2 The general public is fascinated by psychopaths, as depicted in novels and movies through the figure of the serial killer. But what are they really like? Not all psychopaths are serial killers—some are not even criminals. A number have suicidal thoughts. A general problem raised by the specialist literature is that there is no agreement on what psychopathy actually is. It is not considered a mental illness in any country, as this behavioral disorder is not encompassed by any specific definition or description. It is understood differently in the United States and in France. And even within the United States there are two opposing schools of thought.
3 Psychopathy challenges philosophers because it raises questions about the nature of morality. It also challenges judges and expert witnesses by posing the question of whether psychopaths are morally responsible in the usual sense of the term. There is agreement only in relation to a handful of characteristics: relational disturbances in childhood, frequent drug addiction, low or very low capacity for empathy, a feeling of omnipotence, lack of compassion for their victims, manipulative behavior (which supposes an understanding of others), and lack of remorse.
4 Practitioners who have undertaken expert assessments of serial killers for the courts are struck by their coldness, their apparent detachment, and their relief at being in prison.
5 A number of psychopaths will end up in hospital emergency rooms following a suicide attempt: But can they even be treated? Opinions vary. In France, psychiatrists and psychoanalysts seem to agree that psychopathy centers on a narcissistic personality disorder and a “splitting of the ego.”
7 Our selection:
8 Andreas Wilmes, Daniel Zagury, Alexandre Cailleau, Fabien Juan, Anne Sauvaget-Oiry, and Jean-Marie Vanelle.
A highly controversial area
11 What is psychopathy? The range of views on this question make it difficult, if not impossible, to answer. Psychiatrists, neuroscientists, and philosophers are all internally divided. The philosopher Andreas Wilmes attempts to provide a summary of the debate in his article for the journal PSN. Many of the points on which specialists agree are negative in nature: for example, psychopathy “does not affect the subject’s rationality or awareness of their actions”; the personality disorder “does not involve a specific form of criminality”; and “not all [psychopaths] are necessarily criminals.” The positive points of agreement, on the other hand, are relatively vague: “Psychopathy is a personality disorder characterized by disordered emotions and antisocial behavior,” psychopaths are characterized by a lack of empathy toward their victims, are “unreceptive to punishment as a deterrent,” and do not feel remorse.
12 Among psychiatrists, psychopathy is seen differently on either side of the Atlantic. French psychiatrists talk about the three “basic personality traits” of the psychopath: “deficient narcissism,” “lack of behavioral control,” and “deficient emotional control.” In the United States, on the other hand, criminal psychopaths are seen as perfectly capable of “premeditated calculation,” and a diagnosis of psychopathy is not considered a mitigating circumstance by the courts—quite the opposite, in fact. But within the United States there are two opposing schools of thought: the one embodied by the DSM, which represents the dominant doxa; and the almost equally influential one represented by the Psychopathy Checklist developed by the psychiatrist Robert D. Hare. The DSM includes psychopathy under “antisocial personality disorders” and lists objective criteria. Hare sees this as a catch-all of limited use and prefers to introduce qualitative criteria. His list consists of twenty items divided into two sets of factors, the first describing interpersonal and affective characteristics such as “glibness and superficial charm,” and the second outlining lifestyle and antisocial attitudes, including “high proneness to boredom” and “short-term marital relationships.” Clinicians assign each item a score of zero to two, and individuals with a total of thirty or more are considered to have a high “probability of psychopathy.” For Hare, psychopathy originates in a “failure of the socialization processes” that means that psychopaths “experience fear and anxiety to a far lesser extent.” Yet “their decision-making capacities remain intact.”
13 Other psychiatrists object that this amounts to favoring “a diagnostic method that relies essentially on the value judgments of clinicians.” How can symptoms such as “impulsivity, lack of empathy, and lack of emotional depth” be measured objectively? In fact, as Hare acknowledges, expert witnesses giving evidence in court can contradict each other or be biased. He argues that the diagnosis has a predictive value, since prisoners diagnosed with psychopathy have a very high rate of recidivism. But Hare’s critics object that from the point of view of psychiatry, a high recidivism rate does not say anything about the nature of the pathology. Furthermore, research into the treatment of psychopathy has failed to achieve results, supporting the idea that the concept of psychopathy primarily reflects a desire for social control on the part of clinicians. The Australian psychiatrist Paul E. Mullen even goes as far as to describe psychopathy as “a central tool for the new carceral age.”
14 Findings from physiology and neuroscience research are also difficult to interpret. Psychopaths do not in fact necessarily show “total insensitivity to the distress of others,” and brain imaging provides no clear answers. All in all, we might conclude that psychopathy “fails to meet the requirements of scientific precision and therapeutic efficacy for remaining in psychiatric classifications.”
15 Numerous philosophers have also studied this topic, since the existence of psychopaths raises questions about the nature of moral sense and responsibility. Unlike psychiatrists, they “agree that criminal psychopaths should not be held morally responsible.” Wilmes, however, concludes that “valuable as it is, this philosophical discourse often suffers from an overinterpretation of empirical data and fails to rise above meta-ethical disagreements.”
16 In his general conclusion, Wilmes observes that “it seems clear that society cannot regard their transgressive acts as an automatic sign of a disorder. Moreover, most empirical data on psychopaths do not indicate dysfunctions per se, but rather statistical differences: the intensity of their emotions is lower than average, their ability to recognize certain facial expressions seems to be lower, they appear to have poorer moral reasoning, and so forth.”
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Serial killers in their own words
19 Only a handful of specialists have had the opportunity to speak to serial killers. One of these is the psychiatrist and psychoanalyst Daniel Zagury, who has acted as an expert witness for the French courts. Zagury has met around a dozen such criminals, and he recounts his experiences in this article published in the Revue française de psychanalyse. He begins by describing two of these individuals, whom he calls Julien and Jérôme, and then goes on to share his conclusions and questions.
20 Julien’s first victim was a woman who lived near his mother, whom he murdered despite initially intending only to burgle her home. The second person he killed was a man he admired, and his third murder was characterized by “major impulsivity.”
21 Zagury describes feeling like “a wreck” after the interview. “I felt like I had been talking to the devil himself. [. . .] What I felt from him—to the point of being nauseated, almost in physical discomfort—was his calm, his tranquility, his coolness, and his delight in my confusion.” After this visit, Julien killed someone inside the prison itself. Zagury describes his ensuing distress and the intellectual support he found from talking to two psychoanalysts, also psychiatrists like him: Paul-Claude Racamier, who developed the concept of narcissistic perversion, and Claude Balier, author of Psychanalyse des comportements violents. Zagury subsequently discovered the work of the psychologist and psychoanalyst René Roussillon, “which has helped me to understand the complex links between the traumatic zone and criminal acts.” In relation to Julien, he observed “invasion by a phantasmatic brutality, resulting in action,” “a lack of internal coherence, and chaotic and improvised behavior.” After having read a book on demonology, Julien “asked questions of the corpse of his first victim and the decapitated head of the second.” He rationalized his actions by saying that he envisaged for himself “a future entirely focused on the prospect of revenge” after the “hells” he claimed to have endured. He blamed his mother while declaring that he did not want to “put [her] on trial.”
22 Jérôme, meanwhile, had murdered several elderly women. He was happy to provide a detailed account of “what had driven him.” Zagury quotes him as saying: “the conscious me you see before you in no way blames himself, although I know that I did it.” At the end of the examination, the psychiatrist writes, “I caught myself chatting to him as I might have done with someone in my local bar, discussing the latest on our shared sporting passion.” Everything had changed for Jérôme when his mother remarried a younger man following the death of his father: “Most of the serial killers I have assessed express similar rationalizations based on their life stories.” After each of his crimes, Jérôme felt “relaxed.” He had killed “without hatred” and “without feeling as if he was doing something wrong.”
23 After conducting expert assessments of other serial killers, Zagury has concluded that they are characterized by “three variably weighted features: psychopathic imbalance, narcissistic perversion, and annihilation anxiety.” He points to “the omnipotence of the demiurge. What seems to fascinate many serial killers is their mastery over the transition from life to death.” The purpose of killing is “to seal the splitting of the ego.”
24 Zagury then moves on to his examination of three “sexual criminals.” As with Julien and Jérôme, he highlights the contrast between their “unbridled” psychopathic behavior and “their calm, even serene demeanor in prison and their relief at being caught,” with the ability “to greet their expert interlocutors courteously.”
25 Like the American psychoanalyst J. Reid Meloy, Zagury believes that serial killers do not “become psychotic during the act [. . .] Reality testing is not lost completely.” He also observes that “all of the serial killers that I have met, the majority of them psychopaths, have in fact been quite ordinary in terms of their sexual activity, and did not need to resort to perverse scenarios.” He concludes that “clinical analysis shatters all simplistic explanations.”
Daniel Zagury/ Alain Julien, CC 2.0
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When psychopaths turn violent against themselves
29 While psychopaths are usually perceived as presenting a danger to others, they may also harm themselves. In their article for L’information psychiatrique, a group of four Paris-based psychiatrists discuss the management of “psychopaths who are considering or have attempted suicide.” In doing so, they provide valuable information about the specialist literature. After noting that “the concept of psychopathy is a problematic one,” they write: “While some care providers may believe that psychopaths belong in prison rather than hospital, they cannot say the same of suicidal psychopaths.” In fact, “the narcissistic flaws of psychopaths, their tendency toward addictive behaviors, and the dominance of acting-out behaviors in the way they function put them at risk of suicidal behavior.”
30 In an attempt to define the personality of psychopaths, the authors refer to a 1977 publication by the child psychiatrist Hubert Flavigny on psychopathy in adolescents: “Essential symptoms consist of acting out, repetitive behaviors, passivity and idleness, and dependence on others, combined with megalomaniacal demands and the pursuit of instant gratification. Secondary symptoms encompass instability, lack of interest, the need for escape, unstable relationships, and somatic complaints. Finally, background is formed by a permanent anxiety hidden behind an aggressive and provocative self-presentation, and affective frustrations linked to family neglect in early childhood.” The American psychoanalyst J. Reid Meloy, on the other hand, argues that “psychopathic personality organization is an extreme and dangerous subtype of narcissistic personality disorder.” As for acting out, a process common to aggression and suicide, the psychiatrist and psychoanalyst Étienne Trillat describes this as being characterized by “impulsivity, lack of premeditation and clumsy execution, lack of subsequent remorse, and framing the reaction in terms of temperament and behavioral problems.”
31 The authors of the article, meanwhile, note that “in psychopathic patients we observe an impoverished phantasmatic life but a rich instinctual life.” They quote the psychiatrist and psychoanalyst Claude Balier: “The slightest frustration triggers a discharge of anger with aggressive acts toward objects, people, or the self.” Psychopaths often use psychoactive substances as part of a “strategy of [. . .] reassurance.” And withdrawal leads to them “taking real risks, overpowering all caution.” Noting that psychopaths are “most often male,” the authors then look at identifying risk factors, assessing the urgency of the situation, how to deal with it, and how to subsequently reduce the risk of a repeat suicide attempt. In doing so, they emphasize the association between psychopathy and various types of morbidity, including “depression, anxiety disorders, and schizophrenia,” combined with the potential for “brief psychotic disorders.” In the emergency room, the decision may be taken to impose an involuntary hospitalization. In the eyes of many psychiatrists, however, “psychopaths belong in prison and are outside the scope of their work.” Indeed, “psychopathic personalities are not recognized as a mental illness in any country.” The authors do however consider hospital care to be possible, provided that the care team can establish a “relationship of trust.” They note in passing that “while psychopaths are incapable of caring about the suffering of others, they are also incapable of caring about their own.” Psychopaths can only be treated effectively in the context of teamwork, with care providers made aware of the potential risk of manipulation.
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Translator: Hayley Wood, Editor: Matt Burden, Senior editor: Mark Mellor