04 August 2008

Psychopathy: Continuous or Categorical?

I've been thinking about the "continuous vs categorical" debate in relation to psychopathy. I just started reading a book called "Thinking about Psychopaths and Psychopathy" edited by Ellsworth Lapham Fersch. It's a collection of questions and answers from seminars he's given on psychopathy, with contributions by various academics. Based on Fersch's introduction, it looks is promising and insightful. However, I wonder if Fersch really "gets it". While he talks about the importance of psychopathy quite eloquently and identifies the problems inherent in the conflation of psychopathy with antisocial personality disorder, there is a question and answer in the first chapter that is puzzling. (It is possible one of his colleagues answered this question, as the individual author is not listed for each section.)

In this question on the debate between psychopathy as either categorical (i.e. you either have it or you don't, like Turner's syndrome) or continuous (the extreme end of traits shared by everyone, e.g. someone with very high intelligence), he firmly takes the "continuous" side. However, I get the impression that he does so without understanding the crux of the matter, the implications of such a position.

He concludes that psychopathy is continuous because the PCL-R gives results on a spectrum (0 being "least psychopathic", 40 being "most psychopathic"), and because people can score low on the checklist (and thus, technically, have "psychopathic" traits), that people are only "more or less" psychopathic. In other words, because non-psychopaths can score more than 0 on the test and not be considered psychopaths, Fersch concludes that psychopaths only have extreme degrees of more or less "normal" human traits.

I think he is correct, but not for the reasons he would argue, because his argument is fairly weak and susceptible to distortion. First of all, the fact that the PCL-R measures a spectrum of traits does NOT mean that it is measuring a disorder which is itself a "spectrum". The fact that there is no definite "cut off point" on the scale does NOT mean that psychopathy is not categorical. It could just as well mean that we do not yet have the means of identifying an exact cut off point, or that there could be two distinct taxons (normal and psychopathic) that can overlap on the scale.

It is also possible that psychopathy is both categorical and continuous, i.e. that a person is either a psychopath or not, and that those who are psychopaths show a spectrum of indicators of psychopathy (theoretically, all psychopaths would have a majority, perhaps all, of the traits listed in the PCL-R, but they may not be detectable by known personal history and interview).

A thought experiment will make this clearer. Imagine that scientists create a robotic human with artificial intelligence, which will then be tested using a variation on the Turing test, which we will call the "human" test. Questions are asked to the robot based on a checklist of human traits. A normal human, responding to the test, will receive a score of 30 to 40, while primitive forms of AI will receive a low score. Severely mentally ill people may score in the mid-range.

Let us say that our new robot scores 26. It would be fallacious to say that, because the test is continuous, that this implies that the robot is "more or less" human. All it shows is that it shares traits with a human, and these traits may be mere programs. They are algorithms, not experiences with syntactical content. They only give the appearance of humanity.

In this example, one is either a human or not. A human will score mid- to high-range on on the scale, depending on various factors. A non-human will score low- to mid-range. In addition to this categorical difference (human or not), there is a spectrum of how "close" to human a non-human can test. Some robots will test 0 on the scale, while those with complex programming may score fairly high. However, this just shows the limits of the method of testing. Conclusions about the nature of the phenomenon cannot be discerned from measurements of a limited test.

So how do we account for seemingly psychopathic traits in non-psychopaths? I think this can be explained fairly easily. Lobaczewski describes psychopathy as a deficit, NOT an excess. That is, psychopathy is a LACK of certain essential human qualities, and this lack gives rise to the peculiarities of psychopathy. In the case of psychopathy, this lack is syntonic (social) emotions: those responsible for bonding and empathy. Because of this lack, psychopaths see people as objects and a lifestyle develops that makes use of these objects (parasitic, manipulative). Lacking "other-centered" emotions, psychopaths are wholly self-centered (traits which normal humans DO possess, in varying strengths when compared to their other-centered emotions), and thus grandiose, not able to take responsibility. They are unable to feel guilt.

The LACK is what categorically makes them psychopaths, the cause which gives rise to their psychopathic traits WHICH NORMAL HUMANS CAN SHARE. Dabrowski, a contemporary of Lobaczewski, and his concept of multilevelness of emotional functions, provides the necessary context. Normal humanity DOES exist on a spectrum. Many exist with a low level of emotional development, what Dabrowski called primary integration, thus they can be extremely self-centered and even possess many psychopathic traits. As such, normal people can have very poorly developed "other-centered" emotions (and thus the possibility to develop them), the difference being that psychopaths LACK these emotions.

It is also possible that non-psychopathic individuals can originally have such a potential for growth, yet at some point in their lives acquire brain damage that severely alters their emotions and behavior. They can also "learn" psychopathic behaviors. These people may even achieve the same score on the PCL-R as a real psychopath, but people like Fersch don't seem to see this possibility: that the PCL-R is not a perfect measure of psychopathy. It is very effective, but it is not 100% accurate. So the fact that the scale is continuous does NOT imply that the disorder is continuous.

That said, it seems that other factors may be responsible for the continuity WITHIN psychopathy, for example, hippocampus size. Successful psychopaths are perhaps just better at masking their traits, so that an interview and personal history would not necessarily reveal these traits. If we had omniscience, perhaps we would be able to make an accurate diagnosis for these cases, but a mid-range PCL-R score does not necessarily mean that a person is not psychopathic. It could simply be the result of insufficient data.

So it is important to make a distinction between the continuous nature of the PCL-R as an instrument of measurement, and and the nature of psychopathy as a categorical disorder, or taxon. To ignore this distinction is dangerous. As Lobaczewski related from his experience in Poland, pathocratic authorities muddy the waters of psychopathy research so as to evade detection. They do this by creating a "catch-all" phrase for criminal deviance. We have seen this phenomenon in American psychiatry where the official DSM-IV only recognizes "antisocial personality disorder", a catchall label that can apply to both psychopaths and non-psychpoaths. Psychopathy is NOT included in the DSM-IV, and is thus not officially recognized as a valid personality disorder by the Manual.

This might have been enough in pathocracies such as in the Soviet empire, thus providing "cover" for psychopaths who do not fit the diagnosis of "antisocial personality disorder". However, the concept of psychopathy, thanks to Cleckley and Hare, seems too well established in the scientific literature to be so easily embargoed. Thus, a new tactic was needed. Viewing psychopathy as simply an "extreme" form of normality robs us of any real understanding of the disorder.

The entire makeup of a psychopath is qualitatively different from a normal human: their thinking, their worldview, their behavior. It is this "otherness" that is responsible for their dreams of Empire and world domination. By bracketing the true nature of psychopathy from our awareness, we give up any hope of identifying the root cause of the social disease which threatens to choke humanity's life in the near future.


Anonymous Ahmad said...

Dear All,

I am just finishing reading political ponerology; a most enlightening work. I've come to this article in a large broadsheet daily published in the UAE. I am copying the content for you to read. the implications of the article are shattering.


A touch of madness may be the key to greatness
Daniel Bardsley

Last Updated: August 30. 2008 8:38PM UAE / August 30. 2008 4:38PM GMT

Winston Churchill, the prime minister who led Britain during the Second World War, suffered from bipolar disorder. AP

A severe mental illness can be just as debilitating as a crippling physical condition, leaving the sufferer unable to hold down a job, a relationship or have any semblance of a normal life. One psychologist, however, believes that, far from being harmful, in mild form such conditions could hold the key to success in life – and he takes his cue from the countless exceptional people in history who have had to battle with inner demons.

Dr David Geary believes people such as the former British prime minister Winston Churchill, the composer Ludwig Beethoven and the horror writer Edgar Allan Poe show there is a link between mental illness and achievement. Each member of this exalted trio is said to have suffered from manic depression or bipolar disorder, the condition in which periods of elevated mood alternate with spells of depression.

“In most cases, full-blown bipolar disorder is pretty maladaptive, but having the disorder expressed in a mild state could confer benefits,” says Dr Geary, a cognitive development psychologist at the University of Missouri who outlined his ideas in his book, The origin of mind: Evolution of brain, cognition and general intelligence.

The reason, Dr Geary believes, is that during the “mild hypomania” they experience, manic depressives think more quickly, have more energy and are more creative. Confidence levels rise, social inhibitions disappear and the creative juices flow freely. “They can put things together in ways that other people wouldn’t think of or would take them longer to do,” he says.

This idea can be understood by making comparisons to chimpanzees. There is evidence, Dr Geary says, that human brains “run at a higher revs per minute” than those of chimpanzees and other primates. This is because humans evolved mechanisms for speeding up the processing of information.

Hypomania, the theory goes, involves a further speeding up of the brain’s functioning beyond the normal human capacity.

“It’s a continuation of whatever evolved mechanisms are revving up the human brain – they are over-expressed with manic depression,” he says.

Just as the phases of hypomania can bring benefits, so can the down phases. If taken to extremes, ruminating about things can cause severe anxiety or depression. But if done a little, it can be “very helpful”.

“The depression phase can lead to a period of self-reflection and caution. Things can be scrutinised and looked at with a more critical eye,” Dr Geary says.

“Humans have the ability to project themselves forward in time and to simulate different ways of coping with these situations. They can figure out strategies.”

The conditions may not improve the quality of life of those who have them, but it seems they can make them successful.

To be an advantage, Dr Geary says the condition has to be combined with intelligence and an ability to control the disorder’s effects during the down phases.

Often the people who benefit the most are the relatives of someone with a full-blown disorder. Such individuals, Dr Geary says, tend to be “over-represented among high-achievers”.

This explains why, in the modern world, the genes that predispose an individual to a mental disorder are not drummed out of the population by natural selection. While an individual might be disadvantaged by having many types of gene that make them likely to suffer a disorder, if they have a smaller number they could be better off than the average individual.

Attention deficit disorder is another condition with potential benefits, although it illustrates the extent to which advantages depend upon context.

Hyperactive individuals react quickly to changes around them and could be at an advantage in combat situations, for example. The opposite would apply if the same person was in a classroom trying to find the solution to a problem. Then, says Dr Geary, there would be a “context mismatch”.

This means that people with mild forms of mental disorders should be channelled into areas of life in which their special talents can be harnessed, according to Dr Raymond Hamden, a clinical and forensic psychologist at the Human Relations Institute in Dubai. Many such individuals can “think outside the box” in ways the rest of us cannot.

“Sometimes people who suffer from abnormal psychological elements, whether schizophrenia or bipolar disorder, can have interpretations of life that are quite unique,” Dr Hamden says.

“People can go into the fine arts or consulting for architectural design, for theatre or for scripts needed by various entertainers.”

While we can understand the benefits of being slightly off the wall in the modern world, things would have been different in the prehistoric environments in which humans evolved. After all, there cannot have been much demand for advertising gurus, television scriptwriters or design consultants thousands of years ago.

So what selective pressures caused the disorders to evolve back then?

Dr Geary believes the qualities that can make people stand out now could also have been advantageous in times past.

“The way to think about these things is that the more primitive times aren’t quite as different as many people think,” he says.

“They might have been a good hunter or figured out how to plant better crops. For men a good predictor of marriage ability and reproductive success is cultural success. Extra energy, extra ability to think creatively probably would contribute to the ability to achieve cultural success in a range of societies.”

Dr Geary says his ideas could have implications for how clinicians treat people with mental disorders.

Given that some disorders can be “overexpression of what is a good”, it would be a bad thing to completely get rid of the symptoms. Doing that could put the person at a disadvantage.

“They are not ill, it’s just they’re out on the continuum a little bit too far,” he says. “The treatment should bring them back along the continuum rather than switching them to a different category.”

And where would Dr Geary himself like to be on the continuum? “That’s a tough question. Certainly not too far out. Maybe a little bit out”

6:29 PM  
Anonymous m1omg said...

Kim Jong-il seems like the most psychopathic country leaders in the present, he is the perfect essential psychopath - even Stalin helped the people in some way by industrialising the country and Hitler built roads and was capable of sustaining a satelite state of people that were 'inferior' without enslaving or slaughtering them , more precisely it was my contry of Slovakia during the WW2.

They both were total psychopathic tyrants, but Kim Jong-il of 'Democratic' 'Peoples' 'Republic' of Korea defeats them all in sheer coldbloodeness.

The defectors say that they'd rather take a poison pill and die if caught during the escape process, rather than being shipped to the most psychopathical concentration camps ever existing.

When the country was starving during the 90s, he was chubby and smiling and still gave most fraction of their resources to military, instead of giving food aid he just started a propaganda campaign saying that eating 3 meals per day is unhealthy and that they should eat just 2, millions died.

In his pathological narcissm he loses all of his remains of humanity and traces of restraint that even most psychopaths have and declared himself a god, the children are indoctrinated from their preschool age to thank their 'great leader' for everything, he also started a cult of his dead father to mask his own narcissm.

The society in North Korea is unable to resist when they don't know better, they are isolated and most of them think that the rest of the world is much worse off.

The goverment also sells heroin to its people, covertly, but it is still obvious, at least they can have some artifical happiness because life in that country is totally unbearable outside the biggest towns, there are villages that are surrounded by barbed wire electrified fence, Kim is much more psychopathic than even Hitler , much,much worse...they gas families to death and perform atrocious experiments on people in their 'reeducation camps', even Mengele would have vomited; http://freekorea.us/2007/02/18/holocaust-now-looking-down-into-hell-at-camp-22/

I am not posting this for any political agenda, but as an example what would happen if these will inhumans susceed.

And I would kill Kim Jong-il slowly, like a sadist...normally I hate when people are tortured but I would torture and kill kim personally, he is conducting human experiments on about half a million of his own people for no real reason, if this existed


then the Queen of Pain would welcome him gladly

9:43 PM  

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