Psychopathy as a pathological prototype of masculinity
The best way that I can think of to summarize psychopathy is
"extreme cruelty in the service of one's desires". Anybody who would embark on a career of
"extreme cruelty in the service of one's desires" would have to lack
remorse, have little empathy, have
strong desires. Psychopathy is, by definition, an adult disorder. Indeed some of the diagnostic criteria for
its identification suppose it (sexual promiscuity, protracted criminality, etc.). However,
the roots of the disorder are always observed very young. Retrospective investigations of cases of
antisocial personality have found that these people were atypical even as
infants. Indeed, they were remembered by their mothers as
having difficult temperaments even before they could talk: excessive crying, capriciousness, unpredictability of affiliativeness,
inconsolability, etc. The preschool
form is called oppositional syndrome.
The child is demanding,
manipulative, pig-headed, vengeful, troublesome, impulsive,
self-serving, destructive,
disrespectful. During the school years, if the disorder persists, it is given a new
name and is called conduct disorder. It
then includes truancy, stealing, hurting
people or animals, lack of remorse. If the disorder persists into
adolescence, the disorder typically
changes names again and is called antisocial personality. This is where persistent delinquency or even
criminality come in, and the moral
structure now appears clearly deviant:
the antisocial child feels no indeptedness or commitment or caring to
his parents, to people he knows or to
strangers. In late adolescence or
adulthood, if the disorder
persists, it is termed psychopathy. Only the severest cases reach this
stage. The psychopath is impervious to
punishment, is a career criminal, is an extremely effective and intense
manipulator, and is profoundly immoral
in all of his interpersonal relations -which are usually short lived. The cost-benefit assessment he makes of his
antisocial behaviors is extremely biased in favor of his own immediate personal
benefit. He will go to any extreme to
procure pleasure for himself, even very
short lived and superficial,
-including murder.
Psychopathy is an individual pathological condition which comprises
elements of brain dysfunction.
However, psychopaths tend to
loosely associate with each other. One
manner in which this is done is via criminalized motorcycle gangs. A whole industry has developed around some
of these gangs, including the widespread
sale of offensive paraphernalia.
Glorification of random murder on a leather badge to be sewn onto a
leather jacket is an example of such lore.
However, the most inspired such
icon (image/object), I think, is the
famous FTW belt buckle. What could
be more quintessentially psychopathic than the expression “fuck the world” ?
The most frequent co-morbidity of psychopathy is childhood hyperactivity. The co-incidence of antisocial personality and hyperactivity has been estimated to be situated anywhere from 18% to 60% -depending on methodological issues which are very difficult to standardize in such research. At any rate, it is widely agreed that the most common co-morbidity, by far, is indeed hyperactivity. A recent study investigated the neuropharmacology of aggressive and non aggressive hyperactive boys. The aggressive boys were found to have a much lower prolactin (serotonergic) response to fenfluramine, again supporting the indication to the effect that low brain serotonin activity favors violent behavior. Of course, to the extent that alcoholism or drug addiction can be considered a psychopathology (which in my opinion, they can) these are also frequent co-morbidities. Psychopaths are never depressed, not even when they are put away for life in a penitentiary.
The most frequent co-morbidity of psychopathy is childhood hyperactivity. The co-incidence of antisocial personality and hyperactivity has been estimated to be situated anywhere from 18% to 60% -depending on methodological issues which are very difficult to standardize in such research. At any rate, it is widely agreed that the most common co-morbidity, by far, is indeed hyperactivity. A recent study investigated the neuropharmacology of aggressive and non aggressive hyperactive boys. The aggressive boys were found to have a much lower prolactin (serotonergic) response to fenfluramine, again supporting the indication to the effect that low brain serotonin activity favors violent behavior. Of course, to the extent that alcoholism or drug addiction can be considered a psychopathology (which in my opinion, they can) these are also frequent co-morbidities. Psychopaths are never depressed, not even when they are put away for life in a penitentiary.
The endocrinological profile of psychopaths is simple
to understand. They have significantly
higher levels of circulating testosterone than do normal controls. A multitude of different research approaches
have made this point -urine, saliva
and blood serum studies of large normal cohorts comprising men scoring low or
high on psychological scales of aggressiveness or antisocial personality,
studies of recidivist criminals,
studies of violent military personnel, histological (tissue) studies of
male homicide victims in large cities (most of whom are criminals), and of course, studies of urine, saliva,
blood serum, and even of cerebrospinal fluid of antisocial youngsters and
recently, of formally diagnosed
psychopaths. The link between high
circulating testosterone and psychopathy (or character disorder) may be
two-pronged: the high testosterone
level may favor not only increased aggressiveness and but also sexual
promiscuity. Indeed, both traits are known to relate to testosterone
level in normal men. Furthermore, both traits are present in the extreme in
psychopaths. Robin Baker reported in
1997 that in one of his studies the testis size of men who engaged in
extramarital sex was significantly larger than the testis size of men who were
faithful to their spouse. The research
involved 80 student volunteers and a pair of a calipers. Dr Baker asked volunteers to measure the
size of their left testicle, using a set of plastic calipers supplied for the
purpose. They were also asked to reveal their sexual experiences, and to retain
evidence of sperm volume by using condoms and recovering them without spillage
after sex. Plainly, this was not a project for the shy and retiring. The results, Dr Baker said, showed that 12 of
the 80 had been unfaithful to their partners over the period of the study, and
that this was correlated with the size of their testes. Testes size varies greatly in men. In the
study, the smallest was a diminutive eight cubic centimetres (though Dr Baker
conceded there may have been a measurement error) while the largest was 52 cubic centimetres. The
average was 24 cubic centimetres.
Measurement of the sperm ejaculated showed that men with bigger
testicles produced more. Assuming the results are correct, the study raises the
question of why there should be so much variation in testicle size, and why
both patterns of behaviour should have survived through evolution. Study of closely related primates gives a
clue. The uxorious gorilla, which mates
for life, has very tiny testes, while the promiscuous chimpanzee sports
remarkably large ones. The human male
lies between these two extremes, suggesting
that his behaviour pattern may also be intermediate. Dr Baker pointed out that for both the
faithful and the faithless pattern to have persisted through evolution, both
must be equally "fit" in terms of ensuring that the male's genes are
passed on. He argues that promiscuous
men spread their sperm as widely as possible by mating with many women. But
they are not around to help to bring up their children, who therefore have a
lower chance of survival. The faithful, on the other hand, impregnate fewer
women but, because of their stable relationships, are more likely to see their
children grow up to pass on their genes to a further generation. Thus both
approaches can work and remain part of human experience. How typical of normal men are a group
prepared to submit their bodies and
their sex lives to this kind of scrutiny? "Well, they're students,"
says Dr Baker. "In fact, their level of
unfaithfulness seems about right, judged by the results of other surveys." There is another example of testis size being
related to number of sexual partners, namely seasonally breading species such
as macaques. The male testes wax and
wane in response to environmental cues.
When the testes are small, they are sexually inactive (even if
artificially presented with a sexually active female). When the testis recrudesce they become
sexually active. In a posting on the
internet, Kim Wallen reported recently
that « one of the adult males in one of our social groups was missing one
morning early in the breeding season. I
went to the vet and asked where Cp was and was told he had a testicular
infection "his balls were all red and swollen and he had to walk bow
legged, they were so painful". I
informed the vet, who hadn't seen a rhesus monkey breeding season before, that
Cp was just coming into breeding condition and that this was perfectly
normal. Fortunately, they had not yet
castrated him to save his life ».
Wallen believes that the initial causal direction is from the change in
testis size to increased mating because we also know that the exact output of
the tests (hormones, not sperm) is also influenced by sexual experience and sexual
stimuli in the environment. Thus male
rhesus will undergo a seasonal testicular cycle when isolated from females, but
is muted in comparison to the cycle of males in the presence of females. Similarly, exposing a testicular-regressed
male to a sexually active female around the time when the male is about ready
to restart testicular function will bring him back to reproductive condition
faster. However, this doesn't work if he
is exposed to a female during the depths of regression. As in most things
behavioral and endocrinological this is not a simple linear system, says
Wallen, but a feedback system, where the hormonal output of the restarted
testes do affect the male's sex drive and thus the likelihood that he will seek
out sexually stimulating situations, which in turn increase his testicular
output even more. Whether the comparative correlation between testis size and
mating system reflects a vestige of this regulatory system and that this varies
between males of different species has not been addressed. One of the principle reasons that male testes
change in size seasonally is due to activity or inactivity of the Leydig cells
which produce testicular steroids. Thus
testis size is as likely to reflect the amount of testosterone secreted as it
is the number of sperm in each ejaculate,
says Wallen. As for me, I am not venturing to state that psychopaths
have larger testes than normal men (as I do not believe this has yet been
investigated), but I would not be
surprised if such were the case.
The neuropsychology and neurology of psychopathy
places the disorder squarely into the male axis of turbulence disorders
(hyperactivity, Tourette's disease) rather than in the male axis of left
hemisphere disorders (dyslexia, stuttering, developmental dysphasia). Studies which have set out to investigate
hypotheses of left hemisphere or right hemisphere dysfunction have not been
conclusive either way. However, studies which have set out to explore the
hypothesis of a general frontal lobe syndrome have been more successful but not
outstandingly so. On the other
hand, these early studies weren't
targeting any sub-area of the frontal lobes.
Only recently have studies been carried on psychopaths, showing that functions reputed to be
frontodorsolateral are in fact intact in psychopaths, whereas functions reputed to depend on the
basal frontal cortex (the part situated just above the eyeballs) are
defective. Psychopaths are
deviant in their response to the balance
of reward and punishment contingencies
on standardized procedures. They are
impulsive (make commission errors) on tasks well designed to draw out excesses
of such behavior. They are prone to
breaking simple rules on paper and pencil tests. While these findings are suggestive of an orbitofrontal
deficit, they are not conclusive. In fact,
they are nearly tautological (circular)
in the sense that psychopaths are impulsive and rule breakers by
definition, so it should be hardly
surprising that they should behave likewise in testing situations. On the other hand a new finding has helped
break out of the tautology. It is known
that the olfactory neurons most important for identifying odors verbally are
situated in the orbitofrontal cortex,
and to some extent in the median temporal lobes as well. Now psychopathic prisoners could be
predicted to have a deficit in odor discrimination. However it is important to also show that
they do not have a deficit attributable to the olfactory mucosa due to cocaine
sniffing, a practice which is known to
occur even in prisons.
Student’s tribune: Psychopathy as an orbitofrontal syndrome
Such a study has indeed been carried out by a student of mine, Dominique Lapierre. Psychopaths had a significant difficulty in
identifying odors (an orbitofrontal
task), compared to non-psychopathic
prison mates, and yet they had no problem distinguishing odor intensities (a
task which does not require the contribution of the frontal cortex, but rather the olfactory mucosa and the
subcortical neuronal olfactory network).
This particular finding with respect to oder discrimination is
telling: indeed here as elsewhere the
male psychopath simply presents an exacerbated male profile. Recall that normal women outperform normal
men on odor discrimination tasks. In
fact, they do so on exactly the same
test, namely the The University of
Pennsylvania Smell Identification Test (UPSIT).
One particularly meaningful aspect of orbitofrontal function is its
modulatory effect on the limbic system,
including on hypothalamic function.
An orbitofrontal disturbance in psychopathy could explain the emotional
deficit of these people as well as the remarkable fact that their galvanic skin
response (GSR) to punishment or aversive stimulation is abnormally flat. The GSR response is mediated, among other
things, by the sympathetic branch of the
autonomic nervous system, an outlet for
the expression of emotions. This
surely has something to do with the formidable nerves of steel that psychopaths
are known to have.
Quite a few studies have investigated
neurotransmitters in people variably classifiable as severely antisocial or
psychopathic. Several abnormalities
have been found. One finding which has
consistently been reported is that of low serotonin metabolism. This has been found in urine, blood and
cerebrospinal fluid. Even the usual
hormonal responses to serotonergic drugs is dampened in psychopaths. A recent study found that the 5-HIAA
metabolite of serotonin is abnormally low in newborns of people with a family
histroy of antisocial personality
-suggesting that this brain anomaly is an important hereditary cause of
antisocial behavior. Another consistent, but less frequently documented finding is of
high dopamine metabolism. This is the
typical profile of aggressive animals and aggressive humans, these two neurotransmitters being antagonists
one of the other. For a brief moment
while the scientific community was in an uproar of excitement when one team of
researchers found that a mutant allele on chromosome 11 known to modulate the
D2 dopaminergic receptor was frequently present in alcoholics' and psychopaths'
cell samples. The finding was, within a very short period of time, tested by several independent
laboratories. There were more refutations
than replications, so the breakthrough
was probably a false alarm, as often happens in scientific research. New evidence is now indirectly suggesting
that a mutant gene controlling the metabolism of the D4 dopaminergic
receptor might be involved in psychopathy. However,
dopamine metabolism is a very complex affair, and we are far from a
conclusion in psychopathy research.
Finally, the story on
noradrenalin is still up for grabs. For
one thing, two types of noradrenalin receptors, the alpha type and the beta
type, seem to have opposing neurocognitive-behavioral effects, so that measurement of noradrenalin itself
may be misleading or inconclusive. At
any rate, psychopaths seem to have high
levels of noradrenalin, but specific
investigation of noradrenalin as a function of receptor types really needs to
be done.
There are probably a lot of people who think that
psychopathy is learned or that it is entirely environmentally determined. People who believe such a thing will also
typically believe that depression,
anorexia nervosa, or even
schizophrenia are also just culturally caused behaviors. The culturalistic explanation (when you don't
look closely at the relevant detailed information) makes easy sense. If you are depressed, its because something sad happened to
you. If you are anorexic its because
skinny is beautiful in the media. If you
are schizophrenic some horrible thing happened to you that drove you bonkers. If you are psychopathic, your parents were cruel to you. This is certainly how the victims of these
disorders spontaneously interpret their own predicaments. And if you look for such a thing, you will always think you found it. To make things worse, ignorant or predatory
professionals spend years convincing these unfortunate people to dig into their
past (at great expense in fees) to find what the cultural "trigger"
might have been. Now here is my point
of view on this issue. People's
experience certainly can be morbid, and can help push them into
psychopathology. But for the disorders I
have just mentioned, these stressful or
morbid incidents (incest, parental
brutality, etc.) are not enough. There has
to be a congenital, usually hereditary, predisposition. Psychopathy is no exception. Psychopaths are often raised by parents who
also manage to raise a perfectly socialized child as well. Psychopathy runs in families.
Psychopathy, like anorexia nervosa, is associated with a wide spectrum of mental
disorders observed in the family pedigrees (hyperactivity, Tourette's disease,
alcoholism and gambling, and even bipolar affective disease). It does not seem to be transmitted via a
Mendelian (single gene) mechanism, but
rather polygenetically. A recent
estimate based on 2,682 twin samples arrived at a heritability estimate for
character disorder of 71%, which is very
high. Character disorder is a typical
precursor of psychopathy. There have
even been studies of monozygotic and dizygotic twins raised apart. This makes sure that there is not some
esoteric family dynamic affecting identical twins differently from fraternal
twins. These studies give the same
results as studies of twins raised together.
It does not surprise me that this is in fact the case. Such an esoteric dynamic of identical twins
is very rare. One form is called
symbiosis -wherein the two identical
twins create a schizoid world for themselves because of excessive affinity one
for the other. In the case of
psychopaths, this would be extremely
unlikely -since human affinity is not
much a part of their basic vocabulary.
The fact that psychopathy presents itself as an
exacerbation of male typical behavior is summarized in table 11.
Table 11
Summary of gender-typical traits
exacerbated in the psychopathy syndrome
1) it is an externalizing disorder
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2) it is not a stress-related disorder and psychopaths are very
hard to stress
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3) the main co-morbidity (hyperactivity) is male-prevalent
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4) its' onset is in the pre-school years
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5) morbidity is centered
around male-typical concerns such as sensation-seeking, sex, gambling,
violence, monetary gain
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6) circulating testosterone is abnormally high
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7) the sex drive is abnormally high
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8) the right hemisphere is not more affected than the left, but the basal frontal systems seem to be
disordered in a manner which is an exageration of a normal sex difference
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9) more evidence points to excess dopamine mediation of the
disorder than to mediation by any other neurotransmitter, although serotonin metabolism seems to be
abnormally low
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