Assignment: The Trouble with Psychopaths

Assignment: The Trouble with Psychopaths
Assignment: The Trouble with Psychopaths
By contrast to depression, which can often be treated by the administration of mood-enhancing drugs (SSRIs or SNRIs)[footnoteRef:1] and/or psychotherapy, psychopathy is a disorder involving a wide variety of symptoms that, on the face of it, have little in common except for their moral and social undesirability. Depressive symptoms typically form a unified picture of a certain type of affective disorder. Psychopathy has been called a moral or an antisocial disorder [7, 8]. Where it seems relatively obvious, at least in theory, that to treat depression one must help elevate the subject’s mood and alleviate her despair, how to treat amoral or antisocial tendencies is less clear. And since we have experience of ingesting substances that are mood-elevators, at least in the short term, such as champagne or chocolate, it is not too far-fetched to suppose that other substances may produce a longer-term effect on a person’s mood. But what of amorality or antisociality? [1: Serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors.]
Assignment: The Trouble with Psychopaths
On closer inspection, depression and psychopathy have more in common than it might seem at first. The two disorders represent more global divergences of cognitive and emotional functioning compared to the statistical norm. Depressed individuals tend to have a rather dark view of themselves and existence in general, associated with social withdrawal and lack of interest in activities, even those that were previously of great importance to them. Georg Northoff has suggested that depressed individuals may experience difficulties projecting themselves into the future or, if you like, imagining a future different from their current reality.[footnoteRef:2] Psychopaths’ divergence from the statistical norm is also of a more global sort. For the moral and social issues that psychopaths have are not limited to a certain domain. They characterize not a weakness or a lacuna in an otherwise intact socio-moral outlook, but a global socio-moral deficit or dysfunction. It is no coincidence that psychopaths are known to be ‘amoral’ or ‘without conscience’. Let us rehearse, briefly, the main features of the condition. Psychopaths experience relatively little empathy or sympathy and they may be unable to truly love others [10]; they experience little guilt and shame [10], are relatively fearless [11], and experience mainly unstable and shallow emotions.[footnoteRef:3] They can experience an emotion very strongly one minute—great anger for instance—but not at all the next. Their emotional impairments extend to deficits in recognizing certain emotions.[footnoteRef:4] It is often that it is the lack of empathic orientation towards others that allows the psychopath to manipulate, exploit, and parasitize those around him. However that may be, he seems to lack basic respect for others. [2: Interview with Lynn Desjardin, available at: http://www.theroyal.ca/northoff/2011/09/28/800/] [3: In what follows, I am following PCL-R, except where noted. That is, I reference emotional and other disorders that are not part of the diagnostic criteria, but that have nevertheless been documented by at least some important researchers in the field.] [4: Some studies have found that psychopaths have problems recognizing the expression of fear in people’s faces [14], others that they have special problems identifying disgust, but not fear [15]. Sadness recognition might also be a problem, but only in adolescent psychopaths [16]. Vocal affect is another area that has been studied and it would appear that here, too, psychopaths are impaired, but again only with respect of certain emotions. Bagley and colleagues, for instance, only found evidence for general impaired vocal-semantic sadness recognition (with some difference between primary and secondary psychopaths for other emotions) [17].]
Assignment: The Trouble with Psychopaths
Generalizing, we may say that the psychopath tends to regard others as tools or means to his own ends. Being able to lie without compunction no doubt makes it easier for him to use other people. Seeing others as in some sense worthy of respect in their own right appears to be beyond him [18]. The problem is not that he has a tenuous regard for humanity, say, but that he lacks respect even for friends and family. Robert Hare notes that criminal psychopaths distinguish themselves from other career criminals by being as likely to cheat, steal from, mistreat, harm, and generally act irresponsibly towards members of their own family as they are towards others [19, 20]. Psychopathy is par excellence a problem of living with others in organized social groups. More universally, they appear to regard the world and everything in it in terms of its use for their own purposes without being able to see animals, nature, works of art, etc. as having intrinsic value [18]. Famously, all traditional methods of treatment have failed to show results, though some recent treatment programs have shown some progress for adolescents with psychopathic tendencies [21].
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There may be principled, as opposed to more practical, reasons treatments have failed. First, there are those that argue that psychopathy is not a disorder at all, but an evolved strategy. It is, if you like, a human psychological subtype, which either was adaptive in ancestral environments or is currently adaptive in a strictly evolutionary sense. If it is an adaptive strategy, it may be much harder to resolve, if it is resolvable at all, than illnesses or diseases that can be understood as a dysfunction of a system relative to a statistical norm [22]. Second, one might suppose that as a personality disorder, psychopathy is tremendously resistant to treatment. A version of this argument is that it is a special type of mental disorder, i.e. a Cluster B personality disorder, which requires moral commitment for treatment to work. Ultimately, I shall argue (in section 2) for a variation of this position, but where it focuses on commitment, my main concern is the unity of a subject’s moral outlook or, as I shall argue, her Weltanschauung. But first, let us examine the two positions, because the ways in which they fall short is instructive.
There is much evidence of genetic variation within humans. For instance, lactose tolerance or the sickle cell trait are chronic genetic conditions, which confer significant advantages on their bearers, i.e. resistance to parasitization of the red blood cells by the plasmodium falciparum parasite (one of the more serious forms of malaria) and the ability to digest lactose throughout life. In parallel to such genetic variations in physical traits, Linda Mealey argues that psychopathy should be regarded as its own special genotype, adaptive if it occurs relatively infrequently in the group in which it occurs. It is the cheater, defector, or free rider genotype [23].[footnoteRef:5] In the words of Mealey, psychopaths: [5: I simplify Mealey here a bit. She thinks primary psychopaths are genetically disposed to become psychopaths, whereas the expression of secondary psychopathy is more environmentally determined. ]
are designed for the successful execution of social deception and […] they are the product of evolutionary pressures which, through a complex interaction of environmental and genetic factors, lead some individuals to pursue a life strategy of manipulative and predatory social interactions.
Lee Dugatkin [24] has suggested something similar, providing a detailed game theoretic model of the viability of the ‘con artist’. The idea behind these suggestions is relatively simple. Being devoid of the emotions that ordinarily curtail immoral actions of various kinds, psychopaths have an adaptive advantage over people who come fully equipped with empathy, guilt, and shame. Psychopaths are able to break their promises, cheat, lie, steal, and otherwise coerce others into doing their will without experiencing negative emotions as a result. Relative fearlessness and impulsivity may add to such abilities/tendencies. In other words, the psychopath’s presumed deficits enhance his ability to con, manipulate, and coerce others. From a certain perspective, what we call deficits are advantages. Mealey focuses on the emotional deficit, but it is equally likely that their practical reasoning deficit facilitates this type of behavior, perhaps by being undeterred by temporary setbacks in manipulative strategies.
Other defenders of such selectionist accounts of psychopathy stress psychopaths’ sexual strategy. Grant Harris and Marnie Rice [5] point out that not only are psychopaths very promiscuous, but they are also quite willing to use deception and coercion in order to have sex. Sex offenders who “preferentially target “reproductively viable” victims (i.e., postpubertal females) have significantly higher PCL-R scores than those who target all other classes of people” [5, pg. 564].[footnoteRef:6] Michael Seto and Vernon Quinsey [6] point out that from a Darwinian perspective at least, to talk of a condition as pathological (i.e. an illness or a disorder) which leads to increased reproductive success would be nonsensical. Whether to call such conditions diseases or dysfunctions or not, is not relevant to the project at hand. What matters is that there is a difference between conditions that reflect a genotypic variation, and thus an abnormality or a deviation from the statistical norm [cf. 25, 23], and conditions that constitute an abnormality or deviation from the ordinary functioning of the individual. In the latter cases, treatment can be aimed at bringing the subject back to their ‘normal’ state (some state that is within the statistical norm of functioning for that person). But in cases where the deviation is due to genetic variation, treatment aims to change the subject from his or her own norm. And this may be what the obstacle is to ‘treating’ psychopathy. [6: But probably this is primarily true for male psychopaths. Since women traditionally do most of the child rearing and psychopaths are notoriously irresponsible, female psychopaths may not fare particularly well fitness wise. The prevalence rate of psychopathy among women is much smaller than among men, however [30]. ]
Assignment: The Trouble with Psychopaths
The trouble with this line of thinking is that there are, indeed, evolutionary accounts of other mental disorders, such as depression [e.g. 26, 27] and anxiety syndromes [e.g. 28, 29], and yet there are decent treatment options available for both. So it cannot simply be in virtue of being an adaptation that a condition remains untreatable. It must be something more specific about the condition—whether or not we believe it is technically a disorder or an adaptation—that makes it resistant to treatment. One possibility is that psychopathy is really a disorder of the personality or character of a person rather than being an episodic condition, which depression typically is. This is the second position mentioned above. Though psychopathy is not in the DSM-IV, its closest living cousin in that reference work is Antisocial Personality Disorder. Personality disorders are life-long conditions, which affects the very character of the people who suffer from them. Because they affect character as a whole, some people have been very skeptical about the possibility of treating such disorders [31]. Even if treatment is possible, it cannot be aimed at restoring a character that has been overcome by illness—as in depression, for instance—because their illness is, in an important sense, part of who these people are. If one treats the disorder, one changes the personality or character of the individual. This is, perhaps, most dramatic in the case of Dissociative Personality Disorder, where one can argue that by treating the individual, one actually kills off some of her personalities [32].
Assignment: The Trouble with Psychopaths
Some of these personality disorders are disorders in living with others. Louis Chartrand [33] calls Cluster B Personality Disorders—Narcissistic, Histrionic, Borderline, and Antisocial Personality Disorder—“moral” disorders. These are disorders where “it is impossible to imagine a successful “treatment” or “cure” […] that does not involve some sort of conversion or change in moral character.” [33, pg. 71] In the cases of Narcissistic and Histrionic Personality Disorders “the “excessive attention seeking” and “inappropriate sexually seductive and provocative behavior” […] is flatly inconsistent with a pattern of empathy and regard for others.” [33, pg. 71] Any treatment of Antisocial Personality Disorder would have to address and alter the “pervasive pattern of disregard for and violation of the rights of others” [33, pg. 71].[footnoteRef:7] Indeed, such disorders are only treatable if the person shows moral willingness or moral commitment to therapy and change [33, pgs. 71-72]. [7: Here Chartrand quotes directly from the DSM-IV [8, pg. 649].]
If Cluster B Personality Disorders prove difficult to treat because of the need to ensure the subject’s moral commitment, we should expect psychopathy to be even more treatment resistant given that it is, more than any other, a moral disorder. My point is not that psychopathy is reducible to Antisocial Personality Disorder. Rather, if the latter is a moral disorder, psychopathy is even more so given that “the formal criteria of ASP place more emphasis on antisocial and criminal behaviors, and less emphasis on personality traits, than do traditional conceptions of psychopathy and the PCL-R” [34, pg. 5].[footnoteRef:8] Chartrand is a bit cagey about why he thinks that therapy or treatment of Cluster B Personality Disorders requires moral commitment on the part of the subject, other than for the obvious reason that therapy in general requires commitment. What he seems to have in mind is that Cluster B Personality Disorders are moral, not medical, disorders, and that they therefore require moral, not medical, treatment. But moral treatment requires commitment to moral change. At the core of moral treatment for all Cluster B Personality Disorders is “[w]illingness and commitment to developing the capacity for empathy” [34, pg. 71]. Lack of empathy is at the core of Narcissistic Personality Disorder, Antisocial Personality Disorder, and Psychopathy. [8: Antisocial Personality Disorder is a very disputed diagnosis, particularly among psychopathy researchers. At least half of the prison population meets the diagnostic criteria, adding credence to critics who regard it as a thinly veiled “criminality” classification (only a slight advance on “moral insanity”). And many young people, who would have received the diagnosis at one point or other, end up as productive members of society [19]. However, Hare judges that most psychopaths meet the Antisocial Personality Disorder diagnosis [34, 92]. Hart et al. 1991 found that 79.2% of psychopaths had a diagnosis of Antisocial Personality Disorder, whereas only 30.2% of inmates with this diagnosis also met the diagnostic criteria for psychopathy (PCL-R). ]
It is often suggested that the psychopath’s more or less complete disregard for the wellbeing of others is at the core of their disorder [14, 35]. Many studies report a negative relation between empathy and aggression [36, 37]. So it would seem that if we could only increase empathy in violent offenders, we would reduce their violent tendencies.[footnoteRef:9] Psychopathy researchers have not been too optimistic about the prospects of increasing empathy in psychopaths. Their emotional deficits are thought to be too wide-ranging [6]. One now rather famous psychotherapeutic program aimed to increase empathy and responsibility lowered violent recidivism in nonpsychopaths, but increased it in psychopaths [38]. In their assessment of the treatment options for psychopaths, David Thornton & Linda Blud argue that: [21, pg. 534] [9: The matter is more complex than it seems at first. The evidence that empathy reduces violence is mixed [39, 40, 41]. For instance, violent sex offenders often have intact empathy [42]. There is also the additional question of what, exactly, we mean by ‘empathy’. In the psychopathy literature, as many other places, ‘empathy’ may refer to sympathy, empathy, personal distress, emotional reactivity, or emotional contagion [41]. This gives rise to considerable confusion, particularly when considering how to conceptualize the moral impairments of psychopaths [43].]
Motives based on altruism, empathy, deep emotional needs, or long-term self-interest are unlikely to be relevant to psychopathic offenders. Short-term self-interest, excitement, challenges, status, and a sense of power or control are all much more relevant.
Assignment: The Trouble with Psychopaths
This makes it very difficult to see how psychopaths could form a commitment to moral change at all. I take it most moral philosophers would agree that the project of building morality of short-term self-interest is pretty hopeless.