The article reviewed here is by Joel Andrade. The author begins with a historical overview of the construct of psychopathy where perhaps the turning point is the publishing of Hervey Cleckley’s book ‘The Mask of Sanity’ in which 16 personality traits central to the construct are described. Andrade then discusses he issue of whether including antisocial behaviour in the psychopathy construct is really a judgement about good and evil and does so by referring to the literature. There follows the fascinating history of how subsequent editions of DSM-IV have moved from the psychopathy construct to the antisocial personality disorder which includes antisocial behaviours as criteria. There is then a discussion of the Hare’s Psychopathy Checklist and the ability of scores on the HCL to predict recidivism and violent crime before a final conclusion. Andrade has produced an intelligent and well researched article which gives a useful overview of the issues surrounding the construct of psychopathy.
The issue’s here are quite profound and extend across clinical practice, questions of morality, behavioural versus cognitive models, prevention of violence and crime and society’s prevailing norms. Should we consider the psychopathy construct as primary and then treat behaviour as secondary to this? Or should the person’s historical behaviour be used as a psychological marker and what is the relationship of this to stigmatisation? Yet even with the implications of incorporating past antisocial behaviors into such a diagnosis we are still left with the predictive abilities of such a model which in turn produces another paradox. For if we ignore this, then perhaps we avoid the possibility of doing good or preventing harm. With such predictions, perhaps the person themselves can be given insights and with help, the option to expand the possibilities that are available to them outside of the constraints of their psyche. Perhaps another issue is the broken contract between society and the individual in cases of criminal prosecution and the conflict between what the individual may consider as their autonomy and the impact that this has on other people’s autonomy – and ultimately on society’s autonomy. In the middle of this complex manoeuvring, psychiatry continues to progress and hopefully will help to solve some of these problems, better defining psychopathy and the limits of the medical model, improving the quality of life of people with psychopathy* and if they choose help them to improve their relationships with others.
* (for example by treating concurrent pathology) (added 4.10.8)
Andrade Joel. The inclusion of antisocial behavior in the construct of psychopathy: A review of the research. Aggression and Violent Behavior. Volume 13. Issue 4. August-September 2008. pp 328-335.
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