Highlights: May 5–11

Here's what we've loved reading this week, including: why politicians should get familiar with science, our angst about what we wished we looked like, and whether or not sex should be important in romantic relationships.

Psychopath Analysis: The Early Days

We've been trying to figure out psychopaths for over a century.

We hear so much about psychopaths today, from their brain scans to their distinct smell to the content of their Twitter accounts. This past week, a study published in Current Biology described brain scans on three-dozen difficult boys believed to be at risk for adult psychopathy. It provoked pop headlines warning that we might soon be able to spot fledgling psychopaths via MRI. Of course, deep inside such articles was the inevitable retraction: “Not really.”

Today we see two parallel developments about psychopaths: alarmist media hype and continuing research rooted in decades of serious effort. The former threatens to erode the support structure of the latter.

Although psychopathy was recognized ages ago, even by early philosophers, it wasn’t easy to devise a workable concept for diagnosis. Nineteenth-century alienists described it variously as "insanity without delirium," "moral insanity," and "psychopathic inferiority."

These days, the revised Psychopathy Checklist (PCL-R) gets a lot of attention as a primary diagnostic instrument. However, before it was ever formalized and applied to research, its developer, Dr. Robert Hare, published Psychopathy: Theory and Research in 1970. He included a section about how the concept of psychopathy had evolved and how he'd tapped into the clinical state-of-the-art ideas to develop a useful assessment.

Hare has spent more than five decades engaged in research on the nature and implications of psychopathy. Yet becoming the renowned expert that he is today was, in part, serendipitous.

As he worked on his dissertation during the 1960s, Hare had to support himself, so he became a psychologist at a maximum-security prison near Vancouver, BC. Here, he had his first extended encounter with a psychopath.

In published accounts, Hare describes “Ray” as a thin man with an unrelenting stare who showed Hare a knife one day and said he was going to use it on another inmate. “He’d placed me in a bind,” Hare recalled, “challenging me to either show that I was a rat, and therefore not to be trusted, or that I was willing to violate the rules. I elected not to report it, which gave Ray the leverage he sought.”

Hare realized only later that the knife had been a prop. But now Ray “owned” him. He plagued Hare with requests for favors, “usually lying about why he needed them, just to keep his manipulative edge.”

Hare learned that even when he challenged Ray on his lies, Ray shrugged it off. He showed no remorse or concern about consequences. He was always ready to slither into yet another lie. Hare began to take an interest in the kind of person Ray appeared to be.

Already researching the effects of punishment on human behavior, Hare found that Ray seemed resistant to the threat of punishment, so Hare looked into what other clinicans had to say about psychopaths. To his surprise, there was hardly any empirical research. It seemed to be a rich terrain to explore.

At the time, Hare writes, a diagnostic label, “sociopathic personality disturbance, antisocial reaction,” referred to individuals who were “always in trouble,” and who maintained no loyalties. They exhibited emotional immaturity, a lack of good judgment, and an ability to rationalize their behavior to make it seem justified. This label was fairly close but rather clumsy.

A professional group had also suggested “tension discharge disorder, impulse-ridden personality” when dealing with children at risk to become psychopathic. In addition, Hare found the label, “neurotic psychopathy,” for people whose antisocial behavior was rooted in an underlying emotional problem. Some clinicians attempted to type psychopaths into aggressive and passive, while others delineated “simple” and “complex” psychopathy.

In other words, back in the 1960s, a few professionals were trying out ideas, but there was no clear consensus. Most noted a lack of remorse, emotional void, and egocentricity as central characteristics.

Hare focused on the criteria that an American prison psychologist, Hervey Cleckley, had devised. In 1941, Cleckley had published The Mask of Sanity in which he’d distilled sixteen traits and behaviors that formed a specific profile.

Among them were irresponsibility, self-centeredness, shallowness, superficial charm, and lacking in empathy or anxiety. Cleckley also coined the phrase “semantic dementia” to denote the lack of emotion in the psychopath’s verbalizations. Each new edition of his book further crystallized the criteria with clinical examples.

Following this approach, Hare describes psychopathy as a personality disorder that offers a distinctive cluster of traits and behaviors, “most of which society views as pejorative." Among the most salient features are a callous disregard for the rights of others. Without remorse, psychopaths charm and exploit others for their own gain.

Today, we take the diagnosis for granted, and media images have oversimplified the clinical view to create creepy stereotypes. Instant diagnoses of “horrible bosses,” headline-grabbing defendants, and difficult spouses threaten to undermine solid clinical research. Let’s hope that the media fad will soon pass.