FOREWORD
Psychopaths in Our Lives: My Interviews

By Carl B. Gacono, Ph.D. & Aaron J. Kivisto, Ph.D.

Perhaps no area of scientific study so naturally calls upon non-scientists to grapple with its most basic questions, as does the field of personality psychology. From the moment, we wake up to the time we go to sleep, we are typically inundated with stories of other peoples’ behavior – whether it be loving, destructive, or anywhere in between. We learn what happened, who did what, when they did it, and how others responded. We get the facts. But, whether consciously or not, we all go beyond the information that we can so clearly see and hear.

The facts alone don’t tell us what we seem to need to know. Each of us, sometimes deliberately and sometimes automatically, takes these facts and uses them as building blocks to infer motives for why others do what they do. We can’t directly perceive these motivations through our five senses, yet we have a natural tendency to ascribe meaning to our experiences. To figure out the why for each what. Without an understanding of cause and effect, why others do what they do, our worlds feel like little more than a series of unintegrated and incoherent facts.

And so we all grapple with the basic questions faced by personality psychologists: why do people do what they do? And, given what this tells us about them, how might they act in the future? In fact, given just how naturally we seem to infer motives for others’ behavior, one might feel sympathy for Dragnet Detective Joe Friday’s uphill – and probably futile – battle to get his interviewees to stick to “just the facts, ma’am.” This seems to violate our need to understand others, even when (especially when?) their behavior is cruel and appears incomprehensible.

What exactly is personality, and what does it mean when it’s “disordered”? Broadly speaking, personality can be defined simply as the characteristic ways in which a person tends to perceive the world, think, feel, view themselves, and relate to others (Mayer, 2005). Further, contemporary understandings of personality recognize that these characteristics exist on a continuum rather than as discrete attributes that are either present or absent (Marcus, Lilienfeld, Edens, & Poythress, 2006). For example, we all fall somewhere along a range of agreeableness to disagreeableness rather than simply being agreeable or disagreeable. We’re not introverted or extraverted, but somewhere between the two.

Given this, when is personality “disordered,” or “disordered enough” to warrant a psychiatric diagnosis of a personality disorder? According to the American Psychiatric Association’s Diagnostic and Statistical Manual – 5th Edition (DSM-5; APA, 2013), which distinguishes between 10 categories of personality disorders, a personality disorder is diagnosable when an individual’s characteristic ways of thinking, acting, and relating to others (1) deviate markedly from cultural norms and (2) are exhibited across multiple contexts. Put another way, most peoples’ behavior in a given situation reflects a relatively balanced combination of personality-based and situational causes. However, the personality-disordered individuals’ behavior reflects a rigid imposition of their personality that is unresponsive to the unique demands of different situations and settings. When this rigidity impairs peoples’ ability to function in work, love, and other important areas of their lives, they are considered to have a personality disorder.

It has also been suggested that a distinguishing feature between the personality disorders and other psychiatric diagnoses lies in the locus and scope of the suffering that the disorder entails. Most psychiatric disorders, such as Major Depressive Disorder, are diagnosed due to the suffering of the afflicted individual, as it is the exception rather than the rule that the individual with depression causes destruction and suffering in others’ lives. Personality disorders, by contrast, are notable for the broad swath of suffering often experienced by others in the person’s life, sometimes combined with little or no suffering in the individual diagnosed with the personality disorder.

With no diagnosis is this distinction more clear than with Antisocial Personality Disorder (ASPD). It would often be absurd to suggest that the diagnosed individual “suffers from” ASPD, although those who have had the misfortune of encountering such individuals will very often have suffered in some way. Why do people with ASPD – and its more severe variant, psychopathy – create so much destruction? To begin to answer these questions, it’s essential to explain how psychologists recognize and diagnose these individuals.

Despite the fact that the antisocial syndromes, particularly psychopathy, have been the focus of more research than any other personality disorder, terms such as sociopathy, Antisocial Personality Disorder, and psychopathy are often misused and inaccurately viewed as synonymous (Losel, 1998; Gacono, 2000, 2015; Gacono & Meloy, 1994). Conflating these terms ignores the empirically distinct and clinically relevant differences of these constructs, which developed along separate theoretical lines. Psychopathy originated with Pinel’s (1806) clinical observations and introduction of the term manie sans delire, or madness in the absence of delirium. The idea that there existed a type of madness that could spare central mental functions was considered revolutionary at the time, but largely went nowhere for the next hundred years. In 1907, Emil Kraeplin, the father of psychiatric nosology, introduced the term “psychopathic personality,” although his clinical observations about these difficult patients failed to gain momentum.

Eventually, however, Hervey Cleckley’s groundbreaking 1941 text, The Mask of Sanity, established psychopathy as a valid topic of scientific study and introduced a model of psychopathy that remains central to contemporary understandings. Key to Cleckley’s model of psychopathy was the dual emphasis on both behavioral and trait criteria. Cleckley (1941/1976), in contrast to Pinel’s emphasis on focal cognitive and affective defects, framed psychopathy in terms of the personal suffering and social costs psychopaths continually inflict on others. Psychopaths, according to Cleckley, were epitomized by a combination of 16 (reduced from 21 in the original text) characteristics that are associated with an impulsive, irresponsible, and deceitful life-style. In psychoanalytic parlance, the psychopath was pathologically devoid of conflict about the causes or consequences of his antisocial acts. The psychopath’s urge to take, break, or hurt were seen as never truly proportionate to the objects of their efforts, and Cleckley (1941/1976) observed that their antisocial acts often appeared surprisingly lacking in external motivation. The psychopath either blithely ignored reality or refused to acknowledge it. To Cleckley’s psychopath, taking, breaking, and hurting were goals in their own right, with each antisocial act bolstering the individual’s profound egocentrism.

Shepherding Cleckley’s (1941) model of psychopathy into contemporary clinical and forensic practice, Robert Hare developed the Psychopathy Checklists (Hare, 1991, 2003; Forth, Kosson, & Hare, 2003; Hart, Cox, & Hare, 1995), which have become the gold standard for evaluating psychopathy (Gacono, 2000, 2015). Mirroring Cleckley’s emphasis on both trait and behavioral aspects of psychopathy, the Psychopathy Checklists contain two stable factors. The first factor, “callous, remorseless use of others” (Factor 1), is characterized by egocentricity, callousness, and remorselessness, and correlates with Narcissistic and Histrionic Personality Disorders, low anxiety, low empathy, and self-report measures of Machiavellianism and narcissism (Hare, 2003). The second factor, “antisocial lifestyle” (Factor 2), represents an irresponsible, impulsive, thrill-seeking, unconventional, and antisocial lifestyle and correlates most strongly with criminal behaviors, lower socioeconomic background, lower IQ, less education, self-report measures of antisocial behavior, and the diagnoses of Conduct Disorder and Antisocial Personality (Hare, 1991, 2003).

In contrast to psychopathy, sociopathy (APA, 1952) and Antisocial Personality Disorder (APA, 1994, 2013) are terms that have evolved across various editions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM).

The term sociopathy, which lacks contemporary clinical meaning, was introduced by Birnbaum in 1909 to describe individuals exhibiting antisocial behavior, impulsivity, and deficits in empathy and emotional processing. In contrast to conceptualizations of psychopathy at the time, which tended to emphasize a hereditary etiology, sociopathy emphasized the role of environmental factors and personal experiences. A pathological social context was both the cause and consequence of the sociopathic individual’s behavior.

In the first edition of the DSM, which was introduced in 1952, Birnbaum’s notion of sociopathy was included as a diagnosis of “sociopathic personality disturbance.” In the 1968 edition of DSM-II, however, the term sociopathy was replaced by Antisocial Personality Disorder (ASPD). ASPD was defined by its emphasis on incorrigible antisocial traits and behaviors, such as egocentrism, callousness, impulsivity, guiltlessness, and recalcitrance to remediation efforts or punishment (APA, 1968). To the extent that the definition of ASPD in DSM-II (1968) still captured both observable behaviors as well as personality traits, it was in some ways still quite consistent with Cleckley’s (1941) model of psychopathy.

The DSM-III ASPD criteria largely jettisoned the trait features of ASPD and focused primarily on observable behavior (APA, 1980), based largely on the work of Lee Robins (1966), the increasing popularity of a social deviancy model in psychiatric circles, and the aim of increasing inter-rater reliability. The nearly exclusive focus on observable traits has continued through the current DSM-5 criteria for ASPD (APA, 2013). However, what was sacrificed in the interests of increasing reliability was the usefulness (validity) of the disorder (Gacono & Meloy, 1994).

Today, ASPD is most accurately viewed as a diagnosis rooted primarily in socially deviant behavior, regardless of the personality traits of the individual engaged in deviant conduct, whereas psychopathy captures both the problematic behavior as well as the traits that presumably facilitate such misconduct.

There are several implications of psychopathy’s two-factor structure versus the single factor associated with ASPD. First, whereas one can arrive at the ASPD diagnosis by a virtually unlimited number of criteria combinations, categorizing vastly different individuals under the umbrella of this single diagnosis; psychopathy constitutes a more homogeneous syndrome. As a result, base rates for ASPD and psychopathy are significantly different. While ASPD community rates are estimated at 5.8 % of males and 1.2% of females, prison populations will typically have rates of 50% to 80%. Psychopaths will comprise only 15 to 25 percent of the same prison populations.

Finally, and probably most importantly, psychopathy assessment has important clinical and forensic implications in terms of predictive validity, (Gacono, Loving, & Bodholdt, 2001; Gacono 2000, 2015). For instance, high PCL or PCL-R scores have been associated in the research with a higher frequency and wider variety of offenses committed, higher frequency of violent offenses, and higher re-offense rates (Hare, 2003); poor treatment response (Ogloff, Wong, & Greenwood, 1990; Rice, Harris, & Cormier, 1992); and more serious and persistent institutional misbehavior (Gacono, Meloy, Sheppard, Speth, & Roske, 1995; Gacono, Meloy, Speth, & Roske, 1997; Heilbrun, et al., 1998). The ASPD diagnosis is not associated with these same outcomes (Lyon & Ogloff, 2000). One possible interpretation of the relative disconnect between the diagnosis of ASPD, and the prediction of future behavior is that the diagnosis, for all its inter-rater reliability, fails to facilitate understanding of the individual who has broken the rules.
Given the pull we all experience to understand not only what someone has done, but also why they did it, it is perhaps unsurprising that the antisocial syndromes have received so much attention. After the initial reactions of horror and fascination typically elicited by the acts of psychopathic individuals, the question most people struggle with is why. Contemporary clinical and forensic science has aided in this understanding, beginning with the work of Pinel in the early 1800s and solidified through Cleckley and Hare’s enormous contributions. However, none of the contributions of these pioneers toward our understanding of psychopathic individuals would have been possible without the stories of the psychopaths that they encountered. It is easy to lose sight of the centrality of these stories, in large part because they are so rarely detailed.

In the pages that follow, Dianne Emerson provides readers with the rare opportunity to enter the personal lives of three male psychopaths through their own words. Through the careful organization of their everyday stories of who, what, when and where, Emerson ultimately provides the building blocks for readers to understand why these individuals do what they do. Without such stories, there is little hope for understanding.