Creating Conscience, Part 1: A history of treating the psychopath

The mystery of the psychopath. A human riddle that has haunted and stumped us for centuries. Is the psychopath mad or just plain bad? Evil and beyond redemption, or potentially treatable?
(Sean Howard)

The mystery of the psychopath.  A human riddle that has haunted and stumped us for centuries. Is the psychopath mad or just plain bad? Evil and beyond redemption, or potentially treatable? IDEAS producer Mary O'Connell explores these questions in this 3-part series. Part 2 airs Tuesday, November 27; Part 3 airs in Tuesday, December 4.

**This episode originally aired May 15, 2018. 

For more than 200 years, the medical profession has pursued every imaginable idea about what makes the psychopath tick: the cycles of the moon, trace metals in the blood, poor parenting, poverty, homosexuality, cleft palates, brain damage, a genetic predisposition, industrialization, an immoral society. These theories have taken place on the faultline between nature and nurture and have divided psychiatry into competing factions.

One understanding of this disorder is that it's not a disorder at all. It's a mythological category — a moral judgement that we have imposed upon behaviours that we don't particularly understand or like. This is a popular argument amongst criminologists.- Dr. Robert Hare

Psychopaths constitute only about one per cent of the general population, numbers similar to those with schizophrenia. And outside prison, the majority of psychopaths may be involved in running corporations, committing fraud, and they may have numerous partners and children — they don't necessarily end up in jail. But they do form about 20 per cent of the prison population. And it's the psychopaths who get imprisoned for sensational crimes who attract the most attention. In film, they entertain us — just think of Hannibal Lecter in Silence of the Lambs, or Patrick Bateman in American Psycho. Dr. Joanne Intrator, a historian and psychiatrist who's taught a course on psychopaths in film says: "it's easier to dismiss the ultra-violent psychopaths in film today because they are almost 'cartoonish' and that's not necessarily healthy."

Actor Anthony Hopkins as Dr. Hannibal Lecter in the movie "Hannibal". (Phil Bray/MGM Pictures/Universal Pictures/Dino DeLaurentiis)

Canadian expert Dr. Robert Hare has been studying psychopaths for decades. In his early days, he spent time working with them at the old B.C. penitentiary in New Westminster. He remembers one inmate who told him the story of why he was locked up. He'd become irritated with his baby boy crying so he threw him against the wall and killed him. Robert Hare remembers the story was told in the most casual of tones. He thinks the adult psychopath cannot be treated, asserting that "a conscience cannot be retrieved where one does not exist".    

However, in the 1960's there was a push in Western Europe and North America to create a conscience for the psychopath. Using ideas imported from Britain, the proponents of "therapeutic community" believed the environment was at fault, so practitioners used all kinds of tools to encourage the male psychopath to connect with himself and with others. Tools like: hallucinogenic drugs, nude encounter groups, and "rebirthing" them. Rebirthing involved keeping psychopaths nude and in a room called the "capsule". These men were encouraged to become each other's therapist. Practitioners believed this would make them more dependent on each other. They were also encouraged to drink from straws, mounted on the capsule's walls, mimicking, in a sense, breastfeeding. "Therapeutic community" was considered an acceptable medical treatment at the time.

Psychiatrist Robert J. Lifton, noted for his studies of Nazi physicians, has been quoted as saying, "Every discipline courts illusions of understanding that which is not understood." Russian psychiatrist Alexander Luria believed that having a conscience involves — before an act takes place — an inner voice that asks: is this action right or fair? And what are the consequences?  But Elizabeth Kandel Englander, a professor of psychology at Bridgewater State University, thinks our moral decision-making is much more complex than simply having an inner voice. She says, "while many of us speed or cheat on our taxes, even though we know it's wrong, the psychopath does the same thing, only it may apply to murder".  

Think about it. The psychopath doesn't  love anybody. The rest of us have someone we love, even if it's just our mom. So, why would the psychopath do the right thing if he loves nobody?  - Dr. Elizabeth  Kandel-Englander

These days, the pendulum has tilted back to the biology-based thinkers who believe psychopaths suffer from a neuro-developmental deficit — there's something wrong with the psychopathic brain. This assumption fuels much of the research involving studies of the brain scans of psychopaths, looking for clues. And now, many believe there doesn't appear to be any successful treatment for adult psychopaths.  

The future may look brighter for youth offenders with psychopathic traits when they're provided with intensive treatment while still young. Lorraine Johnstone is a forensic psychologist based in Scotland, who thinks the vast majority of youth offenders have experienced complex trauma as children so she believes, "the right treatment should involve creating empathy — and that creates your conscience".  

Guests in this episode:

  • Dr. Jeffrey Smalldon is a Forensic Psychologist in Columbus, Ohio. 
  • Dr. Robert Hare is Professor Emeritus, Department of Psychology, at the University of British Columbia, and author of Without Conscience
  • Dr. Elizabeth Kandel-Englander is a Professor of Psychology at Bridgewater State University, and founder of the Massachusetts Aggression Reduction Center.  
  • Dr. Marnie Rice was Research Psychologist at the Waypoint Centre for Mental Health Care (formerly Penetanguishene Mental Health Centre).  

Further reading:

**This episode was produced by Mary O'Connell.


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