Introduction to Section I
Are psychopaths born or made? Robert Hare (personal communication, January 2000) told me this question was akin to attempting to describe a soccer field by its length or its width; both dimensions are necessary to capture the expanse, or expansive personality, that we see before us. When this question is posed to me by others, I point out that the more realistically based question is how nature and nurture shape each other over time, since a child comes into the world with a certain genotype that is phenotypically expressed according to the vagaries of personal experience.
ATTACHMENT, AROUSAL, AND ANXIETY
“The house of psychopath” is built on a psychobiological foundation of no attachment, underarousal, and minimal anxiety. I think these are necessary and related, but insufficient, characteristics that provide certain predispositions for the development of a psychopathic character.
Attachment is a biologically rooted, species-specific behavioral system that maintains close proximity between child and caretaker. It was first conceptualized and investigated by John Bowlby, James Robertson, and Mary Ainsworth at the Tavistock Clinic in London (Robertson and Bowlby, 1952; Bowlby, 1953; Ainsworth and Bowlby, 1954). Attachment is deeply rooted in both birds and mammals but is generally absent in reptiles.1 It begins with goal-directed but objectless behaviors, such as sucking or crying, which seek to maintain physiological homeostasis in the human infant by securing warmth, touch, and food. Over time—the length of which is one of the contentious debates in developmental psychology—the proximity-seeking behavior becomes more object related and emotionally nuanced as the child attaches to the maternal object. Attachment is often defined as a strong affectional bond in both children and adults. Ainsworth (1989) termed it “a relatively long-enduring tie in which the partner is important as a unique individual and is interchangeable with none other” (p. 711). One of the reasons that attachment has been so thoroughly researched is the ease with which it can be behaviorally measured: proximity seeking to an object, distress when the object leaves, and the nature of the reunion behavior when the object returns. According to Miller (chapter 10, this volume) and Bursten (chapter 17, this volume), mastering mother’s return may be the central task of consolidating one’s healthy narcissism. A pathology of attachment is an acute or chronic disturbance in the bond that exists between infant and caretaker. Ainsworth (1989) labeled one of these disturbed patterns of attachment behavior anxious avoidant attachment and described it as a child’s attempting to live in a pseudo-autonomous manner, chronically displaying a pattern of detachment, or indifference, to the rejecting or intrusive, but also abandoning, object. The anxious avoidant child, however, is chronically stressed but still attached. Ainsworth paralleled this finding with the third stage of attachment disruption proper, detachment; but subsequent research indicated that detachment is a different pattern characterized by apathy, self-absorption, preoccupation with nonhuman objects, and no displays of emotion (Bowlby, 1969). After prolonged separation, or a series of attachment disruptions, this attachment pathology may usher in affectionless psychopathy, well illustrated by Bowlby’s 1944 paper on “Forty-Four Juvenile Thieves” (chapter 3, this volume). Bowlby (1988) later theorized that the attachment pattern seen in juvenile thieves is caused by constant maternal rejection. Current clinical wisdom supposes that future psychopaths are recruited chiefly from either the avoidant or the detached types.
Bartholomew (1990) developed a corresponding model of adult attachment based on positive and negative concepts of self and other. Her first three types—secure, preoccupied, and fearful—propose a certain positive and negative valence for the self and object; but most salient to psychopathy is her fourth type, dismissing attachment, which is analogous in some ways to the avoidant pattern of infancy.2 Here is an easily understood pathology of attachment in which the self is viewed as positive and objects are viewed as negative. In a more psychodynamic frame, a narcissistic homeostasis is maintained through the idealization of the self and the devaluation of others. The dismissing attachment pattern relies on a strategy that minimizes distressing thoughts and affects associated with rejection by maintaining emotional distance from others (Rosenstein and Horowitz, 1996). Research has shown that dismissing attachment is correlated with conduct disorder and antisocial personality disorder (Allen, Hauser, and Borman-Spurrell, 1996), where it is assumed that acting-out behaviors are aimed at alleviating internal distress. In two related studies, Raine, Brennan, and Mednick (1994, 1997) demonstrated in a large cohort of Danish adult males that birth complications and maternal rejection in the first year of life predisposed them to an early onset (before 18 years) of violent crime (robbery, rape, murder, assault, or domestic violence). Having been reared in a public-care institution and a documented attempt to abort the fetus were among the data measuring their rejection by mother and obviously underscore the severity of the attachment disruption for these men.
The second corner of this psychobiological foundation is an arousal problem: autonomic hyporeactivity, especially to punishment or aversive consequences. The evidence for this variable extends back to the early work of Hare and his colleagues (Hare, 1970), which demonstrated peripheral autonomic irregularities among psychopaths, most notably through the use of skin conductance (SC) or GSR measures.3 Although his work focused on adult Canadian criminals, the finding of autonomic hyporeactivity to punishment has since been replicated in other samples, including noncriminals, by other independent research groups throughout the world (Raine, 1993). What appears to be implicated in these studies is an attentional deficit among antisocial and criminal populations, which is further validated by the power of attention deficit disorder in childhood to predict criminality (Gittelman et al., 1985; Weiss et al., 1985).
The research, however, is not without its inconsistencies. For instance, one area of study argues for the importance of schizotypy, or schizotypal personality disorder (DSM-IV: American Psychiatric Association, 1994), as a moderator variable for orienting deficits across samples of criminal, antisocial, and psychopathic individuals: high schizotypy in these groups increases their orienting deficits (Raine et al., 1999). Other research has shown enhanced orientation to a task among antisocials when it is seen as positive and interesting (Raine, 1989), while the orienting deficits appear limited to neutral or unpleasant stimuli.
The most important body of work related to arousal, however, and one that implicates the relationship between arousal, attachment problems, and violent criminality, is the biosocial research that finds “chronic cortical underarousal” to be a cause of early onset, and serious, habitual criminality (Raine et al., 1997). Not only do measures of chronic cortical underarousal, suggested by low resting heart rate, poor skin conductance, and slow wave (theta) EEG activity, correlate with habitual criminality, but together they have a predictive power that can override the influence of the environment, especially when the latter is what we would consider normal, nurturing, and “good enough.”
Raine, Venables, and Williams (1990) demonstrated that these three measures of low CNS and ANS arousal at age 15 in a nonrandom sample of London male adolescents predicted habitual criminality when the men reached age 24. In a test of a reversal of their hypothesis—that elevated levels of CNS and ANS reactivity would protect individuals who were raised by criminal fathers from habitual criminal behavior—Brennan et al. (1997) studied four samples of Danish males and did find significantly higher reactivity among the noncriminals raised by criminal fathers: even higher than the reactivity of the noncriminals raised by noncriminal fathers!
Extending their work on the relationship between cortical underarousal and aggression, Raine and his colleagues have published several studies of a large sample of Mauritian4 children (N = 1795) who are being followed longitudinally and were first examined at age three. The researchers’ first published study tested the hypothesis that low resting heart rate, the best replicated biological correlate of childhood antisocial and aggressive behavior (Raine, 1993), measured at three years of age, would predict aggression at age 11 years. They supported their hypothesis, and gender and ethnicity made no difference. Eleven different biological, psychological, and psychiatric mediators and confounds also did not change the significant group differences (Raine, Venables, and Mednick, 1997). In their second study, the same large sample of Indian and Creole children from Mauritius were tested in a prospective longitudinal design, and aggressive children at age 11 were found to have had increased measures of stimulation-seeking, fearlessness, height, and weight at age three years when compared with the nonaggressive children (Raine, Reynolds, et al., 1998). In their third study of the same children from Mauritius, a developing tropical country very different from our Western culture, Scarpa et al. (1997) showed that children designated inhibited at age three showed significantly higher heart rates and skin conductance arousal when compared with uninhibited children. Studies have shown that such inhibition is related to the development of future anxiety disorders (Kagan, Reznick, and Snidman, 1987; 1988), and reduced inhibition is related to future antisocial behavior (Farrington, 1987).
Which brings me to the third corner of this psychobiological foundation: minimal anxiety. When anxiety is felt, such inchoate unpleasant emotion may signal danger from within or from outside, and, when it is specifically object related, we refer to it as fear. When the object is fantasy based, or patently unreasonable, we may see the patient as phobic or delusional. Fear and anxiety appear to have distinct physiological substrates (Dien, 1999; Rosen and Schulkin, 1998).
From a developmental attachment perspective, interpersonal anxiety emerges, typically in the service of safety and survival when a child perceives a stranger, since distress in the infant in the presence of someone who is unknown may be a signal to the caretaker that real danger may exist. Bowlby (1960) noted that the evolutionary basis of the causes of anxiety—the appearance of a stranger, actual separation, the anticipation of loss—keeps the maternal object in close proximity to the child and the child out of the grasp of predators; society still punishes parents as “grossly negligent” who drift out of range of their infants’ distress calls, as if predators, in their contemporary metamorphosis as abductors5 and child molesters, lurk around every corner and in every park.
In the realm of antisocial behavior, particularly psychopathy, however, anxiety is minimal or absent. This conclusion was first noted in Lykken’s (1957) study, which found that anxiety differentiated secondary (anxious) psychopaths from primary (nonanxious) psychopaths. Blackburn (1975, 1998) has also identified these secondary psychopaths as being socially anxious, withdrawn, and moody, in contrast to primary psychopaths, who are hostile, extraverted, self-confident, and low-to-average anxious. Other laboratory studies support the clinical observation that anxiety is low in psychopaths (Ogloff and Wong, 1990), but self-report measures typically show a weak or neutral relationship between psychopathy and anxiety (Hare, 1991). Negative correlations between anxiety and psychopathy are more evident if the “aggressive narcissism” (Meloy, 1992) aspect of psychopathy is factored in. This component appears in children at risk of becoming psychopaths in adulthood and is referred to as a “callous / unemotional” factor or grouping of traits (Frick et al., 1994).
There is, however, a problem. Rates of anxiety disorders in conduct-disordered children range from 22% to 33% in community samples (Russo and Beidel, 1993), and significant correlations are found between antisocial behavior and anxiety on various childhood behavioral rating scales. Even the diagnosis of antisocial personality disorder in adulthood (DSM-IV: American Psychiatric Association, 1994) highly correlates with a variety of Axis I anxiety disorders (Boyd et al., 1984). How do we reconcile these findings with the low-anxiety hypothesis as a foundation for psychopathy? The answer appears to lie in separating the callous / unemotional traits of the psychopathic child from his impulsivity / conduct problems. When this is done (Frick et al., 1999), there emerges a strong negative relationship between these traits and anxiety in the psychopathic child: as subjects become more callous and unemotional, their anxiety dissipates. And, if the presence of conduct problems is controlled, a significant positive correlation between fearlessness and callous / unemotionality is seen. In other words, when the internal life of the child at risk for psychopathy, or what Lynam (1996) refers to as the “fledgling psychopath,” is carefully studied and his acting-out behaviors are viewed as secondary to his emotional and defensive construction, a clear picture emerges of a developing youngster who has minimal anxiety and is essentially fearless.
No attachment, underarousal, and minimal anxiety biologically anchor the foundation of the psychopath. As we see later in adulthood, these substrates manifest in a fearless and sensation-seeking lifestyle, one that is unfettered by the constraints of an affectional bond, excitability or worry, or fear of violating the rules of others.
David Levy (chapter 2, this volume), John Bowlby (chapter 3), Lauretta Bender (chapter 5), and Kate Friedlander (chapter 6) are the early pioneers who charted the unknown territory of attachment pathology in psychopathy. Although they did not have knowledge of the inherited and acquired biological defects that provide the foundation for the “house of psychopath,” their insights into the phenomenology of these patterns—and their thoughtful speculation as to etiology—are quite remarkable. For example, most of our earliest authors focus on the impact of neglect in fostering anger, impeding the formation of an object relation to the mother, and stimulating a pseudo-autonomous striving that we label pathologically narcissistic. They also stress the centrality of the joy of loving, and the pleasure derived from it, for both mother and child. Perhaps most important, the beginnings of character disturbance may be concealed by a surface adaptation, what Cleckley (1941) would later call a “mask of sanity.”
FAILURES OF INTERNALIZATION
Psychological failures parallel the biological deficits of the “fledgling psychopath” (Lynam, 1996). These are failures of internalization, which Hartmann (1939) originally described as the evolutionary and phylogenetic transfer of functional-regulatory mechanisms from outside to inside. Piaget (1954) called this process assimilation, and Schafer (1968) noted that this transfer can be either reality based or fantasy based.
Within traditional psychoanalytic theory, failures of internalization begin with an organismic distrust of the sensory-perceptual environment and selective early incorporative deficits. Incorporation is the most developmentally primitive form of internalization, as the infant attempts to take in an object through the mouth; and, depending on the nature of the object—whether hard or soft—the consequent behavior will be to suck or to bite, to swallow or to sever. If normal development proceeds, these incorporative experiences are mostly hedonic, psychologically gratifying, and physiologically stabilizing. The emotional background of these incorporative experiences is a basic trust of the holding environment (Erikson, 1950).
In psychopathy, however, these incorporative failures6 predict subsequent problems with two kinds of internalization: identifications and introjections. Identifications are modifications of the self or behavior to increase resemblance to the object (Schafer, 1968). Introjections are objects that are internalized but maintain a relationship to the self. When an introjection is conscious, it may be “seen” or “heard” in the mind, but it is not considered part of the self. It is subjectively experienced as “not-I” (Meloy, 1985). Borderline personality-disordered patients often complain of such powerful persecutory “voices,” and these introjects may be misdiagnosed as auditory hallucinations.
In psychopathy, objects desired for internalization as either identifications or introjects are completely absent, not available when wanted, or harsh and unpleasant. There results a dearth of soothing internalization experiences. Through various kinds of conditioning, such as punishment (the presentation of an unpleasant stimulus) or negative reinforcement (the withdrawal of a pleasant stimulus), the child may come to anticipate hard, aggressive objects and may identify with such objects for both adaptive and defensive reasons.
Grotstein (1982) referred to an associated identification as the stranger selfobject and defined it as a normal preconceived fantasy that helps the infant anticipate the presence of the predator in the external world. I refer to this fantasy in the fledgling psychopath as the predator part-object. It is the primary archetypal internalization and a core narcissistic identification of the grandiose self-structure (Kernberg, 1984). It will later become the ideal self of the adult psychopath and will manifest in the positive emotional valence he attaches to his criminal versatility. As one psychopathic inmate said with disdain when he was handed his lengthy rap sheet by a television interviewer, “This isn’t my complete body of work!”
The predator part-object of the psychopath as a primary unconscious identification is also evident in Rorschach research. We have noted (Meloy and Gacono, 1992) the degree to which psychopaths, both men and women, will often transform benign percepts into predatory ones: “It’s a butterfly … with claws”; “It’s a whale … with a shark fin”; “I see two carnivorous wolves … I wish I could see doves mating”; “A bat or evil moth, a furry animal that doesn’t suckle to its mom.” Such predatory identifications are also interpersonally evident in the pleasure psychopaths take when dominating others in real life, instead of experiencing any joy in affectional relating. This is a dominance-submission paradigm or power gradient—the seeds of sadism—which is often felt by clinicians as being “under the thumb” or being controlled by psychopathic patients. This prey-predator dynamic is also experienced with psychopathic children, adolescents, and adults in countertransference responses that are atavistic, visceral, and often felt as spontaneous autonomic arousal while one is in their presence: piloerection on the back of the neck is most common. This autonomic arousal signals a phylogenetically old fear of being prey to the predator, which internally for the psychopath is surmounted by a complete identification with the latter and the disavowal of the feared introject of the predator. He becomes what he fears the most.
The etiology of failed internalizations and, instead, a primary identification with the predator part-object is unknown. The other papers in our first section, especially those by Phyllis Greenacre (chapter 4), Adelaide Johnson (chapter 7), Helene Deutsch (chapter 8), and Donald Winnicott (chapter 9) are clearly biased toward a nurturing failure; but the importance of biology in habitual criminality and psychopathy should not be dismissed (Raine, 1993; Cooke, Forth, and Hare, 1998), nor should its likely impact on internalizations. Studies have shown that psychopathy has a negative curvilinear relationship to neglectful and abusive childhood family experiences (Marshall and Cooke, 1999). In other words, those persons who are severely psychopathic were less influenced by family factors when they were growing up; whereas those with low-to-moderate psychopathy were strongly influenced by family experience. Neuroimaging (PET) also suggests that functional deficits measured by radioactive glucose among samples of murderers with extensive criminal histories are more pronounced among those from good rather than poor home environments (Raine, Stoddard, et al., 1998).
THE GRANDIOSE SELF AND OMNIPOTENT FANTASY
Internalizations are most relevant to the structure of the self. Central to psychopathy is a variation of the grandiose self-structure, first formulated by Kernberg (1976) in his theoretical understanding of narcissistic personality disorder (see chapter 21). The grandiose self-structure, a pathological formation rather than a developmental fixation,7 has three fused, or condensed, components: a real self, the actual specialness of the child; an ideal self, a fantasized self-concept, which compensates for severe oral frustration, rage, and envy; and an ideal object, a fantasized image in the child’s mind of a completely loving and accepting parent, often at odds with the actual behavior of the real parent. A psychopathology of narcissism is the functional and affective core of psychopathy. The development of the grandiose self-structure—an unconscious construct filled with conscious images—is the scaffolding that continues the construction of the “house of psychopath.” Conscious articulations of the self as predator, a dominant idealization, and others as prey, a submissive devaluation, are the clinical observations we make that bring us closest to the grandiose self-structure in the patient.
A psychopathic sexual murderer articulated his response to Card VIII of the Rorschach, usually seen as one or two animals: “In the grey, it looks like some kind of monster eating the winged humanoid. What was Rorschach thinking? That’s it.”
There continues to be intact reality testing in psychopaths, the ability to separate perceptually internal from external stimuli, yet he conceives of others as extensions of the self. Objects, both as internal representations and as real people, exist for the purpose of gratification of sexual or aggressive impulses and do not conceptually otherwise exist. This distinction may seem unimportant, but it becomes clinically and forensically very relevant when the presence or absence of psychosis in psychopathy is considered. As research has shown (Gacono and Meloy, 1994), most psychopaths are organized at a borderline level of personality with intact reality testing; nevertheless, psychosis can exist in a psychopath, reality testing or the perceptual differentiation between self and others can dissolve, and his motive for predation can become delusional.
The psychopathic grandiose self-structure is maintained as a primary identification through the behavioral devaluation of others in the real world. Although omnipotent fantasy is a clear byproduct of the grandiose self-structure, and partially maintains it, it is my observation that psychopaths must aggressively devalue others in real life to shore up their idealized identifications of the self as Predator. Fantasy alone is insufficient, unlike the more benign narcissistic personality disordered person who can nurture a private omnipotent fantasy of himself without actually damaging or degrading other people. Although this clinical observation is verifiable and forensically notable—it is one reason why psychopaths cause such destruction—the basis of this failure of fantasy, the impotence of omnipotence, is unknown. The most parsimonious theory is that psychopaths will habituate, or desensitize to their own fantasies of omnipotence. The specter of deflation haunts the edges of their psyches; autonomic arousal, already low to begin with, further ebbs; and emotions of boredom and envy begin to reach consciousness. Therefore, psychopaths act on others to derogate, devalue, dismiss, and, in some cases, destroy to once again maintain their peculiarly dependent narcissistic equilibrium.8
Omnipotent fantasy has a role, of course, in normal childhood development. In the fledgling psychopath, it has gone awry for any number of reasons: first, the parental environment may be so neglectful (see chapter 8) that omnipotent fantasy provides a compensatory retreat for the pain and deprivation suffered by a disregarded child; second, the environment may be so directly abusive—whether aggressively, sexually, or in some malignant, classically conditioned combination—that the child internalizes and strongly identifies with the abusive parent as a predator for whom he will eventually no longer be prey but will instead prey on others; or, third, the environment may be quite adequate and loving for most children, but in the fledgling psychopath a combination of biological predispositions makes containment and modulation of aggression impossible (Lykken, 1995). Such dispositions could range from hyperactivity, impulsivity, and attentional deficits (Lynam, 1996), through a largely heritable callousness and lack of emotion (Patrick, 1994), to a neurologically based life course of persistently antisocial behavior (Moffitt, 1993).
PRIMITIVE INTERNALIZED OBJECT RELATIONS
When one gazes upon a psychopath, there is less there than meets the eye; for example, his internalized object relations are relatively simple and primitive (ontogenetically young). The fledgling psychopath remains at a preoedipal or borderline level of personality organization. There is no tripartite (ego, id, superego) structure to his personality. Internalized objects remain part-objects in the sense that good and bad qualities are not integrated into a whole representation. The self is either good or bad; others are either good or bad. The development of a grandiose self-structure, however, allows for the maintenance of a tenuous narcissistic equilibrium in which self-representations are always positive and other representations are always negative. Unpleasant affects associated with self-representation, such as envy, are quickly evacuated through projection onto, or through projective identification into, others. Predatory idealization is maintained; prey devaluation is maintained. A dyadic self- and object world exists without the oedipal defenses, such as repression, or more mature structuring of a superego.
This state of mind is fundamental to the work of Kernberg (1980) and of his muse, Jacobson (1964), and is often misunderstood in failed attempts to reconcile a tripartite theory of personality structure with those authors’ dyadic theory of primitive object relations. Repression must activate if there is to be a differentiated ego and id, and ideal self-representations must integrate with ideal object representations as an ego ideal if the differentiation between ego and superego is to begin. In the preoedipal personality of the fledgling psychopath, which continues into adulthood, there are only dyadic self- and object representations, which are either condensed (the grandiose self-structure; see Kernberg, 1984) or displaced somewhere else, usually outside the self.
One 34-year-old serial murderer I evaluated, although both moderately psychopathic and pathologically narcissistic, could not completely rid himself of his bad objects. He was clinically depressed and had very low self-esteem. He had abducted, raped, and killed two young women and readily referred to the “sick, twisted” part of himself that committed these acts. He hated his mother owing to her abandonment of him and her drunken promiscuities with many men. He selected intoxicated victims his mother’s approximate age when she left him and had rape fantasies toward his mother beginning at age 13 or 14. He believed he should be executed and wished his father had killed him when he beat him as a boy.
The simplicity and primitiveness of the psychopath’s dyadic world may be masked by the patient’s higher than average IQ. Clinicians may delude themselves into assuming a more complex, tripartite structure than actually exists and invest more therapeutic optimism, especially in an adult psychopathic patient, than is warranted. Gross contradictions in the observed state of mind of the psychopath may be the first clinical clue that integration of the emotional valence of self- and object representations has not occurred. These contradictions may frighten and confuse the clinician, but the psychopath, when confronted, does not see a problem.
The same serial murderer had an affectionate, loving relationship with his pregnant girlfriend while he nurtured his subterranean paraphilic fantasies and raped and murdered his two victims over the course of four months. He had also carried on a consensual relationship with another girlfriend 10 years earlier, during which he had serially raped two stranger females. When asked about this seeming contradiction, he said, “One is taking, the other is sharing.”
SUPEREGO ABNORMALITIES
Without the biological substrate of normal attachment and the anxiety concomitant with the loss of the maternal object (or the more developmentally mature fear of loss of the love of the object), internalizations largely fail, along with the ability to internalize values. The adult psychopath is a valueless person.
Kate Friedlander refers to this in her notion of “latent delinquency” (chapter 6); and Adelaide Johnson began to explore this blighted territory with her concept of “superergo lacunae” (chapter 7). Moral responsibility is a moot question in psychopathy. Not only is there an inability to compare good and bad objects—the cognitive beginning of superego development and morality—there may be a complete “reversal of values” and a consequent identification with badness or evil.
One very bright 60-year-old psychopath, in prison for life, could argue quite convincingly that people in prison were all victims and those in society were the victimizers. Nevertheless, he believed, and incorrectly quoted Solzhenitsyn to bolster his argument, that the greatest freedom of all was incarceration.
A probation officer once characterized to me this reversal of values as the psychopath’s ability to “monkey with your mind.” It also gives the psychopath a tactical advantage, since internal constraints do not inhibit moment-to-moment gratification of impulse.
The psychopath’s vestigial burden of conscience, however, is located in Jacobson’s (1964) concept of the first layer of normal superego development: the sadistic superego precursors, which are projected aspects of early persecutory objects, cast out to deny aggression in the midst of frustration. Kernberg (1984) referred to this superego layer as the first of his six levels of superego pathology. The observed clinical manifestation of sadistic superego precursors is the psychopath’s use of sadism to achieve pleasure. Sexually sadistic criminals evidence this behavior most readily in their propensity to abduct and torture victims (Dietz, Hazelwood, and Warren, 1990). The identification with sadistic persecutory objects is very different from that of the borderline patient, who may feel tortured “in his mind” by such sadistic introjects; borderline patients are much more amenable to treatment.9 We have found in our research a significant relationship of some magnitude between various measures of sadism-pleasure derived from the suffering and domination of another person—and psychopathy (Holt, Meloy, and Strack, 1999).
Sadistic superego precursors in the preoedipally organized fledgling psychopath are most clinically evident in cruelty to animals, particularly domestic pets. This infliction of suffering on a dependent and affectionate animal is the child’s attempt to evacuate his own helpless rage and instead feel pleasure through omnipotent control. The memory of helplessness is obliterated through mastery of, and identification with, the sadistic superego precursors. Although all children feel helpless rage at times, and the defense against this emotion is the psychodynamic basis of the sadistic impulse, it is fully acted out by only a select few children who lack the internalized ability to constrain it. Felthous and Kellert (1986) showed a significant correlation between cruelty to animals in childhood and protean violence in adulthood.10
AFFECTS AND DEFENSES
Psychopaths live in a presocialized emotional world. Psychopaths possess an emotional range and depth and object relatedness similar to—although not identical with—those of a young toddler prior to sustained interaction with his peers. Emotions that are consciously felt include excitement, rage, boredom, envy, frustration, dysphoria, and shame. These feelings do not require whole-object relatedness, that is, the representation of self and others as whole, real, meaningful, and separate. They are part-object emotions and are felt quickly, expressed coarsely, and dissipated rapidly. The process or phenomenon of feeling, what is clinically referred to as modulation of affect, remains this way into adulthood; psychopathic men typically modulate affect as five-to seven-year-old children do (Gacono and Meloy, 1994).
Once again, what is absent is most important. The fledgling psychopath, partially due to his preoedipal personality organization, will not evidence the more mature feelings that necessitate whole-object relatedness and a capacity for attachment. These emotions include anger, guilt, fear, depression, sympathy, empathy, remorse, gratitude, sadness, loneliness, and reciprocal joy—a range of feeling that is broad, deep, and complex. For example, the popular notion of empathy, to “put yourself in the other person’s shoes,” is a welcome behavior when first seen in a child. It also correlates with a developing ability to separate reality from fantasy, as defenses such as repression mature which do not require the perceptual distortions inherent in such preoedipal defenses as projection and denial (Vaillant, 1993). There is also no requirement that the other person’s shoes be the same size as that of the empathic one; empathy requires the ability to recognize the uniqueness and separateness of the other. All this is lacking in the psychopath.
In our research with adult antisocial and psychopathic males and females, we found a predominance of preoedipal defenses, most commonly devaluation, denial, splitting, omnipotence, and projective identification (Gacono and Meloy, 1994). Although more mature “neurotic” defenses, such as rationalization, will occasionally appear, the defenses cluster at a borderline level of personality organization (Kernberg, 1975). The dynamic nature of defenses (change over brief periods of time) has been demonstrated in a series of Rorschach studies (Meloy et al., 1997).
The more primitive the defense, the more obvious it is to the clinician. Projection, for example, maintains the demarcation between inside and outside, but the origin of the stimulus is relocated. A young psychopath might feel envy toward a psychotherapist who is desperately trying to be as empathic as possible in the treatment sessions. The patient’s envy is stimulated by his perception of the therapist’s “goodness,” something the patient does not see in himself. The patient quickly defends against this intolerable insight, although it is perhaps accurate, by attributing to the therapist his felt “badness” through cruel and repeated verbal devaluations of her. Envy subsides in the midst of his rage because he has damaged her “goodness,” and it is no longer there to be possessed, at least momentarily. His conception of her as a part-object allows him to maintain his projection since other remedial aspects of her personality do not come into his awareness to dilute his derogation of her as a psychotherapist.
Jealousy is a more developmentally mature and complex emotion than envy; it is triadic (two competing for the love of one) and requires the capacity for attachment and therefore the threat of loss of the love of the object. Jealousy is more apparent in males and likely serves reproductive success (Berke, 1988; Buss, 2000). It is typically not an emotion felt by psychopaths and is more likely to be seen in such common pathologies of attachment as stalking and in ordinary sexual pair bonds.11
The most troublesome question, and one that is not yet resolved, is whether such affective and defensive primitiveness is solely adaptive, in the sense of facilitating the search for gratification from the environment, or instead wards off low (if not despicable) self-esteem. Willock (1986, 1987), adopting the latter interpretation when clinically treating less disturbed but conduct-disordered children, has written elegantly on this topic. We (Gacono and Meloy, 1994) researched a sample of 60 conduct-disordered children, ages 5–12, and found low self-esteem, chronic emotional detachment, and minimal anxiety in comparison with normal children. Two-thirds of these children were the solitary-aggressive subtype, a DSM-III-R (American Psychiatric Association, 1987) grouping of conduct-disordered children at highest risk for psychopathy in adulthood. Their object representations, moreover, were significantly more likely to be categorized as sources of narcissistic mirroring or overwhelming and malevolent forces than in our normal comparison group: a typical example of the latter is (Rorschach Card II), “an explosion, volcano, eruption, the cut away side of molten lava blowing out all over the place … red, looks like a man crawling because his feet got tore off” (Gacono and Meloy, 1994, p. 32).
Again, are such thoughts and feelings defensive, adaptive, or both? There does not appear to be a general theoretical answer to this question, but from a clinical perspective, the resolution is easily found. Psychological testing will usually differentiate a primary psychopathic child (who often has been raised by prosocial parents) from a much more defensive and treatable child with conduct disorder (whose parents are often both abusive and neglectful) in that the latter child will show evidence of both attachment and anxiety. Behaviorally, in children with conduct disorder, there will also be an absence of repetitive acts of cruelty toward domestic animals. Intensive psychoanalytic treatment will also show gains in these children (Fonagy and Target, 1996), especially if anxiety is present.
The remaining chapters in this section, by Milton Miller (chapter 10), Seymour Halleck (chapter 11), and myself (chapter 12), attempt to shed further light on the hypothesized psychodynamics of psychopaths. In his poetic chapter, Miller speaks to the discontinuity in the sense of time of psychopaths, but in a more subtle manner, he also speaks to the superficiality of psychopaths and their inability to deepen their relationships to objects. A paucity of identifications means there is no grief when there is loss and therefore no depth of attachment. Halleck depicts psychopathy as a defensive search for painless freedom from objects. Although I disagree, his argument is provocative and illustrates our propensity to idealize certain perceived characteristics of psychopaths as we struggle with our own anxieties and attachments. My chapter, which concludes the first section, is an attempt to comment on the interface of evil and psychopathy, with appropriate deference to a psychodynamic that is often denied because it frightens—sadism.
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1Sometimes people with reptiles as pets will misinterpret their thermotropic (heat-seeking) behavior as an emotion related to attachment (S. Geeks, personal communication, January 2000).
2In Bartholomew’s work both dismissive and fearful are considered to derive from the avoidant strategy. An avoidant strategy is based on either a fear of rejection by the object or a dismissal of the value of the object. This distinction is impossible to make in infancy, but it is valid and important in adulthood—and also in particularizing the attitude of the psychopath.
3A mild electrical current is passed across the finger, and, depending on how much the subject is perspiring—a direct measure of autonomic activity—skin conductance varies.
4Mauritiuiss an island in the Indian Ocean off the coast of Africa. This cohort includes almost the entire population of that age in the two towns of Quatre Bornes and Vacaos born in 1969.
5Most child abductors, in fact, are family members, for example, estranged spouses.
6On occasion, forensic cases are tried in which psychopathy and cannibalism are both present, such as that of Jeffrey Dahmer, the Milwaukee man who ate body parts of his victims. This behavior may represent a very primitive psychotic attempt to master these early incorporative failures.
7It is difficult to advance a theoretical understanding of psychopathy if pathological narcissism is considered only a developmental fixation. Hence, Heinz Kohut and the self psychologists make virtually no reference to psychopathy in any of their writings.
8In other work (Gacono and Meloy, 1994) we have noted that psychopaths will produce a plethora of narcissistic mirroring as well as violent symbiosis responses to the Rorschach, a combination that suggests a developmentally young transference to others and a need to aggressively separate from others at the same time. This response combination may psychodynamically give us some clues to answer the paradoxical question, if psychopaths are so detached from others, why do they keep interacting with them in such destructive ways?
9Recent research, however, suggests that sexual sadists will role play being the victim, thus assuming a masochistic position, in autoerotic activities or with a consensual partner (Hazelwood and Warren, 2000). This finding suggests that there is an intrapsychic oscillation between the sadistic object as an introject and as an identification, a point conveyed by the very term sadomasochism in earlier psychoanalytic writings (Stekel, 1929).
10The State of California recently passed a law requiring psychological counseling as a condition of probation for those convicted of cruelty to animals.
11Recent research (Meloy, 1998) has found that most people who stalk are not psychopaths, a finding consistent with their chronic emotional detachment. Those who stalk form an intense, preoccupied attachment to their objects of pursuit and are quite obsessive and relentless.