Psychopaths- the wolves among us

The joy of my job is that I get to talk to a lot of people. I talk with them when they are at low points in their lives; when they are vulnerable and hurt. There is a lot of honesty, much barebones of stories, not much bull. As a result of my experience, I have concluded that 90% of humanity is mostly good. Granted, mostly good people can commit the most heinous of crimes, but the struggle is universal. We try our best for our children; we mourn the loss of loved ones. We feel pride, envy, love, fear and try to get on with it.

It seems to me that 10% of humanity seriously stuffs it up for the rest of us. That small slice of the population causes a great deal of mankind’s pain and suffering (that 10% and addiction, but that is a topic for another blog).

Psychopaths make up part of this 10 %. Although only one percent of the population are full-blown psychopaths, the condition is a spectrum disorder and even “mild” psychopaths manage to cause much misery.

I would caution against untrained people going about diagnosing personality disorders. But having a bit of knowledge could help refine your instincts and save you from a world of suffering.

Psychopaths are described in psychiatry under the diagnostic criteria for Antisocial Personality Disorder. The diagnosis includes criteria such as failure to obey laws and norms, impulsivity, lack of remorse, lying, manipulating, putting others at risk, irritability and aggression. Of course, we can all be antisocial at times. Another diagnostic criterion is consistency. The traits are present throughout life, even in childhood when it is called conduct disorder.

These are people with different wiring to us. You can’t identify a psychopath by looking at him (the male to female ratio is about 20:1). But you can identify a psychopath by looking at his brain. In MRIs of psychopaths, we see specific structural abnormalities in the orbitofrontal cortex, the social parts of the brain. These parts of the brain play a role in regulating our emotions and influencing our sense of morality and empathy. Psychopaths’ amygdalas are 18% smaller. Amygdalas influence our fear, anger and pain responses. Psychopaths have higher pain thresholds and do not easily feel fear.

Psychopaths need not be psychopathic killers. They have a genetic variation to the MOAO gene, a gene which is linked to high violence. The current theory is that for this gene to be “switched on” there needs to be trauma before puberty. Serious, violent trauma. This might explain why the notorious psychopaths, like Ted Bundy and Charles Manson,  have histories of childhood sexual abuse.

Psychopaths can be very successful. While about 1% of the general population scores high on psychopathy, this proportion rises to 4% for top CEOs and 30-40% for the prison population. I have not found the stats for politicians, but I would guess they would be high.

I am reminded of a patient* of mine who came to me because she was very confused about her conflicting emotions. Her prominent husband had just been discharged from ICU after a car accident and was making a good recovery – to her dismay. She remembers the relief she felt when the doctors said that he might not make it. Being essentially a nice person, she was very confused and guilty about these feelings. She had never thought of leaving her husband. He was a good provider, and as he often reminded her, she was nothing without him. On their honeymoon he held her over a cliff, but said he was just joking. He always drove recklessly fast, even when the kids were in the car. He could not abide criticism; you were either with him or against him. Even a minor difference of opinion could induce a rage. He never physically hurt her, but she did fear him. My patient thought that perhaps she was being overdelicate.

I had never met her husband, but these and other stories left me convinced that he rated high on psychopathy. That is the way with psychopaths. They rarely seek psychiatric help, but everyone around them gets damaged.

We might start wondering about concepts of good and evil. But these are philosophical constructs imposed by people who are wired to be empathetic.

Psychopaths know right from wrong, but their path is guided by their own best interests, even if those best interests are amusement at the cost of another’s safety. They are aware of our emotions, very astutely, and know how to prey on them and manipulate them. They don’t feel these emotions themselves; their emotional repertoire is very shallow. Mostly they don’t know that they are psychopathic since they rarely seek out psychiatric help. If the diagnosis is made, they don’t mind, and will quickly acknowledge a sense of being different, of being special.

For this blog, I engaged a few psychopaths in online conversations via the platform Quora. A few referred to normal people as “neurotypicals”. One told me that his wife divorced him because two weeks after their son died he told her that it was over, but couldn’t understand why she was still upset. Another said that he was a logical hunter amongst emotional sheep. He wasn’t being grandiose, just factual.

The high-functioning amongst the psychopaths keep a tight lid on violence. They value logic, but only if logic has a self-serving purpose. Judicial punishment or aversion therapy is considered as unjust or abusive, because they see nothing wrong with how they think and act, making them very resistant to rehabilitation. What seems to work is negotiating with their needs. Something along the line of “if you keep being violent, you are going to stay in prison a long time.” When this kind of intervention is used in prison populations, psychopaths are discharged 30% earlier than their counterparts due to their exemplary behaviour.

I do not dislike psychopaths. On the contrary, I find them fascinating. I do accept that they are as they are, no amount of therapy is going to change that. Because I would prefer to avoid pain and trauma, I would not knowingly enter into a relationship with them.  A bit of knowledge won’t protect anyone, but hopefully, it will help hone instincts a bit.

*Patient details changed to  protect anonymity