Saturday, March 29, 2014

The Psychopath

     'Madness without delirium', 'moral insanity' - these are just two of the terms that had been used until the late 1800s to describe the personality without a conscience, the personality with a lack of social responsiveness. The term 'psychopath' was first coined by a German clinician and since then has been used as the description of the criminal with violent, unstable behaviour.
A Psychopath? Not Really.

     The term 'sociopath', first used in the 1930s, is considered by some to be a synonym for psychopath, by others to describe an individual with behaviours which are perhaps less extreme. Today, the same definitions and uses of the terms 'psychopath' and 'psychopathy' are not accepted by all researchers. Most agree that psychopathy is a personality disorder characterized by a pattern of disregard for the feelings of others and often the rules of society.
     The psychopath has a lack of empathy and lack of remorse as well as very shallow emotions. However there is no consensus about the symptom criteria for psychopathy, and no psychiatric or psychological organization has sanctioned a diagnosis of 'psychopathy'. Many researchers do not consider the terms antisocial personality disorder (ASPD) and psychopathy as being synonymous.
     ASPD refers to broad behavioral patterns based on clinical observation, whereas psychopathy assesses character as well as behavior.
A Psychopath?

     The definition of ASPD is so broad that it is estimated that between 50-80% of male inmates qualify as meeting its criteria whereas, Hare estimates that only 11-25% of male inmates meet the criteria for psychopathy.
     To make the understanding of these two terms even more confusing, the current edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders Text Revision (DSM-IV-TR), published in 2000 describes antisocial personality disorder (ASPD), which is characterized by a long-standing history of criminal and often physically aggressive behavior and refers to it as synonymous with psychopathy. Much research, however, shows that measures of psychopathy and ASPD overlap only moderately.
     The characteristics of the psychopathic personality was first described systematically by Medical College of Georgia psychiatrist Hervey M. Cleckley in 1941 who described psychopathy as consisting of a specific set of personality traits and behaviors. According to Cleckley, a psychopath was superficially charming, tending to make a good first impression on others and often striking observers as remarkably normal.
     This disarming presentation hides the reality of the psychopathic individual who is self-centered, dishonest and undependable and will, at times, engage in irresponsible behavior for no apparent reason other than the sheer fun of it.   The psychopath is devoid of guilt, empathy and love and will have only casual and callous interpersonal and romantic relationships. They may offer excuses for their reckless actions blaming others, are often impulsive and rarely learn from their mistakes or benefit from negative feedback.
Hervey M. Cleckley

     With this definition in mind, psychopaths seem overrepresented in prisons, many studies indicating that as many as 25 percent of inmates meet the diagnostic criteria for psychopathy. But other research also suggests that a sizable number of psychopaths may be walking among us in everyday life. There may actually exist 'successful psychopaths', people who attain prominent positions in society, such as politics, business and entertainment. Most psychopaths are male and the 'condition' of psychopathy is present in both Western and non-Western cultures.
     As recently as the mid-1970s, almost 80 percent of convicted felons in the United States were being diagnosed as sociopaths/psychopaths. In 1980, psychologist Robert Hare of the University of British Columbia devised the Hare Psychopathy Checklist (revised five years later and now known as the PCL-R) which has become a standard ratings tool most often used in forensic settings to assess psychopathy, using a forty point scale. Using the PCL-R, one study suggested that 1-2% of the general US population score high enough to be considered potential psychopaths.
Robert Hare

     There is little evidence of a cure or effective treatment for psychopathy. No medications can instill empathy, and psychopaths who undergo traditional talk therapy often simply become more adept at manipulating others and more likely to commit crime.
     According to Dr. Hare, psychopathy stems from as yet unconfirmed 'genetic neurological predispositions and as yet unconfirmed social factors in upbringing'. Although the term 'psychopath' is not officially used in diagnostic manuals (DSM-IV), it is still used by many mental health professionals and by the general public as well as by the press and in fictional portrayals (ex Hannibal Lecter).
     Although psychopathy is associated with and in some cases is defined by conduct problems, criminality or violence, many psychopaths are not violent, and psychopaths are, despite the similar names, rarely psychotic.

University of British Columbia, Vancouver, Canada
     Unfortunately, the label of 'psychopath' has both political and social implications. By definition, a psychopath is an individual who is likely beyond rehabilitation - today, an accusation which is 'politically incorrect'.
     In the United States,  high PCL-R scores have been used as an argument to support the death-penalty. In the UK, there is debate whether some individuals with personality disorders (such as psychopaths) should be detained even if they haven't committed a crime.

     The Hare Psychopathy Checklist, Revised (PCL-R) is a clinical rating scale consisting of 20 items. Each of the items in the PCL-R is scored on a three-point scale according to specific criteria through file information and an interview of the patient. A value of 0 is assigned if the item does not apply, 1 if it applies somewhat, and 2 if it fully applies.
Hannibal Lecter
     These scores are used to predict risk for criminal re-offence and probability of rehabilitation.
     There are similarities or 'cross-overs' with other psychiatric conditions, such as PCL-R Factors 1a and 1b being seen also in narcissistic personality disorder and histrionic personality disorder.
     PCL-R Factors 2a and 2b are strongly correlated to antisocial personality disorder as defined in the DSM-IV.
     The PCL-R was developed primarily as an assessment for convicted criminals. As with any 'interview' device, the quality of ratings may depend on how much background information is available, whether the person being rated is honest as well as the objectivity of the interviewer.

The Hare Psychopathy Checklist, Revised (PCL-R)
Factor 1: Personality 'Aggressive narcissism'
a. Glibness/superficial charm
b. Grandiose sense of self-worth
c. Pathological lying
d. Cunning/manipulative
e. Lack of remorse or guilt
f. Shallow affect (genuine emotion is short-lived and egocentric)
g. Callousness; lack of empathy
h. Failure to accept responsibility for own actions

Factor 2: Case history 'Socially deviant lifestyle'
a. Need for stimulation/proneness to boredom
b. Parasitic lifestyle
c. Poor behavioral control
d. Lack of realistic long-term goals
e. Impulsivity
f. Irresponsibility
g. Juvenile delinquency
h. Early behavior problems
i. Revocation of conditional release

Traits not correlated with either factor
a. Promiscuous sexual behavior
b.Many short-term marital relationships
c. Criminal versatility
d. Acquired behavioural sociopathy/sociological conditioning (Item 21(d): a newly identified trait i.e. a person relying on sociological strategies and tricks to deceive)
     The PCL-R is referred to by some as the 'gold standard' for assessing psychopathy. Thirty out of a maximum score of 40 is recommended as the cut-off for the label of psychopathy (Hare, 2003), although there is little or no scientific support for this as a particular break point.
     In research, a cut-off score of 25 is sometimes used. This threshold varies between jurisdictions as well -  the UK has used a cut-off of 25 rather than the 30 used in the US.
     Other studies attempt to describe 'psychopaths' according to their major characteristics, separating them into 4 groups (primary and secondary first described by Cleckley in 1941):
     Primary psychopaths do not respond to punishment, apprehension, stress, or disapproval. They are able to inhibit their antisocial impulses most of the time, not because of conscience, but 'because it suits their purpose at the time'. Words do not seem to have the same meaning for them as they do for the general population. At times, it seems they are unable to grasp the meaning of their own words ('semantic aphasia'). They don't follow any life plan and are incapable of experiencing any genuine emotion.

Unable to Resist Temptation?
     Secondary psychopaths are risk-takers but are also more likely to be stress-reactive, worriers, and guilt-prone. They expose themselves to more stress than the average person and are as vulnerable to stress as the average person. They are daring, adventurous, unconventional people who began playing by their own rules early in life. They are strongly driven by a desire to escape or avoid pain, but are unable to resist temptation. As their anxiety increases toward some forbidden object, so does their attraction to it. They live their lives by the lure of temptation.
     Both primary and secondary psychopaths can be subdivided into:
     Distempered psychopaths fly into a rage or frenzy more easily and more often than other subtypes. Their frenzy will resemble an epileptic fit.
     They are also usually men with incredibly strong sex drives, capable of astonishing feats of sexual energy, and seemingly obsessed by sexual urges during a large part of their waking lives. Powerful cravings also seem to be in their character, cravings such as drug addiction, kleptomania, pedophilia, any illicit or illegal indulgence. They like the endorphin 'high' of excitement and risk-taking (see post: Your Personal Narcotic).

     Charismatic Psychopaths are charming, attractive liars. They are usually gifted at some talent or another, and they use it to their advantage in manipulating others. They are fast-talkers and possess an almost demonic ability to persuade others out of everything they own, even their lives. Leaders of religious sects or cults (see post: The Reverend Jim Jones) might be psychopaths if they lead their followers to their deaths. This subtype often comes to believe in their own fictions and are irresistible.
     Popular misconceptions surrounding psychopathy persist (possibly due to the condition's depiction in the media):
1. All psychopaths are violent - not true.
Ted Bundy

     Psychopathy is a risk factor for future physical and sexual violence and at least some serial killers—Ted Bundy,John Wayne Gacy and Dennis Rader, the infamous “BTK” (Bind, Torture, Kill) murderer—have manifested numerous psychopathic traits, including superficial charm and a profound absence of guilt and empathy.
     Most psychopaths, however, are not violent, and most violent people are not psychopaths. In the days following the horrific Virginia Tech shootings of April 16, 2007, many newspaper commentators described the killer, Seung-Hui Cho, as 'psychopathic'. Yet Cho exhibited few traits of psychopathy. Those who knew him described him as markedly shy, withdrawn and peculiar.

Seung-Hui Cho
2. All psychopaths are psychotic - not true.
     In contrast to people with psychotic disorders, such as schizophrenia, who often lose contact with reality, Psychopaths are almost always rational in contrast to people with psychotic disorders (ex schizophrenia) who often lose contact with reality.
     The psychopath is well aware that his ill-advised or illegal actions are wrong in the eyes of society but shrug off these concerns. Some serial killers referred to by the media as psychopathic, such as Charles Manson (see post: Death Cults) and David Berkowitz, displayed striking features of psychosis rather than psychopathy.

Charles Manson
     For example, Manson claimed to be the reincarnation of Jesus Christ, and Berkowitz believed he was receiving commands from his neighbor Sam Carr’s dog (hence his adopted nickname 'Son of Sam').

3. Psychopathy is untreatable - not necessarily true.
     Psychopaths are often unmotivated to seek treatment but some studies suggest that psychopaths may benefit as much as non-psychopaths from psychological treatment. Even if the core personality traits of psychopaths are exceedingly difficult to change, their criminal behaviors may prove more amenable to treatment.
David Berkowitz

     Is there a difference between psychopathy and sociopathy? Are psychopaths and sociopaths two different disorders?
     Some literature says that these two conditions are similar yet somewhat different. Some studies place the prevalence of 'sociopathy' at 4% in our society. This compares with a prevalence for anorexic eating disorders of 3.43% (nearly epidemic); schizophrenia occurs in only about 1% of the population; the rate of colon cancer in the United States, considered 'alarmingly high' is about 40 per 100,000 - one hundred times lower than the rate of antisocial personality.
     The high incidence of sociopathy in western (and likely, every) modern society has a profound effect on the rest of us who must live with them or, at least, have them live among us. Most people, however, know nothing about this disorder and, if they do, they think only in terms of violent psychopathy - murderers, serial killers, mass murderers - people who are conspicuous, who break the law and who, if caught, will be imprisoned, perhaps even executed by our legal system.
     The following, according to one article, is a comparison of the characteristics of the psychopath and the sociopath.
                                                    Psychopath                                                  Sociopath
Social relationships            unable to maintain normal relationships         appear normal in relationships Tendency to violence                          yes                                                             yes
Behaviour                                        erratic                                                       controlled
Suffers from                        antisocial personality disorder                         antisocial personality disorder
Criminal behaviour             erratic-leave clues and evidence                          well-planned-clues rarely left 
     Psychopaths often live at the fringes of society, are often extremely disorganized and are unable to maintain normal relationships with family, friends or co-workers. 
     Sociopaths, in contrast, can be obsessively organized and normal in their social relationships and caring towards their parents. A sociopath would likely live an outwardly normal life in a regular neighborhood and appear to blend in well with society.
     Psychopaths are often unable to hold down a steady job and house whereas sociopaths often have very successful careers and try to make others like and trust them.
     The sociopath is able to understand human emotions quite well but is unable to experience them. This allows the sociopath to be master manipulators of human emotions.
     Violence by a psychopath is erratic and unplanned and after the erratic act, psychopaths  generally leave behind a large trail of clues. On the other hand, sociopaths may take years to plan acts of violence and revenge, making it difficult to catch them. Each step in the violent act of the sociopath is carefully planned, their crime often undetected.

     Psychiatrists often don't distinguish between psychopaths and sociopaths but rather label a person with antisocial personality disorder (ASPD) with, perhaps the subclassification of 'sociopath' (if their mental condition is a result of mainly social conditions such as abuse during childhood) and 'psychopath' (if the condition is mainly congenital).
     If there are true differences between these two 'conditions' then there certainly are similarities as well.
      According to some therapists, both sociopaths and psychopaths face medical disorders that can be treated or alleviated if properly diagnosed, the treatment involving both psychotherapy as well as proper medication.
     In both situations, signs of the disorder begin to establish and surface at around fifteen years of age. The presenting symptom may be excessive cruelty to animals followed by lack of conscience, remorse or guilt for hurtful actions to others later on stage.
Animal Cruelty

     There may be an intellectual understanding of appropriate social behaviour but no emotional response to the actions of others.
     Psychopaths (perhaps the more severe form of the same disorder?) may also face an inability to form genuine relationships, and may show inappropriate or out of proportion reaction to perceived negligence.
     But why do these people exist? Is their behaviour an illness/a disease? Can this type of murderously depraved behaviour be biologically based?
     There is evidence that problems in brain structure and chemistry do play a part. Most experts agree that there is no neurological 'litmus test' for psychopathy. At King’s College London, scientists claim to have found the strongest evidence yet that psychopaths have abnormalities in key areas of their 'social brains'. The researchers looked at MRI brain scans of 44 male violent offenders (murderers and rapists), 17 fitting the diagnosis for psychopathy.
King's College, London

     The prisoners with psychopathic traits had significantly smaller amounts of grey matter in regions associated with processing 'empathy, moral reasoning and 'self-conscious' emotions, such as guilt and embarrassment'. Other studies have implicated abnormalities in the amygdala (the area associated with aggression), lesions in the orbitofrontal cortex as well as in the white matter connecting the two brain regions.
     Genetics may also play a role. One gene in particular has been implicated (MAO- A), which produces an enzyme that breaks down serotonin, a neurotransmitter which affects mood and can have a calming effect.
The Amygdala-Associated With Aggression

     Named the 'warrior gene', it has been theorized that the calming effects of serotonin may not always be effective in people born with a variant of this gene. Some researchers postulate that the brains of psychopaths may be wired for rewards.
     Brain scans show that people with high levels of 'impulsive antisociality' show greater activity in parts of the brain related to anticipating and expecting rewards. If those rewards don’t come nearly as frequently as expected, the psychopath becomes more aggressive, more frustrated and more alienated toward the world.
     Other studies suggest psychopaths’ brains have an enhanced ability to sense certain emotions — in particular, fear. They seem better able to pick up cues of vulnerability or weakness, making them, in a sense, a natural-born predator.

A Man With the 'Warrior Gene'?
     Certainly in modern times (and probably throughout human history), psychopaths/sociopaths have been tormenting our societies.
     During the Second World War, German Nazi and Japanese military physicians carried out cruel 'experiments and research' on prisoners, documenting their findings in scientific fashion for the purpose of 'discovery' and 'curiosity'.
     At Auschwitz, under the direction of Dr. Eduard Wirths, selected inmates were subjected to various experiments which were supposedly designed to help German military personnel in combat situations, to aid in the recovery of military personnel that had been injured, and to advance the racial ideology backed by the Third Reich.

     Unit 731 was a biological and chemical warfare research and development unit of the Imperial Japanese Army that undertook lethal human experimentation during the Second Sino-Japanese War (1937–1945) followed by World War II. This 'medical' unit was responsible for some of the most notorious war crimes carried out by Japanese personnel.
     The atrocities committed by the commander Shiro Ishii (see post: Death by Physician) and others under his command in Unit 731 included alive and awake dissection of prisoners (including pregnant women, impregnated by the doctors themselves) and amputation then reattachment of limbs to other parts of the victim's body.

Nazi 'Experiments'
     Some prisoners had parts of their bodies frozen and thawed to study the resulting untreated gangrene. Some victims were used as living test cases for grenades and flame throwers. Others were injected with strains of diseases (disguised as 'vaccinations') to study their effects.
     Male and female prisoners were deliberately infected with syphilis and gonorrhea through rape, then 'study' of their disease carried out.

Unit 731 'Experiments'

     More recent, in 2011 and 2012, are the cases of Canadian Luka Magnotta and Norwegian Anders Breivik.
     Nicknamed the one newspaper as the cannibal killer, Luka Magnotta (not his real name but rather one of several aliases) was said to have been inspired by a Jack the Ripper-style slaughter video game starring Christopher Walken.  
     Walken played a cop named Vince Magnotta in the 1996 game Ripper. Luka, a 29 year old gay porn 'star', adopted the same surname when he changed his name from Eric Newman in 2006. 
Luka Magnotta

     The game starts with emails sent to a newspaper from a serial killer addicted to butchering his victims. Luka Magnotta allegedly murdered his Chinese boyfriend, Jun Lin, with an ice pick in his Montreal apartment then dismembered the body, mailing one foot and one hand to two federal Canadian political parties and the other foot and hand to two private schools in Vancouver. The torso of his victim was discovered in a dumpster near his apartment.
On July 1, 2012, Canada Day (the country's national holiday), a severed head was discovered in a Montreal urban park.
     Magnotta fled Canada and, after an international alert, was arrested in Berlin and returned to Canada.   A few years back, Magnotta posted a video on You-Tube of footage of him carrying out strangulation and suffocation of several kittens.
     Magnotta is awaiting psychiatric assessment and trial but has already submitted a plea of not guilty on murder charges.
Ripper Video Game

     Another modern-day (possible) psychopath is the anti-Islam militant Anders Behring Breivik arrested in Norway for the killing of 77 people on July 22, 2011. 
     Breivik had admitted (with pride) to the bombing of the government’s headquarters in Oslo in  July, killing eight people, before gunning down 69 and injuring a further 242 (all victims mostly teenagers), at a summer camp of the ruling Labour Party.
     He however, denied criminal guilt and subjected the country to a trial during which the court had to rule on both his guilt, and his sanity. Breivik attempted to use the trial as a microphone for his ideology, keeping Europe 'white' and free from Islam.
     The question of guilt was not an issue as he admitted to the murders but it was Breivik's sanity which had been, from the outset, the central question the court was obliged to answer. A number of forensic and prison psychiatrists had told the court that they believed that  Breivik was not psychotic and therefore accountable for his actions.
Anders Behring Breivik

     However two people (the authors of the first psychiatric assessment) disagreed, stating that the man was psychotic at the time of his crimes and that he suffered from paranoid schizophrenia.
     Prosecutor Svein Holden stated that, given there were still doubts about his insanity, Breivik should be placed in psychiatric care and not sent to prison. Breivik himself called psychiatric care 'a fate worse than death'. If convicted of murder as a sane individual, Breivik would face a maximum prison sentence of 21 years under Norwegian law. Commitment to psychiatric care would mean Breivik could be confined for a long time, perhaps for the rest of his life. The legal system in Norway is scheduled to make a decision in July or August 2012.
     These are all cases of murderous individuals in modern times.
     But were the Nazi doctors in the German concentration camps and the Japanese doctors of Unit 731 true psychopaths? Or were these men simply being led along by 'group think' or 'crowd psychology' (see post: The Demagogues-How Do They Do It?). Would they have behaved in a similar way if there had been no war?
     Luka Magnotta certainly seems to fit the criteria for a psychopath. His psychiatric assessment is pending as of June 2012.
Breivik's Fascist Salute at the Start of Court

     Anders Breivik had a well thought out plan but allowed himself to be easily caught. At this point in time, there does not seem to be full agreement as to whether this man is sane or not, whether he is a true psychopath or really psychotic.
     Finally, is there really a difference between a psychopath and a sociopath? Perhaps one is only a more extreme form of the other.
     And are these two disorders (psychopathy and sociopathy) really different presentations of 'antisocial personality disorder' as defined in the DSM-IV?
     More precise definitions may possibly be helpful in treatment for the more extreme cases or may even signal that any attempt at treatment or rehabilitation would be futile.
     But for the population threatened by these individuals, for the victims of their crimes, definition is, more often irrelevant.
     For an interesting discussion on the absence of empathy ( a hallmark of the psychopath), click on the link below.  
     *Psychopathy and sociopathy: subjects of research for the novel Whip the Dogs - Amazon Kindle;
The Tao of the Thirteenth God - Amazon Kindle.

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