The diagnosis of psychopathic personality disorder has salience for forensic clinical practice. It influences decisions regarding risk, treatability and sentencing, indeed, in certain jurisdictions it serves as an aggravating factor that increases the likelihood of a capital sentence. The concatenation of symptom that is associated with modern conceptions of the disorder can be discerned in early writings, including the book of Psalms. Despite its forensic clinical importance and historical pedigree the concept remains elusive and controverted. In (...) this paper I describe an attempt to map the concept of psychopathic personality disorder—the Comprehensive Assessment of Psychopathic Personality (CAPP). I outline the processes used to create the concept map; I summarise evidence in support of the content validity of the map and describe different operations designed to operationalise the construct. It is only when conceptual clarity is achieved that valid operations and measures can be created. I end with a plea for more carefully considered application of statistical methods; applications that better fit the theoretical questions being posed. (shrink)

Personality-disordered individuals of certain types tend to exhibit behaviors that cause particular problems for the Ethics and Compliance (E&C) function inorganizations. This paper defines personality-disordered individuals and focuses on three types that might create such problems: the psychopath, the narcissist, and the obsessivecompulsive personality. We provide a working hypothesis about the problems that they may cause in organizations and then report the results of an exploratory study of E&C personnel. The paper concludes with recommendations for managers and (...) for future research. (shrink)

I present two philosophical arguments that Antisocial Personality Disorder (ASPD) and Psychopathy can be expected to be culturally variable. I argue that the ways in which people with ASPD and psychopaths can be expected to act will vary with societal values and culture. In the second part of the chapter, I will briefly review some of the empirical literature on cross-cultural variation in ASPD and psychopathy and argue that it is consistent with my philosophical claims. My conclusion in (...) this chapter is that methods of diagnosis will need to be culturally specific. A diagnostic instrument (such as the PCL-R or DSM) should not be uncritically employed in cultures that are very different from those in which it was initially developed. (shrink)

In attempting to explain or deal with negative workplace behaviours such as workplace bullying, the notion of ‘workplace psychopaths’ has recently received much attention. Focusing on individual aspects of negative workplace behaviour is at odds with more systemic approaches that recognise the contribution of individual, organisational and societal influences, without seeking to blame a person(s) for their behaviour or personality disorder. Regarding a coworker as a psychopath is highly stigmatising, and given the relatively low prevalence of psychopathy in (...) the community, is likely to be incorrect. Sources promoting the notion of workplace psychopathy provide lists of diagnostic criteria and appear to encourage the perception that it is common. This research examines how lay persons use behavioural criteria consistent with psychopathy and the label ‘psychopath’ in relation to a coworker. 307 Australian workers completed an online survey concerning their experience of workplace bullying, which also asked them to rate a coworker’s behaviour on a range of scales to assess perceptions of psychopathy. Rates of psychopathy, when using labels and behavioural criteria, were found to be much higher than scientific estimates of prevalence, for both participants who had been bullied and those who had not. A higher proportion of non-bullied participants classified a coworker as a psychopath when using the label ‘psychopath’, compared to when using behavioural criteria. The notion that there are psychopaths in every workplace should be treated with caution to ensure that the potential for ‘misdiagnosis’ and stigmatisation do not cause further harm in situations of unacceptable workplace behaviours. (shrink)

I argue for two propositions. First, contrary to the common wisdom, we may justly punish individuals who are not morally responsible for their crimes. Psychopaths – individuals who lack the capacity to feel sympathy – help to prove this point. Scholars are increasingly arguing that psychopaths are not morally responsible for their behavior because they suffer from a neurological disorder that makes it impossible for them to understand, and therefore be motivated by, moral reasons. These same scholars then infer (...) from this conclusion that they must also lack criminal responsibility and therefore that our continuing to punish psychopaths for their crimes is unjust. My response is that this inference is entirely fallacious. -/- Criminal responsibility turns out to be quite distinct from moral responsibility. The two kinds of responsibility require very different conditions to be satisfied. In particular, criminal responsibility, unlike moral responsibility, does not require an agent be able to grasp and follow moral reasons; it requires only that the individual be able to grasp and follow criminal laws. Once this point is recognized, it becomes much easier to accept my thesis: while the subset of psychopaths who commit crimes are not morally responsible for their criminal behavior because they cannot understand moral reasons, they are still criminally responsible because they can understand what the consequences will be if they get caught. For this reason, even though I concede that psychopaths are not morally responsible for the crimes that they commit, our practice of punishing them for these crimes is still just. -/- Second, I argue that psychopathy is a mental illness and should be recognized as such. One reason that it should be recognized as a mental illness is simply because it is; it satisfies the main criteria for inclusion in the DSM-IV, the “bible” of mental disorders. The other reason is more practical than conceptual. It starts with two facts: the U.S. Supreme Court has decided that the preventive detention of any individual who is not a criminal suspect is not constitutional unless the individual is not only dangerous but also mentally ill; and psychopathy is not currently considered to be a mental illness. So, as things now stand, we cannot preventively commit dangerous psychopaths – that is, psychopaths who have clearly indicated that they will be committing serious crimes. Instead, we must wait for them to commit the crimes before we can lock them up. Unfortunately, this incarceration always comes too late for the victims. It would therefore be better if we could lock them up before they actually inflict any harm. Once again, then, I propose that the legal and psychological communities classify psychopathy as a mental illness. (shrink)

This title was first published in 2000: Personality disorder/Psychopathy has long troubled philosophers, lawyers and mental health practitioners. This book is highly topical in tackling the interface of applied philosophy and psychiatry at a time when government and clinicians are giving careful consideration to new forms of treatment of people with psychopathic disorder. The book brings together contributions from lawyers, philosophers, psychiatrists and clinical managers to explore the inter-related conceptual and political implications of Psychopathy.

New discoveries in neuroscience challenge our understanding of human responsibility and justice. Recent studies suggest that psychopaths not only exhibit specific behavioral patterns but may also have a distinct neuroanatomical blueprint. Scientists have shown that a significant number of individuals who have demonstrated psychopathic behaviors have reduced volume and other anatomical changes in various regions of the cerebral cortex as well as decreased functional connectivity between different brain areas (i.e., smaller dysfunctional amygdalae). These findings raise ethical questions about how (...) our criminal system deals with these individuals. Should dysfunctional anatomical or diseased features exonerate affected individuals from any responsibility for their criminal activity or the suffering they have caused to their victims? It is estimated that individuals with the signs and symptoms of antisocial personality disorder make up 25% of inmates. Should individuals classified with this disorder be incarcerated with other criminals? In this paper, we summarize the results of the latest brain imaging studies performed on individuals with antisocial personality traits, referred to as psychopaths or sociopaths, and we explore some of the ethical issues concerning psychopathy and the law. (shrink)

Psychopaths are often regarded as a scourge of contemporary society and, as such, are the focus of much public vilification and outrage. But, arguably, psychopaths are both sinned against as well as sinners. If that is true, then their status as the victims of abusive subcultures partially mitigates their moral responsibility for the harms they cause. We argue, from the neuroethics of psychopathy and antisocial personality disorder (ASPD), that communities have a moral obligation to psychopaths as well as (...) a case against them. A reflection on the genesis and developmental epidemiology of psychopathy reveals an individualist, attribution-type error evident in much Western psychological and legal thinking—an error that obscures important moral truths about psychopaths. The resulting analysis makes us reconsider the distinction between disorders and moral failings and the ethical significance of the biological or neurocognitive mechanisms underpinning psychopathy. We claim that casting aside the deficit model (based on the presupposition that psychopaths are intrinsically unlike the rest of us) in favor of a relational and holistic view of personality potentiates a more informed and inclusive set of ethical, forensic, and therapeutic attitudes. (shrink)

Psychopathy is a personality disorder characterized by emotional deficits and a failure to inhibit impulsive behavior and is often subdivided into “primary” and “secondary” psychopathic subtypes. The maladaptive behavior related to primary psychopathy is thought to reflect constitutional “fearlessness,” while the problematic behavior related to secondary psychopathy is motivated by other factors. The fearlessness observed in psychopathy has often been interpreted as reflecting a fundamental deficit in amygdala function, and previous studies have provided support for a low-fear (...) model of psychopathy. However, many of these studies fail to use appropriate screening procedures, use liberal inclusion criteria, or have used unconventional approaches to assay amygdala function. We measured brain activity with BOLD imaging in primary and secondary psychopaths and non-psychopathic control subjects during Pavlovian fear conditioning. In contrast to the low-fear model, we observed normal fear expression in primary psychopaths. Psychopaths also displayed greater differential BOLD activity in the amygdala relative to matched controls. Inverse patterns of activity were observed in the anterior cingulate cortex (ACC) for primary versus secondary psychopaths. Primary psychopaths exhibited a pattern of activity in the dorsal and ventral ACC consistent with enhanced fear expression, while secondary psychopaths exhibited a pattern of activity in these regions consistent with fear inhibition. These results contradict the low-fear model of psychopathy and suggest that the low fear observed for psychopaths in previous studies may be specific to secondary psychopaths. (shrink)

Psychopathy is a personality disorder frequently associated with immoral behaviors. Previous behavioral studies on the influence of psychopathy on moral decision have yielded contradictory results, possibly because they focused either on judgment (abstract evaluation) or on choice of hypothetical action, two processes that may rely on different mechanisms. In this study, we explored the influence of the level of psychopathic traits on judgment and choice of hypothetical action during moral dilemma evaluation. A population of 102 students completed (...) a questionnaire with ten moral dilemmas and nine non-moral dilemmas. The task included questions targeting both judgment (“Is it acceptable to … in order to …?”) and choice of hypothetical action (“Would you … in order to …?”). The level of psychopathic traits of each participant was evaluated with the Levenson Self-Report Psychopathy (LSRP) scale. Logistic regression fitted with the generalized estimating equations method analyses were conducted using responses to the judgment and choice tasks as the dependent variables and psychopathy scores as predictor. Results show that a high level of psychopathic traits, and more specifically those related to affective deficit, predicted a greater proportion of utilitarian responses for the choice but not for the judgment question. There was no first-order interaction between the level of psychopathic traits and other potential predictors. The relation between a high level of psychopathic traits and increased utilitarianism in choice of action but not in moral judgment may explain the contradictory results of previous studies where these two processes were not contrasted. It also gives further support to the hypothesis that choice of action endorsement and abstract judgment during moral dilemma evaluation are partially distinct neural and psychological processes. We propose that this distinction should be better taken into account in the evaluation of psychopathic behaviors. (shrink)

Dietmar Hübner and Lucie White question the ethical justification of employing risky neurosurgical interventions to treat imprisoned psychopaths. They argue that (1) such interventions would confer no medical benefit on the psychopath as there is no “subjective suffering” involved in psychopathy and (2) psychopaths could not voluntarily consent to such procedures because they could have no “internal motivation” for doing so. In the course of their discussion, the authors insightfully show that certain aspects of the psychopath’s personality structure are (...) especially relevant to assessing the ethics of risky treatment options. As I argue, however, the particular conclusions that the authors draw are too strong. A deeper look at the psychopathic profile casts doubt on (1) and (2). In some cases, psychopaths can be plausibly construed as experiencing subjective suffering on account of their disorder and as appropriately motivated to voluntarily consent to neurosurgical treatment. After arguing for this view, I suggest that the psychopath’s consent to neurosurgical intervention might nonetheless be problematic, as their emotional incapacities might preclude their abilities to adequately appreciate the relevant risks. (shrink)

A pressing and difficult practical problem concerns the general issue of the right social response to offenders classified as having antisocial personality disorder. This paper approaches this general problem by focusing, from a philosophical perspective, on the still relevant but more approachable question whether psychopathic offenders are morally responsible. In particular, I investigate whether psychopaths possess moral understanding. A plausible way to approach the last question requires a satisfactory philosophical interpretation of the empirical evidence that appears to (...) show that psychopaths fail to draw the distinction between conventional and moral norms. Specifically, I will consider a recent philosophical debate polarized between supporters of rationalist and sentimentalist accounts of moral understanding. These opponents have discussed whether the case of psychopathy offers empirical support for their account and undermine the rival view. I will argue that the available empirical data leave the outcome of this discussion indeterminate. However, this implies that both these principal theories of moral understanding, if independently motivated, would imply that psychopaths have certain deficits that might affect their moral understanding and, consequently, their moral responsibility. (shrink)

A pressing and difficult practical problem concerns the general issue of the right social response to offenders classified as having antisocial personality disorder. This paper approaches this general problem by focusing, from a philosophical perspective, on the still relevant but more approachable question whether psychopathic offenders are morally responsible. In particular, I investigate whether psychopaths possess moral understanding. A plausible way to approach the last question requires a satisfactory philosophical interpretation of the empirical evidence that appears to (...) show that psychopaths fail to draw the distinction between conventional and moral norms. Specifically, I will consider a recent philosophical debate polarized between supporters of rationalist and sentimentalist accounts of moral understanding. These opponents have discussed whether the case of psychopathy offers empirical support for their account and undermine the rival view. I will argue that the available empirical data leave the outcome of this discussion indeterminate. However, this implies that both these principal theories of moral understanding, if independently motivated, would imply that psychopaths have certain deficits that might affect their moral understanding and, consequently, their moral responsibility. (shrink)

Psychopathy is a disorder involving personality and behavioral features associated with a high rate of violent aggression and recidivism. This paper explores potential psychopharmacological therapies to modulate dysfunctional neural pathways in psychopaths and reduce the incidence of their harmful behavior, as well as the ethical and legal implications of offering these therapies as an alternative to incarceration. It also considers whether forced psychopharmacological intervention in adults and children with psychopathic traits manifesting in violent behavior can be justified. (...) More generally, the paper addresses the question of how to weigh the psychopath’s presumptive right to non-interference in his brain and mind against the public interest in avoiding harm. (shrink)

In this chapter, we investigate whether psychopathy is a mental disorder. We argue that addressing this question requires engaging, at least, with three principal issues that have conceptual, empirical, and normative dimensions. First, it must be established whether current measures of psychopathy individuate a unitary class of individuals. By this we mean that persons classifed as psychopaths should share some relevant similarities that support explanation, prediction, and treatment. Second, it must be proven that psychopathy harms the person who has (...) it. Third, it must be established that the harm associated with psychopathy is relevant for the ascription of disorder status. Regarding this latter issue, we argue that psychopathy should be considered a disorder if its harmfulness derives from certain incapacities or limited capacities. These incapacities should affect basic competences that are justifably required for conducting a preferable type of life. Within this framework, we tentatively advance the hypothesis that some normatively justifed conclusions and empirical evidence about psychopathy, that needs nonetheless to be further investigated, might support the claim that people with psychopathy have a mental disorder. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.2 (2003) 193-194 [Access article in PDF] A Comment on Christopher Ciocchetti:"The Responsibility of the Psychopathic Offender" Daniel W. Shuman Questions of responsibility for serious harm are complex and potentially divisive. The way in which we frame these questions and the criteria by which we assess answers to them are colored, in part, by the lens though which we view them. I am a (...) law professor whose writings includes issues relating to criminal responsibility of person with mentally disabilities and I come to this commentary from that perspective. For me questions of moral responsibility raise psychological and philosophical, as well as legal, questions.Ciocchetti's (2003) paper addressees the criminal responsibility of the psychopathic offender. Not sure quite what the author meant by this label, I began to try to understand the concept of psychopathic offender by picking up my DSM-IV-TR and found no reference to such a diagnostic category. Absent a handy reference in the DSM, I looked in the paper for some other definition or recognition of the category of psychopathic offender and found no satisfactory grounding in any body of sound research. Left with the author's unsupported assertions that such a category of persons exists and that they behave in ways the author asks me to accept without support, my lawyer instincts cautioned me to proceed carefully. The psychopathic offender the author describes might well exist, but I am not persuaded of that, nor would be my legal colleagues, absent proof.Next, to the author's thesis that "[t]he offender must have the capacities necessary to understand relationships to justify holding that offender responsible" (p. 176) and that because psychopaths lack this capacity they should not be held criminally responsible. Is the author proposing a new test for criminal responsibility? Certainly no test for criminal nonresponsibility based on mental disability (i.e., insanity defense) in Anglo-American jurisprudence, or any other with which I am familiar, makes status (i.e., a diagnostic category) exculpatory for criminal responsibility. Rather, every test addresses the impact of a mental illness or disorder on the cognitive or volitional capacity of the offender at the time of the offense. The author offers no reason to reject the approach taken for the last several hundred years [End Page 193] by Anglo-American jurisprudence. Moreover, to the extent that status or diagnostic category is relevant in the insanity defense in Anglo-American jurisprudence, character or personality disorders (the genus to which I take it that psychopathy belongs) are often specifically excluded from consideration. For example, the Texas Penal Code (Tex. Penal Code Ann. § 8.01 (Vernon 1994)) states that:It is an affirmative defense to prosecution that, at the time of the conduct charged, the actor, as a result of a severe mental disease or defect, did not know that his conduct was wrong. The term "mental disease or defect" does not include an abnormality manifested only by repeated criminal or otherwise antisocial conduct.The federal Insanity Defense Reform Act raises the same issue: The government relies on the legislative history of 18 U.S.C. § 17, which states: "The concept of severity was added to emphasize that non-psychotic behavior disorders or neuroses such as an 'inadequate personality,' 'immature personality,' or a pattern of 'antisocial tendencies' do not constitute the defense.".... The government argues that because Dr. Lorenz would have testified that Salava was not psychotic but suffered from antisocial personality disorder, his testimony was not relevant to either prong of the insanity defense under the statute.... As a general matter, the government's point is well-taken. It seems clear that Congress intended by its inclusion of the modifier "severe" to place certain "disorders" outside the purview of the insanity defense altogether. United States v. Salava, 978 F.2d 320, 323 (7th Cir. 1992) Nowhere in the paper does Chiochetti acknowledge or address these societal judgments of moral responsibility that have already rejected a far more modest version of his proposal in categorically ruling out character or personality disorders from inclusion as... (shrink)

The research into the typical behavioral pattern, motivational structure, and the value system of psychopaths can shed light on at least three aspects related to the analysis of the moral agency. First, it can help elucidating the emotive and cognitive conditions necessary for moral performance. Secondly, it can provide empirical evidence supporting the externalist theories of moral motivation. Finally, it can bring into greater focus our intuitive notion of the limits of moral responsibility. In this paper I shall concentrate on (...) the last one—the question of responsibility of the amoralists, but the discussion will have an indirect bearing on the other two themes as well. My main reason for holding psychopaths morally responsible breaks down into two claims: the assumption that most ordinary people are morally responsible for their intentional actions and the denial that the psychopaths are qualitatively different from the non-psychopaths. This thesis is further defended against two objections. First, I am arguing that the genetically based emotive deficiency of the psychopaths cannot be seen the factor condemning them to amoral existence, and thus cannot be cited as an exempting condition. Secondly, my position is defended against the claim that psychopaths are partly responsible for their actions. It is argued that the notion of partial responsibility is either incoherent or else rests on a false empirical premise. My conclusion is in agreement with, and provides a theoretical justification for, the position of most classifications of the persons with antisocial personality disorder in the DSM IV. (shrink)

The drift toward behavioral accounts of the cluster of psychological and behavioral traits that were interchangeably referred to as psychopathy, sociopathy and anti-social personality is interesting and well worth exploring. Justman's correct that before the work of the Feighner group and the adoption of Antisocial Personality Disorder in the Diagnostic and Statistical Manual of Mental Disorders -III, the choice of concept did not seem to be vital and in the Mask of Sanity, Cleckley mentions all three terms (...) and does not seem to think much hangs on which term we choose.It seems correct that many held the absence of guilt to be the psychological marker of psychopathy... (shrink)

Both individuals with diagnosed with Autism Spectrum Disorder and individuals high in psychopathic traits show reduced susceptibility to contagious yawning; that is, yawning after seeing or hearing another person yawn. Yet it is unclear whether the same underlying processes are responsible for the relationship between reduced contagion and these very different types of clinical traits. College Students watched videos of individuals yawning or scratching while their eye movements were tracked. They completed the Interpersonal Reactivity Index, the Autism-Spectrum Quotient, (...) the Psychopathy Personality Inventory-Revised, and the Adolescent and Adult Sensory Processing Disorder Checklist. Both psychopathic traits and autistic traits showed an inverse relationship to contagious yawning, consistent with previous research. However, the relationship between autistic traits and contagious yawning was moderated by eye gaze. Furthermore, participants high in autistic traits showed typical levels of contagious itching whereas adults high in psychopathic traits showed diminished itch contagion. Finally, only psychopathic traits were associated with lower overall levels of empathy. The findings imply that the underlying processes contributing to the disruptions in contagious yawning amongst individuals high in autistic vs. psychopathic traits are distinct. In contrast to adults high in psychopathic traits, diminished contagion may appear amongst people with high levels of autistic traits secondary to diminished attention to the faces of others, and in the absence of a background deficit in emotional empathy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Third Way: Social Disability and Person-Centered AssessmentChristopher Heginbotham (bio)Keywordsimpaired functioning, psychopathic, personality disorder, neurological damage, psychotherapyJohn Sadler’s Fascinating Paper identifies a significant problem with existing diagnostic classifications. But in doing so he raises further unresolved philosophical, nosological, and practical problems. Although he is undoubtedly right in showing that the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV (and International Classification of Diseases [ICD]-10) do not (...) provide an adequate categorization, he is I believe wrong to use the term “vice” to describe the cluster of wrongful acts.“Vice” conjures up images of Miami, drugbusting police, prostitution, and other activities that are characterized by one thing—by and large, these are actions undertaken knowingly, usually for financial gain. These are not the actions of people with impaired mental functioning as a result of mental disorder or neurological damage. It is of course true that human trafficking and enforced prostitution may mean women forced into prostitution against their will, but rarely are these women considered mentally disordered solely as a result of their prostitution. Yet it is capacitated, premeditated wrongdoing that is normally considered to be “vice.”By contrast, all the cases cited in the paper describe conditions that are almost certainly the result of some form of impaired functioning, either owing to early childhood experiences (Case A), familial culture and conditioning (Case B), or neurological damage (Case C). The common thread in these cases is impaired capacity—in Case A this could be described as due to psychopathic or personality disorder (I distinguish the two separately rather than describe the phenomenon as “psychopathic personality disorder”) as a result of multiple childhood traumas. Their presentation is not unexpected given the person’s history and, although the condition may have become refractory, it might be amenable to treatment with psychoanalytically oriented psychotherapy, given sufficient time and a nurturing environment (Bateman and Fonagy 2006, 2008; Cordess and Cox 1996; Levy 2008).The description of Case B leaves a lot of room for doubt and uncertainties. Did Ms A really try to smother her child? She confessed to one occasion, but was this under duress? Did she feel that if she agreed she would be treated more leniently? And if she was guilty, does it suggest “vice,” a premeditated act, or is there another explanation—attention [End Page 31] seeking because of low self-esteem or a personality disorder as a result of some abuse that had not been identified? Almost certainly from the description given this would not count, for me at any rate, as vice. Her actions may be odd, bizarre, or dangerous, but did they demonstrate a mens rea? Was Ms A making adequate evaluative judgments of her situation and that of her child? We know from clinical work with very damaged women in forensic mental health services that early physical, emotional, or sexual abuse leads in turn to women harming both themselves and their children (Bland et al. 1999; Cordess and Cox 1996; see also for example, Jeffcote and Watson 2004). Or perhaps, speculatively, her condition was Munchausen’s by proxy?Case C is horrendous but does not lend itself readily to the forms of psychiatric classification available. Indeed there is no easy way to describe such actions other than those of someone who is either incapable of understanding the nature and consequence of the actions that he has undertaken, or is simply “mad” in a folk sense. Prima facie this seems to be the result of permanent and little understood neurological damage. However, this case comes closest to the evil that is implied in the term “vice”; and might be diagnosed similarly to a celebrated English murderer, that of Peter Sutcliffe, the so-called Yorkshire Ripper. Sutcliffe was diagnosed as suffering from paranoid schizophrenia, although the jury at his trial found that he was fit to plead, and he was initially sent to prison, where he deteriorated. He is now, and has for some time, been in Broadmoor high secure hospital.The result of these comments is that I agree fully with John Sadler’s conclusions, but for rather different reasons. DSM-IV categories try and fail to offer a symptomatology for... (shrink)

The psychopathic personality disorder historically has been thought to include an insensitivity to morality. Some have thought that the psychopath's insensitivity indicates that he does not understand morality, but the relationship between the psychopath's defects and moral understanding has been unclear. We attempt to clarify this relationship, first by arguing that moral understanding is incomplete without concern for morality, and second, by showing that the psychopath demonstrates defects in frontal lobe activity which indicate impaired attention and adaptation (...) to environmental conditions which are relevant to the formation of complex intentions. We argue that these frontal lobe defects can help to explain both the psychopath's apparent insensitivity to morality and his characteristic imprudence. (shrink)

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their (...) deficient practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)

Anger is probably one of the mostly debated basic emotions, owing to difficulties in detecting its appearance during development, its functional and affective meaning (is it a positive or a negative emotion?), especially in human beings. Behaviors accompanied by anger and rage serve many different purposes and the nuances of aggressive behaviors are often defined by the symbolic and cultural framework and social contexts. Nonetheless, recent advances in neuroscientific and developmental research, as well as clinical psychodynamic investigation, afford a new (...) view on the role of anger in informing and guiding many aspects of human conducts. Developmental studies have confirmed the psychophysiological, cognitive and social acquisition that hesitate in the pre-determined sequence appearance of anger and rage in the first two years of life. The so-called affective neurosciences have shown the phylogenetic origin of the two circuits underlying the emergence of anger along with its evolutionary role for promoting survival. This view has been integrated by the psychodynamic theory of motivational systems that attribute a double role to anger: on the one hand, this affect works as an inwardly directed signal concerning a pressure to overcome an obstacle or an aversive situation; on the other hand, anger is also an outwardly directed communicative signal establishing differentiation and conflict within interpersonal relationships and affective bonds. Of course, human peculiar mental functioning requires the appraisal of such signals by higher cortical functions and, there is little doubt that the meaning that orientates individual behaviors is, eventually, construed on a social and cultural level. At the same time, everyday life experiences as well as clinical insights into psychopathic, narcissistic and borderline personality pathology clearly illustrate the necessity to correctly interpret and give answers to the basic questions raised around the topic of anger as a basic emotion. (shrink)

This article critically examines Louis Charland’s claim that personality disorders are moral rather than medical kinds by exploring the relationship between personality disorders and virtue ethics. We propose that the conceptual resources of virtue theory can inform psychiatry’s thinking about personality disorders, but also that virtue theory as understood by Aristotle cannot be reduced to the narrow domain of ‘the moral’ in the modern sense of the term. Some overlap between the moral domain’s notion of character-based ethics (...) and the medical domain’s notion of character-based disorders is unavoidable. We also apply a modified version of John Sadler’s “moral wrongfulness test” to borderline and narcissistic personality disorders. With respect to both diagnoses, we argue that they involve negative moral evaluations, but may also have indispensable nonmoral features and, therefore, classify legitimate psychiatric disorders. (shrink)

Many feminist researchers have been critical of the psychiatric category of borderline personality disorder 1 and have emphasized the gendered nature of the diagnosis. It is estimated that people diagnosed with BPD comprise 1 to 2 percent of the general population in the United States in a given year, and that women represent 75 percent of those diagnosed.2 Critics have argued that the diagnosis reinforces double-binds for women and pathologizes traits associated with both conventional femininity, such as emotionality, (...) dependency, and self-destructiveness, and unconventional femininity, such as rebelliousness and sexual promiscuity (Lester 2013; Potter 2009; Shaw.. (shrink)

Is psychopathy born or made? Contemporary psychopathy research shows that there is much wrong with this question. It is increasingly accepted that the development of psychopathy is dependent on multiple causal factors interacting with one another. However, there remains the major theoretical challenge of understanding the relations between these multiple causal factors in the developmental process. In this paper, I argue that the conventional picture of gene-environment interactionism does not offer an adequate account of psychopathy development. Instead, I propose that (...) a theoretical framework from the philosophy of biology, namely developmental systems theory, can facilitate a better understanding of psychopathy development that captures the contingent and dynamic relations between multiple causal factors. Some practical implications of a developmental systems theory approach to psychopathy are also explored. (shrink)

Several researchers point to disorganized attachment as a core feature of borderline personality disorder (BPD). However, recent studies suggest that specific internal working models (IWMs) of each parent combine to account for child outcomes and that a secure relationship with one parent can protect against the deleterious effects of an insecure relationship with the other parent. It was thus hypothesized that adolescents with BPD are more likely to be disorganized with both their parents, whereas non-clinical controls are more (...) secure with at least one of their caregivers. Thirty-six adolescents with BPD and 30 control participants (aged 13-19) were included. Psychiatrist diagnosis was verified with the SIDP-IV and comorbidity was assessed using the Kiddie-SADS. Reported trauma was assessed with the Childhood Trauma Questionnaire. Attachment IWMs of each parent were assessed with the Attachment Multiple Model Interview (AMMI), which enables separate coding for each attachment figure and in which disorganization is conceptualized as conflicting attachment strategies within a specific relationship. Results of a logistic regression analysis suggested that beyond insecure attachment, being disorganized not just with one but with both parents is particularly characteristic of adolescents with BPD. Conversely, belonging to the non-clinical group was predicted by higher security scores with the father and lower deactivation with the mother. Although higher levels of childhood abuse or neglect were reported by adolescents with BPD, the retained attachment dimensions predicted group membership over and above reported trauma. These findings have important implications for clinical intervention and highlight the protective role fathers may have. (shrink)

The traditional view that having a personality disorder, unlike other mental disorders, is not usually reason enough to consider a person incompetent to make healthcare decisions is challenged. The example of a case in which a woman was treated for a physical disorder without her consent illustrates that personality disorder can render a person incompetent to refuse essential treatment, particularly because it can affect the doctor–patient relationship within which consent is given.

Whether treatment decision-making capacity can be meaningfully applied to patients with a diagnosis of “personality disorder” is examined. Patients presenting to a psychiatric emergency clinic with threats of self-harm are considered, two having been assessed and reviewed in detail. It was found that capacity can be meaningfully assessed in such patients, although the process is more complex than in patients with diagnoses of a more conventional kind. The process of assessing capacity in such patients is very time-consuming and (...) may become, in itself, a therapeutic intervention. (shrink)

Once common, therapeutic privilege—the practice whereby a physician withholds diagnostic or prognostic information from a patient intending to protect the patient—is now generally seen as unethical. However, instances of therapeutic privilege are common in some areas of clinical psychiatry. We describe therapeutic privilege in the context of borderline personality disorder, discuss the implications of diagnostic non-disclosure on integrated care and offer recommendations to promote diagnostic disclosure for this patient population. There are no data in this work.

'Cruel' simply ignores the supposed fact/value dichotomy and cheerfully allows itself to be used sometimes for a normative purpose and sometimes as a descriptive term.Personality disorders have always attracted considerable attention within the philosophy of psychiatry. It was not until two papers written by Louis Charland, however, that they simulated a wider and lively debate. The importance and, at least partly, the strength of Charland's analyses lie in the fact that they are relatively particular and focused in their...

Personality disorders: illegitimate subject positions The diagnosis of personality disorder is common in mental health nurse settings and is a term often used without critical consideration. In clinical practice, the term personality disorder has pejorative connotations, which arise out of the way in which these behaviours are constructed as behavioural rather than psychiatric. The discursive construction of categories of personality disorder are inculcated into clinical practice and become taken‐for‐granted by those in practice culture. (...) The construction of some personalities as disordered and, therefore, illegitimate becomes natural. This paper provides a critical analysis of the diagnosis and suggests an approach to mental health nursing care that is more legitimising for those people who receive psychiatric diagnoses. (shrink)

People with personality disorders should be treated fairly. Potential crime victims should be protected. That much is uncontroversial. The hard questions ask what is fair, when is protection adequate, and how should we achieve fairness and protection together. Peay outlines five main hurdles that the law must jump to reach these goals. All five raise serious challenges. To begin to address these challenges, we must first clarify what a personality disorder is. The notion of a personality (...) disorder is defined very broadly in DSM-IV-TR as any inflexible, pervasive, enduring, stable, and early-onset pattern of experience and behavior that deviates markedly from cultural expectations, leads to clinically .. (shrink)

The diagnostic category of borderline personality disorder (BPD) has come under increasing criticism in recent years. In this paper, we analyze the role and impact of epistemic injustice, specifically testimonial injustice, in relation to the diagnosis of BPD. We first offer a critical sociological and historical account, detailing and expanding a range of arguments that BPD is problematic nosologically. We then turn to explore the epistemic injustices that can result from a BPD diagnosis, showing how they can lead (...) to experiences of testimonial injustice which impede patient engagement in meaning-making activities, thereby undermining standard therapeutic goals. We conclude by showing how our arguments bolster ongoing efforts to replace the diagnostic category of BPD with alternatives such as complex post-traumatic stress disorder. (shrink)

All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood. (Article 1, Universal Declaration of Human Rights 1948) This resounding statement encapsulates a number of problematic themes for lawyers with respect to personality disorder, and acutely so for the extremes of personality disorder embraced by designations such as psychopathy or dangerous and severe personality disorder (...) (DSPD). These designations are in themselves contentious; they do not have commonly agreed definitions either across disciplines or across jurisdictions. Morse (2008), for example, argues in a fascinating account that .. (shrink)

In “Personality Disorders: Moral or Medical Kinds—or Both?” Peter Zachar and Nancy Nyquist Potter (2010) reject any general dichotomy between morality and mental health, and specifically between character vices and personality disorders. In doing so, they provide a nuanced and illuminating discussion that connects Aristotelian virtue ethics to a multidimensional understanding of personality disorders. I share their conviction that dissolving morality–health dichotomies is the starting point for any plausible understanding of human beings (Martin 2006), but I register (...) some qualms about their discussion of responsibility. Zachar and Potter target the morality-health dichotomy as it appears in Louis C. .. (shrink)

A striking feature of post-modernism is its distrust of the subject. If the modern period, beginning with Descartes, sought in the subject a source of certainty, an Archimedian point from which all else could be derived, post- modernism has taken the opposite tack. Rather than taking the self as a foundation, it has seen it as founded, as dependent on the accidents which situate consciousness in the world. The same holds for the unity of the subject. Modernity, in its search (...) for a single foundation, held the subject to be an indissoluble unity. Post-modernism’s position, by contrast, is announced by Nietzsche: “The assumption of one single subject is perhaps unnecessary; perhaps it is just as permissible to assume a multiplicity of subjects, whose interaction and struggle is the basis of our thought and our consciousness in general? ...My hypotheses: The subject as multiplicity.” Given this, there is a natural correspondence between the success of post- modernism and the current interest in multiple personality disorder. In the latter, we actually have the experience of a “multiplicity of subjects” in their interaction and struggle. The subject stands there before us “as multiplicity.” It gives us a concrete case, one which raises some of the pressing questions associated with the post-modern denial of the subject. Confronting it, we ask: how real are the personalities composing the multiplicity of this disordered self? What, in fact, does this multiplicity tell us about the self? about its genesis and status? What does it reveal about “our thought and consciousness in general”? I plan, in the short compass of this paper, to sketch some answers to these questions. §1. A brief description of MPD. The American Psychiatric Association gives two criteria for (MPD) multiple personality disorder. First, and most obviously, there is “the existence within the person of two or more distinct personalities or personality states (each with its own relatively enduring pattern. (shrink)

Individuals with conditions like borderline personality disorder experience chronic, pervasive impairments that interfere with moral functioning. Even in recovery these individuals are plagued by residual symptoms, requiring diligence and management. First, I stipulate that some individuals who recover from BPD act morally. I argue that by acting morally while managing residual symptoms these individuals expand the boundaries of traditional Aristotelian virtue. Individuals who recover from BPD are simultaneously virtuous and outside the boundaries of traditional Aristotelian virtue if they (...) meet the following conditions: they experience marked, unchangeable morally-relevant difference in moral faculties; act morally at approximately the same rate or better than other moral agents; and act morally for the right reasons. These individuals challenge the boundaries of traditional Aristotelian virtue by demonstrating that many views of temperance and virtue are too restrictive. I evaluate multiple interpretations of McDowell’s [1] silencing view and call for a more inclusive virtue ethics that embraces continence in the vein of Foot’s [2] corrective view. (shrink)

This book is the second volume of an interdisciplinary study, chiefly one of philosophy and psychology, which concerns personality, especially the abnormal in terms of states of aloneness, primarily that of the negative emotional isolation customarily known as loneliness. Other states of aloneness investigated include solitude, reclusiveness, seclusion, desolation, isolation, and what the author terms “aloneliness,” “alonism,” “lonism,” and “lonerism.” Insofar as this study most explicitly focuses on abnormal personalities, it employs the general and specific definitions of personality (...) aberrations as formulated by the American Psychiatric Association in its latest edition of the _Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)_. The author views personality as preeminently comprised of the individual's interpersonal relationships. Unlike the _DSM-IV_, he proposes that people with personality disorders not only possibly but necessarily manifest deviancy regarding interpersonal functioning via serious shortcomings in shared inwardness, paramountly reciprocated intimacy. This work also engages in an analysis of five social factors that are conducive to predisposing, precipitating, and maintaining negative kinds of personality and aloneness. The author has formed these factors into an acronym titled _SCRAM_ since when they are present, intimacy scurries away and in its absence, loneliness and other sorts of unwanted aloneness scamper in and fill the person with unhappiness via, for instance, sadness and self-worthlessness. The constituents of SCRAM are the following social illnesses: _S_uccessitis (for example, the fixation on fame and fortune), _C_apitalitis (greed-driven, unfettered capitalism), _R_ivalitis (competitivitis), _A_tomitis (hyper-individualism), and _M_aterialitis (for example, the anti-spirituality of consumeritis). In sum, this book provides a different perspective on personality via the lenses of various types of aloneness and their lack of public and private intimacy, especially love. (shrink)

Borderline Personality disorder is a severe personality dysfunction characterized by behavioural features such as impulsivity, identity disturbance, suicidal behaviour, emptiness, and intense and unstable relationships. Approximately 2% of the population are thought to meet the criteria for BPD. The authors of this volume - Anthony Bateman and Peter Fonagy - have developed a psychoanalytically oriented treatment to BPD known as mentalization treatment. With randomised controlled trials having shown this method to be effective, this book presents the first (...) account of mentalization treatment for BPD. The first section gives an overview of BPD, including discussion of nosology, epidemiology, natural history, and psychosocial aetiology. It additionally summarises the present state of our research knowledge about effective psychotherapeutic treatments and use of medication. The second section outlines the authors' theoretical approach and contrasts it with other well known methods, including DBT, CAT, and CBT. In the extensive final section, the authors outline their clinical approach starting with how treatment is organised. A detailed account of the transferable features of the model is provided along with the main strategies and techniques of treatment. Numerous clinical examples are given to illustrate the core techniques and detailed information provided about how to apply aspects of the mentalization based treatment approach in everyday practice. Aimed at mental health professionals, along with counsellors, psychotherapists, and psychoanalysts, the book will be a valuable tool, providing an effective means of treating those suffering from Borderline Personality Disorder. (shrink)

The DSM-IV-TR (American Psychiatric Association 1994, 689) defines personality disorder (PD) as: An enduring pattern of experience and behavior that deviates markedly from the expectations of an individual’s culture. This pattern is manifested in two (or more) of the following areas: 1 Cognition (i.e., ways of perceiving and interpreting self, other people, and events); 2 Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response); 3 Interpersonal functioning; and 4 Impulse control. B The enduring ..

Louis Charland has argued that the Cluster B personality disorders, including borderline personality disorder, are primarily moral rather than clinical conditions. Part of his argument stems from reflections on effective treatment of borderline personality disorder. In the argument from treatment, he claims that successful treatment of all Cluster B personality disorders requires a positive change in a patient’s moral character. Based on this claim, he concludes (1) that these disorders are, at root, deficits in (...) moral character, and (2) that effective treatment of these disorders requires a sort of moral education rather than clinical intervention. In this paper, I evaluate the argument from treatment through a critical analysis of two psychotherapeutic interventions that have shown recent effectiveness against borderline personality disorder. I suggest that both Dialectical Behaviour Therapy and Mentalization-Based Treatment indicate that borderline personality disorder is, at root, a deficit in non-moral cognitive and emotional capacities. I suggest that these non-moral deficits obscure the expression of an otherwise intact moral character. In light of this, I conclude that effective treatment of borderline personality disorder requires primarily clinical intervention rather than moral edification. (shrink)

When i was in graduate school, I inadvertently walked in on a fellow student taking his comprehensive exams. He was extremely frustrated because two of the questions asked about conceptual issues in personality and personality disorders. This student was not expecting such questions and considered them to be unfair. I knew other students in that same program who would have considered it a gift to get such “interesting” questions. Those clinical and counseling psychologists with theoretical–philosophical interests are often (...) attracted to the topics of personality and personality disorders. It has, therefore, puzzled me why these same topics are largely ignored by those philosophers who study the conceptual issues of .. (shrink)

Most clinicians and mental health practitioners are reluctant to work with people with dangerous and severe personality disorders because they believe there is nothing that mental health services can offer. Dangerous and severe personality disorder also signals a diagnosis which is problematic morally. Moral philosophy has not found an adequate way of dealing with personality disorders. This paper explores the question: What makes a person morally responsible for his actions and what is a legitimate mitigating factor? (...) How do psychiatric nurses working with this client group understand the awful things some clients do? What concepts do they need, if they are to know how to explain and how to react? It is suggested that dangerous and severe personality disorder is best regarded as a moral category, framed in terms of goodness, badness, obligation and other ethical concepts. It seems plausible that in important ways the dangerous and severe personality disordered client does not understand morality or understands it differently. The peculiar position of the dangerous and severe personality disordered individual in our system of moral responsibility stems from his apparent inability to see the importance of the interests of others. It might be more helpful to regard personality disordered clients as we do children: partially but not fully reasonable for their actions. We might regard the dangerous and severe personality disordered client responsible for those actions which he most clearly understands, such as causing others physical pain, but not for those with which he is only superficially engaged, such as causing emotional pain. The paper concludes by suggesting that the dangerous and severe personality disordered individual does not fit easily into any conventional moral category, be it criminal, patient, animal or child, and thus an assessment of his moral accountability must take into consideration his special circumstances. (shrink)