This is an excellent collection of
essays, remarkably consistent in tone and quality, that presents comprehensive
coverage of the latest work on psychopathy.
While the book is aimed at practitioners psychologists and
psychiatrists in both forensic and non-forensic settings it is readily
accessible to philosophers with an interest in the moral psychological
implications of psychopathy. All the
authors presume a basic familiarity with Cleckleys seminal treatise on psychopaths
(The Mask of Sanity ), but there are plenty of useful references
for catch-up reading. Indeed, the last
of four Appendices is a wonderful, topically organized Bibliography.
Seventeen chapters are organized
into three main sections. The first
focuses on conceptual issues, the second on clinical issues, and the third on
applications of the construct of psychopathy in a wide variety of areas,
including the treatment and management of substance abusers and sex offenders,
hostage negotiation, and industrial-organizational psychology. There is not a dull paper here. And without repetition or awkwardness, each
paper speaks to one or both of the books two main themes.
The first of these is to correct
the common misunderstanding that psychopathy and antisocial personality
disorder (ASPD) are identical. ASPD
appears as a Personality Disorder in DSM-IV, while psychopathy does
not. This is more than a mere
terminological matter. A diagnosis of
ASPD is warranted on the basis of a series of predominantly behavioral
criteria, whereas psychopathy, now reliably measured by Hares Psychopathy
Checklist (revised), is composed of two stable factors. Factor 1 captures personality traits
of callousness, lack of remorse, low empathy and low anxiety (among
others). Factor 2 captures behavioral
traits such as thrill-seeking, irresponsible and impulsive actions, and
unconventional and antisocial lifestyle.
Of course, it is Factor I that has drawn the attention of moral
philosophers: psychopaths moral motivation appears to be radically at odds
with their moral knowledge. They have
no difficulty recognizing moral transgressions, they just dont seem to care
much about them. The distinction
between ASPD and psychopathy is empirically borne out by the relative
frequencies of the conditions in forensic populations: In forensic
populations, baserates for ASPD are 50% to 80%, compared with only 15% to 25%
meeting criteria for diagnosis of psychopathy (60).
One might wonder what hangs on this
distinction, since psychopathy appears to be a type of ASPD.
The second main theme of the book speaks to this question. Because of their particular personality
psychopaths present unique challenges to the clinician. Exquisite abilities for deception and
manipulation make therapeutic relations difficult and, in some cases, risky for
the clinician. Clinicians need to
understand who they are dealing with; Chapter 8 offers useful guidelines for
navigating these troubles. In addition,
while psychopaths can feign improvement, the condition appears not to be
treatable. A diagnosis of psychopathy,
especially in adolescents, can result in clinical abandonment. Chapters 1, 2, 3
are relevant here. And Chapter 6
provides a good account of the ways in which the construct of psychopathy has
been deployed in both civil and criminal legal cases. The take home message is that while effective and safe dealings
with psychopaths requires our recognizing psychopathy as distinct from ASPD,
caution must be exercised in labeling individuals as psychopaths. In particular, a finding of psychopathy must
not be allowed to muscle out other clinically relevant factors.
Addressing questions about the
treatment and management of psychopaths will be facilitated by a better
understanding of the mechanisms of psychopathy, and in particular, of the
natural history of the condition. All
the papers the first conceptual section of the book are helpful here. There is excellent discussion of the
developmental dimensions of psychopathy and of the latest empirical work bearing
on hypotheses about the centrality to psychopathy of various affective and
information-processing deficits. No one
theory about the underlying mechanisms of psychopathy is endorsed, rather the
research is laid out in ways that allow the reader to make her own assessments.
It is impossible to do justice to all that is
interesting, convincing and important in this book. But one further feature
bears mention. For the most part, what
we know about psychopathy has emerged from work with incarcerated
populations. However, not all
psychopaths are criminals, and those who live among us cause substantial damage
to their families, acquaintances, and coworkers. The editor is to be applauded, then, for including several
contributions which report on work with psychopaths in the general
community. This research is in its
infancy, yet as chapter 12, Psychopathic Manipulation at Work, makes
abundantly clear, it is vitally important.
In sum, this book is an outstanding
contribution to the field. Practicing
clinicians and researchers will find it useful, and, for philosophers
interested in psychopathy, it is an indispensable resource.
© 2002 Susan Dwyer
Susan Dwyer,Ph.D. is Associate Professor of
Philosophy at UMBC (Baltimore, Maryland) where she directs the Masters Program
in Applied and Professional Ethics.