Normal With a Pinch of Psycho

The spine-chilling Hollywood productions that instantly become American classics reawaken crimes of the most grisly serial killers, hand picking and fabricating the most detestable psychopathic traits into a spooky brew of your guilty pleasure. Thankfully, the majority of these murderous transgressions are a fiction of Hollywood. The reality is that many psychopaths never go on to become murderers, or even become violent offenders (at least not physically).

But, Hollywood did, as it often does, glean its material for the infinite renditions of Texas Chainsaw Massacre from a true house of horrors. Sometimes regarded as “The Original Psycho,” Ed Gein inspired at least two other iconic thrillers: Psycho and Silence of the Lambs. Although often concealed from the media, there are also tragic non-fictions involving unrepentant child killers; children that some professionals argue are early emerging psychopaths. One such tragedy ended in the lives of two little boys, ages 3 and 4 years old, who were unabashedly, without remorse, strangled by infamous 11-year-old, Mary Bell. In another well-known case, 9-year-old Jeffrey Bailey pulled up a chair to watch after he pushed a toddler into a motel swimming pool (Kahn, 2012, Times). When questioned, Bailey simply told the police that he wanted to see someone drown (Kahn).

Unfortunately, despite our advances in understanding the human brain and many psychopathologies, there is no psychiatric diagnosis for psychopathy. In fact, there is still much controversy over what defines it, and no fixed consensus as to the underlying causes (Fallon, 2013). The closest standard for diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM) is antisocial personality disorder (ASPD). Increasingly, however, many psychiatrists and psychologists are agreeing that “[ASPD] is not always the animal you’re looking for” (Fallon).

The underlying problem with defining what constitutes a psychopath is that there are different kinds. Not to mention, some indicative personality traits found in psychopaths overlap with, or are easily confused with diagnostic criteria for other disorders such as narcissism, antisocial personality disorder, and sexual sadism. Typically, psychopathic traits are divided into two categories of factors: one takes into account antisocial and criminal behavior, and the other considers one’s social relationships and interactions via manipulation, pathological lying or lack of empathy—to name a few (Fallon). Behaviors that may be seen as acts of simple wickedness to the unacquainted are distinct beasts to experts like Jean Decety of the University of Chicago and Nigel Blackwood at King's College London. 

With the intention of narrowing down what exactly makes the psychopath tick, Decety and colleagues contrasted psychopaths to sexual sadists, while Backwood contrasted individuals with antisocial personality disorder to psychopaths.

In brief, Decety took brain scans of 15 violent sexual offenders, eight of whom were diagnosed as sexual sadists, while they were shown images of people in pain against controls (images involving no pain). For instance, participants might have been shown an image of someone stabbing another person’s hand with scissors, or an image of someone stabbing a table (Szalavitz, 2012, Time). The brain scans demonstrated that sadists, compared to other sexual offenders, showed more activity in their amygdala when viewing the images involving pain. Additionally, when asked to rate the pain experienced by victims in the images, sadists rated the pain as more intense than non-sadists, and the more intense the sadists rated the pain, the more activity there was in a brain region involved in bringing one’s own feelings to awareness, called the insula (Szalavitz).

As explained by Decety, “If you live with a psychopath and you cry because that person was unpleasant to you, that probably doesn’t matter to him. He is not moved and doesn’t care, because he doesn’t feel anything about what you feel. The sadists do feel. They understand that the victim is in pain. They experience it vicariously and are aroused by it.”

Separately, Blackwood found that in comparison to people with antisocial personality disorder (ASPD) only, psychopaths showed reduced volume in both the temporal pole and the anterior rostral prefrontal cortex (arPFC); brain regions that play a key role in understanding one’s own, as well as others’ thoughts and emotions. Blackwood’s findings suggest that although psychopaths must retain at least some awareness of what others are thinking and feeling--evidenced by their ability to manipulate others--damage in these areas may explain their indifference to others’ feelings, as well as their own emotionlessness (Szalavitz).

Correspondingly, previous research has shown that abnormalities in the ventromedial prefrontal cortex (vmPFC), an area important for social and affective decision-making, distinguish the brains of psychopaths from non-psychopaths. Abnormalities in this region may account for psychopaths’ disregard for negative consequences often resulting from socially unacceptable behaviors (Szalavitz).

Comparatively, Blackwood depicts individuals with ASPD as often engaging in reactive violence to threats that may not exist, and may consequently feel remorse; whereas, psychopaths may be equally violent but cold. Furthermore, it’s typical of individuals with both ASPD and psychopathy to have experienced abuse during childhood; however, as adults, psychopaths exhibit little anxiety and effectively no fear, while individuals with ASPD may show signs of posttraumatic stress disorder (PTSD) (Szalavitz).

For author of The Psychopath Inside, James Fallon, a self-described biologically tagged psychopath, successful neuroscientist of 40 years, and beloved husband and father, what makes a psychopath a psychopath comes down to three key factors: "(1) unusually low functioning of the orbital prefrontal cortex and anterior temporal lobe, including the amygdala, (2) the high-risk variants of several genes, the most famous being the warrior gene, and (3) early childhood emotional, physical, or sexual abuse" (Fallon).

According to Fallon, there is a blurry line that separates him as a non-physically violent psychopath from a violent criminal predator. Fallon almost inherited a recipe for disaster: the warrior gene along with genes associated with antisocial behavior, low anxiety and empathy, and the same functional and structural abnormalities he had been identifying in the brains of psychopathic criminals and even murderers for years.

Despite having this fundamental biology, Fallon lacked what he views as the final ingredient: a violent early environment. Destructive environmental influences that persist early on in development may make up that blurry line that divides “a prosocial psychopath or somebody on the edge who doesn’t act out violently, to someone who is a real violent predator” (Fallon).

Despite young Fallon’s scientific bias that individuals are concocted from an 80:20 dose of genetics and environment, early experience can and does act as a much more profound determinant of whether or not someone who possesses the biology divulges such violent psychopathic behavior.

This interplay of nature and nurture during early childhood is the origin from which all antisocial behaviors seem to be derived, and in some cases, personality disorders such as ASPD and psychopathic traits can emerge as early as 2 or 3-years old (Szalavitz).

Adult ASPD first asserts itself early in life in the form of childhood conduct disorder (CD), “characterized by persistent defiant and sometimes cruel behavior” (Szalavitz). Although CD is a pre-diagnoses required for adult ASPD, at least one-third grow out of CD and do not develop ASPD, and most will not become psychopaths.

On the other hand, children who are identified with callous/unemotional traits are at the most risk for becoming psychopaths, and consist of a smaller group who are early on characterized as exhibiting “a lack of fear and indifference towards others” (Szalavitz).

Decety predicts that the foundation for sexual sadism is also laid down very early in infancy via the development of pleasure and pain pathways that correspond to being either nurtured or abused as babies. To further explain, Decety reminds us that for many years children are dependent on their caregivers, and so when abused, they love the people who are causing them pain. The pathways in the brain involved in processing pain and the pathways involved in the experience of pleasure overlap and are interrelated; thus, when a child learns to link loving his or her caregivers and the pleasure he or she experiences from loving them, with the pain they’re inflicting, the child may begin to seek and develop pleasure from pain (Szalavitz).

Experts agree that separate diagnoses with high diagnostic sensitivity are crucial for developing treatments for these personality disorders in children and adults. Both children with callous/unemotional traits and adult psychopaths lack fear of punishment and are more or less indifferent to the thoughts and feelings of others, making the development of treatments and successful rehabilitation extraordinarily difficult (Szalavitz). While children with CD often have strong antisocial behaviors, treatments that involve reforming children’s home environments are often successful. Unsurprisingly then, it is much easier to reform adults with ASPD than psychopaths (Szalavitz).

Presently, there is a need for continued research that specifically focuses on what differentiates those who outgrow their CD and callous/unemotional traits from those who become psychopaths (Szalavitz). Moreover, Fallon points out that because some personality disorders, including psychopathy, emerge early on, it’s crucial that we acquire more trained eyes. Early recognition of troubling behaviors could potentially offshoot a child who has these genetic predispositions from crossing that dividing line from not dangerous to dangerous.

In essence, being able to identify and notify parents to watch for the emergence of certain behaviors opens the possibility of earlier treatment and cautions parents to the increased susceptibility and potentially detrimental effects of stressful interactions like bullying or abuse, while promoting a nurturing and supportive home environment.

On the whole, elements that compose the mosaic of psychopathic traits seem to be present in a variety of degrees and combinations describing the different kinds of psychopaths that Fallon and many other professionals recognize. It's true that we may be able to describe psychopaths with some certainty, but we have scarcely begun to understand them. In Fallon’s world, the uncertainty of the future will become his ultimate test. “…The essential difference in criminality between that and murder is something we all hate and we all fear. It just isn’t known if there is some absolute trigger” (Fallon).

Fallon, J. (2013). The Psychopath Inside: A Neuroscientist's Journey Into the Dark Side of the Brain. 

           New York, NY: Penguin Group.
Kahn, J. (2012, May 11). Can You Call a 9-Year-Old a Psychopath? The New York Times.

Szalavitz, M. (2012, May 14). Understanding Psychopathic and Sadistic Minds. TIME.