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Book Forum: Forensic Issues   |    
Psychopathy: Antisocial, Criminal, and Violent Behavior
Am J Psychiatry 1999;156:1660-a-1661.
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edited by Theodore Millon, Erik Simonsen, Morten Birket-Smith, and Roger D. Davis. New York, Guilford Publications, 1998, 476 pp., $60.00.

The "psychopathic mind" compels constant attention in journalism, film, and literature. It is surprising, then, that the psychiatric literature on psychopathy is so often disappointing: desiccated, weighed down with polemics, and often preoccupied with controversy over definitions: who is a psychopath, and who is merely self-centered, antisocial, impulsive, violent, and/or criminal?

Psychopathy, as we are reminded by the editors of this book, was the first of the personality disorders to be named. It is often confused with antisocial personality disorder, but it is not the same thing at all, and the propensity to use the two terms interchangeably has hampered research and understanding. The resulting problems are evident in this book, for most of the research cited is research on antisocial personality—probably because people with antisocial personality disorder are more numerous than those who are psychopathic, and they are more easily accessible to researchers in the prisons where so many of them are incarcerated.

Twenty-five years ago, the British psychiatrist Sir Aubrey Lewis deplored the failure of psychiatric efforts to deal with the "elusive category" of psychopathy: "The effect of reading solid blocks of literature is disheartening; there is so much fine-spun theorizing, repetitive argument, and therapeutic gloom" (1). The current book, the product of an international symposium, suggests that little has changed. Many of the authors of its 28 chapters acknowledge that psychopathy remains an ill-defined concept. Some of the authors even challenge the book’s core concept: "These terms serve to confuse and mislead…psychopathic disorder does not exist" (John Gunn, p. 32). Likewise, Hans Toch considers "psychopathy" to mean little more than the plain English "I don’t like you" dressed up in a polysyllabic medical gown. He views the concept as a political and ideological term: a diagnosis that allows us to feel good about locking up and forgetting troublesome people.

Other contributors contend that psychopathy as a concept is not just useful but essential to understanding antisocial behavior. Outstanding among these is Robert D. Hare, whose synopsis of decades of research by himself, his collaborators, and others is Psychopathy’s most clearly written chapter.

Thomas A. Widiger and Donald R. Lynam, quoting Hare, make the important point that psychopathic individuals are not a distinct subspecies of the human race. Rather, psychopathic tendencies are a part of the human condition, and when those traits are present in sufficient degree, we affix the label "psychopath." This fact may seem banal, but some of the contributors come close to assuming that people fall into distinct and nonoverlapping categories: normal (us) and psychopaths (them). For example, Theodore Millon and Roger D. Davis categorize psychopathic individuals as "spineless," "threatened," "volatile," "hurtful," "unforgivable," "disappointed," "frustrated," "surly," "truculent," "irrational," "frenzied," "hypersensitive," "unrestrained," "wild," "sadistic," "precipitous," and "vindictive," all on one randomly selected page (p. 166). These adjectives describe no particular individual but, rather, the authors’ view of one type of psychopathic individual. Similar collections of adjectives could be culled from several other chapters. These generalizations seem to be based on knowledge acquired entirely from distant vantage points such as reviews of prison files, responses to questionnaires, and psychophysiological measurements. Only a few of the contributors acknowledge that they have ever spoken to—or listened to—a psychopathic individual. No doubt all of the authors have seen and heard psychopathic individuals close up, but the fact that they have found nothing worth reporting from those encounters has led to a book in which the people who are its subjects are visible only from a great distance, like clusters of galaxies on an astronomer’s photographic plate.

A number of authors, such as psychoanalyst Otto Kernberg, engage in spinning of theory without visible connection to data. Others use sociological data to argue for radical political action. The psychologist David T. Lykken, alarmed by the decline of the two-parent family, argues for licensing mothers. The price of a license would be a husband in the home. Lykken would require single mothers to give up their infants to be adopted or raised in foster homes or institutions. The state would inject second offenders with long-lasting antifertility drugs.

It is remarkable that Lykken, so open to radical action, gives no consideration to measures that would support two-parent families, multigenerational families, and cohesive communities. He blames much of modern sociopathy on the social fission that has split many nuclear families, leaving only mother-children fragments. He seems unaware that fragmented families and a shredded social fabric are not universal, not even in modern societies with many rich and many poor. The conditions that Lykken argues—quite plausibly—are "factories of crime" are not universal, so they are subject to change, perhaps by means less radical than raising millions of children in institutions and sterilizing women who commit a second unlicensed birth.

Lewis’ "therapeutic gloom" is also much in evidence. In fact, William H. Reid counsels abandoning efforts to understand psychopathic individuals. He explains, "The answer to most violent crime does not require such intellectual hairsplitting" (p. 115). What is needed, he argues, is to set aside our "sense of fairness" and to suspend "some rights of people who have not been convicted of any crime" lest we "lose our democracy" (p. 114, emphasis in original). Reid concedes that imprisoning potentially bad children before they are convicted of breaking laws may be "distasteful." By way of explanation, he points out that "most of us agree that we need to slaughter animals from time to time" (p. 114).

Other contributors provide less heat than Reid, but not necessarily more light. Many readers may be unable to find illumination in phrases such as Henry Richards’ "nonmetabolized (personified and polarized) early introjections of the archetypal experience of the stranger selfobject" (p. 73), "semantogenic process" (p. 74), and "metarepresentational context" (p. 78).

The 36 contributors to Psychopathy include proponents of all the major ideas and ideologies in the field of psychopathy and sociopathic personality disorder. Those ideas and ideologies are often diametrically opposed, and they represent strong moral convictions on the part of their believers. It must have been a lively symposium, but the resulting book will challenge the attention-focusing abilities of all but the most determined reader.

Lewis A: Psychopathic personality: a most elusive category. Psychol Med  1974; 4:133–140


Lewis A: Psychopathic personality: a most elusive category. Psychol Med  1974; 4:133–140

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