What Should We Do With Psychopaths?

Written by Jimmy Ji

Edited by Mira Singh

Impressions around the group, psychopaths, are almost always negative these days. Viewed much more menacingly compared to similar personality disorders such as Bipolar Personality Disorder (BPD), psychopathy seems to have garnered an excessively terrible reputation. 

The reason for the stigmatisation around psychopaths seems to be perpetuated by the demonisation and dehumanisation of psychopathic individuals by the media. The process involves many separate categories of the media. For example, documentaries such as “Conversations with a Killer: The Ted Bundy Tapes” attempt to show an authentic and honest view of the infamous psychopathic murderer, however still only demonstrate an extremely negative example of psychopathy and do not disclaim so. Shows and movies engraved in popular culture such as “American Psycho”, “Silence of the Lambs”, and “Hannibal” provide impressionable figures such as “Patrick Bateman” and “Hannibal “the Cannibal” Lector” that leaves the audience with a biased opinion about psychopaths. Thinking that psychopaths are always callous, manipulative, and cold-blooded slaughter machines. News reports about crazed, trigger-happy, and psychopathic maniacs on an insane killing streak across states and countries leaving gruesome signatures at crime scenes with their terrifying Modus Operandi. There are countless examples of these influences that have been instilled throughout the development of contemporary media that have directly caused the horrible notoriety of psychopaths today. Even though these depictions are not the complete truth due to the lack of comprehensive information about the mental disorder, they still demonstrate the possible malice psychopaths can unleash. This poses the question, what should we do with psychopaths? Segregate them from the public in order to prevent the horrible acts they seem to always commit, or treat them like any other patient suffering from unwilling conditions? 

Before answering that question, it is important to get a comprehensive understanding of what psychopathy really is. Separated from the field of psychopathology, an umbrella term for abnormal syndromes and disorders of the human psyche, psychopathy solely focuses on the specific personality disorder.

So then what is in actuality, a psychopath? Psychopathy is a psychological phenomenon that has terrorised society since the discovery of its effects on the human psyche in the early 1800s by French psychiatrist Phillipe Pinel, who called it “insanity without delirium” (Anderson & Kiehl, 2014). 88 years later German psychiatrist J.L.A. Koch named the condition “psychopastiche” (The Psychopath, 2017), which evolved into the modern term of psychopathy. The first significant publication on the research of psychopathy was “The Mask of Sanity”, written and first published in 1941 by Hervey M. Cleckley, where he described his clinical interviews with patients in a locked institution (Mask of Sanity, 1941). For the past few decades, the lead researcher in this field has been Robert D. Hare, who is known for his psychopathy checklist, PCL-R, a  current list of criteria for distinguishing psychopaths (Robert Hare, 2022). To this day, psychopathy is a widely recognised psychological syndrome classified as a subcategory under the Antisocial Personality Disorder alongside Sociopathy. It is recorded in the newest editions of the International Classification of Diseases published by the World Health Organisation and the Diagnostics and Statistical Manual of Mental Disorders published by the American Psychology Association (APA) (Hare et al., 2015).

The modern definition of psychopathy is understood as a complex personality disorder defined by a range of traits such as callousness, manipulativeness, lack of empathy, a grandiose sense of self-worth, superficial charm, recklessness, and a disregard for societal norms (Willem, 2014). Biologically speaking, psychopathy does in fact have physical differentiation with the average person. Those with the disorder usually have an abnormal amygdala, ventromedial prefrontal cortex (Schultz et al., 2016), and right temporal lobe, causing hardships in feeling empathy and/or guilt (Koenigs, 2012). Individuals diagnosed with psychopathy also tend to have an enlarged corpus striatum, which causes them to be more easily incentivised by rewards (Glenn et al., 2010). There is also a major contrast in the anatomy of the prefrontal cortex, a separate region from the ventromedial prefrontal cortex whose details will be discussed later in the article.

Estimating the population of psychopaths is ineluctably difficult due to their tendencies to be pretentious, however, an estimate could be made. According to an article published by the APA, around 30% of US adults show psychopathic traits, while 1% are serious enough to be clinically diagnosed as having the disorder of psychopathy. There is currently no study that evaluates the population of psychopaths globally (Marsh, 2022). 

Genetic and environmental factors influence psychopathy. Many twin studies conducted suggest that individuals with a genetic predisposition towards impulsivity and lack of empathy may be more susceptible to developing psychopathy when exposed to adverse environmental conditions, such as childhood abuse, neglect, or a lack of positive parental attachment. However, it is also possible to develop psychopathy solely due to environmental factors without obvious genetic influence. This type of genetic predisposition is in fact prevalent in psychological disorders, such as depression, Bipolar personality disorder, or even ADHD. It is always the contribution of multiple factors including but not limited to genetics, that develop such syndromes (Essi Viding & McCrory, 2012). The role of culture is also significant in the development of psychopathy. Interestingly, psychopaths from different cultures will have different traits that are more prevalent compared to other cultures. A study that compared sociocultural influences on psychopathy traits in two different cultural contexts, western and south-eastern, showed that collectivism and Zhongyong thinking from the southeast negatively correlated with the maladaptive aspects of psychopathy (affective/interpersonal and behavioural), whereas individualism and dialectical self-concepts from the west positively correlated with the behavioural aspect of psychopathy. Interestingly, the dialectical self-concept also negatively correlates with Boldness. However, the majority of these associations did not differ significantly between the Western and East Asian samples, suggesting that it is very possible for there to be a potential universality of the psychological processes of psychopathy in relation to cultural values and thinking styles (Shou et al, 2021). Notably, psychopathy manifests differently in subjects of different sexes. There are more male psychopaths than females by small differences. The symptoms can also differ, such as females generally being more deceitful whereas males generally being more anti-social. These results were obtained from a study conducted on psychopathic inmates in Sweden (Strand & Henrik Belfrage, 2005).

An even more important distinction between psychopaths is the successful versus the unsuccessful. Psychopathic subjects are separated into two categories on this specific part of the brain. Unsuccessful psychopaths have less grey matter in the prefrontal cortex, causing their control of thoughts and impulses to be modicum. Compared to the similar ventromedial prefrontal cortex which helps with controlling emotions, the prefrontal cortex is the executive section of the brain that mainly manages higher-order cognitive functions, such as decision-making. People with a dysfunctional prefrontal cortex are unable to control themselves well, causing issues in daily tasks such as controlling thoughts and emotions. This category of psychopathic subjects is more likely to act on their violent thoughts with disregard for the law, allowing them to be convicted more easily. In comparison, successful psychopaths have greater control over emotions, which paired with the callousness of all psychopaths causes them to be extremely effective and productive members of society. This category of psychopaths is also often wealthy and powerful (Koenigs, 2012).

Due to psychopathy’s effect on the subjects’ behaviours, successful psychopaths have proven to be extremely useful in leadership settings. Caused by their callous-unemotional and manipulative traits, gargantuan drives towards rewards and successes, and their ability to control their impulses that cannot be done by unsuccessful psychopaths. A study performed by Paul Biake and Robert D. Hare in 2006 named “Snake in Suits” identified that around 1% of senior positions in business are occupied by psychopaths. These “high-status” psychopaths were extreme workaholics and manipulators. The study also revealed unique traits in either sex of the successfully psychopathic subjects. Females tend to manipulate with a nurturing, motherly image, males with an intimidating, “macho” figure, which corresponds to the Swedish inmates study mentioned earlier. The manipulation used in such corporate scenarios proved to be beneficial for the company in question as it increased employee productivity and sometimes bonds. (Snakes in Suits, 2006) 

However, psychopathic leaders are not always beneficial. Studies such as “Leaders without ethics in global business: corporate psychopaths” and “Psychopathy screening for public leadership” led by Clive Boddy also examine the possibilities of psychopaths being in high positions (Boddy et al., 2010). However, the evidence instead points to the seeming malevolence psychopathic subjects could impose on society (Emerald Insight, 2015). Events such as the Enron Scandal in 2001 display the potential harm corporate psychopaths could do. Enron was a Wall Street corporation that fell to fraudulent accounting performed by corporate psychopaths who gained a mass of wealth from this operation. This case evokes moral questions on whether psychopaths should be restrained or supervised in corporate and political settings, and whether psychopathic leaders are sustainable in their positions (the Handy Psychology Answer Book, 2023).

Now to discuss the cures of psychopathy. To the public’s knowledge, there are no cures for psychopathy so far. There are ways to mitigate the disorder’s effects, but it can’t be removed from a person as most mental disorders go (Anderson & Kiehl, 2014). ] However, through cognitive-behavioural therapy and training such as cognitive processing therapy (CPT) or psychoanalysis at a young age, juvenile patients displaying psychopathic traits can learn to empathise. Providing a healthy child and teenage hood without major traumatic events also prevents the development of psychopathy in adult years (Pisano et al., 2017). To clarify, psychoanalysis focuses on exploring the unconscious through methods such as hypnosis and dream interpretation However, This method comes with risks of uncovering even more trauma and causing the conditions of the patient to become even more severe. This method was spearheaded by the father of modern psychology Sigmund Freud and used ever since the end of the 1800s. On the other hand, CPT is a more recently developed method which is able to adjust behaviour and symptoms by conditioning the patients. This can be done in many different ways. For example, exposing a patient with nyctophobia to more and more darkness gradually. Despite sounding like it can develop a plethora of extra disorders such as PTSD, it is actually rather safe when planned by professionals. Other than that, strategies such as the Good-lives model (GLM), ​​a strengths-based rehabilitation theory, could potentially aid psychopathic individuals in their road to self-improvement. It focuses on setting pragmatic and individualised goals that can help the patient manage their life with the disorder. Even though GLM was developed to help with the recovery of mentally ill sex offenders, it could also serve as a good strategy to help direct the psychopathic subject in realising their goals and appropriate ways to reach them (Ward & Gannon, 2006).

In conclusion, through exploring the details of what being a psychopath means, both biologically, behaviorally, and even from a human resources perspective, it is clear that psychopathy is a disorder that should be treated instead of left alone or even stigmatised as it has in the modern society. This stigma around the disorder requires addressing as the harm in this is much more than some emotional offence it may bring to patients. It is more importantly a major roadblock for patients’ willingness to seek professional assistance. Furthermore, without adequate treatment, patients could fulfil the heinous and incorrect expectations society has put on them and commit horrible crimes that, in reality, are actually highly preventable through correct treatment. Hence, it is important for people to be educated and aware of the truth of what psychopaths are, their capabilities of functioning in society, and how we should treat them. Psychopaths are sick people, not inherent monsters.

Bibliography:

1. Anderson, N. E., & Kiehl, K. A. (2014). Psychopathy: Developmental perspectives and their implications for treatment. Restorative Neurology and Neuroscience, 32(1), 103–117. https://doi.org/10.3233/rnn-139001

2. The Psychopath. (2017). Google Books. https://books.google.com.sg/books?hl=en&lr=&id=8lYPEAAAQBAJ&oi=fnd&pg=PP1&ots=QJ5VgYTKUJ&sig=pBcQeWOxfgqV183is4sRnQLKxHQ&redir_esc=y#v=onepage&q&f=false

3. Google Books. (2019). Google.com.sg. https://www.google.com.sg/books/edition/The_Mask_Of_Sanity/00aQCwAAQBAJ?hl=en&gbpv=0

4. Robert Hare’s Page for the Study of Psychopaths, “Sociopaths”, Violent Offenders, Serial Killers... (2022). Hare.org. http://www.hare.org/#:~:text=Founded%20by%20world%20renowned%20expert,forensic%20consulting%20and%20research%20company.

5. Hare, R., Hart, S. D., & Harpur, T. J. (2015). Psychopathy and the DSM-IV criteria for antisocial personality disorder. Philpapers.org. https://philpapers.org/rec/HARPAT-27

6. Willem. (2014). The Hidden Suffering of the Psychopath. Psychiatric Times, 31. https://www.psychiatrictimes.com/view/hidden-suffering-psychopath

7. Schultz, D. H., Balderston, N. L., Baskin-Sommers, A., Larson, C. L., & Helmstetter, F. J. (2016). Psychopaths Show Enhanced Amygdala Activation during Fear Conditioning. 7. https://doi.org/10.3389/fpsyg.2016.00348

8. Koenigs, M. (2012). The role of prefrontal cortex in psychopathy. 23(3). https://doi.org/10.1515/revneuro-2012-0036

9. Glenn, A. L., Raine, A., Yaralian, P., & Yang, Y. (2010). Increased Volume of the Striatum in Psychopathic Individuals. 67(1), 52–58. 

10. Marsh, A. (2022). Why psychopathy is more common than you think, with Abigail Marsh, PhD. Https://Www.apa.org. https://www.apa.org/news/podcasts/speaking-of-psychology/psychopathy#:~:text=Although%20severe%20psychopathy%20affects%20just,some%20level%20of%20psychopathic%20traits.

11. Essi Viding, & McCrory, E. (2012). Genetic and neurocognitive contributions to the development of psychopathy. 24(3), 969–983. https://doi.org/10.1017/s095457941200048x

12. Shou, Y., Shi En Lay, De, S., Nakiya Xyrakis, & Sellbom, M. (2021). Sociocultural Influences on Psychopathy Traits: A Cross-National Investigation. Journal of Personality Disorders, 35(2), 194–216. https://doi.org/10.1521/pedi_2019_33_428

13. Strand, S., & Henrik Belfrage. (2005). Gender differences in psychopathy in a swedish offender sample. 23(6), 837–850. https://doi.org/10.1002/bsl.674

14. Koenigs, M. (2012). The role of prefrontal cortex in psychopathy. 23(3). https://doi.org/10.1515/revneuro-2012-0036

15. Google Books. (2019). Google.com.sg. https://www.google.com.sg/books/edition/Snakes_in_Suits/8-_urXom4ykC?hl=en&gbpv=1&printsec=frontcover

16. Boddy, C. R., Ladyshewsky, R. K., & Galvin, P. (2010). Leaders without ethics in global business: Corporate psychopaths. 10(3), 121–138. https://doi.org/10.1002/pa.352

17. International Journal of Public Leadership | Emerald Insight. (2015). Emerald.com. https://www.emerald.com/insight/publication/issn/2056-4929

18. Was the Enron scandal an example of psychopathic traits on the part of corporate executives? - The Handy Psychology Answer Book. (2023). Papertrell.com. https://www.papertrell.com/apps/preview/The-Handy-Psychology-Answer-Book/Handy%20Answer%20book/Was-the-Enron-scandal-an-example-of-psychopathic-traits-on-t/001137018/content/SC/52cb02e782fad14abfa5c2e0_default.html

19. Anderson, N. E., & Kiehl, K. A. (2014). Psychopathy: Developmental perspectives and their implications for treatment. 32(1), 103–117. https://doi.org/10.3233/rnn-139001

20. Pisano, S., Muratori, P., Gorga, C., Levantini, V., Iuliano, R., Catone, G., Coppola, G., Milone, A., & Masi, G. (2017). Conduct disorders and psychopathy in children and adolescents: aetiology, clinical presentation and treatment strategies of callous-unemotional traits. Italian Journal of Pediatrics, 43(1). https://doi.org/10.1186/s13052-017-0404-6

21. Ward, T., & Gannon, T. A. (2006). Rehabilitation, etiology, and self-regulation: The comprehensive good lives model of treatment for sexual offenders. 11(1), 77–94. https://doi.org/10.1016/j.avb.2005.06.001