Psychopathy as Mental illness

Patients with psychosis often have poor insight into their illness. Poor insight into illness is, at least among patients with psychosis, a good predictor of treatment non-adherence. This is no mystery, for as Xavier Amador asks, "Who would want to take medicine for an illness they did not believe they had?" What is curious is that some patients with psychosis do adhere to treatment despite a lack of insight. Why do these patients adhere to treatment, given that they do not (...) believe they are ill to begin with? In this paper, I attempt to answer this question. I do so by first considering cases of non-psychotic patients who adhere to treatment despite a lack of insight. I point out that these sorts of cases are commonplace, and attempt to explain why they arise. The explanation is given in terms of anticipated treatment benefits. However, these benefits are not conceptualized by the patient in terms of pathology. The patient does not, in other words, think of such benefits in terms of illness, symptoms, treatment, and so forth. I then argue that the proposed explanation can be extended to account for why psychotic patients without insight sometimes adhere to treatment. I conclude by drawing out some of the practical implications of the proposed view. I first argue, on practical as well as ethical grounds, that improving insight for purposes of treatment adherence is misguided. I then suggest that such adherence might be increased simply by explaining treatment benefits in language that does not presuppose that the patient is, in any sense, "ill," "diseased," "sick," "unwell," and so on. (shrink)

The British National Institute for Health and Clinical Excellence has recently released new guidelines for the diagnosis, treatment and prevention of the psychiatric category antisocial personality disorder. Evident in these recommendations is a broader ambiguity regarding the ontology of ASPD. Although, perhaps, a mundane feature of much of medicine, in this case, ontological uncertainty has significant ethical implications as a product of the profound consequences for an individual categorised with this disorder. This paper argues that in refraining from emphasising uncertainty, (...) NICE risks reifying a controversial category. This is particularly problematical given that the guidelines recommend the identification of individuals “at risk” of raising antisocial children. Although this paper does not argue that NICE is “wrong” in any of its recommendations, more emphasis should have been placed on discussions of the ethical implications of diagnosis and treatment, especially given the multiple uncertainties associated with ASPD. It is proposed that these important issues be examined in more detail in revisions of existing NICE recommendations, and be included in upcoming guidance. This paper thus raises key questions regarding the place and role of ethics within the current and future remit of NICE. (shrink)

In order to assess the potential of psychopathy to increase evolutionary fitness, we examined the relations between psychopathy and fitness indicators (number of children and grandchildren, problems in physical health both in parents and offspring) in a sample of post-reproductive individuals (N = 187; Mage = 66.52). Specifically, we explored the possibility that psychopathy traits are involved in evolutionary trade-offs: both positive and negative relations with different fitness components. Psychopathy was measured via three traits—interpersonal, affective, and lifestyle characteristics, which are (...) operationalized by proxy scales derived from the HEXACO-PI-R inventory. Research findings showed that interpersonal traits were positively related to the number of children and negatively to the number of grandchildren and problems in physical health; lifestyle characteristics were positively associated with problems in physical health in participants’ offspring. The data are in line with previous studies which explored the relations between psychopathy and fitness. The findings extend on previous studies by suggesting that psychopathy may be involved in evolutionary trade-offs, especially the quantity-quality trade-off. These trade-offs may in return maintain inter-individual variation in psychopathy. (shrink)

In the present study, we tested the hypothesis that psychopathy emerges as an adaptive behavioral response to a harsh environment: psychopathy could represent a mediator in the link between a harsh environment and fast life history pathway. We measured environmental harshness, psychopathy (boldness, meanness, and disinhibition), and a wide range of life history parameters (expected longevity, covitality, age at first menstruation, age at first sex, mating success, planned age at first reproduction, and expected total fertility) in a sample of young (...) female adults (N = 196). Factor analysis of the life history indicators produced three- and two-factor solutions and we decided to analyze the latter one—extracted components are described as long-term mating and expected future fitness. Environmental harshness was positively related to psychopathy and negatively to expected future fitness. Path analysis revealed that the disinhibition trait mediates the link between the environment and expected future fitness. Analysis also showed adaptive differences between boldness and disinhibition: while both psychopathy traits were negatively associated to long-term mating, boldness was positively related to expected future fitness, in contrast to disinhibition which showed negative associations with this life history measure. Hence, boldness showed the highest adaptive potential. Study results are in line with life history theory in humans and show the heuristic power of applying behavioral ecological framework to the study of psychopathy. (shrink)

Tankersley has provided an interesting collection of data about various groups of antisocial individuals. Is this a paper about the moral reasoning of psychopaths, or is it an attempt to address a philosophical question—whether moral behavior is primarily driven by emotions (moral sentimentalism) or by reasons (moral rationalism)—empirically? I think it attempts a little of both, although I concentrate on the latter. -/- The trouble with much of the literature on psychopathy is the terminological confusion, and Tankersley has not escaped (...) this. Several disciplines, with their own languages, have an interest in antisocial individuals and use similar sounding words in different ways. It is easy to get confused. Doctors make diagnoses. Antisocial (or dissocial) personality disorder is a medical diagnosis, and has a clear, operationalized definition. By virtue of being a disorder, it must result in some impairment in the functioning of the individual. Psychopathy is a psychological construct, not a diagnosis, and attempts to measure (in a reliable and valid way, using the Psychopathy Checklist) aspects of a person's mind particularly relevant to antisocial behavior. Psychopathy and antisocial personality disorder are different approaches to the same natural phenomenon, but they are not coterminous. There are many individuals with antisocial personality disorder who are not psychopaths. There are some individuals who are psychopaths who do not have any medical diagnosis (e.g., the so-called white collar psychopath). Psychopathy is not a subset of antisocial personality disorder (pace Tankersley 2011, and Herpertz and Habermeyer 2004). (shrink)

In their paper “Is psychopathy a mental disease?”, Thomas Nadelhoffer and Walter Sinnott-Armstrong argue that according to any plausible account of mental disorder, neural and psychological abnormalities correlated with psychopathy should be regarded as signs of a mental disorder. I oppose this conclusion by arguing that at least on a naturalistically grounded account, such as Wakefield’s ‘Harmful Dysfunction’ view, currently available empirical data and evolutionary considerations indicate that psychopathy is not a mental disorder. For an online version of the paper, (...) see https: //rdcu.be/bffeZ. (shrink)

Many spectacular claims about psychopaths are circulated. This contribution aims at providing the reader with the more complex reality of the phenomenon (or phenomena), and to point to issues of particular interest to philosophers working in moral psychology and moral theory. I first discuss the current evidence regarding psychopaths’ deficient empathy and decision-making skills. I then explore what difference it makes to our thinking whether we regard their deficit dimensionally (as involving abilities that are on or off) and whether we (...) focus on primary or secondary psychopathy. My conclusion is that most grand claims about psychopathy settling long-standing debates in moral philosophy and psychology are overblown, but there is much to be learnt from this disorder when it comes to formulating modern theories of moral psychology. (shrink)

The diagnosis of psychopathic personality disorder has salience for forensic clinical practice. It influences decisions regarding risk, treatability and sentencing, indeed, in certain jurisdictions it serves as an aggravating factor that increases the likelihood of a capital sentence. The concatenation of symptom that is associated with modern conceptions of the disorder can be discerned in early writings, including the book of Psalms. Despite its forensic clinical importance and historical pedigree the concept remains elusive and controverted. In this paper I describe (...) an attempt to map the concept of psychopathic personality disorder—the Comprehensive Assessment of Psychopathic Personality (CAPP). I outline the processes used to create the concept map; I summarise evidence in support of the content validity of the map and describe different operations designed to operationalise the construct. It is only when conceptual clarity is achieved that valid operations and measures can be created. I end with a plea for more carefully considered application of statistical methods; applications that better fit the theoretical questions being posed. (shrink)

The question of whether psychopaths are criminally and morally responsible has generated significant controversy in the literature. In this paper, we discuss what relevance a psychopathy diagnosis has for criminal responsibility. It has been argued that figuring out whether psychopathy is a mental illness is of fundamental importance, because it is a precondition for psychopaths’ eligibility to be excused via the legal insanity defense. But even if psychopathy counts as a mental illness, this alone is not sufficient to show the (...) insanity defense is applicable; it must also be shown that, as a result of the illness, specific deficits in moral understanding or control are present. In this paper, we show that a diagnosis of psychopathy will generally not indicate that a defendant is eligible for an insanity defense. This is because the group of individuals subsumed under the diagnosis is so heterogeneous that while some psychopaths do show significant impairments in affect and control which may impact on their responsibility, many psychopaths are not incapacitated in a way relevant to responsibility. (shrink)

In this paper it is proposed that important components of moral development and moral judgment rely on two forms of emotional learning: stimulus-reinforcement and response-outcome learning. Data in support of this position will be primarily drawn from work with individuals with the developmental condition of psychopathy as well as fMRI studies with healthy individuals. Individuals with psychopathy show impairment on moral judgment tasks and a pronounced increased risk for instrumental antisocial behavior. It will be argued that these impairments are developmental (...) consequences of impaired stimulus-aversive conditioning on the basis of distress cue reinforcers and response-outcome learning in individuals with this disorder. (shrink)

Mealey's article on the sociobiology of sociopathy raises questions about the relationship between adaptiveness and abnormality. Although sociopathy may be adaptive, simply defining medical and psychiatric disorders in terms of evolutionary function is problematic. Rather, sociopathy may be characterized as a relatively atypical disorder, an entity to which it may be useful to extend the metaphors of the medical model.

In the forensic field, psychopathy is a disorder that raises many questions. Indeed, the diagnostic evaluation by the PCL-R offers no opportunity to assess the variability of the disorder on the entire life. However, the dimensional scales used to assess this fluctuation, at least in the medium term. This study helps to validate the CAPP-IRS using the PCL-R with forensic patients.

The term “psychopath” has enjoyed wide currency both in popular culture and among specialists in forensic psychiatry. Historians, however, have generally neglected the subject. This essay examines the history of psychopathy in the country that first coined the term, developed the concept, and debated its treatment: Germany. While the notion can be traced to nineteenth-century psychiatric ideas about abnormal, yet not completely pathological, character traits, the figure of the psychopath emerged out of distinctly twentieth-century preoccupations and institutions. The vagueness and (...) plasticity of the diagnosis of psychopathy proved to be one of the keys to its success, as it was embraced and employed by clinicians, researchers, and the mass media, despite attempts by some to curb its use. Within the span of a few decades, the image of the psychopath became one of a perpetual troublemaker, an individual who could not be managed within any institutional setting. By midcentury, psychopaths were no longer seen as simply nosological curiosities; rather, they were spatial problems, individuals whose defiance of institutional routine and attempts at social redemption stood in for an attributed mental status. The history of psychopathy therefore reveals how public dangers and risks can be shaped and defined by institutional limitations. (shrink)

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)

Antisocial behavior is a heterogeneous construct that can be divided into subtypes, such as antisocial personality and psychopathy. The adverse consequences of antisocial behavior produce great burden for the perpetrators, victims, family members, and for society at-large. The pervasiveness of antisocial behavior highlights the importance of precisely characterizing subtypes of antisocial individuals and identifying specific factors that are etiologically related to such behaviors to inform the development of targeted treatments. The goals of the current review are to briefly summarize research (...) on the operationalization and assessment of antisocial personality and psychopathy; to provide an overview of several existing treatments with the potential to influence antisocial personality and psychopathy; and to present an approach that integrates and uses biological and cognitive measures as starting points to more precisely characterize and treat these individuals. A focus on integrating factors at multiple levels of analysis can uncover person-specific characteristics and highlight potential targets for treatment to alleviate the burden caused by antisocial behavior. (shrink)

Recently, attempts have been made to determine the evolutionary status of psychopathy. However, there is still a gap in empirical literature regarding the connection between psychopathy and fitness. In the present study, we explored the relations between the four-factor model of psychopathy and reproductive success as a fitness indicator in a sample of male convicts (N = 181). Direct relations were analyzed, together with the interaction effects between psychopathy and family risk factors (presence of criminality, substance abuse, and maltreatment in (...) participants’ families). Basic regression models showed that the facet of interpersonal style is positively related to fitness, while other psychopathic characteristics had a negative connection with the criterion measure. Additionally, we found three significant interactions, which further clarified the relation between psychopathy and reproductive success. One of the interactions showed that affective traits can facilitate fertility in unfavorable environmental conditions. Results support a hypothesis of a possible adaptive function of psychopathy, broaden the concept of “successful psychopathy,” and confirm a view of psychopathy as a heterogeneous and complex construct, consisting of facets with distinct content. (shrink)

Philosophers typically rely on empirical data when they comment on psychopaths’ moral responsibility. Many argue that psychopaths, as per the data, suffer from significant impairments in the precursors of moral reasoning and behavior, and therefore they should not be held morally responsible for their actions. However, careful analysis of these studies shows that this view is mistaken. We discuss how several philosophers— perhaps following the lead of social scientists—have systematically misinterpreted or simplified psychological data to support their conclusions about psychopaths’ (...) responsibility. We discuss four data sources: Case studies, the moral/conventional distinction task, fear conditioning, and facial affect recognition experiments. We examine how errors in the interpretation of these data have influenced, for the worse, the moral responsibility discourse. We recommend that philosophers exercise more caution in drawing conclusions from the psychological data on psychopaths. (shrink)

Background -/- Impulsivity is generally considered a core feature of psychopathy, however one problem with understanding the association between these constructs is that both are multifaceted. Existing research often treats one or both of these constructs as unidimensional with important information regarding the complex nature of the relationship being lost. To clarify this issue the present study employs a canonical correlation analysis (CCA) which allows for the comparison of two multifaceted measurement scales simultaneously. -/- Methods -/- Respondents (n = 970) (...) completed the Barratt Impulsiveness Scale (BIS-11) and the Psychopathic Personality Inventory (PPI). CCA was performed to explore the strength and nature of the association between impulse control and psychopathy. -/- Results -/- There was a large correlation (r = 0.57) between BIS-11 and PPI total scores. Further exploration using CCA showed that 70.2% of the variance was shared between the subscales, and three significant canonical functions emerged. These were found to be interpretable and suggest that impulsivity relates to the broader psychopathy domain in a complex fashion, and that non-planning impulsivity may be the primary trait which distinguishes between psychopathy subtypes. -/- Discussion -/- The findings support a complex multi-dimensional relationship between impulsivity and psychopathy. The simple impulsivity-psychopathy correlation has much less explanatory power than has a multivariate approach. (shrink)

Background -/- Psychopathy is a mental health disorder characterized by callous and impulsive antisocial behavior, and it is associated with a high incidence of violent crime, substance abuse, and recidivism. Recent studies suggest that the striatum may be a key component of the neurobiological basis for the disorder, although structural findings have been mixed, and functional connectivity of the striatum in psychopathy has yet to be fully examined. Methods -/- We performed a multimodal neuroimaging study of striatum volume and functional (...) connectivity in psychopathy using a large sample of adult male prison inmates (N = 124). We conducted volumetric analyses in striatal subnuclei and subsequently assessed resting-state functional connectivity in areas where volume was related to psychopathy severity. -/- Results -/- Total Psychopathy Checklist Revised and factor 2 scores (which index the impulsive/antisocial traits of psychopathy) were associated with larger striatal subnuclei volumes and increased volume in focal areas throughout the striatum, particularly in the nucleus accumbens and putamen bilaterally. Furthermore, at many of the striatal areas where volume was positively associated with factor 2 scores, psychopathy severity was also associated with abnormal functional connectivity with other brain regions, including dorsolateral prefrontal cortex, ventral midbrain, and other areas of the striatum. The results were not attributable to age, race, IQ, substance use history, or intracranial volume. Conclusions -/- These findings associate the impulsive/antisocial dimension of psychopathy with enlarged striatal subnuclei and aberrant functional connectivity between the striatum and other brain regions. Furthermore, the colocalization of volumetric and functional connectivity findings suggests that these neural abnormalities may be pathophysiologically linked. (shrink)

In a recent study, we found a negative association between psychopathy and violence against genetic relatives. We interpreted this result as a form of nepotism and argued that it failed to support the hypothesis that psychopathy is a mental disorder, suggesting instead that it supports the hypothesis that psychopathy is an evolved life history strategy. This interpretation and subsequent arguments have been challenged in a number of ways. Here, we identify several misunderstandings regarding the harmful dysfunction definition of mental disorder (...) as it applies to psychopathy and regarding the meaning of nepotism. Furthermore, we examine the evidence provided by our critics that psychopathy is associated with other disorders, and we offer a comment on their alternative model of psychopathy. We conclude that there remains little evidence that psychopathy is the product of dysfunctional mechanisms. (shrink)

Psychopaths routinely disregard social norms by engaging in selfish, antisocial, often violent behavior. Commonly characterized as mentally disordered, recent evidence suggests that psychopaths are executing a well-functioning, if unscrupulous strategy that historically increased reproductive success at the expense of others. Natural selection ought to have favored strategies that spared close kin from harm, however, because actions affecting the fitness of genetic relatives contribute to an individual’s inclusive fitness. Conversely, there is evidence that mental disorders can disrupt psychological mechanisms designed to (...) protect relatives. Thus, mental disorder and adaptation accounts of psychopathy generate opposing hypotheses: psychopathy should be associated with an increase in the victimization of kin in the former account but not in the latter. Contrary to the mental disorder hypothesis, we show here in a sample of 289 violent offenders that variation in psychopathy predicts a decrease in the genetic relatedness of victims to offenders; that is, psychopathy predicts an increased likelihood of harming non-relatives. Because nepotistic inhibition in violence may be caused by dispersal or kin discrimination, we examined the effects of psychopathy on (1) the dispersal of offenders and their kin and (2) sexual assault frequency (as a window on kin discrimination). Although psychopathy was negatively associated with coresidence with kin and positively associated with the commission of sexual assault, it remained negatively associated with the genetic relatedness of victims to offenders after removing cases of offenders who had coresided with kin and cases of sexual assault from the analyses. These results stand in contrast to models positing psychopathy as a pathology, and provide support for the hypothesis that psychopathy reflects an evolutionary strategy largely favoring the exploitation of non-relatives. (shrink)

The aim of this paper is to analyze, from a philosophical perspective, the scientific robustness of the construct of psychopathy as measured by the Psychopathy Checklist Revised that was developed by Robert Hare (1991; 2003). The scientific robustness and validity of classifications are topics of many debates in philosophy of science and philosophy of psychiatry more specifically. The main problem consists in establishing whether scientific classifications reflect natural kinds where the concept of a natural kind refers to the existence of (...) some objective divisions in nature that do not depend exclusively on subjective judgments of the classifier. The construct of psychopathy is especially interesting since the diagnosis of psychopathy has substantial social consequences. In the light of the recent debates regarding the problem of natural kinds in philosophy of psychiatry, we advocate the following distinction between two types of scientific classifications: natural and practical kinds. Natural kinds refer to those categories that are united by common causal mechanisms or properties. Practical kinds refer to categories that fulfill some practical classificatory goals such as prediction. We argue that the construct of psychopathy can fulfill the role of a practical kind. In addition, we contend that our current scientific knowledge about psychopathy does not allow us to conclude that this category is a natural kind. (shrink)

The crucial problem in the philosophy of psychiatry is to determine under which conditions certain behaviors, mental states, and personality traits should be regarded as symptoms of mental illnesses. Participants in the debate can be placed on a continuum of positions. On the one side of the continuum, there are naturalists who maintain that the concept of mental illness can be explained by relying on the conceptual apparatus of the natural sciences, such as biology and neuroscience. On the other side (...) of the continuum, there are normativists who maintain that the appropriate characterization of the concept of mental illness cannot avoid reference to epistemic, moral and other social values. Although, this article is primarily an introduction to the debate, we stress the importance of the normativist positions. (shrink)

This Note examines whether, and at which stages, a criminal defendant should be permitted to offer genetic evidence of a predisposition to psychopathy. Drawing on multidisciplinary sources, including the work of legal scholars, neurobiologists, psychologists, and medical researchers, the Note discusses psychopathy, its symptoms, and how it is measured, along with the proposed genetic and environmental causes of the disorder. The Note then examines current evidence rules and trends in the admissibility of genetic evidence at the guilt/innocence phase of criminal (...) trials and at sentencing. After discussing the potential effects of admitting evidence of a genetic basis for psychopathy at both of these phases, the Note concludes that the stigmatizing nature of the disorder and the uncertainty over its causes make it inadvisable to admit this type of evidence at the guilt/innocence phase of trial. However, admitting this evidence at sentencing is not objectionable. (shrink)

The current research applied a mid-level evolutionary theory that has been successfully employed across numerous animal species—life history theory—in an attempt to understand the Dark Triad personality trait cluster (narcissism, psychopathy, and Machiavellianism). In Study 1 (N = 246), a measure of life history strategy was correlated with psychopathy, but unexpectedly with neither Machiavellianism nor narcissism. Study 2 (N = 321) replicated this overall pattern of results using longer, traditional measures of the Dark Triad traits and alternative, future-discounting indicators of (...) life history strategy (a smaller-sooner, larger-later monetary dilemma and self-reported risk-taking behaviors). Additional findings suggested two sources of shared variance across the Dark Triad traits: confidence in predicting future outcomes and openness to short-term mating. (shrink)

The Axis II Work Group of the Task Force on Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) has expressed concern that antisocial personality disorder (APD) criteria are too long and cumbersome and that they focus on antisocial behaviors rather than personality traits central to traditional conceptions of psychopathy and to international criteria. R. D. Hare et al describe an alternative to the approach taken in the DSM-III—Revised (DSM-III—R; American Psychiatric Association, 1987), namely, the revised Psychopathy Checklist. The authors also (...) discuss the multisite APD field trials designed to evaluate and compare 4 criteria sets: the DSM-III—R criteria, a shortened list of these criteria, the criteria for dyssocial personality disorder from the 10th edition of the International Classification of Diseases (World Health Organization, 1990), and a 10-item criteria set for psychopathic personality disorder derived from the revised Psychopathy Checklist. (PsycINFO Database Record (c) 2015 APA, all rights reserved). (shrink)

Background Men with antisocial personality disorder show lifelong abnormalities in adaptive decision making guided by the weighing up of reward and punishment information. Among men with antisocial personality disorder, modifi cation of the behaviour of those with additional diagnoses of psychopathy seems particularly resistant to punishment. Methods We did a case-control functional MRI (fMRI) study in 50 men, of whom 12 were violent off enders with antisocial personality disorder and psychopathy, 20 were violent off enders with antisocial personality disorder but (...) not psychopathy, and 18 were healthy non-off enders. We used fMRI to measure brain activation associated with the representation of punishment or reward information during an event-related probabilistic response-reversal task, assessed with standard general linear-model-based analysis. Findings Offenders with antisocial personality disorder and psychopathy displayed discrete regions of increased activation in the posterior cingulate cortex and anterior insula in response to punished errors during the task reversal phase, and decreased activation to all correct rewarded responses in the superior temporal cortex. This finding was in contrast to results for off enders without psychopathy and healthy non-off enders. Interpretation Punishment prediction error signalling in off enders with antisocial personality disorder and psychopathy was highly atypical. This finding challenges the widely held view that such men are simply characterised by diminished neural sensitivity to punishment. Instead, this fi nding indicates altered organisation of the information processing system responsible for reinforcement learning and appropriate decision making. This difference between violent offenders with antisocial personality disorder with and without psychopathy has implications for the causes of these disorders and for treatment approaches. (shrink)

Psychopathy represents a unique set of personality traits including deceitfulness, lack of empathy and guilt, impulsiveness, and antisocial behavior. Most often in the literature, psychopathy is described as pathology — a disorder that has been linked to a variety of biological deficits and environmental risk factors. However, from an evolutionary perspective, psychopathy, while it could be a disorder, has been construed in the context of an adaptive strategy. In this article we will examine the strengths and weaknesses of two models (...) suggesting that psychopathy is an adaptive strategy, and one model suggesting that it is a form of pathology resulting from accumulated mutations. Overall, we do not find that there is strong enough evidence to draw firm conclusions about one theory over another, but we highlight some areas where future research may be able to shed light on the issue. (shrink)

One of the philosophical discussions stimulated by the recent scientific study of psychopathy concerns the mental illness status of this construct. This paper contributes to this debate by recommending a way of approaching the problem at issue. By relying on and integrating the seminal work of the philosopher of psychiatry Bill Fulford, I argue that a mental illness is a harmful unified construct that involves failures of ordinary doing. Central to the present proposal is the idea that the notion of (...) failure of ordinary doing, besides the first personal experience of the patient, has to be spelled out also by referring to a normative account of idealised conditions of agency. This account would have to state in particular the conditions which are required for moral responsibility. I maintain that psychopathy is a unified enough construct that involves some harms. The question whether the condition involves also a failure of ordinary doing, as this notion is understood in this paper, is not investigated here. (shrink)

Whether psychopathy is a mental disease or illness can affect whether psychiatrists should treat it and whether it could serve as the basis for an insanity defense in criminal trials. Our understanding of psychopathy has been greatly improved in recent years by new research in psychology and neuroscience. This illuminating research enables us to argue that psychopathy counts as a mental disease on any plausible account of mental disease. In particular, Szasz's and Pickard's eliminativist views and Sedgwick's social constructivist account (...) of mental illness that might exclude psychopathy are not plausible, and there is no reason to exclude psychopathy under Boorse's and Scadding's biomedical accounts, Wakefield's harmful dysfunction account, and the DSM-IV-TR objective harm account of mental disease. The basic reason is that psychopathy involve neural dysfunction that increases risk of serious harm and loss to people with psychopathy. (shrink)

Psychopathy is often characterized in terms of what I call “the language of disorder.” I question whether such language is necessary for an accurate and precise characterization of psychopathy, and I consider the practical implications of how we characterize psychopathy—whether as a biological, or merely normative, disorder.