Treatment of Psychopathy
© Rhonda Freeman, PhD | All Rights Reserved
To date, the treatment of psychopathy has been challenging. There have been very few research studies and dollars put toward modifying this condition in comparison to other psychiatric disorders. Psychopaths represent a small portion of our population, however their behaviors can impact millions. Perhaps even billions if they are a politician.
Although we know something must be done to help them (and us), the mental health treatment of psychopathy has not been successful. There have been a few studies on the topic and so we have learned a few things … such as what not to do. We’ve learned that traditional psychotherapy is usually not productive or helpful for a person with psychopathy. However, there is some indication that specific behaviors can be changed. Of course those behavior changes would require their effort and interest, for those changes to take place. They will revert right back to baseline, since the condition is not being modified.
From a neurobiological standpoint (in my opinion), emotions cannot be developed within an adult if they do not have the emotional capacity available to generate and feel those emotions.
Medications might help address some of the emotion dysregulation that many with psychopathy demonstrate. However, we do not have a medication for the coldness and lack of caring. And this is such an obstacle in their relationships – the coldness. Unfortunately, there is no pill (to date) for callousness, arrogance, antagonism, low empathy, and immorality .
As you can see, our current medication and non-medication interventions do not reduce the core symptoms of psychopathy. Research indicates that this disorder far exceeds antisocial behavior alone, but rather is associated with significant emotional processing problems.
Psychopaths do not process emotional information and social experiences in the same manner as a non-psychopathic individual does. For example, they use people, rather than connect with them and often view interactions or situations in basic, binary terms:
winners versus losers smart versus dumb powerful versus weak.
We do not have a treatment that can generate emotional states such as empathy, bonding, or caring. Hence, when partners expect a change from a psychopathic partner through the process of love or pointing out his/her hurtful behaviors, the outcome is never change. The outcome is usually a ramping up of the abuse.
It is extremely difficult to modify brain functions when there are neurobiological limitations of this complexity (e.g., inability to process empathy, lack of bonding, incapable of remorse).
This is a high risk population with the requirement of intense treatments with a specialist to even bring about minor behavior changes (Skeem, Monahan, & Mulvey, 2002). Specific behavioral changes do not necessarily require alterations in emotional processing. Skeem and colleagues (2002) studied a group of violent psychopaths and concluded that these individuals actually benefited from frequent and consistent therapeutic interventions.
“…our findings that psychopathic patients tend to become less violent after receiving adequate doses of treatment suggests that psychopathic patients might be appropriately reconceptualized as high risk cases in need of intensive services.” (Skeem et al., 2002, p. 599).
Hmmm, I would never take that kind of risk and maintain exposure to a violent psychopath simply because he was undergoing intense therapy.
What will happen to the public if we continue without effective treatments?
If we continue without effective treatments for psychopathy, this could place the public, particularly unknowing, trusting romantic partners, at great risk. Without treatment there are no global tools to protect our society (even to a small degree) from the impact of psychopathic behavior, thought styles and influence. This presents a problem, because that means there will be more innocent victims who will wind up requiring legal and/or mental health assistance to deal with victimization.
Chronic infidelity, neglect, intimate partner violence, random & mass shootings, child abuse, corporate crimes, mass murders, child abductions, serial killings, pedophilia, rape, verbal aggression & intimidation are often committed by those with strong psychopathic traits.
Unfortunately, we are at risk with psychopaths in the community. As Dr. Hare stated, this condition “spells trouble” for the rest of us. There is not much the public can do until the crime has been committed or the loss suffered. Although we may not be successful at protecting ourselves from the random criminal acts or influence of individuals with psychopathic traits (e.g., mass shooter, corporate criminal, politician), psychopathy education can help increase awareness that individuals who lack key components of humanity are within our community. Perhaps for some, such awareness and education will limit or prevent intimate involvement with an individual with psychopathy.
Will they accept treatment? Not likely
“There’s Nothing Wrong with Me!”
As you probably already know, many people with psychopathy are disinterested in treatment. And even the suggestion that something is wrong with them can ignite rage and place others at risk. Most tend to be arrogant and consider their personality status a reflection of superiority, not dysfunction. It is not uncommon that they view those who are ’emotional’ or have capacity for a full range of emotions, as weak in comparison to them.
There are several researchers working on creating treatment interventions. This would benefit us all, as there would be a chance of making our society a little safer.
Rhonda Freeman, PhD
© 2013 NeuroInstincts | All Rights Reserved
Skeem, J., Monahan, J., & Mulvey, E. (2002). Psychopathy, Treatment Involvement, and Subsequent Violence Among Civil Psychiatric Patients. Law and Human Behavior, Vol. 26, No. 6, 577 – 603.