Colum>>' Co\u*ft
What is
a
psychopath?
A definition of probably the most widely misunderstood disorder in the whole of psychiatry by Dr. Whiteley, who is medical director of the Henderson Hospital, Surrey, where he runs a therapeutic community for the treatment of people that the public have been conditioned to fear
J. Stuart
Whiteley
term 'psychopath' has been incorporated into vocabulary almost as a word of abuse. It is certainly an emotive word and conjures up pictures of a vicious, violent, and possibly sexually perverted, criminal. The newspaper accounts of sensa-
criminal but not all criminals are psych' and vice versa. One forensic psychiatr' has estimated that about 30% of the general pris0 population is psychopathic and, in a unit for ps' chopaths outside the penal system, 70% had sol1 history of conviction?but this could vary from serious assault to stealing a bicycle. What the psychopath does do is to offend agatf the accepted moral and social codes of behavio^
tional murders, true-life stories such as Truman Capote's In Cold Blood and the film Bonnie and Clyde foster this image. Certainly some psychopaths do commit murder, but twice as many murderers have no psychiatric disability whatever. Certainly some psychopaths
version or promiscuity all may be more forms of such behaviour, whilst indifference to feelings of others, extreme egocentricity, untru1 fulness and lack of responsibility are perhaps \c overt vices. Again, not all alcoholics are psyc^'
The our
20
are
pathic
Alcoholism, addiction, fraud, theft, sexual Pe
obvioj
P^ths and
not all
psychopaths
are
alcoholics, etc.,
Psychopathic
behaviour covers a whole range activities and varies from the mildly aberrant o the grossly abnormal. What is needed, in addil0tl, for the diagnostic stamp of 'psychopath' is an Pparent lack of awareness that what one is doing ls m any way at fault; the non-existence of a sense .
shame
It
was
or guilt. Pritchard,
an English psychiatrist, who, in ~~5, first described the condition and separated it Q from other types of abnormal behaviour which ?uld be recognised as a result of mental subnorallty (i.e. deficiency of intellectual development) r mental disease (i.e. impairment of reason, inand judgement by a pathological process). ^c_t Pritchard then took the step that has plagued us
since. He called j;Ver aviour 'Moral
this disorder of social beInsanity' and thus placed it under ^medical umbrella. For the last 150 years the argument has raged? re they mad or bad? We still have no satisfactory answer. ^king The laws
relating to mental subnormality were Pplied initially on the grounds that people with a im^ticiency of moral development were moral imbeciles. J^cileswasand comparable to intellectual wholly inappropriate and resulted in perof normal intelligence being confined and t ained witti mental defectives, but it was not unthat the legislation was thrown out. ^22 *Qen there was a further search for medical as?ns for this type of abnormal behaviour, and .
CQ
things
as
minor brain
lobe and ^Poral ^lng infections
damage, epilepsy
in the
inflammation of the brain fol-
were
all
implicated.
These factors
uld produce the type of behaviour called psychobut only in a minority of cases were such
^thic, g
origins to be found. ^Ual ifficulties encountered
during
?Mh received much attention
as
personality
more
evidence
the effects of early life on later ?tional behaviour and neurotic illness. How?. the difference between the neurotic and the ?Path seems to be that, whereas the former sUft ^rom disability and is ill, the latter does out rather causes those around him to suffer, j nherited characteristics, methods of child rear. cultural expectancies and training have all suggested as causative agents and each one
ei^Ul^ulated
on
HonkS
offer. Very recently an abnormal pattern (the XYY syndrome) has but jt P11 discovered in some criminal psychopaths n?t confined to such. The children brought up he communal and parent-deficient Kibbutzim 0? srael are reputed to have a higher incidence of p s?nality problems, but this is debatable. Disc*s in certain towns have their well-known
c,s something to
ker?mosome
higher incidence
of gangsterdom and disorder. Variable in pattern, uncertain in origin and
vague in
definition, psychopathic disorder was planted firmly in the realm of the psychiatrist and medical profession by the 1959 Menonce more
tal Health Act which redefined the condition as one of three quite distinct types of mental disorder thus:
Psychopathic Disorder?a persistent disorder of disability of mind (whether or not including subnormality of intelligence) which results in abnormally aggressive or seriously irresponsible conduct on the part of the patient, and requires or is susceptible to medical treatment. New
provided exclusively for the treatment centres envisaged, but these have not really come into being in the intervening ten years and the special laws are not utilised at all extensively. The difficulty with the psychopath is that he just does not fit into the medical model of illness. Psychopathy is a social disorder. In its causation
legislation psychopath and
was
new
and for its treatment we must look at social interactions. Normally we learn the patterns of social behaviour through contact with (1) mother, (2) father and the family and (3) school and the early extra-family encounters. Factors which may be absent, misleading, misunderstood or frankly wrong are numerous and they possibly combine to impede the normal social learning process in the case of the psychopath. Pete, for example, was the illegitimate child of two erratic people (genetic influence) in downtown Glasgow (environment of social disorder). He was brought up in the institutional type of children's home (maternal deprivation). He was also crippled by polio and daily asked a friend to tie his laces (personal vulnerability) and one day his 5-year-old friend said: 'No?I won't tie your laces' (traumatic experience). This is, perhaps, an over-simplification and doubtless there were other similar incidents with additive effect, but this story?like In Cold Blood ?is a true one and the incident is one which I heard Pete tell as if it were yesterday. Pete turned his back on his friend?and on society. From then on he went his own way, made his own rules and avoided for ever the possibility of another hurtful encounter. He became an aggressive, impulsive anti-social misfit, stealing what he saw, striking out indiscriminately and shutting himself off for ever from people and feelings. Yet somehow there lingers a doubt about the lesson learned and he repetitively tests out the raw emotions behind that original interchange. 21
He makes increasing demands on others until the inevitable happens and someone says 'No'. Then it seems to Pete's way of thinking that he was right in the first place. People are not to be trusted, relationships and feelings are fraught with disaster and once more he turns his back, confirmed in his mislearned pattern of what goes on between people at an emotional level. Neither wholly mad or wholly bad the psychopath seems a little bit of each but in varying mixtures. Society's response to him will vary too according to the mixture and according to our current degree of tolerance. In the past some of the 'maddest' psychopathic murderers have been summarily executed as more befits the 'baddest'. But, if treatment is considered as feasible and proper, we have to step outside the accustomed medical procedures and create a new social setting in which the early lessons of social behaviour can be relearned. Such a setting is the therapeutic community where a group a young psychopaths are brought together with other young people of varied professional training but leaning toward the sociological and psychological. They live in a close-knit community for the express purpose of examining all communications, reactions and interactions out in the open group setting so that there is no possibility of misperception without the possibility of correction. When people are close together?in a family, workshop or holiday hotel?tensions mount and emotions fly back and forth and when the situation becomes too much one takes off to bed, to the pub or just lets go on some evasive issue and tries to forget it. In the therapeutic community whatever happens is fed back into the common pool then and there and will be discussed, examined from every angle and then opinions expressed and modifications of
attitude suggested. Tom comes in late. He's been drinking and kicks the door panel because the door sticks. At once the community wants to know why. There is no sleeping on it until morning, no taking a sedative to calm him down nor forgetting about it all. This is basic material for treatment. Crude and basic? but so are the emotional lives of the people con-
cerned. The group gathers around Tom and plies him with questions and viewpoints and perhaps gets down to the point that what is really upsetting Tom is that nothing is going right for him in the In the workshop Joe is taking over of the running of the shop. Tom feels a failure all round, so he might as well be one. The angry, hurt, emotionally unformed child is swamping all adult judgement. Joe is brought into
community.
more
and
more
the discussion and begins to see his part in Tofli feelings of uselessness. They work out a differed system of co-operation, of understanding and ap preciation for the other's feelings. It is 2.00 a.tf and everyone goes to bed. Such an intensive living and learning situati"1 going on for 24 hours of the day, possibly f? months, is not for every psychopath. There af many types and degrees of psychopathy and tb 'prescription' must be varied according to tb
'patient'. The more helpless and lost type cannot assufl1 the burden of such self-responsibility and one b3 to modify the community to give them support afl' protection?maybe for life?in the type of reside^ tial hostel that has been very successful with son1
ex-prisoners. The more wildly disordered type of psychopa1 feel even more disturbed in a therapeutic cotf1 munity where the lid is taken off every boilif cauldron. For him one needs to create a corf munity where some external control can be se? to exist, at least in the early stages. Therapeut1 communities in prisons have been described, par' cularly in the U.S.A. and Denmark, and admissi0 to even an ordinary prison is not to be dismiss^ always as totally destructive. With the opportun'1 for a relearning situation added in, the contain^ hold of prison can be a therapeutic and constru' tive measure. Mad or bad? The psychopath is certainly a & figure and deserves our considerable attention, his contact with the rest of society is a series c disastrous (to him) and damaging (to us) which only a better understanding will eradicate.' can
collisi^
What is
a
psychopath?
A definition of probably the most widely misunderstood disorder in the whole of psychiatry by Dr. Whiteley, who is medical director of the Henderson Hospital, Surrey, where he runs a therapeutic community for the treatment of people that the public have been conditioned to fear
J. Stuart
Whiteley
term 'psychopath' has been incorporated into vocabulary almost as a word of abuse. It is certainly an emotive word and conjures up pictures of a vicious, violent, and possibly sexually perverted, criminal. The newspaper accounts of sensa-
criminal but not all criminals are psych' and vice versa. One forensic psychiatr' has estimated that about 30% of the general pris0 population is psychopathic and, in a unit for ps' chopaths outside the penal system, 70% had sol1 history of conviction?but this could vary from serious assault to stealing a bicycle. What the psychopath does do is to offend agatf the accepted moral and social codes of behavio^
tional murders, true-life stories such as Truman Capote's In Cold Blood and the film Bonnie and Clyde foster this image. Certainly some psychopaths do commit murder, but twice as many murderers have no psychiatric disability whatever. Certainly some psychopaths
version or promiscuity all may be more forms of such behaviour, whilst indifference to feelings of others, extreme egocentricity, untru1 fulness and lack of responsibility are perhaps \c overt vices. Again, not all alcoholics are psyc^'
The our
20
are
pathic
Alcoholism, addiction, fraud, theft, sexual Pe
obvioj
P^ths and
not all
psychopaths
are
alcoholics, etc.,
Psychopathic
behaviour covers a whole range activities and varies from the mildly aberrant o the grossly abnormal. What is needed, in addil0tl, for the diagnostic stamp of 'psychopath' is an Pparent lack of awareness that what one is doing ls m any way at fault; the non-existence of a sense .
shame
It
was
or guilt. Pritchard,
an English psychiatrist, who, in ~~5, first described the condition and separated it Q from other types of abnormal behaviour which ?uld be recognised as a result of mental subnorallty (i.e. deficiency of intellectual development) r mental disease (i.e. impairment of reason, inand judgement by a pathological process). ^c_t Pritchard then took the step that has plagued us
since. He called j;Ver aviour 'Moral
this disorder of social beInsanity' and thus placed it under ^medical umbrella. For the last 150 years the argument has raged? re they mad or bad? We still have no satisfactory answer. ^king The laws
relating to mental subnormality were Pplied initially on the grounds that people with a im^ticiency of moral development were moral imbeciles. J^cileswasand comparable to intellectual wholly inappropriate and resulted in perof normal intelligence being confined and t ained witti mental defectives, but it was not unthat the legislation was thrown out. ^22 *Qen there was a further search for medical as?ns for this type of abnormal behaviour, and .
CQ
things
as
minor brain
lobe and ^Poral ^lng infections
damage, epilepsy
in the
inflammation of the brain fol-
were
all
implicated.
These factors
uld produce the type of behaviour called psychobut only in a minority of cases were such
^thic, g
origins to be found. ^Ual ifficulties encountered
during
?Mh received much attention
as
personality
more
evidence
the effects of early life on later ?tional behaviour and neurotic illness. How?. the difference between the neurotic and the ?Path seems to be that, whereas the former sUft ^rom disability and is ill, the latter does out rather causes those around him to suffer, j nherited characteristics, methods of child rear. cultural expectancies and training have all suggested as causative agents and each one
ei^Ul^ulated
on
HonkS
offer. Very recently an abnormal pattern (the XYY syndrome) has but jt P11 discovered in some criminal psychopaths n?t confined to such. The children brought up he communal and parent-deficient Kibbutzim 0? srael are reputed to have a higher incidence of p s?nality problems, but this is debatable. Disc*s in certain towns have their well-known
c,s something to
ker?mosome
higher incidence
of gangsterdom and disorder. Variable in pattern, uncertain in origin and
vague in
definition, psychopathic disorder was planted firmly in the realm of the psychiatrist and medical profession by the 1959 Menonce more
tal Health Act which redefined the condition as one of three quite distinct types of mental disorder thus:
Psychopathic Disorder?a persistent disorder of disability of mind (whether or not including subnormality of intelligence) which results in abnormally aggressive or seriously irresponsible conduct on the part of the patient, and requires or is susceptible to medical treatment. New
provided exclusively for the treatment centres envisaged, but these have not really come into being in the intervening ten years and the special laws are not utilised at all extensively. The difficulty with the psychopath is that he just does not fit into the medical model of illness. Psychopathy is a social disorder. In its causation
legislation psychopath and
was
new
and for its treatment we must look at social interactions. Normally we learn the patterns of social behaviour through contact with (1) mother, (2) father and the family and (3) school and the early extra-family encounters. Factors which may be absent, misleading, misunderstood or frankly wrong are numerous and they possibly combine to impede the normal social learning process in the case of the psychopath. Pete, for example, was the illegitimate child of two erratic people (genetic influence) in downtown Glasgow (environment of social disorder). He was brought up in the institutional type of children's home (maternal deprivation). He was also crippled by polio and daily asked a friend to tie his laces (personal vulnerability) and one day his 5-year-old friend said: 'No?I won't tie your laces' (traumatic experience). This is, perhaps, an over-simplification and doubtless there were other similar incidents with additive effect, but this story?like In Cold Blood ?is a true one and the incident is one which I heard Pete tell as if it were yesterday. Pete turned his back on his friend?and on society. From then on he went his own way, made his own rules and avoided for ever the possibility of another hurtful encounter. He became an aggressive, impulsive anti-social misfit, stealing what he saw, striking out indiscriminately and shutting himself off for ever from people and feelings. Yet somehow there lingers a doubt about the lesson learned and he repetitively tests out the raw emotions behind that original interchange. 21
He makes increasing demands on others until the inevitable happens and someone says 'No'. Then it seems to Pete's way of thinking that he was right in the first place. People are not to be trusted, relationships and feelings are fraught with disaster and once more he turns his back, confirmed in his mislearned pattern of what goes on between people at an emotional level. Neither wholly mad or wholly bad the psychopath seems a little bit of each but in varying mixtures. Society's response to him will vary too according to the mixture and according to our current degree of tolerance. In the past some of the 'maddest' psychopathic murderers have been summarily executed as more befits the 'baddest'. But, if treatment is considered as feasible and proper, we have to step outside the accustomed medical procedures and create a new social setting in which the early lessons of social behaviour can be relearned. Such a setting is the therapeutic community where a group a young psychopaths are brought together with other young people of varied professional training but leaning toward the sociological and psychological. They live in a close-knit community for the express purpose of examining all communications, reactions and interactions out in the open group setting so that there is no possibility of misperception without the possibility of correction. When people are close together?in a family, workshop or holiday hotel?tensions mount and emotions fly back and forth and when the situation becomes too much one takes off to bed, to the pub or just lets go on some evasive issue and tries to forget it. In the therapeutic community whatever happens is fed back into the common pool then and there and will be discussed, examined from every angle and then opinions expressed and modifications of
attitude suggested. Tom comes in late. He's been drinking and kicks the door panel because the door sticks. At once the community wants to know why. There is no sleeping on it until morning, no taking a sedative to calm him down nor forgetting about it all. This is basic material for treatment. Crude and basic? but so are the emotional lives of the people con-
cerned. The group gathers around Tom and plies him with questions and viewpoints and perhaps gets down to the point that what is really upsetting Tom is that nothing is going right for him in the In the workshop Joe is taking over of the running of the shop. Tom feels a failure all round, so he might as well be one. The angry, hurt, emotionally unformed child is swamping all adult judgement. Joe is brought into
community.
more
and
more
the discussion and begins to see his part in Tofli feelings of uselessness. They work out a differed system of co-operation, of understanding and ap preciation for the other's feelings. It is 2.00 a.tf and everyone goes to bed. Such an intensive living and learning situati"1 going on for 24 hours of the day, possibly f? months, is not for every psychopath. There af many types and degrees of psychopathy and tb 'prescription' must be varied according to tb
'patient'. The more helpless and lost type cannot assufl1 the burden of such self-responsibility and one b3 to modify the community to give them support afl' protection?maybe for life?in the type of reside^ tial hostel that has been very successful with son1
ex-prisoners. The more wildly disordered type of psychopa1 feel even more disturbed in a therapeutic cotf1 munity where the lid is taken off every boilif cauldron. For him one needs to create a corf munity where some external control can be se? to exist, at least in the early stages. Therapeut1 communities in prisons have been described, par' cularly in the U.S.A. and Denmark, and admissi0 to even an ordinary prison is not to be dismiss^ always as totally destructive. With the opportun'1 for a relearning situation added in, the contain^ hold of prison can be a therapeutic and constru' tive measure. Mad or bad? The psychopath is certainly a & figure and deserves our considerable attention, his contact with the rest of society is a series c disastrous (to him) and damaging (to us) which only a better understanding will eradicate.' can
collisi^
