The Book of Psychopaths

Source: K. Ramsland

In the news recently were the results from brain scans of a small cohort of psychopathic offenders. Researchers at Radboud University and the Dutch Institute for Forensic Psychiatry found that the compromised quality of white matter linking the amygdala and prefrontal cortex affects the ability to process emotional information that’s related to impulse control. “You can compare these abnormalities in white matter to bad quality highways,” said one researcher. “If the quality of the pavement is insufficient, traffic will stop.” The research team believes this discovery can help with future treatment of psychopaths. Hervey Cleckley encouraged such work over 75 years ago.

Although psychopathy was one of the first personality disorders that psychiatry formally recognized, it was difficult during the nineteenth century to understand it. Alienists described it variously as "moral insanity" and "psychopathic inferiority." It soon became a “trashcan” label for many different conditions.

This changed in 1941, when American psychiatrist Hervey M. Cleckley honed in on a subset of his patients, the psychopaths. Viewing the disorder as the “most baffling and most fascinating,” he was concerned that psychopathy presented “a sociological and psychiatric problem second to none,” in part because psychopaths did not seek treatment. In addition, there were no provisions in prisons or hospitals for dealing with them. Where clinical assessment and treatment were concerned, psychopaths were on a back burner.

Yet, Cleckley thought, someone had to study them. He forged ahead with his seminal work, The Mask of Sanity: An Attempt to Clarify Some Issues About the So-called Psychopathic Personality. Cleckley distilled sixteen traits and behaviors that formed a specific profile. Among them were irresponsibility, self-centeredness, shallowness, superficial charm, lacking in empathy or anxiety, and a likelihood of committing more types of crimes than other offenders. Violent psychopaths were more aggressive, more likely to recidivate, and less responsive to treatment.

Cleckley discovered that psychopaths best show their traits in situations in which they can effectively charm and manipulate. He likened them to a pair of copper wires that carried 2,000 volts of electricity. Kept apart, they were inert. "When we look at them, smell them, listen to them, or even touch them separately, [they] may give no evidence of being in any respect different from other strands of copper." However, connect these wires to a motor to make the circuit and they can be dangerous. "So, too, the features that are most important in the behavior of the psychopath…become manifest only when he is connected into the circuits of a full social life.”

Besides making notes on his patients, Cleckley also examined psychopaths in business, science, politics and medicine – even psychiatry. He also identified some female psychopaths. Among his illustrative case studies is one that he called “a man of the world.”

This person had been educated in prep schools and universities, although he’d shown little interest in his studies. He’d persuaded others to do the work for him, and he had a following of those who were eager to please him. (Cleckley remarks on how easily male psychopaths can charm women and convince them to attend to their needs.) He was pretentious and he liked to shine in social clubs. Considered a “catch,” he went through girlfriends quickly, and cheated on most.

This man had money but ignored his debts. He could whip up passion for a cause although he believed in nothing. When he lost jobs, people supported him and he took advantage. He whined dramatically that his life wasn’t what it should be, although the cause was his own sloth. He indulged in drinking sprees and sought women older then himself who’d spend lavishly on him. He inspired them to mother him. Exploitation was his game.

Cleckley’s work influenced the primary diagnostic instrument used today for assessing psychopathy, the Psychopathy Checklist-Revised (PCL-R). Like Cleckley, inventor Robert Hare describes psychopathy as a personality disorder that offers a distinctive cluster of traits and behaviors. Among the most salient features are a callous disregard for the rights of others, a lack of remorse, parasitic tendencies, and a propensity for predatory behaviors.

Like serial killer Ted Bundy, whom Cleckley met.

When Bundy was caught in Florida in 1978 for the Chi Omega murders, Michael Minerva, his lead defense attorney, invited forensic psychiatrist Emanuel Tanay to evaluate him. Tanay found Bundy to be a narcissistic, self-sabotaging psychopath and declared him incompetent to stand trial. He recommended that Minerva contact Cleckley, the leading authority on this condition, for an assessment.

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Prosecutor Larry Simpson was way ahead of them. He was certain that Bundy was competent and he called up a fishing buddy to support him. It was Cleckley! But he kept this under wraps. When Tanay took the stand during Bundy’s competency hearing, Simpson asked Tanay to name the literature on which he relied. Tanay cited The Mask of Sanity. Simpson asked if he would defer to its author. Tanay said he would. Enter Cleckley, who provided evidence of Bundy's ability to stand trial. There wasn’t much left for Tanay to say, and Bundy was found competent.

Over seventy-five years after The Mask of Sanity was first published, it continues to be cited as a primary reference about the psychopathic condition. Cleckley ended his study on a sobering note. Without adequate legal means to control destructive psychopaths, he stated, and lacking effective therapy, we must try to better understand them. “Eventually,” he said, “we may find this disorder to be not altogether beyond our practice.”