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.  

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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

2) it is not a stress-related disorder and psychopaths are very hard to stress

3) the main co-morbidity (hyperactivity) is male-prevalent

4) its' onset is in the pre-school years

5)  morbidity is centered around male-typical concerns such as sensation-seeking, sex, gambling, violence, monetary gain

6) circulating testosterone is abnormally high

7) the sex drive is abnormally high

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

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