Should Psychopaths be Jailed or Treated (Or Something Else)?

Used to work with psychopaths. I mean, not at McDonald’s or anything, but as a psychotherapist. You may be more familiar with the term sociopaths. The terms are sometimes thrown about interchangeably, but there is a difference. There’s anold saying in the treatment field: psychopaths are born. Sociopaths are made. This means what it says: psychopaths are born with their lack of empathy. It’s genetic, the stuff of serial killer movies, not my favorite genre. Sociopaths become that way due to a history. If you read or watch Truman Capote’s In Cold Blood, you might see the type of history we’re talking about in the childhood of a sociopath. A simple case examination of John Wayne Gacy also gives some insight. Yet most men with histories of abuse and neglect don’t end up as mass murderers, so something else must be at play.

Should they be jailed or treated is the restatement of a simpler question: are psychopathy and sociopathy treatable? The answer to that is probably ‘no.’ These labels are hung on individuals often diagnosed with anti-social personality disorder. There is actually a test called the Hare Psychopathy Index, in use back when I was treating sex offenders that goes on a 30-something point scale. Indeed, it tests lack of empathy, lack of compunction, the inability to follow social norms. Individuals who test high on the Hare tend to exhibit a general spread of criminal behaviors, and most of them end up in prison, which is why, I suppose, prisons end up being such wonderfully antisocial places. They are the world of values you and I know turned upside down.

Psychopathy/socioathy is extremely rare in our society, afflicting at most 2% of the population. They used to train uss to look or the ‘triad of behaviors’ during childhood and adolescence, which included cruelty to animals, fire setting and property destruction. The truth is that these behaviors really don’t predict that some poor boy will become Hannibal Lecter and star on the opposite side of the bars from Jodie Foster. Instead, what you’re looking for is beliefs and rationalizations which support criminal behavior along with high levels of impulsivity. You will find high levels of narcissism, antisocial beliefs and what we call criminogenic associates.

It has been suggested to avoid discussions of empathy with this narrow group, and that talk therapy may actually help men with antisocial traits to get better at what they do: which is to con and manipulate. In my opinion, for a small percentage of the population who actually fit this diagnosis, traditional treatment to re-orient these men toward prosocial goals is probably not too useful. They have characterological limitations befitting of their diagnose. A diagnosis of Anti-Social Personality Disorder, along with all the personality disorders, indicates a pattern of enduring personality characteristics which are difficult, if not impossible, to change in adulthood. As strange as it may seem, these individuals are not considered mentally ill since their disorder does not always impair their functioning at a psychiatric level. For these individual, we hope to (1) contain their behavior based upon external contingencies, and (2) convince them to change their behavior for self-interested reasons.

I wrote The Mind Altar with psychopaths in mind. What do we do with the world’s most dangerous men, men who can’t be rehabilitated, men who can’t be ‘fixed?’ I’ve visited prisons and mental hospitals as part of my work in both the law and psychotherapy. I’m firmly convinced that prison and mental hospitals are simply different aspects of the same societal force. Most men in prison could be diagnosed with a mental illness. So it’s not a hard and fast line, and neither is the line we draw between criminal culpability and the symptoms of mental illness.

Sos what do we do with them, these men? Kill them? That’s been adjudged as cruel and inhumane. Render them infertile? Same. Lock them away forever? We already do that. What if we devised a means of treating them? A hi-tech invention. And what if that system went awry? And the inmates took over the asylum. That’s the set up in Mind Altar. It asks some big questions.

In the end it’s for you to decide.