Without Conscience: The Disturbing World of the Psychopaths Among UsCanadian Psychology
Reviewed by STEPHEN WORMITH
Too often we hear about adults, and now more than ever, adolescents, who perpetrate violence so horrific and seemingly meaningless that their actions defy the understanding of professionals, let alone of the perpetrators' families. The republication of Robert Hare's popular work on the psychopathic personality (originally published in 1995 by Pocket Books, New York) is a testament to the success and importance of this book. Hare paints an intriguing yet scary portrait of this, the most dangerous type of personality disorder. His colourful, but accurate portrayal of the psychopath makes this book equally important alike for parents and clinicians.
Without Conscience is based on more than 30 years of the author's research on psychopathy. The book is written in a sincere and easily readable fashion for a general audience. The research and clinical literature is described in nontechnical terms with a minimum of jargon, making the work accessible to a wide audience. To his credit, Hare does not succumb to the temptation of overstating the findings, as is commonly the case when scientific knowledge is translated for a popular audience. References, which are fewer than one would expect in an academic text but more than in most popular works, are relegated, appropriately, to chapter notes. The empirical literature is interwoven with many personal anecdotes, as well as descriptions of psychopaths and their behaviour from film, literature, and the popular press. With celebrated cases including Clifford Olson, Jack Abbott, Ted Bundy, Jeffrey Dahmar, and the fictional Hannibal Lecter, references range from Ann Landers and Oprah Winfrey to Truman Capote, Joseph Wambaugh, and Norman Mailer. This is a refreshing change from most psychological works and makes compelling reading for the lay person. Yet Without Conscience will also be of interest to any student, clinician, or researcher in the field of forensic or correctional psychology.
By describing the behaviour of dozens of individuals, all of whom "scored high on the PCL" and presented behaviour that shared a number of common themes, Hare, indirectly, provides insight into the personality, if not the mind (he rejects psychodynamic approaches), of the psychopath. It is a personality that is characterized by egocentricity, grandiosity, impulsivity, recklessness, contentment with self, and, most disturbing, a total lack of conscience.
Much of Hare's research has been devoted to the reliable identification of psychopaths. His development of the Psychopathy Checklist (PCL) may represent the single, most important advancement to date toward what hopefully will become our ultimate understanding of psychopathy. Most of Hare's more recent research has used the PCL to study the construct of psychopathy and, in so doing, has contributed to the ongoing validation of the instrument. Therefore, it comes as no surprise that much of the book hinges on his definition, assessment, and diagnostic approach to psychopathy, nor is it a surprise that he is critical of those who would equate psychopathy with "antisocial personality disorder" (APD ) and its diagnostic criteria as set out by the American Psychiatric Association (1994). Hare notes that many APD clients are not psychopaths and therefore should not necessarily share the same pessimistic prognosis. In this vein, he blames professionals, as well as the media, for confusing the issue and he chastises clinicians who conduct mediabased diagnoses for the popular press.
There are a number of important messages conveyed in this book and all of them are based on the author's fundamental perspective about psychopaths. Although not explicitly stated, Hare portrays the psychopath as one who seems to be born, not made. He does this by presenting numerous stories of individuals, who, without explanation, since their home environments appear to be quite normal, begin to behave in a disturbingly egocentric and aggressive manner. Yet Hare is quite candid about the fact that we do not know how or why these children are impervious to the most skilled efforts to foster appropriate socialization. He does, however, cite neurological, biochemical and genetic studies to suggest possible mechanisms and he invokes the heredity-environment interaction to explain how psychopathy may become manifest in very different ways, from con man to killer.
This stance leads to three particular messages of Hare's book. First, the parents and spouses of psychopaths should not feel responsible or guilty about the psychopath's behaviour. Rather, they should consult clinicians with special diagnostic expertise, and if it is determined that one is dealing with a psychopath, specific strategies should be established, basically involving a structured environment with well-defined contingencies and other behavioural management techniques. Second, the personality and behaviour of a psychopath are unlikely to change in any substantial manner, except for some possible diminution with age. Moreover, treatment efforts, especially conventional psychological therapies, are unlikely to be effective, largely because psychopaths are quite content with themselves and believe that their approach to dealing with other people is fully justified and profitable. Therefore, Hare is very critical of insight-based approaches, particularly such as the therapeutic community, which might teach the psychopath to be even a better manipulator. Instead, he insists that any effort to work with psychopaths should incorporate their pervasive self interest, pointing out how, time after time, their antisocial behaviour has not, ultimately, been in their own best interest.
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