Almost a Psychopath

The darker side of human behavior.

May: Psychopath Month

Ongoing interest in psychopathy and those who almost qualify for the diagnosis.

Ronald Schouten, MD, JD and Jim Silver, JD

April may be the cruelest month, but May 2012 appears to be psychopathy month:

• May started with extensive media coverage of findings reported at the Biological Psychiatry meeting in Philadelphia by Nigel Blackwood, whose team at King’s College London’s Institute of Psychiatry used magnetic resonance imaging to examine the brains of 44 violent criminals (only some of whom were psychopaths) and 22 normal volunteers. Their conclusion, yet to be published, was that the volume of the grey matter in the anterior rostral prefrontal cortex and temporal poles of violent criminals with psychopathy was significantly less compared to other non-psychopathic offenders and normals. These are areas of the brain considered to be important for executive functions, like planning and control of behavior and emotion. Their findings reinforce similar results from other researchers, such as Kent Kiehl at the University of New Mexico.

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• Two weeks later, the New York Times Magazine published “Can You Call a 9-Year-Old a Psychopath?” by Jennifer Kahn. This excellent article explores the concept of “callous and unemotional traits” in children that appear to presage the development of psychopathy, as well as the controversy over diagnosing children as psychopaths. As we point out in our book Almost a Psychopath, children and adolescents who exhibit these traits, which may be considered “pre-psychopathic,” appear to be more amenable to treatment than adults suffering from full-blown psychopathy. As Kahn points out, labeling a child as a psychopath can have significant negative consequences for both the child and the parents. And such labeling is both unnecessary and reckless, given that a substantial portion of children who exhibit antisocial behavior grow out of it.

• That same weekend, NPR’s This American Life was devoted to The Psychopathy Test, an exploration of the history of psychopathy and the development of the Hare Psychopathy Checklist Revised (PCL-R), the test most widely used to identify psychopathy. It also looked at the controversial applications of the PCL-R by untrained clinicians and non-clinicians, and the at-times biased application of the instrument.

Why this fascination with psychopathy? Perhaps, like horror movies, this curiosity allows us an opportunity to face demons that we find both interesting and terrifying, and that we have trouble believing are real. In the case of psychopaths, however, these demons are not the stuff of fantasy, and unlike in the movies or on TV, rarely do the forces of good definitively defeat them before the credits roll. Even more intriguing and disturbing, we may recognize some of the traits of psychopaths in our work colleagues, loved ones, or even ourselves. How close are they, or we, to the dark side of human nature represented by psychopathy? Perhaps we are attracted to psychopathy because it lets us draws a clear line that differentiates us from true evil.

As we discuss in our forthcoming book, Almost a Psychopath (www.thealmosteffect.com) psychopathy exists on a continuum. A substantial portion of the population, perhaps as much as 15 percent, exhibits significant psychopathic traits, but not enough to be characterized as true psychopaths; we call these people “almost psychopaths”. It is not uncommon for otherwise good, conscientious people to occasionally engage in behavior that hints of psychopathy, for example manipulating others to achieve a goal, turning on the charm to persuade someone to act in our favor, having no qualms about driving a hard bargain that is very much to our advantage and to the complete, and sometimes painful, disadvantage, of others. The difference between the rest of us and almost psychopaths and true psychopaths, is that we have a sense of when we have crossed the boundary from minor, socially permissible transgressions to truly antisocial behavior. And if we do find ourselves on the wrong side of that boundary, we know it and feel remorse.

Not so for psychopaths, and for many almost psychopaths, who seem incapable of experiencing remorse or empathy. As the work of researchers Kiehl and Blackwood suggests, this may be a function of psychopaths having brains that are different from the rest of us, in some cases manifested in childhood. As psychopathy is studied further, it will be interesting to see if almost psychopaths share some, but perhaps not all, of these brain abnormalities. More importantly, if the behavior of almost psychopaths can be identified in early childhood, there may be a better chance to intervene and prevent their development along the psychopathy continuum.

 

 

Ronald Schouten, M.D., J.D., is an associate professor of psychiatry at Harvard Medical School and director of the Law & Psychiatry Service at Massachusetts General Hospital.

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