To treat a psychopath

Some people are now quite optimistic about the possibility of treating psychopathy with drugs that directly modulate brain function. I argue that this optimism is misplaced. Psychopathy is a global disorder in an individual’s worldview, including his social and moral outlook. Because of the unity of this Weltanschauung, it is unlikely to be treatable in a piecemeal fashion. Recent neuroscientific methods do not give us much hope that we can replace, in a wholesale manner, problematic views of the world with more socially desirable ones. There are, therefore, principled reasons that psychopathy is so singularly treatment resistant.     

The psychopath magnetized: insights from brain imaging

Psychopaths commit a disproportionate amount of violent crime, and this places a substantial economic and emotional burden on society. Elucidation of the neural correlates of psychopathy may lead to improved management and treatment of the condition. Although some methodological issues remain, the neuroimaging literature is generally converging on a set of brain regions and circuits that are consistently implicated in the condition: the orbitofrontal cortex, amygdala, and the anterior and posterior cingulate and adjacent (para)limbic structures. We discuss these findings in the context of extant theories of psychopathy and highlight the potential legal and policy implications of this body of work.     

Neuropsychology of the aggressive psychopath: An integrative review

Neuropsychological studies of aggressive psychopaths have revealed characteristic deficits in skills that require verbal mediation, conceptual integration, and the abilities to anticipate consequences of actions and to use feedback from behavior to modify maladaptive response patterns. Formulations of this impairment pattern in terms of frontal lobe and left hemisphere dysfunction are reviewed. It is proposed that the aggressive psychopath suffers from an inability to form a self-referential conceptual classification system for behavioral control and that this predisposes to behavioral disinhibition in situations of stress and interpersonal ambiguity. Finally, implications of neuropsychological studies of aggressive psychopathy for the study of personality and psychopathology are discussed.     

Identifying the psychopath: The relation of Cleckley's criteria to the interpersonal domain

The relationship between interpersonal behaviour variables has been shown to be defined by a circular ordering, or circumplex, within the framework of a two-dimensional space. It is proposed that Cleckley's criteria of psychopathy represent one axis of this system, hostility vs warmth. It is also proposed that these criteria alone are not sufficient to identify a homogeneous group of deviant persons. Observer ratings of the behaviour of institutionalized mentally-disordered offenders were obtained for Cleckley's criteria and for behavioural dimensions of impulsive aggression and sociability. Cleckley's criteria were found to describe a unitary dimension whose relationship to other variables was consistent with the circumplex model. Cluster analysis of the ratings identified two distinct groups of high scorers on Cleckey's criteria, who were also significantly differentiated by self-report personality variables. Only one of these groups showed the combination of lack of warmth or affection and lack of behavioural control which several investigators consider necessary to define psychopathy. Relationships among individual rating items and some of the personality variables closely approximated the expected circular ordering. Reference to this interpersonal circumplex appears to reconcile some of the differences in current conceptualizations of psychopathic personality.     

The psychopath as observer: emotion and attention in picture processing

This study extended prior work showing abnormal affect-startle modulation in psychopaths. Male prisoners viewed specific categories of pleasant (erotic or thrilling) and unpleasant (victim or direct threat) slide pictures, along with neutral pictures. Acoustic startle probes were presented early (300 and 800 ms) and late (1,800, 3,000, and 4,500 ms) in the viewing interval. At later times, nonpsychopaths showed moderate and strong reflex potentiation for victim and threat scenes, respectively. For psychopaths, startle was inhibited during victim scenes and only weakly potentiated during threat. Psychopaths also showed more reliable blink inhibition across pleasant contents than nonpsychopaths and greater heart rate orienting to affective pictures overall. These results indicate a heightened aversion threshold in psychopaths. In addition, deficient reflex modulation at early times suggested a weakness in initial stimulus evaluation among psychopaths.     

The vindication of the language organ

Ape language research presents us with a worthy and successful example of realist bootstrapping of theorizing and experimentation. In the 1940s, the Hayeses set out without a definition of language, merely taking it that it appeared in the normal maturation of the normal human in normal circumstances and so might appear in a chimpanzee similarly placed. The Gardeners, noting the chimpanzee's limited vocalizing apparatus, tried to show that a chimpanzee would develop language in the same way as the human child if only the language were a sign language. Meshing with research by Premack and Terrace, recent work on fluent human signers of American Sign Language has shown that while chimpanzees can be led to use a gestural pidgin-vocabulary to manipulate and socialize, they in no way develop linguistically as the human infant signer does. In terms of homology, a case can be made that the signing chimpanzees have little improved on the Hayeses' chimpanzee, who eventually vocalized five English words. What this stretch of interaction between theory and experiment bears out is the autonomy of the formal linguistic apparatus from other conceptual and perceptual capacities that we undoubtedly share with our primate cogeners.     

Psychopathic, not psychopath: taxometric evidence for the dimensional structure of psychopathy

Although psychopathy is frequently regarded as qualitatively distinct from other conditions, relatively little research has examined whether psychopaths represent a distinct class of individuals. Using a sample of 876 prison inmates and court-ordered substance abuse patients who were administered the Psychopathy Checklist-Revised (R. D. Hare, 2003), the authors examined the latent structure of psychopathy using several taxometric procedures developed by Meehl and colleagues (P. E. Meehl & L. J. Yonce, 1994; N. G. Waller & P. E. Meehl, 1998). The results across these procedures offer no compelling support for the contention that psychopathy is a taxonic construct and contradict previous reports that psychopathy is underpinned by a latent taxon. The authors discuss the theoretical, public policy, and practice-level implications of these findings.     

The language of absence

This paper will focus on the concept of 'absence', which describes a continuum of non-responsiveness and misattunement of the environment in the stage of absolute dependence; it refers to concepts like lack, failure, non-recognition, impingement, neglect, tantalizing, ranging to mental, physical and sexual abuse. An extreme external absence causes shock and fear. The automatic survival response is an inner absence, an intrapsychic absence, a dissociation of parts of the self. The external and the inner absence are the negative image of each other. The concept of absence points to the synchronicity of outer and inner reality and portrays the non-responded-to needs of the self. This point of view of the development of psychopathology of the self on the basis of massive dissociation is inherently an intersubjective-field-theory. As the inner absence is created as a reaction to an absence of the other, in analysis - the analyst has an active role in reviving it. This paper will explore the language of absence, that is, the derivatives and consequences of these situations in the inner realm, and in the relations with the analyst. It is the author's contention that understanding and speaking this language has important clinical and technical implications. Understanding the language of absence enables the analyst to recognize its intersubjective and its intrapsychic presence, to provide an environment that allows for its revival, and to facilitate and regulate the annihilation anxiety that awakens when dissociated self-states are experienced. When the absence is present, i.e. when the traumatic experience and the dissociated reactions to it are experienced in an attuned relationship, it is rendered with meaning, symbolization, and validation, and enables the survival mode of dissociation to be relinquished.