The Philosophy of Psychopathy

THE PHILOSOPHY OF PSYCHOPATHY DANJ. STEIN* "In all of us, even in good men, there is a lawless wild beast nature. Plato. The concept of mankind's dark side—of the beast within us all—is deeply entrenched in modern thought. Scientists from Darwin to Lorenz have explained the evolutionary and genetic basis ofthe propensity towards violence; writers from Shakespeare to Golding have described conflicts and struggles between passion and reason; and psychoanalysts from Freud onward have emphasized the importance of unconscious destructive forces of die mind in determining outward behavior. In Freud's words, "Homo homini lupus, who can doubt it" [I]. On the other hand, an idealistic view of humans as supremely rational beings, fashioned in the image of God, has also been an important construct in the Judeo-Christian tradition. Science stands as die examplar par excellence of mankind's deductive and investigative capacities. Our artistic achievements point to complementary intuitive and empathie powers. Psychoanalysis promises that the mind is able to draw on diese human potentials to develop a productive and balanced approach to life—"Where id was, there shall ego be" [2]. Physicians are not ordinarily required to participate in tiiis debate on the ultimate nature of humankind. Neverdieless, there are occasions when we are drawn in to it, and where our work may contribute to the dialogue. In this paper, I want to explore die phenomenon ofpsychopathy, or antisocial personality disorder—undoubtedly one of die most intriguing and dismaying diagnoses that we confront. The psychopadr, after all, is a person without conscience, a person who repeatedly bends and breaks die rules of society, a person who apparentiy embodies the essence of darkness. From a purely medical point ofview, psychopadiy is an enigma. We know *Department of Psychiatry, University of Stellenbosch, PO Box 19063, Tygerberg 7505, South Africa.© 1996 by The University of Chicago. All rights reserved. 0031-5982/96/3904-0941$01.00 Perspectives in Biology and Medicine, 39, 4 ¦ Summer 1996 | 569 remarkably little about its etiology, and treatment is invariably ineffective [3] . There is a degree of agreement about the clinical features ofpsychopathy [4] . Antisocial personality disorder entails, first, a pervasive pattern of disregard for and violation of die rights of others ocurring since age 15 years, as indicated by three (or more) of the following: 1.Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest; 2.Deceitfulness, as indicated by repeated lying, use of aliases, or conning otiiers for personal profit or pleasure; 3.Impulsivity or failure to plan ahead; 4.Irritability and aggressiveness, as indicated by repeated physical fights or assaults ; 5.Reckless disregard for safety of self or others; 6.Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations; 7.Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. In addition, die individual must be at least age 18 years and exhibit evidence ofconduct disorder with onset before age 15 years; and the antisocial behavior must not occur exclusively during die course of schizophrenia or a manic episode [8] . However, while it can be clinically diagnosed, the very definition of psychopathy remains unresolved. Some have argued that antisocial personality disorder is a fancy term for a legal phenomenon; that the diagnosis is merely a label for repeat offenders who are unlucky enough to be caught. Others hold that antisocial personality disorder is simply a name given to those who are evil, and that persons who fall under this rubric most likely require religious or spiritual intervention. The category of psychopathy tiierefore sprawls untidily at the intersections of medicine, law, and morality . In this paper I attempt to sketch the oudines ofa philosophical approach to psychopathy. It is often argued that issues in the philosophy of medicine are able to illuminate broader philosophical questions; a conceptual understanding of psychopathy can perhaps shed light on arguments within the philosophy of ethics. Conversely, a philosophy of psychopathy may prove useful in establishing a conceptual basis for the clinical diagnosis and management of this condition. Three Philosophical Positions In order to draw distinctions between...