Category Archives: Psychopathy

Anosognosia, Psychopathy, and the Conscience

How people see and understand themselves is likely to have an impact on how they interpret interactions with others. Here, I briefly explore the brain areas implicated in anosognosia, how these areas are also relevant in psychopathy, and why anosognosia is important when considering the crime and the conscience.

ANOSOGNOSIA AND SELF BELIEF

Anosognosia is defined as the impaired ability of patients with neurological disorders to recognize the presence or adequately appreciate the severity of their deficits [1]. Torrey (2012) cites three examples of anosognosic patients; a stroke victim with a paralyzed arm claimed he couldn’t lift it because he had a shirt on; a woman with paralysis in her left arm was asked to raise it, and instead raised her left leg. When this was pointed out to her she responded that some people call it an arm, others a leg, and jokingly inquired as to the difference; the Supreme Court Justice, William Douglas, was paralyzed on his left side. He claimed this was a myth, and was still inviting people to go hiking [2].

NEUROLOGICAL FINDINGS IN ANOSOGNOSIC PATIENTS

Recent research on this phenomenon has identified deficits in the brain of the patients who in all honesty do not recognize that they are in some way impaired. By using fluorodeoxyglucose positron emission tomography (FDG-PET) and single photon emission computed Tomography (SPECT) Perrotin et al. (2015) found that anosognosic Alzheimer’s patients had a disruption in connectivity between the posterior cingulate cortex (PCC) and the orbitofrontal cortex (OFC) [1]. Ries et al. (2007) also implicated a compromised precuneus in anosognosic patients. These midline structures are susceptible to damage in those with Alzheimer’s Disease (AD) and stroke victims. Anosognosia is also experienced by schizophrenic patients; according to Gerretsen et al. (2015), 60% of schizophrenic patients experience moderate to severe illness awareness, and this can lead to medication non-adherence and poor treatment outcomes [4]; they found left hemispheric dominance in the left prefrontal cortex in anosognosic schizophrenic patients and cortical thinning in the temporoparietalocciptal junction (TPO).

There is still much work to be done to determine the mechanistic and functional basis of anosognosia, and to determine the subtleties between illnesses and disorders, but research is starting to identify suspect brain regions. This is useful if anosognosia is questioned in other disorders, because neurological studies exploring the disorder can be explored and legitimate avenues of scientific inquiry explored.

RESEARCH PARALLELS WITH PSYCHOPATHY

A failure to recognize a disorder is also present in those with psychopathy. While anosognosia is yet to be explored thoroughly in those with psychopathy, there are behavioral items on the Psychopathy Checklist (PCL-R) [5] that suggest anosognosia is present; grandiose sense of self-worth, lack of remorse, and failure to accept responsibility. The sense of self-worth and narcissistic traits of the psychopath clearly means that they think very highly of themselves. This negates the idea that the psychopath believes they suffer from a defect or a disorder; at the most they might recognize that most others are different, and perhaps inferior to themselves. If a lack of remorse is experienced, this is an explicit demonstration that they do recognize, at least on an emotional level, the consequences of their bad behavior as being wrong; if they do not believe their behavior is inappropriate, it stands to reason that they believe they behaved appropriately, and thus experience nothing ‘wrong’ about themselves. This aspect of self-belief and self-reflection is also seen in the psychopath’s failure to accept responsibility; if they are always good and right, there is little motivation to make amends.

Based upon this cursory examination of psychopathic behavior, it would seem reasonable to explore the neurological studies of psychopathy and see if there could be some overlap with previous studies on anosognosia, and in fact some of the same compromised brain areas are implicated. Many studies have demonstrated developmental differences in the PFC of the psychopath (for a review, see Umbach et al. (2015) [6]), and the white matter pathways, such as the uncinate fasciculus (UF) connecting to the PFC from the limbic regions [7]. Perrotin et al. [1] hypothesized that Anosognosia can result from a disruption in connectivity in the UF. When exploring connectivity in the frontoparietal network (FPN), Philippi et al. (2015) found reduced connectivity in those with higher scores on the PCL-R, which included the right precuneus. And to further the overlap, Glenn et al. (2009) [8] found that those with who scored high on the interpersonal factors of the PCL-R (manipulative, conning, deceitful), showed reduced activity in the PCC during an fMRI scan when having to make judgments during moral dilemma scenarios.

Anosognosia and psychopathy both demonstrate complex neurological constructs, and it is premature to conclude that the neurological basis for Anosognosia (itself still understood) would tuck neatly into the already known neurological research on the psychopath. However, given the neat juxtaposition of behavioral traits and neurological dysfunction, it is worth bringing psychopathy into discussions of Anosognosia for the following reason. The research on psychopathy is currently deeper and richer than the research on anosognosia, and behavior of the psychopath has been widely observed and studied. If we can reasonably conclude that psychopaths, particularly criminal psychopaths, are also anosognosics, their behavior can be assessed in light of what it means to recognize no disorder or defect within oneself. The parallel is further relevant with psychopathy when considering that a number of those with schizophrenia, and a minority of those with AD, have been known for antisocial, and sometimes criminal, behavior [9, 10].

ANOSOGNOSIA, ANTISOCIAL BEHAVIOR, AND THE CONSCIENCE

Those with schizophrenia and AD also suffer from abuse, but when they have been known to act violently, their behavior and motivations need to be understood. Torrey (2012) has documented extensively the violent acts of those with schizophrenia [2]. There is usually a history of progressively worse episodes of psychosis that can convince the patient that they are receiving supernatural or alien instructions to kill or harm individuals, and more often than not family members. Whether or not the auditory hallucinations slowly convince the patient over time of the necessity for deadly action, or whether the act is impulsive, after the event the patient often remains remorseless and attributes their behavior to necessary and mandated (often divine) reasons. This state of mind is similar to the violent psychopath, who also viewed his violent actions as necessary and fully justified. The problem is never attributed to the self; a disorder or defect is not recognized. While psychopaths are widely regarded as not having a conscience and experience only limited affect, more research is needed on the experience of conscience by schizophrenics, especially understanding the role that psychosis played in circumventing the conscience and providing them with permission to act. It is also crucial to discover how those events are remembered and felt post psychosis, perhaps when the patient has reconvened their medication.

In illnesses and disorders that can be associated with antisocial behavior or aggression, anosognosia could be a partial reason for the event of the behavior. Not recognizing any problems or defects, and thinking that one acted rightly or righteously, will affect personal judgments on the self-evaluation of behavior. This does not provide a fertile ground for remorse or responsibility, and if the behavior was aggressive, the patient could continue to remain dangerous, inflexible to a reasoned and peaceful behavioral change. This makes the search for the neural representation of anosognosia all the more crucial, treatment all the more pressing, and methods of identification all the more necessary.

© Jack Pemment, 2016

 

REFERENCES

  1. Perrotin, A. et al. (2015). Anosognosia in Alzheimer disease: Disconnection between memory and self‐related brain networks. Annals of neurology, 78(3), 477-486
  2. Torrey, E. F. (2012) The Insanity Offense, New York, W. W. Norton and Company
  3. Ries, M. L. et al. (2007). Anosognosia in mild cognitive impairment: relationship to activation of cortical midline structures involved in self-appraisal. Journal of the International Neuropsychological Society, 13(03), 450-461
  4. Gerretsen, P. et al. (2015). Illness denial in schizophrenia spectrum disorders. Human brain mapping, 36(1), 213-225
  5. Hare, R. D. et al. (1990). The revised Psychopathy Checklist: Reliability and factor structure. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 2(3), 338-341
  6. Umbach, R. et al. (2015). Brain imaging research on psychopathy: Implications for punishment, prediction, and treatment in youth and adults. Journal of criminal justice, 43(4), 295-306
  7. Motzkin, J. C. et al. (2011). Reduced prefrontal connectivity in psychopathy. The Journal of Neuroscience, 31(48), 17348-17357
  8. Glenn, A. L. et al. (2009) The Neural Correlates of Moral Decision-Making in Psychopathy. Retrieved from http://repository.upenn.edu/neuroethics_pubs/55
  9. Fazel, S. et al. (2009). Schizophrenia and violence: systematic review and meta-analysis. PLoS Med, 6(8), e1000120
  10. Lopez, O. L. et al. (2003). Psychiatric symptoms vary with the severity of dementia in probable Alzheimer’s disease. The Journal of neuropsychiatry and clinical neurosciences, 15, 346–353

What’s in a name? The fickleness of sociopathy: Ideas, the suspension of the conscience, and why psychopathy is completely different

(For a PDF version, click here)

There is one question that can often haunt research on mental illness and mental disorders. Simple as it may seem, “What should we call it?” can often pose no end of obstacles, and result in long drawn out debates in the mental health and medical profession. One reason for this is that certain maladies often have numerous dimensions, and symptoms can present differently in those afflicted. Typically, through extensive research, diagnostic criteria are established under the banner of one name; pick up the DSM-V or the ICD-10 and you’ll see the names for all kinds of illness and disorder, with thorough lists of all the symptomatology that is now accompanied and unified under a common name. But these symptoms are often present in other conditions, and present in the patient to different extents. Rendering a diagnosis is indeed a tough challenge for any mental health professional.

 

Another reason that makes it difficult to name a particular mental health phenomenon, is that there is sometimes an inclination for the name to include the developmental origin. This struggle is perfectly captured in the history of psychopathy research. Cleckley, arguably the first psychiatrist to make strides in classifying psychopathy, writing in the 1940s devoted many chapters in his book, The Mask of Sanity, to discussing how the term and the individual were currently seen by the mental health establishment.

 

Every physician is familiar with the term psychopath, by which these people are most commonly designated. Despite the plain etymological inference of a ‘sick mind’ or of ‘mental sickness’, this term is ordinarily used to indicate those who are considered free from psychosis and even from psycho-neurosis.

Cleckley, The Mask of Sanity[i]

 

Clearly, in the mental health profession, a term denoting a ‘sick mind’ is not particularly useful in attempting to make a diagnosis, as it perhaps captures every possible mental malady that can afflict the human brain. However, the term does appear to capture those who are free from psychosis and psycho-neurosis, while still indicating that something is awry within these individuals. The truly psychopathic are renowned for behaving in socially pleasing ways, at least temporarily, before they are implicated in acts of antisocial behavior, sometimes even downright grotesque or horrendous behavior. This nature of the psychopath puzzled mental health experts and laypeople alike, as they pondered how one person could exhibit such extremes of behavior, sometimes in a short space of time.

 

Later, the term ‘psychopath’ clearly evolved and took on new meanings as research on this dangerous personality disorder progressed in the twentieth century. As the esteemed psychologist, Robert Hare, pointed out:

 

[Those] who feel that psychological, biological, and genetic factors also contribute to the development of the syndrome[,] generally use the term psychopath.

 Hare, Without Conscience[ii]

 

Hare stated this in contrast to those who were using the term ‘sociopath,’ who according to Hare were convinced that social factors and early experiences were responsible for the manifestation of this particular disorder, and subsequently this particular type of person, in society.

 

This appearance of two names for the same disorder (psychopathy/sociopathy), and the same person (psychopath/sociopath) becomes problematic. Not only is having two different names for the same condition a little redundant, but the developmental origins, the initial reason for having the two different terms, all belong together. Social factors, early childhood experience, psychological, biological, and genetic factors, all collapse into a uniform analysis of the one condition. Social factors and experience immediately become psychological and biological factors on the level of the brain, and these factors can have a direct impact on the level of gene expression. This is even more profound when the brain is still developing during the formative years, when certain kinds of abuse can result in neurological developmental errors.

 

In early 1990, Hare and his team devised what became the psychopathy checklist, revised.[iii] This built upon earlier research that resulted in the psychopathy checklist,[iv] and has become the gold standard for diagnosing psychopathy. The list is composed of two sets of behavior, dividing them into antisocial traits and personality traits. This diagnostic tool generates a total possible score out of forty, and after a mental health professional has assessed the behavioral history of an individual, any score given in the high twenties and over thirty is indicative of a psychopath. Using this tool, many neuroscientists have created experimental groups of psychopathic individuals and have found unique brain differences between the psychopathic and the non-psychopathic. And so, despite ‘psychopath’ being a vague and somewhat empty term in Cleckley’s era, psychopath research today is incredibly rich from behavioral and neuroscientific input. This richness, coupled with the collapse of social factors in with the biological to describe the same condition, means that the term ‘sociopath’ should be extricated from discussions of the disorder.

 

The term ‘sociopathy’ does become useful again when considered in another context. Hare and Babiak described ‘sociopathy’ in their book, Snakes in Suits, thusly:

 

Sociopathy is not a formal psychiatric condition. It refers to patterns of attitudes and behaviors that are considered antisocial by society at large, but are seen as normal and necessary by the subculture or social environment in which they developed. Sociopaths may have a well-developed conscience and a normal capacity for empathy, guilt, and loyalty, but their sense of right and wrong is based upon the norms and the expectations of their subculture or group.

Hare & P. Babiak, Snakes in Suits[v]

 

This definition is really what sets the two terms apart. Psychopathy is understood as a mental disorder and has formal diagnostic criteria; sociopathy does not. Sociopaths have empathy, guilt, and remorse; psychopaths do not. It is this latter point that is the most profound, because neurological studies have shown us that the areas in the brain that are heavily implicated in moral decision-making are typically malformed and mal-developed in the psychopath. This means that the brain of the psychopath, physically and neurologically, will be significantly different from the brain of the sociopath.

 

With this new definition, sociopathy becomes so much more useful to us. We can now ask questions such as ‘How can someone commit devastating and destructive crimes if they have a conscience?’ and ‘If a sense of right and wrong is represented in a person’s personal ideology, what power do ideas have in influencing a person to commit crimes?’. Sociopathy presents us with the opportunity to study how those with a conscience can, at least temporarily, act unconscionably. It presents us with the opportunity to explore how those with strong moral codes can promote group solidarity, while treating those not in the group as subhuman; think gangs, or the Mafia, or paramilitaries. Exploring the ideas present in the manifestos of spree killers and hate groups also becomes relevant, as they usually purport a version of history where one or more groups in society present as a threat, and why action needs to be taken against this group. All of these people have a conscience, but over time it appears to have become punctured or torn. Sociopathy could help us to understand why this has happened.

 

If we explore perhaps the most antisocial of behaviors, taking the life of another, sociopathy as a study of the ideas that led up to the act adds to our wealth of knowledge of those with disorders or illnesses that can lead to murder. Not all psychopaths are killers, but it is easy to understand how they can kill. Not having a conscience and not feeling guilt or remorse, perhaps even coupled with the pleasure derived from killing or severely injuring others, could easily lead to the act being carried out. Others have suffered psychotic breaks, often over a period of time, and aggression has escalated to the point of lives being taken; this has been true in some with schizophrenia and related conditions. Visual and auditory hallucinations can convince them of the need to act, and when this is coupled with paranoia, something that is often present in the schizophrenic, patients are often compelled to act in a manner they consider appropriate and necessary. Now, it is arguable that as a psychopath does not have a conscience, then they are simply unable to develop a complex ideology of right and wrong behavior; but we could find that sociopathy is comorbid with schizophrenia. Auditory hallucinations become part of the schizophrenic’s experience, and thus represent to them a truth about the world. If, like has been documented elsewhere, the auditory hallucinations are believed to be voices from the supernatural, instructing the person to act, the patient could work those instructions into everything else they believe about the world. A patient with a religious faith could easily believe they are receiving divine instructions to end the lives of people who are secretly evil, for example, demons posing as family members. Their hallucinations make their belief system very real to them, and the drive to act comes from a strong sense of rightness, bolstered by the belief that they are perhaps an avenging angel with a divine mission.

 

There are other abnormalities with neurological correlates that could facilitate taking the life of another. Crimes of passion are quite common, where an individual experiences a heightened sexual or stressful state and lost, only temporarily, a state of rationality. Extreme emotions can sometimes dampen the ability to reason and think clearly, with catastrophic consequences. These can often be exacerbated with those susceptible to anger management issues, or serious stress disorders. Sociopathy could also be present here; a homophobic father who catches his child engaged in a homosexual act could prompt a loss of control due to stress and result in extreme violence. The father would have no doubt been exposed to homophobic ideology before witnessing his child in a same sex relationship, and used the component ideas to justify to him what is true about the world. The perceived infraction from the father’s moral code results in the stress and the loss of control. For the most part, the father has a conscience, and loves his child, but his beliefs about the world seemed to couple with witnessing this act, and worked together with poor stress control to temporarily suspend his conscience.

 

Brain tumors, physical damage to neurological tissue, as well as alcohol and drug use, are also all linked to violent behavior. Here, too, an overarching ideology of what is right and wrong about the world, could work in synchronization with these biological changes to motivate destructive behavior, and the compulsion to act aggressively could even further justify the truth value of the overarching belief system; it has to be true (and thus, right), because why would the desire to act be so strong, otherwise? But does something have to be wrong biologically for toxic ideologies to take root and influence behavior? This is also a question that merits further research. Experiencing the world negatively, either because of something biological, or maybe just suffering from intense psychological hurt and pain, would be enough to make a person crave understanding. During this time they will be receptive to any ideas that seem to explain the negativity, and perhaps claim to provide an answer to end or cure the suffering. This wouldn’t explain all sociopathic behavior, but it would go a long way to understanding its onset.

 

Sociopathic behavior could result if over time, exposure to negative ideas helped to diminish empathy towards other people, and is perhaps demonstrated best by considering the lives of spree killers. Elliot Rodger, Seung-Hoi Cho, Dylan Roof, Anders Breivik, and Christopher Dorner all wrote lengthy manifestos, and some maintained websites and made Youtube videos detailing their grievances at great length. There are various mental illnesses and disorders that have been implicated in the lives of some of those individuals, but it is sometimes hard to substantiate if a diagnosis was made or not. Regardless of conditions or disorders, the manifestos represent a detailed view of the world, as seen by these individuals, including what is wrong with it, and usually what in their view has to happen to fix these societal ills, perhaps taking the form of retribution and revenge. Constructing a manifesto takes a lot of time, and is a significant personal investment for the author; they have taken the time to create a reflection of the world that is accurate to them, built up of the ideas that they think represent the truth and depict reality. The tremendous effort and planning that goes into the manifesto begs the question of what role the manifesto played in bringing them up to their final act. Was it to help them understand why they needed to do what they felt was necessary, thus allowing their conscience to at least temporarily bend to murderous inclinations? Did it help to commit these acts, knowing that people could use the manifesto to understand why it took place, even though they no doubt accepted they would not be alive to witness this ‘understanding’? Finally, if hypothetically they were unable to put a manifesto together, or they believed nobody would ever understand their actions, would their final act still have taken place?

 

There is also the question of how ideology and determining what is true about the world can change after the experience of psychotic episodes. If auditory hallucinations convince a patient of imminent threats or inevitable actions, what the patient believes is true about the world could change; ideas that promote certain kinds of behavior are adopted to achieve goals that fit into an evolving ideological framework. When the psychotic episode has subsided, does the imminence and immediacy of these ideas decrease? Are the ideas eventually discarded as an inaccurate representation of the world? Psychotic episodes are no doubt traumatic because they force the patient to reassess how they are seeing and understanding the world around them, and the more they are forced to reassess, the more traumatic the experience. After a string of psychotic episodes, the patient could well still harbor ideas that became prominent during the last episode, and so certain inclinations that become mandatory are eventually expected. The entanglement of psychosis with ideas and conceptual representations of the world is clearly a crucial study, and could well illuminate the state of the patient’s conscience.

 

This study of sociopathy would also apply to soldiers, who have to be prepared to kill, and destroy infrastructure that could decrease the standing of living for civilians. Soldiers are trained to incapacitate or take the lives of enemy combatants, often by a bloody and violent means. For a soldier to be able to take this action, they have to at the very least temporarily suspend empathy towards other human life, and be comfortable after the carnage with the actions that were taken. Soldiers obviously go into the military with a conscience and do not join out of a love or desire to kill (there is certainly screening to catch this disposition). Ideology can assist with coming to terms with needing to kill, particularly those of nationalism and patriotism; believing that some war is unfortunate but necessary, the war was just, evil has been prevented, and the enemy is a direct threat upon one’s way of life (which is right and true).  When these ideas fail to resonate as true, perhaps based upon personal experiences, the life of soldiers can become a living Hell, especially if they are also suffering from stress-related disorders brought on by extended periods of combat.

 

If we take sociopathy to mean the use of ideology to at least temporarily suspend the conscience or diminish empathy towards others, the example of soldiers as sociopaths opens up an interesting dimension to the discussion. Regardless of political inclinations or personal worldviews, most people would reluctantly accept that sometimes it is necessary for soldiers to kill. Sometimes people have to kill other people. Most of us are fortunate in that we have people who do it in our stead, and we trust them to make those decisions and take all the necessary precautions to keep it as ethical as it can be. If one of the primary purposes of the soldier is to be prepared to kill, then within this framework of sociopathy, we condone the training of sociopaths to carry out this necessary and deadly behavior.  Here, it is crucial to keep this framework of sociopathy in mind, and not treat it as a synonym for psychopathy. Soldiers are not psychopaths. It would be a worthwhile study to track soldiers’ ideologies throughout their careers in the military, because exposure to extreme combat is likely to force the soldier to reassess how they see the world, in a similar manner to schizophrenics experiencing psychotic episodes (a severely agitated mental state, prompting a new understanding of reality). Any time that reality is re-assessed, values of right and wrong can be re-considered, and this will reflect in the overall conscience of the individual. Those forced to re-evaluate the world, due to agitation or trauma, will become open to new ideas and vulnerable to toxic ones, which is one of the reasons why these individuals need constant help and attention.

 

Connecting the dots between ideology and conscience is clearly of paramount importance if we hope to understand violence. This goal can be met with an open, honest, and concerted effort to study sociopathy on the level of the brain, the individual, and society.

© Jack Pemment, 2016

 

References

[i] Cleckley, H., The Mask of Sanity (3rd Edition), EPBM, Brattleboro (2015), p. 27

[ii] Hare, R. D., Without Conscience, Guilford, New York (1999), pp. 23-24

[iii] Hare, Robert D., Timothy J. Harpur, A. Ralph Hakstian, Adelle E. Forth, Stephen D. Hart, and Joseph P. Newman. “The revised Psychopathy Checklist: Reliability and factor structure.” Psychological Assessment: A Journal of Consulting and Clinical Psychology 2, no. 3 (1990): 338

[iv] Harpur, Timothy J., A. Ralph Hakstian, and Robert D. Hare. “Factor structure of the Psychopathy Checklist.” Journal of consulting and clinical psychology 56, no. 5 (1988): 741

[v] Hare, R. D.; Babiak, P., Snakes in Suits, Harper, New York (2007), p. 19

The Onion in the Ointment: Neurodiversity With Psychopathy and Pedophilia

The formation of (and participation in) support groups to help individuals deal with unique medical or psychological conditions is a common occurrence in the United States. These groups help to build solidarity for individuals who once felt isolated, stories and anecdotes can be shared, and potential solutions or coping strategies can be imparted based upon similar experiences. These groups therefore provide an environment that is sensitive to the experiences and conditions that can stoke consternation and grief in everyday life.

Steve Silberman meticulously documented how the right group for those with autism can diminish the stresses experienced in a culture that has struggled to understand this neurodiversity. The number of support groups is endless, and they range from assisting victims of aggression, helping those suffering from debilitating and terminal illnesses, assisting those with neurological or psychological differences, and helping those who experienced extreme weather devastation. The point is that the support is there because there is a difference that majorities of people do not experience (or do not actively address), and this generates adaptation or standard of living concerns.

Technically, anything that meets this description generates the need of a support group, where measures can be addressed to help individuals onto a path that allows them to make the most of life, liberty, and the pursuit of happiness. From a mental health perspective, this is often accompanied by movements that push for culture to accept neurodiversity as personality differences, moving away from the stigmas of disorders.

However, there are at least two groups that by definition fall under the neurodiversity banner, which are problematic; psychopaths and pedophiles. While there is no unified neurological profile that can within an acceptable level of error capture all those that meet the diagnostic criteria for each condition, many studies have identified neurological differences; although, there is much diversity within psychopathy and within pedophilia, which make it hard to suggest unifying neurological differences, and behavior is diverse, too.

The behavior of both psychopaths and pedophiles can often be catastrophic, and could pose a serious threat to those who interact with them. For other neurodiverse conditions, individuals are taught to learn and structure their lives in a way that works with their set of differences; this clearly cannot be encouraged with psychopaths and pedophiles. In fact, if either of these groups wished to exercise their right for self-determination, as certain pedophile groups often have, society will push back. Support groups for pedophiles tend to focus on encouraging them to control their desires and drives, although the success rate remains questionable.

For psychopathy and pedophilia, therefore, neurodiversity is met with the need for resistance and legal protections that inhibit destructive and antisocial behavior which can result from their neurodiversity. This makes them unique from other neurodiverse conditions, and so therefore needs to be acknowledged and addressed in discussions that seek to encourage acceptance of neurodiversity. This may seem obvious, but arguments looking to support self determination based upon diversity need to be taken seriously, not in the least because there are exceptions.

While breaking stigmas remains a crucial battle, psychopathy, along with pedophilia, remain the elephants in the room.

Sources

Neurological study reviews focused on psychopathy

Anderson, N. E., & Kiehl, K. A. (2012) The psychopath magnetized: insights from brainimaging. Trends in cognitive sciences, 16(1), 52-60

Umbach, R., Berryessa, C. M., & Raine, A. (2015) Brain imaging research on psychopathy: Implications for punishment, prediction, and treatment in youth and adults. Journal of criminal justice, 43(4), 295-306

Weber, S., Habel, U., Amunts, K., & Schneider, F. (2008) Structural brain abnormalities in psychopaths—A review. Behavioral sciences & the law, 26(1), 7-28

Neurological study reviews focused on pedophilia

Fonteille, V., Cazala, F., Moulier, V., & Stoléru, S. (2012) Pedophilia: contribution of neurology and neuroimaging techniques. L’Encephale, 38(6), 496-503

Mohnke, S., Müller, S., Amelung, T., Krüger, T. H., Ponseti, J., Schiffer, B., … & Walter, H. (2014) Brain alterations in paedophilia: a critical review. Progress in neurobiology, 122, 1-23

Wiebking, C., & Northoff, G. (2013) Neuroimaging in pedophilia. Current psychiatry reports, 15(4), 1-9

Hervey Cleckley Quote #8

After describing the futile cycle of psychopaths going to prison, to a mental health hospital, and back into society, Cleckley describes the clueless nature of those trying to address those with psychopathic personalities:-

Turning now to penal facilities, now to psychiatric [hospitals], relatives, friends, doctors, lawyers, the community at large, all find they are trying to measure areas in kilowatts or color in inches. Since the fire extinguisher did not particularly help the child’s fever, which has become alarming, we gravely apply a plaster cast.

The Mask of Sanity

Hervey Cleckley Quote #7

[The psychopath] not only reproduces consistently good specimens of human reasoning but also appropriate simulations of human emotion in response to all the varied stimuli of human life. So perfect is this reproduction of a whole and normal man that no one who examines him can point out in scientific or objective terms why he is not real. And yet one knows or feels he knows that reality, in the sense of a full healthy experiencing of life, is not there.

The Mask of Sanity

Training the mind to devalue the lives of others

SociopathyWherever we find crimes against humanity, there is a good chance we will find ideology. And I don’t mean ideology to suggest extremism, just simply the presence of ideas that are used to justify or explain the crime. Whether the crime was intentional, whether it was because of one or many perpetrators, or whether it was accidental, ideas (which may have been present before the crime) will always quickly follow the crime in order to dampen the conscience.

To be sure, a conscience does have to be present in order for it to be dampened. The clinical psychopaths among us are not going to suffer a crisis of conscience should their behavior threaten the livelihood of others. Ideas may be tossed around in a courtroom in defense of their actions (prison is still an inconvenience for a psychopath), but they will not be needed to stop their mind from spinning out of control due to the powerful rehabilitative and sometimes crippling actions of a conscience.

There can be little doubt that our capacity for empathy plays a role in our conscience, after all, it is our empathy that truly allows us to experience the drive to treat others as we ourselves would like to be treated (the Golden Rule). It is truly an admirable state of humanity that one can witness the pain of another and then feel the drive and motivation to end that pain, although this in itself could become part of an ideology that results in the systematic murder of many people to fulfill the goal of ending pain and suffering. And there is also the small caveat of ‘feeling’ another person’s pain with the desire of inflicting more pain, perhaps for the sadistic desire of torture or the cockeyed belief of using pain to gain information.

It is widely acknowledged that there is a dual component to empathy; emotional and cognitive. Emotional empathy represents our strong feelings when we recreate the emotional experiences of others, and cognitive is when we use our reason to understand what somebody must be feeling. These two work together to create our empathic experience, and this experience is the gateway to how we will perceive ourselves after witnessing or thinking about an emotionally salient event. If we are directly involved in the event our conscience is going to want to weigh-in on how to feel, and if we cherish our peace of mind, we have to successfully navigate through our empathic experience of the event and find personal vindication.

The only problem is we can cheat.

As our cognitive empathy is based upon ideas – such as somebody else said they’d call an ambulance, everybody’s doing it, I would’ve caused an accident if I’d have stopped, they were faking so they could rob me – not only can we retrieve our actual memory of events, but we can use our imagination to interpret those events. It doesn’t matter how objectively true or valid these ideas are as far as our conscience is concerned, it is just that we believe them. And nothing validates an idea like other supporting ideas or the agreement of the idea by those we love and/or trust. When the conscience comes knocking, it is the cognitive component of our empathy that can send it on its way. And if certain ideas are heralded as true before an event, particularly a criminal event, such as women are fundamentally different and so need to be treated differently, or they would have killed me if I hadn’t acted, then the inhibitive impact of a conscience before a criminal event and its crippling affect after an event, won’t even be an issue and provides free license to aggressors.

Psychopath experts Robert Hare and Paul Babiak discuss the meaning of sociopath in their book Snakes in Suits. They define it as a person who has a sense morality (unlike a psychopath), but the morality comes from a sub-culture. These people have a sense of right and wrong, but their worldview morally permits them to behave in ways that are harmful to others. Such a sub-culture could be Anti-Semitism or White Supremacy, or any set of beliefs that devalues the lives of others (homophobia, misogyny, racism, ageism, etc.). Sometimes the belief systems aren’t even as extreme as we might think – nationalism, patriotism, and religion have all been used to devalue the lives of others. Beliefs that some of us cherish, such as love of country and love of God, even though seemingly innocuous and noble, could easily be borrowed by new ideas that support devaluing the life of others (such as those who don’t share those beliefs), all to appease our actions and deflect our conscience. The content or nature of the ideas doesn’t matter. If they’re used to devalue life, we’re talking sociopathy.

Of course, somebody who systematically devalues the life of others would not view this as devaluing (how can you devalue something that has no value to begin with?).  Those who recognize and feel that they devalued the life of others can make amends and adjust their future behavior, and this can be for something simple, such as stealing somebody’s pen, to denying a person their basic human rights. In the latter case, if those human rights aren’t even recognized due to a person’s ideology (the guiding force behind cognitive empathy), an aggressor has a powerful weapon to bat away the conscience and perpetuate harmful behavior.

Hervey Cleckley and Psychopathy

Hervey Cleckley. Photo from Wikipedia.

Hervey Cleckley. Photo from Wikipedia.

Hervey Cleckley is arguably one of the first mental health researchers to make sense of psychopathy. He worked as a psychiatrist in the Department of Psychiatry at the University of Georgia School of Medicine. In 1941 he published The Mask of Sanity: An Attempt to Clarify Some Issues About the So-Called Psychopathic Personality. As you can guess by the latter part of the title, in the 1940s there was a lot of confusion about what psychopathy was and how it should be addressed – not just how the public saw it, but how it was treated in legal and psychological/medical circles. In fact, at the end of an article Cleckley wrote for Federal Probation in 1946, he admits, “Psychiatry has not yet been able to prove or demonstrate precisely what is wrong with the psychopath.”

There were a least a couple of reasons for this confusion. First, psychopathic individuals appeared to commit crimes impulsively, even knowing that what they were doing was legally wrong. Cleckley wrote, “While on parole for stealing something [the psychopath] did not need, he will steal again, often taking an object he does not particularly want, and under circumstances that he knows may result in his being discovered as the thief.” This behavior was deeply puzzling, and it must have appeared that the psychopath was acting self-destructively. Now we of course can easily distinguish between knowledge of the law and feeling what is morally right. And we have also hypothesized that psychopaths often get their psycho-physiological kicks from acting recklessly and abusing other people, kicks that are far more important than any legal consequence.

The second reason for this confusion was that the psychopath appeared to act perfectly normal, right up until the very moment that they didn’t. This made it hard to determine whether or not the psychopath knew what was morally acceptable and whether or not they met the legal definition for insanity. The psychopathic offender wasn’t hallucinating. They didn’t display any evidence of brain damage as measured by instruments and tests of the day. The psychopathic behaviors of pathological lying and manipulation made it increasingly difficult to gauge the sincerity of the individual, and that still poses a problem for people today, including trained psychologists.

The writing of Cleckley is actually very amusing. It certainly betrays a stereotypical male attitude from the 1940s. For example, when describing the behavior of the psychopath, Cleckley writes, “Not rarely the records will show that [the psychopath] has won the chancellor’s prize at college for an essay on the Renaissance, or graduated from high school summa cum laude, or outstripped 20 rival salesmen over a period of 6 months, or married the most desirable girl in town.” I think Cleckley overestimates the intelligence of psychopaths to the point where he thought psychopathy and intelligence were naturally entwined, but writing about the Renaissance? To Cleckley, perhaps that is the epitome of scholarly brilliance. But marrying ‘the most desirable girl in town’ is surely a reflection of male chauvinism, even though psychopaths might enjoy the status of being with a beautiful woman.

Another example of Cleckley’s 1940s attitude comes through with, “If [the psychopath] escapes detection [for theft] he will repeat his stealing or perhaps forge a check or noisily entertain a prostitute in the apartment of his respectable and devoted aunt who is away on a week’s vacation.” I feel like this quote speaks for itself.

I have yet to come across any evidence that Cleckley believed women to be psychopathic. If anyone knows different, I would appreciate a reference. The psychopath is always addressed in third person male, which while is a writing bias, I’m sure it also reflects that many (if not all) of the psychopaths Cleckley studied were male. Even now it does seem like most psychopaths are male, but it has been suggested that the diagnostic criteria for determining psychopathy has come from male-dominated research. It is possible that the behaviors of the psychopathic are expressed differently in men and women. In fact, some believe that women are more likely to be diagnosed with Borderline Personality Disorder (BPD) than Antisocial Personality Disorder (APD – this is fairly closely related to psychopathy), because BPD reflects an emotional instability that is strongly associated with women. This bias could naturally lead to the wrong diagnosis.

Source

Cleckley, H. (1946) The Psychopath: A Problem for Society, 10 Federal Probation 22 (22-25)