0 Comments

psychopathy

 

 

 

The term ‘psychopath’ is often used by the tabloid press. In fact, the diagnosis of ‘psychopath’ is no longer given – instead, the term ‘anti-social personality disorder’ is generally used.

When the word ‘psychopath’ is employed by the press, it tends to be used for its ‘sensational’ value to refer to a cold-blooded killer who may (or may not) have a diagnosis of mental illness.

It is very important to point out, however, that it is extremely rare for a person who is suffering from mental illness to commit a murder; someone suffering from very acute paranoid schizophrenia may have a delusional belief that others are a great danger to him/her (this might involve, say, terrifying hallucinations) and kill in response to that – I repeat, though, such events are very rare indeed: mentally ill people are far more likely to be a threat to themselves than to others (e.g. through self-harming, substance abuse or suicidal behaviors).

The word psychopath actually derives from Greek:

psych = mind

pathos = suffering

Someone who is a ‘psychopath’ (i.e. has been diagnosed with an anti-social personality disorder) needs to fulfill the following criteria:

– inability to feel guilt or remorse
– lack of empathy
– shallow emotions
– inability to learn from experience in relation to dysfunctional behaviour

Often, psychopaths will possess considerable charisma, intelligence and charm; however, they will also be dishonest, manipulative and bullying, prepared to employ violence in order to achieve their aims.

According to Professor Stephen Scott of the Institute of Psychiatry, Kings College, London, signs that a child may be at risk of developing psychopathy as an adult include:

  • lack of emotion
  • callousness
  • inability to experience feelings of guilt
  • superficial charm
  • a very ‘short fuse’ and explosive temper
  • intense fascination with inanimate objects such as certain technological devices
  • are not deterred from behaving in anti-social ways by punishment (may display indifference to being punished)
  • impaired activity of the amygdala (a part of the brain that processes emotions and is known to be susceptible to damage as a result of severe and protracted childhood trauma) leading to a lack of emotional response to events/occurrences (such as the suffering of others) that non-psychopaths would find emotionally disturbing and upsetting. This idea is supported by post-mortem studies:

Post-mortem studies have revealed that they frequently have underdeveloped regions of the brain responsible for the governing of emotions (including the amygdala, as highlighted by Professor Scott); IT APPEARS THAT THE SEVERE MALTREATMENT THAT THEY RECEIVED AS CHILDREN IS THE UNDERLYING CAUSE OF THE PHYSICAL UNDERDEVELOPMENT OF THESE VITAL BRAIN REGIONS. It is thought that these brain abnormalities lead not only to a blunting of the individual’s emotions but also to a propensity in the individual to SEEK OUT RISK, DANGER and similar STIMULATION (including violence).

Damage To Prefrontal Cortex:

The healthy development of a region of the brain called the PREFRONTAL CORTEX depends, to a large degree, upon the child experiencing warm, loving, affectionate relationships as he grows up. Being deprived of this can potentially damage the development of this brain region(essentially, without these positive relationships, the brain does not produce enough OPIATES which are needed for the proper development of the particular brain area).

The prefrontal cortex is responsible for self-control, empathy and the regulation of strong emotions such as anger.

As ‘psychopaths’ reach middle-age, fewer and fewer of them remain at large in society due to the fact that by this time they are normally incarcerated or dead from causes such as suicide, drug overdose or violent incidents (possibly by provoking a ‘fellow psychopath’ to murder them). However, it has also been suggested that some possess the skills necessary to integrate themselves into society (mainly by having decision-making skills which enable this and operating in a context suited to their abilities, for example where cold judgment and ruthlessness are an advantage) and become very, even exceptionally, successful; perhaps it comes as little surprise, then, that they are thought to tend to be statistically over-represented in, for example, politics and in CEO roles.

WHAT KINDS OF CHILDHOODS HAVE ADULT ‘PSYCHOPATHS’ HAD?

Research shows that ‘psychopaths’ tend to be a product of ENVIRONMENT rather than nature – i.e. they are MADE rather than born. They also tend to have suffered horrendous childhoods either at the hands of their own parent/s or those who were supposed to have been caring for them – perhaps suffering extreme violence or neglect.

IS THE PSYCHOPATHY TREATABLE?

Whilst there are those who consider the condition to be untreatable, many others, who are professionally involved in its study, are more optimistic. Indeed, some treatment communities have been set up to help those affected by the condition take responsibility for their actions and face up to the harm they have caused. Research is ongoing in order to assess to what degree intervention by mental health services can be effective.

 

When Ten Year Olds Turn Killers – The Case of Jon Venables and Robert Thompson

The case of Jon Venables and Robert Thompson is well known, so it is not necessary to go into details about it here. Suffice it to say, they were both, at the age of ten, found guilty of the profoundly disturbing crime of abducting and murdering the two-year-old James Bulger.

Surprisingly, there seems to have been little media interest in examining the early life experiences of either of the two boys who were prosecuted for the crime, so, in this article, I will look at the environments in which they grew up in order to establish if it is possible to find some clues as to what caused their deeply aberrant behaviour.

Clearly, Jon Venables and Robert Thompson had profoundly intense pent-up anger which they displaced, in a most shocking way, onto the toddler, James Bulger, whom they abducted. But from where did this anger originate? In order to answer this question, it seems common sense to look at their respective home backgrounds.

Robert Thompson had six siblings and it has been written that both he and they were neglected. Furthermore, Thompson’s father left the family home when the young boy was just five years old; and this, it seemed, exacerbated his mother’s drinking problem. At one point, too, she attempted to commit suicide.

On top of this, Thompson’s father was violent, and, before he left his family, had frequently behaved in a threatening and intimidating way towards his son (Robert), and had also physically punished him on regular occasions.

It appears that due to this extremely stressful environment, all the children in the family became disturbed, taking out their anguish on one another – they would, for example, threaten one another with knives.

Indeed, the family was so disrupted, chaotic and unhappy that one child asked to be taken into care. When he later had to come back to the family home, such was his distress that he attempted suicide.

One point, in particular, I think, goes to show the extreme extent to which Robert’s mother neglected him: she was rarely with him to provide emotional support on the many days that it was necessary for him to attend court.

Jon Venable’s family, too, was deeply unhappy and unstable – indeed, this state of affairs had led his parents to divorce. His mother, it seems, was something of a narcissist and was, apparently, far more concerned about her love-life (she had a constant stream of boyfriends) than she was with looking after Jon. She also suffered from mental health problems (predominantly depression) and, like the mother of Robert, had attempted to commit suicide.

Venables was frightened of his mother as she could behave menacingly towards him – he would, for example, take refuge by hiding underneath chairs. More worrying still, he would cut himself with knives.

Together, Venables and Thompson would be absent from school without permission. They would shop-lift and become involved in violent incidents. They had also displayed cruelty towards animals – shooting pigeons with air rifles and tying rabbits to railway lines so that they were run over by the trains. Such cruelty towards animals is known to be one of the risk factors which predict the development of anti-social personality disorder (sometimes referred to as psychopathy) in adult life. 

DANGEROUS AND SEVERE PERSONALITY DISORDER

 

In 1999 the U.K. government introduced a new concept in relation to personality disorders (which, as we know, are much more likely to occur in individuals who have suffered extreme and repetitive interpersonal childhood trauma) called DANGEROUS AND SEVERE PERSONALITY DISORDER (DSPD) and a treatment and assessment program was developed with the aim of ameliorating this newly constructed condition. In order to be deemed to be suffering from DSPD an individual needs to fulfill the following three criteria:

  1. have a severe disorder of personality.
  2. present a significant risk of causing serious physical or psychological harm from which the individual would find it difficult or impossible to recover.
  3. the risk of offending should be functionally related to the personality disorder.

However, with compassion and insight, Kingdon (2007) argues that in order for any treatment to be effective, the issue of stigma needs to be addressed. Pointing out that the term ‘personality disorder’ itself is already an insulting and abusive term (ironically as those labeled as having a personality disorder have very frequently already suffered from abuse in childhood and hardly need to be abused further) and to add the adjectives ‘dangerous’ and ‘severe’ compound the problem further. Indeed, Kingdon entitles the article in which he expresses this view: ‘DSPD or ‘Don’t Stigmatize People in Distress.’

Indeed, we have seen in other articles that I have published on this site that the diagnosing of a personality disorder is fraught with problems in terms of both reliability and validity (e.g. What Are The Differences Between BPD And Complex PTSD?);  Should BPD Be Renamed Emotional Intensity Disorder?;  ‘Unhappy With BPD Diagnosis? Is Formulation The Answer?; ‘Traumatized As A Child And Wrongly Diagnosed With BPD?’ and ‘Labelling People With BPD May Adversely Affect Their Treatment.’).

According to Spitzer et al. (2006), many of those who have received DSPD treatment has a combination of complex PTSD and a documented criminal history.

Treatments:

Notwithstanding the above, a very eclectic approach has been taken to the treatment of DSPD and therapies that have been trialed in treatment units include dialectical behaviour therapy (this therapy was initially devised to treat those suffering from borderline personality disorder), schema-focused therapy, cognitive behavioural therapy, occupational therapy, cognitive interpersonal therapy (in relation to the treatment of past trauma), mindfulness. Treatment units have also provided psychoeducation (e.g. boundary setting, emotion modulation); the teaching of psychological skills (e.g. social skills, anger management, coping skills, stress reduction and emotional management) and programs to specifically address sexual offending, violent offending and drug/alcohol abuse.

Controversy:

DSPD has no real medical basis and the argument for adhering the label to individuals is based upon circular argument i..e. the person behaves as s/he does because s/he has DSPD and has been labelled as having DSPD due to his/her behaviour (by the way, I write ‘s/he’ and ‘his/her’ although only about 2% of those labelled as having DSPD are female. It has also been pointed out that the UK government brought in the concept of DSPD as a way of legally detaining a tiny section of society whom they previously had no legal way removing from society and for political reasons following some particularly heinous crimes that had attracted a great deal of media coverage. Indeed, recently the initial enthusiasm for the DSPD approach to treatment/incarceration in psychiatric hospitals has been in decline.

Is the treatment effective? 

According to the IDEA (Inclusion for DSPD Evaluating Assessment and treatment) study of four pilot DSPD units, based at Oxford University, in the U.K., formal treatment of DSPD patients lasted, on average, for less than 2 hours per week whilst structured activities occupied approximately nine hours per week. Unfortunately, the study was unable to answer the question as to whether or not DSPD units and the treatment they provided ‘worked’ or not as there was no comparison group of individuals who fulfilled the criteria to be admitted to a DSPD unit for treatment but did not do so. However, some initial conclusions were drawn from the study including that treatment was more successful for single men than for married men; treatment was more successful for those from ethnic minorities; increased treatment time was associated with more positive outcomes.

Insights gained from interviews with recipients of treatment in DSPD units:

  • importance of relationships with staff, especially in relation to consistency of staff behaviour
  • importance of relationships between patients (a problematic dichotomy between vulnerable patients and violent patients was described)
  • however, patients interacting with each other seemed to reduce hostility, though not eliminate it
  • access to telephone, television and papers may reduce hostilities
  • the route through the program and ultimate re-emergence into society was opaque which reduced patient motivation
  • patients receiving the DSPD program in hospital settings was associated with a self-perception of being unwell and entitled to treatment
  • patients receiving the DSPD program imprison settings were much less demanding and had fewer entitlements and less control over their situation. 

Further research:

The study concluded that the only way of determining whether the DSPD program works is by implementing a random controlled trial or, failing that, a case-control trial. Long-term follow-up of patients treated at DSPD units into the discharge period and analyzing their recidivism rates is also necessary, concludes the study.

Reducing patients’ distress:

Kingdon emphasizes that whilst reducing the risk of patients/prisoners reoffending, it is also vital not to overlook the need to reduce their personal distress irrespective of whether the individual is in a hospital or prison setting.

The need for empathy:

Kingdon also recognizes that empathy with the patient is necessary in order for treatment to be helpful and whilst some might find this problematic its development is more likely to occur when one considers the often tragic childhoods patients have endured. Given the importance of staff genuineness and their ability to empathize with, and validate, patients feelings and emotions, such qualities, when selecting staff, may be of greater importance than their technical knowledge.

Ethics:

Given that the DSPD program makes it easier to detain individuals against their will and the difficulty in defining what DSPD actually is it is of ethical importance to assess properly its overall benefits.

 

REFERENCES:

  • Kingdon, D., DSPD or ‘Don’t Stigmatise People in Distress’. Advances in Psychiatric Treatment (2007), vol. 13, 333–335  doi: 10.1192/apt.bp.106.003426
  • Tony Maden, Peter Tyrer. Dangerous and Severe Personality Disorders: A New Personality Concept from the United Kingdom. Journal of Personality Disorders 2003 17:6489-496.
  • Spitzer, C., Chevalier, C., Gillner, M., et al (2006) Complex posttraumatic stress disorder and child maltreatment in forensic inpatients. Journal of Forensic Psychiatry and Psychology,
  • 17, 204–216.
  • IDEA (Inclusion for DSPD Evaluating Assessment and treatment) study

David Hosier BSc Hons; MSc; PGDE(FAHE).