Lecture 2: The antisocial (“psychopathic”) personality

1. Lecture 2:The antisocial (“psychopathic”) personality Elliot Ness • The “psychopath” sees himself as the innocent victim of a cruel and oppressive world – other people are to blame for his problems. Others exist for his gratification – they are either an annoyance to be gotten rid of, or else a “resource” for his self-gratification…but is he just, in everyday parlance, a bastard?

2. Contrating views on the concept of “psychopathy” • Like love, a many-splendoured thing” (Howard, 198?) • “The categorical concept of psychopath is…merely a convenient fiction…” Blackburn, 1993) • “A label that lacks all scientific and jurisprudential legitimacy. To retain the concept is morally insane; death to it.” (Caradino, 1998) • “the biggest, most serious and most controversial medico-legal and social problem…They (psychopaths) are the sports of the human race…They are devoid of affection, are cold, heartless, callous, cynical, and show a lack of judgement & forethought which is almost beyond belief…. Conduct abnormality of such a degree & type as to constitute the greatest potential danger to the individual & his victim” (Anonymous psychiatrist, 196?)

3. Interpersonal Affective

4. Pritchard (1837): Moral insanity • “Intellectual faculties appear to have sustained little or no injury, while the disorder is manifest principally or alone, in the state of the feelings, temper or habits…the moral and active principles of the mind are strangely perverted and depraved; the power of self-government is lost or greatly impaired; and the individual is found to be incapable, not of talking or reasoning upon any subject proposed to him…but of conducting himself with decency and impropriety in the business of life”

5. Cleckley: The Mask of Sanity (1955) • Superficial charm & good intelligence; • Absence of delusions/irrational thinking; • Absence of psychoneurosis; • Unreliability; • Untruthfulness & insincerity; • Lack of remorse or shame; • Inadequately motivated antisocial behaviour; • Poor judgement/failure to learn from experience; • Pathological egocentricity & incapacity for love; • General poverty of affect;………….

6. Cleckley’s criteria (cont’d) • Loss of insight; • Unresponsiveness in general interpersonal reactions; • Fantastic & uninviting behaviour with drink and sometimes without. • Suicide rarely carried out; • Sex life impersonal, trivial & poorly integrated; • Failure to follow any life-plan.

7. Psychopathy checklist (PCL): 2 factors • 1 Interpersonal/Affective: “selfish, callous & remorseless use of others” • 2 Chronic ASB: “chronically unstable & antisocial lifestyle”

8. Psychopathy Checklist Factors • Factor 1: Interpersonal-Affective • Glibness and Superficial Charm • Egocentricity/grandiose sense of self-worth • Pathological lying and deception • Conning/Lack of Sincerity • Lack of affect and emotional depth • Callous/Lack of empathy • Failure to accept responsibility for own actions • Drug or alcohol not direct cause of antisocial behaviour

9. Psychopathy Checklist Factors • Factor 2: Social deviance • Proneness to boredom/Low Frustration tolerance • Parasitic Life-style • Short-tempered/Poor Behaviour Controls • Early behaviour problems • Lack of realistic long-term plans • Impulsivity • Irresponsible behaviour as a parent • Frequent marital relationships • Juvenile Delinquency • Poor probation or parole risk • Many types of offense

10. But: 3 factor model seems to fit the data best…. Factor 1: Interpersonal: superficial, grandiose; Factor 2: Affective: lack of remorse, empathy; failure to accept responsibility for actions. Factor 3: Behavioural: Impulsive/poor behavioural controls.

11. Developmental antecedents Conceptual issues/assessment Relationship to DSM-III Pers. Dis. Treatment & Rehabilitation Psychosocial Correlates PSYCHOPATHY Biological correlates Successful vs. unsuccessful Cross-cultural aspects Recidivism

12. Cross-Cultural Issues • 1) Prevalence of psychopathy across cultures? • 2) Appropriate PCL cut-off for ‘diagnosing’ psychopathy: does it vary across cultures? • 3) Is the expression of psychopathy dependent on cultural context, or does its aetiology vary across cultures?

13. Prevalence of psychopathy across cultures… • Does vary: prevalence lower in European countries (15% of prison inmates in Scotland) than in N. American prison samples (25%), BUT.. • While interpers. and social deviance factors vary cross-culturally, the affective factor doesn’t: this is “the pan-cultural core of psychopathy”, whose aetiology presumably is cross-cuturally invariant

14. Are there neurobiological substrates of personality disorders, e.g. psychopathy? • It probably doesn’t make sense to look for a specific brain correlate of e.g. psychopathy; • It makes more sense to look for specific neurocognitive processing deficits, e.g. in processing of affective material (in the case of psychopaths) or deficits in affective self-control, e.g. a lack of ability to delay gratification.

15. Psychopathy: Issues arising • What about “successful (non-criminal) psychopaths”? • Medico-legal issues: • Are they “mad”, “bad” or what? • How to deal with them? • UK Gov’t programme: “Dangerous & Severe Pers. Dis” (DSPD): See Issues in Forensic Psychology #4, B.P.S., 2003 and http://www.dspdprogramme.gov.uk • Are psychopaths treatable? The majority of the literature on therapeutic outcome with psycho’s is pessimistic, but see “Development of a Programme for Violent Psychopathic Offenders” (available from above website). Uses CBT and skills training to target the dynamic risk factors associated with an individual’s violent behaviour

16. Criteria for DSPD: Any of the following must apply: • Very High Psychopathy (PCL >/= 30) • High Psychopathy (PCL 25-29) + at least 1 DSM PD other than ASPD • Two or more DSM pers. dis. Diagnoses • Individual must present with: • High risk (>50% chance of (re)offending • Severe personality disorder (as above) • Risk is linked to the personality disorder

17. Are psychopaths treatable? • The majority of the literature on therapeutic outcome with psycho’s is pessimistic, but see “Development of a Programme for Violent Psychopathic Offenders” (available from website: http://www.dspdprogramme.gov.uk) • Uses CBT and skills training to target the dynamic risk factors associated with an individual’s violent behaviour

18. Are “psychopaths” not just complete and utter bastards? “A label that lacks all scientific and jurisprudential legitimacy. To retain the concept is morally insane; death to it.” (Caradino, 1998)

19. So does the term “psychopathy” and the tests used to measure it (e.g. PCL)….. ……represent the medicalisation of bastardry?

20. But on the other hand, psychopathy has been called…… “the biggest, most serious and most controversial medico-legal and social problem…They (psychopaths) are the sports of the human race…They are devoid of affection, are cold, heartless, callous, cynical, and show a lack of judgement & forethought which is almost beyond belief…. Conduct abnormality of such a degree & type as to constitute the greatest potential danger to the individual & his victim” (Anonymous psychiatrist, 196?)

21. Case of Mr WK: see Hand-outIs he likely to re-offend? • 31-year-old male • Section 121(2)(b)(ii) CJA • Charged with: Rape • Attempted rape • Indecent assault

22. W.K.: FAMILY HISTORY: • Parents separated when W was 2 months • 7 siblings • Disorganised chaotic childhood • Foster care at age 6 years and then again age 14 yrs. • Fighting, theft, truanting from an early age • Left school at 15 yrs with no qualifications • Minimal contact with family over the last 10 years