Is the label «Psychopath» more a moral denunciation than a clinical diagnosis?

That is why Gunn [3] guessed that ‘psychopath’ has become almost synonymous with ‘badness’ – “a powerful concept that is unhelpful in medical science” where “the morality of patient’s symptoms or behaviour ought to be irrelevant”. Toch [30] wrote that he recalled “not a single instance in which my understanding of an offender would have benefited from adjudging the person a psychopath”. Nevertheless, it is very interesting that when a psychiatrist called a patient, who has been rated by PLC-R high enough to reach a conditional psychopathy cut-off, a psychopath, “other people would call this patient a ‘really bad person’” [3, p.36]. Besides, the psychopathy literature tended to “stigmatize almost any offender about whom there was concern or trepidation” [30, p.155]. There were “sexual psychopaths” who are now “sexually violent predators”, there were drug abuse offenders who have been described as “overwhelmingly psychopathic”, and, of course, there always were serial killers who “have been perennial candidates for ‘psychopath of the year’” [30, p.155]. Historically, the term ‘psychopathic’ “was introduced to fully cover all forms of psychopathology” [3, p. 34]. However, nowadays, according to Smith [28], this term means “one whose persistently antisocial and asocial behaviour cannot be primarily attributed to mental subnormality or psychosis, and stimulates society to treat him” as a really bad person who may not be a psychopath at all. Even if this individual was diagnosed with ASPD due to “diagnoses, like all human judgements, can be mistaken” [21, p. 188]. The Stevens study [29] has shown that “the clinicians used the diagnosis of ASPD in more than half of their diagnosable cases, and opined that the diagnosis could be used in these percentages with the entire inmate population”. Thereby, for them, it is just a label.

Summing up, it should be said that psychopathy is “a form of personality disorder with a distinctive pattern of interpersonal, affective, and behavioural symptoms” [12, p. 22], which may be identified with Robert Hare’s PLC-R. The DSM-IV’s and ICD-10’s guidelines as before do not make any distinctions between antisocial personality disorder, or dissocial personality disorder although there are a solid theoretical base and some approximate typologies of psychopathic individuals. Furthermore, antisocial, asocial, impulsive and aggressive behaviour together with lack of remorse, irritability and irresponsibility are considered good reasons to officially diagnose with ASPD any person who acts this way regardless of “many other deviants exhibit dangerous behaviour, but they do not share the character structure of the true psychopathic personality” [21, p. 8]. Besides, many psychopaths may be found in any non-criminal populations, for example, so called ‘corporate psychopaths’, who are capable to live in society conforming to its regulations, and not to be diagnosed with any personality disorders or something like this. The existence of the groups of individuals with psychopathic traits and behaviours, which have little in common with each other leads to the misunderstanding of the nature of psychopathy.

Since psychopathy is untreatable in general, the term ‘psychopath’ seems to be more “a trigger for rejection” [3, p. 95] than a clinical diagnosis, or else “a largely moral term” [3, p. 95] that is a stereotyped and wrongful reflection of the meaning of such words as ‘badness’, ‘incorrigibility’ and ‘monstrous’. Shortly, for the public and some clinicians being ‘psychopath’ implies to be incredibly bad, to be something what cannot be ‘fixed’ and, thereby, strongly needs to be isolated from the others by incarcerating in high security mental hospital or prisons for life. Nevertheless, the ways to help them controlling their impulses have been already found and tested, and in the nearest future, through developing knowledge of psychopathy may be found the effective ways to reduce its displays. Then, probably, the term ‘psychopathic’ of itself as well as associated with it the terms ‘psychopath’, ‘psychopathic disorder’ and ‘psychopathic personality’ stops being a convenient label for a moral denunciation.

Literature 

1.      Blair J., Mitchel D., & Blair K. (2005). Psychopathy: Emotion and the Brain. Carlton, Australia: Blackwell Publishing.
2.      Cleckley H.M. (1941, 1976). The Mask of Sanity (5^th ed.). St. Louis: Mosby.
3.      Gunn J. (1998). Psychopathy: An Elusive Concept with Moral Overtones. In T. Millon, E. Simonsen, M. Birket-Smith, & R.D. Davis, (Eds.). Psychopathy: antisocial, criminal, and violent behaviour. New York, London: The Guildford Press, p.32 - 39.
4.          Hare, R.D., & Hart, S.D., (1995). A commentary on the Antisocial Personality Disorder Field Trial. In W.J. Livesley (Ed.), The DSM-IV Personality Disorders. New York: Guilford.
5.          Hare, R.D., & Hart, S.D., (1995). Psychopathy: Assessment and criminal conduct. In D. Stoff, J. Maser, J. Breiling. (Eds.), Handbook of Antisocial Behaviour. New York: John Wiley & Sons.
6.          Hare, R.D., (1980). A research scale for the assessment of psychopathy in criminal populations. Journal of Personality and Individual Differences, vol. 1, p.111-119.
7.          Hare, R.D., (1991). The Hare Psychopathy Checklist-Revised. Toronto: Multi-Health Systems.
8.          Hare, R.D., (1996). Psychopathy and Antisocial Personality Disorder: a case of diagnostic confusions. The Psychiatric Times, vol. 13 (2), p. 1-6.
9.          Hare, R.D., (1998). Psychopaths and Their Nature: Implications for the Menatl health and Criminal Justice Systems. In T. Millon, E. Simonsen, M. Birket-Smith, & R.D. Davis, (Eds.). Psychopathy: antisocial, criminal, and violent behaviour. New York, London: The Guildford Press, p.188 - 214.
10.       Hare, R.D., (1999). Without Conscience: The Disturbing World of the Psychopaths Among Us. New York: Pocket Books.
11.       Harris, G.T., & Rice, M.E., (2007). Treatment for Psychopathy: A Review for Empirical Findings. In C.J. Patrick, (Ed.). Handbook of psychopathy. New York, London: Guildford Press, p. 555 – 572.
12.       Hart, S.D., & Hare, R.D., (1997). Psychopathy: Assessment and Association with Criminal Conduct. In D.M. Stoff, J. Breiling, & J.D. Maser, (Eds.). Handbook of Antisocial Behaviour. New York, Chichester, Weinheim, Brisbane, Singapore, Toronto: John Wiley & Sons, Inc., p. 22-35.
13.       Herve, H.F., & Hare, R.D., (2004). Psychopathic subtypes and their crimes: A validation study. Paper presented at the annual conference of the American psychology. Scottdale, AZ: Law Society.
14.       Karpman, B., (1941). On the need for separating psychopathy into two distinct clinical types: Symptomatic and idiopathic. Journal of Clinical Psychopathology, vol. 3, p. 112-137.
15.       Lanceley, F.J., (1999). On-scene guide for crisis negotiators. Boca Raton, London, New York, Washington, D.C.: CRC Press.
16.       Lewis, A. (1974). Psychopathic Personality: A most elusive category. Psychological Medicine, vol. 4, p. 133 – 140.
17.       Lykken, D.T., (1995). The Antisocial Personalities. Hillsdale, New Jersey: Lawrence Erlbaum Associates, Inc., Publishers.
18.       Lykken, D.T., (2007). Psychopathic Personality: The Scope of the Problem. In C.J. Patrick, (Ed.). Handbook of psychopathy. New York, London: Guildford Press, p. 3 – 13.
19.       Maslow, A.H., (1954). Motivation and Personality. New York: Harper.
20.       Maudsley, H., (1897, 2006). The pathology of mind. United States: Kessinger Publishing Co.
21.       McCord, W., & McCord, J., (1964). The Psychopath. An essay on the Criminal Mind. Princeton, New Jersey, Toronto, New York, London: An Insight Book, D. vab Nostrand Company, Inc.
22.       Millon, T., & Davis, R.D., (1998) Ten subtypes of psychopathy. In T. Millon, E. Simonsen, M. Birket-Smith, & R.D. Davis, (Eds.). Psychopathy: antisocial, criminal, and violent behaviour. New York, London: The Guildford Press, p.161- 170.
23.       Patrick, C.J., (2007) (Ed.). Handbook of psychopathy. New York, London: Guildford Press.
24.       Pinel,P. (1801, 1962). A treatise on insanity. New York: Hafner.
25.       Poythress, N.G., & Skeem, J.L., (2007). Disaggregating Psychopathy: Where and How to Look for Subtypes. In C.J. Patrick, (Ed.). Handbook of psychopathy. New York, London: Guildford Press, p. 172 – 192.
26.       Sadock, B.J., & Sadock, V.A., (2010) Kaplan and Sadock’s Pocket Handbook of clinical psychiatry (5^th ed.). Philadelphia, Baltimore, New York, London, Buenos Aires, Hong Kong, Sydney, Tokyo: Wolters Kluwe, Lippincott Williams & Wilkins.
27.       Siever, L.J., (1998). Neurobiology in Psychopathy. In T. Millon, E. Simonsen, M. Birket-Smith, & R.D. Davis, (Eds.). Psychopathy: antisocial, criminal, and violent behaviour. New York, London: The Guildford Press, p.231 – 246.
28.       Smith, R.J., (1978). The psychopath in society. New York, San Francisco, London: Academic Press.
29.       Stevens, G.F., (1994). Prison clinicians’ perceptions of antisocial personality disorder as a formal diagnosis. Journal of Offender Rehabilitation, vol. 20, p. 159 – 185.
30.       Toch, H., (1998). Psychopathy or Anrisocial Personality in Forensic Settings. In T. Millon, E. Simonsen, M. Birket-Smith, & R.D. Davis, (Eds.). Psychopathy: antisocial, criminal, and violent behaviour. New York, London: The Guildford Press, p. 144 – 160.
31.       Widiger, T.A., Corbitt, E., (1995). The DSM-IV Antisocial Personality Disorder. In W.J. Livesley (Ed.). The DSM-IV Personality Disorders. New York: Guilford.