This volume addresses a topic that leads the news, informs documentaries and profiles, moves from reportage to entertainment and back again, and concerns everyone who cares or writes about the harm that some do to others. Whether that harm is on an individual or a broader scale, whether it occurs down the street, across the country, or in a continuing television drama or a film, everyone knows about people scammed or injured or killed, put out of work or deprived of retirement funds, lied to or otherwise deceived, and about those people and organizations that do it to them without remorse or guilt. Yet there is also much confusion in society, in the media, even among specialists within the legal and the psychiatric and psychological communities, about the topic.
That confusion starts with the very terms psychopath and psychopathy. While they occur in the popular literature, and are deeply embedded in the public imagination, they appear only indirectly in the official scientific literature. The index to the authorized list of psychological and psychiatric illnesses, as defined by the American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders, does not contain the word psychopath at all. The Manual does say in its general discussion of antisocial personality disorder that the pattern of disregard for, or violation of, the rights of others has also been called psychopathy, sociopathy, or dyssocial personality disorder. In so doing, the Manual equates the four terms. But the Manual only authorizes the use of antisocial personality disorder for diagnostic, treatment, insurance, legal, and other purposes.
So in my own courses over the years, when I have shown all or part of a documentary about serial killers which labels them psychopaths, I have without any consideration of differences, simply told students that the term psychopath is interchangeable with sociopath and antisocial personality disorder and that they can use any one in answering questions, writing exams, and thinking about the issues. Until this seminar I have not considered the differences to any great extent.
Even more confusing to students and to the public at large are the connotations of the word antisocial. Many who hear the word antisocial think of the person who does not interact successfully with others, stays to himself at gatherings, appears either too shy or dismissive of others to be part of something larger than he is. Yet the Manual says, to the contrary, that the individual with antisocial personality disorder may exhibit the superficial charm of someone with the traditional label of psychopath.
To add further to the confusion, the diagnosis of antisocial personality disorder requires the labeled individual to be at least eighteen years old and to have had a diagnosis of conduct disorder before the age of fifteen. And conduct disorder also focuses on behavior rather than personality. It requires that an individual display three of four criteria: aggressivity toward people or animals, property destruction, theft or lying, serious rules violations. Because of these requirements, the label of antisocial personality disorder does not fit some who engage in that pattern of disregard for others. According to the Manual, their criminal behavior is not accompanied by the required personality characteristics, and so they can only be considered as individuals with adult antisocial behavior.
As the Manual lists them, the diagnostic criteria for antisocial personality disorder are behaviors rather than personality characteristics. The diagnosis requires three or more of seven which include repeatedly performing acts that are grounds for arrest, using aliases or lying to gain profit or pleasure from others, failing to plan ahead, engaging in many physical fights or assaults, showing a reckless disregard for one's own or others' safety, failing to sustain consistent work or to honor financial obligations, being indifferent to and lacking remorse for damage done to others. It is behavior rather than personality that determines this diagnosis.
Thus the behavior-based diagnostic criteria listed in the Manual are different from the paragraphs preceding them which describe the disorder and elaborate on personality characteristics. And the Manual's statement that antisocial personality disorder appears to be associated with low socioeconomic status and urban settings conflicts with the analysis presented first in 1942 by Hervey Cleckley, MD, in his work, The Mask of Sanity: An Attempt to Clarify Some Issues About the So-called Psychopathic Personality. He described the characteristics of nonconventional white-collar as well as conventional street psychopaths and illustrated his principles with significant case materials.
More recently, Robert Hare, PhD, registered his disagreement with, even disapproval of, the American Psychiatric Association handling of the issue. He noted that while the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders focus on behavior, the accompanying explanatory material focuses as well on personality, including the superficial charm, failure of empathy, and grandiosity which the Manual admits have been elements of psychopathy. Hare's research and writings argued that the disjunction between the diagnostic criteria presented in the Manual and the accompanying explanatory material demonstrates that psychopathy and antisocial personality disorder are not the same. In his Without Conscience: The Disturbing World of the Psychopaths Among Us, he argued that research on psychopathy showed that it was more complex and nuanced than antisocial personality disorder. It included, he determined, two explicit factors, the first of which is only implicitly presented in the Manual's discursive essay material.
As opposed to the Manual's seven limited diagnostic criteria, Hare operationalized twenty in his Psychopathy Checklist-Revised, the PCL-R. He described the first factor as an emotional one. It refers to the selfish, callous, and remorseless use of others. With information obtained from files and from semi-structured hour-and-a-half to two-hour interviews, it includes eight items: glibness and superficial charm, a grandiose sense of self-worth, pathological lying, manipulativeness, a lack of empathy, and of remorse, shallow affect, and a failure to accept personal responsibility. He described the second factor as a behavioral one. It refers to a chronic, unstable lifestyle. With information gathered from files and other ancillary sources it includes ten items: proneness to boredom, with accompanying need for stimulation, parasitic lifestyle, poor behavioral control, early behavioral problems, including juvenile delinquency, and failure to succeed with lesser forms of sanction, lack of realistic long-term goals, impulsivity, and irresponsibility. Two items, promiscuous sexual behavior and many short-term marital relationships, though they are used, do not load on either factor. And he concluded that while reliable diagnoses of psychopathic personality disorder can be made based solely on extensive file and ancillary material, interviews alone do not lead to reliable diagnoses.
The consequences of the label psychopath extend far beyond a limited diagnostic purpose. Use of the results of the diagnostic labeling occurs in the legal as well as in the mental health system. Because many practical decisions, involving diagnosis, treatment, sentencing, classification, confinement, even death, require the drawing of lines separating the degrees of psychopathy, the PCL-R scoring system accommodates that effort. Scoring each factor as 0, 1, or 2, an individual's total can range from 0 to 40. Lines then have generally been drawn at scores of 30 or more for psychopaths, 21-29 for possible or partial psychopaths, and 20 or less for non-psychopaths. Research has shown that the overall difference among these groups is highly significant.
Hare stated that what the American Psychiatric Association Manual did not do directly in its diagnostic list of criteria for Antisocial Personality Disorder but only by indirection in its paragraphs explaining the diagnosis, he did directly for psychopathy. He differentiated it from Antisocial Personality Disorder; he gave it specificity; he examined the research he and others conducted concerning it; he demonstrated that most psychopaths fit criteria for Antisocial Personality Disorder, but most people with Antisocial Personality Disorder are not psychopaths; and he argued for a revision of the psychiatric nomenclature to take all this into consideration.
Beyond descriptions of the psychological disorder for use in diagnosis and treatment in the mental health system are consequences which flow from a diagnosis of psychopathy in the legal system. Those consequences have considerable importance. The diagnosis impacts the determination of criminal guilt as questions arise about the insanity defense or diminished responsibility. It enters into determinations of sentencing, in terms of severity and of length, and of civil liability, as both may involve intent, mental illness, background factors, standing in the community, personality as well as behavior. Jurors and judges often seek indications of remorse, for example, to help them determine the appropriate consequences for damaging behavior. And when the perpetrators are white-collar and non-conventional, more affluent, perhaps more educated, and generally respected in all other areas of their lives, jurors and judges may assess them differently from conventional offenders who fit the stereotypical lower class, perhaps minority, less educated parameters. And yet both may be psychopaths. More recently, efforts to commit offenders to mental hospitals following completion of their criminal sentences may involve determinations of their psychopathic potential. Finally, questions of executability may involve predictions of future behavior based on labels such as psychopathy. Though all these legal proceedings examine the relation among psychological, familial, social, economic, and racial determinants, society often finds psychological and psychiatric factors the most compelling.
Many commentators have reflected on these matters. In the psychoanalytic literature, Adelaide Johnson wrote in 1949 about superego lacunae in those who commit offenses: their consciences have gaps or holes as does swiss cheese. In the criminologic literature, James Q. Wilson wrote in 1985 about those who are tempted by illegal or immoral behavior and watch to see if anything happens to others who engage in such conduct: lack of enforcement, he argued, breeds further disrespect for and violation of the law. In the behavioral psychological literature, Stanton Samenow revised in 2004 his explorations of criminal thinking patterns, which are now termed cognitive distortions. And in the increasing neuroscientific and biological literature, the influence of genes on behavior has gained added relevance.
A revealing interaction between antisocial behavior and insanity occurred in the two trials of Andrea Yates who methodically drowned her five children in the hour when she was alone with them. In the first trial, the psychiatric testimony of Dr. Park Elliott Dietz appeared influential in convincing the jury that Yates' behavior was antisocial, perhaps psychopathic, rather than the result of psychosis. He concluded that she was not out of touch with reality; in fact, he argued that she had planned their deaths, had waited for an opportune time when she was alone, had called police immediately afterwards to say she had done wrong. The jury found her guilty and she was sentenced to prison. On appeal, her conviction was overturned because of Dietz's inadvertent or deliberate misstatement concerning a television program about someone who drowned her children and then pleaded insanity which program had not even aired. On retrial, a different jury, hearing almost the same evidence and experts, found her not guilty by reason of insanity. The earlier jury had implicitly found her acts to be antisocial, perhaps psychopathic, but not the result of psychosis; the later jury found her acts to be the consequence of her psychotic mental state.
In the psychiatric literature, the American Psychiatric Association asked in its 1982 Statement on the Insanity Defense whether the legal standards in use concerning the insanity defense should be modified. It concluded that the insanity defense ought not to be available for persons primarily diagnosed with personality disorders such as Antisocial Personality Disorder, which it also termed sociopathy. To do so, it maintained, would not accord with modern psychiatric knowledge or beliefs, and it concluded that offenders with antisocial personality disorders should be considered criminally responsible for heuristic reasons if for no other. The American Psychiatric Association determined that only serious disorders, such as schizophrenia or bipolar disorder, should lead to acquittals by reason of insanity.
But a different response followed Yates' second trial. In an editorial arguing for reform, the Boston Herald responded to the second jury's verdict finding Andrea Yates not guilty by reason of insanity in the planned drowning deaths of her five young children by advocating a guilty but insane model. It said that such a verdict would provide a balance between mercy and justice because convicted offenders could receive mental health treatment until their recovery at which time they would finish their sentence in prison. In essence, it argued that a person could be both guilty as a psychopath or antisocial personality would be, and insane as a seriously mentally ill person would be. Yet the two words contradict each other.
This conflict between the words guilty and insane appears unresolvable, and in the Yates case unnecessary, for the solution the Herald sought was exactly what was happening after the first jury found Andrea Yates guilty of murder in 2002. Though sentenced to prison, she was spending most of the time in a prison mental health facility. In other words, the sentence imposed after the first trial found her guilty, as would the guilty part of guilty but insane, but confined her first to a mental health facility, as would the insane part of that verdict, where she would be treated until she was ready, if ever, to enter the prison setting itself.
The idea of guilty but insane has been around for a considerable time. Years ago a professor at Harvard Law School argued for the same thing as the Boston Herald did in response to the Yates case. He advocated the new verdict of guilty but insane to express the psychiatric truth that the offender's mental illness played a significant role in his acts. He advocated turning to modern psychiatry for essential help. But as I wrote then and more recently in Thinking About the Insanity Defense and to the Boston Herald: Why turn only to modern psychiatry for help in determining what contributed to a defendant's criminal behavior? What about modern religion and economics and sociology and philosophy and politics and literature as well as old fashioned common sense? Why should a term like insane, related to psychology though a legal not a psychological or psychiatric term, be added to the word guilty when no other word is added?
Partly insanity has been accorded special status among the excuses or explanations for antisocial conduct because it seems to negate the intent necessary to commit a criminal act; yet Yates intended to kill her children and said shortly afterwards that she knew it was wrong to do so. Partly it has, because psychology is defined as a science of the mind; yet the directly opposing testimony of forensic psychiatrists and psychologists in the Yates' and other trials suggests some lack of scientific precision. And partly it has, because ours has become a psychological society.
Yet some argue that the special status accorded insanity is actually too narrow. Given the chance, their reforms might enumerate the many factors that make it difficult or perhaps impossible in their view for an individual to conform conduct to the requirements of law. Beyond guilty but insane the expansionists might add guilty but fanatically religious, economically disadvantaged, sociologically anomic, philosophically existentialist, politically radical, literarily superior, extremely infatuated, or jealous, or even very, very sorry. They might even argue that these excuses should mandate a finding of innocent. Yet that is what psychopaths argue as they attempt to escape personal responsibility for their acts which have harmed others. The efforts of psychopaths and of defenders of the mentally ill or seriously troubled appear more similar than some might wish to acknowledge.
Others, however, would restrict the excuses that the mentally disordered or the psychopathic could offer, excluding even insanity. Their reform would return to two verdicts, guilty and innocent, so that society can determine through the criminal law what is morally tolerable and what is not. Seriously wounding or killing someone in self-defense may well be tolerable; intending to and killing one's children ought not to be. And, they say, it is unnecessary to add words to the verdict, especially if their only purposes are to make juries more likely to convict and to mandate the place for initial confinement of the defendant.
And now again, in this book about psychopaths and psychopathy, it can be noted that while psychology and psychiatry, and other fields, can help in understanding events which involve the law, the real reform is the courage to take seriously the individual's explanations and to weigh them and the acts in the balance of moral acceptability or unacceptability. That provides justice. Once the verdict is in and the sentence imposed, then every offender ought to receive the help that common sense, or psychology or religion or any other specialty, can offer to help him become better and to deter future offending. That provides mercy. This book details those efforts to understand motives, acts, and consequences through a series of case examples and a series of answers to frequently asked questions.
The cases include both ordinary street and white-collar offenses and both conventional and non-conventional offenders, who range from the completely psychopathic to the potentially or marginally psychopathic to the less psychopathic to the non-psychopathic. In some instances, cases are included simply because one or more commentators have labeled individuals or institutions as sociopathic or psychopathic or antisocial. The cases cover the widest variety of individuals and institutions, from serial killers, to imposters, to governmental officials, to a professor and his student, to corporate executives, to a literary creation, to writers and their subjects, to a video game and its player, to corporations, and cults, and their leaders. The cases attempt to examine the full array of those to whom the label of psychopath has been affixed.
These case analyses, together with the responses to frequently asked questions, are designed to help readers think more clearly about psychopaths and psychopathy. Because of psychopaths' high profile in, and their damage to, society, the effort to understand the legal, psychological, moral, and social significance of psychopaths, and of the larger topic of psychopathy itself, remains especially important.
