Tag Archives: psychopathy

Manifesto: The relationship sociopaths have with themselves

ManifestoINTRODUCTION

Violent crime in the United States unfortunately remains a daily occurrence, and while domestic violence is undoubtedly the most common (and underreported), there now seems to be an increased interest in the role of ideology and murder. The recent shootings in San Bernadino, CA, and Philadelphia, PA, have been attributed to murderers who have been motivated by the ideology of the Islamic State of Iraq and the Levant (ISIL), and only in early October, 2015, Chris Harper Mercer killed nine people near Roseburg, Oregon, after penning his own manifesto that presumably explored his murderous inclinations. In 2014, Elliot Roger shot and killed six people and injured fourteen, after writing a manifesto entitled ‘My Twisted World: The Story of Elliot Roger.’

The motivations behind killing are complex and widely disputed, but it is time for some serious scholarship on the role that ideas play in dampening the conscience, at least temporarily, to provide an individual with a window of time where they have given themselves permission to kill. The role that ideology plays in the act of killing can be explained within the framework of sociopathy, but first this has to be distinguished from its estranged cousin, psychopathy.

 

PSYCHOPATHY

Psychopathy is noted as a mental disorder that is characterized by an emotional deficit and antisocial behavior [1]. Neuroscientists have found some profound differences in the brains of psychopaths when compared to the non-psychopathic, and these differences seem to result from developmental errors [2, 3]. Two key features of the psychopathic is the lack of empathy and remorse, and while many psychopaths are killers, a significant proportion of killers are psychopaths [4]. Psychopathy is also a clinical diagnosis, and so for somebody to truly be called a psychopath, they have to have been assessed by a professional mental health expert.

 

THE ROLE OF WORLDVIEWS AND IDEOLOGIES

When moving through our passage in life, we all develop a sense of what is right about the world, and figuring this out is probably one of the greatest sources of consternation many of us face on a daily basis. There seems to be a duality to this sense; feeling what is right, and then understanding conceptually what is right. When the two fit together, feeling right and being able to describe in words and ideas why we feel right, is an amazing and stable feeling, and the ideas are likely to become part of how we see the world. However, when our ideas and thoughts no longer feel right, or we feel right but do not know why, we are left feeling confused and perhaps even irritated.

Eventually, when we have had enough experiences and self-reflection, we start to develop a complex set of ideas that reflect what we think is true about the world.

During these pensive moments we suspend speculation and possibility surrounding the veracity of the idea, and it moves towards becoming a belief. This suspension could very well mark the difference between the scientific mind and the religious mind, as science only ever deals in probabilities, whereas the religious mind attributes absolute rightness to the core ideas, and this is known as faith (probabilities allow for‘wrongness’, a catalyst for the converse of faith, doubt). Indeed, always allowing a margin of error could mean that a person never has beliefs.

Regardless of how much truth currency we end up placing in our ideas, they become the mental lens that guides our behavior, gives us our sense of morality, and shapes how we will or will not understand the many more concepts and behaviors that will eventually cross our stream of consciousness. The new ideas and behaviors will be measured up against what we already have in our mental banks, and their acceptance into our worldviews will likely be a reflection of how well they agree with the rest of what we think is true about the world. Needless to say, this process can be excruciatingly hard work and can sometimes result in our peace of mind and sense of self being at stake.

 

PSYCHOPATHS AND IDEOLOGY

Our own personal worldviews and ideology tend to develop as we reflect on past experiences, contrast them with new ideas in the present, and then use ourworldview and ideology for perpetual self-reflection and interpreting new events as they arrive. From the case studies of psychopaths described by Cleckley [5] and Hare [4], psychopaths present as individuals who have little to no regard for their own future, let alone the futures of those they interact with. The psychopath appears stuck in the present, with an inability to make long term plans, and also has precious little regard for the past, and so it is questionable that a psychopath can develop a complex worldview.

Our worldview is also a reflection of our sense of morality. The ideas that we come to regard as good ways to live are built into how we see and interpret the world. Therefore, it stands to reason that if a psychopath has a limited sense of morality, any potential worldview or ideology is at an automatic deficit. When asked to justify their criminal behavior, many psychopaths will just admit that there was a rightness to it, mostly because they felt the dire urge to carry it out. The truth criteria behind their reasoning doesn’t fit into a complex philosophical framework, only that as
they felt they had to do it, it must have been the right thing to do.

 

SOCIOPATHY

The terms psychopath and sociopath are often used to describe the same type of person, that is an emotionless individual with a sense of grandeur and is prone to the manipulation of others, but the root words psycho and socio denote different developmental origins. As Hare notes [4], those who prefer the term sociopah tend to think that social forces and early experiences can explain this type of individual, whereas those preferring psychopath think that psychological, biological, and genetic factors offer the best explanation.

This polarized view of the etiology for psychopathy is terribly outdated, and falls victim to the old nature versus nurture discussion on the origin of behavior. Traditionally, a line seems to have been drawn at the skin of individuals, and everything on the inside reflects nature, anything on the outside is nurture, and they are mutually exclusive. While this framework perhaps provides a useful starting point for discussion, we now know that social influences and biology can interact together in very profound ways to influence the future path of an individual from the level of the cell all the way up to the organism. Our senses are lapping up so much information on a daily basis, and all of that information is creating changes in our biochemistry, especially in our nervous system. If a parent yells continually at their child, we may think, “Well, that’s terrible nurturing,” but it is also elevating the level of cortisol in the child’s circulatory system; soundwaves stimulating cells, sending signals that prompt tissues and organs to release molecules into the blood. All sensory stimulation leads to biological changes and activity, which is why this distinction between the two terms denoting etiological differences does not work.

Crucially, Hare and Babiak describe the sociopath as someone who has a sense of morality, but their sense of right and wrong has been informed by a subculture [6]. This
difference between the psychopath and the sociopath is profound, because unlike the psychopath, the conscience and the ability for rationalization in the sociopath are fully intact, which indicates an entirely different neurology. If sociopaths have an ideology, ideas of right and wrong, these ideas must be behind their eventual murderous behavior, and also goes a long way to explain the spree killer.

The term spree killer refers to an individual who is motivated, with varying extents of planning, to commit an act or acts of atrocity in a short space of time. One of the striking features about these types of events is that there is no attempt to hide or conceal the destruction or any associated fatalities or injuries. There is only the event, which must be completed, and often the only outcomes for the killer will be death by a shootout with law enforcement, death by suicide, death by sentence of the death penalty, or lifelong incarceration.

These outcomes provide some insight into the minds of these individuals leading up to and during the act of atrocity. It is inconceivable that at least the majority of these types of killers had no awareness of what would befall them after the event, which means at least one of two things. First, the act itself was valued by the killer more than their own life, and second, there was a physiological drive so powerful in their mind for completing the act that no other behavior was possible in the moment. The necessity of the act, which the killer could have justified to themselves many times, is heavily idea based, and because of this they were likely to have had a worldview containing ideas that devalued the lives of others.

 

THE GREATER GOOD

The idea of the ‘greater good’ is intriguing because when it is placed within an ideological framework that is supposed to promote the good or health of a group as a whole, it inevitably leads to the denial of the rights or even life of an individual or a subgroup of individuals. When the rights of people are often trampled upon for the greater good, the justification for this treatment is often seen as a necessary sacrifice, or once the new ideas or policies are in place, everyone will benefit (legislating common sense).

In order to implement a social or political system that is predicated upon greater good ideas, those with power have to be convinced, legitimately through debate or tacitly through violence. The style of the fight employed for the realization of these ideas is indicative of how well these ideas are to be received and the immediacy with which the advocate needs them to be realized. A potentially receptive audience and a debate reflect an advocate that is patient and willing to modify or compromise. A perceived unreceptive audience and violence reflect an advocate that feels compelled to act and is not willing to compromise. We can spot instances of these behaviors throughout history, particularly in terms of governmental behavior, but the desire for self-expression and the acceptance of ideas also operates on a much smaller scale.

For many, seeking acceptance among peers, or perhaps more potently in school, is a natural, but often painful, part of life. Finding a personal happy medium between what friends think is right and what you think is right is a daunting experience. To add to this, teenagers, by virtue of being young, do not have many other experiences with which to compare their immediate experience in school; this lack of experience in determining what is right for them results in grief and anxiety, and often puts them at the mercy of going along with a group that has met with their approval, even though there is sometimes respect for those who have the confidence to be different and not be influenced by the group, perhaps because it is such a huge pressure to overcome. The acceptance of ideas and behavior in these environments is similar to political expression at a higher social level, and could even be all the worse because of the huge emotional price tag of group acceptance. The perceived receptivity of the group and the compulsion for ideas and behaviors to be accepted could determine a change in tact of how an individual will later confront the group.

Even though many spree killers have no doubt accepted their own demise before they act, it is this notion that fuels their drive to act. They feel that their expression has been permanently blocked by those that need to validate these ideas (and related behavior), and so the only conceivable route of expression becomes violence to those who are blocking. This creates a fertile ground for accepting ideologies that dehumanize these ‘blockers.’ With resentment already in place towards those preventing self-expression, dehumanizing ideology towards these individuals will become palatable and sticky. This ideology, if unchecked, becomes the greater good for the individual in question.

Indeed, it could be useful to look at prejudicial worldviews in light of barriers to self-expression and a person’s right to the pursuit of happiness. Misogyny from men could result if men believe that women, by virtue of being women, will prevent their self-expression, especially sexual expression and subsequent gratification and acceptance. Likewise, Anti-Semitism results when an individual believes that Jews, by virtue of being Jewish, will always seek to prevent the self-expression and pursuit of happiness of non-Jews. At the heart of prejudice, there is always a lazy mind that is unwilling to evaluate people on an individual basis, as sweeping blanket condemnations seek to address painful and confused emotions. A lack of worldly experience, perhaps, would also prevent the person from having the cognitive maturity to make these individual assessments. It is worth asking, therefore, what is the object of the hatred preventing the subject from experiencing? When we have an answer to that question, it tells us all about how the subject thinks they should be able to exist in the world; behaviors they should be allowed to express, and ridding behaviors and ideas that muddy the waters of their idealized life. Knowing this could lead to methods of prevention or even intervention.

 

THE MANIFESTOS OF SOCIOPATHS

When reading a sociopath’s manifesto there are a few important points to note about the writing. The sociopath is usually presenting a history that supports the necessary action that will arrive by the end of the manuscript. As the sociopath’s mindset is heavily ruled by a guiding ideology, their main points or perceived milestones in their own development are likely to be heavily skewed or even fabricated.

However, much insight can be gained into their mind by realizing that the manuscript reflects back to them how they would like to be seen, perhaps not just by their community or the population after they carry out the devastating act, but also to themselves; the manuscript is how the sociopath would like to be seen in the mirror. Once the reflection pleases them, they are free to act.

The sociopath is likely to have spent months, maybe years, carefully crafting the manuscript and gone to painstaking detail to get it just right, and so this helps to combat the idea that they have intentionally gone out of their way to fabricate in order to trick readers. While this is still a possibility, the manuscript is usually a testament to what the sociopath believes is right about the world, after all, it provided them with the justification to act. While the history they present might not be objectively accurate, or perhaps even stunningly ignorant, the sociopath sees themselves ultimately as truthful and righteous, and no doubt want others to see them that way, too.

 

WHY WRITING CAN BE IMPORTANT TO THE SOCIOPATH

While not all manifestos are written, it is worth taking a long hard look at the ones that are. There is a very intimate relationship between an author and their writing, after all, writing is a way from them to organize and catalogue their own thoughts. The linguist, Noam Chomsky, is famous for noting that the majority of our language use is internal, and far exceeds our use of language in dialogue. Just take a moment to realize how frequently your thoughts are rolling through your mind, and how most of them drift in and out of a language, usually your primary one. Writing is the art of taking these ticker-tape thoughts and stabilizing them on the page, and the words can then be further manipulated until they meet with the satisfaction of the author, i.e. capturing (almost) perfectly the author’s intent.

For the confused or troubled mind, where thoughts and feelings are whizzing around like delocalized electrons, writing helps to pull them together into one place and provides the writer with focus. When an individual is experiencing emotional pain and confusion, therefore, this focus provides stability and a platform from which they can move forward. This is far from unique to the sociopath, and is most likely one of the main reasons that people keep diaries or write blogs. Writing facilitates clear thought, and clear thoughts, among other things, help to calm the mind and allow one to plan and project their future; goals can be determined and decisions made over the required behavior to meet those goals.

At some point in the life of the sociopath, the idea for committing an act of atrocity must enter their mind. The ease with which this idea is entertained will depend upon what they think is an accurate worldview (the right and wrong of the act), how necessary the action has become, and how compelled they feel to carry it through. This toxic idea will be stuck in their mind while they seek every justification for accepting it as more than just a good idea, but as something that they are compelled to act upon. During this time, there will likely be a high level of fantasizing and imagining, and an increased exposure to materials and ideas that facilitates the potential action in the mind of the sociopath; the act, slowly but surely, becomes inevitable.

The manifesto is a large part of making the act inevitable. It is worth bearing in mind that these acts are not a part of most people’s daily repertoire, including the soon-to-be-killer, and involve marathon amounts of planning and self-reflection. The sociopath needs to be able to see themselves actually doing the act, and there is very little room for doubt or uncertainty. This is why the manifesto is so important, because it allows the person to review and re-create their life history as if their life was always leading up to the deadly and devastating moment that they have decided is necessary. By cataloguing their history through the lens of their contemporary perturbed mind, therefore, right up until the present day, they are providing themselves with the consent and conviction that they need to go through with their plan.

This manufacturing of consent could also be why it is a good reason to stem the release of the manifesto after an act or at least hide many of the details surrounding the killer for as long as possible. If the manifesto was used as a tool to provide the author with consent to act, there is every chance it could be used by another individual with a similar history as a tool to act. If a like-mind is exposed to the manifesto soon after its author has acted, it could prompt the feeling of the immediacy to act again, perhaps resulting in a copy-cat killing. Silencing the thoughts and ideas of a killer after they have acted can only be effective for so long, but is still worth doing as a precautionary measure.

REFERENCES

1. Hare, R.D.; Harpur, T.J.; Hakstian, A.R.; Forth, A.E.; Hart, S.D.; Newman, J.P. (1990) The revised Psychopathy Checklist: Reliability and factor structure, Psychological Assessment: A Journal of Consulting and Clinical Psychology, 2(3), 338-341

2. Raine, A.; Lencz, T.; Taylor, K.; Hellige, J. B.; Bihrle, S.; Lacasse, L.; Colletti, P. (2003). Corpus callosum abnormalities in psychopathic antisocial individuals, Archives of General Psychiatry, 60(11), 1134-1142

3. Raine, A.; Ishikawa, S. S.; Arce, E., Lencz; T.; Knuth, K. H.; Bihrle, S.; Colletti, P. (2004). Hippocampal structural asymmetry in unsuccessful psychopaths. Biological psychiatry, 55(2), 185-191

4. Hare, R.D. (1999) Without Conscience, New York, Guilford Press

5. Cleckley, H. (2015) The Mask of Sanity (3rd Ed.), Brattleboro, Echo Point Books and Media, LLC.

6. Hare, R.D. & Babiak, P. (2006) Snakes in Suits, New York, Harper Collins

Why do we like psychopaths?

Tree faceI think all of us at one time or another have been fascinated by psychopaths, either from movies and books, or from biographical accounts of the many sadistic personages from history. We still find it hard to reconcile that the actions of some psychopathic killers were also the actions of a sane person, making the psychopath seem like a walking contradiction. This inability to grasp the motivations of the psychopathic has in the past, and no doubt today, too, led to many defendants being sent to a mental institution for treatment, rather than to prison or Death Row.

Trying to make sense of the actions of a psychopath is fraught with difficulty. The irony is that we apply our empathy to understand an individual who consistently fails to understand and feel different points of view.  Inevitably, our empathy fails to recreate anything, and we are left with nothing more than the cliched person suit before us. This subjective black hole leaves the psychopath to some extent undefinable, and like black holes will continue to suck us in as we philosophize over the nature of emptiness. It is this very quality that makes the psychopath a commodity for authors, and a delight for readers.

I am often wary of the admiration some have for the psychopathic, and have sometimes pondered the reasons behind such admiration. I’m the first to admit that I’m academically beguiled by psychopathy. The fact that mental health experts can use any validated psychopathy diagnostic tool to go on and find structural differences in the brains of psychopaths is mind blowing. However, I am also the first to admit how abhorred and repulsed I am when it comes to the behavior of psychopaths, especially when reading the testimony of victims.  This push-pull of intrigue and repulsion commands that a good deal of human thought time is dedicated to the conundrum of psychopathy. And to add another layer, it is not uncommon to see a history of abuse towards a child who later grows up to become a despicable monster – leaving us wanting to save the child, but condemn the adult.

I think psychopaths also represent a freedom to act. There are times when many of us become angry or frustrated with ourselves because we somehow failed to act during a defining or critical moment in our lives. The reason for inaction doesn’t really matter, if we are left feeling frustrated; this is made worse if it has been a continuation of precedent, where we have failed to speak up for most of our lives, and this most recent time was yet another reminder. Psychopaths are not bound by a conscience or a super ego, and so they usually have the motivation to act when they feel appropriate. Psychopaths are seen to get the job done, even if it (probably) means getting your hands dirty. This is a defining characteristic of many folklore and literary heroes.

In a weird way, I also think psychopaths are admired because they have a strong potential to do nasty things to other people. This isn’t to say that we all want to do nasty things to other people and we admire them for that, but being assured in ourselves that we could if we needed to, in a perverse way might reinforce our confidence; this feeds back into the satisfying idea that we could get our hands dirty if needed, within the right moral confines, of course.

We must remind ourselves, though, that it’s dangerous to preserve the psychopathic as a symbol, as a last ditch savior of the human race who can act without emotion. Acting without emotion is not by default a stronger or wiser position, in fact sometimes it’s quite the contrary.

This shows us another reason that people tend to admire the pathologically emotionless. Everyone has been hurt from a relationship, and during those times we have felt weak or humiliated, or just wished to become numb. However, it’s worth bearing in mind that emotions also make the world a very colorful and amazing place to live. Part of growing up is learning to take the rough with the smooth, and we must realize that without emotion life would be extremely dull. It is for this reason that I genuinely pity the psychopath because their disorder has robbed them of the richness and diversity of human experience.

Humans will always allow psychopaths to live on the border between reality and imagination, and it is for this reason they will remain an ever-alluring shadow to the human spirit. But every once in a while, we should remind ourselves of the extreme poverty of the psychopath experience.

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

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

Cleckley, Sexuality, and Circumscribed Behavior Disorder

In The Mask of Sanity, Cleckley devotes a chapter to a case about what was termed Circumscribed Behavior Disorder. Cleckley described it thusly:-

When behavior disorder is circumscribed, in a child or in an adult, one sometimes feels that symptomatically the patient resembles a psychopath but that a different sort of personality lies behind the manifestation.

The chapter is included among other chapters that are supposed to stand in contrast to psychopathic personality to help us better understand the psychopath, and includes such cases as the psychoticthe psychoneurotic, and the malingerer. One certainly gets the feel that this is 1940s psychiatry really struggling with classifications and groupings, after all, behavioral permissibility seems to be determined by the cultural and legal zeitgeist, and if something is deemed ‘wrong’ culturally, then psychiatrists automatically look at it as a disease or disorder.

This chapter is particularly striking, however. There is absolutely NOTHING wrong with the ‘patient’ in this case, a young woman who had sought help because she feared social repercussions  because of her deemed promiscuity. The other chapters all describe behavior or symptoms that now have reputable courses for treatment and therapy (mostly), and while it’s easy to attack the work of Cleckley for the obvious 1940s social climate and prejudices, he wrestles with this patient in the same way that Nietzsche struggled to understand women; if he could just lose the product of his time element from his observations and reasoning, the truth, I think, would have blown him away. You feel like he knows something is wrong in the same way that Mr. Anderson feels that something is wrong in the movie ‘The Matrix’ before he becomes Neo.

The young woman in the case ends up in counseling in her mid twenties. She clearly has a strong and curious sex drive, and she is also thoroughly intelligent, a keen social critic when it comes to cultural mores, and very book smart. She had no desire to form any long lasting relationship with a man (something that unfortunately flagged her as psychologically defective – because of course, sex for sex’s sake is clearly ridiculous). Cleckley interprets this as her not caring who she hurts: If men invest in a series of dates, there is some consensual sexual activity, and then she chooses to move on, the hurt the men suffer is obviously her fault and has nothing to do with their emotional immaturity and possessional attitudes.

In two years, she slept with twenty men. Cleckley notes that she easily experienced vaginal orgasm (wonderful that she had to answer those questions because she’s being screened as sexually dysfunctional), and even so, did not want to stay with any one man. After all, as we know, if women are sexually satisfied, what more could they possibly want out of life? There is never any evidence that she cut and run from relationships, or used sex to steal or blackmail from anyone, only that she ever wanted brief sexual encounters. There was also no guilt felt after sex, which is why Cleckley has connected this apparent disorder to psychopathy in the first place.

Later, the young woman finds an intimate and rewarding relationship with a woman who was fifteen years older and was a part of the faculty with her husband at a local college. This older lady was well read, erudite, and felt a reciprocal attraction; they would together listen to symphonies, read Shakespeare out loud together, and drink and chat well into the night. This progressed into nights spent together in the same bed where they had sex. This happened when the husband was away for research.

While the marital infidelity is enough to make one squeamish, the young woman clearly found everything she wanted in a partner. Who doesn’t want an intellectual, thought-provoking, charming, and sexual guru to spend most of their free time with, especially before the dawn of family and work life?  These needs that the young woman experienced would have made her selfish in the sense that she’s trying to figure out the best place for herself in the world, but her culture was against her all the way. In fact, she tells Cleckley how it was okay for little boys to wander off on tree climbing, hiking, or other adventures, but little girls were more restricted, and how boys became airline pilots, surgeons, and generals, but women became wives, and were destined to a life of housework. She fought this all the way and dared to listen to her own drives, dreams, and desires.

While in counseling, Cleckley noted that she was forced to admit that male and female genitalia are better suited to each other and work together to get better “sensual results.” He seems bang on the money – she was forced or defeated to admit something so preposterous. The concluding part to this chapter is disheartening. She’s being made to ‘understand’ that her feelings and drives are mechanisms for avoiding responsibility, in the same way that a child might feign sickness in an effort to avoid school. She is effectively punished for being herself.

I think Cleckley struggled with this case. He knew her observations of 1940s stereotypes were apt, yet her behavior is interpreted heavily by the prevailing morality of the time. One gets the impression that Cleckley’s primary duty for therapy was to encourage cultural assimilation. It wasn’t until 1973 that homosexuality was finally omitted from the American Psychiatric Association’s Diagnostic and Statistical Manual.

There was a disorder here, but it wasn’t Circumscribed Behavior Disorder. It was oppression.

 

Hervey Cleckley Quotes #6

I am not sure there was ever much more need for “psychosis with psychopathic personality” than for “psychosis with red hair” or “neurosis with a Ph.D. degree.” The new nomenclature appears better designed to avoid unnecessary confusions of this sort.

Mask of Sanity

Hervey Cleckley Quotes #5

Cleckley spends a great deal of The Mask of Sanity attempting to provide a useful framework for studying the psychopath (this is perhaps his main goal).

When speaking of the previous attempts to classify the disorder, Cleckley notes the following:-

A good analogy would arise if someone set out to establish and list scores of inconsequential differences between Buicks, Oldsmobiles, Plymouths, Cadillacs, Lincolns… etc., by studying assiduously a general material in which automobiles, ox-carts, demolished freight cars, jet planes, rural woodsheds, and the village pump were undistinguished, embraced under a single term, and treated through such concepts as can be formed in such an approach.

The Mask of Sanity