Emotional Health · Health

Dr. Ford: Trying to Understand the Mind of a Criminal

fordCecilia Ford, who has been a psychologist in private practice in New York City since 1987, has addressed emotional issues for Women’s Voices in many articles over the years. This week, she takes up a particularly troubling issue.


Once again, a disturbed young man has committed mass murder. Once again, questions have been raised about the need to improve our mental health system. While it’s true that there is much room for improvement in the system, that may not do much to keep these incidents from occurring. That’s because it is very difficult to predict who is likely to become violent and who is not, according to psychiatrist Dr. Richard Friedman. (The New York Times).

“While it is true that most mass killers have a psychiatric illness, the vast majority of violent people are not mentally ill and most mentally ill people are not violent,” Dr. Friedman writes. Much of the violence that psychotic individuals experience is actually directed towards themselves. The voices they hear in their heads are frequently self-critical rather than directed toward others. Friedman reports that “our current ability to predict who is likely to be violent is no better than chance.”

In fact, Dr. Friedman writes, the only mental health disorder that clearly predicts violence is substance abuse: “Drug and alcohol abuse are far more powerful risk factors for violence than other psychiatric illnesses. Individuals who abuse drugs or alcohol but have no other psychiatric disorder are almost seven times more likely than those without substance abuse to act violently.” Dr. Friedman concludes that our best chance to limit violence would be to limit our access to weapons. Opportunity is a crucial factor, regardless of diagnosis, be it substance abuse, psychosis, or even depression: when Great Britain began phasing out a certain kind of gas heat that provided an easy method for people to kill themselves, the suicide rate plummeted (the poet Sylvia Plath ended her life this way).

Is there such a thing as a criminal personality? The only profile that comes close to this idea is that of the “psychopath.” The new psychiatric manual just published last year, DSM-5, has, in fact, renamed this category “anti-social personality disorder.” This may turn out to be helpful because the term psychopath is similar to, yet but quite different from, psychotic. Those who are psychotic are more likely to fit our general notion of “crazy” thoughts and behavior—delusions, hallucinations, loss of the ability to distinguish reality and fantasy. True psychopaths (or sociopaths—the terms psychopath and sociopath are generally used interchangeably) are fully oriented to reality, however, and they are rare: statistics vary, but the estimate is that between 1 percent and 4 percent of Americans can be classified this way. In the prison population, an estimated 20 percent are considered to be psychopaths. They are difficult to study partly because they almost never consult a therapist voluntarily, and if forced to go, they often lie. The entire premise of psychotherapy is based on the idea of wanting to improve yourself by taking responsibility for making changes in your life. Psychopaths rarely are unhappy with themselves, and they don’t feel guilty or conflicted. If they have any problems, it’s someone else’s fault, as they see it.

David Hare, a Canadian psychologist, developed a checklist to determine a person’s level of psychopathy while working in the prison system.

The qualities of a psychopath, as listed by Dr. Hare, are:

  1. Glib and superficial charm
  2. Grandiose self-worth
  3. Need for stimulation, prone to boredom
  4. Pathological lying
  5. Conning and manipulating
  6. Lack of remorse or guilt
  7. Shallowness of expressions
  8. Callousness, lack of empathy
  9. Parasitic lifestyle
  10. Poor behavioral controls
  11. Promiscuous sexual behavior
  12. Early behavioral problems such as lying, fire setting, stealing etc.
  13. Lack of realistic long-term goals
  14. Impulsivity
  15. Irresponsibility
  16. Failure to accept responsibility for own actions
  17. Many short-term marital relationships
  18. Juvenile delinquency, crimes, and acting out between the ages of 13 and 18
  19. Revocation of Conditional Release
  20. Criminal versatility

At first, however, Dr. Hare declined to publish the checklist for fear that it might be misused. According to an episode of the NPR radio show This American Life titled “The Psychopath Test,” his fear has been realized: his work has been widely used to rate prisoners. Once having scored high on the test, inmates have a more difficult time gaining parole, according to the report. But the test is not foolproof—many young offenders engage in behavior that is sociopathic and yet have the capacity for growth and change. A genuine psychopath does not, and is likely to “reoffend.”

As more has become known about psychopaths, it has become clear that they may be born, not made. A bad childhood (or series of harmful incidents, known as ACE’s: “adverse childhood events”) can make it worse—but psychopaths are often found in the midst of normal, or at least average, families. Parents report that these children often display callous behavior at an early age, such as the abuse of animals, which, along with starting fires and bed-wetting, forms a triad of early warning signs of psychopathy.

9781591846000_p0_v1_s260x420Young psychopaths often have a history of truancy, delinquency, and thrill-seeking. But how does this distinguish them from countless other adolescents? Brain imaging research has shown that there are actual structural differences when their brains are compared with those of “normal subjects.” In a bizarre coincidence, neuroscientist Dr. James Fallon discovered that his brain structure closely resembles that of violent psychopaths whose scans he compared his to, as he recounts in The Psychopath Inside: A Neuroscientist’s Personal Journey Into the Dark Side of the Brain. Though he had no history of violence,“Fallon’s PET scan revealed the same functional anomalies of the psychopaths’ brains he had pored over: sluggish activity in both the prefrontal cortex (the part of the brain tasked with processing moral, ethical, and social behavior) and the amygdala (the almond-shaped cluster of nuclei that regulates emotional reactions) and insula (the key structure processing emotional empathy).”

Forced by these findings to re-examine himself, Dr. Fallon saw that he relied, as most psychopaths do, on emotional manipulation in his dealings with others, but he has never been violent, and has never committed a crime.This points to an important point: a sizeable percentage of anti-social personalities are not violent, and may never be.

The dangers inherent in diagnosing and predicting behavior based on brain scans, particularly when there are legal consequences, are obvious. While in the case of some of our most notorious criminals, such as Ted Bundy, a psychopath, it would have been fortuitous to have been able to make an early diagnosis, many violent criminals are neither psychopaths nor mentally ill. Killers like University of California at Santa Barbara’s Elliot Rodger or the Sandy Hook killer, Adam Lanza, are both psychotic rather than psychopathic—that is, they showed signs of having lost touch with reality. In these cases, these men were overcome by emotions that were fed by their delusional thinking. According to Dr. Friedman, this kind of killer is quite rare, but these events get a huge amount of media attention and therefore seem more common than they are.  Indeed, they are so very frightening because they are so random.

Psychopaths in some ways may be easier to spot than a psychotic person who may or may not lose control. Yet they are also good at hiding their true selves and fooling others. There have been some crimes committed by them that have taken everyone by surprise. The case of Leopold and Loeb, convicted of the murder of Bobby Franks in 1924, is a good example of killers with psychopathic personality traits, which may well have been confirmed by brain scans had they been available. The perpetrators, Nathan Leopold and Richard Loeb, both wealthy and precocious young graduate students at the University of Chicago, kidnapped and murdered a young boy purely for the fun of it, and to prove to themselves that they could be criminal masterminds. They planned the murder for six months, yet chose the victim at random (the Franks boy was Loeb’s cousin, but Leopold had never met him) and expressed no remorse when they were caught.

15841837There are many instances of psychopaths who are not violent and who can be very “well integrated” into society. In fact, properly honed, the skills these people have at their disposal make them well suited to success in certain areas where fearless aggression and/or emotional manipulation are valued. The pseudonymous M. E. Thomas (Confessions of a Sociopath: A Life Spent in Hiding) claims to have a very successful career as an attorney and professor of law, for example. (Note that grandiosity is Symptom No. 2.) As a female, she represents a small group—the vast majority of psychopaths are male. But the female without conscience has a great hold on the popular imagination, as she represents a particularly confusing and contradictory type, and is thus all the more dangerous. In our society, women have been taught to be attuned to the feelings of others. When they lack this trait, it can seem especially frightening, as in Thomas’s account of her childhood from Confessions of a Sociopath:

“I was a perceptive child, but I couldn’t relate to people beyond amusing them, which was just another way for me to make them do what or behave how I wanted them to. I didn’t like to be touched and I rejected affection. The only physical contact I sought usually entailed violence. The father of a friend in grade school had to pull me aside and sternly ask me to stop beating his daughter. She was a skinny, stringy thing with a goofy laugh, as if she were asking to be slapped. I didn’t know that I was doing something bad. It didn’t even occur to me that it would hurt her or that she might not like it.”

Women are much more likely to be the victims of psychopaths than to be psychopaths. Male psychopaths are especially good at spotting the kind of nurturing females who are likely to be easy marks. Perhaps you or someone you know has had experiences with the kind of boyfriend who promises a lot but winds up taking everything. One woman with a long history of attraction to abusive men started going “steady” in the eighth grade and gave the boy a valuable gold ring that her parents had given her. He claimed he had lost it before he even got home. Needless to say, he deceived and manipulated her until she finally wised up, but I am startled to recall that this boy was only 14. (He called her years later to set up lunch—then he stood her up.)

imagesIt has been pointed out that skilled psychopaths can be found “hiding in plain sight,” if you look for them. In his segment of the This American Life piece mentioned above, Jon Ronson, author of the book The Psychopath Test, reports on a chilling interview with a former CEO who is very proud of his sangfroid and gleefully recounted his reputation at being an expert in firing people. The fact that this man does not meet all the criteria for psychopathy (he had no history of impulsive behavior during his youth, for example) does not disqualify him from being seen through this lens. The crowning characteristic to look for is his lack of empathy.

As Dr. Hare writes, “the psychopath is like a color-blind person who sees the world in shades of gray but who has learned to function in a colored world.” He says that psychotherapy often makes them worse rather than better: they hone their skills rather than overcome their problems. Because they don’t feel things they way the rest of us do, psychopaths have the freedom to operate without fear or conscience. Looking at some of the recent developments in the corporate world, it’s not hard to accept Ronson’s suggestion that psychopaths make “good CEOs.” They may not be wielding automatic weapons, but they can do plenty of damage without them.

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