Who is a psychopath? The short answer to is NOBODY. How shocking will that appear to the general public who are programmed by social media, BigMedia and popular psychology websites? To learn more, you’d have to study from the facts and my reasoned opinions below. At first I will spend a few minutes demolishing the nonsense spouted by Raj Persaud. Then I will move into the concepts of motives, psychopath and psychopathy. I am not here to diagnose or psychoanalyse Lucy Letby or to argue that she is not a psychopath.
My motives declared
This topic was triggered by Raj Persaud’s supposedly erudite video presentation below in which he stated, “Psychopaths know what they’re doing and know why they’re doing it in my opinion. Nurse Lucy Letby in terms of the features we saw in the court case is not a traditional psychopath there’ve been lots of different theories about the nurse’s motivation in this appalling case the judge in his sentencing appeared to be hinting at maybe his own psychological theory he made a reference to the notion that this nurse was a sadist...”
Raj Persaud is not an expert on psychopathic behaviour. I am – as a forensic psychiatrist! He is dead wrong in perpetuating the myth that ‘psychopaths know what they are doing and know why they’re doing it.’ and therefore may not have an underlying mental disorder. Such a statement is irresponsible for a medical professional because it feeds the lay notion that a) psychopathy is a diagnosis, and b) that people who are socially labelled as psychopaths in the main, know why they are doing what they are doing. As will be shown lower down in this article a considerable fraction of people who inflict psychopathic behaviours will not have motives. The issue of ‘knowing what or why’ is irrelevant. How? A person afflicted by acute paranoid schizophrenia may know ‘what’ and ‘why’ they do what they do, as well as they may not know why they did what they did. Point? There is a tacit assumption – usually arising from American movies a) that if you know what you’re doing you are bad not mad. and b) if you don’t know why or what you are doing you are just plain mad.
But consider the words ‘not a traditional psychopath‘. Now take such words into other domains of discourse. If someone says, ‘You’re not a traditional idiot‘ – that’s insulting. It means you are still an idiot, just not a traditional one! [Just to avoid conceptual drift, I am not calling Raj Persaud an idiot or one of any type]. In effect Raj Persaud implies quite conspicuously that Letby is a psychopath of a non-traditional variety.
Confusion
The confusion is understandable, and it highlights the complex interplay between medical terminology, legal language, and popular culture. While “psychopath” is not a formal diagnosis in major psychiatric manuals like the DSM-V or the ICD-10/ICD-11, the term has gained widespread usage in other contexts.
There is a popular belief among ordinary people that the concept of ‘the psychopath’ exists. I have no doubt that the concept exists in the collective minds of lay people, in much the same way that lots of people believe that spiders are insects.
The general lay public wants to believe that some people are psychopaths and that it is a diagnosis. Many who read tabloids believe that psychopaths are evil or possessed by evil. Evil is seen as an explanation. The confused state of affairs arises from some of the following:
- Forensic use: Tools like Robert Hare’s Psychopathy Checklist-Revised (PCL-R) are used in forensic settings to assess traits associated with psychopathy. This lends a semblance of clinical legitimacy to the term, even though it is not a formal psychiatric diagnosis.
- Media influence: Movies, TV shows, and news outlets often use the term “psychopath” in a sensationalised manner, reinforcing the idea that it is a well-defined, universally understood concept. This includes people like Raj Persaud.
- Cultural beliefs: The term has entered common parlance and is often used colloquially to describe people who exhibit traits commonly associated with psychopathy, such as lack of empathy or manipulative behaviour.
- Legal system: In some jurisdictions, like the United States, psychological evaluations, including assessments of psychopathic traits, can influence legal proceedings, further muddying the waters between clinical and legal definitions.
- Academic discussions: The term is also discussed in academic literature, especially in the fields of psychology and criminology, which can give the impression that it is an accepted medical diagnosis.
The Result:
The term “psychopath” occupies a nebulous space where medical science, legal language, and cultural narratives overlap. This creates a situation where the term is widely recognised and used but lacks a standardised, universally accepted definition in the realm of psychiatric medicine.
In summary, while “psychopath” is not a formal psychiatric diagnosis, its usage in various other contexts has made it a term that many people believe they understand, even though its meaning can vary depending on the context in which it is used.
Motives
The word motive has been popularised in American drama movies, where the concept of “motive” is often simplified and dramatised for storytelling purposes. It serves as a crucial element in the narrative, particularly in genres like crime dramas, thrillers, and mysteries.
The acutely psychotic person who plunges a knife into someone, acting on a delusion will have a motive. That’s not ‘different‘.
Psychopath
The term “psychopath” is not a formal diagnosis in the major diagnostic manuals used by mental health professionals. Let’s break it down by each manual:
- ICD-10 (International Classification of Diseases, 10th Edition):
- The ICD-10 does not have a specific diagnosis for “psychopathy.” However, it does have a category for “Dissocial Personality Disorder” (F60.2), which encompasses some characteristics that might be associated with what laypeople think of as psychopathy.
- ICD-11 (International Classification of Diseases, 11th Edition):
- Similar to the ICD-10, the ICD-11 does not list “psychopathy” as a distinct diagnosis. The closest category is again related to personality disorders, but the terminology and categorisation might differ slightly from the ICD-10.
- DSM-V (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition):
- The DSM-V does not have a diagnosis called “psychopath” either. Instead, it has “Antisocial Personality Disorder” (ASPD), which includes criteria that some might associate with psychopathy. However, it is worth noting that not all individuals with ASPD would be considered “psychopaths” in the colloquial sense of the term.
In summary, while the term “psychopath” is widely recognised and used in popular culture and some professional contexts, it is not a formal diagnosis in the ICD-10, ICD-11, or DSM-V.
Psychopathy
In the field of forensic psychology and criminology, the term “psychopathy” is often used and is typically assessed using tools like the Hare Psychopathy Checklist-Revised (PCL-R). However, this is not a diagnostic tool in the same way the DSM or ICD are, but rather an assessment tool to measure traits associated with psychopathy.
The concept of psychopathy in popular culture often diverges significantly from the clinical and diagnostic criteria used in mental health settings. Here’s a breakdown of some of the key differences and overlaps:
Popular cultural notions of psychopathy:
- Violent and dangerous: In movies, TV shows, and books, psychopaths are often portrayed as violent, dangerous individuals who commit heinous crimes.
- Manipulative and cunning: They are often shown as highly intelligent and manipulative individuals who can deceive and control others.
- Lack of emotion: Popular culture often depicts psychopaths as cold, emotionless beings who lack empathy and guilt.
- Charming and charismatic: Many fictional psychopaths are portrayed as charming, attractive, and even charismatic, which they use to manipulate others.
- Stereotypes: There’s often a one-dimensional portrayal, ignoring the complexity and spectrum of behaviours and traits that can be associated with psychopathy.
Recognised Diagnoses:
- Antisocial Personality Disorder (ASPD): This is the closest diagnosis in DSM-V to what is commonly thought of as psychopathy. It includes traits like disregard for the rights of others, impulsivity, and deceitfulness. However, not all individuals with ASPD are violent or criminal.
- Dissocial Personality Disorder: In the ICD-10 and ICD-11, this is the closest category. It also includes a disregard for social norms and a lack of empathy, but it is a broader category that can include various types of personality disorders.
- Complexity and spectrum: In clinical settings, personality disorders, including those closest to the concept of psychopathy, are considered to be on a spectrum. Not everyone will exhibit all traits or behaviours, and many people may have some traits without having a disorder.
- Non-violence: It is important to note that many individuals who might meet criteria for ASPD or similar disorders are not violent and do not engage in criminal behaviour.
- Assessment tools: Tools like the Hare Psychopathy Checklist-Revised (PCL-R) are used in forensic settings to assess traits associated with psychopathy, but this is not a diagnostic tool in the same way that the DSM or ICD are.
Overlaps:
- Lack of empathy: Both popular culture and clinical diagnoses often include a lack of empathy or disregard for the feelings of others.
- Manipulative behaviour: Both depictions often include a willingness to manipulate others for personal gain.
Differences:
- Violence: Clinical diagnoses do not necessarily include violent or criminal behaviour as a criterion, whereas popular culture often does.
- Sensationalism: Popular culture often sensationalises or exaggerates traits for dramatic effect, which can lead to misunderstandings or stigmatisation.
- Complexity: Clinical diagnoses consider a range of behaviours and symptoms and recognise the complexity and variability of the disorder, which is often lacking in popular portrayals.
In summary, while there are some overlaps between popular culture notions of psychopathy and recognised diagnoses, there are also significant differences, particularly in the areas of violence, complexity, and the spectrum of behaviours.
Concluding remarks
In the landscape of public understanding, the concept of psychopathy becomes a complex tapestry woven from multiple threads. One such thread is the American legal system, which often emphasises motive in criminal cases. This focus can inadvertently suggest that psychopathy is a well-defined medical diagnosis, thereby blurring the lines between legal and medical classifications.
Another thread comes from the work of Robert Hare, whose Psychopathy Checklist-Revised (PCL-R) is primarily used in forensic settings. While the tool assesses a range of traits associated with psychopathy, its use in legal contexts can create confusion. The PCL-R’s wide public discussion further complicates its interpretation, sometimes stripping it of the nuance and context found in academic settings.
The final thread is woven by American movies and media, which frequently portray psychopaths as one-dimensional villains. These portrayals, often sensationalised and simplified, contribute to public stereotypes and misunderstandings. Moreover, the global reach of American media exports these portrayals, influencing perceptions of psychopathy worldwide.
Together, these threads intertwine to create a public perception of psychopathy that may not align with the more nuanced understandings held by professionals. The result is a multifaceted but often confusing picture, where legal, medical, and cultural narratives converge and sometimes clash.
Enter Raj Persaud, who contributes to conflation and confusion of the concepts.