INTRODUCTION
Does the world need another book on psychopaths?1 After all, it seems we have heard or read just about everything there is to say about this most misunderstood of characters. Are they evil from birth? Are they created by perverse or abusive family dynamics? Why do some psychopaths make for such compelling fictional characters? Is my ex or boss a psychopath?
I am not a psychiatrist, someone who diagnoses and treats mental disorders, nor a forensic psychologist, who studies the minds, brains, and behavior of criminals, although I have worked extensively with some of the most influential and experienced members of both professions. My background is a bit different: I originally trained in sociology, a discipline mainly concerned with understanding patterns of relationships and social interaction and which rarely deals with the individual. However, I have worked directly with criminal psychopaths in secure hospitals and in the community for over fifteen years. I have eaten with psychopaths, laughed and cried with them. I have seen them bleed and, in one case, die. They have manipulated me; I have probably manipulated them. And many words have been said—usually not by me—that should never be said by one human to another.
Throughout this time, conducting research, performing assessments and running treatment groups, I have built up both a wealth of experience of how psychopaths interact with people, and a resolute skepticism about the way that psychiatry and forensic psychology views psychopaths. Today I work in a psychiatry department that prides itself on a bio-psychosocial understanding of mental disorder, which means that we always try to understand what influence the circumstances in which people grew up have on their adult lives, when thinking about mental disorder. This is critically important in formulating a treatment plan that can help to persuade a person that there are positive reasons to change, and to avoid re-creating the traumatic, abusive, or neglectful environments of their childhood.
My belief is that to understand people we should always focus on relationships rather than traits and diagnosis, and so I feel I can offer a slightly different perspective on this most misunderstood of personalities. Psychopaths don’t exist in a vacuum; their disorder is about the way they understand and interact with other people, about the relationships they form. One of the questions I sometimes ask my students is whether a psychopath would be able to survive on a desert island far away from other humans. My answer to this is: yes, absolutely. Someone with a diagnosis of, say, schizophrenia or dementia would be unlikely to cope in such an isolated setting on their own and would probably perish. I think a psychopath would thrive.
I also hope I can offer some clarity about what makes a psychopath and whether they can change. There are too many contradictory statements about what the term “psychopath” means and whether treatment always makes psychopaths worse rather than better. There’s a smorgasbord of stubborn misconceptions about people with a psychopathic disorder that come partly from our tendency—and this was certainly the perspective I had when I first started working in secure mental health services in 2004—to think of psychopathy as a footnote for a kind of supervillain, bereft of a moral compass and totally Machiavellian in their expert manipulation of others. In fact, years of experience have taught me that the reality is less dramatic, but perhaps far more unsettling: that psychopaths are, in the vast majority, not experts in much at all, and certainly not intellectual puppet masters like Thomas Harris’s Hannibal Lecter. Rather, they are individuals who, through a toxic and statistically unlikely combination of genetic bad luck and a desperate emotionally, physically, or financially deprived upbringing, have come to lack some of the most basic social skills, powers of reasoning, and emotional responses that contribute so much to making us human. This, I aim to show, is what makes a psychopath.
I want to show how a single word, “psychopath,” is far too narrow a term to capture the diversity of people who have attracted the label. I want to highlight the kind of disturbed environments that create psychopaths and the “containers”—prison and, to a lesser extent, psychiatric hospitals—that perpetuate their social and personal dysfunction, allowing them to hone their skills of manipulation and sadism.
My hope is that the anonymized case studies in this book, each one an amalgamation of the characters whom I have come across in my professional life, help to humanize psychopaths, and help the reader understand why it is so difficult for these men and women to form the kinds of social and emotional relationships we take for granted.
I am interested in whether it is fair to morally judge psychopaths and whether there is a degree of complicity between all of us, professionals and the general public alike, in consigning them to the dustbin of humanity. I think that, more often, professionals working in mental health and criminal justice systems adopt the easier and attractive judgmental perspective on psychopaths, perceiving them as “impossible to rehabilitate” or “naturally evil.” This way, when things go wrong and someone loses their job for a breach of professional ethics for allowing themselves to be manipulated by a psychopath, we comfort ourselves with the notion that the psychopath is simply a genetic aberration we cannot help but can only be intimidated or controlled by. Similarly, if clinicians have nothing to offer someone with psychopathy, this becomes a self-fulfilling prophecy: “I can’t help you, so you must be bad.”2
Combine this with the psychopath’s tendency toward violence, manipulation and controlling behavior, and you’ll find that working with them is very rarely a straightforward or satisfying task. Psychopaths tend to reoffend more prolifically and more quickly than other offenders: one study says that up to 90 percent of psychopathic offenders will be reconvicted of a violent offense within twenty years.3 Diligence and persistence are often rewarded with disappointment and frustration, and sometimes a complaint or a colorful metaphor about your parentage.
This book describes composites of people I have dealt with in my career and some publicly visible ones. They include Danny, a man who is more of a danger to himself than to anyone else. Eddie, who has a terrifying history of violence but has turned away from that life and found empathy and remorse. And Angela, a woman who perhaps scares me more than any of the men I describe. In some way each story challenges the misconceptions about psychopaths, and they will hopefully give you a different perspective on the disorder and the kind of person that springs to mind when we use the word.
CHAPTER ONE
The Masks of Psychopathy
Although psychopathy has been one of the most important and written-about topics of forensic psychiatry and psychology over the last thirty years, it’s astonishing how little we really understand it. In part, this makes sense: psychopaths are not common, the largest group of them are in the criminal justice system, and increasingly doing research in prisons and forensic hospitals is expensive, complex, and often unrewarding. Not to mention, of course, that most psychopaths in prison are probably quite bored and, well, psychopathic: meaning that some of them will be entirely uninterested in engaging in research at all—after all, what would they gain?—and another group will see any research project as an opportunity to present themselves in a particular, usually favorable, light that doesn’t have any basis in reality. Or they’ll just tell some fantastic whoppers and watch the researcher squirm as they try to weigh social convention against the urge to laugh, scream, or slap their research participant (or all three). This is a bit of a shame, because in the early 2000s a lot of progress was made in trying to understand that there were probably several different kinds of psychopath, and that using a single word to describe them all was increasingly problematic.
I want to tease apart the idea that the word “psychopath” or the diagnosis of “psychopathy” refers to a single type of person, instantly recognizable from just about every television program with a one-dimensional bad guy (or gal, more of which later): in fact, people with a diagnosis of psychopathy can differ quite fundamentally from one another in several significant ways. Understanding this and why it might be will prepare you a bit for the variety of presentations—the variety of “masks” that psychopaths wear, or that we project onto them—that we’ll meet in the chapters that follow.
Copyright © 2020 by Dr. Mark Freestone
