The Psychopath Whisperer: The Science of Those Without Conscience

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Authors: Kent A. Phd Kiehl
trying to treat the psychopath, many psychodynamic therapists found the psychopath only got worse and more egocentric.
    This belief carries through to popular culture today. For example, after years of performing psychotherapy on the fictional mafia figure Tony Soprano (portrayed by James Gandolfini) on the American HBO hit television show
The Sopranos
, his therapist declared that she had finally figured out that Tony was an incurable psychopath and so she quit treating him.
    Psychopaths are resistant to psychodynamic treatment, in part because they typically don’t feel there is anything wrong with them; they are rarely interested in participating in therapy or changing. Consequently, psychodynamic therapy was not very successful with psychopaths, and that led to the pervasive view that persists today that psychopaths are untreatable. 17
    Freud’s psychodynamic theory in general and psychoanalytic treatment in particular quickly fell under heavy criticism when it was pointed out that it was not a theory at all; that is, psychodynamic theory does not make any predictions, and hence does not have any testable hypotheses.
    It was American psychiatrist Hervey Cleckley (1903–1984) who changed the face of psychopathy research with his masterpiece
The Mask of Sanity
, first published in 1941. 18 Cleckley sought to clarifythe construct of psychopathy from other incantations of the disorder and to provide the psychiatric community with a treatise on the condition using a plethora of case studies. From these case studies, Cleckley gleaned sixteen criteria that formed the basis for the modern assessment of the condition. In elegant, magnificent prose, Cleckley educates the reader about the symptoms and makeup of psychopathy. Cleckley’s criteria, listed in Box 1, are consistent with the historical traits identified by his predecessors but contain much more detailed analyses and refinement. In four subsequent editions of
The Mask of Sanity
, covering nearly fifty years of clinical experience, Cleckley continued to refine and illustrate psychopathy as we know it today.
    ----

BOX 1
    The 16 characteristics of the psychopath as chronicled in the five editions of
The Mask of Sanity
, by American psychiatrist Hervey Cleckley (1941, 1950, 1955, 1964, 1976).
      1. Superficial Charm and Good “Intelligence”
      2. Absence of Delusions and Other Signs of Irrational Thinking
      3. Absence of “Nervousness” or Psychoneurotic Manifestations
      4. Unreliability
      5. Untruthfulness and Insincerity
      6. Lack of Remorse or Shame
      7. Inadequately Motivated Antisocial Behavior
      8. Poor Judgment and Failure to Learn from Experience
      9. Pathologic Egocentricity and Incapacity for Love
    10. General Poverty in Major Affective Reactions
    11. Specific Loss of Insight
    12. Unresponsiveness in General Interpersonal Relations
    13. Fantastic and Uninvited Behavior with Drink and Sometimes Without
    14. Suicide Rarely Carried Out
    15. Sex Life Impersonal, Trivial, and Poorly Integrated
    16. Failure to Follow any Life Plan
----
    It is impossible to overstate the value of Cleckley’s contribution to the field of psychopathy. The multiple editions of
The Mask ofSanity
revolutionized our understanding and classification of the disorder.

BOX 2
    The 20 items of the Hare Psychopathy Checklist-Revised (Hare, 1991, 2003) are a clinical rating instrument and the gold standard for the assessment of psychopathy since 1991.
    Psychopathy Checklist Items
      1. Glibness/Superficial Charm
      2. Grandiose Sense of Self-Worth
      3. Need for Stimulation
      4. Pathological Lying
      5. Conning/Manipulation
      6. Lack of Remorse or Guilt
      7. Shallow Affect
      8. Callous/Lack of Empathy
      9. Parasitic Lifestyle
    10. Poor Behavioral Controls
    11. Promiscuous Sexual Behavior
    12. Early Behavioral Problems
    13. Lack of Realistic, Long-Term Goals
    14. Impulsivity
    15. Irresponsibility
    16. Failure to Accept Responsibility for Own

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