down exactly what psychopathy is. As I recall her main line of attack is focused on the current conception, the Hare model. The two areas that I think are weakest with the current model are where she focuses, namely the idea that psychopathy is totally untreatable, as well as including criminality as central to the disorder. Both of these assumptions are based on faulty data. For a laugh, check out the methodology of the first study that concluded psychopaths weren't helped by therapy. They put a bunch of violent convicts together naked in a room and gave them a ton of LSD. What a shocker that didn't turn out well.

Skeem's revised model is more like the lack of a model. Rather than claiming to have an objective definition she argues that psychopathy should be understood as a nebulous constellation of personality traits. I think this is a much more realistic approach because people are always going to be more complicated than a checklist. The more I read about the subject the more I question if psychopathy truly exists. "Psychopath" is something that you call an other person. Anyone who claims that title for themselves without any reservations probably wants to see themselves that way, for whatever reason.

There's another really interesting section you may want to check out that probably would be better as another post than an addendum to the first. The section is called "Does Secondary Psychopathy Exist?" and I think poses an important question. I don't think that high anxiety, highly emotionally reactive people are psychopaths, even if they may exhibit similar behavior.


For what it is worth, I completely agree with that last part. These people who feel overwhelmed by their emotions -- their emotions are the root of their impulsivity -- that just sounds like something too different to include in our general conception of what is a psychopath, even if the outward manifestations of it are similar.

What exactly is psychopathy?

A reader sent this interesting article from one of our favorite researchers, Jennifer Skeem, whose previous attack on the PCL-R caused Robert Hare to take her to court and delay the publication before it was eventually released. The article is sort of an interesting primer on psychopathy and summary of the most recent research. She has her own ideas about the correct delineation of psychopathy that seems reasonable. First she discusses why there are so many ideas about what exactly sociopathy is:

As we will discuss, many of the controversies surrounding psychopathy stem from fundamental disagreements about its basic definition, or operationalization. The scope of phenomena encompassed by the term psychopathy has varied dramatically over time, from virtually all forms of mental disorder (psychopathy as “diseased mind”) to a distinctive disorder characterized by lack of anxiety; guiltlessness; charm; superficial social adeptness; dishonesty; and reckless, uninhibited behavior (Blackburn, 1998). Even contemporary conceptualizations of psychopathy contain puzzling contradictions. Psychopaths are often described as hostile, aggressive, and at times revenge driven (N. S. Gray, MacCulloch, Smith, Morris, & Snowden, 2003), yet they are also characterized as experiencing only superficial emotions (Karpman, 1961; McCord & McCord, 1964). They are impulsive and reckless, yet apparently capable of elaborate scheming and masterful manipulation (Hare, 1993). They can rise to high levels of achievement or status in society, attaining success in business and public life, yet present as criminals whose behavior is so poorly thought out and lacking in regard even for self-interest that they occupy bottom rungs of the social ladder

Given these contrasting depictions, it is scant wonder that some experts have concluded that the concept of psychopathy, as commonly understood, is disturbingly problematic: a “mythical entity” and “a moral judgment masquerading as a clinical diagnosis” (Blackburn, 1988, p. 511), “almost synonymous with ‘bad’” (Gunn, 1998, p. 34), “used by the media [to convey] an impression of danger, and implacable evil” (Lykken, 2006, p. 11). In the words of William and Joan McCord (McCord & McCord, 1964), two influential figures in the historic literature on psychopathy, “the proliferation of definitions, the tendency to expand the concept to include all deviant behavior, the discrepancies in judgment between different observers——these pitfalls in the history of the concept—— are enough to make a systematic diagnostician weep” (p. 56).

She then (optimistically) asserts that all is not lost, that sociopathy is a thing and we can figure out what that thing is through careful parsing of the literature and empirical evidence. First she dispels some myths:

• Psychopathy is synonymous with violence: "However, psychopathy can and does occur in the absence of official criminal convictions, and many psychopathic individuals have no histories of violence."
• Psychopathy is synonymous with psychosis: "In contrast with psychotic patients, psychopathic individuals are generally rational, free of delusions, and well oriented to their surroundings"
• Psychopathy is synonymous with antisocial personality disorder (ASPD): "The difference arises largely because measures of psychopathy include personality traits inferable from behavior, whereas measures of ASPD more exclusively emphasize antisocial, criminal, and (to a lesser extent) violent behavior."
• Psychopathic individuals are born, not made: "Contemporary understanding of the pervasive interplay of genetic and environmental influences in determining behavioral outcomes of various kinds argues against the likelihood that any psychiatric condition, including psychopathy, is entirely 'born' or 'made.'"
• Psychopathy is inalterable: "some recent empirical work has emerged to suggest that personality traits in general, and psychopathic traits more specifically, undergo change across major developmental transitions"

The article is quite long. I will probably keep going back to it over the next month or so and perhaps sharing things that I learn here.