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Handbook of PsychopathyReview - Handbook of Psychopathy
by Christopher J. Patrick (Editor)
Guilford Press, 2005
Review by John Z. Sadler, MD
May 16th 2006 (Volume 10, Issue 20)

Psychopathy is a fuzzy concept with an extensive pedigree in clinical psychology, psychiatry, and medicine. The Handbook of Psychopathy is the first comprehensive textbook on the subject that I have seen, and for that reason alone will be of substantial interest to clinicians and researchers working with clients/patients/subjects at the margins of the mental health/criminal justice system interface. At 651 pages, large format, and small type, it functions as a reference work, and will be read through by only a few -- I should confess that I could not read the whole book within the confines of my review period.

The book is edited with multiple authors, and the selection of authors is relevant and authoritative. The book is broken into six sections, "Theoretical and Empirical Foundations," "Issues in Conceptualization and Assessment," "Etiological Mechanisms," "Psychopathy in Specific Populations," "Clinical and Applied Issues," and "Conclusions and Future Directions." Each of these sections, with the exception of the last, feature multiple chapters.

Overall, the book is well-organized, carefully edited for typographical errors, (but not so much stylistic ones), and covers most all one could desire, with important exceptions. The book exhibits the character of the discipline of its author, a psychologist, in that the empirical core of the work is R. D. Hare's PCL-R instrument, and the psychopathy concept is approached primarily from the empirical-descriptive perspective, rather than a historical, philosophical, clinical, or etiological one. This is not to say that the treatment of the subject is skewed, however. The material here will be of substantive interest to clinical and research psychiatrists as well as psychologists, and perhaps to criminologists, specialists in mental health law, and others. I expect to turn to this book again and again.

The flaws of this book reflect many of the problems with the psychopathy concept and its surrounding literature. Through 31 chapters one gets a dizzying array of ways to cut the psychopathy pie; the use of Hare and Cleckley as benchmarks is helpful but can only accomplish so much. It is difficult to generalize findings from one set of empirical data gathered under one version of the construct, to other findings based on similar or only partially overlapping constructs. This is particular acute in considering the etiological chapters. The "antisocial" and "psychopathy" concepts are often used interchangeably; molecular strategems focus on aggressivity crudely conceived with little to no relation to the more finely grained Hare or Cleckley constructs. It is clear from this book that we are not on the same page with the "psychopathic" cluster of phenomena. There is a lot of integrative and synthetic scientific work to do.

My substantive criticisms of this book emerge from editorial interests as well as from limitations in content. As an edited volume, the chapters are referenced individually, so one must search by chapter for a particular citation without a comprehensive reference list at the end. Similarly, the index is of limited use for reference purposes. While thoughtfully broken into a name and subject index, the breakdown of entries is curtailed. For instance, the name index entry for R. D. Hare has 208 separate page references noted, but no breakdown by subject within the entry. In terms of content, a chapter on the history of the psychopathy concept seems like a natural one to me, given the rich heritage of the concept, and the shouting need for a perspective on the mutations of the concept. Moreover, other than Patrick's concluding chapter (which is very good within its own constraints), there is little effort to help the reader trace the variations of the protean psychopathy concept and link these variations to particular research traditions, programs, and findings. Indeed, Patrick's concluding advocacy for a return to Cleckley casts doubt about the real gains of the meticulously done empirical research reviewed throughout his preceding pages. One is left with a lingering hunger for an executive intelligence to help guide us toward what this all means, what we are sure of, what we aren't, and what impact these interpretations could have on practice and research.

 

2006 John Z. Sadler

 

John Z. Sadler, M.D. is Professor of Psychiatry and Director of the Program in Ethics in Science and Medicine at the University of Texas Southwestern Medical Center at Dallas, and author of Values and Psychiatric Diagnosis (Oxford University Press, 2005).


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