Feeling for the Depths

Here is an excellent article on pyschopath by John Seabrook in the New Yorker. It includes definitions, history, case studies, and fascinating personal details:

At thirty-eight, Kiehl is one of the world’s leading younger investigators in psychopathy, the condition of moral emptiness that affects between fifteen to twenty-five per cent of the North American prison population, and is believed by some psychologists to exist in one per cent of the general adult male population. (Female psychopaths are thought to be much rarer.) Psychopaths don’t exhibit the manias, hysterias, and neuroses that are present in other types of mental illness. Their main defect, what psychologists call “severe emotional detachment”—a total lack of empathy and remorse—is concealed, and harder to describe than the symptoms of schizophrenia or bipolar disorder. This absence of easily readable signs has led to debate among mental-health practitioners about what qualifies as psychopathy and how to diagnose it. Psychopathy isn’t identified as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association’s canon; instead, a more general term, “antisocial personality disorder,” known as A.P.D., covers the condition.

There is also little consensus among researchers about what causes psychopathy. Considerable evidence, including several large-scale studies of twins, points toward a genetic component. Yet psychopaths are more likely to come from neglectful families than from loving, nurturing ones. Psychopathy could be dimensional, like high blood pressure, or it might be categorical, like leukemia. Researchers argue over whether tests used to measure it should focus on behavior or attempt to incorporate personality traits—like deceitfulness, glibness, and lack of remorse—as well. The only point on which everyone agrees is that psychopathy is extremely difficult to treat. And for some researchers the word “psychopath” has been tainted by its long and seamy relationship with criminality and popular culture, which began with true-crime pulps and continues today in TV shows like CBS’s “Criminal Minds” and in the work of authors like Thomas Harris and Patricia Cornwell. The word is so loaded with baleful connotations that it tends to empurple any surrounding prose.

I've highlighted one line above. I'm not an expert but my experience says it is a "dimensional" condition, i.e. there are degrees of it. It isn't categoric, i.e. all or none.

Here's the key point of the article:

Kiehl hopes, will confirm his theory, published in Psychiatry Research, in 2006, that psychopathy is caused by a defect in what he calls “the paralimbic system,” a network of brain regions, stretching from the orbital frontal cortex to the posterior cingulate cortex, that are involved in processing emotion, inhibition, and attentional control.

Here's the background info on spotting psychopaths:

In order to distinguish psychopaths from non-psychopaths among the Western volunteers, Kiehl and his students use the revised version of the Psychopathy Checklist, or PCL-R, a twenty-item diagnostic instrument created by Robert Hare, a Canadian psychologist, based on his long experience in working with psychopaths in prisons. Kiehl was taught to use the checklist by Hare himself, under whom he earned his doctorate, at the University of British Columbia. Researchers interview an inmate for up to three hours, and compare the inmate’s statements against what is known of his record and his personal history. The interviewer “scores” the subject on each of the twenty items—parasitic life style, pathological lying, conning, proneness to boredom, shallow emotions, lack of empathy, poor impulse control, promiscuity, irresponsibility, record of juvenile delinquency, and criminal versatility, among other tendencies—with zero, one, or two, depending on how pronounced that trait is. Most researchers agree that anyone who scores thirty or higher on the PCL-R is considered to be a psychopath. Kiehl says, “Someone who scores a thirty-five, a thirty-six, they are just different.

Here's the historical background...

The condition was first described clinically in 1801, by the French surgeon Philippe Pinel. He called it “mania without delirium.” In the early nineteenth century, the American surgeon Benjamin Rush wrote about a type of “moral derangement” in which the sufferer was neither delusional nor psychotic but nevertheless engaged in profoundly antisocial behavior, including horrifying acts of violence. Rush noted that the condition appeared early in life. The term “moral insanity” became popular in the mid-nineteenth century, and was widely used in the U.S. and in England to describe incorrigible criminals. The word “psychopath” (literally, “suffering soul”) was coined in Germany in the eighteen-eighties. By the nineteen-twenties, “constitutional psychopathic inferiority” had become the catchall phrase psychiatrists used for a general mixture of violent and antisocial characteristics found in irredeemable criminals, who appeared to lack a conscience.

In the late nineteen-thirties, an American psychiatrist named Hervey Cleckley began collecting data on a certain kind of patient he encountered in the course of his work in a psychiatric hospital in Augusta, Georgia. These people were from varied social and family backgrounds. Some were poor, but others were sons of Augusta’s most prosperous and respected families. Cleckley set about sharpening the vague construct of constitutional psychopathic inferiority, and distinguishing it from other forms of mental illness. He eventually isolated sixteen traits exhibited by patients he called “primary” psychopaths; these included being charming and intelligent, unreliable, dishonest, irresponsible, self-centered, emotionally shallow, and lacking in empathy and insight.

... Cleckley also argued, the individualistic, winner-take-all aspect of American culture nurtures psychopathy.

... Finally, the emphasis in the word “psychopath” on an internal sickness was at odds with liberal mid-century social thought, which tended to look for external causes of social deviancy; “sociopath,” coined in 1930 by the psychologist G. E. Partridge, became the preferred term. In 1958, the American Psychiatric Association used the term “sociopathic personality” to describe the disorder in its Diagnostic and Statistical Manual of Mental Disorders. In the 1968 edition, the condition was renamed “general antisocial personality disorder.”

Here is the bottom line for those of us dealing with people in the workaday world:

Hare has published two books that translate some of the concepts of psychopathy for a general audience and attempt to teach people how to identify the “successful psychopaths” in their midst. In the introduction to “Without Conscience,” he writes, “It is very likely that at some point in your life you will come into painful contact with a psychopath. For your own physical, psychological, and financial well-being it is crucial that you know how to identify the psychopath.” Among the professions likely to attract psychopaths, he writes, are law enforcement, the military, politics, and medicine, although he notes that these have norms and are self-policing. The most agreeable vocation for psychopaths, according to Hare, is business. In his second book, “Snakes in Suits: When Psychopaths Go to Work,” written with Paul Babiack, Hare flirts with pop psychology when he points out that many traits that may be desirable in a corporate context, such as ruthlessness, lack of social conscience, and single-minded devotion to success, would be considered psychopathic outside of it.

And here is the key problem which we face in trying to use knowledge about psychopathy/sociopathy:

This blurriness in the psychopathic profile can make it possible to see psychopaths everywhere or nowhere. In the mid-fifties, Robert Lindner, the author of “Rebel Without a Cause: A Hypnoanalysis of a Criminal Psychopath,” explained juvenile delinquency as an outbreak of mass psychopathy. Norman Mailer inverted this notion in “The White Negro,” admiring the hipster as a “philosophical psychopath” for having the courage of nonconformity. In the sixties, sociopathy replaced psychopathy as the dominant construct. Now, in our age of genetic determinism, society is once again seeing psychopaths everywhere, and this will no doubt provoke others to say they are nowhere, and the cycle of overexposure and underfunding will continue.