Lecture 2: The antisocial (

1
Lecture 2The antisocial (psychopathic)
personality
Elliot Ness

• The psychopath sees himself as the innocent
  victim of a cruel and oppressive world other
  people are to blame for his problems. Others
  exist for his gratification they are either an
  annoyance to be gotten rid of, or else a
  resource for his self-gratificationbut is he
  just, in everyday parlance, a bastard?

2
Contrating views on the concept of psychopathy

• Like love, a many-splendoured thing (Howard,
  198?)
• The categorical concept of psychopath ismerely
  a convenient fiction Blackburn, 1993)
• A label that lacks all scientific and
  jurisprudential legitimacy. To retain the concept
  is morally insane death to it. (Caradino, 1998)
• the biggest, most serious and most controversial
  medico-legal and social problemThey
  (psychopaths) are the sports of the human
  raceThey are devoid of affection, are cold,
  heartless, callous, cynical, and show a lack of
  judgement forethought which is almost beyond
  belief. Conduct abnormality of such a degree
  type as to constitute the greatest potential
  danger to the individual his victim (Anonymous
  psychiatrist, 196?)

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Interpersonal
Affective
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Pritchard (1837) Moral insanity

• Intellectual faculties appear to have sustained
  little or no injury, while the disorder is
  manifest principally or alone, in the state of
  the feelings, temper or habitsthe moral and
  active principles of the mind are strangely
  perverted and depraved the power of
  self-government is lost or greatly impaired and
  the individual is found to be incapable, not of
  talking or reasoning upon any subject proposed to
  himbut of conducting himself with decency and
  impropriety in the business of life

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Cleckley The Mask of Sanity (1955)

• Superficial charm good intelligence
• Absence of delusions/irrational thinking
• Absence of psychoneurosis
• Unreliability
• Untruthfulness insincerity
• Lack of remorse or shame
• Inadequately motivated antisocial behaviour
• Poor judgement/failure to learn from experience
• Pathological egocentricity incapacity for love
• General poverty of affect.

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Cleckleys criteria (contd)

• Loss of insight
• Unresponsiveness in general interpersonal
  reactions
• Fantastic uninviting behaviour with drink and
  sometimes without.
• Suicide rarely carried out
• Sex life impersonal, trivial poorly integrated
• Failure to follow any life-plan.

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Psychopathy checklist (PCL) 2 factors

• 1 Interpersonal/Affective selfish, callous
  remorseless use of others
• 2 Chronic ASB chronically unstable antisocial
  lifestyle

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Psychopathy Checklist Factors

• Factor 1 Interpersonal-Affective
• Glibness and Superficial Charm
• Egocentricity/grandiose sense of self-worth
• Pathological lying and deception
• Conning/Lack of Sincerity
• Lack of affect and emotional depth
• Callous/Lack of empathy
• Failure to accept responsibility for own actions
• Drug or alcohol not direct cause of antisocial
  behaviour

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Psychopathy Checklist Factors

• Factor 2 Social deviance
• Proneness to boredom/Low Frustration tolerance
• Parasitic Life-style
• Short-tempered/Poor Behaviour Controls
• Early behaviour problems
• Lack of realistic long-term plans
• Impulsivity
• Irresponsible behaviour as a parent
• Frequent marital relationships
• Juvenile Delinquency
• Poor probation or parole risk
• Many types of offense

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But 3 factor model seems to fit the data best.

• Factor 1 Interpersonal superficial, grandiose
• Factor 2 Affective lack of remorse, empathy
  failure to accept responsibility for actions.
• Factor 3 Behavioural Impulsive/poor behavioural
  controls.

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Conceptual issues/assessment
Developmental antecedents
Relationship to DSM-III Pers. Dis.
Psychosocial Correlates
Treatment Rehabilitation
PSYCHOPATHY
Biological correlates
Successful vs. unsuccessful
Cross-cultural aspects
Recidivism
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Cross-Cultural Issues

• 1) Prevalence of psychopathy across cultures?
• 2) Appropriate PCL cut-off for diagnosing
  psychopathy does it vary across cultures?
• 3) Is the expression of psychopathy dependent on
  cultural context, or does its aetiology vary
  across cultures?

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Prevalence of psychopathy across cultures

• Does vary prevalence lower in European countries
  (15 of prison inmates in Scotland) than in N.
  American prison samples (25), BUT..
• While interpers. and social deviance factors vary
  cross-culturally, the affective factor doesnt
  this is the pan-cultural core of psychopathy,
  whose aetiology presumably is cross-cuturally
  invariant

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Are there neurobiological substrates of
personality disorders, e.g. psychopathy?

• It probably doesnt make sense to look for a
  specific brain correlate of e.g. psychopathy
• It makes more sense to look for specific
  neurocognitive processing deficits, e.g. in
  processing of affective material (in the case of
  psychopaths) or deficits in affective
  self-control, e.g. a lack of ability to delay
  gratification.

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Psychopathy Issues arising

• What about successful (non-criminal)
  psychopaths?
• Medico-legal issues
• Are they mad, bad or what?
• How to deal with them?
• UK Govt programme Dangerous Severe
  Pers. Dis (DSPD) See Issues in Forensic
  Psychology 4, B.P.S., 2003 and
  http//www.dspdprogramme.gov.uk
• Are psychopaths treatable? The majority of the
  literature on therapeutic outcome with psychos
  is pessimistic, but see Development of a
  Programme for Violent Psychopathic Offenders
  (available from above website). Uses CBT and
  skills training to target the dynamic risk
  factors associated with an individuals violent
  behaviour

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Criteria for DSPD Any of the following must
apply

• Very High Psychopathy (PCL gt/ 30)
• High Psychopathy (PCL 25-29) at least 1 DSM PD
  other than ASPD
• Two or more DSM pers. dis. Diagnoses
• Individual must present with
• High risk (gt50 chance of (re)offending
• Severe personality disorder (as above)
• Risk is linked to the personality disorder

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Are psychopaths treatable?

• The majority of the literature on therapeutic
  outcome with psychos is pessimistic, but see
  Development of a Programme for Violent
  Psychopathic Offenders (available from website
  http//www.dspdprogramme.gov.uk)
• Uses CBT and skills training to target the
  dynamic risk factors associated with an
  individuals violent behaviour

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Are psychopaths not just complete and utter
bastards?

• A label that lacks all scientific and
  jurisprudential legitimacy. To retain the concept
  is morally insane death to it. (Caradino, 1998)

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So does the term psychopathy and the tests used
to measure it (e.g. PCL)..

• represent the medicalisation of bastardry?

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But on the other hand, psychopathy has been
called

• the biggest, most serious and most controversial
  medico-legal and social problemThey
  (psychopaths) are the sports of the human
  raceThey are devoid of affection, are cold,
  heartless, callous, cynical, and show a lack of
  judgement forethought which is almost beyond
  belief. Conduct abnormality of such a degree
  type as to constitute the greatest potential
  danger to the individual his victim (Anonymous
  psychiatrist, 196?)

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Case of Mr WK see Hand-outIs he likely to
re-offend?

• 31-year-old male
• Section 121(2)(b)(ii) CJA
• Charged with Rape
• Attempted rape
• Indecent assault

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W.K. FAMILY HISTORY

• Parents separated when W was 2 months
• 7 siblings
• Disorganised chaotic childhood
• Foster care at age 6 years and then again age 14
  yrs.
• Fighting, theft, truanting from an early age
• Left school at 15 yrs with no qualifications
• Minimal contact with family over the last 10 years