Como funcionam os psicopatas

Saddam Hussein. Henry VIII. Adolfo Hitler. Apenas a menção desses nomes lembra os atos violentos e intimidações que definiram o que alguns poderiam chamar de seus reinados psicopáticos. Mas e se lhe disséssemos que os estudiosos também atribuíram qualidades psicopáticas a Teddy Roosevelt, Winston Churchill e John F. Kennedy? [fonte: Dutton ] Não, esses líderes frequentemente venerados não eram ditadores assassinos. Mas o fato de que eles compartilham algumas das mesmas qualidades que seus desprezíveis colegas nos diz que a personalidade psicopática, ou psicopatia , é amplamente mal compreendida pelo público em geral.

A psicopatia é um transtorno do espectro , o que significa que as pessoas podem exibir algumas qualidades psicopáticas sem realmente serem um psicopata completo. Somente aqueles que atingem um certo limiar de tais qualidades são considerados psicopatas. Indivíduos com casos extremos tendem a apresentar um conjunto muito específico de características, ou seja, falta de consciência ou empatia. Mas essas tendências hediondas muitas vezes passam despercebidas porque as mesmas pessoas também podem ser muito charmosas. É essa estranha combinação de traços que torna os psicopatas difíceis de identificar e às vezes – mas nem sempre – incrivelmente perigosos [fonte: Psychology Today ].

Surpreendentemente comum, a psicopatia atravessa fronteiras históricas e culturais. A primeira pessoa a descrever tais indivíduos foi Teofrasto, aluno de Aristóteles, um filósofo do século IV a.C. que os rotulou de "os inescrupulosos". A literatura fornece evidências adicionais para seu papel passado na existência humana. Da mitologia grega e romana e épicos chineses a histórias bíblicas e Shakespeare, personagens frios e insensíveis como Medeia, Caim e Ricardo III podem ser praticamente diagnosticados através das páginas de um livro. Sociedades pré-industriais, como os iorubás do sudoeste da Nigéria, até têm sua própria palavra para psicopatas: "aranakan". Eles descrevem um aranakan como "uma pessoa que sempre segue seu próprio caminho, independentemente dos outros, que não coopera, cheio de malícia e teimoso" [fonte:

Hoje, os cientistas estimam que os psicopatas representam até 1% da população geral [fonte: Choi ]. Isso significa que pode haver mais de 3 milhões apenas nos Estados Unidos e chocantes 70 milhões em todo o mundo. Então, por que a sociedade global não desceu para uma paisagem infernal do "Senhor das Moscas " ? Como se vê, a psicopatia é um distúrbio desconcertantemente complexo – o que o torna tão interessante.

1. Nomeando psicopatas
2. Demografia de psicopatas
3. Características do psicopata
4. Causas da psicopatia
5. Diagnóstico e tratamento da psicopatia

O médico francês do século XVIII Phillipe Pinel foi um dos primeiros profissionais médicos a descrever a psicopatia, uma condição que ele chamou de maniaque sans delire , ou "insanidade sem delírio". Outros médicos do século 19 também reconheceram a aflição, descrevendo-a como "loucura racional", "perturbação moral" ou "insanidade moral". Então, em 1888, o psiquiatra alemão JLA Koch lançou um termo próprio: psicopastiche, uma palavra alemã que significa "alma que sofre" - e a palavra "psicopatia" nasceu. Ganhou algum uso clínico no início de 1900, antes que a palavra "sociopatia" a suplantasse na década de 1930, aparentemente para evitar confusão com outra condição, a psicose. A sociopatia também sugeriu a influência de fatores sociais e ambientais na causa do transtorno, que era uma opinião popular na época.

A terminologia atual surgiu em 1980, quando o Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM), que estabelece a terminologia padrão para a profissão psiquiátrica, derrubou o termo sociopatia em favor da condição mais ampla "transtorno de personalidade antissocial" (ASPD). Hoje, os descritores "psicopata" e " sociopata " ainda são comuns e muitas vezes usados ​​de forma intercambiável porque denotam os mesmos traços de personalidade.

Mas há uma diferença, e está na causa: os psicopatas apresentam tendências insensíveis e sem emoção por causa de anormalidades físicas no cérebro, enquanto os sociopatas mostram essas mesmas qualidades como resultado de influências sociais. Da mesma forma, os termos "psicopata primário" e "psicopata secundário" denotam essa mesma divisão física/ambiental. Então, quando os psiquiatras dizem “sociopata” ou “psicopata secundário”, eles estão se referindo essencialmente à mesma coisa [fonte: Hirstein ].

Apesar da publicação de duas novas edições do DSM desde 1980, a psicopatia ainda é relegada à categoria mais ampla de ASPD. É um ponto sensível para muitos especialistas em psicopatia que são rápidos em apontar que as duas condições não são as mesmas e, de fato, apenas 1 em cada 5 pessoas com ASPD são psicopatas [fonte: Kiehl e Buckholtz ].

Psicopata em destaque

Ted Bundy foi um serial killer americano ligado a 36 assassinatos, embora algumas estimativas cheguem a 100 ou mais. Ele normalmente atraía suas vítimas para seu carro, as deixava inconscientes, depois as estuprava e estrangulava. Seu reinado de terror durou de 1973 a 1978, quando ele finalmente foi pego e condenado a três sentenças de morte. Bundy foi executado em 24 de janeiro de 1989 [fonte: Truesdell ].

Now that we've established the history and vocabulary of psychopathy, let's dig a little deeper into the characteristics of the disorder.

A good place to start is with demographics. Do age, race or gender play a role in psychopathy? The answer is a little tricky because psychopaths, by their very nature, aren't likely to admit to having a problem. Without any self-reporting, researchers instead have to rely on survey data gathered largely from criminals who are compelled to undergo psychiatric examination. Conclusions based on such data are often uncertain at best or controversial at worst.

Studies related to age and race are particularly cloudy. One analysis on age, for example, showed that some psychopathic traits appear to decline as patients get older, though it's unclear why [source: Harpur and Hare]. Researchers also disagree about whether children can be considered psychopaths at all. While some studies suggest that infants and toddlers can express traits associated with psychopathy, children can't technically be diagnosed with the disorder, and such traits don't guarantee they'll become psychopaths as adults [sources: Harrold, McLain, Ossola].

More contentious are studies relating psychopathy to race. Such analyses — particularly those that have tried to link high rates of the disorder to African-American and Native-American communities — have been heavily criticized in the psychiatric community as racist and dismissive of socioeconomic factors [sources: Lynn, Zuckerman].

Gender, on the other hand, appears to have a pretty clear influence on psychopathic traits. Women consistently score lower on psychopathic evaluations, a finding that holds up even among violent criminals. One study of a prison population, for example, pinned the occurrence of psychopathy at 11 percent for women versus 31 percent for men [source: Wynne et al.]. Still, some researchers dispute this claim, suggesting instead that women simply express psychopathic traits in a way that overlaps with other conditions, like borderline personality disorder (BPD). According to this theory, women typically diagnosed with BPD — particularly those who swing between extreme emotional responses and callous, manipulative behavior — may just have a female version of psychopathy [sources: Johnston and Sprague et al.].

Psychopaths in Hollywood

Psychopaths make compelling movie characters given the callousness of their crimes, and some are depicted quite accurately. According to a paper published in the Journal of Forensic Sciences, one of the best representations of a psychopath was Anton Chigurh in "No Country for Old Men" [source: Leistedt and Linkowski].

While the demographics of psychopathy may be little murky, the behaviors are pretty well established. The Hare Psychopathy Checklist, the most widely used diagnostic tool for the disorder, lists 20 characteristics: glibness and superficiality, grandiosity, need for stimulation, pathological lying , cunning and manipulativeness, lack of remorse or guilt, emotional shallowness, callousness and lack of empathy, parasitic lifestyle, poor behavioral controls, sexual promiscuity, early behavior problems, lack of realistic long-term goals, impulsivity, irresponsibility, failure to accept responsibility, multiple marriages , juvenile delinquency, revocation of conditional release (like parole violations), and committing a variety of crimes [source: Kiehl and Hoffman].

While someone afflicted with these horrifying traits might seem easy to pick out, psychopaths are actually quite good at hiding them. Still, there are some giveaways. Part of what makes them so hard to pin down is their charm. They're great conversationalists and are generally quite likeable. But things can turn dark when their lack of conscience and empathy shows through; psychopaths will often do harmful things to others and refuse to accept responsibility. Instead, they'll blame others and continue do whatever it takes to achieve their objective. Another giveaway is their ability to use people's emotions against them, using guilt trips, flattery and sympathy to get what they want. As if all that isn't bad enough, psychopaths don't think rules apply to them. They think they can get away with anything because they're smarter and more important than anyone else [source: Morin].

Right now you may be thinking, "Wait, I know someone like that ." And you might be right. Psychopaths aren't all serial killers or even criminals. Sure, they're overrepresented in the prison populations, making up some 25 percent of that group even though they're only 1 percent of the general population [source: Wynn et al.]. But with 3 million in the United States, there are plenty of psychopaths functioning as productive members of society. Some researchers even suggest that psychopathic traits help people succeed in some professions, like politics and finance. One study of the financial services industry, for example, suggests the profession's rate of psychopathy could be as high as 10 percent! That's not surprising, though, when you consider how characteristics like superficial charm, the ability to handle high-pressure situations, the desire for power and a willingness to take risks might be beneficial in these professions. It's no wonder Churchill and Kennedy might've had a touch of the disorder [sources: Silver, "Wall Street"; Silver, "Politicians"].

If you think you know a psychopath, resist the temptation to engage with his manipulations; that's what he wants you to do. Instead, accept that psychopaths are just damaged people whose actions are more meaningful than their words. They'll throw you under the bus if they need to, so guard your reputation, and if you have to, propose strategies in which you both win. In the end, though, it's best just to say away [source: Barker].

Psychotic vs. Psychopathic

"Psychotic" and "psychopathic" are commonly confused terms that mean different things. Psychotic is a general term that refers to people who lose touch with reality. Psychopathic, on the other hand, refers to people who may lack conscience or empathy but are very much in touch with reality. So a serial killer who is psychotic might kill because the voices in his head told him to do it, while a psychopath might kill simply because — while he knows it's wrong — he just doesn't have the conscience to care [source: Bushack].

One of the biggest challenges in studying psychological disorders is that they often result from a complex mix of physical and social factors, and psychopathy is no exception. An analysis of identical twins in Minnesota suggests that the disorder is at least 60 percent determined by genetics, though other sources peg the number closer to 50 percent [sources: Brogaard, Kiehl and Buckholtz]. Either way, it's clear that both factors play an important role.

Identifying social factors has proven to be a difficult task for researchers. Studies have shown that absent fathers and physical neglect in childhood are strongly associated with psychopathic characteristics in adults, but there's no proof that these factors actually cause the disorder. In fact, many of the United States' most notorious psychopathic serial killers — including Ted Bundy and Dennis Rader — grew up in healthy, supportive households. The challenge of positively identifying social factors is that it's difficult to isolate them from physical ones. For example, a psychopath may have been neglected by his father, but it's hard to tell whether the neglect caused his disorder or was an indicator that his father was also a psychopath [sources: Wallisch, Brogaard].

Clearly, social factors can only explain so much. So what's actually going on in the physical structure of a psychopath's brain ? Like many questions about the brain, the answer is complicated. Scientists first suspected damage to the frontal lobe, which among other things processes risk, reward and punishment [sources: Kiehl and Buckholtz, Brogaard].

More recent research, however, has shifted to the brain region known as the paralimbic system. These new findings came about thanks to a technology called functional magnetic resonance imaging, or fMRI , which allows researchers to see to what extent different parts of the brain are being used. As it turns out, psychopathic brains show significantly less activity in the paralimbic system than normal brains, which means it's underdeveloped. So why is this important? The paralimbic region controls moral reasoning, emotional memories and inhibition — in other words, exactly the kinds of characteristics lacking in psychopathic behavior [source: Kiehl and Buckholtz].

Psychopath Spotlight

John Wayne Gacy is among the most reviled serial killers of all time. Like many psychopaths, he was well-liked in his community. At first glance he seemed like a model citizen, participating in many civic organizations and even playing the role of "Pogo the Clown" at children's birthday parties. After a string of sexual assault allegations, however, police found evidence linking the once-respected Gacy to a string of 33 murders (and yes, he committed some of these while dressed as "Pogo"). He was eventually sentenced to 12 death sentences and 21 natural-life sentences, and he died by lethal injection on May 10, 1994 [source: Biography.com].

Psychopathy is incurable. No one knows how to repair the damaged areas of the brain largely responsible for the disorder. But thanks to advancements in diagnosis and treatment, there may be hope for some improvement, particularly if the condition is detected early in life.

The big breakthrough in diagnosis came in 1980, when psychologist Robert Hare developed the Psychopathy Checklist (PCL), a list of 20 traits he attributed to psychopathy. This is how it works: Psychologists ask patients a series of questions to determine whether they possess the traits. If the trait is present, they get two points, and if it's not, they get zero. If the psychologist isn't sure, they get 1 point. The max score is 40, but anything over 30 means the patient is a psychopath.

The test, which was revised in 2003 and is now known as the PCL-R, works surprisingly well. One study showed that while 80 percent of high-scoring criminals reoffended within four or five years, the percentage dropped to 20 or 25 percent among low-scoring criminals. That success, however, has a potential downside: The PCL-R is now used in the parole process to predict whether a criminal will reoffend, keeping otherwise well-behaved criminals in prison indefinitely. It's a use bemoaned by many mental health professionals, including Hare himself [source: Spiegel].

Once someone is diagnosed with psychopathy, treatment options are limited, but not non-existent. In the past, traditional methods like group therapy not only haven't worked, but they've made the problem worse. Surgery, electroshock and drugs were hardly better, producing wildly mixed results. Recent experiments, however, have shown some success, particularly among children.

One promising method, known as decompression treatment, is based on the notion that psychopaths respond better to rewards for good behavior than punishment for bad behavior. In this technique, which involves daily, hours-long sessions of close supervision, psychologists gradually increase rewards for good behavior in an effort to speak to the psychopath's desire to win — and it seems to work. One study of incarcerated boys showed that after two years, only 52 percent of those receiving decompression treatment reoffended compared to 73 percent who received traditional group therapy [source: Kiehl and Hoffman].

Still, there are limitations to treatment. Because the greatest successes seem to come from treating younger patients, older psychopaths are left with few options. And even if there were more options, it's unclear how you would get psychopaths outside the prison system to seek treatment. In their minds, they don't need help; their personality actually makes them better than everyone else.

Reducing the Cost of Psychopathy

Given their propensity to commit crimes, psychopaths exact a tremendous social and financial cost on society — perhaps as much as $460 billion a year. But new treatment methods could lessen these costs in a big way. According to one estimate, techniques like decompression treatment could prevent enough psychopaths from reoffending to provide taxpayers with $115 billion in annual savings [source: Kiehl and Hoffman].

Author's Note: How Psychopaths Work

Psychopaths can be terrifying. That's why people use the term (often incorrectly, I should note) to refer to anyone who is acting really crazy. So it was particularly revealing when, in the course of writing this article, I realized that psychopathy is caused by a structural problem in the body. In that sense, it's just like any other disorder. To make this point, one article suggested that asking someone with psychopathy to show empathy is like asking someone with color blindness to see color. It's just not happening. And it's not like they chose to be that way. So should we ignore the lies, manipulation and murder that is often associated with psychopathy? Certainly not. But this fact will make us all a little more supportive of research into treatment of this horrific condition.

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