Ethical Dilemmas In Putting An End To Psychopathy

Robert Hare’s well-known and widely-used Psychopathy Checklist-Revised (PCL-R) was first released in 1991. Since then, it’s become the gold standard diagnostic tool used by researchers, clinicians, and the justice system in identifying psychopaths and determining risk of reoffending in those who’ve committed violent crimes.

Individually, the 20 traits and behaviors on the PCL-R are relatively manageable and innocuous, but when the majority of them appear in one individual, and for prolonged periods of time, the person is likely to be a psychopath.

Psychology professors Scott O. Lilienfeld and Hal Arkowitz describe pyschopaths thusly:

“Superficially charming, psychopaths tend to make a good first impression on others and often strike observers as remarkably normal. Yet they are self-centered, dishonest and undependable, and at times they engage in irresponsible behavior for no apparent reason other than the sheer fun of it. Largely devoid of guilt, empathy, and love, they have casual and callous interpersonal and romantic relationships. Psychopaths routinely offer excuses for their reckless and often outrageous actions, placing blame on others instead. They rarely learn from their mistakes or benefit from negative feedback, and they have difficulty inhibiting their impulses.”

Psychopaths make up about 1% of the general population, meaning that we are all bound to come in contact with a psychopath or two in our day-to-day lives. And since psychopaths tend to be drawn to careers of power and authority, such as politics, business management, and law, we are all but guaranteed to be influenced by the actions and choices of psychopathic individuals in some way.

To be clear, not all psychopaths commit crimes — nor do all of them exhibit markedly destructive behaviors in their personal and professional lives. Violence is not even part of the formal diagnostic criteria in the PCL-R.

Yet some of the worst crimes known to humankind have been committed by psychopaths. Criminal psychopaths are not discouraged by usual forms of punishment, such as imprisonment, and they nearly always reoffend following release. Roughly 20% of the prison population and at least 70% of all repeat violent offenders are psychopaths. They reoffend more often and more violently than other criminals, and partake in a wider variety of offenses than their non-psychopathic counterparts.

This is why violent psychopaths are some of the most insidiously dangerous offenders of all time. In the United States alone, the fiscal costs resulting from the actions of psychopathic offenders exceed that of alcohol and substance abuse, schizophrenia, smoking, and obesity. In short, violent psychopaths cause a disproportionate amount of harm to their families, co-workers, communities, and society as a whole.

The development of psychopathy in an individual requires a few essential ingredients: specific genetic components interacting with certain environmental insults — the study of which is known as epigenetics. But the development of a violent and criminal psychopath in particular requires the additional ingredients of inequality and injustice, and very likely untold suffering at the hands of those who were supposed to be loving and compassionate.

Despite the correlation between violence and psychopathy, there are no known cures for this neurodevelopmental disorder. With this seemingly hopeless reality, wouldn’t it be wonderful if psychopathy could be treated before it even begins?

That’s why the field of epigenetics may offer a compelling cure for psychopathy — though the societal costs of such a cure might be too great.


There is ample evidence showing that psychopathy results from an interaction between genetic and environmental factors, much like other neurodevelopmental disorders such as autism, Tourette’s syndrome, ADHD, and schizophrenia. This interaction falls under the umbrella of epigenetics, which examines the part of the human genome that modifies or changes cell function by silencing or activating particular genes. Where genetics is the study of variation and mutation in the genome, epigenetics is the study of changes in gene expression that occur without changes in the DNA sequence.

Harmful changes in the epigenome can be inherited or they can arise from certain types of environmental exposure. Some environmental components that can cause detrimental epigenetic changes — both prenatally and throughout life — include smoking, a poor diet, prescription and illegal drugs, abuse of alcohol, and extreme stress. The epigenome is quite sensitive to environmental factors, yet epigenetic changes are reversible, making the epigenome an amenable target of future pharmacologic interventions for many disorders and diseases.

Exposure to physical, emotional, or sexual abuse, neglect, chronic bullying, or other detrimental environmental factors at a young age could determine those who grow up to become violent criminal psychopaths, while those who are raised in loving and attentive families might still be technically psychopathic but may never go on to commit violent crimes. Exactly how these mechanisms lead to violent or criminal psychopathy is still unknown, but may have to do with the strong mirroring abilities of psychopaths. If a child with psychopathic traits is raised in a loving home with considerate caregivers and with a structured environment — where the caregivers lay out clear rules and expectations — that child will likely grow up to mirror that love, consideration, and structure. That is, they will tend to mirror the problem-solving strategies used by those around them.

But take that same child with the loving family and introduce severe bullying at school, for example, and the child may begin to mirror the bullying, violent behaviors instead. Though all humans have these mirroring abilities, which are partly responsible for identity formation, most also have the ability to feel empathy. Empathy will govern most people’s treatment of others, while those with psychopathic traits rely more strongly on mirroring to learn the behaviors that work for them.

Psychopathic traits and behaviors typically become problematic as early as childhood or adolescence, in the form of telltale callous-unemotional traits. Callous-unemotional youth may hurt or kill animals, set fires, purposely injure their siblings and peers, destroy household items, and never show genuine remorse for the suffering they cause. These traits can make children and teens targets of rejection and bullying, further reinforcing and solidifying antisocial behaviors. Youth with psychopathic traits also tend to frustrate and bewilder their parents, and require much more guidance and patience than non-psychopathic youth. Regardless of their ultimate life trajectories, psychopathic individuals introduce unique challenges to the lives of those around them.

With ever-increasing public and professional interest in the area of epigenetics comes the possibility of one day having an epigenetic-based treatment that could reverse the course of psychopathy in the affected individual, thus protecting those who may be adversely impacted by them. Since current management of psychopathic criminals involves incarceration only after a crime — or even a series of potentially very serious and deadly crimes — has already been committed, an epigenetic-based treatment that could be administered early in life, before psychopathic traits take hold, would seem ideal.

While new advances are needed to successfully control and limit psychopathic crime, “the nexus of psychopathy and epigenetics is still at an embryonic stage,” Dr. Armon Tamatea told The Establishment via email earlier this month. Dr. Tamatea, a clinical psychologist and senior lecturer in the School of Psychology at the University of Waikato in New Zealand, authored a paper last year, in which he discusses the ethical, legal, and research implications of viewing psychopathy and potential treatments through the lens of epigenetics.

Dr. Tamatea is cautiously hopeful that epigenetic contributions could help create targeted and personalized treatments of psychopathy, and provide the tools for detecting the first signs of psychopathic risk. He is concerned, though, that an overemphasis on “biologizing psychopathy” might cover over “some very real and complicated issues that predispose a community to raising psychopathic people.” Violent psychopathic individuals, he says, almost always “emerge from spaces of disadvantage and marginalization, such as poverty, abuse, and crime,” and an epigenetic focus might blind us to these realities and further stigmatize an already deeply stigmatized portion of society.

Psychopathy, however, is not a problem that is limited to the underprivileged. Psychopathy does not discriminate. It occurs in all walks of life — in all social classes, ethnicities, religions, and cultures. But Dr. Tamatea’s concerns highlight the necessity of making sure that any future screening for psychopathy and any treatments that might be sanctioned by those in positions of authority would not place a further burden on the underprivileged. It’s easy to imagine a situation where both testing and treatments become forced on lower-class citizens, due to widespread misconceptions about psychopathy, criminality, and the impoverished.

Robert Hare himself, psychopathy expert and creator of the PCL-R, is quoted in a recent issue of Discover magazine as saying: “Psychopathy might not be so disordered and unnatural; it’s something that we can probably work with, help them take advantage of and shape in a way that’s pro-social and productive, good for the individual and society.” This shaping would need to start in the first years of life, and continue throughout all of the developmental stages.

Some psychopathic traits could even be deemed as evolutionarily adaptive and well-suited to certain professions. A lack of empathy and the capacity to maintain one’s cool under pressure, for example, might benefit surgeons, bomb squad technicians, and other life-saving roles that require the ability to think clearly in situations where most would become panicked or incapacitated by their emotions and hyped-up nervous systems.

For now, while the formulation of epigenetic-based treatments is still in its infancy, the focus should be on prevention and on highlighting the precautions that individuals can take to avoid detrimental environmental impacts on themselves, their children, and on future generations. These preventative measures, for the time being, must be general. Live the healthiest life you can, both in terms of physical health and mental health. Follow nutritional guidelines, get adequate sleep, avoid known carcinogens like cigarettes and other tobacco products, drink moderately, seek help and guidance when you know you need it, and speak out for beneficial social and environmental reforms. Be an active participant in your own well-being. Doing so will help avoid harmful epigenetic changes in your own body, and in the bodies of your future children, if you so decide to have them.

As we move nearer to the development of epigenetic-based treatments for psychopathy and myriad other disorders, it is important that the concerns of all members of society are addressed, and that the dialogue remains open to all — especially to those whose voices are less frequently heard.

The more we understand, in the words of Dr. Tamatea, “the more we can prevent future public harm in a humane and just way.”


Lead image: Unsplash

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