Degrees of Psychopathy vs.The Psychopath, D Carveth

Tags: psychopathy, antisocial personality disorder, superego, Meloy, psychopath, Robert Hare, J. Reid Meloy, A New Language for Psychoanalysis, Schafer, R., Norton, Psychoanalytic View, emphasizing, Toronto Psychoanalytic Society, Paul Roazen, Psychoanalytic Study of the Child, Toronto, New York, pathological narcissism, neurotic personality, Given Meloy, primary psychopathy, Melanie Klein, malignant narcissism, Yale University Press, Edoardo Weiss, Neville Symington, Transaction Publishers, New Brunswick
Content: Degrees of Psychopathy vs. "The Psychopath" Donald L. Carveth, Ph.D. Toronto In the late 1960s and early 1970s a romantic sensibility emphasizing the themes of instinctual liberation, de-repression, and empathic responsiveness to narcissistic needs was influential in popular culture and psychoanalysis alike. For the latter, this entailed a relative de-emphasis of its classical concern with themes of guilt and self-punishment-- i.e., with the dynamics of the superego (Carveth 2006). As early as the late 1950s, Sandler (1960) had already noticed that in the indexing of cases at the Hampstead clinic there was a "tendency to veer away from the conceptualization of material in superego terms" (p. 129), itself an index of a flight from the superego that was to continue for several decades, despite attempts by Menninger (1973) and Rangell (1974, 1976), among others, to remind us that intrapsychic conflict often results in compromises between ego and superego as distinct from those between ego and id--i.e., in corruption of conscience and character as distinct from neurosis (though in reality we generally see complex combinations of these phenomena). After some decades in which we seem to have been more interested in the ways people have been injured than in the ways they can be injurious the pendulum has begun to swing in the opposite direction: today we are fascinated by literary and cinematic depictions as well as social scientific accounts of cold, unattached, apparently conscienceless deceivers, manipulators and killers. The recent spate of Popular books, such as Robert Hare's (1993) Without Conscience: The Disturbing World of the Psychopaths Among Us, Martha Stout's (2005), The Sociopath Next Door: The Ruthless Versus the Rest of Us and, most recently, Paul Babiak and Robert Hare's (2006), Snakes in Suits: When Psychopaths Go to Work, together with a range of popular television series, such as The Sopranos, Criminal Minds, and Dexter, is indicative of the fascination with psychopathy in contemporary popular culture. But in contrast to Rangell's and most other psychoanalytic views of compromised integrity or corruption of the superego as an outcome of psychic conflict, in much of the recent scientific literature on psychopathy it is viewed as biologically determined to a significant degree. The notion of the "bad seed" so dramatically presented in the 1956 film of the William March novel and Maxwell Anderson play of that name, an idea that for decades was dismissed as fiction by environmentalistic social scientists, has found new scientific credibility. It seems psychosocial scientists are either inclined to deny the existence of evil or, if forced to acknowledge it, to explain it in deterministic terms. If we have in the past tended to view it one-sidedly as an outcome of environmental trauma and deprivation, today psychopathy is increasingly seen as a product of nature as much as nurture. As First presented as a commentary on J. Reid Meloy's "A Psychoanalytic View of the Psychopath" at the Toronto Psychoanalytic Society's 18th Annual Day in Psychoanalysis, Toronto, April 28th, 2007. Currently under review by Free Associations. 1
usual in social science, voluntaristic or existentialist views emphasizing agency, choice and responsibility are left to the religious or philosophically minded, those unburdened by a priori commitment to various types of determinism. Building on the work of Cleckley (1976), Hare (1993, 2003), and others, J. Reid Meloy (1988, 2001, 2007a, 2007b) has developed what he calls a psychoanalytic view of psychopathy. The collection of papers he edited, The Mark of Cain: Psychoanalytic Insight and the Psychopath (2001), offers an historical review of past psychoanalytic contributions in this area, although these papers mostly predate the discovery of biological factors in severe psychopathy and focus more on psychological and environmental factors in its less severe manifestations. His The Psychopathic Mind (1988) approaches the issue of causation from multiple perspectives, emphasizing the severe pathological narcissism of the psychopath and his/her biologically-based attachment disorder. Meloy (2007b) points out that, some eighty years later, "we define the psychopath's personality ... in essentially the same twofold manner" as did Freud in 1928, stressing "his pathological narcissism and his cruel aggression." Freud's attitude toward the psychopath may also be gleaned from Paul Roazen's (2005) last book, Edoardo Weiss: The House that Freud Built (see review by Carveth 2006). With respect to a patient about whom Weiss had consulted him, Freud wrote: "In the most unfavourable cases one ships such people, as Dr. A., across the ocean, with some money, let's say to South America, and lets them there seek and find their destiny" (Freud as quoted by Roazen, p. 94). As Roazen points out, "As early as 1907 Freud was contrasting 'scoundrels' with 'neurotics' ..." (p. 98), but without, as far as I know, emphasizing biological factors in the genesis of the "scoundrel." We must take care not to oversimplify the relationship between psychopathy on the one hand, and criminality or antisocial personality disorder on the other. There are many people who display psychopathic traits who are not criminals and do not qualify for the diagnosis of antisocial personality disorder; many criminals do not display much psychopathy; and some criminals do not have antisocial personality disorder. Criminal gangs are wary of severe psychopaths for their extreme narcissism makes them unreliable and untrustworthy gang members. In his recent review of the concept of "antisocial personality disorder," Meloy (2007a) writes that "A substantial body of research has shown that, at most, only one out of three patients with antisocial personality disorder has severe psychopathy. ... Psychopathy is not synonymous with behavioral histories of criminality or the categorical diagnosis of antisocial personality disorder, although it is often a correlate of both in severe cases" (pp. 2-3). Meloy (2007b) summarizes his view of the psychopath by underlining three factors: no attachment, underarousal and minimal anxiety. If it's true, as psychoanalysts have been known to quip, the superego is soluble in alcohol, then in narcissism the (mature as distinct from the archaic) superego can be liquidated altogether. But all of us at times display compromised integrity without displaying severe degrees of either narcissism or psychopathy. It is possible to be a 2
wrong-doer, what used to be called a sinner, without being either very psychopathic or very narcissistic, although malignant narcissism is a defining feature of severe psychopathy. On the other hand, I would argue that there can be no significant wrongdoing without at least some degree, however mild, of narcissism and psychopathy, for without these our attachment to, our identification with, and our empathy and concern for others--i.e., our conscience--would restrain us. I have entitled this paper "Degrees of Psychopathy vs. `The Psychopath'" in order to draw attention to the problem of reification. In this regard there is a notable difference between Meloy's (2007a) essay on antisocial personality disorder and his "A Psychoanalytic View of the Psychopath" (2007b). Although in both he refers to degrees of psychopathy ranging from mild (10-19) to moderate (20-29) to severe (30 or above) on the Hare (2003) scale (Meloy, 2007a, p. 2), in the latter he claims that "the more severe the psychopathy, the more psychobiologically rooted is the cause" (Meloy, 2007b, p. 8) and proceeds, on this basis, to separate out the "primary psychopath" from those who, by comparison, seem barely to merit the diagnosis of psychopathy at all. Though Meloy (2007b) refers to Lykken's (1957) differentiation between "secondary (anxious) and primary (nonanxious) psychopaths" (p. 6), in an adjacent sentence he states categorically that "Anxiety is minimal or absent in psychopathy" (p. 6), a statement that implies that the anxious, secondary psychopath is not really a psychopath at all. Similarly, he states categorically that "his [the psychopath's] personality is organized at a preoedipal or borderline level" (p. 13), which is no doubt true of the "primary psychopath" who, again, now seems to be the only psychopath worthy of the name. On the next page Meloy states explicitly that "The neurotically organized psychopath appears to be an oxymoron" (p. 14) and goes on to indicate that "There is no tripartite structure (id, ego, superego) to the psychopath's personality. Internalized objects remain part-objects ..." (p. 14) and defenses remain primitive. Without casting doubt upon Meloy's conceptualization of the paranoid-schizoid nature of the primary psychopath's personality, it is nevertheless important to note that in Kleinian theory an archaic superego is operative in the paranoid-schizoid position. Its central role in psychopathy is stressed in many of the papers collected in The Mark of Cain. The absence of the more mature Oedipus complex and superego described in Freudian ego psychology does not mean the absence of either "preoedipal" triangular conflict or an archaic superego in psychopathy. As Meloy's (2007b) paper proceeds it becomes more and more clear that he is conceiving the primary psychopath as THE psychopath as such. The concept of degrees of psychopathy is being displaced in favor of a dichotomous or polarized conception in which the primary, non-anxious, biologically-based psychopath is the psychopath per se, and the secondary, neurotic or anxious psychopath is not really a psychopath at all. Here we are encountering in the field of psychopathy a problem afflicting the whole field of psychodiagnosis: the tendency for the conception of degrees or continua of pathology to collapse into polarized or reified syndromes. But this is merely a particular instance of 3
the wider problem of human consciousness as such. As what George Steiner (1969) calls "language animals" we try to understand the baffling complexity and flux of our experience by making distinctions, carving out and naming categories. But our distinctions and categories tend to turn into reified or falsely concretized concepts, with all the consequences in racism, sexism, etc., we know all too well. Instead of speaking of the mild, moderate and severe degrees of narcissism and psychopathy displayed by neurotics, borderlines and psychotics, we are instead inclined to speak of "narcissists" and "psychopaths." But note that I just committed the very fallacy I am criticizing in the work of Meloy and most other contributors to the recent literature on psychopathy. Instead of speaking of mild, moderate and severe levels of psychopathology, I resorted to the falsely concretized notions of "the neurotic," "the borderline," "the psychotic." Naturally, this sets the stage for people to come along and write books about the neurotic's "psychotic core" or the micro-psychotic episodes suffered by "the borderline"--notions made necessary by our refusal of the continuum concept in favor of what Albert North Whitehead (1925) called "The Fallacy of Misplaced Concreteness" (p. 25).1 By way of contrast, most of the psychoanalytic essays collected in The Mark of Cain (Meloy 2001) are written in the spirit of the one genus hypothesis that Harry Stack Sullivan (1953) formulated as follows: We shall assume that everyone is much more simply human than otherwise, and that anomalous interpersonal situations, insofar as they do not arise from differences in language or custom, are a function of differences in relative maturity of the persons concerned. ...I have become occupied with the science, not of individual differences, but of human identities, or parallels...I try to study the degrees and patterns of things which I assume to be ubiquitously human (pp. 32-33). These psychoanalytic papers view psychopathy as, for example: an outcome of "the interplay of attachment, identifications, affect, and intellectual development" (Loretta Bender); of affect hunger (David Levy); of the inhibition of love by rage (John Bowlby); of superego pathology due to projected aggression in response to frustration (Phyllis Greenacre); of a "narcissistically disturbed relationship with the mother during early childhood" (Kate Friedlander); of "superego lacunae" due to intergenerationally and unconsciously transmitted immoral and antisocial behaviours (Adelaide Johnson); of an inflated ego ideal (Helene Deutsch); of inadequate "holding" and "containing" of the aggressive impulses of the child by the mother (Donald Winnicott); of the "defensive search for painless freedom from objects" (Seymour Halleck); of the "impulse-feelingdefense triad of greed-envy-devaluation" in which "the psychopath spoils that which he hungrily wants" (Betty Joseph); of the aim of "reunion with the omnipotent object" and 1 Frank Sirotich recently drew my attention to the fact that earlier claims (Harris, Rice & Quinsey, 1994) that psychopathy is a taxon, a discrete class or category, have recently been reviewed and negated by Edens, Lilienfeld, Marcus & Poythress (2006) who provide taxometric evidence supporting a dimensional as opposed to a categorical conception of psychopathy. 4
preservation of the grandiose self through domination and devaluation of the other (Ben Burston); and of pathological narcissism, superego deficits and sadism (Otto Kernberg). In brief commentaries, Meloy expresses his reservations regarding many of these papers, arguing that they overestimate the role of psychodynamic and environmental factors, overemphasize conflict and anxiety, confuse secondary and primary psychopathy, and ignore the biological determinants of the latter. For example, in response to John Lion who emphasizes the importance in treatment of the emergence of the psychopath's sadness and depression as his narcissistic defenses are confronted, Meloy indicates that this applies only to "the patient who has sufficient anxiety and attachment capacity to make the treatment endeavour worthwhile." He argues that "if the psychopathy is severe and biologically rooted, such emotional states will not occur" and "The therapist may find, instead, that his time has been squandered by a chameleon" (p. 265). Similarly, against Betty Joseph's emphasis on the psychopath's defenses against anxiety, guilt and depression, Meloy argues that "neurotic personality organization must be achieved to nurture such socialized feelings" and that "this level of personality will not exist in the more primitive, less conflicted primary psychopath" (p. 227). In the course of his analysis of the character of Heathcliff in Emily Bronte's Wuthering Heights, Neville Symington (1980) affirms Melanie Klein's (1934) view that: One of the great problems about criminals, which has always made them incomprehensible to the rest of the world, is their lack of natural human good feeling; but this lack is only apparent. When in analysis one reaches the deepest conflicts from which hate and anxiety spring, one also finds there the love as well. Love is not absent in the criminal, but it is hidden and buried in such a way that nothing but analysis can bring it to light (Klein, quoted by Symington, in Meloy [2001], p. 289). While Meloy appreciates Symington's insights into "the countertransference aroused by these patients," the "collusion, disbelief, and condemnation" that Symington sees as "superego defenses against our own sadism," he suggests that Symington "overestimates the emotional and moral development of psychopathic persons" (p. 283). Is this to say that Heathcliff, like others in whom love is not absent but only buried, is not a psychopath at all? Or is it to suggest he is only mildly or moderately as distinct from severely psychopathic? Given Meloy's reservations regarding the relevance of psychodynamic factors in what amounts in his view to "true" psychopathy, one wonders why he bothers to collect these psychoanalytic papers in the first place. Is it primarily to point out their irrelevance in light of the new evidence of the biology of psychopathy? Are they primarily of historical interest, indicators of where we were and, in light or recent biological evidence, how far we've come? And why does he title his recent paper "A Psychoanalytic View of Psychopathy" when its main thrust is to emphasize the role of biological rather than psychological and psychodynamic factors in psychopathy? 5
Although Meloy at times employs the language of degrees, of more or less anxiety and attachment capacity, of levels of personality organization, of "the more primitive" and "the less conflicted," his point is that the sorts of psychological factors outlined in the papers collected in The Mark of Cain are of limited relevance with respect to biologically determined primary psychopathy. This theoretical move separates off the "true psychopath" from other types of narcissistic and antisocial personalities, but at the cost of ignoring the concept of degrees of psychopathy and thereby constructing "the psychopath" as essentially Other, if not "beyond the pale," a creature who is reptilian in his incapacity to become truly attached and, thus, as Symington suggests, setting him or her up as a target for projection of our own disowned sadism. If this construction of "the psychopath" sets him up as a target of projection then it may also set him up as a target for injection, of the lethal type. Because the so-called primary psychopath is alleged to have no remorse and to be incurable, we may come to feel justified in remorselessly killing him--especially now that, due to DNA evidence of his guilt, we have less cause to worry about the possibility of executing an innocent person. In this sense, the diagnosis of primary psychopathy might serve to rationalize enactment of our own homicidal inclinations: it may serve to help us kill the killers--and, in so doing, become them. On the other hand, the biological theory of primary psychopathy might have the opposite effect--not of scapegoating the psychopath but of exonerating him. After all, if his condition is biologically determined, what sense does it make to hold him responsible and to punish him for a condition entirely outside his own control? To the argument that psychoanalytic understanding is equally deterministic and that free will and responsibility are no more negated by a biological than by a psychoanalytic view of the determinants of personality and behaviour, I would reply that Freud's (1917) psychic determinism, the view that "the ego is not even master in its own psychic house" (p. 285), was always contradicted by his contrary and equally important revelation of the remarkable degree to which we are, in fact, the unconscious agents of our fates (on this point see Schafer [1976], pp. 153-4). However much the conscious ego might, like Freud, embrace determinism and, hence, claim, rightly or wrongly, to be a product of forces beyond its control, the unconscious superego, like Sartre, is existentialist: insisting upon our agency, it holds us to account. In this connection, my clinical experience has, over the years, convinced me that, in the long run, nobody gets away with anything. However repressed or split off, the unconscious superego--like the Biblical God who "called unto Adam ... Where art thou?" (Genesis 3:9) and who "said unto Cain, Where is Abel thy brother?" (Genesis 4:9)--sees and knows all and, unless guilt is faced and borne, unconsciously arranges for its punishment (Carveth 2006). If you think psychopaths, unlike ordinary sinners, have no superego and can get away with anything, note how many of them wind up in jail; note the effect of their psychopathy on their families ("visiting the iniquity of the fathers upon the children unto the third and fourth generation" (Exodus 20:5). Read about the life and times of Lord 6
Conrad Black of Crossharbour. It's true, as Johnny Cash reminds us, "You can run on for a long time, run on for a long time, but sooner or later, God [read the unconscious superego] will cut you down" (Johnny Cash Tribute Video). I remember Conrad at UCC where he "broke into the principal's office, stole the exam papers and offered them for sale" to other boys (The Life and Times of Conrad Black). Though expelled (and later honoured as an Old Boy for reasons not hard to guess), he ran on for a long time. It was in 1927, in The Secret of Father Brown, that G.K. Chesterton wrote the following, which rather succinctly, and without either dehumanizing or exonerating wrongdoers, summarizes the concerns I have been elaborating: No man's really any good till he knows how bad he is, or might be; till he's realized how much right he has to all this talk about `criminals,' as if they were apes in a forest ten thousand miles away; till he's got rid of all the dirty self-deception of talking about low types and deficient skills; till he's squeezed out the last drop of the oil of the Pharisees; till his only hope is somehow or other to have captured one criminal, and kept him safe and sane under his own hat (p. 466). Now, of course, it can be argued that Chesterton is writing here about criminals and garden-variety scoundrels, not psychopaths, as it could be argued I was doing when writing above about Lord Black. On the other hand, the continuum concept suggests that all wrongdoing entails some degree of both narcissism and psychopathy. Exchanging a theory of degrees of psychopathy for a reified conception of the true psychopath increases the risk of projection and scapegoating--which was Chesterton's point. It is not my aim to cast doubt on the validity of the science reviewed for us by Meloy, Hare and others, but rather to express, in the spirit of Max Weber, my anxiety regarding its potential unintended social consequences. Sociologists in the 1960s developed a critique of asylums and the "institutionalization" they were found to create. No one anticipated that governments would welcome such research as an opportunity to cut spending with the consequence of homeless ambulatory schizophrenics living in cardboard boxes in Parkdale. What worries me is what might well be the unintended consequences of the new biological research on psychopathy, namely: 1. The utilization of such evidence to form a reified or falsely concretized conception of "the psychopath" that invites projection and scapegoating. 2. The denial of a psychopathic dimension of human personality as such that takes the form of a continuum from mild to moderate to extreme, an idea that forces us to confront the degree of psychopathy in ourselves instead of projecting it into the Other and condemning and possibly persecuting (or even executing) it there. Meloy (2007a) has himself written of the countertransference reaction to psychopathy that Lion (1978) calls "therapeutic nihilism" and Symington (1980) calls "condemnation": 7
Instead of arriving at a treatment decision based on a clinical evaluation, including an assessment of the severity of psychopathy, the clinician devalues the patient as a member of a stereotyped class of "untouchables." The clinician does to the patient with antisocial personality disorder what the patient does to others. Symington (1980) called this condemnation and it psychoanalytically reflects the clinician's identification with this aspect of the patient's character (2007a, p. 10). Is the tendency to reify the concept of "the primary psychopath" a manifestation of such condemnation? Naturally I am in no way implying that potential misuse of scientific truth in any way justifies irrationalist evasion or denial of such truth. As Meloy and others quite correctly emphasize, the frightening reality of severe psychopathy must be faced, including the scientific evidence of significant biological factors in its causation. I am in no way positing nurture against the new evidence of the role of nature in the genesis of severe psychopathy, but only arguing against the tendency to reify "the psychopath" as such. For just as the frightening reality of severe psychopathy must be faced, so must the frightening potential uses of this reality. In my view, one way to work against such misuse is to adhere scrupulously to the continuum concept which, in reminding us of the lesser degrees of psychopathy we share with those who manifest it in more severe forms, makes it more difficult for us to project and to scapegoat others for what we refuse to see in ourselves. References Babiak, P. & R.D. Hare (2006). Snakes in Suits: When Psychopaths Go to Work. New York: Regan Books/Harper Collins. Carveth, D.L. (2006). Review of Paul Roazen (2005), Edoardo Weiss: The House that Freud Built. Can. J. Psychoanal./Rev. Can. Psychanal. 14, 1 (Spring 2006): 146150. -----. (2006). Self Punishment as Guilt Evasion: Theoretical Issues. Canadian Journal of Psychoanalysis/Revue Canadienne de Psychanalyse 14, 2 (Fall 2006): 172-96. Cash, Johnny. Lyrics for Song: God's Gonna Cut You Down. Album: American V: A Hundred Highways. Video: http://www.youtube.com/watch?v=DgNBNoyRZuM Chesterton, G.K. (1927). The Secret of Father Brown. In: The Complete Father Brown. London: Penguin, 1981. Cleckley, H.M. (1976). The Mask of Sanity, 5th ed. St. Louis: Mosby . 8
Edens, J.F., Lilienfeld, S.O., Marcus, D.K. & N.G. Poythress, Jr. (2006). Psychopathic, not Psychopath: taxometric evidence for the dimensional structure of psychopathy. J. Abn. Psych. 115, 1: 131-144, Freud, S. (1917). Introductory Lectures on Psycho-Analysis (Part III). The standard edition of the Complete Psychological Works of Sigmund Freud, Volume XVI (1916-1917). Psychoanalytic Electronic Publishing, 2007. http://pep-web.org/document.php?id=se.016.0000a Hare, R.D. (1993). Without Conscience: The Disturbing World of the Psychopaths Among Us. New York: Pocket Books. -----. (2003). Hare psychopathy checklist-revised 2nd Edition technical manual. Toronto: Multihealth Systems, Inc. Harris, G.T., Rice, M.E., & V.L. Quinsey (1994). Psychopathy as a taxon: evidence that psychopaths are a discrete class. J. Con. Clin. Psych. 62: 387-397. Lord Black of Crossharbour: The Life and Times of Conrad Black CBC, documentary originally aired March 24, 2005: http://www.cbc.ca/lifeandtimes/black.html Klein, M. (1934). On criminality. In: Love, Guilt and Reparation and Other Works. London: Hogarth Press, 1975. Lykken, D. (1957). A study of anxiety in the sociopathic personality. J. Abn. Soc. Psychology: 55:6-10. Meloy, J. Reid (1988). The Psychopathic Mind: Origins, Dynamics, and Treatment. Northvale, NJ: Aronson. -----. (Ed.) (2001). The Mark of Cain: Psychoanalytic Insight and the Psychopath. Hillsdale, NJ: The Analytic Press. -----. (2007a). Antisocial personality disorder. In Gabbard, G. (Ed.). Gabbard's Treatments of Psychiatric Disorders, 4rth ed. Arlington, VA: American Psychiatric Press, in press. -----. (2007b). A psychoanalytic view of psychopathy. Unpublished paper presented at the Toronto Psychoanalytic Society's 18th Annual Day in Psychoanalysis, Ignatieff Theatre, Trinity College, University of Toronto, Saturday, April 28th, 2007. Menninger, K. (1973). Whatever Became of Sin? New York: Bantam. Rangell, L. (1974). A psychoanalytic perspective leading currently to the syndrome of the compromise of integrity. Int. J. Psycho-Anal., 55:3-12. 9
-----. (1976). The Mind of Watergate: An Enquiry Into the Compromise of Integrity. New York: Norton. Roazen, P. (2005). Edoardo Weiss: The House that Freud Built. New Brunswick (U.S.A.) & London (U.K.): Transaction Publishers. Sandler, J. (1960). On the concept of the superego. Psychoanalytic Study of the Child 15: 128-162. Schafer, R. (1976). A New Language for Psychoanalysis. New Haven: Yale University Press. Steiner, G. (1969). The Language animal. In Extra-Territorial:Papers on Literature and the Language Revolution. New York: Atheneum, 1971. Stout, M. (2005), The Sociopath Next Door: The Ruthless Versus the Rest of Us. New York: Broadway Books. Sullivan, H.S. (1953). The Interpersonal Theory of Psychiatry. New York: Norton. Symington, N. (1980). The response aroused by the psychopath. In: Meloy, J.R. (Ed.) (2001), The Mark of Cain. Hillsdale, NJ: The Analytic Press, pp. 283-296. Whitehead, A.N. (1925). Science in the Modern World. New York: Free Press, 1997. © Donald Carveth 2007 [email protected] http://www.yorku.ca/dcarveth 10

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