The Psychopath Whisperer: The Science of Those Without Conscience (8 page)

While almost everyone recognized the importance of the affective traits Cleckley and Hare articulated, some psychiatrists had doubts about average clinicians’ abilities to reliably detect affective criteria, such as lack of empathy, guilt, or remorse.

One common mistake that leads to overrating some of the affective items, such as
Lack of Empathy
, is to focus on a single bad thing that the person did, such as the index crime the individual committed that prompted his or her assessment and scoring. For example, if an individual commits a sex offense against a child, many trainees in the room will raise their hands when asked if this behavior merits a high score on
Lack of Empathy
. But they are wrong.
²⁴
The sex offense is only one piece of evidence suggesting impairment in empathy. To score high on
Lack of Empathy
, an individual must have evidence of the trait from multiple life domains and for the majority of his or her life—echoing Koch’s seminal contribution to the assessment of personality (disordered) traits. So the individual who committed a sex offense against a child may very well deserve a high score on
Lack of Empathy
but if they do, it will be because the person has demonstrated impaired empathy for a long time in other areas of his or her life as well—the single offense alone does not automatically warrant the high score.

One trick we teach clinicians when rating items on the Psychopathy Checklist is to ignore the index offense—the offense for which a client is convicted or incarcerated. The individual should get the same psychopathy item scores regardless of the crime that leads to his or her imprisonment. This avoids the common issue where
one monstrous deed leads raters to score the individual high on all traits.

Without proper training, the average clinician will likely have trouble producing valid ratings of psychopathy. The simple fix to this problem is that clinicians who need to perform psychopathy assessments as part of their practices or jobs should participate in a special professional training session. This is one of the reasons why continuing education is a required part of being licensed for any practitioner in psychology or psychiatry.

However, it was this tension—between those who did and did not think the affective traits could be reliably diagnosed—that drove the swinging pendulum of the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental Disorders (DSM)
classification of psychopathy over successive iterations.

The
DSM
is the “bible” of mental illnesses in the United States. It provides a template for how clinicians assess and classify patients into various categories of mental illness. Determining a patient’s diagnosis is usually the first step toward determining the best course of treatment. However, defining
mental illness
is a complicated process, and I always teach my students that they need to go beyond the
DSM
. That is, the
DSM
is a good starting point, but if you really want to be on the cutting edge of the science of mental illness or developing new treatments, you must educate yourself about the strengths and weaknesses of any psychiatric diagnosis. Moreover, the
DSM
is an evolving document that is shaped by science, economics, and politics (not necessarily in that order). Thus, it is incumbent upon researchers that they understand the history of the mental illness they are studying and learn how the illness has been assessed in previous iterations of the
DSM
.

There was widespread dissatisfaction
²⁵
,
²⁶
with early versions of the
DSM
treatment of antisocial personality disorder/psychopathy. This led the American Psychiatric Association to conduct field studies in an effort to improve the coverage of the traditional symptoms of psychopathy. As a result,
DSM-IV
(and
DSM-5
) reintroduced some of the affective criteria that
DSM-III
left out, but in a compromise, they provided virtually no guidance about how to integrate the symptoms.

Perhaps more important—and dangerous—forensic practitioners may diagnose a client with
DSM
antisocial personality disorder but mistakenly draw upon the literature using the Psychopathy Checklist and incorrectly relate the latter findings on recidivism and treatment outcomes to a client with only minimal antisocial symptoms.

I routinely consult with lawyers and judges, and it is not uncommon for them to have been told by their consulting forensic practitioners that the Psychopathy Checklist and
DSM
antisocial personality disorder criteria are the same when they are absolutely not.

In professional training seminars, I sum up the relationship between
DSM-IV
antisocial personality disorder and psychopathy as assessed with the Psychopathy Checklist this way:

The
DSM
antisocial personality disorder criteria get you about halfway to the diagnosis of psychopathy using the Hare Psychopathy Checklist-Revised. If you are a clinician working in the community and you complete an interview with your client and he or she meets
DSM
criteria for antisocial personality disorder, you know you are dealing with someone with a difficult personality. But then clinicians need to go beyond the
DSM
criteria and assess for psychopathy using the Hare Psychopathy Checklist-Revised. In this way the clinician will know whether he or she is dealing with a psychopath or not, drawing upon all the thousands of papers that have been published on psychopathy to help develop a treatment and management strategy for a client. If you are working in a forensic setting, you should simply skip the
DSM
criteria and use the Hare Psychopathy Checklist-Revised.

The evolution of psychopathy has been full of twists and turns, but the scientific community has finally sorted out a common metric for the condition. In the next chapter, I’ll explore the symptoms of psychopathy in more detail, illustrated by case examples of two notorious assassins.

Americans were stunned twice in the latter half of the
nineteenth century by presidential assassinations. The first assassination, of President Abraham Lincoln by John Wilkes Booth, occurred in 1865. Sixteen years later, in 1881, Charles Julius Guiteau assassinated President James A. Garfield. The two assassins used the same instrument to execute their malfeasance, a .44-caliber revolver, but that is where the similarities end.

John Wilkes Booth was a prominent stage actor who led a relatively charmed life. A Southern sympathizer, Booth murdered Lincoln just days following the surrender of Confederate general Robert E. Lee in an attempt to turn the tide of the Civil War back on the side of the South. Charles Guiteau’s crime, contrary to Booth’s, was utterly motiveless and simply mystified Americans. The trial of Guiteau for the assassination of President Garfield would fracture the medical and legal community over the diagnosis of
moral insanity
and its relationship to criminal responsibility.

Many people assume horrific crimes indicate the perpetrator has a disturbed, even deranged, personality. I am often asked whether all murderers are psychopaths. Many people assume they are. But as we’ve seen, psychopathy is more complicated than the details of any single crime can capture, no matter how despicable the act. In the
pages that follow, I intend to assess the traits of psychopathy in two of the most notorious assassins in American history, to show how the scoring of an individual on the basis of those traits leads to a clinical diagnosis. As we know from
Chapter 2
, psychopathy, as assessed by the Hare Psychopathy Checklist, is comprised of 20 items that typify the affective, impulsive, and antisocial symptoms of the condition. Each of the items is scored on a three-point scale. A “0” indicates that the trait does not characterize the individual, a “1” indicates that the trait describes the individual in some areas, and a “2” indicates that the trait is present in all aspects of the individual’s life. Typically, I would interview the individuals before scoring them, but of course Booth and Guiteau are deceased, so we will have to rely on the historical record. Thankfully, there is abundant information available on both men, due to the infamy of their crimes. We have available to us dozens of reports from family, friends, investigative journalists and reporters, autobiographies, historical biographies, and even personal diaries. These collateral sources are sufficient to score the items on the Psychopathy Checklist for both assassins. In scoring Booth and Guiteau, we have to be careful not to let our ratings of psychopathic traits be overly influenced by the assassinations both men carried out. Despite the fact both men committed a horrific crime against the nation, we cannot let a single incident distort our assessment; we must consider the totality of both men’s lives.

My goal in this chapter is to offer readers a window into how scientists assess psychopathic traits in an individual. Typically, the Psychopathy Checklist is part of the risk assessment of criminal offenders, but the checklist is also being used in other parts of the legal system, including custody disputes, divorce court, and other adversarial processes. The assessment of these traits is not as simple as it might seem, and the results that follow might be surprising. Let’s go through the traits, one by one, and assess John Wilkes Booth and Charles Guiteau in light of what we know.

One aspect of psychopaths’ behavioral repertoire is that they often speak quickly, volubly, and interrupt the flow of the conversation frequently, in an energized speech that observers can find difficult to follow and process in real time. The listeners are bombarded with so much information that they often leave the conversation not having been able to digest it all. Then, as observers recall the conversation, their minds interpolate, usually in a very positive sense, the information that was presented. The psychopath often comes off as quick witted, even likable, but the listeners’ “gut” feelings detect that there is something not quite right about the individual. It takes practice to sift through psychopathic speak.

One of my favorite things to do with college psychology undergraduates is to send them to prison to interview psychopathic inmates without letting them read the collateral files first or letting them know the individuals they are interviewing are psychopaths. I’ll observe an interview and let the novice probe and question the subject. Upon completing the interview, I ask the undergraduate what he or she thought of the guy. More often than not I get a response such as “He was so nice, I can’t imagine why he is in prison” or “If that guy was on the outside, I’d get a beer with him.” Then I let them read the inmate’s file. “This can’t be the same guy,” a novice commonly replies. I tell the student, “Go reinterview the inmate now that you have studied the collateral information.” During the reinterview, the novice asks, “Why didn’t you tell me about all that stuff in your file, all the crimes you committed, the rape, the robbery?” The psychopath more often than not replies with something like “Oh, that’s the old me. I wanted to talk about the new me.”

It’s a valuable lesson for anyone who wants to work with psychopaths. It is not possible to score psychopathic traits based on an interview alone. You need collateral information if you want to score individuals with these traits.

Do you think that the victims of the psychopaths thought they were in danger? Of course not. They might have seen warning signs, they might have felt a little tug in their gut that something was off,
but most victims of psychopaths don’t understand the kind of person they are dealing with, or they would have stayed far away. As a psychologist, you need to trust that gut feeling and investigate. Don’t be caught off guard. Being careful and prepared is never a bad thing when you work with psychopaths.

With regard to Charles Guiteau, evidence from business partners, his former wife, parents and siblings, friends, acquaintances, personal attorneys, and newspaper reports about his life and trial suggest he exhibited superficial glibness in all facets of his life. Guiteau would engage in conversations with such force and excitement that it would make an impression upon everyone with whom he came in contact. Guiteau earns a high score, a 2, on this item.

In contrast to Guiteau, John Wilkes Booth has been referred to as the Brad Pitt of his times. He was attractive, athletic, and an engaging stage performer from a family of famous thespians. He performed Shakespeare and other classics in over thirty cities. He helped introduce high-powered spotlights with colored light to the stage to rave reviews and popularity. He was known as a ladies’ man. Women, enthralled with his performances, literally lined up to go back to his room with him. Booth was considered genuinely charming and he had a sparkling personality. There is no evidence of psychopathology with regard to this trait, but he did embody a celebrity lifestyle, including an attitude of superiority, which merits some consideration. I score him a 1 (moderate) on our three-point scale (0, 1, or 2).

To sum up the scoring of the two assassins on this trait:

John Wilkes Booth aspired to follow in the footsteps of his famous father, Junius Brutus Booth. Junius was an international star, considered
one of the foremost tragedians in British theater before relocating to the United States in 1821. He toured throughout the United States to enormous acclaim. Famed poet Walt Whitman described him as “the grandest histrion of modern times.”

John Wilkes’s older brother, Edwin, also achieved significant popularity as a Shakespearean actor. Edwin is considered one of the greatest American actors to ever play the role of Hamlet.