Tag Archives: psychopathy

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

How do you get a psychopath through a maze?

Sorry, I couldn’t resist.

Cleckley psychopath maze