treating psychopaths -- 8/27/15

Today's encore selection -- from "Inside the Mind of a Psychopath" by Kent A. Kiehl and Joshua W. Buckholz. The bizarre world of psychopaths, and the equally bizarre world of psychopathy treatment. Some researchers have estimated that as many as 500,000 psychopaths inhabit the U.S. prison system, and there may be another 250,000 more living freely -- perhaps not committing serious crimes, but still taking advantage of those around them. Psychopathy is caused in large part by differences in biology. Images of psychopaths' brains made by Kent A. Kiehl show a pronounced thinning and underdevelopment of the paralimbic tissue, and area which includes the orbitofrontal cortex, the amygdala, the anterior cingulate cortex and the insula:

"Between the two of us [authors], we have interviewed hundreds of prison inmates to assess their mental health. We are trained in spotting psychopaths, but even so, coming face to face with the real article can be electrifying, if also unsettling. One of the most striking peculiarities of psychopaths is that they lack empathy; they are able to shake off as mere tinsel the most universal social obligations. They lie and manipulate yet feel no compunction or regrets -- in fact, they don't feel particularly deeply about anything at all. ...

"Psychopaths are curiously oblivious to emotional cues. In 2002 James Blair of the NIMH showed that they are not good at detecting emotions, especially fear, in another person's voice. They also have trouble identifying fearful facial expressions. ...

"Psychopaths often cover up their deficiencies with a ready and engaging charm, so it can take time to realize what you are dealing with. Kent A. Kiehl used to ask inexperienced graduate students to interview a particularly appealing inmate before acquainting themselves with his criminal history. These budding psychologists would emerge quite certain that such a well-spoken, trustworthy person must have been wrongly imprisoned. Until, that is, they read his file -- pimping, drug dealing, fraud, robbery, and on and on -- and went back to reinterview him, at which point he would say offhandedly, 'Oh, yeah, I didn't want to tell you about all that stuff. That's the old me.'...

"A man we will call Brad was in prison for a particularly heinous crime. In an interview he described how he had kidnapped a young woman, tied her to a tree, [abused] her for two days, then slit her throat and left her for dead. He told the story, then concluded with an unforgettable non sequitur. 'Do you have a girl?' he asked. 'Because I think it's really important to practice the three C's -- caring, communication and compassion. That's the secret to a good relationship. I try to practice the three C's in all my relationships.' He spoke without hesitation, clearly unaware how bizarre this self-help platitude sounded after his awful confession. ...

"Thanks to technology that captures brain activity in real time, experts are no longer limited to examining psychopaths' aberrant behavior. We can investigate what is happening inside them as they think, make decisions and react to the world around them. And what we find is that far from being merely selfish, psychopaths suffer from a serious biological defect. Their brains process information differently from those of other people. It's as if they have a learning disability that impairs emotional development. ...

"Kiehl has launched an ambitious multimillion-dollar project to gather genetic information, brain images and case histories from 1,000 psychopaths and compile it all into a searchable database. ... Between 15 and 35 percent of U.S. prisoners are psychopaths. Psychopaths offend earlier, more frequently and more violently than others, and they are four to eight times more likely to commit new crimes on release. In fact, there is a direct correlation between how high people score on the 40-point screening test for psychopathy and how likely they are to violate parole. Kiehl recently estimated that the expense of prosecuting and incarcerating psychopaths, combined with the costs of the havoc they wreak in others' lives, totals $250 billion to $400 billion a year. No other mental health problem of this size is being so willfully ignored.

"Billions of research dollars have been spent on depression; probably less than a million has been spent to find treatments for psychopathy. ... There is room for optimism: a new treatment for intractable juvenile offenders with psychopathic tendencies has had tremendous success. Michael Caldwell, a psychologist at the Mendota Juvenile Treatment Center in Madison, Wis., uses intensive one-on-one therapy known as decompression aimed at ending the vicious cycle in which punishment for bad behavior inspires more bad behavior, which is in turn punished. Over time, the incarcerated youths in Caldwell's program act out less frequently and become able to participate in standard rehabilitation services. A group of more than 150 youths treated by Caldwell were 50 percent less likely to engage in violent crime afterward than a comparable group who were treated at regular juvenile corrections facilities. The young people in the regular system killed 16 people in the first four years after their release; those in Caldwell's program killed no one."


author:

Kent A. Kiehl and Joshua W. Buckholtz

title:

"Inside the Mind of a Psychopath"

publisher:

Scientific American Mind

date:

September/October 2010

pages:

22-29

COMMENTS (2)

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badmemory@att.net

Yesterday at 1:53pm
Methinks psychopaths are more common than the authors' estimate. For example, politicians commonly exhbit signs of psychopathy. They are charming, extraordinary liars, often show little or no feeling or remorse about the consequences of their acts, and, most notably, are sometimes caught red-handed committing illegal acts that violate the very causes or legislation they support. Can they not, when possible, be subjected to brain scans such as those employed by the authors to test their hypothesis? Let the public beware.

peter.inova@mac.com

Yesterday at 12:01pm
I know that there are non-criminal psychopaths, but does that mean it shows up in a broad spectrum or is it most often a pathology that appears positive/negative? Would a criminal like Bernie Madoff be appropriately characterized as psychotic?


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