in defense of psychopathy

I don't mean here to defend psychopathic behavior, of course, but rather the concept of psychopathy as a useful way to categorize behavior.

Over on Facebook, my friend Karla Mancero recently shared an article by Lydia Brown titled "Why the Term ‘Psychopath’ is Racist and Ableist". I started to comment on Facebook but found that I was writing a short essay with links to several sources that I wanted to preserve, so decided to flesh it out a little more and post here.

Let me first say that I agree wholeheartedly with Karla's statement that "Big difference between having or not having empathy and having difficulty expressing empathy. That would be most humans. Many of us probably were not taught how to express empathy or encouraged to be empathetic growing up." But I find several problems with applying that statement to the ideas that Brown discusses.

Since to some degree Brown seems to be confusing or conflating the notions of autism and psychopathy, let me also say that as a martial arts instructor in a system which strives to be open to people with special needs, I've worked with a few mildly autistic students over the years. And as a software developer, well, you can't swing a USB cable in most offices full of hackers without hitting someone who displays at least some symptoms of Asperger's syndrome. (As a result of which, you'll also find many techies who question the milder end of the "autistic spectrum" being labeled as "disorders". I do suspect that we'll see a walk-back on part of that in years to come, that some of the apparent increase in autism in recent years is just a pathologization of certain personality traits. But that's a rant for another time.)

But as someone who teaches people how to deal with violence, I'm also keenly interested in understanding mental and behavioral disorders that are linked to violence. That certainly includes psychopathy. Whether it includes autism is questionable. On the one hand, there is some evidence that people with autism are actually less likely to be convicted of violent crime then the general population. On the other, if a person with autism does behave violently towards a caregiver, the incident may be less likely to be handled as a criminal matter up until a stranger is involved -- even when the violence is serious -- so there may be a selection bias at work.

And violence committed by people with autism tends to be "affective" rather than "predatory", a response to an immediate situation rather than the sort of premeditated violence that marks psychopathy. As Amy S.F. Lutz writes, "There was a time when my own son Jonah, now 13, was prone to such violent rages that I feared I might end up like Trudy Steuernagel, who was bludgeoned in 2009 by her 19-year-old autistic son Sky Walker, or Linda Foley, who was also beaten to death by her 18-year-old stepson, Henry Cozad. But I was never afraid Jonah would massacre 20 kids with a semi-automatic rifle." While up to 30 percent of people with autism show aggressive behavior -- often towards themselves rather than others -- the high frequency of co-morbid conditions complicates the question of whether this is due to autism.

But it should be clear that the behaviors involved with psychopathy and autism are quite different. So why Brown's conflation or confusion of the two conditions? History may be to blame. The term "autistic psychopathy" was once used for what we now call "Asperger’s syndrome". Discussion is complicated by the fact that several terms have been used in several different ways to describe these disorders since the 1800s. There's a good overview of the history of the terms and concepts related to psychopathy in Joel T. Andrade's Handbook of Violence Risk Assessment and Treatment.

In short, psychopathy was once a very broad term for any mental/behavioral disorder -- a pathology of the psyche; so this catch-all would have included what we now call autism. In the more modern sense, while the DSM claims psychopathy is equivalent to antisocial personality disorder (ASPD), the broader literature -- particular work based around the Hare Psychopathy Checklist-Revised (PCL-R) -- disagrees and finds psychopathy to be a more specific concept, related both to personality factors and to behavior. Brown's claim that "[psychopathy] doesn’t exist in the DSM-IV or the DSM-5...[e]ven the medical-industrial complex does not recognize psychopathy as a diagnosis" is not exactly accurate. It is listed in the DSM-IV as a synonym for ASPD, and is understood by some in the profession -- particularly those working with violent criminal offenders -- as a distinct disorder.

Though ASPD, psychopathy, and autism are properly understood as distinct conditions, they do all have a relationship to empathy. Brown states several times that "Empathy is what makes us human," though it's not clear to me if she is saying this herself or quoting a social attitude. But empathy is neither necessary nor sufficient for human-ness. Non-human animals display empathic behavior. And as much as we might like to disown those who display not just a difficulty with but a complete absence of empathy -- the serial killers and the like -- they're just as much Homo sapiens as anyone, fruits from the same tree.

But the big problems with Brown's thesis are right there in the title of her piece. She claims that the idea of psychopathy is racist. Now, it must be said that in this racist society any mental and physical health concepts may be applied in a racist way, ASPD and psychopathy not excepted. But that does not mean that the concepts themselves are racist.

In fact, one meta-analysis of 21 studies using the PCL-R and related tests, found no significant difference between black and white adults. The related condition of "conflict disorder" is dignosed in a higher percentage of white youth, at least outside of prisons; some have argued that this results in black youth being under-served by the mental health system, rather than the sort of medicalization of resistance that Brown claims.

And given the confusion between autism with psychopathy, it's worth nothing that "white" children are actually more likely to be diagnosed as autistic. They're also more likely to be diagnosed as ADHD.

Are these results due to an anti-white bias? I think we can discount that hypothesis. Could there be an actual phenomenon where whites are (for biological or cultural reasons) more vulnerable to these disorders, or are white kids are more likely to be seen as "sick" while non-white kids exhibiting the same behaviors are seen as "bad"? My money's on the later, though I wouldn't rule out the former without some evidence.

And the concept of psychopathy is no more "ableist" than any other category of "mental illness". One may debate whether the entire concept of mental illness has validity, as Szasz for example has; or one may accept the general concept while debating whether the behaviors grouped together as "autism" or "ASPD" or "psychopathy" are clinically and socially useful concepts. But the idea of psychopathy is no more ableist than the idea of bipolar disorder.

Under all this, I think that Brown does have a good point: perhaps we shouldn't throw the term "psychopath" around lightly, especially to describe those who engage in oppression of racial/ethnic/religious/gender/sexual/etc. groups than their own. The failing these people have is not the total lack of empathy that characterizes the psychopath; it is rather a division of the world into an "in-group" and an "out-group", and a sharp limiting of empathy to those in the in-group. A racist can really, really care about other people...of their own race.