Seen as monsters or as evil geniuses, they populate our imagination and our fictions. Tony Montana, Hannibal Lecter, Dexter Morgan… These characters are described as psychopaths, killers as fascinating as they are terrifying. However, are all psychopaths dangerous criminals capable of sadistic murder? Nothing is less certain, because that would amount to denying the complexity of this personality disorder.
During his public hearing “Treating Psychopathy” at the High Authority for Health (HAS) in 2005, psychology professor Serge Lesourd said: “I will only use the term ‘psychopathies’ in the plural, because reading the literature as well as my clinical practice suggests that, under this term, several psychopathological forms are concealed.” Psychopathy nevertheless conceals a reality that must be defined. First of all, a hollow definition, it is not a mental or psychiatric illness but a personality disorder.
This difference is not neutral. Personality defines the stable part and the enduring characteristics in the psyche of an individual. It determines the way in which this individual interacts with the world around him and with other people, but also the way in which he himself perceives his own emotions, his own cognitions. When someone has a personality that we will call problematic or pathological, he shows a certain rigidity, is unable to adapt and is likely to commit morally and/or socially inappropriate acts.
This is the reason why the HAS recommends to use the expression “personality organization with psychopathic expression” which refers to the culmination of a complex and multifactorial psycho-behavioral process (social, affective, psychological, genetic, nervous and hormonal functions seem to be intertwined in its causes). Suffice to say that making the term “psychopath” a synonym for “mentally ill” is absolutely wrong. As there are different definitions, it is difficult to determine the prevalence of this disorder in the general population, but it is estimated at 1% of population.
Conjunction of Troubles
It now remains to understand what this “personality organization with psychopathic expression” return. Margaux Guillotte, psychiatrist, explains: “Psychopathy is a concept that has evolved a lot. In the DSM-5 [manuel diagnostique et statistique des troubles mentaux de l’association américaine de psychiatrie, ndlr], psychopathy is related to antisocial personality disorder while there are differences. In the CIM 10 [classification internationale des maladies, ndlr], psychopathy is associated with dyssocial personality disorder and emotionally labile borderline personality criteria.
There would thus be the conjunction of two troubles. On the one hand, dyssocial personality disorder is manifested in particular by a cold indifference towards the feelings of others, a tendency to have a persistently irresponsible attitude, a disregard for rules and social constraints, an inability to maintain relationships interpersonal skills, a very low tolerance for frustration, a lowered threshold for the discharge of aggression or even violence, an inability to feel guilt or to learn from sanctions, and a tendency to blame others or provide plausible explanations for a behavior.
And, on the other hand, traits related to emotionally labile personality, such as impulsiveness, mood instability, poor coping skills, and explosive and impulsive behaviors.
Margaux Guillotte notes the main traits that distinguish the psychopathic person from the one with an antisocial personality disorder: “A part of pathology of attachment – often linked to a history of affective deficiencies – at the origin of an affective detachment which will cause a deficit of empathy, and a part of pathological narcissism, with a need to triumph over others, seeing no need to change and feeling no remorse.”
The narcissistic personality
This position, which is that of the HAS and which makes it possible to subtly evoke psychopathy, is not entirely shared by Prof. Thierry H. Pham, doctor in psychology from the Catholic University of Louvain. For him, psychopathy is the combination of an antisocial or dyssocial personality disorder and a narcissistic personality disorder. “The narcissistic personality is characterized by a number of traits. A good self-image, arrogance, a feeling of superiority, a lack of empathy, emotional coldness, indifference to others, a pathological propensity to lie, a tendency to exploit others in interpersonal relationships.
The specialist explains how to use the Hare scale (or PCL-R) which is a twenty-question questionnaire aimed at determining whether an individual has traits of a psychopathic personality and the results of which are of course to be studied with the background of the person and the assessment carried out in the interview.
These two means of apprehending psychopathy nevertheless make it possible to identify quite similar behaviors. Behaviors, because, unlike people who suffer from a psychiatric illness, psychopaths suffer little from their personality and do not seek help on their own. “They most often access care when they are obliged to, especially when their criminal acts are brought to justice, when they arrive in prison for example”notes Dr. Guillotte.
“A side of manipulation”
Does this mean that all psychopaths end up one day or another having to deal with justice? This is not obvious. “We cannot make a causal link between the organization of the personality with psychopathic expression and delinquency. There are psychopathic people who can commit acts of delinquency, but not all acts of delinquency are of psychopathic origin., insists Dr. Guillotte. She notes, however, that “Psychopathic people who commit reprehensible acts are distinguished from other so-called antisocial criminals by a greater ability to control themselves, to better adapt to social codes in order to integrate into the environments that interest them. They build a “healthy” public image while their personality is quite unstructured.
Thus, the famous serial killers are extremely obsessive psychopaths, able to carry out their dark design for years by giving an appearance “healthy” in society, as the famous Ted Bundy.
Ted Bundy, during his trial in 1979. | Donn Dughi / State Archives of Florida, Florida Memory via Wikimedia
Still, these serial killers are in a way the tip of the iceberg of psychopathy. Indeed, psychopathy is not synonymous with violent acts and bloody murders. Doctor Pham explains that there are “different profiles of psychopaths. Those we talk about the most are those that tick all the boxes: manipulation, indifference to others, social parasitism, criminal action. These people sometimes commit acting out with a violent connotation, but it can also be less violent acting out such as fraud, trafficking…”
For Doctor Guillotte, “many psychopaths will never be authors of violent acts and will rather be on the side of manipulation to achieve their ends, manipulation of others for their own interests, in defiance of social norms, to enrich or take pleasure”.
This is how we enter the category of white-collar psychopaths which remains relatively unknown: “They are intelligent people, explains the psychiatrist. With an extremely sharp mind, capable of having a brilliant career, of occupying a position of responsibility. They are part of a system that can cause harm to others, with psychological damage such as harassment, or damage to property such as tax evasion.
Some will get caught, others won’t – and if they have to deal with a judge, it will be, for example, simply, for a divorce… Some may come across as haughty, contemptuous, hurtful people when others give the change that they could have, seen from the outside, a more or less ordinary existence, while breaking moral or social rules here and there.
Thierry H. Pham concludes however: “These are lives oriented towards prestige, the desire to be superior to others… Just as many signs which reflect an overestimation of oneself and an adequate lifestyle with narcissism. It can last a long time, the person is powerful, he exercises control over those around him, is influential. But there is a flashback at one point: the victims begin to file a complaint and this opens the way to other denunciations.
The challenge of care
However, psychopathic people are not necessarily lost causes for society. Like all personality disorders, psychopathy begins to be diagnosed in early adulthood, but there may be warning signs during childhood and adolescence. “It would be necessary to be able to detect the organization of the personality with psychopathic expression in adolescence, where conduct disordersthe most characteristic being undoubtedly the cruelty towards animals”, explains Dr. Guillotte. But these teenagers are not necessarily taken care of, in particular because they often have dysfunctional families.
Then, when psychopathic people are encouraged to care, it is possible to set up care even if it is not simple. First, because there is no medicine like for psychiatric illnesses, then because the therapeutic alliance is extremely difficult to establish.
For Dr Guillotte, “it is possible to set up a psychotherapy which will always be long and difficult to initiate, because it is a question of taming oneself. Analytical-inspired psychotherapy is of interest in the management of personality disorders. It makes it possible to work on old traumas that may have prompted the patient to cut himself off from his affects. Starting from their suffering can be a way of bringing out a need. When people agree, we can work on relearning certain skills such as empathy”. In addition, specialists agree on the fact that psychopathic behavior tends to subside after 40 years.