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11 - Dangerous cases: when treatment is not an option

Published online by Cambridge University Press:  14 August 2009

By
J. Reid Meloy  and
James A. Reavis
Edited by
Bert van Luyn ,
Salman Akhtar  and
W. John Livesley
J. Reid Meloy
Affiliation:
Associate Clinical Professor of Psychiatry University of California, San Diego, CA, USA; Adjunct Professor University of San Diego School of Law, San Diego, CA, USA; President, Forensis San Diego, CA, USA
James A. Reavis
Affiliation:
Director of Forensic Services Relationship Training Institute, San Diego, CA, USA
Bert van Luyn
Affiliation:
Symfora Group, The Netherlands
Salman Akhtar
Affiliation:
Thomas Jefferson University, Philadelphia
W. John Livesley
Affiliation:
University of British Columbia, Vancouver
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Summary

There are those who walk among us that have no conscience. They mouth certain feelings, but have no emotion. They do not bond to any living creatures. Because of their chronic emotional detachment and often sadistic impulse, they aggress without inhibition when their desires are thwarted. Their sole relational goal is to dominate their objects. They are the consummate “intraspecies predators” (Meloy and Meloy, 2002).

Although this sounds like fiction, it is not. Each of these assertions is supported by abundant empirical evidence. We are describing, of course, the psychopathic subject in his most severe, ontogenetic form. Psychopathy research is burgeoning, and over the past decade the world scientific literature has yielded over a thousand studies. When psychopathy enters the consulting room, for the psychotherapist or psychoanalyst it is a sign of danger.

The nature of the beast

We theoretically conceive of psychopathy as a genotype, much like schizotypy (Raine et al., 1995) – a stable constellation of biologically predisposed traits and behaviors which exists in various members of our species. In the context of certain social and cultural norms, psychopathy has different levels of phenotypic expression. For example, best estimates suggest that psychopathy in its most severe form is present in 1% of the world's population (Hare, 2003). However, the prevalence of antisocial personality disorder (ASPD), as most recently defined in DSM-IV-TR (American Psychiatric Association, 2000), varies considerably across cultures.

Type
Chapter
Information
Severe Personality Disorders , pp. 181 - 195
Publisher: Cambridge University Press
Print publication year: 2007

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References

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn., text revision. Washington, DC: American Psychiatric Association.
Ashford, J., Sales, B. and Reid, W. (eds.) (2001). Treating Adult and Juvenile Offenders with Special Needs. Washington, DC: American Psychological Association.
Babiak, P. and Hare, R. D. (2006). Snakes in Suits: When Psychopaths go to Work. Los Angeles, CA: Regan Books.
Bursten, B. (1973). The Manipulator. New Haven, CT: Yale University Press.
Cahill, T. (1986). Buried Dreams. New York: Bantam Books.
D'Silva, K., Duggan, C. and McCarthy, L. (2004). Does treatment really make psychopaths worse? A review of the evidence. J Pers Disord 18: 162–177.Google Scholar
Gabbard, G. (1994). Psychodynamic Psychiatry in Clinical Practice: The DSM-IV Edition. Washington, DC: American Psychiatric Press.
Gabbard, G. (1996). Love and Hate in the Analytic Setting. Northvale, NJ: Aronson.
Gacono, C. and Meloy, J. R. (1994). The Rorschach Assessment of Aggressive and Psychopathic Personalities. Hillsdale, NJ: Lawrence Erlbaum Association.
Gacono, C. and Meloy, R. (2002). Assessing antisocial and psychopathic personalities. In Butcher, J. (ed.) Clinical Personality Assessment: Practical Approaches. New York: Oxford University Press, pp. 361–375.
Gacono, C., Meloy, R., Speth, E. and Roske, A. (1997). Above the law: escapes from a maximum security forensic hospital and psychopathy. J Am Acad Psychiatry Law 25: 547–550.Google Scholar
Greenacre, P. (1958). The impostor. Psychoanal Q 27: 359–382.Google Scholar
Hare, R. (1981). Psychopathy and violence. In Hayes, J., Roberts, T. and Solway, K. (eds.) Violence and the Violent Individual. New York, NY: Spectrum.
Hare, R. (2003). Hare Psychopathy Checklist-Revised (PCL-R), 2nd edition, technical manual. Toronto: Multihealth Systems.
Hare, R., McPherson, L. and Forth, A. (1988). Male psychopaths and their criminal careers. J Consult Clin Psychol 56: 710–714.Google Scholar
Hare, R., Clark, D., Grann, M. and Thornton, D. (2000). Psychopathy and the predictive validity of the PCL-R: an international perspective. Behav Sci Law 18: 623–645.Google Scholar
Harris, G., Skilling, T. and Rice, M. (2001). The construct of psychopathy. In Tonry, M. and Morris, N. (eds.) Crime and Justice: An Annual Review of Research. Chicago, IL: University of Chicago Press, pp. 197–264.
Hart, S., Cox, D. and Hare, R. (1995). The Hare PCL:SV Psychopathy Checklist: Screening Version. Toronto: Multihealth Systems.
Kernberg, O. (1984). Severe Personality Disorders. New Haven, CT: Yale University Press.
Kessler, R., McGonagle, K., Zhao, S.et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry 51: 8–19.Google Scholar
Kiehl, K., Smith, A., Hare, R.et al. (2001). Limbic abnormalities in affective processing by criminal psychopaths as revealed by functional magnetic resonance imaging. Biol Psychiatry 50: 677–684.Google Scholar
Levenston, G., Patrick, C., Bradley, M. and Lang, P. (2000). The psychopath as observer: emotion and attention in picture processing. J Abn Psychology 109: 373–385.Google Scholar
Lion, J. (1978). Outpatient treatment of psychopaths. In Reid, W. (ed.) The Psychopath: A Comprehensive Study of Antisocial Disorders and Behaviors. New York: Bruner/Mazel, pp. 286–300.
McGinniss, J. (1983). Fatal Vision. New York: Putnam Publishing Group.
Meloy, J. R. (1988). The Psychopathic Mind: Origins, Dynamics, and Treatment. Northvale, NJ: Aronson.
Meloy, J. R. (2001). The Mark of Cain. Hillsdale, NJ: The Analytic Press.
Meloy, J. R. (2007). Antisocial personality disorder. In Gabbard, G. (ed.), Treatments of Psychiatric Disorders, 4th Edition. Washington, DC: American Psychiatric Press.
Meloy, J. R. and Meloy, M. J. (2002). Autonomic arousal in the presence of psychopathy: a survey of mental health and criminal justice professionals. J Threat Assessment 2: 21–33.Google Scholar
Meloy, J. R., Hempel, A., Gray, T., Mohandie, K., Shiva, A. and Richards, T. (2004). A comparative analysis of North American adolescent and adult mass murderers. Behav Sci Law 22: 291–309.Google Scholar
Monahan, J., Steadman, H. and Silver, E. (2001). Rethinking Risk Assessment: The MacArthur Study of Mental Disorder and Violence. Oxford: Oxford University Press.
Racker, H. (1968). Transference and Countertransference. New York: International Universities Press.
Raine, A. (1993). The Psychopathology of Crime. San Diego, CA: Academic Press.
Raine, A., Lencz, T. and Mednick, S. (1995). Schizotypal Personality. Cambridge: Cambridge University Press.
Reavis, J. (1998). Individualistic-collectivistic cultures and psychopathy. Unpublished doctoral dissertation, United States International University, San Diego (1998).
Reich, A. (1951). On countertransference. Int J Psychoanal 32: 25–31.Google Scholar
Rice, M., Harris, G. and Cormier, C. (1992). Evaluation of a maximum security therapeutic community for psychopaths and other mentally disordered offenders. Law Human Behav 15: 625–637.Google Scholar
Rule, A. (1980). The Stranger Beside Me. New York: W.W. Norton.
Searles, H. (1979). Countertransference and Related Subjects. New York: International Universities Press.
Seto, M. and Barbaree, H. (1999). Psychopathy, treatment behavior, and sex offender recidivism. J Interpersonal Violence 14: 1235–1248.Google Scholar
Skeem, J., Monahan, J. and Mulvey, E. (2002). Psychopathy, treatment involvement, and subsequent violence among civil psychiatric patients. Law Human Behav 26: 577–603.Google Scholar
Stewart, J. B. (1999). Blind Eye. New York: Simon and Schuster.
Strasburger, L. (1986). Treatment of antisocial syndromes: the therapist's feelings. In Reid, W., Dorr, D., Walker, J.et al. (eds.) Unmasking the Psychopath. New York: W.W. Norton, pp. 191–207.
Symington, N. (1980). The response aroused by the psychopath. Int Rev Psychoanal 7: 291–298.Google Scholar
Vise, D. (2002). The Bureau and the Mole. New York: Atlantic Monthly Press.
Weiner, I. (1998). Principles of Rorschach Interpretation. Mahwah, NJ: Lawrence Erlbaum Associates.
Williamson, S., Hare, R. and Wong, S. (1987). Violence: criminal psychopaths and their victims. Can J Behav Sci 19: 454–462.Google Scholar
Wong, S. and Hare, R. (2005). Guidelines for a Psychopathy Treatment Program. Toronto: Multihealth Systems Inc.

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  • Dangerous cases: when treatment is not an option
    • By J. Reid Meloy, Associate Clinical Professor of Psychiatry University of California, San Diego, CA, USA; Adjunct Professor University of San Diego School of Law, San Diego, CA, USA; President, Forensis San Diego, CA, USA, James A. Reavis, Director of Forensic Services Relationship Training Institute, San Diego, CA, USA
  • Edited by Bert van Luyn, Salman Akhtar, Thomas Jefferson University, Philadelphia, W. John Livesley, University of British Columbia, Vancouver
  • Book: Severe Personality Disorders
  • Online publication: 14 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544439.012
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Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Dangerous cases: when treatment is not an option
    • By J. Reid Meloy, Associate Clinical Professor of Psychiatry University of California, San Diego, CA, USA; Adjunct Professor University of San Diego School of Law, San Diego, CA, USA; President, Forensis San Diego, CA, USA, James A. Reavis, Director of Forensic Services Relationship Training Institute, San Diego, CA, USA
  • Edited by Bert van Luyn, Salman Akhtar, Thomas Jefferson University, Philadelphia, W. John Livesley, University of British Columbia, Vancouver
  • Book: Severe Personality Disorders
  • Online publication: 14 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544439.012
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Dangerous cases: when treatment is not an option
    • By J. Reid Meloy, Associate Clinical Professor of Psychiatry University of California, San Diego, CA, USA; Adjunct Professor University of San Diego School of Law, San Diego, CA, USA; President, Forensis San Diego, CA, USA, James A. Reavis, Director of Forensic Services Relationship Training Institute, San Diego, CA, USA
  • Edited by Bert van Luyn, Salman Akhtar, Thomas Jefferson University, Philadelphia, W. John Livesley, University of British Columbia, Vancouver
  • Book: Severe Personality Disorders
  • Online publication: 14 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544439.012
Available formats
×