The Wisdom of Psychopaths (9 page)

Figure 2.6. A four-factor model of the PCL-R (from Hare, 2003)

Psychopathy, in other words, is a composite disorder consisting of multiple interrelated components that range discretely and independently along a number of different spectra: interpersonal, emotional, lifestyle, and antisocial—a witches’ brew of personality leftovers.

But which of these spectra are most important? Is someone who scores high on the antisocial elements of the checklist, for example, and lower, say, on the interpersonal dimension, more or less of a psychopath than someone whose profile is the complete opposite?

Questions like these surface quite regularly in the battle for the psychopath psyche, in the empirical and diagnostic combat zones of clinical definition. Take, for instance, DSM’s listing of Antisocial Personality Disorder (ASPD), an area of particular strategic importance in the epidemiological conflicts. The official line, as set out by the American Psychiatric Association, is that ASPD and psychopathy are, in fact, synonymous. ASPD is defined as “a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood.” The individual must be age eighteen or over, show evidence of conduct disorder
⁸
before the age of fifteen, and present with at least three of the following criteria:

But is this really the same thing as psychopathy? Many theorists argue not—and that although there is certainly overlap between the two, the fundamental difference lies in insidious vagaries of emphasis: in the manifest imbalance between the welter of behavioral items of “socially deviant” criteria that characterize ASPD and the core affective impairment, the shadowy emotional twilight, redolent of the psychopath.

The ramifications, statistical or otherwise, are not without consequence.
In prison populations ASPD is the psychiatric equivalent of the common cold, with as many as 80 to 85 percent of incarcerated criminals, according to Robert Hare, meeting the requirements for the disorder. Contrast this with just a 20 percent hit rate for psychopaths.
In addition, this 20 percent minority punches well above its weight. Around 50 percent of the most serious crimes on record—crimes such as murder and serial rape, for instance—are committed by psychopaths, and continue to be committed by psychopaths.

Studies comparing the recidivism rates among psychopathic and non-psychopathic prisoners reveal that the former are up to three times more likely to reoffend than the latter within a period of just one year. If we factor violence into the equation, the curve gets even steeper. The psychopath emerges as anything up to five times more likely to beat, rape, kill, or mutilate his way back behind bars. More accurate is to say that the relationship between ASPD and psychopathy
is asymmetrical. For every four people diagnosed with ASPD, you may also have a psychopath on your hands. But every individual presenting with psychopathy will also, by default, be presenting with ASPD.

To demonstrate a little more clearly, perhaps, the difference between the two syndromes, consider the following two case histories:

CASE 1

Jimmy is thirty-four years old and has been sentenced to life imprisonment for murder. He’s always had a short fuse, and got involved in a fight in a pub that ended in a fatal head injury. Generally speaking, Jimmy is popular in prison, keeps his nose clean and his head down. First impressions of him are of an immature, happy-go-lucky kind of guy who gets on well with staff and fellow prisoners alike.

Jimmy’s criminal record (which consists of around half a dozen offenses) began at the age of seventeen when he was arrested for shoplifting—though before that, according to his parents, things were already going downhill. A couple of years earlier, when he was fifteen, Jimmy began drifting into trouble both at home and at school. He started staying out late at night, joined a notorious local gang, lied habitually, got into fights, stole cars, and vandalized property. When he turned sixteen, Jimmy dropped out of school and began working for a well-known department store, loading trucks. He also began to drink heavily, occasionally stealing from the warehouse to “tide him over.” He had trouble holding on to his money, and making ends meet frequently posed a challenge, so he started dealing marijuana. A couple of years later, three months after his eighteenth birthday, he wound up on probation and moved in with his girlfriend.

After losing his job, and subsequently several others, Jimmy found work at a garage. Despite constant arguments over his drinking, drug
dealing, and spending habits, his relationship with his girlfriend remained pretty much on track for a while. There were a couple of affairs, but Jimmy put an end to both of them. He felt guilty, he said. And he was also concerned that his girlfriend would find out, and leave him.

Then the drinking started getting out of hand. One night, in his local pub, Jimmy got in a fight. The bar staff intervened quickly and Jimmy was shown the door. Normally, he would’ve gone quietly. But this time, for some reason, he just couldn’t “let it go.” So he picked up a pool cue and smashed it—with so much force it shattered—over the other guy’s head from behind: a blow, unfortunately, which caused a massive brain hemorrhage. The police arrived. And Jimmy confessed on the spot. At his trial, he pleaded guilty.

CASE 2

Ian is thirty-eight and is serving a life sentence for murder. One night he pulled into a motel to get something to eat and ended up shooting the receptionist at point-blank range in order to steal the money from her till. In prison, he’s known to be heavily involved in both taking and dealing drugs—plus quite a few other forms of racketeering. He is charming and upbeat to talk to—at least, that is, to start with. But conversations usually end up taking a violent or sexual turn, a fact not lost on female members of the staff. He’s had a number of jobs on the wing since being admitted, but his unreliability, combined with his explosive aggression (often when he fails to get his own way), have led to a checkered employment history. Ask fellow prisoners what they think of him and most of them admit to a mixture of fear and respect. It’s a reputation he enjoys.

Ian’s criminal record begins at the age of nine, when he stole some computer equipment from his local youth club. It quickly escalated into the attempted murder of a classmate when he was eleven. When confronted by Ian in the school lavatories, the boy refused to hand over his dinner money—so Ian put a plastic bag over his head and attempted to suffocate him in one of the cubicles. But for the intervention
of a teacher, Ian says, he would have “made sure the fat bastard never needed his dinner money again.” Recalling the incident, he shakes his head and smiles.

On leaving school, Ian spent most of his time checking in and out of various secure units. His criminal proclivities were versatile, to say the least: deception; shoplifting; burglary; street robbery; grievous bodily harm; arson; drug dealing; pimping. Unable to hold down a job for more than a couple of weeks at a time, he either sponged off friends or lived off the proceeds of his crimes. He enjoyed a transient existence, drifting from sofa to sofa and hostel to hostel, preferring to move around instead of putting down roots. Since he exuded a confident, charming, and self-assured persona, there was always someone willing to put a roof over his head—usually “some woman” he’d chatted up in a bar. But inevitably it ended in tears.

Ian has never been married, but has had a string of live-in girlfriends. His longest relationship lasted six months, and like all the others, it was peppered with violent rows. On each occasion, it was Ian who moved into his partner’s place, rather than the other way round. And, on each occasion, he “swept them off their feet.” Affairs were commonplace. In fact, Ian has trouble remembering a time when he didn’t, as he puts it, “have more than one chick on the go”—though he claims he was never unfaithful. “Most of the time I came back to her at night,” he says. “What more do they want?”

At his trial, the evidence against Ian was ironclad. Yet he entered a plea of not guilty, and still, to this day, maintains his innocence. As the verdict was read out in court, he smiled in the direction of the victim’s family and gave the judge the finger as he was escorted from the dock. Since being in prison, Ian has filed two appeals against his sentence. He is supremely confident, despite repeated protestations to the contrary from his solicitor, that his case will be reviewed and that the verdict will be overturned. The champagne’s on ice, he says.

So you’re the clinician, and Ian and Jimmy are cellmates. They’re sitting in the corridor awaiting consultation. Do you think you could
identify the psychopath out of the two? On the surface, it might be difficult. But let’s look again at the criteria for ASPD. Both show a failure to conform to social norms. And both have tendencies toward poor behavioral control—toward impulsivity, aggressiveness, and irresponsibility. A clear-cut diagnosis, I’d suggest.

But now let’s examine the psychopathic narrative. The need for stimulation and a parasitic lifestyle? More Ian’s bag than Jimmy’s, I would say. Yet it’s when we come to emotion, or more specifically the lack of it, that Ian’s “mask of sanity” really begins to slip. Charming, grandiose, manipulative, deficient in empathy and guilt: Ian is so good at psychopathy, it’s almost as if he’s been practicing. As if he’s recently come out of some secret psychopath finishing school—with honors. ASPD is psychopathy with added emotion. Psychopathy is an emotionless void.

That psychopathy doesn’t pass muster with the custodians of
DSM
is an intriguing act of omission. The reason most cited for its curious and conspicuous exclusion is one of empirical intractability—that, and its supposed synonymy with ASPD. Guilt, remorse, and empathy are not, perhaps, the most quantifiable of constructs to grapple with. So best, instead, to stick to observable behavior, lest the specter of subjectivity rear its head.

This is problematic, to say the least.
For a start, studies reveal that concordance rates among clinicians are actually pretty high when it comes to the PCL-R. The scale, to use the proper terminology, has good “inter-rater reliability.” And besides, as one senior psychiatrist told me, “you can smell a psychopath within seconds of them coming through the door.”

But that’s not the only bone of contention. The enigma of the psychopath’s identity, of what, precisely, the mask of sanity conceals, is given another phenomenological twist by an unnerving observation
a little closer to home. Not all psychopaths are behind bars. The majority, it emerges, are out there in the workplace. And some of them, in fact, are doing rather well. These so-called successful psychopaths—like the ones Scott Lilienfeld studies—pose a problem for ASPD and, incidentally, for proponents of the PCL-R.

A recent study led by Stephanie Mullins-Sweatt at Oklahoma State University presented attorneys and clinical psychologists with a prototypical description of a psychopath. After reading the profile, the two groups of professionals were put on the spot. Were they, Mullins-Sweatt wanted to know, able to call to mind anyone they knew, past or present, who, in their own personal opinion, was befitting of such a description (and who, needless to say, was successful in their given career)? If so, could they rate that person’s personality on a test of the Big Five?

The results made interesting reading. Consistent with expectation, the successful psychopaths—conjured, among others, from the worlds of business, academia, and law enforcement
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—emerged as nefarious and dastardly as ever. Just like their unsuccessful counterparts, they were described in general terms as being “dishonest, exploitative, low in remorse, minimizing of self-blame, arrogant, and shallow.”

No surprises there. But when it came to the Big Five, the similarity continued. Just as in Donald Lynam’s study, where the experts donned their rating caps, the successful psychopaths, like their prototypical alter egos, are portrayed (hypothetically) as being high on dimensions of assertiveness, excitement-seeking, and activity … and low on dimensions of agreeableness, such as altruism, compliance, and modesty. Moreover, with the exception of self-discipline (on which the unsuccessful psychopaths bombed and the successful ones excelled), conscientiousness profiles are also seen to converge, with both groups maxing on competence, order, and achievement-striving.