Media sources have long since adored stories about ‘psychopaths,’ including classic cinematic villains like Hannibal Lector and Alex DeLarge, more recent television antiheroes like Dexter Morgan and Frank Underwood, and real-life examples like Jeffrey Dahmer and Robert Pickton. The term has come up repeatedly through the American presidential race, through accusations that both Donald Trump and Hillary Clinton may be psychopaths. But are any of these individuals absolute examples? Technically no, because no singular, undisputed definition or diagnosis of psychopathy even exists.
Psychopathy is a fluid concept with an equally unstable past. Its most common understanding was perhaps best surmised in its first official definition. In the early 1800s, French psychiatrist Philippe Pinel coined the term “manie sans délire” (insanity without delirium) to describe those who showed no outward signs of psychosis, yet still behaved with an exceptional moral depravity of which the general population was incapable. The actual term ‘psychopath’ was coined by German psychiatrist J.L.A. Koch in 1888, though the definition was then broadened to include anyone who caused harm to themselves or others. This dismissed the diagnostic roots in moral depravity that Pinel had established, and that is now recognized as a central characteristic. By the 1920s the term broadened further, and defined anyone exhibiting abnormal psychology. People who were depressive, submissive, or notably withdrawn or insecure were all deemed psychopaths.
The meandering definition was eventually centered in a book by an American psychiatrist: Hervey Cleckley, “the most influential figure in the study of psychopathy.” In the first edition of his 1941 book, accurately titled The Mask of Sanity: An Attempt to Clarify Some Issues About the So-Called Psychopathic Personality, Cleckley described 21 characteristics that constituted a psychopath, though these would later be shortened to 16 in all subsequent five revisions. In 1980, Robert Hare, a Canadian professor and criminal psychology researcher, drew heavily on ideas from Cleckley’s book to create a determining measure for psychopathy. In 1991, this test was revised to become what is now widely considered the “gold standard” of psychopathy diagnoses, The Hare Psychopathy Checklist-Revised (PCL-R).
The PCL-R describes 20 traits used to examine the existence and degree of psychopathy in adults (Hare also modified a version of the test for youth, ages 12-18). Traits are identified through a two-part examination: a review of collateral information (e.g. nature of relationships, familial medical and personal history, stability of education, work, and social life), and a relatively structured interview with the patient—though, in the PCL-R, a diagnosis of psychopathy can also be achieved without the latter. Patients are then given a score out of 40. A clinical diagnosis of psychopathy is issued at a score of 30 or more. People who do not have criminal backgrounds normally score around five, while many non-psychopathic criminal offenders often score around 22. Hare also asserted that results of the checklist are only reliable if the testing has been conducted by a properly licensed clinician, and in a properly licensed and regulated environment. It is the PCL-R that is used in courts and institutions in order to test for psychopathy, likelihood of recidivism, and necessity of treatment; it also aids in determining the type and extent of criminal sentencing.
And yet, true to history, there are still many that denounce and challenge Cleckley, and the PCL-R. The PCL-R has been criticized for having too great a focus on criminality, and for being too tailored for a typical prison demographic, instead of for the general public. Questions have also been raised over the feasibility of clinicians conducting the checklist to accurately identify these traits.
To rectify these perceived faults, Dr. Scott O. Lilienfeld, an American psychologist and psychology professor, created another test now among the most frequently used self-report measures of psychopathy, the Psychopathic Personality Inventory-Revised (PPI-R), in 2005 (revised from the original edition in 1996). The PPI-R is instead self-administered, and has 154 traits divided into two categories: fearless dominance and self-centered impulsivity. In turn, there have been disputes over this test as well—some have argued that the fearless dominance category does not accurately indicate psychopathy itself, and that the self-administration aspect of the test is unreliable. Professional consensus is spread over the many other significant tests, including the triarchic model of psychopathy, the categories for which are boldness, disinhibition, and meanness, while public consensus darts around the 765,000 results that pop up upon Googling “psychopathy test.”
Despite its notoriety, there is no official diagnosis for psychopathy in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the standard criteria for diagnosing and understanding mental disorders in North America. The DSM has attempted to create a diagnosis for psychopathy, called Antisocial Personality Disorder (ASPD), which overlaps with many of the items that are outlined in the PCL-R and that are generally agreed upon in psychiatry. However Hare himself, and many others in the field, have established that ASPD is not an apt depiction of what can commonly be understood as psychopathy. Hare and others central to understandings of psychopathy had made clear that affective traits, like selfishness, egocentrism, and a lack of empathy, were fundamental to the diagnosis. However in the DSM-III, published in 1980, ASPD was instead characterized primarily by the ways in which social norms were broken, such as lying, stealing, and even traffic arrests, diminishing these traits that so many saw as crucial. This definition was also far too broad to constitute psychopathy as established by other tests and ideas. While most that are understood to be psychopaths meet the criteria for ASPD, most people with ASPD are not actually psychopaths by this same popular criteria. As it stands, only one in five people with ASPD could fit a diagnosis of psychopathy.
And yet, many believe psychopathy to be a finalized diagnosis supported by psychiatric certainty, immediately indicative of an individual’s character. This perception has been largely influenced by negative media portrayals, in which psychopaths are often cast in villainous roles. While these depictions may ring a vaguely relative truth—yes, Hannibal Lecter is a psychopath according to all of the previously mentioned tests—they are largely overly dramatic, and imply traits and behaviours that are not actually associated with psychopathy.
“At the very least the media should show both sides of psychopathy, not just showing them as cold-blooded murderers. Psychopathy does not mean criminality” clarified Guillaume Durand, a PhD candidate in neuroscience at Maastricht University. “[Media] don’t show that there is actually very little agreement on what psychopathy is.”
In 2013, two Belgian psychiatrists addressed how movies portrayed so-called psychopaths. They studied over 400 films released between 1915, beginning with Birth of a Nation, and 2010, ending with The Lovely Bones, all of which included a villain that was portrayed as a psychopath. The psychiatrists had to eliminate all but 126 of these films, because most of the portrayals were “too caricatured and or too fictional” to constitute even a vaguely correct reflection of psychopathy. This in itself is a powerful reflection of how movies choose to portray psychopathy. What they identify as the “Hollywood psychopath” encompasses a variety of symptoms not typical with psychopathy, including high intelligence, fascination with fine arts, obsessive behaviour, and exceptional capacity for violence and killing. They also clarified that most characters largely associated with psychopathy, like Norman Bates from Psycho, actually suffer from psychosis, which is a disconnect with reality, not a personality disorder. The study praised Anton Chigurh from No Country for Old Men, Henry from Henry – Portrait of a Serial Killer and Gordon Gekko from Wall Street for being more accurate and insightful views on psychopathy.
“Usually more representation is always positive—people always fear what they don’t know. But [the media] only gives one side” said Durand.
This may have adverse effects on not only interpretation, but actual treatment and professional relation to psychopathy. Matthew Burnett, a psychology graduate student from the University of Saskatchewan, published a dissertation in 2013 on how psychopathy as portrayed in Canadian media (in this case news sources) may adversely affect widespread interpretation. He found that news representation often sensationalize stories regarding psychopaths, and that this leads to popular misinterpretation of the disorder, and popular expressions of doubt over potential for reform. He also found that media sources overwhelmingly associate psychopathy with violence and dangerousness. In sampling a prison, inmates, correctional officers, and staff interviewed all maintained “highly negative, distorted, and damning [views]” of psychopathy. Because prisons are largely intended to rehabilitate in Canada, this is only made more disturbing.
“My definition [of a psychopath] is an individual that lacks remorse, who is in poor control of their actions, is guiltless and dishonest, but can also display positive traits, like fearlessness and painlessness” said Durand.
By: Alexa Battler
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