The Psychopath, Revised

Source: With Permission from Ebury Press

Many prominent experts on the disorder called psychopathy have a story about how a psychopath once duped them. Hervey Cleckley, who identified 16 traits and behaviors in such people in his groundbreaking 1940s-era book, The Mask of Sanity, tells one. So does Robert Hare, creator of the primary diagnostic instrument, the Psychopathy Checklist-Revised (PCL-R). Hare views psychopathy as a personality disorder that involves a callous disregard for the rights of others, a lack of remorse, and a propensity for predatory behaviors. Hare protégée Kent Kiehl documents his work with fMRI brain scans of psychopaths in The Psychopath Whisperer. He likewise describes the psychopaths who targeted him during his stint as a prison psychologist.

Now Mark Freestone, a senior lecturer in the Centre for Psychiatry, Queen Mary University of London, details his experience from over 15 years of clinical research. He, too, got “leveraged,” and like the others, he's used his experience to educate us. In Making a Psychopath, Freestone engagingly describes seven distinctly different dicey characters. Aside from those named in the public domain, each “patient” is a composite of people from his work. Freestone hopes to show that criminal psychopaths are significantly diverse in their backgrounds, character, and “ways of being dangerous.” He thinks the concept has been overloaded with media hype, as well as focused too firmly on traits and behaviors—especially the villainous ones. “To understand people,” he states, “we should always focus on relationships.”

Freestone’s table of contents calls to mind The Mask of Sanity. In fact, the first chapter is “The Mask of Psychopathy.” The others are organized around the seven cases, or types of psychopaths. Like Cleckley. I also thought of Theodore Millon’s nine psychopathic subtypes, each named for a predominant behavior (greedy, risk-taking, malevolent, etc). Freestone gives us the hit man, the con man, the parasite, and the borderline, among others. He also includes a female. Putting these subjects in motion in situations and relationships effectively brings them alive. It's not hard to envision people we may know who are like them.

However, he points out, his work is not about the individuals he describes so much as “what we can learn from them and how they shape our treatment of psychopaths.” He thinks we misconceive psychopathy as a unified condition when in fact the disorder covers a variety of manifestations, some with no similarity to others.

Freestone is a consultant for the popular television series, Killing Eve, which features the psychopathic female assassin, Villanelle. A producer had invited him to help them create a believable character. He saw that Villanelle, appropriately devoid of empathy or warmth, kills for kicks and money. Unlikely but possible. True to psychopathic form, Villanelle views people as a means to an end. As Freestone worked on this project, he recalled tales from his past encounters with actual psychopaths that he thought might “give a window into what it’s like interacting with people with a diagnosis of psychopathy.” Hence, the book.

Freestone began his work with research funding to study subjects in the Dangerous and Severe Personality Disorder Programme in England and Wales. During the early 2000s, the program’s innovative treatment plan offered hope of successful outcomes. This involved four special high-security units to house Britain’s most dangerous offenders. Freestone worked in the units from 2004 to 2013, keen to learn if the treatment would make a difference. In the process, he observed a wide range of psychopathic types.

“Paul” has a high PCL-R score of 38. He’s genial and charming. Freestone, then in his mid-20s, describes how Paul took him under his wing “protectively.” He “couldn’t have been nicer…always gregarious and keen to integrate me.” Paul seemed to understand Freestone’s passion for the work. Freestone didn’t notice how Paul’s internal calculations of who owed whom what demonstrated a keenly manipulative skill. No one eluded his predatory eye, including the naïve young researcher. Freestone got set up and he learned an important lesson.

But the lesson is not the point. Freestone wants to show that Paul’s manner of being a psychopath is different from “conman Tony" and “Arthur,” the unremarkable parasite, and from Jason, a pathological liar. The amalgamated but believable case histories remind us to resist stereotypes that oversimplify.

But what about Villanelle? It turns out that she does have a counterpart. The female psychopath Freestone describes is real-life Angela Simpson, an American killer with a lack of empathy or remorse. Over three days, she mercilessly brutalized a man in a wheelchair, including pulling out his teeth. She wished only that she could have made it last longer, and said she’d kill again. She had no bad feeling about it: “Why should I?”

Psychopathy Essential Reads

Revising My Ideas About a Kid Who Killed

How Many Female Psychopaths Are There?

Freestone thinks that the currently accepted psychopathy diagnosis fails to encompass the range of psychopaths he presents. Adding their background, motivations, and response (or not) to treatment gives a fuller picture. His stories demonstrate that psychopaths are people who “through a toxic and statistically unlikely combination of genetic bad luck and a desperate emotionally, physically, or financially deprived upbringing, have come to lack some of the most basic social skills, powers of reasoning, and emotional responses” needed to be human. Since the condition has a complex causality, he states, it will likely require complex treatment.

The final chapter of Making a Psychopath draws it all together as Freestone hopes to “rehumanize” our perception of psychopaths. He states that “an overhaul of the terminology, diagnostic process, and treatment of psychopathy is long overdue.” With early enough intervention and a more informed approach, children at risk for becoming adult psychopaths might achieve a “more developed cognitive empathy” that could support their social integration.

No doubt, there will be pushback from some who are invested in psychopathy research (not to mention media that embrace the stereotype), but Freestone’s call for reform is worth considering. He paid his dues in the facilities. He’s earned the right to be heard.