Insights into Psychopathy: Where We Stand

Psychopathy, the word itself raises fear and entails a feeling of darkness. In the coming text we will take time to explore the construct of psychopathy and better understand why it has such a profound effect on all of us. Will we find solace in the rarity of the pathology, its detectability, and treatability, or will we be haunted by the lurking presence of evil and its influence in the corruption of bonding in our societies?

Research on the question brought us to the works of Theophrastus (c. 371–287 BCE), a Greek philosopher who studied under Plato and Aristotle. During his life, he published many treatises on different subjects. His series of sketches of individuals from everyday Athenian life, “The Characters of Theophrastus (δεισιδαιμονίας Ισ᾽) ” could be considered one of the first “scientific” description of personality types. In his text, translated from ancient Greek by Charles E. Bennet and William A. Hammond, professors at Cornell University, we came across a description of “The Vicious Man”:

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The Vicious Man

Viciousness is love of what is bad. The vicious man is one who associates with men convicted in public suits, and who assumes that, if he makes friends of these fellows, he will gain in knowledge of the world, and so will be more feared. Of upright men, he declares that no one is by nature upright, but that all men are alike, and he even reproaches the man who is honorable.

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While Theophrastus does not talk of psychopathy proper, his portrait of “The Vicious Man” includes three characteristics that would be recognized by any of us has basics continuants of a psychopathic personality structure: love of evil, the exploitation of others for power, and a fundamental conviction of human amorality. But do we have enough evidence to say for sure that the vicious man is a psychopath?

The short answer is no. This is why we will give you an overview of the development of the construct and an insight into the roots of contemporary definition of psychopathy.

Psychopathy, an elusive construct

Historically, the confusion around the construct stems from a myriad of sources. Among them, prejudices regarding mental illness, social norms on morality, and theoretical frameworks can account greatly for the lack of consensus among researchers who studied psychopathy (Arrigo & Shipley, 2001).

For example, many writers attribute the origin of the concept of psychopathy to the French psychiatrist Philippe Pinel who made observations about patients who would engage in impulsive and sometimes extremely violent behaviors including self-harm (Arrigo & Shipley, 2001). He called the psychological disturbance they were suffering from “manies sans délire”, meaning that their behaviors are not the result of a thought disorders or delirium, but rather of disorders of affects. In the French post revolution era, when sanity was judged by the Old Testament of the Bible and low intellect and delirium where the usual criteria for mental illness (Stevens, 1993), his ideas where revolutionary. But was it PInel’s intent to define psychopathy?

A paper by James Horley, professor of history, at the University of Alberta, answers that question. After a close analysis of the work of Pinel, it become clear to Horley that Pinel’s advocacy for “moral treatment”, a plea to treat the mentally ill with humanity and dignity, was misconstrued by influential authors as a treatment for a pathology of “morality”, as dysfunction of the ethical system. (Horley, 2014)

In his article, he also notes that the same misattribution of the origin of the construct of psychopathy was given to James Cowles Prichard (1935), who attempted to categorize psychiatric disorders especially in relation to the notion of “moral insanity” in English common law. Like Pinel, he tought of “moral insanity” as disorders of feelings in contrast to disorders of intellect. His unfortunate use of “moral insanity” to describe mentally ill patients, led some to misinterpret the construct as a constitutional inability to understand right from wrong.

Reflecting on those historical observations, and many others that we can’t describe in length in this article, we came to realize that, from very early on, the construct of psychopathy suffered from the confusion between temporary failure of the ethical system caused by affect dysregulation resulting from extreme circumstances or moods disorders, partial dysfunction of moral structures related to general personality pathology, and complete lack of ethical structure as core component of psychopathy.

Emergence of a modern theory of psychopathy

One of the prominent figures of our modern definition of psychopathy is Hervey Cleckley, a clinical psychiatrist who detailed basic characteristics of psychopaths in his text The Mask of Sanity , a landmark book on the study of psychopathy that is still in use today in case studies. (Cleckley, 1941).

He saw psychopaths as:

1. Interpersonally
   • Grandiose
   • Arrogant
   • Callous
   • Superficial
   • Manipulative
2. Affectively
   • Short-tempered
   • Unable to form strong emotional bonds with others.
   • Lacking in empathy, guilt, or remorse
3. Behaviorally
   • Irresponsible
   • Impulsive
   • Prone to violate social and legal norms and expectations.

Additionally, he stressed the fact that many psychopaths never fall into the legal system and are prone to undergo endeavors that bring wealth and material success. Even if he adopted a Neo-Freudian approach to the description of the disorder, he expressed important reserves on the effectiveness of any type of psychotherapy.

As we can see, Cleckey’s vision defines in broad strokes the core features of a psychopathic personality structure, giving us the first strong base from which to assess and predict treatability of individuals who have, through criminal behavior, shown functional failure of their ethical system. With his ideas, he offered psychiatry, psychology, and the legal system ways to invest psychological and rehabilitation resources to individuals who can benefit from them and protect society from those who can not.

This encouraged many scholars and researchers to embrace the construct of psychopathy and eventually led to the inclusion of the concept in the early versions of the DSM and the ICD-10.

Psychopathy Checklist-Revised (PCL-R)

Building on Cleckley’s work, Canadian researcher Robert Hare, whose contributions have been fundamental to the study and understanding of psychopathy, developed the Psychopathy Checklist (PCL) and its revised version, the Psychopathy Checklist-Revised (PCL-R), which has become a standard tool for assessing psychopathy in clinical, forensic, and research contexts.

Hare’s PCL-R is a 20-item assessment instrument designed to measure the traits and behaviors associated with psychopathy. The assessment was conducted through a semi-structured interview and review of the individual’s records, covering aspects of his or her personality and behavioral history. Items on the PCL-R assess factors such as

1. Superficial characteristics and verbosity.
2. Grandiose egocentrism.
3. Need for stimulation or tendency to become bored.
4. Pathological lying.
5. Manipulation and deception.
6. Lack of remorse or guilt.
7. Superficial emotions.
8. Callousness and lack of empathy.
9. Parasitic lifestyle.
10. Poor behavioral control.
11. Sexual promiscuity.
12. Early conduct problems.
13. Lack of realistic long-term goals.
14. Impulsivity.
15. Irresponsibility.
16. Inability to take responsibility for one’s own actions.
17. Short-term marital relationships.
18. Juvenile delinquency.
19. Revocation of probation.
20. Criminal versatility.

The PCL-R has had a profound impact on the study, diagnosis, and treatment of psychopathy. It has been used extensively in forensic settings to assess the risk of recidivism and violence, select treatment strategies, and plan for the management of individuals with high scores on the scale.

Hare’s work has helped solidify psychopathy as a recognized diagnostic construct, distinguishing it from other personality disorders and underscoring its relevance to psychology and criminal justice. In addition, Hare focused on the potential biological basis of psychopathy, suggesting that differences in brain processing may play a role in the development of psychopathic behavior.

In sum, Robert Hare’s work has been instrumental in advancing our understanding of psychopathy, providing critical tools for its assessment and study while fostering an ongoing debate about the nature and treatment of this complex personality disorder.

The Anatomy of Evil

However, it was trough the dedication of Michael H. Stone, a psychiatrist born in New York State in 1933, that the study and conceptualization of the concept of psychopathy acquired real relevance for the psychiatric community. Undoubtedly, he has left an indelible mark on the world of forensic psychiatry and the study of psychopathy and human malice, impacting in various ways the field of mental health, the legal system, and popular culture.

One of his most outstanding books is “The Anatomy of Evil”, through which he made a notable contribution to the study of psychopathy and personality disorders, specifically with the development of the “Evil Grading Scale.” This scale ranks acts of evil from the least severe to the most extreme, considering the perpetrator’s intent, lack of remorse, brutality of actions, and other psychological and environmental factors.

The scale has 22 progressing levels of evil, from less serious acts of selfishness to increasingly calculated and ruthless actions, reaching torturous murders or behaviors that indicate profound disregard for human life. This classification seeks to understand not only the seriousness of the acts committed, but also to investigate the hidden reasons and mental states of those who carry them out. Considerations in his system of classification include the following:

1. people who killed exclusively in self-defense, showing no psychopathic tendencies.
2. jealous lovers who committed crimes; they may be immature and/or egocentric but not psychopathic.
3. partners, associates, or enthusiastic lovers of dangerous murderers. They have impulsive and aberrant personalities with antisocial traits.
4. people who killed in self-defense but largely provoked the aggression towards them.
5. psychologically traumatized individuals who are desperate and murder family members who sexually abused them. May include drug addicts whose motive for murder is to obtain money or drugs but who do not possess significant psychopathic characteristics. They have some remorse for committing acts.
6. People who act impulsively, “in the heat of the moment.” They did not exhibit any marked psychopathic characteristics.
7. Highly narcissistic individuals, indistinguishable from people with some kind of psychotic disorder, kill people around them mainly out of jealousy or passion.
8. Non-psychopathic individuals with high levels of repressed rage; they kill when triggered or ignited by an event.
9. Scorned jealous lovers with psychopathic characteristics.
10. Individuals who killed people who got in their way or witnesses who could give them away. They have egocentric but not clearly distinguishable psychopathic personalities.
11. Same as level ten, but with a noticeable psychopathic personality.
12. Power-hungry psychopaths who killed when they felt cornered.
13. Psychopaths full of rage, who lost control of their rage.
14. Ruthlessly self-centered psychopathic conspirators who want to profit from someone.
15. Multihomicidal psychopaths who kill as many people as they can in cold blood in one day of spree killing.
16. Psychopaths who commit several or multiple criminal acts, who are not satisfied with killing once and may include vicious acts.
17. Sexually perverse serial killers and torturer-murderers, although their main purpose is rape, as the subsequent homicide is for the purpose of not being reported by the victim.
18. Murderers who torture their victims beforehand, although their main motivation is murder.
19. Psychopaths inclined towards terrorism, subjugation, rape, and intimidation.
20. Psychotic torturers and murderers, in whom torture is the primary motivation.
21. Psychopaths who are extremely interested in torture but are not known to have committed homicide.
22. Extreme torturers and psychopathic killers, in whom torture is the primary motivation. Their crimes involve prolonged sexual torture, followed by murder of their victims.

This study of evil, aimed to understand environmental, neurological, and genetic factors, is one of his most important contributions. It supports a multidisciplinary approach to intertvention involving therapy, medication, and, in certain cases, judicial intervention to address the various aspects of psychopathy and other similar disorders.

Michael Stone’s heritage

After reading the works of Michael Stone, we felt the construct of psychopathy come into focus and we hope it has the same effect on you. We also felt amazed on the extent of his work on psychopathy and evil, and a little discouraged to know that we would not be able to describe the full impact of this work on society. So we have settled on giving you a quick summary, so all members can assess the depth of what he has left us in different fields:

Psychiatry and Forensic Psychology: Understanding Psychopathy and Antisocial Behavior: Stone’s detailed analysis has contributed considerably to improving our understanding of psychopathy by thoroughly examining the factors that influence violent and antisocial behaviors. The Evil Grading Scale assists mental health professionals in assessing and understanding human evil in the clinical setting by categorizing acts according to their severity and underlying motivations.

Risk assessment and management: Stone’s work has influenced strategies for assessing and managing risk in individuals with severe personality disorders or those prone to violence. His studies provide valuable insights for creating treatment programs and intervention strategies that aim to prevent the recurrence of violent behavior.

Expert Testimony: Stone’s expertise in forensic psychiatry has been crucial to understanding the minds of defendants and determining their legal responsibility, which has qualified him to serve as an expert in numerous legal cases. His work assists courts in differentiating different personality disorders and their impact on criminal behavior, which influences sentencing and treatment decisions.

Public Policy and Legislation: Stone’s research can have an indirect impact on the creation of public policy and legislation related to the treatment of offenders with severe mental disorders, as well as on issues related to public safety and standards for granting parole.

Education and Public Awareness: Stone has used his books and media to raise public awareness of personality disorders and antisocial behavior. By helping non-experts better understand complex issues, greater knowledge and understanding of these disorders can be promoted. It also dispels myths about psychopathy and promotes an informed debate on the concept of evil and justice.

Media and Entertainment Influence: Stone’s work on the Gradation of Evil Scale has generated interest among content creators in film, television, and literature. This result has been inspired by depictions of characters with personality disorders and reflections on the nature of evil.

As you can see, Michael H. Stone’s contributions extend beyond the traditional descriptive approach to psychopathy, innovating with a focus on understanding the internal world of the psychopath and expanding this concept beyond mere behaviour. His perspective has undoubtedly enriched the understanding of psychopathy by viewing it from a structural standpoint. It broadened the knowledge and interest of many professionals regarding the structural approach, a field in which Stone was a significant figure and to which he contributed greatly.

This structural approach allows for a more nuanced understanding of psychopathies, recognizing the varied nuances and degrees of psychopathy, which in turn facilitates more tailored and effective treatment and management strategies. By moving beyond the surface-level characterization of psychopaths as merely manipulative or harmful, Stone’s work encourages a deeper exploration of the psychological roots of their behaviors, leading to a more empathetic and scientifically informed approach to addressing their needs and mitigating their impact on society. Hence, he provides us a with holistic picture that enables professionals working across disciplines to tackle complicated cases with a deeper understanding and foresight.

As we conclude this overview of the construct of psychopathy, we are filled with gratitude towards colleagues who chose to walk the path of darkness so we would be able to find our way. We specifically convey our posthumous appreciation to Micheal Stone. Thank you for the immense contribution you have made to the expansion of the knowledge about psychopathy and evil. You made the world a little safer for all of us.

Veronica and Mathieu

References

1. T. (1902, January 1). The Characters of Theophrastus.
2. Arrigo, B. A., & Shipley, S. (2001, June). The Confusion Over Psychopathy (I): Historical Considerations. International Journal of Offender Therapy and Comparative Criminology, 45(3), 325–344. https://doi.org/10.1177/0306624×01453005
3. Shipley, S., & Arrigo, B. A. (2001, August). The Confusion over Psychopathy (II): Implications for Forensic (Correctional) Practice. International Journal of Offender Therapy and Comparative Criminology, 45(4), 407–420. https://doi.org/10.1177/0306624×01454002
4. Horley, J. (2014, July 22). The emergence and development of psychopathy. History of the Human Sciences, 27(5), 91–110. https://doi.org/10.1177/0952695114541864
5. Cleckley, H. M. (1941, January 1). The Mask of Sanity. An Attempt to Reinterpret the So-called Psychopathic Personality.
6. Stone, M. H., & Stone, M. H. (2017, January 1). The Anatomy of Evil. Prometheus Books.