Recipe for psychopaths?

No specific recipe, says researcher Jennifer Skeem, whom you may remember as the one whom Robert Hare tried to legally silence. From medicalxpress.com:

“There is no real recipe for psychopathic personality disorder,” she says. “The environmental factors are as ill-defined as the genetic factors, although antisocial behavior mixed with a history of punitive discipline, abuse and neglect seems to apply in many cases.”

On violence:

Psychopathy is not synonymous with violence, Skeem notes. In fact, she has found that psychopathic people often have no history of violent behavior or criminal convictions. 

“An individual doesn’t necessarily need to be physically violent or a common street criminal to have psychopathic traits,” she says. Researchers estimate that about 1 percent of the general population are psychopaths. 

Famous sociopaths?

Skeem points to Gordon Gekko, the unscrupulous financial executive played by Michael Douglas in the 1987 film “Wall Street,” as someone with all the signs of psychopathy. 

She cites Ponzi scheme mastermind Bernie Madoff and Enron executive Andrew Fastow – ruthless, detached individuals who showed little remorse for robbing victims of their life savings – as real-life examples. Psychopathic traits helped them quickly climb the corporate ladder yet ultimately led to their downfall. 

Good sociopaths?

Can such traits ever be used for good? Skeem notes that the bold, risk-taking bomb squad leader in the Academy Award-winning movie “The Hurt Locker” succeeded in a high-pressure environment thanks to psychopathic tendencies. Of course, some psychopaths do resort to violence and crime. But according to Skeem, youth and adults with high scores on measures of psychopathy can exhibit reduced violent and criminal behavior after intensive treatment, such as mental health counseling and drug abuse rehabilitation. “There is scant scientific evidence to support the claim of ‘once a psychopath, always a psychopath,’” she says.

One one size fits all, parting thoughts:

“Research on psychopathy has evolved to a level that it can greatly improve on the current one-size-fits-all policy approach,” Skeem says.

The origins of criminality as a feature of sociopathy (part 3)

Because it largely captures people who commit crimes, either sociopathic or non, the PCL-R is both over-inclusive of non-sociopathic criminals and under-inclusive of non-criminal sociopaths. (Id, citing Lilienfeld, 1994.) At best, research based on the PCL-R can be characterized as “a literature on unsuccessful psychopathy.” Id. However not all sociopaths are unsuccessful. Rather the “great majority of psychopaths” have (Id, quoting Hercz, 2001, ¶ 11.) via their “ individual differences in talents and opportunities” channeled their psychopathic tendencies not into criminality, but into heroism, worldly success, etc. Id, citing Cleckley, 1976; Harkness & Lilienfeld, 1997; Lilienfeld, 1998; Lykken, 1995. Hare himself has conceded, most sociopaths are not criminals.

Although Hare never filed suit, he successfully delayed publication of Skeem and Cooke’s article by three years. He was also roundly criticized as improperly interfering with the peer review process. In an article titled “Fear Review,” Scientific American writes : “’It was [a] shock,’ Skeem says of Hare's legal threat. ‘this is not about Professor Hare, and it's only incidentally about the Psychopathy Checklist,’ she says. ‘The focus was really on how we could move the field forward.’”

Hare conceded in his response to Skeem and Cooke that the PCL-R does not embody the concept of psychopathy, nor is criminality a necessary component, but there are only twenty factors and three of them specifically deal with criminality: “criminal versatility”, “juvenile delinquency” and “revocation of conditional release” (revoked parole). Another is “many short-term marital relationships”. Only half of the factors track Cleckley sociopathy.

How did non-Cleckley traits enter the PCL-R?

[B]ecause participants in the PCL development sample were criminals rather than nonincarcerated patients or nonpatients, it seems likely that the initial candidate pool included many more deviance-related items, such that [Cleckley’s] positive adjustment indicators dropped out in the selection process. The result is that the PCL-R, compared with Cleckley’s original diagnostic criteria, contains items that are uniformly indicative of deviancy and psychological maladjustment.

Patrick, et al. (2009).

Studying exclusively criminals and then assuming sociopathy must be related to criminality seems like an obvious sampling error. If I exclusively studied my church congregation for sociopathy, could I properly infer a connection between sociopathy and organized religion? Even Hare admits “the majority of psychopaths aren't criminal,” so how could he be satisfied basing his test exclusively on criminals?

Despite round criticism from the psychological community, the PCL-R’s psychopath has left a lasting academic and public impression. Notwithstanding mounting research to the contrary, the dominant popular view of sociopathy is Hare’s criminal recidivist remorseless killer. This is the psychopathy of Hollywood murder movies. I too am scared of such a person, although I haven’t yet encountered one.

Modern researchers remain divided between Cleckley’s carefree bon vivant and Hare, Rollins, McCord and McCord’s criminal deviant.  While Cleckley’s view of sociopaths amounted to emotional colorblindness, Hare et al. depict a “bad egg” rife with moral rottenness – a severely emotionally damaged individual characterized by a loveless and guiltless existence of unrestrained malice for fellow man. Id. Where Cleckley saw “boldness,” they see “meanness.” Where Cleckley saw a lack of connection to the sociopath’s own feelings and the feelings of others, they see a vicious disregard for the feelings of others. Id. Cleckley sought to understand underlying thought patterns, they sought to label external behavior. Cleckley saw a potential patient, they see a social predator. Cleckley saw a problem for which he was seeking a cure.[i] They see a problem that needs to be identified and isolated to protect society, or as Hare has said:

Measurement and categorization are, of course, fundamental to any scientific endeavor, but the implications of being able to identify psychopaths are as much practical as academic. To put it simply, if we can't spot them, we are doomed to be their victims, both as individuals and as a society.

Hare’s remorseless criminal psychopath is associated with “Factor 2 psychopathy”. While Factor 1 traits track Cleckley’s sociopath, Factor 2 adds new traits largely associated with deviance. Not surprisingly, there is little correlation between Factor 2 and Factor 1 traits. In fact, some flatly contradict each other:

•         High aggression, impulsivity, and sensation seeking. Harpur et al., (1989); Hare, (1991).
•         Aggression provoked by reactionary anger. Patrick & Zempolich, (1998); Porter & Woodworth, (2006).
•         High levels of alcohol and drug dependence. Hare, (2003); Smith & Newman, (1990).
•         Deviant behavior.  Hall et al. (2004)
•         High disinhibition and boredom, anger, alienation, distress at negative everyday events. Id.
•         Low conscientiousness and low interest in achievement. Id.
•         Low personal socioeconomic status. Id.
•         Historic and future crimes against people, including violent crimes. Skeem, Mulvey, and Grisso (2003)
•         High aggressiveness. Id.
•         Low agreeableness and lower connection to or interaction with other people. Id.
•         High FFM neuroticism (worrying or negative feelings about everyday incidents), low FFM agreeableness, and low conscientiousness.

o   Interestingly, these are exactly opposite of the Factor 1 results for these categories.

Patrick, et al. (2009).

How can the same group be characterized by both high emotional reactiveness and low emotional reactiveness? Are they angry anxious drug addicts or are they happy-go lucky charmers? Are they impulsive sadist below-the-poverty-line loners or socially dominant Machiavellian CEOs? Are we looking at violent offenders who have a hard time regulating their overpowering emotions or feckless opportunists who have a hard time feeling their own or others’ emotions? Are they primarily emotionally or intellectually driven? Reactive or proactive?

As researchers have posited, the same group can’t really be both, unless we’re talking about two or more separate but related things. Perhaps, as some have suggested, one thing is more nature and the other nurture. Some say one is a sociopath and the other is a psychopath. Or one is a primary sociopath and the other a secondary sociopath. Some say they have the same underlying cause, but only manifest differently. For example, that sociopathy manifests itself naturally in boldness, and meanness is only what happens when you combine sociopath plus risk factors, e.g. childhood neglect or abuse, low socioeconomic status, low education, single parent household, etc. When Cleckley’s emotional blindness is given prosocial outlets, they argue, it can lead to “social efficacy, imperturbability, and tolerance of danger” and if not, “impulsivity, rebelliousness, alienation, and aggression.” Id. This would explain the shared traits (fearlessness and boldness) you see between criminal and non-criminal sociopaths as well as the differences in behavior between the two.[ii]

---

[i] Cleckley’s position was that he knew of no treatment, but he blamed it in part on the collective evasion of the issue by the psychological community and society at large rather than any definitive evidence of there being no treatment:

Although I spared no effort to make it plain that I did not have an effective therapy to offer, the earlier editions of this book led to contact with psychopaths of every type and from almost every section of the United States and Canada. Interest in the problem was almost never manifested by the patients themselves. The interest was desperate, however, among families, parents, wives, husbands, brothers, who had struggled long and helplessly with a major disaster for which they found not only no cure and no social, medical, or legal facility for handling, but also no full or frank recognition that a reality so obvious existed.

….the psychopath presents an important and challenging enigma for which no adequate solution has yet been found. Although still in the unspectacular and perforce modest position of one who can offer neither a cure nor a well-established explanation, I am encouraged by ever increasing evidence that few medical or social problems have ever so richly deserved and urgently demanded a hearing.

Cleckley, “Mask of Sanity”.

[ii] See, e.g.:

“The boldness component of psychopathy, which is tapped weakly and incompletely by the items of the PCL-R, is important to distinguish in turn from the meanness component, which is well represented in the PCL-R. One reason is that the distinction between boldness and meanness is crucial to reconciling Cleckley’s conception of psychopathy with that advanced by more criminologically oriented theorists (e.g., McCord & McCord, 1964; Robins, 1966). Another is that boldness, although phenotypically distinct from meanness, appears to share a key etiologic substrate (i.e., diminished fear capacity). This raises the important developmental question, discussed in the last major section below, of what intersecting etiologic factors give rise to meanness as opposed to boldness in temperamentally fearless individuals.

Yet another reason is that the construct of boldness is likely to be of unique importance in understanding so-called “successful psychopaths”: individuals exhibiting high levels of charm, persuasiveness, imperturbability, and venturesomeness who achieve success in society as military, political, or corporate-industrial leaders (cf. Lykken, 1995).”

Patrick, et al. (2009).

I'm not a crook

From Friday's NY Times, an article with accusations of potential censorship against everyone's favorite psychopath scholar with a monopoly on this poorly understood disorder, Robert Hare, regarding his alleged overemphasis of criminality in the PCL-R:

Academic disputes usually flare out in the safety of obscure journals, raising no more than a few tempers, if not voices. But a paper published this week by the American Psychological Association has managed to raise questions of censorship, academic fraud, fair play and criminal sentencing — and all them well before the report ever became public.

The paper is a critique of a rating scale that is widely used in criminal courts to determine whether a person is a psychopath and likely to commit acts of violence. It was accepted for publication in a psychological journal in 2007, but the inventor of the rating scale saw a draft and threatened a lawsuit if it was published, setting in motion a stultifying series of reviews, revisions and legal correspondence.
***
The inventor of the clinical test, Robert D. Hare, an emeritus professor of psychology at the University of British Columbia, sees a different principle at stake.

“The main issue here is that these authors misrepresented my views by distorting things I said,” he said in a telephone interview. “I have been doing this work for 40 years and never seen anything like it.”
***
The paper — “Is Criminal Behavior a Central Component of Psychopathy?” — was circulated widely among forensic psychologists well before publication. Experts say the scientific issue it raises is an important one.

Dr. Hare’s clinical scale, called the Psychopathy Checklist, Revised, is one of the few, if not the only, psychological measures in forensic science with any scientific backing. Dr. Hare receives royalties when the checklist is used; he called the income it generated “modest” compared with providing paid expert testimony — which he said he does not do.

Dr. Skeem and Dr. Cooke warned in their paper that the checklist was increasingly being mistaken for a complete definition of psychopathy — a broader personality construct that includes deceitfulness, impulsivity and recklessness, though not always aggression or illegal acts. The authors contended that Dr. Hare’s checklist warps that concept by making criminal behavior a more central component than it really is.

Dr. Hare maintains that he has stressed “problematic, not antisocial or criminal, behavior” and that his comments were distorted.

Dr. Skeem said she was “just worn out” by the prolonged dispute.

“When we first wrote the paper,” she said, “we saw it simply as a call to the field to recognize we were going down a path where we were equating an abstract concept with a checklist, and it was preventing us from looking at the concept more closely.”

The report appears in the June issue of the journal Psychological Assessment — that is, along with a rebuttal by Dr. Hare, and a return response from Dr. Skeem and Dr. Cooke.

The abstract of the offending paper:

The development of the Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 2003) has fueled intense clinical interest in the construct of psychopathy. Unfortunately, a side effect of this interest has been conceptual confusion and, in particular, the conflating of measures with constructs. Indeed, the field is in danger of equating the PCL-R with the theoretical construct of psychopathy. A key point in the debate is whether criminal behavior is a central component, or mere downstream correlate, of psychopathy. In this article, the authors present conceptual directions for resolving this debate. First, factor analysis of PCL-R items in a theoretical vacuum cannot reveal the essence of psychopathy. Second, a myth about the PCL-R and its relation to violence must be examined to avoid the view that psychopathy is merely a violent variant of antisocial personality disorder. Third, a formal, iterative process between theory development and empirical validation must be adopted. Fundamentally, constructs and measures must be recognized as separate entities, and neither reified. Applying such principles to the current state of the field, the authors believe the evidence favors viewing criminal behavior as a correlate, not a component, of psychopathy.

"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.

DSM-5 vs. PCL-R

A reader comments about the differences between the proposed DSM-5 and the PCL-R:

As far as sociopathy goes, the DSM-IV diagnosis was woefully inadequate. It provided no real insight into the disorder and lacked strong empirical evidence; that is why scholars such as Robert Hare and Theodore Millon have said that sociopathy and antisocial personality disorder are two independent constructs and why Hare went further to create the psychopathy checklist. While the psychopathic checklist is a much more accurate diagnostic tool, it also lacks empirical evidence. For one, it looks at personality as a binary construct. You either you have it or not and if not. It says psychopaths are both quantitatively and qualitatively different from non-psychopaths. But personality is not that clean cut. Everyone has psychopathic traits to a greater or lesser degree. It also doesn’t take into account the heterogeneity within psychopathy. According to Hare for and individual to receive a diagnosis in psychopathy they would have to score relatively high on factor 1 and 2, but that is far from true. Some patients would score high on the disinhibited component others on the antagonistic component and while some score high on both. There is abundant evidence that the impulsive-antisocial (disinhibited-externalizing) and affective-interpersonal (boldness-meanness) components of psychopathy differ in terms of their neurobiological correlates and etiologic determinants according to the work group of the DSM 5. So as far as the DSM and sociopathy researchers go, yes, there has been a disagreement between the two and up until now I think the PCL-R was the most useful when comparing it to antisocial personality disorder, but in all honesty, the DSM 5 seems to have a stronger scientific and empirical basis to not only psychopathy but personality as a whole. 

The DSM 5 seems to have a stronger scientific and empirical basis to not only psychopathy but personality as a whole. In contrast to the PCL-R, the DSM 5 derived its criteria from scientific data not theory. In a contested article by Skeem and Cooke, "Is Criminal Behavior a Central Component of Psychopathy? Conceptual Directions for Resolving the Debate," the two colleagues posit that the field of forensic psychology has prematurely embraced Hare's Psychopathy Checklist-Revised (PCL-R) as the gold standard for psychopathy, due in large part to legal demands for a tool to predict violence. Yet the PCL-R's ability to predict violent recidivism owes in large part to its conflation of the supposed personality construct of psychopathy with past criminal behavior, they argue: 

“[T]he modern justice context has created a strong demand for identifying bad, dangerous people…. [The] link between the PCL and violence has supported a myth that emotionally detached psychopaths callously use violence to achieve control over and exploit others. As far as the PCL is concerned, this notion rests on virtually no empirical support…. [T]he process of understanding psychopathy must be separated from the enterprise of predicting violence.” 

Criminal behavior weighs heavily in the PCL's 20 items because the instrument emerged from research with prisoners. But using the PCL-R's consequent ability to predict violence to assert the theoretical validity of its underlying personality construct is a tautological, or circular, argument, claim Skeem and Cooke. Or, as John Ellard put it more directly back in 1998: 

"Why has this man done these terrible things? Because he is a psychopath. And how do you know that he is a psychopath? Because he has done these terrible things." 

All in all, the PCL- R tends to do a better job measuring criminality. Not psychopathy, which is a personality disorder and can’t be adequately recognized by a set of twenty criteria combined with an arbitrary diagnostic threshold. (That threshold being 30). 

Psychopath myths

From Scientific American, author of the book "50 Great Myths of Popular Psychology," Scott Lilienfeld, discusses some myths and misconceptions about psychopaths. Some of the highlights:

• Few disorders are as misunderstood as is psychopathic personality.
• Research also suggests that a sizable number of psychopaths may be walking among us in everyday life. Some investigators have even speculated that “successful psychopaths”—those who attain prominent positions in society—may be overrepresented in certain occupations, such as politics, business and entertainment. Yet the scientific evidence for this intriguing conjecture is preliminary.
• Psychopathy seems to be present in both Western and non-Western cultures, including those that have had minimal exposure to media portrayals of the condition.

Here are the myths:

1. All psychopaths are violent. Research by psychologists such as Randall T. Salekin, now at the University of Alabama, indicates that psychopathy is a risk factor for future physical and sexual violence. Moreover, at least some serial killers—for example, Ted Bundy, John Wayne Gacy and Dennis Rader, the infamous “BTK” (Bind, Torture, Kill) murderer—have manifested numerous psychopathic traits, including superficial charm and a profound absence of guilt and empathy. Nevertheless, most psychopaths are not violent, and most violent people are not psychopaths. . . . Regrettably, the current (fourth, revised) edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders Text Revision (DSM-IV-TR), published in 2000, only reinforces the confusion between psychopathy and violence. It describes a condition termed antisocial personality disorder (ASPD), which is characterized by a longstanding history of criminal and often physically aggressive behavior, referring to it as synonymous with psychopathy. Yet research demonstrates that measures of psychopathy and ASPD overlap only moderately.
2. All psychopaths are psychotic. In contrast to people with psychotic disorders, such as schizophrenia, who often lose contact with reality, psychopaths are almost always rational.
3. Psychopathy is untreatable. . . . Although psychopaths are often unmotivated to seek treatment, research by psychologist Jennifer Skeem of the University of California, Irvine, and her colleagues suggests that psychopaths may benefit as much as nonpsychopaths from psychological treatment. Even if the core personality traits of psychopaths are exceedingly difficult to change, their criminal behaviors may prove more amenable to treatment.

Questioning the validity of the PCL-R

From the Drs. Skeem and Cooke article that got Dr. Robert Hare's panties all in a wad about the validity of his PCL-R (Psychopathy Checklist Revisited):

“Without a history of violent or criminal behavior, even an individual with pronounced interpersonal and affective traits of psychopathy is unlikely to surpass the PCL–R’s threshold score for diagnosing psychopathy.”

“We specifically argue that the process of understanding and appropriately diagnosing psychopathy must be separated from the enterprise of predicting violence.”

“First, the PCL–R is a measure that imperfectly maps psychopathy, the domain of interest. Second, the PCL–R’s factor structure is not a conceptualization of, or explanation for, psychopathy and does not fully correspond to Cleckley’s (1941) conceptualization, on which it is purportedly based. Third, reification of the PCL–R forecloses on the possibility of iteratively using theory and empirical results to revise this tool (and others) to advance understanding of psychopathy.”

“’Thanks to Hare, we now understand that the great majority of psychopaths are not violent criminals and never will be. Hundreds of thousands of psychopaths live and work and prey among us’ (Hercz, 2001, ¶ 11). The two-factor model poorly identifies this “great majority of psychopaths” who escape contact with the legal system or simply express their psychopathic tendencies in a manner that does not conflict with the law.”

“Beyond past criminal behavior, adding such variables as gender, age, or substance abuse to the PCL–R might also improve prediction of violence. Such an improvement would not imply that these characteristics are central to psychopathy.”

“The pursuit of validly diagnosing a personality disorder is distinct from the enterprise of predicting violence.”

(Email me if you would like to read the article in its entirety.)

The origins of criminality as a feature in sociopathy (part 2)

Cleckley’s sociopath was “bold”, boldness here being “a capacity to remain calm and focused in situations involving pressure or threat, an ability to recover quickly from stressful events, high self-assurance and social efficacy, and a tolerance for unfamiliarity and danger. Terms related to boldness include fearless dominance (Benning, Patrick, Blonigen, et al., 2005), daringness, audacity, indomitability, resiliency (Block & Block, 1980), and hardiness (Kobasa, 1979).” Id. Bold individuals are likely to show: “social dominance, low stress reactivity, and thrill–adventure seeking (Benning et al., 2003; Benning, Patrick, Blonigen, et al., 2005) . . . imperturbability, social poise, assertiveness and persuasiveness, bravery, and venturesomeness.” Id.

Boldness was evident in [Cleckley’s] case descriptions and diagnostic criteria in terms of poise and high social efficacy, absence of anxiety or neurotic symptoms, diminished emotional responsiveness, imperviousness to punishment (“failure to learn by experience”), and low suicidality. Other historic writers concerned with psychopathy in psychiatric patients as opposed to criminal samples (e.g., Kraepelin, Schneider) also identified bold externalizing types. Id.

Cleckley studied non-criminal sociopaths at a large inpatient facility. No other researcher has focused so extensively on non-criminal sociopaths.

Most researchers studied criminals, and consequently defined sociopathy as a dark strain of criminal deviance. Early researchers William Maxwell McCord and Joan McCord painted a picture in “The Psychopath: An Essay on the Criminal Mind” (1964) of a socially detached, predatory, aggressive, and remorseless individual plagued by angry-reactive forms of aggression and resultant criminality. Similarly Lee Robins, whose work underlies the DSM-V’s “Antisocial Personality Disorder” (ASPD), focused on a maladjustedness marked by persistent aggression, criminality, and destructiveness. Robins (1966, 1978).

Around that same time, Robert Hare developed his Psychopathy Checklist (now revised, PCL-R), based on the Canadian criminal population. The PCL-R is the most popular diagnostic tool for sociopathy. Hare based it on Cleckley’s sociopath, however, it is distinctly darker:

In contrast with Cleckley’s portrayal of psychopathic patients as personable and ostensibly well meaning but feckless and untrustworthy, this latter perspective conceptualizes psychopathic individuals as cold, abrasive, and aggressively exploitative in their interactions with others.

Patrick, et al. (2009).

Cleckley saw “boldness.” Hare substituted “meanness.” Why? Interestingly, Hare’s own early work also found boldness instead of meanness. Id. What changed?

Alice, a sociopath I met in Australia, theorizes that it wasn’t the sociopaths that changed, but Hare. Alice thinks Hare is biased. In fact, she goes so far as to tell me she believes he’s a subclinical narcissist. Her evidence for narcissism includes Hare’s statements that suggest he has a fragile ego and needs to be liked by others. For instance, you could read the following statement as a theory about how most people feel, or you could read between the lines and see someone who is overly concerned with how he is perceived by others:

“We are haunted to some degree by questions about our self-worth. As a consequence, we continually attempt to prove to ourselves and others that we are okay people, credible, trustworthy, and competent.”

He does seem to take the misdeeds of sociopaths personally, for example he warns:

“All the reading in the world cannot immunize you from the devastating effects of psychopaths. Everyone, including the experts, can be taken in, conned, and left bewildered by them.”

Hare speaks from personal experience. He is on record describing his first encounter with a sociopath “Ray” as a long con in which Ray influenced Hare to break prison rules. Hare said he did what Ray asked to build a “rapport”. Due in part to Hare’s influence, Ray received a plum job in the prison mechanic shop. When Hare’s tenure at the prison ended, Ray performed a tune-up on Hare’s car. The brakes failed while Hare was driving down a hill, family in tow. A local mechanic confirmed that the brakes had been rigged with a slow leak. 

Alice thinks this early experience and his continuing inability to build a rapport with prison sociopaths caused him to harden his heart against them. Alice thinks he sought payback by portraying them in the worst psychological light possible, destroying their possibility of parole.

Alice’s theory for Hare’s anti-sociopath bias is consistent with the facts as we know them.

To give you an idea of Hare’s lack of scientific objectivity, in his book Without Conscience: The Disturbing World of the Psychopaths Among Us he calls sociopaths the “monsters of real life” and warns:

“On a more personal level, it is very likely that at some time in your life you will come into painful contact with a psychopath. For your own physical, psychological, and financial well-being it is crucial that you know how to identify the psychopath, how to protect yourself, and how to minimize the harm done to you.”

Hare has manifested other narcissistic traits. In a widely publicized move, he threatened to enjoin the publication of an academic, peer-reviewed article that criticized his PCL-R. The article, by researchers Jennifer Skeem and David Cooke, argued that “the PCL–R weighs antisocial behavior as strongly as—if not more strongly than—traits of emotional detachment in assessing psychopathy.” Consequently, it “is overly saturated with criminality and impulsivity (Blackburn, 2005; Forouzan & Cooke, 2005)” and as such, it “imperfectly maps psychopathy” and “does not fully correspond to Cleckley’s (1941) conceptualization, on which it is purportedly based.” 

"Bridging the Gap Between Scientific Evidence and Public Policy"

To address some of the misconceptions I've been seeing recently about sociopaths, a peer-reviewed academic article on public policy implications of sociopaths. From the summary to: "Psychopathic Personality: Bridging the Gap Between Scientific Evidence and Public Policy" co-authored by Jennifer Skeem, among others:


Few psychological concepts evoke simultaneously as much fascination and misunderstanding as psychopathic personality, or psychopathy. Typically, individuals with psychopathy are misconceived as fundamentally different from the rest of humanity and as inalterably dangerous. Popular portrayals of “psychopaths” are diverse and conflicting, ranging from uncommonly impulsive and violent criminal offenders to corporate figures who callously and skillfully manuever their way to the highest rungs of the social ladder.


Despite this diversity of perspectives, a single well validated measure of psychopathy, the Psychopathy ChecklistRevised (PCL-R; Hare, 1991; 2003), has come to dominate clinical and legal practice over recent years. The items of the PCL-R cover two basic content domains—an interpersonalaffective domain that encompasses core traits such as callousness and manipulativeness and an antisocial domain that entails disinhibition and chronic antisocial behavior. In most Western countries, the PCL-R and its derivatives are routinely applied to inform legal decisions about criminal offenders that hinge upon issues of dangerousness and treatability. In fact, clinicians in many cases choose the PCL-R over other, purpose-built risk-assessment tools to inform their opinions about what sentence offenders should receive, whether they should be indefinitely incarcerated as a “dangerous offender” or “sexually violent predator,” or whether they should be transferred from juvenile to adult court.
***
Despite the predominance of the PCL-R measurement model in recent years, vigorous scientific debates have continued regarding what psychopathy is and what it is not. Should adaptive, positive-adjustment features (on one hand) and criminal and antisocial behaviors (on the other) be considered essential features of the construct? Are anxious and emotionally reactive people that are identified as psychopaths by the PCL-R and other measures truly psychopathic? More fundamentally, is psychopathy a unitary entity (i.e., a global syndrome with a discrete underlying cause), or is it rather a configuration of several distinguishable, but intersecting trait dimensions? 

Although these and other controversies remain unresolved, theory and research on the PCL-R and alternative measures have begun to clarify the scope and boundaries of the psychopathy construct. In the current comprehensive review, we provide an integrative descriptive framework—the triarchic model—to help the reader make sense of differing conceptualizations. The essence of this model is that alternative perspectives on psychopathy emphasize, to varying degrees, three distinct observable (phenotypic) characteristics: boldness (or fearless dominance), meanness, and disinhibition. The triarchic framework is helpful for clarifying and reconciling seemingly disparate historical conceptions, modern operationalizations, and contemporary research programs on psychopathy.

In many cases, the findings we review converge to challenge common assumptions that underpin modern applications of psychopathy measures and to call for cautions in their use. For example, contemporary measures of psychopathy, including the PCL-R, appear to evidence no special powers in predicting violence or other crime. Instead, they are about as predictive as purpose-built violence-risk-assessment tools, perhaps because they assess many of the same risk factors as those broader-band tools. Specifically, the PCL-R and other psychopathy measures derive most of their predictive utility from their “Factor 2” assessment of antisocial and disinhibitory tendencies; the “Factor 1” component of such measures, reflecting interpersonal and affective features more specific to psychopathy, play at best a small predictive role. Similarly, current measures of psychopathy do not appear to moderate the effects of treatment on violent and other criminal behavior. That is, an increasing number of studies suggest that psychopathic individuals are not uniquely “hopeless” cases who should be disqualified from treatment, but instead are general “high-risk” cases who need to be targeted for intensive treatment to maximize public safety.

Misunderstandings about the criminal propensities and treatability of individuals achieving high scores on measures like the PCL-R have been perpetuated by professionals who interpret such high scores in a stereotypic manner, without considering nuances or issues of heterogeneity. A key message of our review is that classical psychopathy, whether measured by the PCL-R or other measures, is not monolithic; instead, it represents a constellation of multiple traits that may include, in varying degrees, the phenotypic domains of boldness, meanness, and disinhibition. Measures such as the PCL-R that do not directly assess features of low anxiety, fearlessness, or boldness more broadly tend to identify heterogeneous subgroups of individuals as psychopathic. As a consequence, efforts to apply one-size-fits-all public policies to psychopathic individuals may be doomed to failure. In aggregrate, these conclusions may help to shed light on what psychopathy is, and what it is not, and to guide policy interventions directed toward improved public health and public safety.

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.