The Psychopath
Understanding and Treatment

Abstract
Mental health disorders are among the most complex disorders to understand. Persons with these types of disorders are not commonly accepted into society. Psychopaths are among some of the most difficult disorders to treat. These persons most often come from a background lacking structure and continuity. Proper treatment is heavily debated.

Report
It is a popular belief that psychopaths are considered to be individuals that are as brilliantly charming as they are morally insane. However, the tendency to refer to the psychopathic behavior as “morally insane” is a misconception. Regardless of scientific discoveries, psychopathy is a disease which results in a physiological deficiency. The brain of psychopaths is believed to fail in generation of proper wave activity. Waves emitted are generally slower in individuals suffering from psychopathic behavior. This fundamental incompetence is responsible for a lower degree of arousal when these persons face a threatening situation. Their lack of anxiety and consequent careless behavior in any situation is commonly referred to as lack of conscience. These individuals lack the plethora of emotions that arise in the “normal” individual; that is, the ability to feel, to anticipate the breaking of the law, or to feel sorry when they break these laws. They are deprived of a conscience which organizes the moral notions of good and bad. In normal behavior, acts are constrained by external laws at work in society. The conscience of average individuals are able to anticipate any destructive action which could obstruct the law. Psychopaths don’t have such a capacity. They are leading a life which ignores external impediments. This fundamental unawareness is directly related to a slower activity of waves at work in the brain. This abnormality blocks the entire process of learning. The lower waves produce a decreased response of anxiety which causes the psychopaths to not be anxious or afraid of punishment when they perform a reprehensible action. According to Cleckley’ s definition of psychopathic behavior in the Mask of Sanity , (1988) when one of them breaks the law, he or she does not experience a sense of shame or guilt. When psychopaths are faced with any form of punishment – it could be physical pain or punishment regardless of the deliberate breaking of laws- they do not react with as much anticipation as the average individual. This is because they lack a part of the neurological process which allows them to avoid pain; that is, the adequate rise in palmar sweat gland activity which generates the adequate stimulus. Therefore, the psychopath will reproduce the same harmful actions again and again. In 1954, Ellington’ s experiments showed that between 31 % and 58 % of psychopaths showed some form of electroencephalogram abnormality located in the temporal lobes of the cerebral hemispheres. Another experience regarding the lack of anxiety in psychopaths was lead in 1965 by Robert Hare. In that experience, psychopathic and non-psychopathic subjects were told that each time they would see the number eight in a series of number from one to twelve, they would receive an electric shock. Non-psychopathic individuals showed higher rates of anxiety when they knew the number eight was about to come. On the contrary, psychopathic individuals remain perfectly calm at the sight of the feared number. These results are important since they show that it is a physiological deficiency rather than deliberate insanity that is responsible for the psychopath’s criminal behavior. Another perception largely spread among the population concerns the traditional representation of the psychopath who is figured out as a habitual pleasure seeker, constantly searching for the next big thrill. In the movie the Silence of the Lambs, such a personality is embodied in Hannibal Lector, a frightening psychopath who, by his compelling need of strong experiences, breaks the boundaries of decency. The portrayal of this character embodies the collective myths referring to the mental scheme of the psychopath. The representation is romanticized in order to play with society’s fascination for the violation of laws. However, the popular myths have captured one of the most fundamental features of the psychopathic personality as described by Cleckley, cited in p. 479 of Abnormal Behavior. “Most psychopaths become bored quickly with the humdrum of everyday life. They search constantly for new thrills and experiences - daring robberies, impersonations, confidence games, new varieties of drugs and deviant sexual behavior”. The psychopath occasionally needs to receive a stimuli stronger than the average person in order to be aroused and, eventually, find “the game” exciting. Therefore, psychopath’s brain activity is not always below the average. Otherwise, this decreased activity would have it made difficult to explain the energy the psychopath shows in order to catch his victim. When an immediate reward is offered, impulsivity of the individual suffering from psychopathic disorder increases through an immediate responsiveness to the appealing stimulus. From a neurological point of view, the slow brainwaves are balanced by a peak of specific waves located in the temporal area and linked to the individual’s impulsivity; which, in that case, appears every time there is a promise of instantaneous reward. In 1993, Patterson and Newman conducted a test, the purpose of which was to analyze the reaction of psychopaths when they were confronted with instantaneous rewards. The results where puzzling. While the non-psychopathic individuals, conscious that they were losing their money, stopped to play, nine out of ten psychopaths continued to play even though they had lost money on nineteen of the twenty trials. In that case, the immediate reward which was money functioning as a powerful stimulus, constituted the new thrill. Since psychopathic behavior violates the laws at work in society, the view commonly held among people is that, from an early age, environmental factors cause the psychopathic disorder. The characteristics underlying psychopathy are denial of the society’s rules or simply lack of concern for the other fellow men. It can be asserted that, at some point in their life, the maturation of a psychopath’s self has encountered several barriers which, in turn, have resulted in a distorted ego in the young adult. The psychopath is unable to avoid the satisfaction of his primary impulses as well as not feeling the guilt associated with the breaking of a given rule. All these processes were part of the values that, as a young child, the individual has internalized through particular schemes. These schemes referred to as cognitive schemes essentially lie in the emotional responses which are provided by the external world. Through these cognitive clues, an entire world of tenderness and care provides the baby with identifiable marks necessary to his present and future well being. These cognitive schemes are mediation processes between the individual and the world in the sense that, through them, the child distinguishes the good from the bad. Little by little, he is able to build his consciousness of the surrounding world. But, because either the psychotic child has been stopped from doing so at some point of his life or that, generally, these signs have been distributed in spare quantity, the individual will develop psychopathic tendencies since he lacks the ability to relate himself to the world in a proper way. One quick look at the background of Charles Manson is enough to understand the role played by environmental factors in his rearing and the consequent deviant personality he developed through the years. In the book abnormal behavior on p. 488, it is showed that Manson’s mother “modeled a life of prostitution, irresponsibility and crime. She probably provided little in the way of cognitive structuring about rules, consequences, or values.” For the young boy there was little left to model his life on. What he became later has been certainly influenced by the poor education he received which, in turn, resulted in a subsequent failure to internalize society’s prohibitions. The biological approach provided the theory of environmental factors as shaping the future personality with a number of interesting clues. Franz Kallman found that a high percentage of children of psychopaths ended up themselves with psychopathic disorders. The main reason was that their parents were indeed institutionalized for psychopathic symptoms and once left alone, these children experienced the deprivation of external warnings consequent to the familial structure’s withdrawal. As a result of this lack of guidance, they ended up psychopaths. Moreover a study focusing on children who spend their early years in institutions where there is less love offered than in a family structure, revealed that they later showed an aggressive behavior toward both humans and animals. However, the assertions have to be manipulated cautiously in the sense that if those children later displayed a criminal behavior though vandalism, truancy and antisocial activities, not all of them ended up psychopath. Seventy to 85 percent of individuals classified as criminals meet the criteria for anti- social personality disorder. By contrast only 15 to 25 percent of convicted criminals meet the criteria for psychopathy. All experiments stated above have shown how the characteristics of psychopathy as a disease are dramatically profound. Generally, the subjects’ clear lack of conscience diminishes dramatically their concrete chances of effective treatment. Nevertheless, science has built its success on an attempt to improve on common limitations, constantly challenging even the most irremediable cases. In that perspective, through the years, several approaches to the treatment of psychopathy have been designed. From a biological point of view, if we assume that psychopathy is a disease which has its physical causes in an abnormal brain activity, that physiological deficiency can be corrected by drug treatment. However, the implications of such treatments have to be considered carefully for whoever is aware of the ethical implications involved by such manipulations. For a long time, psychopaths have been treated with a variety of drugs such as dilantin, sodium, and amphetamine sulfate. Occasional recoveries have been reported. However, the lack of follow-up studies once the subject stopped taking the medications has called into question the overall efficiency of the treatment. Generally, patients do show improvement while taking their medications as prescribed. Moreover, if the drug treatment effectively alleviates the pain, it involves a passive approach to that disease. Indeed, to give a psychopath a pill for lack of real structures adapted to his particular disease represents an “easy way” to deal with the problem.
One illustrative case concerns the use of such drugs treatments in the late 70’s. In that time, assuming that psychopathy was an incurable disease, certain institutions distributed those drugs “too generously”, which, in turn, led the patients suffering from psychopathic symptoms to experiencing a general apathy. This process raised an ethical question: 1. To what extent should the pain be alleviated? 2. Were these drugs administered in order to help the patients or simply to put them in a great situation of passivity, making sure they would not hurt anyone? Still, this passivity was believed to be better than the manifestation of psychopathic symptoms in which the patient could have an uncontrollable outburst of rage. However, drug treatment generally tries to stabilize the situation rather than look for dynamic solutions which involve an active participation both of the doctor and of his patient. In any case, the use of mediations has to be manipulated cautiously in order to avoid such excesses. Doctors should use them only when it has been established case per case that the violent behavior is clearly related to a brain dysfunction. From a psycho dynamic perspective, the treatment of psychopathic disorders through psychoanalysis is believed by many to be inadequate. Psychoanalysis tends to analyze the conflicts between the id, the ego and the superego. These internal conflicts are at the basis of the personality. On the contrary, a psychopath doesn’t experience these underlying conflicts.

He has become psychopath precisely because he lacked a superego which could have provided him social standards .Whereas most of us are able to sit in an armchair and express our remorse, the psychopath is not likely to expand himself in sorrowful complaints about all the damages he caused to his surroundings. In fact, if his disease is a result of a poor internalization of moral values, he is not able to be lucid and clear about himself. This lack of clarity related to a lack of conscience is one of the reasons why Freud refused to cure a certain category of patients, precisely those who manifested a clear distortion of reality although they were fully aware. Among this category were the schizophrenics but also the psychopaths. Similarly, in Mask of Sanity, Cleckley concluded that psychotherapeutic treatments to treat psychopathy have been disappointing in the sense that they failed to provoke changes to the psychopath’s daily behavior.
Therefore, the best approach to the treatment of psychopathy is that which takes into consideration the environmental factors and attacks the problem from its basis by providing the child with psychopathic tendencies a secure environment where he can learn to anticipate his negative instincts by developing a positive sense of the self. Some believe that the control of psychopathy lies in institutional programs. From January 1954 to February 1955, a study at the Wiltwyck School In New York was conducted. The institutional program at work in the school emphasized a loving permissive environment which gradually replaced permissiveness by efforts to teach social control and responsibility. As a result, the children developing psychopathic disorders responded positively to the treatment. They showed an increase in the internalization of social standards which allowed them to re- experience feelings of guilt and shame.
In conclusion, considering the fact that there is no real treatment which has proven to be effective on a larger scale, it is dangerous to let the psychopaths operate in everyday life by lack of social structures. Hare notes the connection between psychopathy and domestic abuse. Psychopaths are generally intelligent and superficially charming enabling them to exploit others’ weaknesses. In a culture that promotes superficial values, the psychopath will thrive.

References
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV) .
Cleckley, H. (1982). The mask of sanity (mosby medical library). St.louis: Plume.
Hare, R. D. (2003) The Hare Psychopathy Checklist - Revised (2nd edn). Multi-Health Systems.
P. Lawrence and N. Nohria, Driven: How Human Nature Shapes Our Choices, 2002, Jossey- Bass, San Francisco, CA.
P. Lawrence, “The Biological Basis of Morality?,” Business, Science, and Ethics, E. Freeman and P. Werhane, Editors, 2004, Society for Business Ethics, Charlottesville, VA.
Wong, S. C. P. & Hare, R. D. (2005) Guidelines for a Psychopathy Treatment Program. Multi- Health Systems.