In this commentary, I address two points raised by Fields: the origin of other-regarding beliefs, and the management of psychopaths, if they are not criminally responsible (as Fields suggests). I argue that the capacity to form affective bonds is necessary in order to hold other-regarding beliefs, and that a psychological developmental perspective may be helpful in understanding the moral understanding of the psychopath. In response to Fields’s view that psychopaths should receive “treatment,” I suggest that most forensic psychiatrists do not agree.
personality disorder, empathy, development, remorse, attachment theory
Insufficient attention has been paid to the problem posed by so-called “psychopaths.” Lloyd Fields’s paper is therefore welcome. Here I shall focus on two issues: the nature and acquisition of other-regarding beliefs, and the implications for managing those who do not have them.
Fields argues that there is a subgroup of psychopaths, unable to form “other-regarding beliefs”; that such beliefs provide a motivation for acting in a particular way, and result in a “[disposition] to experience certain emotions and to have certain attitudes.”
But it is arguable that the disposition to experience certain emotions and have certain attitudes towards others could be critical to acquiring the capacity to have other-regarding beliefs. If one asks what stops people from hurting others, a common answer is that it makes people feel bad. To quote Mencius (Legge, 1960): “All men have a mind which cannot bear to see the suffering of others.”
The question then is, how does anyone acquire a notion of “the other,” such that failing to endorse other-regarding principles/beliefs has an adverse effect on the subject?
Mencius’ “mind” implied “reciprocity,” and involved four components:
i. The recognition of another’s distress
ii. Being moved by that distress (empathy)
iii. Wishing to reduce that distress (sympathy)
iv. Altruism (the sense of obligation to reduce distress, and guilt if one fails).
By these criteria, (iv) resembles Fields’s “other-regarding” belief, in that the sense of obligation provides a reason for acting. I would argue that (iv) is a virtue, which requires (i), (ii) and (iii) as capacities—not necessarily separate, but different aspects of a broader “affective” capacity. It is this affective capacity which is arguably lacking in the psychopath.
Some of these capacities have already been discussed in the literature of psychopathy. It is the [End Page 279] failure to recognize another’s distress which Cleckley describes in many of his cases (Cleckley 1964), and which he describes as a type of “agnosia.” This term implies some neuropathological deficit, and there is some evidence for such deficits in psychopaths, mainly in the autonomic nervous system. Blair (1995) has also suggested that psychopaths lack a (postulated) violence inhibitory mechanism (VIM).
It could be argued, however, that such neuropathological hypotheses lead to circular arguments about psychopathy, as described by Barbara Wootton 1(Wootton 1959). A more fruitful account is offered by theories (such as attachment theory) which offer a developmental account which includes both psychological and neuropathological perspectives. Described and developed by Bowlby (1969), attachment theory draws on experimental work with non-human primates and emphasises the importance of relationships with significant others in infancy for the development of later social relationships (Harlow 1975; Ruppenthal et al 1976). Such attachment relationships are also important for the development of cortical neural networks, and the modulation of stress, which can itself be neurotoxic (Sapolsky 1994).
How could attachment theory be relevant to acquiring an affective capacity? The earliest work on attachment behaviors showed that monkeys failing to make early attachments behaved recklessly with other monkeys, and could not make relationships (for example, to mate). Of particular relevance was the finding that such monkeys launched suicidal attacks on monkeys higher in the hierarchy; not dissimilar to those “self-defeating” behaviors which Cleckley described in human psychopaths.
So much for possibly psychopathic monkeys; do humans with failed attachments lack affective capacity? There is evidence that substantial proportions of “psychopaths” have histories of failed attachments in childhood. The more severe the failure, the more severe the disturbance in adulthood, which might explain why there is a range of psychopathic behavior. It is striking...