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Neuroethics

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01.10.2008 | Original Paper

Psychopathy Without (the Language of) Disorder

verfasst von: Marga Reimer

Erschienen in: Neuroethics | Ausgabe 3/2008

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Abstract

Psychopathy is often characterized in terms of what I call “the language of disorder.” I question whether such language is necessary for an accurate and precise characterization of psychopathy, and I consider the practical implications of how we characterize psychopathy—whether as a biological, or merely normative, disorder.

No one challenges the idea that psychopaths are lacking in the moral emotions, such as empathy, guilt, remorse, and shame. However, not everyone agrees that such deficits invariably conflict with social norms. See, e.g., Hare [8].

Because contemporary theorists tend to focus on the personality (vs. behavioral) features of psychopathy, there is less of a tendency to conceptualize psychopathy primarily in terms of social pathology. Such pathology is, however, what effectively defines “Antisocial Personality Disorder,” as that condition is characterized in the DSM-IV.

Hare [7].

Gathered from forensic populations, and diagnosed in accordance with Hare’s PCL-R.

See, for instance, Mealey [15], Harris et al. [9], and Kinner [12]. Kinner [12] provides a brief survey of the history of evolutionary approaches to psychopathy.

Grant Harris has indicated (personal correspondence) that when he denies that psychopathy is a “disorder,” disorder is to be understood in roughly Wakefield’s [23] sense: as involving “harmful dysfunction,” where “dysfunction” is understood in evolutionary terms.

From here on, I will use quotation marks around “disorder” only when I intend the expression to be interpreted metaphorically, as indicative of some sort of normative disorder.

Although the expression “antisocial” suggests merely normative disorder, I have highlighted it because it is coupled with the assumption, rejected by selectionists, that all “healthy” human beings are genetically programmed for successful socialization. Thus, Blair’s use of “antisocial” indirectly suggests biological dysfunction, and is therefore theory-laden in the sense with which I am concerned.

One might argue that while a selectionist account specifies the “ultimate” cause of psychopathy, a neurological difference (not dysfunction) account specifies the “proximate” cause of that condition. Thanks to Grant Harris for drawing my attention to this possibility. Murphy et al. [17] make a similar observation.

As I suggest below, this bias is sometimes logical and sometimes merely rhetorical.

Qua person (a social construct), it is relatively uncontroversial that the psychopath is, in some metaphorical sense, “malfunctioning.”

Thanks to both Neil Levy and Shaun Nichols for drawing my attention to these points.

See Radical Conceptual and Linguistic Shift below for a detailed defense of this claim.

See, for instance, Kuhn [13].

Such an explanation is provided in Pathological Effects/Pathological Causes below.

The resultant conceptual shift might approximate a Kuhnian [13] “paradigm shift.”

Crucially, the psychopath will not be seen/characterized as a disordered duck whose disorder causes him to think and act like a rabbit. He will be seen/characterized as a “well-ordered” rabbit who thinks and acts just like a rabbit is supposed to think and act.

As above, theory-laden expressions are italicized.

Roughly, the achievement of reproductive goals without the “hindrances” imposed by norms of the sort ordinarily internalized through socialization.

The same point applies to the original passage. It is Blair’s language, and not the facts he describes, that effectively rules out a selectionist conception of psychopathy. I say “effectively rules out” only because, as noted above, the ruling out might, in some cases, be more rhetorical than logical.

Here, I am trying to avoid the value-ladenness of locutions like “antisocial” and “pro-individual.”

I do not mean to suggest that one or the other of these two conceptions must be correct. There are many other ways in which psychopathy might be conceptualized. Perhaps most obviously, one might think of psychopathy, not as a biologically-based condition, but as an environmentally-based one. Mealey [15] argues that psychopathy can be biologically, or environmentally, based. See her (1995) discussion of the distinction between primary and secondary sociopathy.

See Harris et al. [9] for empirical data that support a selectionist account of psychopathy.

This assumption is not universal, as it is not made by selectionists.

See Harris et al. [9]. Indeed, as Harris [10] points out, the “special skills” associated with psychopathy, such as glibness and charm, are not what one would expect to see in neurologically impaired individuals.

The principle is clearly not true in general. If X is a pathology, it does not follow that its cause must be pathological, if this means that the cause is not well-designed. HIV is an example of a paradigm pathology which is well-designed for replication. Thanks to Neil Levy for drawing my attention to this point.

This reinforces the point made in note 26 above.

Thanks to Neil Levy for this point.

This way of thinking is in line with the DSM-IV definition of “mental disorder,” which makes explicit reference to the “distress,” “disability,” and “loss of freedom” that such disorders tend to cause.

See Harris et al. [9].

It is not only the psychopath’s amorality, but also his imprudence, that puts him at increased risk for loss of freedom. See Mailbom [14] for a discussion of the psychopath’s impaired practical reasoning.

A frequently cited statistic is that, while psychopaths make up at least 20% of the prison population, they make up only about 1% of the general population.

I have in mind cases where the death penalty is applied. However, it seems likely that the psychopath’s fearlessness would lead to reduced life expectancy, independently of any criminal behaviors. Might not reduced life expectancy then constitute grounds for regarding psychopathy as a biological disorder? Not clearly. After all, being male is associated with reduced life expectancy, but we do not therefore conclude that being male is a biological disorder. Clearly, more needs to be said about the relationship between reduced life expectancy and biological disorder.

For more on the importance of independent motivation, see Morse [16].

See Morse [16] for a clear characterization of the notion of “criminal responsibility.”

Given the current lack of consensus, one might well wonder whether such images should even be admissible in criminal trials.

See Kinner [12] for a similar point. M. Stout’s popular The Sociopath Next Door [20] is full of advice on how to identify and deal with the psychopaths that one encounters in ordinary everyday settings.

See Wong and Hare’s [24] “Guidelines for a Psychopathy Treatment Program,” for an example of such a program.

It seems that cognitive behavioral treatments have proven counter-productive. See Harris et al. [9].

See, for instance, the papers in Sinnott-Armstrong’s [19] The Psychology and Biology of Morality.

Szasz himself [21] suggests that if conditions regarded as “mental” illnesses are subsequently discovered to have their origins in structural/functional brain “abnormalities,” then those conditions are, in fact, genuine (rather than mental) illnesses, and so amenable to medical treatment. The question, of course, is whether the psychopath’s neurology is rightly conceptualized as “abnormal” (or as merely “unusual”).

American Psychiatric Association. 1994. The diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Association.

Blair, J. 2003. Neurobiological basis of psychopathy. British Journal of Psychiatry 182: 5–7.CrossRef

Blair, J. 2007. Aggression, psychopathy, and free will from a neuroscience perspective. Behavioral Science and the Law 25(2): 321–331.CrossRef

Blair, J., et al. 2005. The psychopath: Emotion and the brain. Malden, MA: Blackwell Publishing.

Boorse, C. 1975. On the distinction between disease and illness. Philosophy and Public Affairs 5: 49–68.

Crespi, B., et al. 2007. Adaptive evolution of genes underlying schizophrenia. Proceedings of the Royal Society: Biological Sciences 274 (no. 1627): 2801–2810.CrossRef

Hare, R.D. 1991. The Hare psychopathy checklist—revised (PCL-R). Ontario: Multi-Health Systems.

Hare, R. 1993. Without conscience: The disturbing world of psychopaths among us. New York: Guilford Press.

Harris, G., et al. 2001. The construct of psychopathy. Crime and Justice 28: 197–264.

10.

Harris, G. (forthcoming) In In cold blood: The evolution of psychopathy. Oxford: Oxford University Press.

11.

Kendell, R.E. 1975. The concept of disease. British Journal of Psychiatry 127: 305–315.CrossRef

12.

Kinner, S. 2003. Psychopathy as an adaptation: Implications for society and social policy. In Evolutionary psychology and violence, eds. R. Bloom and N. Dess, 57–81. Westport, CT: Praeger Publishers.

13.

Kuhn, T. 1962. The structure of scientific revolutions. Chicago: University of Chicago Press.

14.

Maibom, H. 2005. Moral unreason: The case of psychopathy. Mind & Language 20: 237–257.CrossRef

15.

Mealey, L. 1995. The sociobiology of sociopathy: An integrated evolutionary model. Behavioral and Brain Sciences 18: 523–599.CrossRef

16.

Morse, S. 2006. Brain overclaim syndrome and criminal responsibility: A diagnostic note. Public Law and Legal Theory Research Paper Series No. #06–35: 397–417.

17.

Murphy, D., et al. 2000. Darwin in the Madhouse: Evolutionary psychology and the classification of mental disorders. In Evolution and the human mind: Modularity, language and meta-cognition, eds. P. Carruthers, and A. Chamberlain, 62–92. Cambridge: Cambridge University Press.

18.

Prichard, J.C. 1835. A treatise on insanity. London: Sherwood, Gilbert, and Piper.

19.

Sinnott-Armstrong, W. (ed.) 2007. The psychology and biology of morality. Cambridge, MA: MIT Press.

20.

Stout, M. 2005. The sociopath next door. New York, NY: Broadway Books.

21.

Szasz, T. 1960. The myth of mental illness. American Psychologist 15: 113–118.CrossRef

22.

Thompson, P.M. et al. 2001. Mapping adolescent brain change reveals dynamic wave of accelerated gray matter loss in very early-onset schizophrenia. Proceedings of the National Academy of Sciences 28no. 20: 11650–11655.CrossRef

23.

Wakefield, J. 1997. When is development disordered? Developmental Psychopathology and the harmful dysfunction analysis of mental disorder. Developmental Psychopathology 9: 269–290.CrossRef

24.

Wong, S., and R. Hare. 2005. Guidelines for a psychopathy treatment program. Toronto, Ontario: Multi-Health Systems.

Titel: Psychopathy Without (the Language of) Disorder
verfasst von: Marga Reimer
Publikationsdatum: 01.10.2008
Verlag: Springer Netherlands
Erschienen in: Neuroethics / Ausgabe 3/2008
Print ISSN: 1874-5490
Elektronische ISSN: 1874-5504
DOI: https://doi.org/10.1007/s12152-008-9017-5

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