How should we use the psychopathy label, and what about the diagnosis itself? Have we understood all there is to understand, and where do we put the line between 'psychopath' and 'not psychopath'? A Reader wrote an intelligent comment on this subject and I think it is worth more than another comment, so I reply in the form of the following article where I say what I think about the matter after posting the Reader's comment first.
It comes here:
I would like your opinion on something. I'm having a bit of trouble with believing this whole 'psychopathy diagnosis'. Why is it that the world has taken on the notion of this diagnosis without trying to objectively evaluate it?
Personally I do believe there is a distinct personality type that is different to other personality types (ASPD,BPD etc.),which has some of the features of Psychopathy. However I don't think it is as black and white as some people suggest. I've met people in my life who have certain features of psychopathy, and I also wonder whether 'psychopathy' is subject to change."
As a psychologist in training who has read a lot of research into psychopathy, I feel the urge to comment on this.
Firstly, psychopathy *has* been objectively evaluated. In order for a personality trait to be considered valid, it must meet several criteria. First, measures of that trait have to succeed on a statistical test called the Cronbach's alpha, which measures the extent to which the items on that test correlate with each other (which implies that they measure the same underlying thing). Second, the trait has to be stable over time - not 100% stable, but significantly better than chance. And thirdly, it has to predict other variables in a way that makes sense with what the trait is supposed to mean. A number of research studies, using several different psychopathy measures (not just the PCL-R - in fact, it's one of the poorer tests), have found that the trait of psychopathy meets all three of those criteria.
However, it certainly is not black-and-white. No matter which test is used, the scores are always found to be continuously distributed, with most people earning very low scores, some getting slightly higher scores, some getting moderate scores, some high scores and some getting extremely high scores. Precisely where to draw the line is somewhat uncertain.
But just because there's a spectrum doesn't mean there isn't a purpose to defining a category of people with an extreme degree of a particular trait. Autism is on a similar kind of spectrum, but those who score extremely high on autistic traits show important differences from normal people and need to be managed differently (eg avoiding sensory overload, using direct and unambiguous communication, etc). Similarly, those who score extremely high on psychopathic traits need to be managed differently (eg motivating by rewards rather than punishment, explaining moral concepts in terms of self-interest, etc). And if we are trying to identify extreme high scorers, we need to use some sort of categories, even if that means picking an arbitrary dividing line.
And now my reply (with quotes):
Personally I do believe there is a distinct personality type that is different to other personality types (ASPD,BPD etc.),which has some of the features of Psychopathy.While it's true that psychopathy is a distinct condition in and of itself, it's also true that most if not all Cluster B conditions share some, but not all, of the same symptoms. But it's there as a distinct diagnosis because it has features that it is alone with. No other condition has an inherent absence of "efficient" functionality in the amygdala and dysfunctions in the frontal cortex which in combination leads to a strongly lowered or, in a few cases, complete absence - of certain core actions such as love and fear.
In all other cases we can observe the same absence, but for one it is never chronic, the person has known and understood mores, to mention an example, and there are usually other traits present which we don't see in psychopaths.
I can mention the feeling of emptiness which is so common in BPD, and the switching between a high level of emotion and a deep coldness and detachment.
As a psychologist in training who has read a lot of research into psychopathy, I feel the urge to comment on this.Congratulations with this study. It's a big study if one really wants to be good at it.
I had a friend who has Asperger's Syndrome - I only stopped corresponding with her this last Autumn but otherwise knew her long back into my imprisonment where she first contacted me. She wanted to study and become a psychologist. But her immediate family was her only social network (apart from me), and they kept her from realizing this dream of hers. She was so afraid of loosing them that nothing I said could persuade her to go through with it (I haven't experienced before. that my logic, support and loyalty can't break through an unhealthy attachment to others, even family (in fact often family or family members), but in her case there was nothing I could do. And so I stopped taking contact this past Autumn.
The last time I spoke to her I informed her that my health has been declining rapidly due to the refusal to treat me that I've been receiving, and I told her that I could well be on my way to dying soon. But she hasn't cared enough to call or text me, and I just have to write it off as an experience that was good while it lasted, that I know I've helped her A LOT over the years, so not all was for nothing, I was just left out in the cold when I no longer could be the perfect gentleman who took her on cruises or flew her to New York to shop, or - later on - recycled the few really good restaurants in her capital.
So when talking about psychopathy traits in other Cluster B Disorders (or Conditions as I prefer to call them) - I don't know that Asperger's is anything other than an Autism spectrum diagnosis (on it's way out according to some) - but she definitely was a user of people. She would find a man, fall helplessly in love with him and flirt shamelessly until she had him, and then she'd grow bored and almost immediately start testing his boundaries. If he tolerated her promiscuity she lost all respect for him and teased him worse, if he didn't accept it she would feel abused and after some going forth and back free herself in favor of some other guy, and the cycle could start all over again. - I alone was the only one she didn't play these games with, but she showed me proudly how she did it with everybody else. - It all happened over the net, by the way, and she was diagnosed with Schizoid PD as well.
But imagine if her energy and talents could've been directed into a psychology study, what this might have changed - especially if she had a friend/mentor to help her with the coping emotional stuff.
However, it certainly is not black-and-white. No matter which test is used, the scores are always found to be continuously distributed, with most people earning very low scores, some getting slightly higher scores, some getting moderate scores, some high scores and some getting extremely high scores. Precisely where to draw the line is somewhat uncertain.This is a very significant problem. In Scandinavia (<-- you will find a lot of very nice statements about this place in this Wiki article) f.ex., you can be labeled a psychopath if you score 18 on the PCL-R. Whether you can get the actual diagnosis with such a score I don't know, but in that area it matters little because it't the general opinion that counts and which you will be treated according to.
This is the negative side of psychopathy research. Western societies have for a long time had a tendency to limiting the mainstream code for what is normal.
But this is also the reason why it's so much more important that what cutting edge research has come to know as 'good psychopaths' speak up and get heard, and that will only happen if they're supported by those who understand the message. It is in the end a matter of human rights and the freedom of us all - the freedom to live and think and choose as we individually see fit, for as far as it doesn't hurt others.
That is not to say I believe you shouldn't be allowed to protect yourself - another thing that has been made fully official in Scandinavia: You don't have right to protect yourself or, if you're a woman, to protect your dignity (by law you are not aren't allowed to carry pepper sprays or even deodorants or anything else that can be used in self defense. Weapons are illegal and common citizens are not allowed to own or carry a weapon. Since more or less anything ca be used as a weapon, it up to the police to decide from situation to situation what is a weapon and what isn't. I'm told that a common screwdriver is very often considered a weapon if it helps getting a person convicted.
Oppositely you can get away with horrendous physical crimes without getting much more than a slap over the fingers. 2 years in prison for rape is no uncommon - though any sentence for rape IS uncommon. But the registration fever alone is a weapon that is used against people all of their lives (the blank slate after 10 years is a LIE and doesn't exist except in writing). It is things like these that we're all up against - though I'll admit that Scandinavia is so infected at this point that starting to try and do anything there is a dead dog.
If we are to change anything for the better of mankind we have to act fast and be consistent, and we need to do it from places where the law is working relatively well. San Francisco is such a place, to mention but one. I believe there are places in France and England too, and I know there are many places scattered over the US, where you have the protection of the law that enables you to do something constructive as long as you respect the laws.
And in respect to what I've said about variety and spectra, both here and elsewhere in my writings, I'd still say that Robert Hare isn't all wrong (even though I have changed my opinion of his school of thinking to some extent, but I can still recognize what I first thought when I read some of his texts and books). He has noticed how the system in the Western societies become in themselves psychopathic, and in my opinion there's no doubt about this. But it isn't the psychopaths who make all these decisions, it's the normal people. And they make such decisions because they don't understand psychopathy and are content with the boogeyman theory - something we don't have to understand. Something we can just smug and easy agree is horrendous and inhuman and should be put away forever or even killed, eliminated.
But just because there's a spectrum doesn't mean there isn't a purpose to defining a category of people with an extreme degree of a particular trait. Autism is on a similar kind of spectrum, but those who score extremely high on autistic traits show important differences from normal people and need to be managed differently (eg avoiding sensory overload, using direct and unambiguous communication, etc). Similarly, those who score extremely high on psychopathic traits need to be managed differently (eg motivating by rewards rather than punishment, explaining moral concepts in terms of self-interest, etc). And if we are trying to identify extreme high scorers, we need to use some sort of categories, even if that means picking an arbitrary dividing line.I completely agree. This is what we hope to get out and make others understand. Once we can get to a point where authorities such as psychiatry, general healthcare, police and other coercive authorities, we can start talking to the congress (and what else it is called in other countries) about arranging some wider and easier available schooling and education about psychopathy and the role it can play in our society if we let it and if we know enough about it to let it.
As for the place and role of psychopathy in the modern diagnostic system of criteria, I still think it deserves a place, and I have to say that I am not much for arbitrarily decided lines or definitions when it comes to what is human and how it is human or less human.
I think we will need to come to terms with the fact that there are gray areas in everything, we can continue to draw lines and we can draw them precisely, but new ones will be called for because each new line will reveal a new gray area, and then that has to be evaluated until we can find a perfect position and form for a line for that. It is called evolution, and there's nothing wrong with it in and of itself.
The problem arrives when we start to think the cognitive process of the evaluation system is linear and final.
We can already see from examples dating back in our own present Christian Era history that reality is subject to change when the circumstances and way of thinking calls for it.
Lesss than 500 years ago we navigated the sea using a compass that was designed according to a system the had the Earth as the centrum of the universe. In other words, we navigated after a system that had the Earth sitting static and unmoving in the center while everything else, including the Sun, revolved around the Earth.
Today, when we look at the sextant and the compass of those days we can see it is ludicrous to base a global travelling system on the thesis that the Earth doesn't move and that everything revolves around us.
But it worked! And the Theory surrounding the Reality that was generally believed the be the final and indisputable version thereof at the time, worked. It worked until new thoughts came up that superseded the old world view because what it stood for, what it explained was supported by enough people, and it made sense!
What is just as thought provoking is that much the same unwillingness to accept the new paradigm back then went on as id happening now, in our own time about psychopathy and world economy and how and by whom the world is being ruled in general. - The only real difference is that this time we really better have to act fast! And that means Act! where ever you can, support anybody and everybody who leads the march in that direction which you want and wish to bear fruit - and do it loudly!
If you haven't already, I would strongly encourage you all to read Kevin Dutton's and Andy McNab's The Psychopath's Guide to Success and Jon Ronson's The Psychopath Test.