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)

Since its publication, the Psychopathic Personality Inventory and its revision (Lilien- feld & Andrews, 1996; Lilienfeld & Widows, 2005) have become increasingly popular such that it is now among the most frequently used self-report inventories for the assessment of psychopathy. The current meta-analysis examined the relations between the two PPI factors (factor 1: Fearless Dominance; factor 2: Self-Centered Impulsivity), as well as their relations with other validated measures of psychopathy, internalizing and externalizing forms of psychopathology, general personality (...) traits, and antisocial personality disorder symptoms. Across 61 samples reported in 49 publications, we found support for the convergent and criterion validity of both PPI factor 2 and the PPI total score. Much weaker validation was found for PPI factor 1, which manifested limited convergent validity and a pattern of correlations with central criterion variables that was inconsistent with many conceptualizations of psychopathy. (shrink)

Personality-disordered individuals of certain types tend to exhibit behaviors that cause particular problems for the Ethics and Compliance (E&C) function inorganizations. This paper defines personality-disordered individuals and focuses on three types that might create such problems: the psychopath, the narcissist, and the obsessivecompulsive personality. We provide a working hypothesis about the problems that they may cause in organizations and then report the results of an exploratory study of E&C personnel. The paper concludes with recommendations for managers and (...) for future research. (shrink)

I present two philosophical arguments that Antisocial Personality Disorder (ASPD) and Psychopathy can be expected to be culturally variable. I argue that the ways in which people with ASPD and psychopaths can be expected to act will vary with societal values and culture. In the second part of the chapter, I will briefly review some of the empirical literature on cross-cultural variation in ASPD and psychopathy and argue that it is consistent with my philosophical claims. My conclusion in (...) this chapter is that methods of diagnosis will need to be culturally specific. A diagnostic instrument (such as the PCL-R or DSM) should not be uncritically employed in cultures that are very different from those in which it was initially developed. (shrink)

In attempting to explain or deal with negative workplace behaviours such as workplace bullying, the notion of ‘workplace psychopaths’ has recently received much attention. Focusing on individual aspects of negative workplace behaviour is at odds with more systemic approaches that recognise the contribution of individual, organisational and societal influences, without seeking to blame a person(s) for their behaviour or personality disorder. Regarding a coworker as a psychopath is highly stigmatising, and given the relatively low prevalence of psychopathy in (...) the community, is likely to be incorrect. Sources promoting the notion of workplace psychopathy provide lists of diagnostic criteria and appear to encourage the perception that it is common. This research examines how lay persons use behavioural criteria consistent with psychopathy and the label ‘psychopath’ in relation to a coworker. 307 Australian workers completed an online survey concerning their experience of workplace bullying, which also asked them to rate a coworker’s behaviour on a range of scales to assess perceptions of psychopathy. Rates of psychopathy, when using labels and behavioural criteria, were found to be much higher than scientific estimates of prevalence, for both participants who had been bullied and those who had not. A higher proportion of non-bullied participants classified a coworker as a psychopath when using the label ‘psychopath’, compared to when using behavioural criteria. The notion that there are psychopaths in every workplace should be treated with caution to ensure that the potential for ‘misdiagnosis’ and stigmatisation do not cause further harm in situations of unacceptable workplace behaviours. (shrink)

Psychopathy is a personality disorder frequently associated with immoral behaviors. Previous behavioral studies on the influence of psychopathy on moral decision have yielded contradictory results, possibly because they focused either on judgment (abstract evaluation) or on choice of hypothetical action, two processes that may rely on different mechanisms. In this study, we explored the influence of the level of psychopathic traits on judgment and choice of hypothetical action during moral dilemma evaluation. A population of 102 students completed (...) a questionnaire with ten moral dilemmas and nine non-moral dilemmas. The task included questions targeting both judgment (“Is it acceptable to … in order to …?”) and choice of hypothetical action (“Would you … in order to …?”). The level of psychopathic traits of each participant was evaluated with the Levenson Self-Report Psychopathy (LSRP) scale. Logistic regression fitted with the generalized estimating equations method analyses were conducted using responses to the judgment and choice tasks as the dependent variables and psychopathy scores as predictor. Results show that a high level of psychopathic traits, and more specifically those related to affective deficit, predicted a greater proportion of utilitarian responses for the choice but not for the judgment question. There was no first-order interaction between the level of psychopathic traits and other potential predictors. The relation between a high level of psychopathic traits and increased utilitarianism in choice of action but not in moral judgment may explain the contradictory results of previous studies where these two processes were not contrasted. It also gives further support to the hypothesis that choice of action endorsement and abstract judgment during moral dilemma evaluation are partially distinct neural and psychological processes. We propose that this distinction should be better taken into account in the evaluation of psychopathic behaviors. (shrink)

Psychopaths are often regarded as a scourge of contemporary society and, as such, are the focus of much public vilification and outrage. But, arguably, psychopaths are both sinned against as well as sinners. If that is true, then their status as the victims of abusive subcultures partially mitigates their moral responsibility for the harms they cause. We argue, from the neuroethics of psychopathy and antisocial personality disorder (ASPD), that communities have a moral obligation to psychopaths as well as (...) a case against them. A reflection on the genesis and developmental epidemiology of psychopathy reveals an individualist, attribution-type error evident in much Western psychological and legal thinking—an error that obscures important moral truths about psychopaths. The resulting analysis makes us reconsider the distinction between disorders and moral failings and the ethical significance of the biological or neurocognitive mechanisms underpinning psychopathy. We claim that casting aside the deficit model (based on the presupposition that psychopaths are intrinsically unlike the rest of us) in favor of a relational and holistic view of personality potentiates a more informed and inclusive set of ethical, forensic, and therapeutic attitudes. (shrink)

This title was first published in 2000: Personality disorder/Psychopathy has long troubled philosophers, lawyers and mental health practitioners. This book is highly topical in tackling the interface of applied philosophy and psychiatry at a time when government and clinicians are giving careful consideration to new forms of treatment of people with psychopathic disorder. The book brings together contributions from lawyers, philosophers, psychiatrists and clinical managers to explore the inter-related conceptual and political implications of Psychopathy.

Psychopathy is a personality disorder characterized by emotional deficits and a failure to inhibit impulsive behavior and is often subdivided into “primary” and “secondary” psychopathic subtypes. The maladaptive behavior related to primary psychopathy is thought to reflect constitutional “fearlessness,” while the problematic behavior related to secondary psychopathy is motivated by other factors. The fearlessness observed in psychopathy has often been interpreted as reflecting a fundamental deficit in amygdala function, and previous studies have provided support for a low-fear (...) model of psychopathy. However, many of these studies fail to use appropriate screening procedures, use liberal inclusion criteria, or have used unconventional approaches to assay amygdala function. We measured brain activity with BOLD imaging in primary and secondary psychopaths and non-psychopathic control subjects during Pavlovian fear conditioning. In contrast to the low-fear model, we observed normal fear expression in primary psychopaths. Psychopaths also displayed greater differential BOLD activity in the amygdala relative to matched controls. Inverse patterns of activity were observed in the anterior cingulate cortex (ACC) for primary versus secondary psychopaths. Primary psychopaths exhibited a pattern of activity in the dorsal and ventral ACC consistent with enhanced fear expression, while secondary psychopaths exhibited a pattern of activity in these regions consistent with fear inhibition. These results contradict the low-fear model of psychopathy and suggest that the low fear observed for psychopaths in previous studies may be specific to secondary psychopaths. (shrink)

I argue for two propositions. First, contrary to the common wisdom, we may justly punish individuals who are not morally responsible for their crimes. Psychopaths – individuals who lack the capacity to feel sympathy – help to prove this point. Scholars are increasingly arguing that psychopaths are not morally responsible for their behavior because they suffer from a neurological disorder that makes it impossible for them to understand, and therefore be motivated by, moral reasons. These same scholars then infer (...) from this conclusion that they must also lack criminal responsibility and therefore that our continuing to punish psychopaths for their crimes is unjust. My response is that this inference is entirely fallacious. -/- Criminal responsibility turns out to be quite distinct from moral responsibility. The two kinds of responsibility require very different conditions to be satisfied. In particular, criminal responsibility, unlike moral responsibility, does not require an agent be able to grasp and follow moral reasons; it requires only that the individual be able to grasp and follow criminal laws. Once this point is recognized, it becomes much easier to accept my thesis: while the subset of psychopaths who commit crimes are not morally responsible for their criminal behavior because they cannot understand moral reasons, they are still criminally responsible because they can understand what the consequences will be if they get caught. For this reason, even though I concede that psychopaths are not morally responsible for the crimes that they commit, our practice of punishing them for these crimes is still just. -/- Second, I argue that psychopathy is a mental illness and should be recognized as such. One reason that it should be recognized as a mental illness is simply because it is; it satisfies the main criteria for inclusion in the DSM-IV, the “bible” of mental disorders. The other reason is more practical than conceptual. It starts with two facts: the U.S. Supreme Court has decided that the preventive detention of any individual who is not a criminal suspect is not constitutional unless the individual is not only dangerous but also mentally ill; and psychopathy is not currently considered to be a mental illness. So, as things now stand, we cannot preventively commit dangerous psychopaths – that is, psychopaths who have clearly indicated that they will be committing serious crimes. Instead, we must wait for them to commit the crimes before we can lock them up. Unfortunately, this incarceration always comes too late for the victims. It would therefore be better if we could lock them up before they actually inflict any harm. Once again, then, I propose that the legal and psychological communities classify psychopathy as a mental illness. (shrink)

New discoveries in neuroscience challenge our understanding of human responsibility and justice. Recent studies suggest that psychopaths not only exhibit specific behavioral patterns but may also have a distinct neuroanatomical blueprint. Scientists have shown that a significant number of individuals who have demonstrated psychopathic behaviors have reduced volume and other anatomical changes in various regions of the cerebral cortex as well as decreased functional connectivity between different brain areas (i.e., smaller dysfunctional amygdalae). These findings raise ethical questions about how (...) our criminal system deals with these individuals. Should dysfunctional anatomical or diseased features exonerate affected individuals from any responsibility for their criminal activity or the suffering they have caused to their victims? It is estimated that individuals with the signs and symptoms of antisocial personality disorder make up 25% of inmates. Should individuals classified with this disorder be incarcerated with other criminals? In this paper, we summarize the results of the latest brain imaging studies performed on individuals with antisocial personality traits, referred to as psychopaths or sociopaths, and we explore some of the ethical issues concerning psychopathy and the law. (shrink)

A pressing and difficult practical problem concerns the general issue of the right social response to offenders classified as having antisocial personality disorder. This paper approaches this general problem by focusing, from a philosophical perspective, on the still relevant but more approachable question whether psychopathic offenders are morally responsible. In particular, I investigate whether psychopaths possess moral understanding. A plausible way to approach the last question requires a satisfactory philosophical interpretation of the empirical evidence that appears to (...) show that psychopaths fail to draw the distinction between conventional and moral norms. Specifically, I will consider a recent philosophical debate polarized between supporters of rationalist and sentimentalist accounts of moral understanding. These opponents have discussed whether the case of psychopathy offers empirical support for their account and undermine the rival view. I will argue that the available empirical data leave the outcome of this discussion indeterminate. However, this implies that both these principal theories of moral understanding, if independently motivated, would imply that psychopaths have certain deficits that might affect their moral understanding and, consequently, their moral responsibility. (shrink)

A pressing and difficult practical problem concerns the general issue of the right social response to offenders classified as having antisocial personality disorder. This paper approaches this general problem by focusing, from a philosophical perspective, on the still relevant but more approachable question whether psychopathic offenders are morally responsible. In particular, I investigate whether psychopaths possess moral understanding. A plausible way to approach the last question requires a satisfactory philosophical interpretation of the empirical evidence that appears to (...) show that psychopaths fail to draw the distinction between conventional and moral norms. Specifically, I will consider a recent philosophical debate polarized between supporters of rationalist and sentimentalist accounts of moral understanding. These opponents have discussed whether the case of psychopathy offers empirical support for their account and undermine the rival view. I will argue that the available empirical data leave the outcome of this discussion indeterminate. However, this implies that both these principal theories of moral understanding, if independently motivated, would imply that psychopaths have certain deficits that might affect their moral understanding and, consequently, their moral responsibility. (shrink)

The psychopathic personality disorder historically has been thought to include an insensitivity to morality. Some have thought that the psychopath's insensitivity indicates that he does not understand morality, but the relationship between the psychopath's defects and moral understanding has been unclear. We attempt to clarify this relationship, first by arguing that moral understanding is incomplete without concern for morality, and second, by showing that the psychopath demonstrates defects in frontal lobe activity which indicate impaired attention and adaptation (...) to environmental conditions which are relevant to the formation of complex intentions. We argue that these frontal lobe defects can help to explain both the psychopath's apparent insensitivity to morality and his characteristic imprudence. (shrink)

Dietmar Hübner and Lucie White question the ethical justification of employing risky neurosurgical interventions to treat imprisoned psychopaths. They argue that (1) such interventions would confer no medical benefit on the psychopath as there is no “subjective suffering” involved in psychopathy and (2) psychopaths could not voluntarily consent to such procedures because they could have no “internal motivation” for doing so. In the course of their discussion, the authors insightfully show that certain aspects of the psychopath’s personality structure are (...) especially relevant to assessing the ethics of risky treatment options. As I argue, however, the particular conclusions that the authors draw are too strong. A deeper look at the psychopathic profile casts doubt on (1) and (2). In some cases, psychopaths can be plausibly construed as experiencing subjective suffering on account of their disorder and as appropriately motivated to voluntarily consent to neurosurgical treatment. After arguing for this view, I suggest that the psychopath’s consent to neurosurgical intervention might nonetheless be problematic, as their emotional incapacities might preclude their abilities to adequately appreciate the relevant risks. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.2 (2003) 193-194 [Access article in PDF] A Comment on Christopher Ciocchetti:"The Responsibility of the Psychopathic Offender" Daniel W. Shuman Questions of responsibility for serious harm are complex and potentially divisive. The way in which we frame these questions and the criteria by which we assess answers to them are colored, in part, by the lens though which we view them. I am a (...) law professor whose writings includes issues relating to criminal responsibility of person with mentally disabilities and I come to this commentary from that perspective. For me questions of moral responsibility raise psychological and philosophical, as well as legal, questions.Ciocchetti's (2003) paper addressees the criminal responsibility of the psychopathic offender. Not sure quite what the author meant by this label, I began to try to understand the concept of psychopathic offender by picking up my DSM-IV-TR and found no reference to such a diagnostic category. Absent a handy reference in the DSM, I looked in the paper for some other definition or recognition of the category of psychopathic offender and found no satisfactory grounding in any body of sound research. Left with the author's unsupported assertions that such a category of persons exists and that they behave in ways the author asks me to accept without support, my lawyer instincts cautioned me to proceed carefully. The psychopathic offender the author describes might well exist, but I am not persuaded of that, nor would be my legal colleagues, absent proof.Next, to the author's thesis that "[t]he offender must have the capacities necessary to understand relationships to justify holding that offender responsible" (p. 176) and that because psychopaths lack this capacity they should not be held criminally responsible. Is the author proposing a new test for criminal responsibility? Certainly no test for criminal nonresponsibility based on mental disability (i.e., insanity defense) in Anglo-American jurisprudence, or any other with which I am familiar, makes status (i.e., a diagnostic category) exculpatory for criminal responsibility. Rather, every test addresses the impact of a mental illness or disorder on the cognitive or volitional capacity of the offender at the time of the offense. The author offers no reason to reject the approach taken for the last several hundred years [End Page 193] by Anglo-American jurisprudence. Moreover, to the extent that status or diagnostic category is relevant in the insanity defense in Anglo-American jurisprudence, character or personality disorders (the genus to which I take it that psychopathy belongs) are often specifically excluded from consideration. For example, the Texas Penal Code (Tex. Penal Code Ann. § 8.01 (Vernon 1994)) states that:It is an affirmative defense to prosecution that, at the time of the conduct charged, the actor, as a result of a severe mental disease or defect, did not know that his conduct was wrong. The term "mental disease or defect" does not include an abnormality manifested only by repeated criminal or otherwise antisocial conduct.The federal Insanity Defense Reform Act raises the same issue: The government relies on the legislative history of 18 U.S.C. § 17, which states: "The concept of severity was added to emphasize that non-psychotic behavior disorders or neuroses such as an 'inadequate personality,' 'immature personality,' or a pattern of 'antisocial tendencies' do not constitute the defense.".... The government argues that because Dr. Lorenz would have testified that Salava was not psychotic but suffered from antisocial personality disorder, his testimony was not relevant to either prong of the insanity defense under the statute.... As a general matter, the government's point is well-taken. It seems clear that Congress intended by its inclusion of the modifier "severe" to place certain "disorders" outside the purview of the insanity defense altogether. United States v. Salava, 978 F.2d 320, 323 (7th Cir. 1992) Nowhere in the paper does Chiochetti acknowledge or address these societal judgments of moral responsibility that have already rejected a far more modest version of his proposal in categorically ruling out character or personality disorders from inclusion as... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Third Way: Social Disability and Person-Centered AssessmentChristopher Heginbotham (bio)Keywordsimpaired functioning, psychopathic, personality disorder, neurological damage, psychotherapyJohn Sadler’s Fascinating Paper identifies a significant problem with existing diagnostic classifications. But in doing so he raises further unresolved philosophical, nosological, and practical problems. Although he is undoubtedly right in showing that the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV (and International Classification of Diseases [ICD]-10) do not (...) provide an adequate categorization, he is I believe wrong to use the term “vice” to describe the cluster of wrongful acts.“Vice” conjures up images of Miami, drugbusting police, prostitution, and other activities that are characterized by one thing—by and large, these are actions undertaken knowingly, usually for financial gain. These are not the actions of people with impaired mental functioning as a result of mental disorder or neurological damage. It is of course true that human trafficking and enforced prostitution may mean women forced into prostitution against their will, but rarely are these women considered mentally disordered solely as a result of their prostitution. Yet it is capacitated, premeditated wrongdoing that is normally considered to be “vice.”By contrast, all the cases cited in the paper describe conditions that are almost certainly the result of some form of impaired functioning, either owing to early childhood experiences (Case A), familial culture and conditioning (Case B), or neurological damage (Case C). The common thread in these cases is impaired capacity—in Case A this could be described as due to psychopathic or personality disorder (I distinguish the two separately rather than describe the phenomenon as “psychopathic personality disorder”) as a result of multiple childhood traumas. Their presentation is not unexpected given the person’s history and, although the condition may have become refractory, it might be amenable to treatment with psychoanalytically oriented psychotherapy, given sufficient time and a nurturing environment (Bateman and Fonagy 2006, 2008; Cordess and Cox 1996; Levy 2008).The description of Case B leaves a lot of room for doubt and uncertainties. Did Ms A really try to smother her child? She confessed to one occasion, but was this under duress? Did she feel that if she agreed she would be treated more leniently? And if she was guilty, does it suggest “vice,” a premeditated act, or is there another explanation—attention [End Page 31] seeking because of low self-esteem or a personality disorder as a result of some abuse that had not been identified? Almost certainly from the description given this would not count, for me at any rate, as vice. Her actions may be odd, bizarre, or dangerous, but did they demonstrate a mens rea? Was Ms A making adequate evaluative judgments of her situation and that of her child? We know from clinical work with very damaged women in forensic mental health services that early physical, emotional, or sexual abuse leads in turn to women harming both themselves and their children (Bland et al. 1999; Cordess and Cox 1996; see also for example, Jeffcote and Watson 2004). Or perhaps, speculatively, her condition was Munchausen’s by proxy?Case C is horrendous but does not lend itself readily to the forms of psychiatric classification available. Indeed there is no easy way to describe such actions other than those of someone who is either incapable of understanding the nature and consequence of the actions that he has undertaken, or is simply “mad” in a folk sense. Prima facie this seems to be the result of permanent and little understood neurological damage. However, this case comes closest to the evil that is implied in the term “vice”; and might be diagnosed similarly to a celebrated English murderer, that of Peter Sutcliffe, the so-called Yorkshire Ripper. Sutcliffe was diagnosed as suffering from paranoid schizophrenia, although the jury at his trial found that he was fit to plead, and he was initially sent to prison, where he deteriorated. He is now, and has for some time, been in Broadmoor high secure hospital.The result of these comments is that I agree fully with John Sadler’s conclusions, but for rather different reasons. DSM-IV categories try and fail to offer a symptomatology for... (shrink)

Psychopathy is a disorder involving personality and behavioral features associated with a high rate of violent aggression and recidivism. This paper explores potential psychopharmacological therapies to modulate dysfunctional neural pathways in psychopaths and reduce the incidence of their harmful behavior, as well as the ethical and legal implications of offering these therapies as an alternative to incarceration. It also considers whether forced psychopharmacological intervention in adults and children with psychopathic traits manifesting in violent behavior can be justified. (...) More generally, the paper addresses the question of how to weigh the psychopath’s presumptive right to non-interference in his brain and mind against the public interest in avoiding harm. (shrink)

In this chapter, we investigate whether psychopathy is a mental disorder. We argue that addressing this question requires engaging, at least, with three principal issues that have conceptual, empirical, and normative dimensions. First, it must be established whether current measures of psychopathy individuate a unitary class of individuals. By this we mean that persons classifed as psychopaths should share some relevant similarities that support explanation, prediction, and treatment. Second, it must be proven that psychopathy harms the person who has (...) it. Third, it must be established that the harm associated with psychopathy is relevant for the ascription of disorder status. Regarding this latter issue, we argue that psychopathy should be considered a disorder if its harmfulness derives from certain incapacities or limited capacities. These incapacities should affect basic competences that are justifably required for conducting a preferable type of life. Within this framework, we tentatively advance the hypothesis that some normatively justifed conclusions and empirical evidence about psychopathy, that needs nonetheless to be further investigated, might support the claim that people with psychopathy have a mental disorder. (shrink)

The research into the typical behavioral pattern, motivational structure, and the value system of psychopaths can shed light on at least three aspects related to the analysis of the moral agency. First, it can help elucidating the emotive and cognitive conditions necessary for moral performance. Secondly, it can provide empirical evidence supporting the externalist theories of moral motivation. Finally, it can bring into greater focus our intuitive notion of the limits of moral responsibility. In this paper I shall concentrate on (...) the last one—the question of responsibility of the amoralists, but the discussion will have an indirect bearing on the other two themes as well. My main reason for holding psychopaths morally responsible breaks down into two claims: the assumption that most ordinary people are morally responsible for their intentional actions and the denial that the psychopaths are qualitatively different from the non-psychopaths. This thesis is further defended against two objections. First, I am arguing that the genetically based emotive deficiency of the psychopaths cannot be seen the factor condemning them to amoral existence, and thus cannot be cited as an exempting condition. Secondly, my position is defended against the claim that psychopaths are partly responsible for their actions. It is argued that the notion of partial responsibility is either incoherent or else rests on a false empirical premise. My conclusion is in agreement with, and provides a theoretical justification for, the position of most classifications of the persons with antisocial personality disorder in the DSM IV. (shrink)

The drift toward behavioral accounts of the cluster of psychological and behavioral traits that were interchangeably referred to as psychopathy, sociopathy and anti-social personality is interesting and well worth exploring. Justman's correct that before the work of the Feighner group and the adoption of Antisocial Personality Disorder in the Diagnostic and Statistical Manual of Mental Disorders -III, the choice of concept did not seem to be vital and in the Mask of Sanity, Cleckley mentions all three terms (...) and does not seem to think much hangs on which term we choose.It seems correct that many held the absence of guilt to be the psychological marker of psychopathy... (shrink)

Both individuals with diagnosed with Autism Spectrum Disorder and individuals high in psychopathic traits show reduced susceptibility to contagious yawning; that is, yawning after seeing or hearing another person yawn. Yet it is unclear whether the same underlying processes are responsible for the relationship between reduced contagion and these very different types of clinical traits. College Students watched videos of individuals yawning or scratching while their eye movements were tracked. They completed the Interpersonal Reactivity Index, the Autism-Spectrum Quotient, (...) the Psychopathy Personality Inventory-Revised, and the Adolescent and Adult Sensory Processing Disorder Checklist. Both psychopathic traits and autistic traits showed an inverse relationship to contagious yawning, consistent with previous research. However, the relationship between autistic traits and contagious yawning was moderated by eye gaze. Furthermore, participants high in autistic traits showed typical levels of contagious itching whereas adults high in psychopathic traits showed diminished itch contagion. Finally, only psychopathic traits were associated with lower overall levels of empathy. The findings imply that the underlying processes contributing to the disruptions in contagious yawning amongst individuals high in autistic vs. psychopathic traits are distinct. In contrast to adults high in psychopathic traits, diminished contagion may appear amongst people with high levels of autistic traits secondary to diminished attention to the faces of others, and in the absence of a background deficit in emotional empathy. (shrink)

Clinical psychologists remain puzzled about the diagnostic basis and therapeutic disposition of individuals who present with a clinical profile of psychopathy. Psychopaths have been characterized as lacking in conscience and presenting a mask of sanity, thus differentiating them from psychotics and neurotics. The clinical profile of the psychopathic personality seems at odds with Kant’s moral philosophy, in which Kant characterizes not only the central role of conscience in moral judgment, but in which Kant also insists that every person (...) has a conscience. In this paper the clinical assessments presented by Cleckley and Hare in particular are juxtaposed to Kant’s philosophical position, thereby to gain an understanding what is at the base of the psychopathic personality disorder. The clinical and the moral-philosophical assessments are reconciled, nonetheless leaving the clinical psychologist with the difficult task of therapeutic disposition. (shrink)

The term psychopathy refers to a personality disorder associated with callous personality traits and antisocial behaviors. Throughout its research history, psychopathy has frequently been described as a peculiar form of moral blindness, engendering a narrative about a patient stereotype incapable of taking a genuine moral perspective, similar to a blind person who is deprived of proper visual perceptions. However, recent empirical research has shown that clinically diagnosed psychopaths are morally more fit than initially thought, and the blindness-analogy (...) now comes across as largely misleading. In this contribution, the moral-blindness analogy is explored in an attempt to qualify anew its relevance in psychopathy theory and research. It is demonstrated that there are indeed theoretically relevant parallels to be drawn between blindness and psychopathy, parallels that are especially illuminating when accounting for the potential symptomatology, dimensionality, and etiological nature of the disorder. (shrink)

Anger is probably one of the mostly debated basic emotions, owing to difficulties in detecting its appearance during development, its functional and affective meaning (is it a positive or a negative emotion?), especially in human beings. Behaviors accompanied by anger and rage serve many different purposes and the nuances of aggressive behaviors are often defined by the symbolic and cultural framework and social contexts. Nonetheless, recent advances in neuroscientific and developmental research, as well as clinical psychodynamic investigation, afford a new (...) view on the role of anger in informing and guiding many aspects of human conducts. Developmental studies have confirmed the psychophysiological, cognitive and social acquisition that hesitate in the pre-determined sequence appearance of anger and rage in the first two years of life. The so-called affective neurosciences have shown the phylogenetic origin of the two circuits underlying the emergence of anger along with its evolutionary role for promoting survival. This view has been integrated by the psychodynamic theory of motivational systems that attribute a double role to anger: on the one hand, this affect works as an inwardly directed signal concerning a pressure to overcome an obstacle or an aversive situation; on the other hand, anger is also an outwardly directed communicative signal establishing differentiation and conflict within interpersonal relationships and affective bonds. Of course, human peculiar mental functioning requires the appraisal of such signals by higher cortical functions and, there is little doubt that the meaning that orientates individual behaviors is, eventually, construed on a social and cultural level. At the same time, everyday life experiences as well as clinical insights into psychopathic, narcissistic and borderline personality pathology clearly illustrate the necessity to correctly interpret and give answers to the basic questions raised around the topic of anger as a basic emotion. (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)

This article proposes a formal model that integrates cognitive and psychodynamic psychotherapeutic models of psychopathy to show how two major psychopathic traits called lacks remorse and self-aggrandizing can be understood as a form of abnormal Bayesian inference about the self. This model draws on the predictive coding (i.e., active inference) framework, a neurobiologically plausible explanatory framework for message passing in the brain that is formalized in terms of hierarchical Bayesian inference. In summary, this model proposes that these two cardinal (...) psychopathic traits reflect entrenched maladaptive Bayesian inferences about the self, which defend against the experience of deep-seated, self-related negative emotions, specifically shame and worthlessness. Support for the model in extant research on the neurobiology of psychopathy and quantitative simulations are provided. Finally, we offer a preliminary overview of a novel treatment for psychopathy that rests on our Bayesian formulation. (shrink)

I consider two essays by Joel Feinberg: his treatment of the moral obligation to obey the law, and his exploration of the evils of the Holocaust.

In The Rules of Insanity, Carl Elliott draws on philosophy and psychiatry to develop a conceptual framework for judging the moral responsibility of mentally ill offenders. Arguing that there is little useful that can be said about the responsibility of mentally ill offenders in general, Elliott looks at specific mental illnesses in detail; among them schizophrenia, manic-depressive disorders, psychosexual disorders such as exhibitionism and voyeurism, personality disorders, and impulse control disorders such as kleptomania and pyromania. He takes a particularly (...) hard look at the psychopath or sociopath, who many have argued is incapable of understanding morality. Making extensive use of psychiatric case histories, Elliott explores the various ways in which mental illness can affect a person's intentions and thus excuse him or her from moral responsibility. (shrink)

M. Scott Peck's proposed "evil" subtype of narcissistic personality disorder is distinguished from psychopathy by the use of self-deception to keep the emotional consequences of his or her crimes out of conscious awareness. A true psychopath, who does not have a conscience and does not accept morality, has no need of self-deception. Group evil, in Peck's analysis, is related to, and has much in common with, individual evil, including self-deception. There are many models of self-deception, but Davidson's model (...) seems directly relevant to the psychology of evil as described by Peck. This is illustrated with examples from personal experience, Gitta Sereny's biography of Albert Speer and Alexander Solzhenitsyn's account of the Soviet Gulag. (shrink)

Psychopathy fascinates. Modernist writers construct out of it an image of alienated individualism pursuing the moment, killing they know not why, exploiting in passing, troubled, if troubled at all, not by guilt, but by perplexity (Camus 1989; Gide 1995; Mailer 1957; Musil 1996). Psychiatrists and psychologists—even those who should know better—are drawn by it to take off into philosophical speculation about morality, evil, and the beast in man (Mullen 1992; Simon 1996). Philosophers succumb to the temptation of attempting to ground (...) speculation in the supposed facticity of psychopathy. -/- Psychopathy is a cultural construct with roots going back to the eighteenth century, but which only came to full flower over the last fifty years (Hare 1998; Lewis 1974). The currently fashionable constructions of psychopathy find wide acceptance among clinicians and academics. The problem is, however, whether the concept has connections that have been established to the behavior, psychopathology, or the structure and function of brain worthy of according even a modest level of scientific status. There is little point in basing an argument on some supposed scientific gold standard if what glitters is iron pyrites (fools' gold). -/- Neil Levy's opening paragraph contains the statement "Yet in other respects they seem quite irrational; so much so that the term moral insanity has sometimes been applied to them" (p. 129). This both asserts that there is a category "them," namely the psychopaths, and connects them to "moral insanity." Moral insanity entered the language of psychiatry when Pritchard chose to use the term to translate Pinel's category of mania sans deliré (Pritchard 1836). Pinel was attempting to conceptualize a range of disorders that bordered on insanity in the sense of severe disturbances of affect, judgment, and behavior, but that were not accompanied by hallucinations or delusions (Pinel 1798/1964). In today's terminology, the cases he described would probably fall into diagnostic groups, including major depression, bipolar disorder, epilepsy, and a range of personality disorders. A number of his more striking case histories involved antisocial and even murderous behavior, which probably reflected Pinel's role in assessing offenders for the criminal courts of Paris. Pritchard's use of the English word "moral" reflected an appeal first to its use at the time to designate something which was like or similar, but not identical (a usage the OED labels "vulgar"), and second moral in the sense of ethical, conforming to virtuous behavior. Anglophones seized on the latter meaning, although Pinel emphasized the former. Forty years later, Henry Maudsley, the most widely read psychiatrist of his generation, could assert that moral insanity was as real as Colour blindness, some people being Colour blind and some moral blind (Maudsley 1879). Moral insanity became connected variously to phrenology with its own bump over the underlying moral cortex, with the twisted genetics of degeneration, with atavistic theories of criminality, and with a range of disorders of brain from epilepsy to frontal lobe damage (Combed 1853; Ellis 1890; Pick 1989). Although it is anachronistic to use the terms "psychopathy" and "moral insanity" together, it is clear they occupied a similar social and psychiatric space, albeit in different era. This should caution against too ready acceptance of psychopathy which may turn out to be as empty and dangerous a conceptualization as moral insanity. Why dangerous? Dangerous to those labeled, because the morally insane and the moral imbeciles were placed in preventive detention in asylums and prisons, and even sterilized in some jurisdictions. Dangerous to society, because it gave a spurious scientific justification for viewing crime not as reflecting the social evils of deprivation, ignorance, and inequality but as the ravages of the born criminals. -/- Psychopaths are not, as Levy asserts, "(causally) responsible for … more than fifty percent of violent crime" (p. 129). A proportion of violent offenders, which varies widely between observers, are labeled psychopaths. This is often on the basis of Hare's psychopathy checklist, which is a subjective, albeit through training aspiring to be reproducible, and to some extent self-sustaining, evaluation system (Hare 1980, 2003). Part of the checklist gathers data on prior antisocial behavior; part constrains the examiner to subjectively estimate such matters as glibness and callousness, part requires judgments about whether the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Psychiatric Comorbidity:More Than a Kuhnian AnomalyPeter Zachar (bio)Keywordscomorbidity, classification, epidemiology, differential diagnosis, personality disorderDr. Aragona's article in this issue of Philosophy, Psychiatry, & Psychology makes some important points regarding the relationship between comorbidity rates and the classification system currently used in psychiatry. Particularly persuasive is his claim that observed patterns of comorbidity are, in important respects, consequences of the structure of the classification system. I am not convinced, (...) however, that comorbidity is best conceptualized as an artifact of the taxonic structure of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). Instead, I suggest that the use of dichotomies such as true versus artifactual should be used with caution when psychiatric classification is being discussed.In contrast with the artifact hypothesis, I argue that the phenomena covered by the term "comorbidity" are real, expectable features of the psychiatric domain. They are not the phlogiston and luminiferous ether of psychiatry. I am skeptical of the notion that high comorbidity rates as a whole can be understood as Kuhnian anomalies, or that there is a crisis, or that after a period of revolutionary science a new paradigm would eliminate these 'anomalies.' In short, high rates of comorbidity in psychiatry will not simply disappear once scientists develop a better nosological paradigm. High levels of comorbidity can, however, be both lowered and provided a better, evidence-based conceptual framework.Many Conditions, One OrganIn general medicine, comorbidity conventionally refers to the simultaneous occurrence of two independent disease processes or distinct clinical entities, such as heart disease and liver cancer (Feinstein, 1970; Jablensky 2004). The presence of one disease is supposed to affect the other in such a way that the co-occurrence of the two has implications for prognosis and treatment.Comorbidity in psychiatry is a broader concept, referring to a variety of conditions that overlap in multiple ways. The different kinds of overlap are amenable to detailed empirical analysis (e. g., Klein and Riso 1993; Neale and Kendler 1995). Depressive reactions to primary disorders, attention deficit symptoms associated with mania, panic attacks in the context of severe borderline personality disorder, substance abuse disorders among psychopaths, histrionic dynamics combined [End Page 13] with narcissistic personality traits, and emergent conditions such as schizoaffective disorder are all distinct types of comorbidity. The kinds of overlapping conditions just listed are sometimes termed psychiatric comorbidity. Also important is comorbidity between psychiatric disorders and general medical conditions as is studied in behavioral medicine and health psychology. The crisis, if there is one, is a crisis of comorbidities.The heart disease and liver cancer type of comorbidity as independent organ systems being affected is ruled out a priori in psychiatric comorbidity proper. In psychiatry, "psychopathological disease processes" can all be expected to affect a single organ, namely the brain or, more likely, affect the different systems that are tightly integrated in the brain. The tight integration can make putative comorbid psychiatric disorders difficult to disentangle.It is a widely held consensus that causes, not organ systems, are what matter in comorbidity. In this tradition, Dr. Aragona claims that in general medicine shared symptoms between two diseases (such as fever and fatigue) are not a problem because the diseases are differentiated with respect to etiology; in psychiatry, however, where syndromes are differentiated by a description of symptoms only, symptomatic overlap is a problem.Is descriptive psychopathology, therefore, a root cause of the "crisis of comorbidity" and should it be abandoned in favor of etiological classification? Unfortunately, forcing psychiatric nosology to conform to an etiological paradigm is unlikely to resolve the problem of psychiatric comorbidity. As noted, the problem is one of distinguishing between the different etiological disease processes that are affecting tightly integrated systems in the brain. The brain as a whole is a multilevel, dynamic, and open system, which has an ecology (Zachar 2000). As argued by Kendler (2005) and Schaffner (2002, 2008), it has not thus far, and may never be fully possible to segregate causes and their associated psychiatric disorders into parsimonious etiological packages. In the ecology of neuroscience, causes and effects tend to merge in a continuous series of common pathways.It would be foolish... (shrink)

Psychopathy is increasingly in the public eye. However, it is yet to be fully and effectively understood. Within the context of the DSM-IV, for example, it is best regarded as a complex family of disorders. The upside is that this family can be tightly related along common dimensions. Characteristic marks of psychopaths include a lack of guilt and remorse for paradigm case immoral actions, leading to the common conception of psychopathy rooted in affective dysfunctions. An adequate portrait of psychopathy is (...) much more complicated, however. Though some neural regions and corresponding functions are commonly indicated, they range across those responsible for action planning and learning, as well as emotional processes. Accordingly, a complete fine-grained map of all neural mechanisms responsible for psychopathy has not been realized, and even if it were, such a map would have limited utility outside of the context of surgical or chemical intervention. The utility of a neural-level understanding of psychopathy is further limited by the fact that it is only applicable in the clinical identification of individual subjects, and the neuro-chemical/biological correction of those subjects after they are positively identified as psychopaths. On the other hand, an information processing model of moral cognition provides for wider-ranging applications. The theoretical and practical implications for such a feasible working model of psychopathic personalities are assessed. Finally, this chapter raises the possibility of directed modification of social-environmental factors discouraging the development of psychopathic personalities in the first place, modifications which are also open to simulation and testing in terms of the same model of moral cognition. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Psychopathy, Other-Regarding Moral Beliefs, and ResponsibilityLloyd Fields (bio)AbstractIn this paper I seek to show that at least one kind of psychopath is incapable of forming other-regarding moral beliefs; hence that they cannot act for other-regarding moral reasons; and hence that they are not appropriate subjects for the assessment of either moral or legal responsibility. Various attempts to characterize psychopaths are considered and rejected, in particular the widely held view (...) that psychopaths are, in general, incapable of understanding moral concepts. The particular disability proposed here, the incapacity to form other-regarding moral beliefs, is then derived from an analysis of what is required for someone to be a responsible agent. This is illustrated with a detailed case history. A defect of this kind is shown to vitiate moral responsibility, because it renders the psychopath irresponsive to the social pressures which normally ensure respect for moral norms. It is also shown that the psychopath is not a suitable subject for the assessment of legal responsibility, because he lacks the capacity to act from common prudence to avoid sanctions. I conclude that the attempt to characterize particular defects from among the heterogeneity of psychopathic subjects, could lead to better targeted, and hence to more effective, management of particular cases.KeywordsCriminality, mental illness, personality disorder, blame, liability, moral beliefs, guilt, social moralityIntroductionThe term “psychopath” has been used with a wide variety of different meanings and, no doubt, covers a heterogeneous group of subjects (Criminal behaviour and mental health 1992). My aim in this paper is to argue that at least a subgroup of those subjects are characterized by an inability to form other-regarding moral beliefs—and hence, for this particular reason, are not morally responsible agents—and that they also lack the capacity for prudence, and hence are not legally responsible agents.I begin by distinguishing the particular sense in which I will be using the term “psychopathy.” I then consider some suggestions in the literature regarding the defect by which psychopaths might be characterized—that they are mentally ill, or incapable of understanding moral concepts. In rejecting these, I come to the suggestion that the relevant defect is an inability to form other-regarding moral beliefs, a defect which is graphically illustrated by a case report from the literature. I explore the implication of this kind of defect for [End Page 261] moral responsibility as a socially-embedded notion, and the implication of the psychopath’s inability to exercise prudence in relation to legal liability.Nothing in this paper should be taken to suggest that psychopaths are irredeemable. On the contrary, as I argue in an endnote, correctly characterizing the defect from which they suffer leads directly to forms of treatment whose effectiveness has acquired a measure of empirical support.The Nature of PsychopathyPsychopathy is not a homogeneous concept; there are different types of psychopaths. For example, Henderson identified a type of psychopath who he classified as “Predominantly Creative,” exemplified by such figures as T. E. Lawrence and Joan of Arc. In people of this type genius is associated with heightened sensitivity, psychosexual immaturity and emotional instability (Henderson 1939, 108–20; Henderson and Gillespie 1969, 317). Predominantly creative psychopaths do not come within my purview.By “psychopathy” I shall mean the specific form of personality disorder described by Cleckley in his book, The Mask of Sanity (Cleckley 1964). Cleckley’s description forms the basis of Hare’s Revised (20-item) Psychopathy Checklist. The Checklist includes the following personality traits and deviant behaviors:1. Glibness/superficial charm.2. Grandiose sense of self-worth.3. Need for stimulation/proneness to boredom.4. Pathological lying.5. Conning/manipulative.6. Lack of remorse or guilt.7. Shallow affect.8. Callous/lack of empathy.9. Parasitic lifestyle.10. Poor behavioral controls.11. Promiscuous sexual behavior.12. Early behavior problems.13. Lack of realistic, long-term plans.14. Impulsivity.15. Irresponsibility.16. Failure to accept responsibility for own actions.17. Many short-term marital relationships.18. Juvenile delinquency.19. Revocation of conditional release.20. Criminal versatility (Hare 1986, 18). 1This conceptualization resembles in many respects the category of Antisocial Personality Disorder as described in the American Psychiatric... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:On the Importance of Conceptual ContrastsMadness, Reason, and Mad PrideAwais Aftab, MD (bio)Garson (2023) offers an engaging historical and philosophical discussion around the importance Late Modern thinkers assigned to the task of differentiating madness from idiocy (or more specifically, to the tripartite distinction of sanity, madness, and idiocy). Based on this analysis, Garson’s identifies the need to offer a positive account of mental illness—one that does not define the (...) essence of mental illness exclusively as the absence, lack, or failure of the power of reasoning. Following the Late Modern thinkers (Locke, Kant, Wigan, and Heinroth), Garson concludes that madness is infused with reason, and what characterizes madness is the presence of reason in an altered and mutated form. This is all worth taking seriously. My own assessment of this historical and philosophical material nonetheless differs from that of Garson. To recognize madness as possessing reason within it in an altered form may be of less profound significance than he thinks it is. Garson’s discussion commendably highlights the importance of making conceptual contrasts explicit in definitional debates, and this should indeed lead us to search for contrasts that are more philosophically illuminating (what is better will depend on the context of inquiry). However, in my view, the recognition of madness as altered reason neither reframes the project of defining “mental disorder” nor does it provide an intellectual scaffolding for mad activism.The significance of “madness contains reason within in but in an altered or perverse form” is difficult to translate into contemporary scientific terms, and the fuzziness and historical baggage around the terms “madness,” “reason,” and “perversion” does not make it easy. “Mental disorder” or “psychopathology” means to us something quite different than what madness meant to Late Modern thinkers, and while “madness” remains a popular term in philosophical literature, there is no clarity on the nature of overlap between the domain of madness and the domain of conditions currently classified by the diagnostic manuals. Mental disorders, as currently conceptualized, include a motley of conditions that were previously characterized using terms such as idiocy, madness, neuroses, and psychopathic personalities. [End Page 297]From our contemporary vantage point, to compare idiocy and madness is to make a distinction within the domain of psychopathology. We are comparing two groups of psychiatric conditions. The lessons we derive from this comparison do not necessarily extrapolate well to a comparison of mental disorders with something outside the domain of psychopathology. To the extent that psychopathology is inclusive of both idiocy and madness, psychiatric disorders both contain and do not contain “reason” within them. The domain is heterogenous in this regard, and broad generalizations about the nature of reason in the mental disorders would be simplistic at best and inaccurate at worst. Other distinctions that we have made within the domain of psychopathology have included organic versus functional, neurosis versus psychosis, categories versus continua, and distinctions used within nosology have included operationalized criteria versus phenomenology, idiographic versus nomothetic, medical versus non-medical, description versus explanation, and so on (Aftab & Ryznar, 2021; Zachar, Banicki, & Aftab, 2023), all of which have the potential to offer a positive account of some aspect of psychopathology.It is worth nothing that the distinction between “absence of reason” versus “perversion of reason” is analogous to the common distinction between absence of function and altered function in patho-physiology. Such a distinction exists for almost every function that exists. Consider vision: absence of vision (blindness) and altered vision (illusions, distortions, hallucinations). Consider hypoesthesia (reduced sense of touch) and paraesthesia (altered sense of touch—tingling, pricking, burning, etc.). Garson alludes to diminished sexual capacity versus paraphilia as an analogy, but he does not seem to appreciate that the analogy applies much more broadly. Is the distinction between absence of reason versus perversion of reason of any greater significance than the distinction between blindness and hallucination? If we were to say, “What distinguishes hallucination from blindness is not the failure, absence, or lack of sight, but its presence—albeit in a perverse and mutated form,” how profound would it really be for our notions of disorder? Or imagine some Late Modern physician saying that a disturbance of speech and... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Recent and Classic References at the Interface of Philosophy, Psychiatry, and Abnormal PsychologyArticlesAggernaes, A. 1972. The expanded reality of hallucinations and other psychological phenomena. Acta Psychiatrica Scandinavica 48: 220–238.Anonymous. 1991. Child sexual abuse and the limits of responsibility. Lancet 337: 890.Anonymous. 1993. Mental incapacity and medical treatment. Lancet 341: 1123–1124.Appelbaum, M. D., and A. Creer. 1993. Confidentiality in group therapy. Hospital and Community Psychiatry 44: 311–312.Beatson, J. A. 1993. (...) The psychiatrist and peer review—a psychodynamic review of the literature. Australia and New Zealand Journal of Psychiatry 27: 311–318.Berrios, G. E. 1987. Dementia during the seventeenth and eighteenth centuries: a conceptual history. Psychological Medicine 17: 829–837.Blackburn, R. 1988. On moral judgments and personality disorders: the myth of psychopathic personality revisited. British Journal of Psychiatry 153: 505–512.Blackmon, W. D. 1993. Are psychoanalytic billing practices ethical? American Journal of Psychotherapy 47: 613–620.Blashfield, R. K., and J. G. Draguns. 1976. Evaluative criteria for psychiatric classification. Journal of Abnormal Psychology 85, no. 2: 140–150.Blashfield, R. K., J. Sprock, and A. K. Fuller. 1990. Suggested guidelines for including or excluding categories in the DSM-IV. Comprehensive Psychiatry 31, no. 1: 15–19.Blashfield, R. K., J. Sprock, D. Haymaker et al. 1989. The family resemblance hypothesis applied to psychiatric classification. Journal of Nervous and Mental Disease 177: 492–497.Borys, D. S. 1994. Maintaining therapeutic boundaries: the motive is therapeutic effectiveness not defensive practice. Ethics and Behavior 4, no. 3: 267–273.Brown, W. M. 1985. On defining disease. Journal of Medicine and Philosophy 10: 311–328.Bub, J. 1994a. Is cognitive neuropsychology possible? Proceedings of the Biennial Meetings of the Philosophy of Science Association 1: 417–427.Bub, J. 1994b. Testing models of cognition through the analysis of brain-damaged performance. British Journal of Philosophy of Science 45, no. 3: 837–855.Buck, C. 1989. Problems with the Popperian approach: A response to Pearce and Crawford-Brown. Journal of Clinical Epidemiology 42: 185–187.Buck, R. 1994. The neuropsychology of communication: spontaneous and symbolic aspects. Journal of Pragmatics 22, no. 3-4: 265–278.Camp, N. M. 1993. The Vietnam war and the ethics of combat psychiatry. American Journal of Psychiatry 150: 1000–1009.Crockett, C. 1961. Ethics, metaphysics, and psychoanalysis. Inquiry 4: 37–52.Dalton, E., K. Hopper, and S. Reiner. 1976. Ethical issues in behavior control. Values and Ethics in Health Care 2: 1–40.Faust, D. 1993a. Use and then prove, or prove and then use? Some thoughts on the ethics of mental health professionals’ courtroom involvement. Ethics and Behavior 3, no. 3-4: 359–380.Fodor, J., and E. Lepore. 1994. What is the connection principle? Philosophy and Phenomenological Research 54: 4.Foss, L. 1994. Putting the mind back into the body: a successor scientific medical model. Theoretical Medicine 15, no. 3: 291–313.Galletly, C. A. 1993. Psychiatrist-patient sexual relationships: the ethical dilemmas. Australia and New Zealand Journal of Psychiatry 27: 133–139.Glymour, C. 1994. On the methods of cognitive neuropsychology. British Journal of Philosophy of Science 45, no. 3: 815–835.Gottlieb, M. C. 1994. Ethical decision making, boundaries, and treatment effectiveness: a reprise. Ethics and Behavior 4, no. 3: 287–293.Gutheil, T. G. 1994. Discussion of Lazarus’s “How certain boundaries and ethics diminish therapeutic effectiveness”. Ethics and Behavior 4, no. 3: 295–298.Helme, T. 1993. A special defence—a psychiatric approach to formalising euthanasia. British Journal of Psychiatry 163: 456–466.Kovel, J. 1976–77. Therapy in late capitalism. Telos 30: 73–92.Lazarus, A. A. 1994a. How certain boundaries and ethics diminish therapeutic effectiveness. Ethics and Behavior 4, no. 3: 255–261.Lazarus, A. A. 1994b. The illusion of the therapist’s power and the patient’s fragility: my rejoinder. Ethics and Behavior 4, no. 3: 299–306.Lehrman, N. S. 1980. Psychiatric power and responsibility: Abuse and abdication, a proposed corrective conference. The Humanist 40: 9–13.Lockhart, T. 1992. Professions, confidentiality, and moral uncertainty. Professional Ethics: A Multidisciplinary Journal 1, no. 3-4: 33–52.Margolin, S. G. 1964. The scientific status of psychoanalytic clinical evidence (II). Inquiry 7: 37... (shrink)

Psychopathy is among the more widely discussed personality disorders. Psychopathy is intriguing for many reasons, one of which is that many of the most famous and heinous villains, real or imagined, are psychopathic. Understanding how a person could be so evil is clearly a very important, fundamental social concern. Yet, there remains no consensus as to even an authoritative description of the disorder. It is our impression, perhaps incorrectly, that Justman is arguing for a central importance of (...) lack of guilt.We begin by noting that it is only the rare person who has all of the features of a respective personality disorder (Widiger &... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Psychopathy, Other-Regarding Moral Beliefs, and Responsibility”Jennifer Radden (bio)Fields’s line of reasoning may be summarized, though to do so is to lose much that is nice, and important, in the details. He begins by distinguishing the kind of disorder we are dealing with. Psychopathy is a personality disorder: an unchanging, trait-based condition, not a mental disease or illness. Then he asks why we might judge (...) the presence of psychopathy to vitiate moral and legal responsibility, and answers that psychopathy must reflect some kind of disability. It has been hypothesized (by Duff) that this disability concerns moral understanding, but Fields offers an alternative account. Rather than lacking moral understanding, he argues, the psychopath is disabled in that he cannot form other-regarding moral beliefs. A very convincing argument is then made to persuade us that such a disability would—or should—constitute an excuse.Much of this reasoning is unassailable, and Fields’s careful and systematic approach is impressive. Yet I am left with a lingering concern. He has not convinced me that the psychopath is incapable of forming instead of merely disinclined to form the required sort of moral beliefs. And rather than furthering or supporting his incapacity explanation, Cleckley’s example of Milt undermines it.Maybe the example of Milt’s callousness is the place to start, although whether this is as strong an example as Fields and Cleckley seem to think of psychopathy, is questionable. It is a rather underdescribed example, certainly. We are told that this is the unvarying pattern of Milt’s behavior. Indeed, it has to be to fit the clinical definition of psychopathy as a trait-based character disorder rather than a short-lived “out of character” response. And yet Milt has reached driving age and his mother is still naive enough to expect he’ll pick her up! We need to know more. If mother hasn’t grasped Milt’s dispositional traits yet, why not? Perhaps these traits are not so unvarying and entrenched after all. Or mother is colluding, or denying? Perhaps the understanding between mother and son contained meanings not apparent in the bald clinical description provided by Cleckley. There may be more to this story than meets the eye.So I’m not sure that the example successfully illustrates the clinical definition of psychopathy. But let’s say it does. If we accept the story as we are told it, there remains a gap in the reasoning. That Milt lacks the capacity to form such (other regarding) beliefs, and to harbor guilt feelings as Fields asserts, would explain his irresponsible [End Page 287] behavior—why he “so easily gives way to whims, even though he knows that to do so is to leave his mother... stranded”(p. 33).An incapacity to form other-regarding beliefs may explain this behavior, true. But so equally might being someone given to whims. After all Milt might just have the personality trait, also long established and unchanging, that he gives in to whims more often than most. This is what people sometimes mean when they attribute impulsiveness. And impulsiveness is not only a rather common trait; as it happens it is also one associated with this particular disorder (among others).Fields recognizes the type of explanation which refers to the presence of an unthought out impulse to act, a whim explanation. But he fails to give this kind of explanation its due, using it only selectively and arbitrarily. If, as Field establishes, it is more coherent to think that Milt’s initial offer to his mother was a matter of whim—rather than evidence of the other-regarding belief that one ought to concern oneself with the welfare of one’s parents—then there is no reason to suppose that his failure to follow through and pick her up was not also a whim. This second whim represents an equally satisfactory (simple, plausible, explanatory, not ad hoc ) explanation: Milt might have come to pick up his mum but he whimfully chose not to.And this is a separate and distinct explanation from the one Fields proposes in terms of incapacity. A whim is not (immediate) evidence of incapacity... (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 lieu of an abstract, here is a brief excerpt of the content:Commentary on “Psychopathy, Other-Regarding Moral Beliefs, and Responsibility”R. A. Duff (bio)AbstractI make four criticisms of Fields’s account of one type of psychopathy as a responsibility-negating personality disorder which involves an incapacity to form other-regarding moral beliefs. First, his account of what it is to hold moral beliefs (in terms of accepting universal practical principles) actually specifies neither a necessary, nor a sufficient, condition for holding a moral (...) belief. Second, he is too quick to dismiss the suggestion that what psychopaths suffer from is an inability to understand moral concepts and values. Third, he does not show why we should ascribe an incapacity to accept moral beliefs to the psychopath, rather than a culpable failure to do so. Fourth, he suggests too weak a criterion of criminal liability, as requiring only the capacity to act for prudential reasons.KeywordsMoral beliefs, moral understanding, incapacity, criminal liabilityFields argues that we can properly count at least one type of psychopathy as a personality disorder which negates moral responsibility. This is not because, as others have argued, such psychopaths cannot understand moral concepts and moral values, but because they suffer an incapacity to form other-regarding moral beliefs, i. e., to accept practical moral principles; we cannot hold them morally responsible for failing to accept or obey moral principles which they lack the capacity to accept. Nor, he also argues, should we hold them criminally liable, since they lack that capacity to act for prudential reasons to which a deterrent system of law appeals.His paper rightly emphasizes the interdependence of psychiatry and philosophy, in this as in other contexts. A psychiatric account of psychopathy as a disorder involving some kind of moral incapacity must depend for its precise sense on an adequate account of the concepts of moral capacity and incapacity: an account which should draw on the resources of moral philosophy. Philosophers who aim to understand those concepts will do well to attend, as Fields does attend, to psychiatric discussions and case histories: not only because this is necessary if their comments on mental disorder or on psychopathy are to be adequately informed, but also because careful attention to the problematic phenomena of mental disorder can also illuminate our understanding of the rational powers and capacities which are lacking or distorted in the disordered, and which philosophers hope to analyze. Fields is also clearly right to emphasize that the criteria of moral responsibility might not be the same as the appropriate [End Page 283] criteria of criminal liability: that the question of whether psychopaths should be criminally liable cannot necessarily be answered simply by determining whether they are morally responsible.However, I do not think that he has provided an adequate account of psychopathy as a personality disorder which negates moral responsibility and criminal liability. I will comment on four aspects of his discussion.First, as Fields recognizes, one who wants to argue that psychopaths lack the capacity to form moral beliefs owes us an account of what it is to form, or hold, a moral belief. Fields’s account is familiar, but arguable. To hold a moral belief is to accept, and to be motivated by, a universal practical principle: a principle which one regards as providing very strong reasons for action, and breaches of which arouse such responses as (third-person) disapproval or (first-person) guilt. It could be plausibly objected, however, that accepting some universal practical principle is neither a necessary nor a sufficient condition for holding a moral belief.It is not a sufficient condition, partly because not any universal practical principle which an agent treats as being important can intelligibly count as a moral principle. The principle “One should never split an infinitive” cannot, by itself, count as a moral principle; and if someone treated it as if it were a moral principle, we would judge his moral understanding, and his rational capacities, to be seriously impaired. This suggests that a purely formal account of the “moral,” like Fields’s (an account that pays no attention to the content of what could count as a moral principle) cannot be adequate (see Foot 1978). A further, related reason for the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Explication or Explanation?Giovanni Stanghellini (bio) and Mario Rossi Monti (bio)Keywordsexplanation, explication, interpretation, phenomenology, psychopathologyMike Martin's paper raises questions about the process and the effectiveness of psychotherapy in the case of an Iraq war veteran, Colin, described by Dr. Bailey in his essay “A Painful Lack of Wounds”: does psychotherapy succeed? If so, why does it succeed? How far is and should psychotherapy be value free? The clinical phenomenon discussed (...) in this paper is defined as a serious but not severe depression occurring upon returning from the Iraq war. The impression, from the vantage point of a psychotherapist, is that too many details are lacking from the account that is provided and that the case is hurriedly explained away invoking a naturalistic evolutionary model.The psychotherapeutic, as well as the clinical (Stanghellini 2007) and the research (Stanghellini and Ballerini 2008) interview is a quest for meaning. Its first concern is an accurate unfolding of subjective experiences and the organization of these experiences according to a pattern of sense that is immanent to the experiences themselves; the interpretation or the explanation of these experiences according to a model that is not immanent in the clinical material itself may come as a later step.The first step may be called the explication of case material. It consists in bringing out the raw feelings of the patient's experiences and the personal meanings that the patient attributes to his experiences. Here is a list a questions that a clinician would (tactfully) address to Dr. Bailey's patient to enrich the clinical explication of this case (a great deal of questions, of course, can be found also in Martin's [2009] commentary): What are the phenomenal features of Colin's “depression”? Which thoughts and emotions are involved? Anxiety? Anguish? Fear? Frustration? Anger? Irritability? Sadness? Apathy? Guilt? Shame? Which other experiences are involved, for example, physical pains or somatic symptoms? What is it like for Colin not to have proven his “manhood” in Iraq? What does it mean for him to be a “man”? Why does he want to be a man? How does it look like his “ideal” man? How does he exactly feel and what does he mean by “being a wimp”?We also need to illuminate the internal relations of dependence between these experiences: are these phenomena each one independent form the others, or can we find a meaning organizer among them (Rossi Monti and Stanghellini 1996), for instance a core emotion that let us understand the manifold of symptoms as a unitary structure? Does Colin feel angry for not being assigned to a combat duty? Or guilty because he did not object to this? Or does he feel ashamed because he was judged not suitable for a combat duty? Apparently, there is a “basic” wound here, maybe a narcissistic one—the epicenter of a story that reminds us of Ajax's “madness” when the Greek generals did not offer [End Page 237] him Achilles’ weapons. Looking for this wound with Colin and through Colin's words is much different from endorsing an armchair theory of his “depression.” The latter reminds us of someone who feels full after reading the restaurant menu.We need to look for the relations between these clinical phenomena and the situation (event) in which they take place: what do we know about the pathogenetic situation? We know that the same person in different situations can behave and be valued in opposite ways. As Kretschmer pointed out, persons that in times of peace psychiatrists would label as psychopathic personalities in troubled times become celebrated heroes. In the same manner, a boy with an antisocial personality disorder can become a hero if he put his “qualities” to the service of military special forces. In particular, what did Colin expect from enrolling in the army? His expectations were his own or someone else's hopes? What happened exactly in Iraq? What does “Iraq” mean for the patient? What did he do and what did he not do to become a “man” or a hero there? Is Iraq the only place where someone can demonstrate to be a man? Is being a hero the only valuable way... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Response to the CommentariesLloyd FieldsAbstractIn this response, I address three points raised in the commentaries: the question of whether there is a legitimate formal use of “moral,” the claim that a certain sort of affective capacity is required for acquiring the capacity to form other-regarding moral beliefs, and the problem of how to show that psychopaths lack the capacity to form other-regarding moral beliefs. I maintain that there is (...) a use of “moral” according to which moral beliefs need not be rational. Regarding the affective capacity that Adshead identifies, I explain that I had not intended that such a capacity be constitutive of a moral belief, even an other-regarding one. I then try a new approach, in the light of Adshead’s commentary, to the third point addressed, according to which the psychopath is unable to form other-regarding moral beliefs because a causally necessary condition for doing so is absent in him.KeywordsMoral beliefs, moral understanding, personality disorder, empathy, incapacity, responsibilityThe criticisms offered in the three excellent commentaries on my paper raise deep and important issues. I agree with many of the points made and will respond to three key issues: (1) the question of whether there is a legitimate formal use of “moral”; (2) the claim that there is a certain sort of affective capacity that is required in order to form other-regarding moral beliefs; (3) the problem of how to show that psychopaths lack the capacity to form other-regarding moral beliefs.I concede that Duff establishes (Duff 1977) that the psychopath lacks moral understanding in Duff’s own content-based sense of “moral.” It is illuminating, however, to emphasize that in my formal sense a psychopath of the kind that I consider in my paper is capable of some degree of understanding of “moral” concepts. Unlike Duff, I do not build rationality into my account of moral principles. Hence, I can accommodate eccentric, irrational or even “crazy” moral beliefs like that of Duff’s split-infinitive fanatic. A person can have irrational factual beliefs; why not irrational moral beliefs?Adshead in her commentary attributes to me the claim that moral beliefs, including other-regarding beliefs, “result” in a disposition to experience certain emotions, and to have certain attitudes in certain situations. She then writes, “it is arguable that the disposition to experience certain emotions and have certain attitudes towards others could be critical to acquiring the capacity to have other-regarding beliefs.” There is only an apparent disagreement here. First, I intended to claim that a disposition to experience certain emotions, etc., is partly constitutive of having a moral belief, not a result of having one. Second, in specifying my third condition of having a moral belief, I had in mind such attitudes and emotions as approval, disapproval, indignation and remorse. Adshead identifies an affective capacity, aspects of which are the recognition of, empathy with, and sympathy with, another’s distress. This capacity seems to correspond more or less to what Rousseau described as “natural compassion” (Rousseau [End Page 291] 1973, 66–69), which arises prior to reflection and the use of reason, and which is exemplified by a mother’s responsiveness to the distress of her child. Rousseau distinguished natural compassion from moral virtues, which require the use of reason. I agree with Adshead that having this affective capacity is likely to be critical to acquiring the capacity to have other-regarding moral beliefs.Radden’s incisive commentary poses the problem of how to show that the psychopath lacks the capacity to form other-regarding moral beliefs, since this does not follow from the fact that he fails to form them. In the light of Adshead’s commentary, I should like to try a different approach to this problem. At least one type of situation in which we say that something, x, cannot do a certain sort of thing, d, is one where a causally necessary condition for x doing d is absent. For example, we should say of a car, not simply that it does not run, but that, as it is presently constituted, it cannot run, if we found that the carburetor of its... (shrink)

How psychopaths and their capacity for moral action are viewed is not only philosophically interesting but is also important and relevant for policy. The philosophical discussion of psychopathy has focussed upon the psychological faculties that are prerequisites for moral responsibility and empirical findings regarding psychopathy that are relevant to philosophical accounts of moral understanding and motivation. However, there are legitimate worries about whether psychopathy is a robust scientific construct, and there are risks attached to reifying psychopathy or other psychiatric constructs. (...) We defend the concept of psychopathy by pointing out the relevance of empirical studies about it for our ordinary practices of ascribing moral responsibility and folk psychological accounts of moral understanding and motivation. (shrink)

This article critically examines Louis Charland’s claim that personality disorders are moral rather than medical kinds by exploring the relationship between personality disorders and virtue ethics. We propose that the conceptual resources of virtue theory can inform psychiatry’s thinking about personality disorders, but also that virtue theory as understood by Aristotle cannot be reduced to the narrow domain of ‘the moral’ in the modern sense of the term. Some overlap between the moral domain’s notion of character-based ethics (...) and the medical domain’s notion of character-based disorders is unavoidable. We also apply a modified version of John Sadler’s “moral wrongfulness test” to borderline and narcissistic personality disorders. With respect to both diagnoses, we argue that they involve negative moral evaluations, but may also have indispensable nonmoral features and, therefore, classify legitimate psychiatric disorders. (shrink)

Several researchers point to disorganized attachment as a core feature of borderline personality disorder (BPD). However, recent studies suggest that specific internal working models (IWMs) of each parent combine to account for child outcomes and that a secure relationship with one parent can protect against the deleterious effects of an insecure relationship with the other parent. It was thus hypothesized that adolescents with BPD are more likely to be disorganized with both their parents, whereas non-clinical controls are more (...) secure with at least one of their caregivers. Thirty-six adolescents with BPD and 30 control participants (aged 13-19) were included. Psychiatrist diagnosis was verified with the SIDP-IV and comorbidity was assessed using the Kiddie-SADS. Reported trauma was assessed with the Childhood Trauma Questionnaire. Attachment IWMs of each parent were assessed with the Attachment Multiple Model Interview (AMMI), which enables separate coding for each attachment figure and in which disorganization is conceptualized as conflicting attachment strategies within a specific relationship. Results of a logistic regression analysis suggested that beyond insecure attachment, being disorganized not just with one but with both parents is particularly characteristic of adolescents with BPD. Conversely, belonging to the non-clinical group was predicted by higher security scores with the father and lower deactivation with the mother. Although higher levels of childhood abuse or neglect were reported by adolescents with BPD, the retained attachment dimensions predicted group membership over and above reported trauma. These findings have important implications for clinical intervention and highlight the protective role fathers may have. (shrink)

Many feminist researchers have been critical of the psychiatric category of borderline personality disorder 1 and have emphasized the gendered nature of the diagnosis. It is estimated that people diagnosed with BPD comprise 1 to 2 percent of the general population in the United States in a given year, and that women represent 75 percent of those diagnosed.2 Critics have argued that the diagnosis reinforces double-binds for women and pathologizes traits associated with both conventional femininity, such as emotionality, (...) dependency, and self-destructiveness, and unconventional femininity, such as rebelliousness and sexual promiscuity (Lester 2013; Potter 2009; Shaw.. (shrink)

The diagnostic category of borderline personality disorder (BPD) has come under increasing criticism in recent years. In this paper, we analyze the role and impact of epistemic injustice, specifically testimonial injustice, in relation to the diagnosis of BPD. We first offer a critical sociological and historical account, detailing and expanding a range of arguments that BPD is problematic nosologically. We then turn to explore the epistemic injustices that can result from a BPD diagnosis, showing how they can lead (...) to experiences of testimonial injustice which impede patient engagement in meaning-making activities, thereby undermining standard therapeutic goals. We conclude by showing how our arguments bolster ongoing efforts to replace the diagnostic category of BPD with alternatives such as complex post-traumatic stress disorder. (shrink)

'Cruel' simply ignores the supposed fact/value dichotomy and cheerfully allows itself to be used sometimes for a normative purpose and sometimes as a descriptive term.Personality disorders have always attracted considerable attention within the philosophy of psychiatry. It was not until two papers written by Louis Charland, however, that they simulated a wider and lively debate. The importance and, at least partly, the strength of Charland's analyses lie in the fact that they are relatively particular and focused in their...

Whether treatment decision-making capacity can be meaningfully applied to patients with a diagnosis of “personality disorder” is examined. Patients presenting to a psychiatric emergency clinic with threats of self-harm are considered, two having been assessed and reviewed in detail. It was found that capacity can be meaningfully assessed in such patients, although the process is more complex than in patients with diagnoses of a more conventional kind. The process of assessing capacity in such patients is very time-consuming and (...) may become, in itself, a therapeutic intervention. (shrink)

The traditional view that having a personality disorder, unlike other mental disorders, is not usually reason enough to consider a person incompetent to make healthcare decisions is challenged. The example of a case in which a woman was treated for a physical disorder without her consent illustrates that personality disorder can render a person incompetent to refuse essential treatment, particularly because it can affect the doctor–patient relationship within which consent is given.