Psychopathy and the neighbours of narcissism Part B: Psychopathy
Warning: This post contains references to trauma and abuse
Dr Harold Shipman, a serial killer with 218 confirmed victims, was caught in 1998
In part A, I looked at the connections between narcissism and personality disorder diagnoses (traditionally referred to as borderline/emotionally unstable, antisocial and narcissistic) and also complex post-traumatic stress disorder (C-PTSD). Now I turn to psychopathy.
Psychopathy* – what kind of ‘monster’ is this?
It’s been over 10 years since Jon Ronson’s ‘The Psychopath Test’1 – a witty journey alongside the confusing concept of psychopathy in the psychological and psychiatric world. Little has changed. The first confusing thing about psychopathy is that it is not listed in the DSM2 or ICD3 psychiatric manuals as a diagnosis. The second confusing thing about psychopathy is that the originator of the concept - -Robert Hare - proposed it specifically for the diagnostic manuals but was rejected. Instead, we have ‘antisocial personality disorder’ in the DSM manual. The third confusing thing is that ASPD and psychopathy are not the same thing.
I have said that C-PTSD and EUPD overlap (see part A). Putting that comparison to one side, EUPD also overlaps with narcissistic personality disorder and with antisocial personality disorder which are each somewhat more severe than EUPD – antisocial PD being more impulsive and unstable in mood, and narcissistic PD less impulsive and more stable in mood.
Where does psychopathy fit in? There are essentially two arguments about psychopathy. The first, is that psychopathy is a more severe extension of antisocial personality disorder (ASPD). This is the view of both the DSM and ICD psychiatric manuals. But those who support the concept of psychopathy as a distinct phenomenon – including Robert Hare - argue that viewing psychopaths as having ‘extreme ASPD’ is a mistake. The argument goes like this: Yes, in some ways psychopathy is like a more severe form of antisocial PD. But that doesn’t account for some of the features of psychopathy that are really quite different to antisocial PD. So, what are these features? A recent book, presenting the argument that psychopathy is different, states:
“Some people with psychopathic personalities have successful lives receiving social approval and admiration.”4
The author, Thompson is pointing out that those with ASPD are impulsive, unstable and reckless – often ending up in prison. Some psychopaths on the other hand, achieve over time, great power and admiration. Others describe psychopathy as ASPD with more grandiosity, charm and social abilities5. Do this group of psychopaths, who are not so impulsive and reckless, but instead gain admiration and success, start to sound familiar? The creator of the Psychopathy Checklist, Robert Hare, co-wrote a book about psychopaths in the corporate world. They argue that ASPD people don’t infiltrate the business and entertainment worlds. No, they don’t. But narcissistic people do.
In the earliest days of the concept of psychopathy, Hervey Cleckley wrote his influential ‘The Mask of Sanity’6. Cleckley’s description of the psychopath focussed on an inability to experience deep emotions “particularly love and compassion”. Again, this sounds like a link to narcissism.
Another pioneer behind the concept of psychopathy was David Henderson. In 1939 one of his three types of psychopath was the “creative psychopath”. This description also brings to my mind narcissism and, perhaps, more than one celebrity name:
“[An] erratic and moody person but brilliant and near genius”7
Henderson named examples of creative psychopaths in history: Joan of Arc and Lawrence of Arabia. It strikes me that whilst these figures were, as he argues, people who moved ‘against the herd’7, they were also something Henderson, in 1939, did not seem to notice. They were famous celebrities – admired and talked about long after death.
Today, psychopathy is defined by Robert Hare’s Psychopathy Check List – the PCL-R9. When Hare describes psychopathy in detail, he often highlights features of narcissism:
“Charming”8 (b4 p 18) (need to be admired is in the DSM criteria for NPD)
Lacking empathy9 (this is in the DSM criteria for NPD)
Lacking remorse9 or “conscience” (avoidant of shame, or lacking empathy - this is in the DSM criteria for NPD)
Showing leadership traits8
No loyalty (no emotional attachment)8
Shallow emotional experience9
ASPD traits with “added grandiosity”8 (self-importance is in the DSM criteria for NPD)
Excellent verbal skills (intellectual skills are strong whilst emotions are cut off)8
Chameleon – like – in order to maintain control – to come out on top+8 (this is in the DSM criteria for NPD)
“People with status/ celebrity are particularly attractive”8 (this is in the DSM criteria for NPD)
Never modest but often arrogant8 (225) + (this is in the DSM criteria for NPD)
Can’t take blame for mistakes or feel remorse or guilt8 (225) (avoidant of shame)
Thrive where there is money, status or power to be gained8. 99-100
Thrive where there is a culture that rewards flare and initiative rather than reliability or methodicalness. 8
The Psychopathy Checklist9 has 20 criteria for diagnosing psychopathy. Half of these line up with a ‘factor 2’ type of psychopathy. And these factor 2 criteria are to a large extent, the narcissistic features. So this could be described as ‘narcissistic psychopathy’. ‘factor 1’, lines up more with antisocial personality disorder.
With industrial psychologist Paul Babiak, Robert Hare8 wrote a book on how psychopaths infiltrate corporations with disastrous consequences. How do they deal with the apparent prominence of narcissism in these psychopaths – something they repeatedly draw our attention to? Apparently, by avoiding the word ‘narcissism’. They do admit in places that NPD, as it becomes more severe, becomes “difficult to distinguish from psychopathy” 8. But many of these identifiers of psychopathy correspond to items in the diagnostic criteria for narcissistic personality disorder and narcissism more widely.
One genuine distinction between psychopathy and personality disorders may be the degree of genetic influence. This may increase as severity increases, and in psychopathy it is estimated to be around 50% genetic and 50% environmental (such as trauma) influences4. However, it seems that with the Psychopath Check List, Hare is using a different measuring device to measure the same thing as severe personality disorder. If Hare were measuring carrots, it is as if Hare’s tape measure starts at 30cm and he is describing only ‘very long carrots” whilst claiming that they are a unique kind of vegetable. The DSM/ICD tape measure starts at 5cm and goes up to 35cm but is rarely used on carrots over 25cm - because the prison psychiatrist will tend to reach for the PCL-R instead. And if the psychopath is not in prison, s/he isn’t going to a psychiatrist and asking to be assessed. It’s not what psychopaths do…
Has any authority figure on personality disorders pointed this out? Some have. Otto Kernberg, a world authority on narcissism, has always argued that psychopathy is an extension of ASPD. But he also describes extreme narcissism in psychopathic terms:
“These individuals sometimes demonstrate charm and seductiveness that masks their underlying lack of capacity for deeper relationships, their sense of entitlement, and their ruthless manipulation of others”10
Malkin, in his book ‘Rethinking Narcissism’11, says that all psychopaths are narcissistic. But after criticising Kernberg’s portrayal of narcissism as being like ‘Frankenstein’s monster’, he says that it is the psychopath that is this monster Kernberg seems to be looking for. Again, the debate slips into ‘monster’ or ‘not monster’. What happens to the continuum from one to other? Clearly, no one wants to be connected to these monsters. And why would they?
Although the psychopath does behave like a ‘monster’, so do severely narcissistic people at times. The concepts I have described here overlap and are not like seperate building blocks. But if they were, they might be arranged as in the diagram below, building up to the severity of psychopathy in its antisocial and its narcissistic forms.
Psychopathy, narcissism and invulnerability
My aim when I began researching this post was to point out how different narcissism and psychopathy are. Sherlock Holmes is far from being a psychopath. But I have come to see psychopathy as related to narcissism in a way that I did not expect. Still, it is not the same.
Enlisted into the ‘dark triad’ of personality traits, narcissism and psychopathy have always been portrayed more as ‘wickedness’ or ‘evil’ – separated from those concepts we think of as mental health problems. Psychopaths are often described as a kind of alien subspecies of human. It seems to me that psychopathy is a kind of convergence in increased severity, of personality disorders – ASPD and NPD in particular. EUPD can be thought of as a milder and broad set of difficulties to which gets added antisocial and narcissistic features more or less as problems become more severe10. As severity, stability and inflexibility increase further, we find what Hare identifies, in 1.2% of the general population, as psychopathy4.
Psychopathy is in large part narcissism – with its severe and stable distance from feelings, potential for intellectual performance, compulsive need for power, seduction and charisma. I have described narcissism in this blog as being orientated around vulnerability - around a need for distance from it. To be vulnerable feels unsafe. There is avoidance of any internal experience of vulnerability. But this can also be achieved by being in a relationship to vulnerability in someone else. Likewise, in psychopathy, we see within the person even greater distance from vulnerability, but sometimes a visible and intimate relationship with vulnerability in others. The starkest examples can be found in serial killers such as Harold Shipman and recently in the UK, Lucy Letby.
At times, those we elevate to iconic celebrity status ultimately turn out to be psychopathic. These will most likely be the ‘narcissistic psychopaths’ - using charm and charisma to win admiration and status. As the life of DJ and presenter Jimmy Savile in the UK demonstrated, vulnerability was again, always tragically close by12.
Am I being soft on psychopathy and narcissism? No. I wouldn’t disagree that these are channels though which evil is able to move around our world and down generations. But in the case of the influencer, the celebrity and the leader, there is audience and voter participation in this movement and gaining of power.
Why do we repeat our part - treating each icon (or leader), no matter how severe their hunger for fame and power, as if they are ‘low risk’ and worthy of our mousepad click – until the shock headlines arrive? One reason might lie in the illusion of narcissism and psychopathy – that there is no vulnerability. No weakness. No trauma. And how well they hide their hunger. Perhaps it is that we ourselves – the audience – the voters - long for someone to look after us who is, finally, faultless. Perhaps we too have had experiences of vulnerability that were just too much to repeat13.
*Sociopathy is sometimes used in place of psychopathy, although Robert Hare views sociopathy as different.
References
1. Ronson, J. (2011) The Psychopath Test. Picador
2. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) Washington, DC: American Psychiatric Publishing.
3. World Health Organisation (2019). ICD-11: International classification of diseases (11th Revision)
4. Thompson, N. (2019). Understanding Psychopathy: The Biopsychosocial Perspective (New Frontiers in Psychology). Routledge.
5. Strickland, C.M., Drislane, L.E., Lucy, M., Krueger, R.F.Patrick, C.J. (2013). Characterizing Psychopathy Using DSM-5 Personality Traits. Assessment. 20(3)
6. Cleckley, H. (1941). The Mask of Sanity: An Attempt to clarify some issues about the so-called psychopathic personality. Cleckley.
7. Henderson, D.K. (1939). Psychopathic States. New York.
8. Babiak, P. & Hare, R.D. (2006). Snakes in Suits: When Psychopaths go to Work. Harper.
9. Hare, R.D. (2003). The Hare Psychopathy Checklist- Revised (2nd Ed). Toronto, Canada. Multi-Health Systems.
10. Diamond, D., Yeomans, F.E., Stern, B.L. & Kernberg, O.F. (2022) Treating Pathological Narcissism with Transference Focussed Therapy. Guildford.
11. Malkin, C. (2015) Rethinking Narcissism. Harper Wave
12. Davies, D. (2015). In Plain Sight: The Life and Lies of Jimmy Savile. Quercus.
Mayseless, O. & Popper, M. (2007). Reliance on leaders and social institutions: An attachment perspective. Attachment and Human Development, 9(1), 73-93.