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THE CRIMINAL PSYCHOPATH: HISTORY, NEUROSCIENCE, TREATMENT, AND ECONOMICS
Kent A. Kiehl and Morris B. Hoffman
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Abstract
The manuscript surveys the history of psychopathic personality, from its origins in psychiatric folklore to its modern assessment in the forensic arena. Individuals with psychopathic personality, or psychopaths, have a disproportionate impact on the criminal justice system. Psychopaths are twenty to twenty-five times more likely than non-psychopaths to be in prison, four to eight times more likely to violently recidivate compared to non-psychopaths, and are resistant to most forms of treatment. This article presents the most current clinical efforts and neuroscience research in the field of psychopathy. Given psychopathy’s enormous impact on society in general and on the criminal justice system in particular, there are significant benefits to increasing awareness of the condition. This review also highlights a recent, compelling and cost-effective treatment program that has shown a significant reduction in violent recidivism in youth on a putative trajectory to psychopathic personality.
Psychopaths consume an astonishingly disproportionate amount of criminal justice resources. The label psychopath is often used loosely by a variety of participants in the system—police, victims, prosecutors, judges, probation officers, parole and prison officials, even defense lawyers—as a kind of lay synonym for incorrigible. Law and psychiatry, even at the zenith of their rehabilitative optimism, both viewed psychopaths as a kind of exception that proved the rehabilitative rule. Psychopaths composed that small but embarrassing cohort whose very resistance to all manner of treatment seemed to be its defining characteristic.
Psychopathy is a constellation of psychological symptoms that typically emerges early in childhood and affects all aspects of a sufferer’s life including relationships with family, friends, work, and school. The symptoms of psychopathy include shallow affect, lack of empathy, guilt and remorse, irresponsibility, and impulsivity (see Table 1 for a complete list of psychopathic symptoms). The best current estimate is that just less than 1% of all noninstitutionalized males age 18 and over are psychopaths.1 This translates to approximately 1,150,000 adult males who would meet the criteria for psychopathy in the United States today.2 And of the approximately 6,720,000 adult males that are in prison, jail, parole, or probation,3 16%, or 1,075,000, are psychopaths.4 Thus, approximately 93% of adult male psychopaths in the United States are in prison, jail, parole, or probation.
Table 1
Table 1
The 20 Items Listed on the Psychopathy Checklist-Revised (Hare 1991; 2003)
Psychopathy is astonishingly common as mental disorders go. It is twice as common as schizophrenia, anorexia, bipolar disorder, and paranoia,5 and roughly as common as bulimia, panic disorder, obsessive-compulsive personality disorder, and narcissism.6 Indeed, the only mental disorders significantly more common than psychopathy are those related to drug and alcohol abuse or dependence, depression and post-traumatic stress disorder.
No matter where one stands on the long-debated question of whether “nothing works” when it comes to criminal rehabilitation,7 there is no doubt that the psychopath has grossly distorted the inquiry. Psychopaths are not only much more likely than non-psychopaths to be imprisoned for committing violent crimes,8 they are also more likely to finagle an early release using the deceptive skills that are part of their pathologic toolbox,9 and then, once released, are much more likely to recidivate, and to recidivate violently.10
