Much of medical science today is about further understanding disease, disorder, and treatment. By manipulating context, we hope to tease the unknowns out of the chaotic vacuum of human ignorance into the controlled environment of categorization and understanding. There is nothing more satisfying in research to draw a statistically probable connection between concept x and concept y. The mind revels in these successes and after years of research, shedding blood, sweat, and tears, it can feel like the beast has been tamed.
However, as is the nature of scientific knowledge, there are never absolutes, only probabilities. And so once we have our category, it soon becomes apparent that sub-categories are needed. In the world of psychology, humans are forever providing exceptions to what we thought we knew (who would’ve thought that with billions of neurons and trillions of synapses, humans would ever throw continual curve balls?).
In psychopathy research, there have been some tremendous strides in identifying those with the disorder. The PCL-R and the CAPP are both powerful tools, but it is also important to remember that just as all people are different, the list of behaviors that make up these tests can be exhibited very differently, depending on the individual. This is partly why it takes a trained mental health expert, with a thorough understanding of the subject’s history, to determine whether or not the criteria is met.
Psychopathy, for many years now, is still being explored within different sub categories; along gender lines, within prison populations, in children and adolescents, and in those whose behavior never resulted in incarceration. The latter of this group have previously been termed ‘successful’ psychopaths, and researchers have pushed to see if there are any brain differences that could explain this phenomenon; for example, do psychopaths who have never been incarcerated have better impulse control? Does the way they express their ‘psychopathic’ behavior never quite fall foul of the law? Are they simply more intelligent and better at covering their criminal tracks?
Cleckley seems to recognize the problem of varying degrees of psychopathy in a variety of different individuals. In The Mask of Sanity, he lists six types of individual and attempts to explain how psychopathy manifests in all of them: These are psychopaths as business man, man of the world, gentleman, scientist, physician, and psychiatrist.* This list is clearly indicative of his time, and one has to wonder what the few pages on psychopath as customer service representative, rap star, or cable guy would look like. However, it is an interesting debate to see if there is anything remotely formulaic about how a psychopath’s career could influence and be influenced by all of the behaviors they are known to exhibit (in varying frequency), that is if they are a psychopath that can maintain a career for any length of time.
Psychopathy remains a very dynamic disorder, and there is clearly a profound amount of difference between those afflicted. There are many areas in the brain that have been implicated in the disorder, and it is when these areas have failed to develop that the disorder could start to make an appearance. One has to wonder that in the symphony of brain development, how much of x has to fail to develop, in light of the failures of y and z to reach maturation? What are the ratios in terms of tissue development and cellular activity that will increase the probability of psychopathic behavior to the point where the disorder is there to stay?
How much can psychopathy be parceled up, before it splits into independent diagnostic components?
*Despite having listed two female case studies, when theorizing Cleckley tends to default to psychopaths as male.