ETIOLOGY, TREATMENT, AND CURES FOR PSYCHOPATHY
So wise so young, they say do never live long (III, i, 79).
The realm of psychopathy is a frightening disorder, plaguing a small percentage of people. Sufferers often develop antisocial behavior, marked by maladaptive personality traits. For centuries, many causes behind this disorder have been speculated, but the etiology remains inconclusive. There are three mainstream etiologies presented today, however. They consist of a confluence of biological, environmental, and social factors which may be equal in contribution. If the emergence of psychopathy develops from biosocial conditions, is there an effective treatment and therefore cure for an adult psychopath? There is vast and varied literature which attempts to explain every detail about this perplexing disorder.
This paper will explore antisocial personality disorder and its centrality to psychopathy, using information collected from verifiable sources. The intent is to analyze the accumulated information and reach a conclusion regarding the etiology and possible treatment and cure(s) for the adult psychopath.
DIFFERENTIATING COMMONLY LINKED CONCEPTS
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Today there are two concepts associated with psychopathy: sociopathy and antisocial personality disorder, or ASPD. When compared, a crucial distinction separates them as two unique terms. On one hand, sociopathy is a personality disorder, conjoined noticeably with antisocial behavior (Kerns, 2008a). On the other hand, psychopathy is ASPD and it is marked by callous, aggressive and violent antisocial thought which manifests into behavior (Kerns, 2008b). Formerly, ASPD was synonymously referred to as psychopathic or sociopathic disorder, but is no longer (Gunderson, 2006). This is due to experts vacillating on the differences between psychopathy and sociopathy; some were convinced the terms were extensions, and not synonymous with ASPD (Blair, 2006). But others thought the concepts were indeed identical.
In accordance to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, more commonly referred to as the DSM-IV,the official term for a psychopath is ASPD. The following is an excerpt (pp. 649-650) of the diagnostic criterion:
A. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by at least three (or more) of the following:
1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
3.impulsivity or failure to plan ahead
4.irritability and aggressiveness, as indicated by repeated physical fights and assaults
5.reckless disregard for the safety of self or others
6.consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
7.lack of remorse, as indicated by indifference to or rationalizing having hurt, mistreated, or stolen from another
B.Individual is at least 18 years.
C.There is evidence of Conduct Disorder with onset before age 15 years.
D.The occurrence of antisocial behavior is not exclusively during the course of a Schizophrenic or Manic Episode.
E.Evidence of conduct disorder onset before age fifteen.
The debate between psychopathy and sociopathy has endured for many years, to this day. Some claim the distinctions are minute, while others deem them vast and nearly incomparable. According to The Hare Psychopathy Checklist-Revised (PCL-R), there are a plethora of behavioral traits distinct to psychopaths. These include grandiosity; impulsivity; versatility in criminal activity; violations of conditional release; manipulative behavior; parasitic existence; irresponsibility; shallow affect; poor control of aggression; promiscuity; several short-term relationships; callousness; pathological lying; juvenile delinquency; rejects responsibility; poor behavioral controls; lacks goals; need for stimulation; impression management; and lack of remorse (Wiebe, 2003). Observing these traits, what contributing factors develop and when? Are genetics to blame or does family history have an impact on the nature of a psychopath?
Biochemical interactions have been linked to the emergence of psychopathic behavior. There are relatively new and pertinent findings regarding the varied chemical nature of this disorder, which strongly suggest biochemistry as a contributing factor.
There is evidence that imbalances of the chemicals serotonin and monoamine oxidase, which are linked to compulsivity and depression, are found in psychopaths (Vronsky, 2004a). One study revealed a strong correlation between prison inmates with ASPD and an aggressive personality. Those scoring high in aggressiveness with a high probability of ASPD resulted in elevated sex hormone-binding globulin (Aluja & Garcia, 2007). Additional biochemical findings include anything from high cerebrospinal fluid free testosterone - related to sensation-seeking - to an extra Y chromosome (Cocarro, Beresford, Minar, Kaskow, & Geracioti, 2006; Vronsky, 2004a).
Psychopathic behavior emerges not only from biological factors, though. Genetics and environmental conditions, too, play considerable factors. To illustrate, at a multi-disciplinary Symposium held by the FBI in 2005 experts in their field who have either investigated, prosecuted, or studied serial killers agreed on the above factors. Considering biological conditions, Morton et al. (n.d.) agreed that documented cases where people who did not have a violent history but later sustained a severe brain injury resulted in violent behavior. (Mind you, not all who suffer from a serious brain injury develop psychopathic tendencies. This is rather an illustration of a common link between psychopaths.) Tracing genetics, other experts have found abnormalities in brain development, like in the corpus callosum, a band of fibers that connect the two hemispheres together. A professor at USC College of Letters, Arts, and Sciences compared this band to psychopaths and a control group; his findings have broken new ground in the etiology of psychopathy. Nearly 25 percent of the psychopaths had a larger corpus callosum, and 7 percent were longer (“USC Study”, 2004). This means that lack of emotions as well as remorse was increased.
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Today, research continues to discover the emergence of factors that contribute to psychopathic development. In early August of this year, a team of psychologists used a scanning device known as diffusion tensor magnetic resonance imaging, or DT-MRI, to determine whether there was a connection in brain formation and function in psychopaths; their brain anatomy was compared to a control group consisting of non-psychopathic patients. The findings revealed a significant difference in the structural connection between the uncinate fasciculus (UF), amygdala, and orbitofrontal cortex (OFC). The UF is a fiber tract which connects the brain to the anterior temporal and frontal lobes, such as the OFC, and the amygdala (Highley, Walker, Esiri, Crow, & Harrison, 2002). This explains the seeming inability for a psychopath to experience crucial emotional reactions like fear, which is controlled by the amygdala, and higher decision-making skills steered by the OFC (Henderson, 2009a). “There needs to be a connection between these two areas of the brain, which deal with emotions and the control of emotions,” contested Dr. Craig, one of three leading professors of the study. Additionally, their findings revealed that this abnormality increased with the severity of the disorder (Henderson, 2009b).
In a less direct approach, psychologist Joseph Newman (2006a) delved into the mind of psychopaths and found equally disturbing and compelling revelations. Devoting 25 years of his life to this study (which consists of various researches), Newman investigated prison inmates at various Wisconsin penitentiaries. One research case documented the distinct time lapse in inmates responses to purposely mislabeled images, like the illustration of a pig labeled as a dog. Newman compared the responses of psychopath to non-psychopath inmates and the results showed that the latter group would take longer to answer. Conversely the psychopath inmates responded more hastily, hardly discerning the inconsistencies. Shockingly, the case did not test emotions frequently ascribed to psychopathic behavior, therefore supporting Newman's theory that psychopaths may suffer from an “informational processing deficit”, where the psychopathic mind struggles to processes peripheral cues (“Mental Health”, 2006b). “When emotions are their primary focus, we've seen that psychopathic individuals show a normal (emotional) response. But when focused on something else, they become insensitive to emotions entirely,” said Newman (“Mental Health”, 2006c).
Still others recognize the relationship between genetics, the environment and its consequences to psychopathy. Dr. Robert Hare, a renowned psychologist who has studied psychopaths for more than three decades, believes traits like shallow affect and callousness is heritable. He therefore believes the socialization process is not easy for those afflicted with such traits.
STAGES OF A PSYCHOPATH
The Psychopath and His Mother
In contrast to medical theories, family events during the stages of child development may also contribute to the progression of psychopathy. Throughout pregnancy and post birth, a mother especially starts to bond with her baby. She begins to cultivate a relationship as soon as she is aware of her conception, and when the infant enters the world, her bond is emotionally strong. Though this is the case with most mothers, there are exceptions where some do not immediately bond and some do not bond at all with their infants. According to the Mayo Clinic Family Health Book (1990a), infant bonding occurs almost immediately if the child is healthy. Whether or not there is a “critical period” for infant bonding, however, is unknown; “the key is not when it happens but that it does: it is most important that the bonding eventually take place,” (Mayo Clinic Family Health Book, 1990b, 34). If an infant is denied bonding through affection, then its self-conscious will become alienated. Thus it is an identifiable being entirely of the self and therefore may develop the cognitive processes and behavioral traits befitting a psychopath. In contrast to the Mayo Clinic Family Health Book, the Federal Bureau of Investigation (FBI) believes there is a critical time frame when an individual is most greatly affected by an event or series of events in their life. In addition, based on a pioneering case study directed by the FBI, agents of the bureau conclude there are several factors that contribute to the making of a psychopath, including genetic predisposition (as aforementioned) and the choice to engage in their crimes.
Physical and Mental Trauma
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The psychological makeup of a psychopath is another identifiable component of the FBI perspective. In the study, agents discovered surprising statistics regarding the parent-child history of serial killers: less than 60 percent had both parents at birth; 47 percent of their fathers left prior to turning age twelve; nearly 45 percent accounted a sour relationship with their mother; and a large percentage - 72 - accounted a sour relationship with their father or “male parental ” (Vronsky, 2004b). In accordance to Eric Erikson's eight stages of development, young children attempt to attain autonomy through gender identification during their second year of life. This theory has been used to explain the intense relationship between male serial murderers and their mothers: if a young male child fails to reach autonomy with his mother, either through a nonexistent foundation from which to do so or he simply cannot attain, then the child will harbor fits of profound anger well into adolescence (Vronsky, 2004c). Similarly, if a child is unable to mimic coping skills or these skills are not presented by their parental s, then the child's “emotional wounds” will not heal and, again, feelings will remain ‘bottled up' (“The Coping Brain,” 2008). In addition to concealed stresses, the FBI study revealed high percentages of psychological (74) and physical (42) abuse during childhood; aggressive hostility in adults has been linked to childhoods such as these (Vronsky, 2004c). Moreover, substance abuse has also contributed to the induction of aggression and violence (Morton et al., n.d.b).
Perhaps the most reputable source for the causality behind psychopathic tendencies is none other than the FBI. Their National Center for the Analysis of Violent Crime (NCAVC) is entirely devoted to providing support for law enforcement agencies in myriad aspects, one of which is homicide. Together these agents, along with the attendees at the Symposium, agreed that two factors significantly contributed to psychopathy: (1) there is no single cause or factor solely responsible and (2) it is a personal choice to engage in criminal activities, the latter being considered the most important (Morton et al., n.d.c).
Throughout the years, many treatments have been attempted to cure the dysfunctions of the psychopath's brain. However, through these attempts, several dilemmas have arisen. As previously mentioned, there are many factors that contribute to the makeup of a psychopath and they need to be analyzed in order to ensure the proper course of therapy is discovered. Unfortunately, many treatments are ineffective for psychopaths. Dr. Robert Hare warns in his book, “Without Conscience”, that treatment may be harmful because psychopaths can con their therapist by mimicking the correct responses that he or she would want to hear. He claimed that psychopaths love “touchy-feely” therapy because this provides them with the opportunity to exercise their manipulative skills. An example of this can be seen by looking back at the effects of the Social Therapy Unit (STU) that operated in the 1960s through 70s (Harris, n.d.). This was an insightful and emotion evoking therapy where patients were placed in clinical leadership roles. All of the clinicians and experts viewing from the outside were satisfied with the results of the program and found it to be effective. However, the follow up revealed that the majority of their patients not only relapsed but increased in violence. This study, along with many others, shows that clinicians do not always have the best understanding of the psychopathic mind simply based on their behavior and/or emotions. Moreover, treatment is counterproductive.
Drug Therapy Dilemmas: Behavioral Disorder
Because the makeup of the brain of a psychopath is abnormal, specific attempts have been made to treat it. Knowing and understanding the risks of releasing incarcerated or hospitalized psychopaths back into society, drugs seem to be the first logical choice for treatment. However, a major dilemma with drug therapy is that one must assume the drug is being taken voluntarily by the patient. Another dilemma is understanding the psychopath's specific violent tendencies, as this is a significant trait. It is thus imperative to further extensive research on psychopathy in its entirety, for with this understanding, the proper drug treatment can be determined.
According to medical doctor Larry Siever (2008), aggression can be defined as hostile, injurious, or destructive behavior, conceptualized by understanding the emergence of aggression through the channeling of insufficiently constrained stimuli via response of the limbic system. Siever explains that amygdala activity in excess combined with insufficient regulation of the prefrontal cortex can increase aggressive acts. The deficits in the prefrontal region can be treated by increasing levels of serotonin especially in the orbital cortex area of the brain using selective serotonin reuptake inhibitors (SSRIs). Serotonin transporter activity can be monitored with the use of PET imaging.
Corresponding to the previously stated findings of Dr. Hare, he has also established that one-half of violent serial rapists are psychopaths. To treat this type of criminal activity, according to Paul Kaihla (“Sex Offenders,” 1995), there is one treatment that has proven results for serial rapists. The therapy consists of a class of drugs known as anti-androgens, given by pill or injection. This “chemical castration” reduces levels of male testosterone eliminating erections and fantasy. Approximately ten percent of sex offenders are given this treatment. In some cases, it is a requirement for parole.
As we have looked over the violent behavior of psychopaths, we can begin to look at ways to treat the aggression as well as anti-social characteristics associated with them.
These treatments are powerful drugs which can be used to temper myriad symptoms experienced by psychopaths with ASPD. Unfortunately, the Food and Drug Administration does not expressly endorse any medications for this disorder, so psychiatrists prescribe a plethora of drugs to manage specific symptoms (“Treatment and drugs”, 2008a). This is most likely due to insufficient research suggesting the effectiveness of any available medication (Grohol, 2009).
Specific Drugs Used
There are six psychopharmacological medications generally used today. The first are mood stabilizers, which reduce irritability and impulsivity. The popular drug Lithium is used as an anti-aggressive treatment which works by “enhancing serotonergic activity” (Krawkowski, 2007). The second are anticonvulsants, which can also be used to reduce the aforementioned symptoms. The third medication available is beta-blockers, which are primarily used to treat heart disorders. However, some are used for various behaviors. Nadolol, for example, can be used to treat high blood pressure and prevent migraine headaches, but it can also be used to treat aggressive behavior, as can Propranolol, another beta-blocker (“Nadolol”, 2009; “Propranolol”, 2009). An additional beta-blocker is Pindolol, used to manage hypertension as well as situational anxiety and is a potential agent for antidepressants (“Pindolol”, 2009). These drugs have adverse effects for patients with heart disease, asthma, and diabetes, however, so this prevents them from being used too often. The fourth are antipsychotic, which can inhibit the neurotransmitter dopamine and therefore calm aggressive states (Bazire, Branch, Collins, Ng, & Purdy, 2008). The fifth medication available are anti-anxiety, which help to reduce anxiousness, agitation or even insomnia (“Drugs and treatment”, 2008b). The last are antidepressants; they may only be administered to non-depressed antisocial personality patients.
Alternatively, neurofeedback (also known as EEG or biofeedback) is a therapy used to teach the brain to self-regulate appropriate brain waves. Since many patients suffering from ASPD may have damage to the left or right frontal lobes, this therapy may be a beneficial form of treatment. It consists of placing electrodes on the head of the patient and a reward is given when the brain responds correctly. For the most effective treatment, neurofeedback is best used in conjunction with other psychopharmacological agents. The duration of the treatments may last anywhere from one to five years before a positive clinical outcome is reached, however (Masterpasqua & Healy, 2003).
Other treatments available include Freudian psychoanalytical and psychodynamic therapies, which both focus on the internal conflicts of patients and attempt to solve them through a traditional “talking therapy.” Psychoanalysis, especially, focuses on the environment as well as surrounding community (“Freud's free clinics”, 2006). This method attempts to help the patient to feel emotions and take responsibility for their thoughts and actions. It is proposed by experts that most psychopaths create a façade of callousness that can act as a shield, thus protecting them from external threats. This façade may be broken down, however, as their anxieties are relieved by understanding the internal conflicts that plague them. Both of these methods associate such conflicts with unresolved issues stemming from childhood, which may be unconscious issues (www.scinet.cc). This method is offered in several ways, including individual, group, or family sessions, depending on the patient (“Treatments and drugs”, 2008c).
Yet another available treatment option is behavioral therapy. This treatment attempts to teach patients how to meet their needs without reducing to violence. It is done by gaining an understanding of their underlying issue(s) making up their psychological (and possibly neurological) dysfunction. Programs like anger management, psychoeducation, self-monitoring, relaxation, and guided imagery are all programs that may benefit certain ASPD patients. Like most treatments, behavioral therapy is most effective when a patient desires treatment. Unfortunately, based on the psychopath's callous and remorseless tendencies, it is unlikely that behavioral treatment will be productive.
According to an article titled, “Antisocial Personality” in the Harvard Mental Health Letter (2001), researchers discovered that only 21% of men with antisocial personality admitted to a state psychiatric hospital improved later in life with no symptoms, disorder, or problems.
As of today, no cure exists for the suffering psychopath. This is due to the lack of effective methods to alter their personality, which directly impacts possible cures for them (Wormith, 2000). Treatment has shown to be counterproductive - though successful treatment has occurred, it is rare and still, no cure has ensued afterwards. It is suggested, though, that psychopathy itself and even combined with ASPD stabilizes or diminishes with age (Beers, 2003).
In observance of psychopathy, the emergence seems to manifest during the developmental years of childhood, which is considered by some to be a critical period for psychopathic behavior to arise. According to Dr. Hare, this behavior is marked by characteristics like grandiosity; impulsivity; manipulative behavior; irresponsibility; poor control of aggression; callousness; pathological lying; juvenile delinquency; and need for stimulation. Many experts agree these are among several primary traits which classify their tendencies. On the contrary, there are some who wholly disagree, arguing that they are not distinctive to a single identifiable trait. And still yet, explanations remain inconclusive regarding the cause(s) behind the discernible deeds of psychopaths. Experts behind nineteenth century criminology once professed a genetic predisposition to psychopathic behavior, then twentieth century experts proclaimed environmental factors were to blame (Vronsky, 2004d; Hoffman, 2004). Today a middle-ground has been reached: a combination of the previously stated and social factors.
The theories surrounding treatment for changing their behavior is undeniably perplexing. Still, myriad treatment options are available for the modern psychopath ranging from psychopharmalogical stabilizers to stress and anger management techniques. Unfortunately, the effectiveness has proved rather contrary; it is counterproductive, instead. A primary example of this is the case of Peter Woodcock, a psychopathic murderer who was sent to a psychiatric facility in Canada for murdering children. On the day he was first awarded a three-hour pass, he murdered again, then confessed to the police on the same day. Obviously, decades of treatment do not necessitate success in curing a psychopathic patient. In addition, no identifiable cure exists today. Some experts assume that the desire to commit heinous acts - such as serial murder - dissolve with age, which has been deemed a cure. In the case of psychopath Edmund Kemper, he grew tired of killing and surrendered to the police. “I couldn't keep on going forever . . . I really couldn't have. Emotionally, I couldn't handle it much longer. Toward the end there, I started feeling the folly of the whole damn thing, and at the point of near exhaustion, near collapse, I just said the hell with it and called it all off. Let's say . . . I wore out of it” (Vronsky, 2004e). Perhaps this is the most terrifying threat psychopaths pose to the masses: their ability to blend in with society. They later marry and create families; hold stable jobs; and exude an existence which resembles ours. They pursue common and sometimes esteemed occupations - corporate CEOs, registered nurses, politicians - and it seems their purpose in life is to engage in criminal acts of various natures, yet the purport of these acts is still widely questioned, as is madness itself.
Overall, these results conclude that psychopathy developing from biosocial interactions generally cannot be treated. In addition, not all psychopaths are caught; this further attests to the difficulty in attempted treatment as a crime is committed and the responsible remain unscathed, but also that a clinical methodology to identify a criminal predisposition does not exist. There are cases where effective treatment has occurred, but it is very rare. Sometimes specific tendencies can be pinpointed and managed, but psychopathy as a disorder is incurable.
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