THE CRIMINAL PSYCHOPATH:  HISTORY, NEUROSCIENCE, TREATMENT, AND ECONOMIC

Kent A. Kiehl and Morris B. Hoffman

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059069/, extracts from above follow. ]

Abstract

The manuscript surveys the history of psychopathic personality, from its origins in psychiatric folklore to its modern assessment in the forensic arena. Individuals with psychopathic personality, or psychopaths, have a disproportionate impact on the criminal justice system. Psychopaths are twenty to twenty-five times more likely than non-psychopaths to be in prison, four to eight times more likely to violently recidivate compared to non-psychopaths, and are resistant to most forms of treatment. This article presents the most current clinical efforts and neuroscience research in the field of psychopathy. Given psychopathy’s enormous impact on society in general and on the criminal justice system in particular, there are significant benefits to increasing awareness of the condition. This review also highlights a recent, compelling and cost-effective treatment program that has shown a significant reduction in violent recidivism in youth on a putative trajectory to psychopathic personality.

Psychopaths consume an astonishingly disproportionate amount of criminal justice resources. The label psychopath is often used loosely by a variety of participants in the system—police, victims, prosecutors, judges, probation officers, parole and prison officials, even defense lawyers—as a kind of lay synonym for incorrigible. Law and psychiatry, even at the zenith of their rehabilitative optimism, both viewed psychopaths as a kind of exception that proved the rehabilitative rule. Psychopaths composed that small but embarrassing cohort whose very resistance to all manner of treatment seemed to be its defining characteristic.

Psychopathy is a constellation of psychological symptoms that typically emerges early in childhood and affects all aspects of a sufferer’s life including relationships with family, friends, work, and school. The symptoms of psychopathy include shallow affect, lack of empathy, guilt and remorse, irresponsibility, and impulsivity (see Table 1 for a complete list of psychopathic symptoms).  [ .  .  .  . ] 

Table 1

The 20 Items Listed on the Psychopathy Checklist-Revised (Hare 1991; 2003)

The items corresponding to the early two-factor conceptualization of psychopathy,⁸⁹ subsequent three-factor model,⁹⁰ and current four-factor model are listed.⁹¹ The two-factor model labels are Interpersonal-Affective (Factor 1) and Social Deviance (Factor 2); the three-factor model labels are Arrogant and Deceitful Interpersonal Style (Factor 1); Deficient Affective Experience (Factor 2), and Impulsive and Irresponsible Behavioral Style (Factor 3); the four-factor model labels are Interpersonal (Factor 1), Affective (Factor 2), Lifestyle (Factor 3), and Antisocial (Factor 4). Items indicated with “–” did not load on any factor.

	Item	2 Factor Model	3 Factor	4 Factor
1	Glibness-Superficial Charm	1	1	1
2	Grandiose Sense of Self Worth	1	1	1
3	Need for Stimulation	2	3	3
4	Pathological Lying	1	1	1
5	Conning-Manipulative	1	1	1
6	Lack of Remorse or Guilt	1	2	2
7	Shallow Affect	1	2	2
8	Callous-Lack of Empathy	1	2	2
9	Parasitic Lifestyle	2	3	3
10	Poor Behavioral Controls	2	—	4
11	Promiscuous Sexual Behavior	—	—	—
12	Early Behavioral Problems	2	—	4
13	Lack of Realistic, Long-Term Goals	2	3	3
14	Impulsivity	2	3	3
15	Irresponsibility	2	3	3
16	Failure to Accept Responsibility	1	2	2
17	Many Marital Relationships	—	—	—
18	Juvenile Delinquency	2	—	4
19	Revocation of Conditional Release	2	—	4
20	Criminal Versatility	—	—	4

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Psychopathy is astonishingly common as mental disorders go. It is twice as common as schizophrenia, anorexia, bipolar disorder, and paranoia,⁵ and roughly as common as bulimia, panic disorder, obsessive-compulsive personality disorder, and narcissism.⁶ Indeed, the only mental disorders significantly more common than psychopathy are those related to drug and alcohol abuse or dependence, depression and post-traumatic stress disorder.

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A BRIEF HISTORY OF PSYCHOPATHY

A. Emptied Souls

The idea that some humans are inherent free riders without moral scruple seems to have become controversial only in the postmodern era, when it has become fashionable to deny that any of us have a “nature” at all. For as long as humans have roamed the Earth, we have noticed that there are people who seem to be what psychiatrist Adolf Guggenbühl-Craig called “emptied souls.”¹⁷ One of Aristotle’s students, Theophrastus, was probably the first to write about them, calling them “the unscrupulous.”¹⁸ These are people who lack the ordinary connections that bind us all and lack the inhibitions that those connections impose. They are, to over simplify, people without empathy or conscience.

Psychopathy has always been part of human society; that is evident from its ubiquity in history’s myths and literature.¹⁹ Greek and Roman mythology is strewn with psychopaths, Medea being the most obvious.²⁰ Psychopaths populate the Bible, at least the Old Testament, perhaps beginning with Cain. Psychopaths have appeared in a steady stream of literature from all cultures since humans first put pen to paper: from King Shahyar in The Book of One Thousand and One Nights;²¹ to the psychopaths in Shakespeare, including Richard III and, perhaps most chillingly, Aaron the Moor in Titus Andronicus; to the villain Ximen Qing in the 17th century Chinese epic Jin Ping Mei, The Golden Vase.²² More recent sightings in film and literature include Macheath, from Berthold Brecht’s Three Penny Opera, Alex DeLarge in Anthony Burgess’ A Clockwork Orange, and Hannibal Lecter in Silence of the Lambs.²³

No cultures, or stations, are immune. One of the modern fathers of the clinical study of psychopathy, Hervey Cleckley, famously opined that the Athenian general Alcibiades was probably a psychopath.²⁴ And of course there was the Roman emperor Caligula. But psychopaths much more typically come from the ranks of the ordinary. Cleckley wrote extensively about ordinary patients he classified as having severe forms of psychopathy and whom he opined were almost all “plainly unsuited for life in any community; some are as thoroughly incapacitated, in my opinion, as most patients with unmistakable schizophrenic psychosis.”²⁵ But he also examined patients who were highly functioning businessmen—men of the world as he put it—scientists, physicians and even psychiatrists. These people were able to navigate the demands of modern society, despite having the same clinical constellations as their less-functioning brethren, including grandiosity, impulsivity, remorselessness and shallow affect. These functioning psychopaths have become the objects of much recent attention.²⁶

Although in this article we will focus on research efforts in the U.S. and Canada, psychopathy is a worldwide problem. In 1995, NATO commissioned an Advanced Study Institute on Psychopathic Behavior, the scientific director of which was Robert Hare, whose seminal clinical assessment instrument is discussed in detail in Part II below.²⁷ One of the important collections on psychopathy, cited throughout this article, was the product of a 1999 meeting held under the auspices of the Queen of Spain and her Center for the Study of Violence.²⁸ Also discussed below²⁹ is the British practice of expressly addressing the problem of the psychopath in commitment statutes in ways that have been generally more aggressive, at least theoretically, than is done in North America.

Psychopaths also appear in existing preindustrial societies, suggesting they are not a cultural artifact of the demands of advancing civilization but have been with us since our emergence as a species. For example, the Yorubas, a tribe indigenous to southwestern Nigeria, call their psychopaths aranakan, which they describe as meaning “a person who always goes his own way regardless of others, who is uncooperative, full of malice, and bullheaded.”³⁰ Inuits have a word, kunlangeta, that they use to describe someone whose “mind knows what to do but he does not do it,” and who repeatedly lies, steals, cheats, and rapes.³¹

While the capacity to identify with the thoughts and feelings of fellow human beings undoubtedly has innumerable cultural variations, it is beginning to be clear that evolution has built into the human brain a central core of moral reasoning that is more or less universal.³² It is that central core that is missing in psychopaths.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059069