One of the most enduring ideas about crime — and violence more broadly — is that a lot of it is committed by people we call “psychopaths.” If you didn’t grow up with procedurals like “Law & Order: SVU” or movies about serial killers, then you may have seen the more recent cascade of viral explainers. To summarize the various popular and scientific definitions: People with psychopathy lack feelings of empathy and remorse, and can be charming, manipulative and impulsive as they seek to dominate and harm.
But there is shockingly little science behind the diagnosis of psychopathy, according to a new book by Rasmus Rosenberg Larsen, a philosophy and forensic science professor at the University of Toronto. In “Psychopathy Unmasked: The Rise and Fall of a Dangerous Diagnosis,” Larsen argues that the widespread use of this personality disorder in legal settings has had massive and largely negative consequences in courts and prisons across the world.
Hard numbers are elusive, but Larsen estimates that across the world, hundreds of thousands of people suspected or convicted of crimes have been assessed with some version of the “Psychopathy Checklist” since its publication in 1991. (It’s popularly known as the “Psychopath Test,” due to the bestselling book by journalist Jon Ronson.) Clinicians score people by reviewing records and interviewing them to assess a range of personality traits (“glibness,” “lack of remorse”) and behaviors (“pathological lying,” “juvenile delinquency”). In the U.S., the checklist has informed whether some people in prison make parole and whether others face the death penalty.
But Larsen examined the research literature and found that people who scored high were not, as many believe, entirely unable to exhibit empathy or benefit from treatment. He found that incarcerated people with high scores were not significantly more likely to commit more crimes after release. Larsen suggests the diagnosis itself may be little more than a way to make some sentences harsher while scaring and titillating the wider public.
Larsen’s book will surely be greeted with skepticism by experts who believe they’ve seen psychopathy in the flesh. “Every society has found the need to identify and deal with individuals who tend to be habitually violent, take advantage of others, and hoard resources,” says Henry Richards, a Seattle-based forensic psychologist who says ethical clinicians offer evidence behind their scores. Richards told me that Larsen glosses over a lot of nuance in his quest for a takedown, and that plenty of researchers already believe psychopathy can be treated. He says Larsen fails to provide a compelling alternate theory for why a small number of people do commit so many crimes.
But both sides agree, perhaps unsurprisingly, that pop culture can have a distorting effect on juries, judges and members of the public trying to make sense of these ideas. This conversation with Larsen was edited for length and clarity.
I think most people assume they know what a “psychopath” is. You argue that it’s a relatively new idea.
The ideas behind psychopathy — that some people lack empathy and were basically born criminals — emerged as far back as the 1700s, as a handful of doctors wondered just why seemingly normal people would do bad things. But the idea of a ‘personality disorder’ was controversial back then because it suggested the patient’s soul was not intact somehow, that God’s work was flawed.
The idea grew, however, and in 1941, psychiatrist Hervey M. Cleckley wrote “The Mask of Sanity” and popularized the idea of psychopathy. He faced a lot of skepticism, and he was frustrated, until his death in 1984, that most researchers were still just not buying it, or couldn’t agree on how to define it. Cleckley was also behind the idea of multiple personalities, which was later questioned as well.
But then Dr. Robert Hare published the psychopathy checklist in 1991 and followed it with a bestselling book called “Without Conscience.” He described psychopaths as “social predators who charm, manipulate, and ruthlessly plow their way through life, leaving a broad trail of broken hearts, shattered expectations, and empty wallets.”
I don’t want to reduce this story to individual people, but Hare was a great communicator and networker, able to get funding and inspire other researchers. His checklist helped give psychopathy an empirical basis — concrete qualities that can be measured by different researchers, who could look at the same person and often get the same results.
Crime went up in the 1980s, politicians wanted to get “tough,” and courts and prison officials were hungry for answers about why crime happens. In the 1990s, there was also a rise in talk of “juvenile superpredators,” which in some ways worked as a synonym for psychopaths of a younger age. Hare decided to let nonresearchers use the checklist.
Judges, parole boards and others in the justice system came to see people with the psychopathy diagnosis as chronic offenders, and could justify keeping them in prison for longer. They could withhold therapy because the emerging theory was that it’s a waste of time.
Hare expressed some ambivalence about how his checklist was used. I do not think he had bad intentions. But he released the tool, which meant he lost control of how it was used, as its use exploded.
You do not dwell on pop culture, but surely that is a big part of this story too, right?
There were movies that introduced some themes of psychopathy in the 1960s and 1970s, like “A Clockwork Orange” and “Badlands.” But in 1979, Ted Bundy goes on trial for killing two college students, and it’s the first trial to ever be nationally televised. Bundy represents himself, and he’s charming and good-looking. Psychiatrists are able to say: This man is living proof of this disorder we’ve been talking about.
Researchers are human beings. As the notion of psychopathy becomes more popular, it becomes easier to get funding and attention. You pick this topic, and you can control dinner party conversations for the next 10 years!
But people also selectively ignored the parts of the Ted Bundy story that did not quite fit the mold. There were signs he suffered from delusions and heard voices, along with sexual urges and alcohol and drug use. A lot of serial killers actually have mentioned different kinds of urges that they feel can be satisfied by killing. But that’s not actually part of the psychopathic personality as researchers describe it.
A natural objection to your argument would be: Look at all of these serial killers. Surely something like psychopathy must explain their behavior.
The connection between serial killers and psychopathy was kind of tacked together once both got popular, but they are distinct. Researchers often claim that psychopathy affects about 1% of the general population, including lots of very successful people. That would be 4 million people in North America right now.
One study says there have been more than 3,600 serial killers since 1900. So if serial killers were a justification for the reality of psychopathy, you’d expect to see far more of them?
And it assumes most of them would meet the diagnosis. One study found many serial killers do not score especially high on the checklist.
People who committed violent crimes have had their brains scanned. People diagnosed with psychopathy have impairments in various parts of the brain, right?
Across more than a hundred studies of brain images, no consistent patterns emerged. Plus, these studies tend to be in prisons, where all sorts of other factors could explain the few patterns that have emerged: head trauma, substance abuse, the effects of solitary confinement. Unfortunately, in most cases, neuroimaging studies do not control properly for such variables, so the research is inconclusive.
There’s also a popular idea that someone diagnosed with psychopathy cannot be treated, and that treatment might make them more dangerous. But I’ve seen a growing number of researchers say they can be treated. You looked at the backstory of this idea.
This idea stems from a 1992 study that looked at people in this one mental health treatment facility, in Canada, and found many committed new crimes after release faster and more violently, compared with a control group. But it later came out that the facility was not really treating these people. It was torturing them. Making them sit in a closet for days. Stripping them naked. Loading them up with hallucinogens. And that study is still being cited.
How much is the diagnosis being used across the criminal justice system today? And should we keep using it at all?
We should end the use of the “psychopathy” diagnosis and the checklist because they are not based on sound evidence and can inflame biases. There are other ways to assess peoples’ risk levels and potential for rehabilitation that are more effective. Many psychiatrists are already using them in courts and prisons. We don’t have a good sense of how often the checklist or diagnosis still comes up, but I have noticed, anecdotally, that psychopathy is not the hot topic it once was at academic conferences. Still, I worry that even if the diagnosis fades, something else will replace it: We are always looking for simple explanations for why people commit violence, but the reasons why are almost always pretty complex.