by Nikos Theodorakis

Abstract

The current paper traces the roots of the hotly debated concept of psychopathy and its relationship to criminal behavior. We begin with a short overview of the term followed by key contributions to the  term and its notion. Modern perceptions are then reviewed with particular emphasis on the Psychopathy Checklist and its revisions. We criticize the current tools used to measure psychopathy and recognize their limitations. We then combine psychopathy and criminality shedding light on various contributions in the field. Psychopathy is further compared to criminal recidivism. The paper concludes with the necessity to investigate more the interaction between psychopathy and criminal behavior since it has only been explored to a very limited extent.

The concept of psychopathy is widely contested from a theoretical as well as a scientific point of view. Though its importance is evident not only in the fields of psychiatry and psychology, but also in other disciplines, such as criminology, it nonetheless remains a mental disorder which has not yet been fully explored. Further discovery of this construct will help in the process of correlating psychopathy scores to delinquent behaviour.

To help clarify psychopathy, this paper will address its general thematic area by reviewing theoretical foundations, recent developments and criticism of the concept. A brief summary will follow, focusing on the association of psychopathy to criminal behaviour, showing that it is mainly indicative and not determinative of the effect, but certainly more efficient when predicting probable recidivism. Ethical and philosophical aspects of biological factors are analyzed along with up-to-date studies that correlate psychopathy with offending. Psychopathy and its tools can be used by scientists and policy analysts to draw modern crime prevention tools and implement their findings to formulate more solid risk assessment mechanisms for future offending. Finally the paper will conclude with some comments regarding the issue discussed.

 

Overview of the term

Looking back to the origins of the term, Theophrastus, one of Aristotle’s students, describes the characteristics of psychopathy in the same way that they are defined in the present day.1 The term ‘psychopathy’ itself is etymologically linked to the illness of the mind, to the notion of being ‘constitutionally  inferior’  – in  the  sense of  being  irresponsible  and  morally  weak  throughout  life.2

1 Theodore Millon and Roger Dale Davis, Disorders of Personality: DSM-IV and Beyond (2nd edn John Wiley & Sons 1996)

2 Andrew E.Skodol, Psychopathology and Violent Crime (American Psychiatric Press 1998)

Variations of the term were used until the mid-twentieth century since no universally accepted definition existed.

More specifically during the 19th century various psychiatrists tried to mold the term: in 1801 a French psychiatrist, Phillipe Pinel, observed a group of people that seemed to behave crazily without actually being crazy, which led him to coin the term “manie sans delire”.3 Contributions to the evolution of the term are also attributed to Benjamin Rush who in 1812 diagnosed a patient with ‘inmate preternatural moral depravity’, while in 1835 Pritchard employed the label ‘moral insanity’ and Robert Koch, a German systematic, first used the term ‘psychopathic’ in 1891 in order to describe a group of symptoms that present knowledge identifies as personality disorders.4

The phrase ‘psychopathic personality’ per se signifies mental abnormality, according to Kraeplin; he further elaborated using examples of antisocial behaviour such as the Zechprellerei (leaving restaurants without paying), Streitsucht (quarrelsomeness), and Reuelosigkeit (lack of repentance), whereas  his  Haltlosigkeit  (uninhibitedness)  and  Verschrobenheit  (eccentricity)  did  not  carry  an overtone of amorality.5

Psychopathy is eventually described by the constitutional inability to establish objective relationships and to effectively lie, as a constitutional deficiency in volition and emotion, while sometimes the vagabond,  the  sex  pervert  and  the  addict  are  included  in  the  list  of  psychopathic  types.6  The anthropologist Murphy analysed things towards this direction and studied a group of yupik-speaking Inuits at the Bering Strait. This group made use of an idiomatic term (‘kunlangeta’) which was analogous to what could be defined as psychopaths.

While the term was not totally delineated, a consensus emerged concerning the existence of a series of symptoms which were associated with aggression, impulsivity and antisocial behavior.7 A tripartite classification was introduced by Henderson describing the ‘predominantly aggressive psychopath’, the ‘inadequate psychopath’ and the ‘creative psychopath’. A predominantly aggressive psychopath is a potentially dangerous individual subject to fits of violence. The inadequate siphons a living off  society by swindling or pilfering, crimes that involve little over aggression. Vagrants and petty thieves fall into this category. Creative psychopaths are highly individualistic, sometimes eccentric people determined to create a path for themselves no matter the obstacles they might face in the process. Henderson includes in this category such prominent and respected figures as Joan of Arc and Lawrence of Arabia.

Kahn differentiated according to the types of ‘impulsive’, ‘weak’ and ‘sexual’ psychopath, and Schneider the ‘labile’, ‘explosive’ and ‘wicked’ psychopath.8 The more we indulge in the available bibliography, the more different versions we will detect. Ultimately, in the mid 20th century, the concept of psychopathy was narrowed down to refer to personality disorders in general which were defined as disturbances of their integration with intellectual functions that resulted in socially disruptive behavior.9

 

Key Contributions

The origins of modern psychopathy are traced in the work of Cleckley and more specifically in his book The Mask of Sanity, where he posed 16 criteria for the diagnosis of psychopathy, considering psychopaths mainly as disguised mentally ill individuals.10 Psychopathic individuals can be found in every manifestation of life, among businesspeople, lawyers and academics.11 Modern psychologists further indicate that professionals such as managers and CEOs have greater probability of being diagnosed with a psychopathic disorder compared to the average person.12 Dutton incorporates the latest advances in brain scanning and neuroscience to support that a professional who e.g. lacks empathy has more in common with a serial killer who kills for pleasure than we may wish to admit. He further argues that there are “functional psychopaths” among us who use their detached, unflinching and charismatic personalities to succeed in mainstream society. Some professional fields are particularly fertile for them, which means the more “psychopathic” they are, the more likely they are to succeed.13

Cleckley also viewed tendencies toward violence and major crime as something “independent, to a considerable degree of the other manifestations which we regard as fundamental” of psychopathy. Furthermore many of the psychopaths’ attitudes and behaviours have a predatory quality, while their use of intimidation and violence tends to be cold-blooded and instrumental and is more likely to be straightforward, uncomplicated and scrupulous than an expression of deep-seated distress or comprehensible precipitating factors.14

A critical contribution in the study of psychopathy was made by Robert Hare, who developed his original Psychopathy Checklist (PCL) which was used as a tool to assess the degree of psychopathy in adults.15 A revised version of this checklist was launched in 1991, the PCL-Revised (PCL-R from now on), including new tests, explicitly the Antisocial Process Screening Device (ASPD) and the Psychopathy Checklist: Youth Version (PCL-YV from now on).16 The revised psychopathy checklist has  gained  wide  recognition  and  has  become  a  standard  instrument  in  forensic  psychiatry,  by focusing stricto sensu on personality traits, since 15 out of 20 features included in the list are personality-related.

The specific traits as defined by Hare in his psychopathy checklist are the following; glib and superficial charm;  grandiose estimation of  self;  need for stimulation;  pathological  lying; cunning and manipulativeness; lack of remorse or guilt; shallow affect; callousness and lack of empathy; parasitic lifestyle; poor behavioral controls; sexual promiscuity; early behaviour problems; lack of realistic long- term goals; impulsivity; irresponsibility; failure to accept responsibility for own actions; many short- term  marital  relationships;  juvenile  delinquency;  revocation  of  conditional  release  and  criminal versatility.17

The evaluation process of the PCL-R symptoms is rated on the merits of an interview parallel to a methodical appraisal on file information of the patient, while the assessor uses all the information available to understand life-time patterns of behaviour, in order to ensure that the symptoms are persistent, pervasive and pathological.18 The greater the number of symptoms that match those in the list, the closer the patient is to the prototypical psychopath.19

 

Modern perception and criticism

 Today’s perception of psychopathy is influenced by the development of the Psychopathy Checklist Revised (PCL-R; Hare 1990) which has proven to be one of the most valuable instruments in the endeavor of predicting future offending; a diagnosed score of over 30 (25 for Europe) is closely linked to  criminal  recidivism.20  This  score  has  been  repeatedly  used  as  a  risk  factor  towards criminal behavior in various studies that focus on psychopathic disorders.21 Systematic reviews and meta- analyses in the field further consider the mean score as the departure point that determines criminal tendency.22

The Checklist has nonetheless received its fair share of criticism in the scientific community. According to Nedopil, the elements of this test are so many that cannot be perceived as an entity.23 Other psychiatrists postulate that the elements contained in the list are subjective which renders a diagnosis a delicate, if not futile task.24 Scientists further add to the debate the fact that modern neurobiological findings concerning psychopathy also involve neurotransmitters, hormones,  subcortex, cortex, reduced physiological stress reaction, reduced functioning in the anterior cingulate and amygdale, physiological stress reaction and other integrations.25 The aforementioned imply that the checklist itself might be an anachronistic and inaccurate technique as science evolves.26

Various experiments have been conducted to assess the construct of psychopathy. One of them is Damasio’s somatic marker hypothesis which related psychopathy to deficits in the ventromedial prefrontal cortex. Lösel and Schmucker27 used the gambling task to test the role of attention as moderator, using forty-nine male inmates who were assessed by the PCL-R. Even though results did not reveal general relation between psychopathy and gambling task performance, psychopathic inmates with low attention scores gambled worse than the rest.

Furthermore, the PCL is generally acknowledged as a ‘valid instrument’.28 However, the validity of the tool is fiercely debated; this deliberation focuses on the assumption that criminal behaviour is a  central component of the psychopathic personality disorder, whereas classic conceptualizations of psychopathy29, including the conceptualization on which the PCL is allegedly based30, focus heavily  on interpersonal and affective traits– something also known as  “emotional detachment”.31 According  to other researchers, significant culture bias exists in PCL-R ratings.32

The findings reported by Murrie concerning the extremely poor ‘field reliability’ of the PCL33 reinforce the above-mentioned criticism. It is argued that confidence intervals should be reported for these scores, while examiners should be clear that these confidence intervals are based on PCLs completed in research contexts- and finally intervals for PCLs completed in adversarial contexts may be considerably wise. Accordingly, it could be pointed out that PCL is used as a violence risk- assessment (and not as a diagnostic tool) because most of the PCL’s predictive utility is not attributable to its assessment of emotional detachment and also because the PCL generally lacks incremental  predictive  utility,  especially  when  compared  to  specifically  designed risk-assessment tools.34

To elaborate, psychopathy is considered a bona fide mental disorder, while it also meets the legal criteria to be characterized as such; it is an internal, intransient and involuntary abnormality of the mind, and is associated with an impairment of some specific cognitive and volitional functions especially cognitive functions related to and volitional impairments.35 Moreover, the nature and the severity of the functional impairments associated with psychopathy are not generally considered sufficient to mitigate culpability. Research has also established a strong link between the  psychopathic traits and aggressive behaviour, mainly in adult offenders, antisocial children and adolescents, and civil psychiatric patients.36 Even though this antisocial personality disorder is visible from the age of 15 and can be measured reliably with the PCL: YV37, it cannot be indisputably characterized as psychopathy before the age of 18.

 

Psychopathy and Criminality

It is clear that psychopathy is not synonymous with criminality; hence most criminals are not psychopaths and few of them are successful in using their capabilities to victimize the general public.

There are indications that the personality structure and tendency for unethical behaviour are potentially the same in criminal and noncriminal psychopaths.39 According to Silver et al.,40 “Psychopathy’s defining characteristics, such as impulsivity, criminal versatility, callousness and lack of empathy and remorse, make the conceptual link between violence and psychopathy straightforward.” In the effort to understand the relation between psychopathy and criminal behaviour, it must be noted that psychopaths constitute only approximately 1% of the global population but they represent the 25% of prison population in the United States, and 4% among corporate CEOs.41 This statistical fact advocates in favor of the argument that psychopathy and criminal behavior are correlated, further research is however needed in order to indubitably prove this connection.

Cleckley believes that the man who is essentially criminal may be regarded as consistently purposive, whereas the psychopath on the other hand seems hardly purposive at all.42 Apart from the definition   of psychopathy however, experiments have been conducted for more than half a century, indicating that people who commit crimes and behave violently statistically are more likely to suffer from major mental disorders than to be non-disordered.43 Different types of investigations have been held; follow- up studies of psychiatric patients discharged to the community; studies of the prevalence of the major mental disorders among convicted offenders and investigations of unselected birth cohorts comparing the prevalence of criminality among persons with major disorders and with no disorders. There is also a fourth type of investigation concerning aggressive behavior which produced results pointing to the conclusion that persons suffering from one or other of these mental disorders are more likely than non-disordered persons to commit crimes and to perpetrate acts of violence.44

Thus while the PCL includes the most common criminal behaviour items, it is not an appropriate tool for identifying the ‘successful psychopath’, the individual with the psychopathic personality who does not appear in prison populations because he manages to stay within the law or at least to avoid criminal  prosecution.45  This  should  be  noted  when  we  attempt  to  interpret  the  relation between psychopathy and crime, as the main sample consists of psychopaths who are ‘unsuccessful’, which limits the importance of the PCL test in understanding criminal behaviour. It is interesting to underline that psychopathy may predict violence more effectively than general criminality whereas despite the wide variation of methodology used across different studies meta-analyses show that it is possible to summarize the predictive validity of psychopathy with respect to violence in terms of a single number, technically known as an ‘effect size’.46

Scientists claim that there are certain associations between psychiatric disorders and offending; with regards to the Personality Disorder there is a feature common among serious offenders creating a link between antisocial personality and violent offences.47 In this context, two pathways, between the Impulsive and Irresponsible Behavioural Style facet and Criminal Behaviour were required to explain the relationships in the PCL-R data; one is the direct path and the other is mediated by the PCL-R  item early behavioural problems.48 The direct link between the facet and offending is understandable in terms of lack of forethought risk-taking and lack of concern for the future where the structural model can serve as a basis for theoretical speculations about why these constellations of personality traits may affect the likelihood of future offending.49

In the wider field of experiments, techniques of brain imaging have also shown  many  findings including those reviewed by Raine, Raine and Buchsbaum and Henry and Moffit (1997).50 These findings generally lead to the assumption that violent offenders have structural and functional deficits in the anterior regions of the brain, more specifically in the frontal lobe and the temporal lobe.51 Moreover, scientists conducted further research using the method of positron emission tomography – PET scan – (Goyer et al. 1994, Volkow et al. 1995, Kuruoglu et al 1996, Seidenwurm et al. 1997,

Intrator et al. 1997), concluding that poor functioning of frontal and temporal regions of the brain is particularly salient in antisocial individuals with poor frontal functioning. Out of the five studies, four showed evidence of frontal malfunction while three showed evidence of temporal lobe malfunction.52

The above-mentioned biological findings could provoke severe reactions in a multidimensional level. Generally, biological research provides a new perspective of psychopathy, similarly challenging the conceptualization of crime. The application of these biological findings could entail serious political, theological and moral issues, but could also prove useful in the evolution of the society, since with careful steps these new data could help with the interpretation of mental illnesses and their correlation to crime. The Lombrosian theories and techniques are unacceptable in modern science and any biological contribution must be skillfully crafted in order not to discriminate or target specific categories of people.

The yet emerging field of neuro-criminology may prove useful in creating and implementing new crime prevention and risk assessment tools that will be based solely on scientific criteria.53 Prominent psychologists like Raine now contemplate –using findings from genetic research- that the seeds of sin are sown early in life, which gives rise to abnormal physiological functioning that cultivates crime. Markers such as pulse rate may even account for violent behavior; new biosocial approaches however can potentially change the brain and prevent violence.

Demanding legal and ethical dilemmas arise since these findings may lead to a futuristic situation where the increasing ability to identify violent offenders early in life might affect crime-prevention policies.  The  debate  is  ever  going  for  aspects  such  as  the  Indeterminate  Sentence  for  Public Protection (IPP). Current theories even go as far to suggest we should partially sacrifice our notions of privacy and civil rights to identify children as potential killers in order to help deter crime.54 These issues generate numerable questions, such as should we punish individuals with little or no control over their violent behaviour? It is certain that these issues will be of primary concern in the near future since  they  raise  various  philosophical  and  legal  issues  that  need  to  be  scholarly  addressed.55

According to Hare, aggression and violence are not unitary constructs since they take many forms  and involve many levels of interpersonal and social complexity. Even though not all the psychopaths come into close contact with the justice system, their defining features clearly place them at high risk for crime and violence.56 However, psychopaths differ from ordinary criminals in that their typical criminal career is relatively short, with the exception of certain individuals that spend much of their life as delinquents.57 An individual who starts his criminal career in an early age is usually a criminal for  the rest of his life, whereas this pattern is not observed with psychopaths who seem to abandon their criminal career earlier. More specifically some of these persistent offenders begin their criminal activities at an early stage of their life, whereas some of them become less antisocial during middle age and give up criminality by the age of 40, which means that the number of criminal offences decreases to that of the average offender.58 This is not to suggest that they are not criminals since as we’ll analyze in the following section psychopathy and criminal recidivism are correlated; it merely posits the duration of offending.

 

Psychopathy and Criminal Recidivism

Psychopathy is however linked not only to general criminal behaviour, but also to criminal recidivism; this is consistently associated with a variety of socially deviant behaviours because of the persisting and enduring assemblage of interpersonal, affective and behavioural characteristics that define the disorder.59 Findings indicate that psychopathic convicts have a 2.5 times higher probability to be released from jail than undiagnosed ones, even though they are more likely to recidivate.60

It can be stated that PCL-R is an accurate predictor of recidivism and violence inside prison life and, even though psychopathy is not the only risk factor, it cannot be ignored.61 In order to formulate a concrete conclusion for the above, several studies have been conducted comparing the recidivism rates of offenders subdivided into groups according to their PCL scores.62 Across five studies (Hart et al., 1988a; Hemphill, 1992; Rice et al., 1992; Ross et al., 1992; Serin & Amos, 1995) involving a total of 1,021 male offenders, the general recidivism rates during the entire outcome period in percentage for the low, medium and high PCL/PCL-R groups respectively, were 39.7, 54, 9 and 74.1 (with low and high being 20 and 30).

The degree of association between the PCL/PCL-R and criminal behaviours compares favorably with other well-established behavioural and biomedical research findings.63 Thus, psychopathy should be considered important in any assessment and explanation of violence empirically related to potentially reoccurring violence and relevant when forming crime prevention policy.64 We note that even though the PCL and the PCL-R were primarily constructed to measure the clinical construct of psychopathy, they turned out to be strong predictors of recidivism and violence. This derives mainly from the fact that the 20 items capture most of the traits that contribute to understanding criminal behaviour, consequently providing the basis needed to evaluate the probabilities of reoffending.65

 

Conclusions

According to Hart, “Failure to consider psychopathy when conducting a risk assessment may be unreasonable –from a legal perspective– or unethical –from a professional perspective.”66 In the context of predicting violence and criminal behaviour however, the predictive validity of psychopathy is complicated, as some of the psychopathic symptoms can be directly related to crime. This makes it almost impossible to determine whether a disorder is per se predictive or whether that past behaviour predicts future criminal behaviour.67

All in all we observe that the ability of the psychopathy checklist to predict recidivism, violence, and treatment outcome has considerable cross-cultural generalizability as well as its derivatives play a major role in the understanding and prediction of crime and violence.68 Psychopathy can be used as an important indicator of criminal behaviour, in the broader context of tools used for risk assessment and can indubitably prove valuable in the field of Criminology and Criminal Justice.

 

Nikos Theodorakis

Ph.D. Candidate, Institute of Criminology, University of Cambridge,

United Kingdom; Visiting Researcher, Harvard Law School,

United States of America

 

 

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2 Andrew E.Skodol, Psychopathology and Violent Crime (American Psychiatric Press 1998) IALS Student Law Review | Volume 1, Issue 1, Autumn 2013, pp. 47-56 | Page 47 This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License

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