How should society deal with psychopaths?

The most important thing to know is that they exist. Psychopaths are out there – ready, willing and able to take advantage of you without giving it a second thought, even if it were to ruin your life. Indeed, some psychopaths would consider it an added bonus if it did. Worse, you are unlikely to know what you are dealing with because you don’t know what to look out for.

This is partly the fault of the media and the way psychopaths are represented in popular culture. The term “psychopath” likely evokes a vivid image of real or fictional characters like Charles Manson or Hannibal Lecter. When pressed for a definition, many people would consider someone who is a sadistic serial killer and criminal mastermind with a deranged and twisted mind who also takes pleasure in the suffering he inflicts as the prototype that defines the condition.

One implication of this definition is that psychopaths must be exceedingly rare and not really something to worry about in everyday life. This is perhaps comforting, but just like real drowning looks nothing like drowning on the big screen, popular imagination harbors a lot of misconceptions when it comes to psychopaths. To make matters worse, psychopaths deliberately work on maintaining a “mask of sanity.” They know they have to conceal their nature in order to more effectively manipulate and exploit you, which is why most victims of psychopaths are blindsided by psychopathic behavior.

Fortunately, science made a lot of progress in understanding and detecting psychopaths in the past century.

What psychopathy is – and what it’s not

The first thing to understand about psychopaths is that the condition is ironically named. The term literally translates to “suffering souls,” but while psychopathy objectively does tend to cause a lot of difficulties and strife in the lives of psychopaths, they are unlikely to be distressed by this. Instead, they are generally the ones who are dishing out the suffering, and are doing so without losing much sleep over it. Unlike most mental or neurological diseases, it is not really accurate to say that psychopaths are “suffering” from psychopathy. Generally, they are not actually suffering – rather they make others suffer for their sins. This is why psychopaths don’t typically seek treatment for their condition. Psychopaths are usually only diagnosed if and when their behavior is so far outside of the bounds of societal norms that they end up in prison, which about two-thirds of them eventually do. This makes it hard to estimate the prevalence of psychopathy, but experts estimate that between one in 100 to 200 males – the condition seems to be more rare in females – would qualify for a diagnosis of psychopathy if they were evaluated. This rate implies that they are common enough to worry about because you are likely to know a few of them personally, whether you recognize that they are psychopaths or not. Crucially, they cause far more than their fair share of suffering.

So it is critical to understand what psychopathy is and is not. Importantly, while the terms sound similar – and screenwriters like to conflate the condition for dramatic effect – psychopathy has nothing to do with psychosis. Psychopaths generally do not suffer from hallucinations, are not acting in ways that are patently irrational, nor are they out of touch with physical reality.

Traits of psychopaths – and what it’s like to be one

What seems to be central to the condition is a dramatically muted emotional affect. While there is controversy in the field about how this manifests specifically, the signs of disordered affect are everywhere. For instance, some studies show that psychopaths do not exhibit normal physiological responses (e.g., increase in sweat or change in heart rate) when looking at disturbing images of atrocities. Some experts maintain that it is next to impossible to startle a psychopath or win a staring contest with one.

The problem with this lack of normal emotional affect is that most of us use it to guide our social behavior. We need emotions like empathy or guilt in order to develop a moral compass, to distinguish what is right from wrong when it comes to treating others. Indeed, psychopaths don’t seem to be big on compassion or regret. Studies show that when asked to assess what feels more wrong – kicking a baby or kicking a sack of rice – psychopaths tend to treat either scenario with an equal degree of equanimity.

Of course, this is inconceivable to most of us. Generally speaking, most people expect others to feel and act more or less as they themselves would. However, in the case of psychopaths, this heuristic fails; non-psychopaths can hardly conceive ever doing anything remotely like the things that psychopaths do all the time without any qualms whatsoever.

A metaphor that can help to grasp what it feels like to be a psychopath might be to consider how you would feel about spilling milk. It’s unfortunate, but nothing to cry over. And of course one has to break a couple of eggs to make an omelet – that is just how things are. Psychopaths treat people like you would treat objects – things to be manipulated for their personal gain with no conceivable ethical or moral dimension.

As a consequence, the psychopath exhibits a profound indifference to the suffering his actions cause others.

The implications of such a condition are predictably dramatic; freed from the ethical shackles imposed on behavior by conscience, the psychopath pursues his antisocial agenda of personal gain with abandon, uninhibited and untroubled.

This, in turn, leads to a wide variety of behavioral tendencies that can be captured by the tests experts use to diagnose psychopathy in individuals. These sound a lot like blood tests (e.g., PCL-R, which stands for Psychopathy Checklist – Revised), but actually check behavioral traits such as lack of responsibility and remorse, pathological lying, manipulativeness and cunning, sexual promiscuity, impulsivity and irresponsibility, superficial affect and charm, criminal behavior and so on.

While the behavioral manifestations of the psychopathic lifestyle can be bewilderingly diverse, they are all consistent with a disturbed emotional affect as the root cause. Neuroimaging studies suggest that this is indeed the case, as psychopaths show dramatic anatomical and functional differences – relative to controls – particularly in brain regions that together form the paralimbic system, which has been associated with and implicated in emotional processing.

So while psychopathy is classically considered as a personality disorder, it really is a brain disorder, specifically a disorder of emotional circuitry that deals with interpersonal relations. As such, it fits with a number of other conditions that we now recognize as biological in nature, but are manifesting socially or behaviorally.

Sociopath vs. psychopath

This dual nature poses a challenge for society. It also clarifies a common confusion regarding the difference between sociopaths and psychopaths. While some use these words interchangeably, “sociopath” is an ideological term that became fashionable in the 1970s, and which implies that this condition is mostly or even solely determined by dysfunctional social conditions. In light of the evidence that psychopathy involves clearly specified neural systems, which suggests that the condition is biological at its core, there really might be no such thing as a sociopath. Psychopathy appears increasingly less as a character flaw and more like a brain defect.

Nature vs. nurture

Of course, the question whether psychopaths are born or made is very much unresolved, as the etiology of the condition is still unclear. Most likely, it involves a combination of both genetic and social factors. On the one hand, it is increasingly apparent that signs of psychopathy – both behavioral and neural – can already be present very early in childhood, suggesting that there might be a strong genetic component to the condition. On the other hand, there is plenty of evidence that environmental factors also play a role. For instance, an uninvolved or absent father or physical neglect in childhood are strong predictors of psychopathic traits in adulthood. It is even hard to tease apart genetic and environmental components. For instance, in the example above, it is conceivable that uninvolved fathers are uninvolved because they are psychopaths as well. Obviously, it is ethically unthinkable to do experiments to resolve this question conclusively. As is usually true for complex neural-psycho-social conditions, it is likely the case that a combination of genetic predispositions and environmental triggers underlies the development of adult psychopathy.

How should society deal with psychopaths?

But regardless of cause, plenty of psychopaths exist right now and we have to deal with them, both as a society and individually.

It is perhaps not surprising that the psychopathic lifestyle eventually leads most psychopaths to prison. However, societal notions of justice were conceived in a time before we understood anything about brain disorders, so they are still not well suited to address them. For instance, the criminal justice system does presume that people can tell right from wrong and are equal before the law. But what if psychopaths don’t – or can’t – care about what is right and wrong and what if the brains of psychopaths are demonstrably different from those of the rest of the population? The current default societal response to psychopathy – imprisonment – seems a bit naïve, as it does not suit the peculiarities of the condition. While going to prison is a deeply traumatic experience for most, all accounts suggest that psychopaths don’t seem to be particularly bothered by the occasion. Worse, it seems to have no curative effect – statistically, psychopaths have a probability to reoffend that approaches certainty. Given their mental makeup, this is not surprising. To summarize, prison seems to have no deterrent, punitive or curative effect on psychopaths, which is why it can be considered woefully inadequate as a treatment option. This is another irony of psychopathy – those who are most likely to end up in prison are least likely to be affected by it.

Whether psychopaths can be reformed at all is an open question. Apart from prison, traditional forms of therapy are neither sought by psychopaths, nor is there any evidence that they work. However, there are promising new intervention models that go beyond punishment; for instance, “decompression” that seek to re-form the kinds of psychosocial bonds that the psychopath never made in his childhood. The jury on whether these interventions work in the long term is still out, but we – as a society – need to start taking psychopathy and its underlying brain pathology seriously. Psychopaths can inflict quite a bit of suffering on their path to prison; the annual economic damage in the US alone is estimated to be in the hundreds of billions of dollars.

Also, there is the case of the “successful psychopath” that does not end up in prison. If a psychopath is skilled enough to avoid this fate, he can utilize his natural ruthlessness to single-mindedly go after and achieve his self-aggrandizing goals. While it is not true that – as the characteristically hyperbolic media narrative would have it – 10 percent of Wall Street executives qualify as psychopaths, there is no question that psychopaths are overrepresented in leading positions in many fields. Power and recklessness is a toxic mix, and the fallout from that combination makes for riveting narratives that sell newspapers on a daily basis.

Society will have to come to terms with this one way or the other, as it is getting ever more vulnerable to psychopaths. In a way, it is a great time to be a psychopath, as society is ever more fractured which allows for reputation management and the emergence of a sharing economy (Craigslist, AirBnB, et al) critically relies on trust but provides ideal hunting grounds for psychopaths to exploit unsuspecting victims.

Maybe part of the solution is more research; the science of psychopathy is only now coming into its own as the condition has been understudied for a long time. Perhaps this is not surprising, given that the disorder is inherently paradoxical in nature. Most cultures sharply distinguish the archetypes of victims – who are deserving of our sympathy and compassion – from perpetrators, who are only deserving of our scorn and punishment. But what if there is a condition – psychopathy – where unsuffering victims are remorseless perpetrators that cause a lot of suffering at the same time? Society might ultimately be unsympathetic, but needs a better understanding of psychopathy for sheer self-protection.

As neuroscience progresses, society will increasingly have to come to grips with biological disorders that affect the brain and but manifest socially and behaviorally. In the case of psychopathy, it does so in an extremely detrimental and antisocial fashion. Our institutions and legal theory will have to catch up with our scientific understanding of these conditions and disorders.

How can you protect yourself?

Meanwhile, what can you do as an individual?

Most importantly, awareness of the condition is helpful, as detection is critical. The psychopath next door is unlikely to be a chainsaw-wielding killer – given the psychopathic propensity to cloak their tendencies – but can do a lot of damage to your life all the same. If you consider a normal emotional response central to the human experience, it is critical to understand that there are extremely cold-blooded aliens in human form among us.

There needs to be no value judgment attached to this – think of psychopathy as the moral equivalent of color blindness. While you might not be able to relate to psychopaths, you can still adapt your behavior. And as dealing with a psychopath can be life ruining, the only way to win might be not to play. Unless you happen to be the bigger psychopath.

Excerpt from Psychopaths in our midst — what you should know By Pascal Wallisch, PhD, November 2014

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