When I was a young man, a newly licensed psychologist in the State of California, Kathy Wachter-Poynor, the local public mental health director, offered me a position that was to change my life and my career. She asked if I would consider developing an acute psychiatric inpatient program for mentally ill offenders in a maximum security setting. My excitement, composed equally of a tremendous naivete and a fierce ambition, both now tempered by years of experience, carried me into this valley of the shadow of death. Thankfully, I did come to fear evil.
I fairly quickly arrived at the realization that little was clinically known about some of the men I began to encounter. In those days of the ancien régime—DSM III had just been published—the application of specific criteria to arrive at a reliable, descriptive diagnosis was the coin of the realm. Little thought was given to the notion of psychopathy; no contemporary psychoanalytic writers used the term (although a few still clung to the anachronistic word sociopathy); and the word psychopath was central only to the empirically rigorous, and nonanalytic, psychological research of Robert Hare and his students at the University of British Columbia, unheralded at that time.
Unable to shake my undergraduate major in history at the College of Wooster, I began to peruse the older psychoanalytic literature for hints of clinical wisdom concerning the psychopath. I began also to search for contemporary psychoanalytic theorists who were at least obliquely interested in the internal life of such untreatable persons. I found a vein of data: gems from the past and a few diamonds from the present.
This book crystallized in my mind about six years ago, when I realized that my private intellectual labor of love might be of use to others; it could possibly become a published anthology of psychoanalysts’ approaches to various facets of the psychopath, a book informed and balanced by what is currently known about psychopathy from a social, psychological, and biological research perspective.
My search for a publisher was met with several rejections. In addition, I found a daunting economic problem: reprinting published papers meant purchasing the reprint permissions, and no publisher wanted such costs to be added to the risk of printing a book that would have a small audience. The problems were solved when I received the generous support of the John Jay College of Criminal Justice Foundation and won Paul E. Stepansky’s enthusiasm as Managing Director of The Analytic Press, in my opinion the premiere publishing house for psychoanalytic books.
I have organized the book into two sections: development and psychodynamics, and psychodiagnosis, treatment, and risk management. In the attempt to bring some clinical order to a varied literature, I have placed each chapter in chronological order within each section. All papers appear in their original form except for minor editorial changes. The organization reflects my belief that most of the authors were familiar with, and had read the work that had come before them, an optimism that may be more wishful than empirical; but this approach also lends a certain historical thread to the book. I begin each of the two sections with an introduction, which is my attempt to flesh out what can be psychoanalytically known about psychopaths at present. I then introduce the authors to follow and integrate our combined knowledge into other, nonanalytic domains of work, such as neurobiology, clinical psychiatry, and experimental psychology. It is illuminating to hear what analysts have said about psychopathy over the past decades and the success they have had—despite the difficulties of studying psychopaths—in applying the analytic way of knowing to discover important facets of this character pathology. As we shall see, there is an important psychoanalytic tributary feeding this cresting river of knowledge concerning the psychopath.
The mature and informed reader will nevertheless discover that certain authors or papers are missing. I offer only two weak excuses: the need for economy of size and my discovery that there is much repetition in the literature. For example, Phyllis Greenacre (1958) wrote a paper entitled “The Impostor,” which was published in Psychoanalytic Quarterly three years after Helene Deutsch’s paper of the same name appeared in the same journal. For the sake of brevity and equanimity, I decided to publish another paper of Greenacre’s, “Conscience in the Psychopath” (chapter 4), and forego her expansion of the work of Deutsch. Likewise, I originally intended to include two papers by Otto Kernberg but found that “Clinical Aspects of Severe Superego Pathology,” a chapter in his 1984 book of reprinted articles, Severe Personality Disorders, was almost completely contained in a subsequent paper, “The Narcissistic Personality Disorder and the Differential Diagnosis of Antisocial Behavior,” published five years later in Psychiatric Clinics of North America (chapter 21).
Some authors, however, are notable for their absence: Otto Fenichel, Melita Schmideberg, Franz Alexander, and Melanie Klein, to name a few. Although each of these psychoanalysts is historically linked with the topic of this book, I did not include them, as well as others, for one of several reasons: their salient work was not contained in a representative scientific paper, but instead was dispersed throughout books and difficult to extract; their work may have provided a theoretical or clinical foundation for others’ more specific writings on psychopathy but, when considered alone, was too far removed from the topic; or their work was earnest but, in the light of subsequent writings and research, generally wrong. For example, the thesis of Franz Alexander’s (1930) paper, “The Neurotic Character,” in which he attempted to fit the psychopath into his Procrustean bed, has not been borne out; subsequent research has shown that psychopaths are typically organized at a borderline, rather than a neurotic, level of personality (Gacono and Meloy, 1994).
I am also a great admirer of the work of Robert Lindner. His hypnoanalysis of a psychopath in Rebel Without a Cause (1944) and his compilation of case studies, The Fifty-Minute Hour (1954), remain classics in our field. He also did much to strengthen the role of psychology in psychoanalysis and made substantial contributions to Rorschach research concerning antisocial personalities. Although I did not include a selection from his writings in this book, he remains an influential source in my understanding of psychopaths. He captured quite eloquently the lure and the danger of this character disorder in his own words: “Psychopaths sparkle with the glitter of personal freedom, the checks and reins of the community are absent, and there are no limits either in a physical or a psychological sense” (Lindner, 1944, p. 13).
What matters to the psychopath is risk and reward. What matters to us who encounter the psychopath in our hospitals, prisons, jails, and communities is safety and understanding. I hope this book contributes to our endeavors.
REFERENCES
Alexander, F. (1930). The neurotic character. Internat. J. Psycho-Anal., 11: 292–311.
Gacono, C. & Meloy, J. R. (1994). Rorschach Assessment of Aggressive and Psychopathic Personalities. Hillsdale, NJ: Lawrence Erlbaum Associates.
Greenacre, P. (1958). The impostor. Psychoanal. Quart., 27:359–382.
Kernberg, O. (1984). Severe Personality Disorders. New Haven, CT: Yale University Press.
Lindner, R. (1944). Rebel Without a Cause. New York: Grune & Stratton.
Lindner, R. (1954). The Fifty-Minute Hour. New York: Dell.