David Baxter PhD
Late Founder
Suffering Souls: The search for the roots of psychopathy
by John Seabrook, The New Yorker
November 10, 2008
Dr. Kent Kiehl uses MRI technology to scan prison inmates for signs of pyschopathy in the hope of discovering a treatment.
The Western New Mexico Correctional Facility sits in high-desert country about seventy miles west of Albuquerque. Grants, a former uranium boomtown that depends heavily on prison work, is a few miles down the road. There?s a glassed-in room at the top of the prison tower, with louvred windows and, on the ceiling, a big crank that operates a searchlight. In a box on the floor are some tear-gas shells that can be fired down into the yard should there be a riot. Below is the prison complex?a series of low six-sided buildings, divided by high hurricane fences topped with razor wire that glitters fiercely in the desert sun. To the east is the snow-covered peak of Mt. Taylor, the highest in the region; to the west, the Zuni Mountains are visible in the blue distance.
One bright morning last April, Dr. Kent Kiehl strode across the parking lot to the entrance, saying, ?I guarantee that by the time we reach the gate the entire inmate population will know I?m here.? Kiehl?the Doc, as the inmates call him?was dressed in a blue blazer and a yellow tie. He is tall, broad-shouldered, and barrel-chested, with neat brown hair and small ears; he looks more like a college football player, which was his first ambition, than like a cognitive neuroscientist. But when he speaks, in an unexpectedly high-pitched voice, he becomes that know-it-all kid in school who intimidated you with his combination of superior knowledge and bluster.
At thirty-eight, Kiehl is one of the world?s leading younger investigators in psychopathy, the condition of moral emptiness that affects between fifteen to twenty-five per cent of the North American prison population, and is believed by some psychologists to exist in one per cent of the general adult male population. (Female psychopaths are thought to be much rarer.) Psychopaths don?t exhibit the manias, hysterias, and neuroses that are present in other types of mental illness. Their main defect, what psychologists call ?severe emotional detachment??a total lack of empathy and remorse?is concealed, and harder to describe than the symptoms of schizophrenia or bipolar disorder. This absence of easily readable signs has led to debate among mental-health practitioners about what qualifies as psychopathy and how to diagnose it. Psychopathy isn?t identified as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association?s canon; instead, a more general term, antisocial personality disorder, known as A.P.D., covers the condition.
There is also little consensus among researchers about what causes psychopathy. Considerable evidence, including several large-scale studies of twins, points toward a genetic component. Yet psychopaths are more likely to come from neglectful families than from loving, nurturing ones. Psychopathy could be dimensional, like high blood pressure, or it might be categorical, like leukemia. Researchers argue over whether tests used to measure it should focus on behavior or attempt to incorporate personality traits?like deceitfulness, glibness, and lack of remorse?as well. The only point on which everyone agrees is that psychopathy is extremely difficult to treat. And for some researchers the word ?psychopath? has been tainted by its long and seamy relationship with criminality and popular culture, which began with true-crime pulps and continues today in TV shows like CBS?s Criminal Minds and in the work of authors like Thomas Harris and Patricia Cornwell. The word is so loaded with baleful connotations that it tends to empurple any surrounding prose.
Kiehl is frustrated by the lack of respect shown to psychopathy by the mental-health establishment. ?Think about it,? he told me. ?Crime is a trillion-dollar-a-year problem. The average psychopath will be convicted of four violent crimes by the age of forty. And yet hardly anyone is funding research into the science. Schizophrenia, which causes much less crime, has a hundred times more research money devoted to it.? I asked why, and Kiehl said, ?Because schizophrenics are seen as victims, and psychopaths are seen as predators. The former we feel empathy for, the latter we lock up.?
In January of 2007, Kiehl arranged to have a portable functional magnetic-resonance-imaging scanner brought into Western?the first fMRI ever installed in a prison. So far, he has recruited hundreds of volunteers from among the inmates. The data from these scans, Kiehl hopes, will confirm his theory, published in Psychiatry Research, in 2006, that psychopathy is caused by a defect in what he calls ?the paralimbic system,? a network of brain regions, stretching from the orbital frontal cortex to the posterior cingulate cortex, that are involved in processing emotion, inhibition, and attentional control. His dream is to confound the received wisdom by helping to discover a treatment for psychopathy. ?If you could target the brain region involved, then maybe you could find a drug that treats that region,? he told me. ?If you could treat just five per cent of them, that would be a Nobel Prize right there.?
The four hundred and six prisoners in the Western New Mexico facility are serving sentences ranging from a year to life without parole. New Mexico uses a classification system that assigns each inmate a number from one to six, with six being reserved for the most violent offenders; Western has inmates of all levels up to five. Although not all psychopaths are violent, Kiehl told me, the majority are fours, fives, and sixes.
Unlike most academic psychopathy researchers, Kiehl has spent many hours in the company of his subjects. When he meets colleagues at conferences, he told me, ?they always ask, ?What are they like?? These are guys who have spent twenty years studying psychopaths and never met one.? Although the number of psychopaths who are not in prisons is thought to exceed the number who are?if the one-per-cent figure is correct, there are more than a million psychopaths at large in the United States alone?they are much harder to identify in the outside world. Some are ?successful psychopaths,? holding down good jobs in many types of industries. It is generally only if they commit a crime and enter the criminal-justice system that they become available for research.
In the conference room where Western?s warden, Anthony Romero, greeted Kiehl, there was a framed tableau of illegal items confiscated from inmates, including handmade shivs and crude tattooing devices. Romero explained that Kiehl was using the scanner not only to study psychopathy but also to measure the level of craving in the brains of substance abusers as they go through a treatment program, also run by Kiehl, which is funded by the National Institute on Drug Abuse. The volunteer rate among the inmates is more than ninety per cent (although some are too muscle-bound to fit inside the scanning tube). As a ?collateral benefit,? Kiehl throws in a free clinical examination of their brains. (He has discovered previously undetected tumors in about five per cent of the volunteers.) In addition to the pay they receive for their time (a dollar an hour, Western?s standard rate for prison labor), inmates get pictures of their brains that they can post in their cells. ?There?s a lot of joking among the prisoners about who?s got the biggest brain,? Romero said.
The scanner was housed in a tractor-trailer parked behind the prison?s I.D. center. We followed a correctional officer through an internal courtyard to the rehab wing, which consisted of a large common area surrounded by two-man cells. The prisoners were standing at attention outside their cells, some holding mops and brooms. I entered a vacant cell and saw the occupant?s brain, a grainy black-and-white image on a piece of a paper, its edges curling, tacked up over the desk.
Then we walked through the common room and out a door at the other end, passing under a large poster with lines that read, ?I am here because there is no refuge, finally, from myself.? The officer led us along a corridor of offices in which students from the University of New Mexico, where Kiehl is on the faculty, conduct psychopathy interviews and also counsel participants in the drug-treatment program. Carla Harenski, one of Kiehl?s postdocs, was interviewing a beefy guy with a tattoo on his neck. Her office, like those of all the researchers in the lab, is equipped with a button she can press to call for help if an interview gets out of hand.
In order to distinguish psychopaths from non-psychopaths among the Western volunteers, Kiehl and his students use the revised version of the Psychopathy Checklist, or PCL-R, a twenty-item diagnostic instrument created by Robert Hare, a Canadian psychologist, based on his long experience in working with psychopaths in prisons. Kiehl was taught to use the checklist by Hare himself, under whom he earned his doctorate, at the University of British Columbia. Researchers interview an inmate for up to three hours, and compare the inmate?s statements against what is known of his record and his personal history. The interviewer ?scores? the subject on each of the twenty items?parasitic life style, pathological lying, conning, proneness to boredom, shallow emotions, lack of empathy, poor impulse control, promiscuity, irresponsibility, record of juvenile delinquency, and criminal versatility, among other tendencies?with zero, one, or two, depending on how pronounced that trait is. Most researchers agree that anyone who scores thirty or higher on the PCL-R is considered to be a psychopath. Kiehl says, ?Someone who scores a thirty-five, a thirty-six, they are just different. You say to yourself, ?Aha, here you are. You are why I do this.? ?
Harenski recently interviewed a Western inmate who scored a 38.9. ?He had killed his girlfriend because he thought she was cheating on him,? she told me. ?He was so charming about telling it that I found it hard not to fall into laughing along in surprise, even when he was describing awful things.? Harenski, who is thirty, did not experience the involuntary skin-crawling sensation that, according to a survey conducted by the psychologists Reid and M. J. Meloy, one in three mental-health and criminal-justice professionals report feeling on interviewing a psychopath; in their paper on the subject, Meloy and Meloy speculate that this reaction may be an ancient intraspecies predator-response system. ?I was just excited,? Harenski continued. ?I was saying to myself, ?Wow. I found a real one.? ?
At the end of the hall, a door led outside to the trailer. Inside, there was a small sitting area; computer screens and hard drives were built into a large console in the center, and the fMRI scanning tube was at the back. Its surfaces were made of molded white plastic. Harenski?s husband, Keith, the chief MRI technician in Kiehl?s lab, sat in front of the computer, monitoring a scan in progress. The screen showed what the inmate inside the scanner was seeing. All that was visible of him was his feet, covered with dirty white athletic socks, which protruded from the mouth of the tube.
Kiehl and the researchers in his lab have designed two tests?or tasks, as the researchers call them?one word-based and the other image-based. Kiehl said he had avoided complicated moral problems, such as the classic trolley dilemma, in which the subject is asked to choose whether to cause one person?s death in order to save the lives of others in the path of a runaway trolley, because psychopaths might not understand the problem or wouldn?t answer seriously. ?You try to minimize their opportunities for messing with you,? he said. The same tasks are performed by control groups, one of non-psychopathic inmates and another of non-inmates with intelligence-test scores and educational backgrounds similar to those of the inmates.
The word-based task was under way. The inmate was being shown a series of words and phrases, and was supposed to rate each as morally offensive or not. There were three kinds of phrases: some were intended as obvious moral violations, like ?having sex with your mother?; some were ambiguous, like ?abortion?; and some were morally neutral, like ?listening to others.? The computer software captured not only the inmate?s response but also the speed with which he made his judgment. The imaging technology recorded which part of the brain was involved in making the decision and how active the neurons there were.
Neurons in the brain consume oxygen when they are ?firing,? and the oxygen is replenished by iron-laden hemoglobin cells in the blood. The scanner?s magnet temporarily aligns these iron molecules in the hemoglobin cells, while the imaging technology captures a rapid series of ?slices??tiny cross-sections of the brain. The magnet is superconductive, which means it operates at very cold temperatures (minus two hundred and sixty-nine degrees Celsius). The machine has a helium cooling system, but if the system fails the magnet will ?quench.? Quenches are an MRI technician?s worst fear; a new magnet costs about two million dollars.
The inmate wore a helmet with a head coil for receiving magnetic data and, on the inside, a screen on which words were projected. A sensor measured ?skin conductance??palm sweat. During the functional imaging scans, there was a series of high-pitched beeps, then a loud drilling sound. And during the brain-anatomy scans the machine made a low, rapid thumping, like a metal heartbeat. As the inmate?s brain was scanned, he crossed his feet at the ankles and then uncrossed them. His toes wiggled.
Psychopaths are as old as Cain, and they are believed to exist in all cultures, although they are more prevalent in individualistic societies in the West. The Yupik Eskimos use the term kunlangeta to describe a man who repeatedly lies, cheats, steals, and takes sexual advantage of women, according to a 1976 study by Jane M. Murphy, an anthropologist then at Harvard University. She asked an Eskimo what the group would typically do with a kunlangeta, and he replied, ?Somebody would have pushed him off the ice when nobody else was looking.?
The condition was first described clinically in 1801, by the French surgeon Philippe Pinel. He called it ?mania without delirium.? In the early nineteenth century, the American surgeon Benjamin Rush wrote about a type of ?moral derangement? in which the sufferer was neither delusional nor psychotic but nevertheless engaged in profoundly antisocial behavior, including horrifying acts of violence. Rush noted that the condition appeared early in life. The term ?moral insanity? became popular in the mid-nineteenth century, and was widely used in the U.S. and in England to describe incorrigible criminals. The word ?psychopath? (literally, ?suffering soul?) was coined in Germany in the eighteen-eighties. By the nineteen-twenties, ?constitutional psychopathic inferiority? had become the catchall phrase psychiatrists used for a general mixture of violent and antisocial characteristics found in irredeemable criminals, who appeared to lack a conscience.
In the late nineteen-thirties, an American psychiatrist named Hervey Cleckley began collecting data on a certain kind of patient he encountered in the course of his work in a psychiatric hospital in Augusta, Georgia. These people were from varied social and family backgrounds. Some were poor, but others were sons of Augusta?s most prosperous and respected families. Cleckley set about sharpening the vague construct of constitutional psychopathic inferiority, and distinguishing it from other forms of mental illness. He eventually isolated sixteen traits exhibited by patients he called ?primary? psychopaths; these included being charming and intelligent, unreliable, dishonest, irresponsible, self-centered, emotionally shallow, and lacking in empathy and insight.
?Beauty and ugliness, except in a very superficial sense, goodness, evil, love, horror, and humor have no actual meaning, no power to move him,? Cleckley wrote of the psychopath in his 1941 book, The Mask of Sanity, which became the foundation of the modern science. The psychopath talks ?entertainingly,? Cleckley explained, and is ?brilliant and charming,? but nonetheless ?carries disaster lightly in each hand.? Cleckley emphasized his subjects? deceptive, predatory nature, writing that the psychopath is capable of ?concealing behind a perfect mimicry of normal emotion, fine intelligence, and social responsibility a grossly disabled and irresponsible personality.? This mimicry allows psychopaths to function, and even thrive, in normal society. Indeed, as Cleckley also argued, the individualistic, winner-take-all aspect of American culture nurtures psychopathy.
The psychiatric profession wanted little to do with psychopathy, for several reasons. For one thing, it was thought to be incurable. Not only did the talking cure fail with psychopaths but several studies suggested that talk therapy made the condition worse, by enabling psychopaths to practice the art of manipulation. There were no valid instruments to measure the personality traits that were commonly associated with the condition; researchers could study only the psychopaths? behavior, in most cases through their criminal records. Finally, the emphasis in the word ?psychopath? on an internal sickness was at odds with liberal mid-century social thought, which tended to look for external causes of social deviancy; ?sociopath,? coined in 1930 by the psychologist G. E. Partridge, became the preferred term. In 1958, the American Psychiatric Association used the term ?sociopathic personality? to describe the disorder in its Diagnostic and Statistical Manual of Mental Disorders. In the 1968 edition, the condition was renamed ?general antisocial personality disorder.?
Cleckley?s book fell out of favor, and Cleckley described himself late in life as ?a voice crying in the wilderness.? When he died, in 1984, he was remembered mostly for his popular study of multiple-personality disorder, written with Corbett Thigpen, The Three Faces of Eve.
In 1960, Robert Hare took a job as the resident psychologist in a maximum-security prison about twenty miles outside Vancouver. On his first day, a tall, slim, dark-haired inmate came into his office and said, ?Hey, Doc, how?s it going? Look, I?ve got a problem. I need your help.? Hare later wrote of this encounter, ?The air around him seemed to buzz, and the eye contact he made with me was so direct and intense that I wondered if I had ever really looked anybody in the eye before.? Hare asked the inmate, whom he called Ray in his account, to tell him about his problem. ?In response, he pulled out a knife and waved it in front of my nose, all the while smiling and maintaining that intense eye contact,? Hare wrote in his 1993 book, Without Conscience: The Disturbing World of the Psychopaths Among Us. Ray said he was planning to use the knife on another inmate, who was making overtures to his ? ?prot?g?,? a prison term for the more passive member of a homosexual pairing.? Ray never harmed Hare, but he successfully manipulated him throughout Hare?s eight months at the prison, and two and a half years later, after Hare had joined the faculty at the University of British Columbia, Ray, now paroled, tried to register there with a forged transcript.
Hare wasn?t familiar with the psychopathy literature when he was working at the prison. Later that year, he moved with his family to London, Ontario, where he pursued a Ph.D. at the University of Western Ontario. (When his brakes failed at the first steep hill on the trip east, he recalled that Ray had worked on his car in the prison garage.) His dissertation was on the effects of punishment on human learning and performance. One day in the library, he came across The Mask of Sanity. Reading Cleckley?s case histories put Hare in mind of Ray, and of other types he had encountered in the maximum-security prison. Were these men psychopaths? Over the next year, Hare read not only Cleckley but also the early literature Cleckley had synthesized. After receiving his doctorate, in 1963, and returning to Vancouver, he set about what would be his life?s work: the study of psychopathy, and the creation of the Psychopathy Checklist, the twenty-item diagnostic instrument that Kiehl is using at Western.
Thanks to the checklist, scientists working in different places can be confident that the subjects they are studying are taxonomically similar. The PCL also has a wide variety of forensic applications. It is employed throughout Canada in parole-board hearings and is gaining popularity in the U.S. In the thirty-seven states that allow the death penalty, a high psychopathy score is often used by prosecutors as an ?aggravating factor? in the penalty phase of capital cases. Psychopathy scores have also been used in child-custody cases; a high score may result in one parent?s loss of custody. Hare?s influence on the field of psychopathy is profound. Today, Hare?s former students hold important administrative positions throughout the Canadian prison system, and are prominently represented in the next two generations of psychopathy researchers around the world.
by John Seabrook, The New Yorker
November 10, 2008
Dr. Kent Kiehl uses MRI technology to scan prison inmates for signs of pyschopathy in the hope of discovering a treatment.
The Western New Mexico Correctional Facility sits in high-desert country about seventy miles west of Albuquerque. Grants, a former uranium boomtown that depends heavily on prison work, is a few miles down the road. There?s a glassed-in room at the top of the prison tower, with louvred windows and, on the ceiling, a big crank that operates a searchlight. In a box on the floor are some tear-gas shells that can be fired down into the yard should there be a riot. Below is the prison complex?a series of low six-sided buildings, divided by high hurricane fences topped with razor wire that glitters fiercely in the desert sun. To the east is the snow-covered peak of Mt. Taylor, the highest in the region; to the west, the Zuni Mountains are visible in the blue distance.
One bright morning last April, Dr. Kent Kiehl strode across the parking lot to the entrance, saying, ?I guarantee that by the time we reach the gate the entire inmate population will know I?m here.? Kiehl?the Doc, as the inmates call him?was dressed in a blue blazer and a yellow tie. He is tall, broad-shouldered, and barrel-chested, with neat brown hair and small ears; he looks more like a college football player, which was his first ambition, than like a cognitive neuroscientist. But when he speaks, in an unexpectedly high-pitched voice, he becomes that know-it-all kid in school who intimidated you with his combination of superior knowledge and bluster.
At thirty-eight, Kiehl is one of the world?s leading younger investigators in psychopathy, the condition of moral emptiness that affects between fifteen to twenty-five per cent of the North American prison population, and is believed by some psychologists to exist in one per cent of the general adult male population. (Female psychopaths are thought to be much rarer.) Psychopaths don?t exhibit the manias, hysterias, and neuroses that are present in other types of mental illness. Their main defect, what psychologists call ?severe emotional detachment??a total lack of empathy and remorse?is concealed, and harder to describe than the symptoms of schizophrenia or bipolar disorder. This absence of easily readable signs has led to debate among mental-health practitioners about what qualifies as psychopathy and how to diagnose it. Psychopathy isn?t identified as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association?s canon; instead, a more general term, antisocial personality disorder, known as A.P.D., covers the condition.
There is also little consensus among researchers about what causes psychopathy. Considerable evidence, including several large-scale studies of twins, points toward a genetic component. Yet psychopaths are more likely to come from neglectful families than from loving, nurturing ones. Psychopathy could be dimensional, like high blood pressure, or it might be categorical, like leukemia. Researchers argue over whether tests used to measure it should focus on behavior or attempt to incorporate personality traits?like deceitfulness, glibness, and lack of remorse?as well. The only point on which everyone agrees is that psychopathy is extremely difficult to treat. And for some researchers the word ?psychopath? has been tainted by its long and seamy relationship with criminality and popular culture, which began with true-crime pulps and continues today in TV shows like CBS?s Criminal Minds and in the work of authors like Thomas Harris and Patricia Cornwell. The word is so loaded with baleful connotations that it tends to empurple any surrounding prose.
Kiehl is frustrated by the lack of respect shown to psychopathy by the mental-health establishment. ?Think about it,? he told me. ?Crime is a trillion-dollar-a-year problem. The average psychopath will be convicted of four violent crimes by the age of forty. And yet hardly anyone is funding research into the science. Schizophrenia, which causes much less crime, has a hundred times more research money devoted to it.? I asked why, and Kiehl said, ?Because schizophrenics are seen as victims, and psychopaths are seen as predators. The former we feel empathy for, the latter we lock up.?
In January of 2007, Kiehl arranged to have a portable functional magnetic-resonance-imaging scanner brought into Western?the first fMRI ever installed in a prison. So far, he has recruited hundreds of volunteers from among the inmates. The data from these scans, Kiehl hopes, will confirm his theory, published in Psychiatry Research, in 2006, that psychopathy is caused by a defect in what he calls ?the paralimbic system,? a network of brain regions, stretching from the orbital frontal cortex to the posterior cingulate cortex, that are involved in processing emotion, inhibition, and attentional control. His dream is to confound the received wisdom by helping to discover a treatment for psychopathy. ?If you could target the brain region involved, then maybe you could find a drug that treats that region,? he told me. ?If you could treat just five per cent of them, that would be a Nobel Prize right there.?
The four hundred and six prisoners in the Western New Mexico facility are serving sentences ranging from a year to life without parole. New Mexico uses a classification system that assigns each inmate a number from one to six, with six being reserved for the most violent offenders; Western has inmates of all levels up to five. Although not all psychopaths are violent, Kiehl told me, the majority are fours, fives, and sixes.
Unlike most academic psychopathy researchers, Kiehl has spent many hours in the company of his subjects. When he meets colleagues at conferences, he told me, ?they always ask, ?What are they like?? These are guys who have spent twenty years studying psychopaths and never met one.? Although the number of psychopaths who are not in prisons is thought to exceed the number who are?if the one-per-cent figure is correct, there are more than a million psychopaths at large in the United States alone?they are much harder to identify in the outside world. Some are ?successful psychopaths,? holding down good jobs in many types of industries. It is generally only if they commit a crime and enter the criminal-justice system that they become available for research.
In the conference room where Western?s warden, Anthony Romero, greeted Kiehl, there was a framed tableau of illegal items confiscated from inmates, including handmade shivs and crude tattooing devices. Romero explained that Kiehl was using the scanner not only to study psychopathy but also to measure the level of craving in the brains of substance abusers as they go through a treatment program, also run by Kiehl, which is funded by the National Institute on Drug Abuse. The volunteer rate among the inmates is more than ninety per cent (although some are too muscle-bound to fit inside the scanning tube). As a ?collateral benefit,? Kiehl throws in a free clinical examination of their brains. (He has discovered previously undetected tumors in about five per cent of the volunteers.) In addition to the pay they receive for their time (a dollar an hour, Western?s standard rate for prison labor), inmates get pictures of their brains that they can post in their cells. ?There?s a lot of joking among the prisoners about who?s got the biggest brain,? Romero said.
The scanner was housed in a tractor-trailer parked behind the prison?s I.D. center. We followed a correctional officer through an internal courtyard to the rehab wing, which consisted of a large common area surrounded by two-man cells. The prisoners were standing at attention outside their cells, some holding mops and brooms. I entered a vacant cell and saw the occupant?s brain, a grainy black-and-white image on a piece of a paper, its edges curling, tacked up over the desk.
Then we walked through the common room and out a door at the other end, passing under a large poster with lines that read, ?I am here because there is no refuge, finally, from myself.? The officer led us along a corridor of offices in which students from the University of New Mexico, where Kiehl is on the faculty, conduct psychopathy interviews and also counsel participants in the drug-treatment program. Carla Harenski, one of Kiehl?s postdocs, was interviewing a beefy guy with a tattoo on his neck. Her office, like those of all the researchers in the lab, is equipped with a button she can press to call for help if an interview gets out of hand.
In order to distinguish psychopaths from non-psychopaths among the Western volunteers, Kiehl and his students use the revised version of the Psychopathy Checklist, or PCL-R, a twenty-item diagnostic instrument created by Robert Hare, a Canadian psychologist, based on his long experience in working with psychopaths in prisons. Kiehl was taught to use the checklist by Hare himself, under whom he earned his doctorate, at the University of British Columbia. Researchers interview an inmate for up to three hours, and compare the inmate?s statements against what is known of his record and his personal history. The interviewer ?scores? the subject on each of the twenty items?parasitic life style, pathological lying, conning, proneness to boredom, shallow emotions, lack of empathy, poor impulse control, promiscuity, irresponsibility, record of juvenile delinquency, and criminal versatility, among other tendencies?with zero, one, or two, depending on how pronounced that trait is. Most researchers agree that anyone who scores thirty or higher on the PCL-R is considered to be a psychopath. Kiehl says, ?Someone who scores a thirty-five, a thirty-six, they are just different. You say to yourself, ?Aha, here you are. You are why I do this.? ?
Harenski recently interviewed a Western inmate who scored a 38.9. ?He had killed his girlfriend because he thought she was cheating on him,? she told me. ?He was so charming about telling it that I found it hard not to fall into laughing along in surprise, even when he was describing awful things.? Harenski, who is thirty, did not experience the involuntary skin-crawling sensation that, according to a survey conducted by the psychologists Reid and M. J. Meloy, one in three mental-health and criminal-justice professionals report feeling on interviewing a psychopath; in their paper on the subject, Meloy and Meloy speculate that this reaction may be an ancient intraspecies predator-response system. ?I was just excited,? Harenski continued. ?I was saying to myself, ?Wow. I found a real one.? ?
At the end of the hall, a door led outside to the trailer. Inside, there was a small sitting area; computer screens and hard drives were built into a large console in the center, and the fMRI scanning tube was at the back. Its surfaces were made of molded white plastic. Harenski?s husband, Keith, the chief MRI technician in Kiehl?s lab, sat in front of the computer, monitoring a scan in progress. The screen showed what the inmate inside the scanner was seeing. All that was visible of him was his feet, covered with dirty white athletic socks, which protruded from the mouth of the tube.
Kiehl and the researchers in his lab have designed two tests?or tasks, as the researchers call them?one word-based and the other image-based. Kiehl said he had avoided complicated moral problems, such as the classic trolley dilemma, in which the subject is asked to choose whether to cause one person?s death in order to save the lives of others in the path of a runaway trolley, because psychopaths might not understand the problem or wouldn?t answer seriously. ?You try to minimize their opportunities for messing with you,? he said. The same tasks are performed by control groups, one of non-psychopathic inmates and another of non-inmates with intelligence-test scores and educational backgrounds similar to those of the inmates.
The word-based task was under way. The inmate was being shown a series of words and phrases, and was supposed to rate each as morally offensive or not. There were three kinds of phrases: some were intended as obvious moral violations, like ?having sex with your mother?; some were ambiguous, like ?abortion?; and some were morally neutral, like ?listening to others.? The computer software captured not only the inmate?s response but also the speed with which he made his judgment. The imaging technology recorded which part of the brain was involved in making the decision and how active the neurons there were.
Neurons in the brain consume oxygen when they are ?firing,? and the oxygen is replenished by iron-laden hemoglobin cells in the blood. The scanner?s magnet temporarily aligns these iron molecules in the hemoglobin cells, while the imaging technology captures a rapid series of ?slices??tiny cross-sections of the brain. The magnet is superconductive, which means it operates at very cold temperatures (minus two hundred and sixty-nine degrees Celsius). The machine has a helium cooling system, but if the system fails the magnet will ?quench.? Quenches are an MRI technician?s worst fear; a new magnet costs about two million dollars.
The inmate wore a helmet with a head coil for receiving magnetic data and, on the inside, a screen on which words were projected. A sensor measured ?skin conductance??palm sweat. During the functional imaging scans, there was a series of high-pitched beeps, then a loud drilling sound. And during the brain-anatomy scans the machine made a low, rapid thumping, like a metal heartbeat. As the inmate?s brain was scanned, he crossed his feet at the ankles and then uncrossed them. His toes wiggled.
Psychopaths are as old as Cain, and they are believed to exist in all cultures, although they are more prevalent in individualistic societies in the West. The Yupik Eskimos use the term kunlangeta to describe a man who repeatedly lies, cheats, steals, and takes sexual advantage of women, according to a 1976 study by Jane M. Murphy, an anthropologist then at Harvard University. She asked an Eskimo what the group would typically do with a kunlangeta, and he replied, ?Somebody would have pushed him off the ice when nobody else was looking.?
The condition was first described clinically in 1801, by the French surgeon Philippe Pinel. He called it ?mania without delirium.? In the early nineteenth century, the American surgeon Benjamin Rush wrote about a type of ?moral derangement? in which the sufferer was neither delusional nor psychotic but nevertheless engaged in profoundly antisocial behavior, including horrifying acts of violence. Rush noted that the condition appeared early in life. The term ?moral insanity? became popular in the mid-nineteenth century, and was widely used in the U.S. and in England to describe incorrigible criminals. The word ?psychopath? (literally, ?suffering soul?) was coined in Germany in the eighteen-eighties. By the nineteen-twenties, ?constitutional psychopathic inferiority? had become the catchall phrase psychiatrists used for a general mixture of violent and antisocial characteristics found in irredeemable criminals, who appeared to lack a conscience.
In the late nineteen-thirties, an American psychiatrist named Hervey Cleckley began collecting data on a certain kind of patient he encountered in the course of his work in a psychiatric hospital in Augusta, Georgia. These people were from varied social and family backgrounds. Some were poor, but others were sons of Augusta?s most prosperous and respected families. Cleckley set about sharpening the vague construct of constitutional psychopathic inferiority, and distinguishing it from other forms of mental illness. He eventually isolated sixteen traits exhibited by patients he called ?primary? psychopaths; these included being charming and intelligent, unreliable, dishonest, irresponsible, self-centered, emotionally shallow, and lacking in empathy and insight.
?Beauty and ugliness, except in a very superficial sense, goodness, evil, love, horror, and humor have no actual meaning, no power to move him,? Cleckley wrote of the psychopath in his 1941 book, The Mask of Sanity, which became the foundation of the modern science. The psychopath talks ?entertainingly,? Cleckley explained, and is ?brilliant and charming,? but nonetheless ?carries disaster lightly in each hand.? Cleckley emphasized his subjects? deceptive, predatory nature, writing that the psychopath is capable of ?concealing behind a perfect mimicry of normal emotion, fine intelligence, and social responsibility a grossly disabled and irresponsible personality.? This mimicry allows psychopaths to function, and even thrive, in normal society. Indeed, as Cleckley also argued, the individualistic, winner-take-all aspect of American culture nurtures psychopathy.
The psychiatric profession wanted little to do with psychopathy, for several reasons. For one thing, it was thought to be incurable. Not only did the talking cure fail with psychopaths but several studies suggested that talk therapy made the condition worse, by enabling psychopaths to practice the art of manipulation. There were no valid instruments to measure the personality traits that were commonly associated with the condition; researchers could study only the psychopaths? behavior, in most cases through their criminal records. Finally, the emphasis in the word ?psychopath? on an internal sickness was at odds with liberal mid-century social thought, which tended to look for external causes of social deviancy; ?sociopath,? coined in 1930 by the psychologist G. E. Partridge, became the preferred term. In 1958, the American Psychiatric Association used the term ?sociopathic personality? to describe the disorder in its Diagnostic and Statistical Manual of Mental Disorders. In the 1968 edition, the condition was renamed ?general antisocial personality disorder.?
Cleckley?s book fell out of favor, and Cleckley described himself late in life as ?a voice crying in the wilderness.? When he died, in 1984, he was remembered mostly for his popular study of multiple-personality disorder, written with Corbett Thigpen, The Three Faces of Eve.
In 1960, Robert Hare took a job as the resident psychologist in a maximum-security prison about twenty miles outside Vancouver. On his first day, a tall, slim, dark-haired inmate came into his office and said, ?Hey, Doc, how?s it going? Look, I?ve got a problem. I need your help.? Hare later wrote of this encounter, ?The air around him seemed to buzz, and the eye contact he made with me was so direct and intense that I wondered if I had ever really looked anybody in the eye before.? Hare asked the inmate, whom he called Ray in his account, to tell him about his problem. ?In response, he pulled out a knife and waved it in front of my nose, all the while smiling and maintaining that intense eye contact,? Hare wrote in his 1993 book, Without Conscience: The Disturbing World of the Psychopaths Among Us. Ray said he was planning to use the knife on another inmate, who was making overtures to his ? ?prot?g?,? a prison term for the more passive member of a homosexual pairing.? Ray never harmed Hare, but he successfully manipulated him throughout Hare?s eight months at the prison, and two and a half years later, after Hare had joined the faculty at the University of British Columbia, Ray, now paroled, tried to register there with a forged transcript.
Hare wasn?t familiar with the psychopathy literature when he was working at the prison. Later that year, he moved with his family to London, Ontario, where he pursued a Ph.D. at the University of Western Ontario. (When his brakes failed at the first steep hill on the trip east, he recalled that Ray had worked on his car in the prison garage.) His dissertation was on the effects of punishment on human learning and performance. One day in the library, he came across The Mask of Sanity. Reading Cleckley?s case histories put Hare in mind of Ray, and of other types he had encountered in the maximum-security prison. Were these men psychopaths? Over the next year, Hare read not only Cleckley but also the early literature Cleckley had synthesized. After receiving his doctorate, in 1963, and returning to Vancouver, he set about what would be his life?s work: the study of psychopathy, and the creation of the Psychopathy Checklist, the twenty-item diagnostic instrument that Kiehl is using at Western.
Thanks to the checklist, scientists working in different places can be confident that the subjects they are studying are taxonomically similar. The PCL also has a wide variety of forensic applications. It is employed throughout Canada in parole-board hearings and is gaining popularity in the U.S. In the thirty-seven states that allow the death penalty, a high psychopathy score is often used by prosecutors as an ?aggravating factor? in the penalty phase of capital cases. Psychopathy scores have also been used in child-custody cases; a high score may result in one parent?s loss of custody. Hare?s influence on the field of psychopathy is profound. Today, Hare?s former students hold important administrative positions throughout the Canadian prison system, and are prominently represented in the next two generations of psychopathy researchers around the world.