On The Morality Of: Treating Psychopaths

Earlier this week I caught a post on Lindsay Beyerstein's blog Duly Noted, highlighting a horrifying NYT story wrestling with the question of whether children can be psychopaths, and if so, whether they're doomed to grow up into adult psychopaths or whether there's any intervention that can be effective.

"Psychopath" isn't a general term for an unpleasant person, but a term with a specific psychological meaning. Psychopaths score highly on indexes of what's called callous-unemotional behavior and show a pervasive disregard for the well-being of others and the rules of the society they live in. In spite of this, they tend to be very glib, superficially charming, and adept at getting others to like and trust them. It's been claimed that brain scans of psychopaths show differences with the brains of ordinary people, most notably in the neurological systems that process emotion.

The scary part is that, unlike people with autism spectrum disorders, psychopaths don't have any difficulty inferring what other people are thinking or feeling. It's just that this knowledge doesn't have any emotional resonance to them; it doesn't provoke ordinary feelings of compassion or sympathy. However, they're very effective at using it to deceive, manipulate, and intimidate others. Psychopaths are overrepresented among violent criminals and reoffend at much higher rates than non-psychopaths, and so far, no drug or therapy is known to be effective at treating them.

The existence of psychopaths poses thorny questions on issues of good and evil, of free will and to what extent we're responsible for our own personality, of the malleability of the mind and whether genetics is destiny. For theists, I would think it's especially problematic - if a detectable brain alteration causes evil behavior, the only rational conclusion is that behavior comes from the brain and not a soul. But even for atheists who want to live in a peaceful society that respects human rights, this is an issue without any easy or obvious answer.

I do have to disagree with Amanda Marcotte's take, in that if psychopathy is a mental disorder, it's one that's very unlike other mental disorders, since it involves no defect in perception or reasoning ability. As one journal article put it, "What is known about psychopaths is consistent with the view that they do not have a mental disorder as it is usually defined," and speculated that it may be an alternative evolutionary strategy. I find this plausible, since evolutionary logic predicts that in any group of sociable, cooperating agents, it's inevitable that cheaters who try to exploit the system will periodically arise.

Regardless, there's still the question of what we should do about them. You could argue that psychopaths, in a certain sense, are like other dangerous animals, like rabid dogs or sharks. It may well be that they can't help who they are, that their behavior was predetermined by their genes or the wiring of their brains. But even if that's true, they're still dangerous to the rest of us in a way that people with, say, autism spectrum disorders aren't. Especially given that there isn't any effective treatment, if there was a brain scan that could reliably show who was, or who was going to become, a psychopath, what would we do with that information?

Just to be clear, I'm not advocating a Department of Pre-Crime that would scan people's brains and preemptively incarcerate those who were deemed likely to be dangerous. All people deserve the right to a presumption of innocence. If we scanned everyone's brain, we might well find that millions of people have the characteristic brain changes of psychopathy, but only a tiny minority of those are criminals or violent. (Some people have suggested, semi-seriously I think, that psychopaths often do well in business and end up becoming corporate executives.)

The fairest approach here, I think, is that if a person convicted of a crime was deemed to be psychopathic, we could sentence them to involuntary commitment, just as we would with any mental illness that makes reoffending highly probable and jail unlikely to work as a deterrent. In the absence of any effective therapy, I recognize that this might well be a life sentence. But one of the purposes of imprisonment is to protect society from people who are dangerous, and aren't the rare violent psychopaths basically the epitome of that?

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