Treatment, Profiling of Psychopaths, Personality Disorder - Essay Example

Criminal Behaviour - Psychopathy: Treatment, Profiling of Psychopaths, Personality Disorder 2006 A personality disorder is characterized by a history of continuous and chronic antisocial behaviour that is not attributable to severe mental retardation, schizophrenia, or manic episodes, and is also called antisocial personality. This is a synonym for antisocial personality disorder (ASPD), a category listed in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and is applicable to the majority of criminals. The distinction between psychopathy and ASPD is of considerable significance to the mental health and criminal justice systems. In the UK, 'psychopatic disorder' is a legal term used in the Mental Health Act 1983, and is 'a persistent disorder or disability of mind which results in abnormally aggressive or seriously irresponsible conduct'. [The Mental Health Act 1983, 2000] For example, most jurisdictions consider psychopathy to be an aggravating rather than a mitigating factor in determining criminal responsibility. In some states an offender convicted of first-degree murder and diagnosed as a psychopath is likely to receive the death penalty on the grounds that psychopaths are cold-blooded, remorseless, untreatable and almost certain to re-offend. But many of the killers on death row were, and continue to be, mistakenly referred to as psychopaths on the basis of DSM-III, DSM-III-R or DSM-IV criteria for ASPD. ASPD and psychopathy might now be more or less synonymous constructs. [Hare, 1999] Psychopaths generally are more violent than non-psychopaths, and are more likely to engage in a variety of different types of aggressive acts, but tend to engage in predominantly instrumental (calculated) violence, threaten strangers with weapons and to be motivated by vengeance, retribution, or money. [Hart S.D., Forth A.E., Hare R.D.; 1994] The psychopaths' profile includes such individual characteristics as sense of entitlement, disparate understanding of behaviour and socially acceptable behaviour; they are unremorseful, apathetic to others, unconscionable, blameful to others, manipulative and conning, affectively cold, disregardful of social obligations, non-conforming to social norms, irresponsible. Traditionally, affective and interpersonal traits such as egocentricity, shallow effect, deceit, manipulativeness, lack of empathy, selfishness, guilt or remorse are central individual characteristics in the conceptualization and diagnosis of psychopathy. [Cleckley,1976; Hare, 1993; Widiger & Corbitt, 1995] In 1980 psychopathy was renamed antisocial personal disorder and is now defined by persistent violations of social norms, including lying, stealing, truancy, traffic arrests and inconsistent work behaviour. These features appear to be visible through failure to make intimate relationships, impulsiveness, lack of guilt, not learning from adverse experience. [Harris G.T., Rice M.E., Quinsey V.L., 1993] Hare in his 'Without Conscience' (1999) defines that psychopaths charm and exploit others for their own gain, they lack empathy, sense of responsibility, they manipulate, lie and con others with no regard for anyone's feelings. Psychopathy is characterized by such traits as lack of remorse or empathy, shallow emotions, egocentricity, glibness, manipulativeness, parasitic lifestyle, episodic relationships, low frustration tolerance and persistent violation of social norms. [Hare, 1999] Dr.Hervey Cleckley in 'The Mask of Sanity' came up with 16 traits that formed a specific pattern of perspective and behaviour, and to see the 'symptoms' of psychopathy one should connect him with the circuit of a full social life. Psychopaths miss the qualities that people depend on for living in social harmony. [Cleckley, 1976] The psychopathic personality disorder items fall into two clusters: One cluster - Factor 1, reflects core interpersonal and affective characteristics; the other cluster - Factor 2, consists of items that reflect a socially deviant and nomadic lifestyle. The PCL-R items are grouped around two basic factors, affectiveinterpersonal features and socially deviant lifestyle (both have been divided into four facets). Hart & Hare (1989) found that psychopaths were significantly less likely that non-psychopaths to have any Axis I disorder other than substance use and significantly more likely to have antisocial personality disorder. The type of violence in which the psychopaths engage is different from that of non-psychopathic offenders. They tend not to commit crimes of passion, may be motivated by weak emotions breaking through weaker restraints; they may simply be reaching, showing off or exerting control as a means of proving themselves. In most cases, their crimes are cold-blooded, and they left excited by them rather than guilty. A strong tendency towards sadism is noticed in those who are serial killers. [Hare, 1999] Most psychopaths are said to meet the criteria for ASPD, but most individuals with ASPD aren't psychopaths. As a result, a diagnosis of ASPD has limited for making differential predictions of response to treatment. [Hare, 1994; Harris et al., 1993] Recent laboratory researchers show that psychopaths differ dramatically from non-psychopaths in their performance of a variety of cognitive and affective tasks. Compared to normal individuals, psychopaths are less able to process or use the deep semantic meanings of language and to appreciate the emotional significance of events or experiences. [Larbig et al., 1992; Patrick, 1994; Williamson et al., 1991] There exist many treatment approaches to personality disorder, such as cognitive behavioral therapy (CBT), and variants of this called cognitive analytic therapy (CAT) and dialectic therapy, or psychodynamic group therapy that is used in setting of a therapeutic community (TC). Antisocial personalities are to initiate therapy mandated by a court, and the efficacy of this treatment is largely unknown. Based on the fact that psychopaths do change their behavior somewhat as they get older, Hare has stayed that they not only do not improve with the treatment, but may actually get worse, learning better ways to manipulate the system to their advantage and to play 'head games' with the clinicians. He also stresses the fact that for female offenders the scores of PCL-R are a few points lower than for male offenders. When there are children, the youth version of the PCL-R (PVL, YV) is used. For diagnosing a psychopath the P-Scan that consists of 120 characteristics as a non-clinical tool is also of great importance. [Hare, 1998] Socially deviant behaviours such as impulsivity, the need for stimulation, and irresponsibility, actually tend to decrease with age. Here biological basis may also play its role: for example, the level of testosterone going down with age will lead to the decrease of aggressiveness. That is why the treatment is to be focused on the issues of the psychopaths' antisocial behaviour, such as impulsivity, stimulation-seeking and irresponsibility. [Hilton, 2004-2005] Milieu therapy is recommended as the treatment for psychopathy, after which they tend to have a higher rate of general and violent recidivism. One of the most popular program for psychopaths has been a therapeutic community, but recent studies have shown that in ten years, the psychopaths in the program became more violent. That is why many psychologists doubt there is any effective treatment. They view psychopathy as not a clinical disorder that can be treated. Thus, the best is behaviour modification that also works with healthy persons. The treatment programs must be explicit and concentrate on reinforcing behaviour incompatible with psychopathic conduct and penalties for impulsive, dishonest, aggressive, irresponsible, and of course, criminal actions. The consequences for behaviour besides are to be consistently monitored by institutional staff. The greatest prospect of applying the wrap-around behavioural principles to psychopaths lies in the challenge of conditional release. [Hilton, 2004-2005] The focus on personal characteristics in diagnosing a criminal psychopath suggests that treatment should focus on personal change and control rather than on a medical cure, it should involve a risk-managing approach. [Blackburn, 1993; p.179-208] Therefore, treatment might be best viewed as part of a broader risk-management strategy that will improve the offender's self-regulation and include the monitoring and avoidance of high-risk situations in the community. Treatment targets should be criminogenic needs, but the reduction of symptoms besides is important to improve the offender's quality of life. References 1. Blackburn R. (1993) Clinical Programs with Psychopaths. In 'Clinical Approaches to the Mentally Disordered Offender, Howells K. and Hollin C.R., eds; Chichester: Wiley 2. Cleckey H.M. (1976) The Mask of Sanity, 5th ed. St. Louis, MO: Mosby 3. Hare R.D. (1999) Without Conscience: The Disturbing World of the Psychopaths Among Us. New York: Guilford Press 4. Hare. R. D. (1998) "Psychopaths and their nature: Implications for the Mental Health and Criminal Justice Systems," in T. Millon, E. Simonsen, M. Biket-Smith, R. D. Davis (Eds.) Psychopathy: Antisocial, Criminal and Violent Behavior. (188-212), New York: Guilford Press 5. Harris G.T., Rice M.E., Quinsey V.L. (1993) Violent recidivism of mentally disordered offenders: the development of a statistical prediction instrument. Criminal Justice and Behavior. Vol.20(4): 315-335 6. Hart S.D., Forth A.E., Hare R.D. (1994) Psychopathy as a risk marker for violence: development of a screening version of the Revised Psychopathy Checklist. In: Monahan J, Steadman HJ, eds. Violence and Mental Disorder: Developments in Risk Assessment. Chicago: University of Chicago Press 7. Hilton N.Z. (Winter 2004-2005) 'What treatment works for psychopathy' in Entre Nous 8. Larbig W., Veit R, Rau H, et al. (Oct. 1992) Cerebral and peripheral correlates of psychopaths during anticipation of aversive stimulation. Paper presented at the annual meeting of the Society for Psychophysiological Research; San Diego 9. Patrick C.J. (1994) Emotion and psychopathy: some startling new insights. Psychophysiology. Vol. 31: 319-330 10. The Mental Health Act 1983. An Outline Guide (2000). UK: Mind Publications 11. Widiger T.A., Corbitt E. (1995) The DSM-IV Antisocial Personality Disorder. In: Livesley W.J., ed. The DSM-IV Personality Disorders. New York: Guilford 12. Williamson S.E, Harpur T.J, Hare R.D. (1991) Abnormal processing of affective words by psychopaths. Psychophysiology. Vol. 28: 260-273. Read More