The Psychopath Inside Read Free Page B

an individualized profile rather than a single numerical score or a categorical yes-or-no diagnosis. You can’t judge health or obesity on height and weight alone. Are you exercising? What are you eating and drinking? You can be overweight but in great shape. A doctor who knows you well would take all of that into account.
    It’s also difficult to summarize a collection of behaviors as one disorder. There’s a lot of overlap between conditions, such as histrionic, narcissistic, and antisocial personality disorders. And everyone is a little bit psychopathic and has a little bit of ADHD and so on. Psychiatry is moving away from categorical thinking—the latest diagnostic manual talks about “dimensions” to disorders—but it’s hard when doctors don’t want to learn new methods, insurance companies need to rely on specific diagnoses, and everyone likes closure and clearly defined labels. I see psychopathy like others see art; I can’t define it, but I know it when I see it.
    One question people often ask is if there is a difference between a sociopath and a psychopath. Barring the fact that manypsychologists deny the existence of either, in a clinical setting the difference is purely semantic. Robert Hare has pointed out that sociologists are more likely to focus on the environmental or socially modifiable facets of the disorder, so prefer the term
sociopathy
, whereas psychologists and psychiatrists prefer to include the genetic, cognitive, and emotional factors as well as the social factors when making a diagnosis, and therefore would opt for
psychopathy
. Since I am a brain scientist and am interested in the genetic and neurological causes of this personality disorder, I will use the term
psychopath
for the purposes of this book. And I will use it to describe people with some combination of those four facets of the Hare Checklist: interpersonal, affective, behavioral, and antisocial traits.
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    I have been interested in the brain ever since I saw the movie
Charly
when I was a junior in college in 1968. It is a story about an intellectually handicapped man who has the will to change his life and to learn how to learn. And learn he does, temporarily becoming a genius after undergoing a new neurosurgical procedure, the same procedure done to his alter ego, a laboratory mouse. This prescient film on the biological and chemical basis of behavior provided a clear career direction for me.
    Throughout my career, I have studied many facets of the brain. Whereas most researchers tend to specialize in a relatively narrow field of study, my interests have covered all manner of territory—from stem cells to sleep deprivation.
    I started studying psychopathy in the 1990s, when I was askedby my colleagues in the Department of Psychiatry and Human Behavior at the University of California, Irvine, to analyze PET scans of particularly violent murderers, including serial killers, who had just been convicted in court, and were subsequently starting the penalty phase of their trials. It is during this stage of the legal process that a murderer typically agrees to undergo a brain scan, often in the hope that a finding of brain damage will lead to a more lenient sentence.
    As I’ve already mentioned, we know very little about psychopathy, but without scanning technology, we’d probably know even less. It’s easy for a psychopath to feign caring and remorse when his brain tells a different story. This is the work I’d been doing that October day in 2005, when I discovered my odd brain scan indicating reduced activity in areas responsible for empathy and ethics.
    You might assume, given my closeness to the subject, that I’d be scared or worried or upset. But I wasn’t because I knew better. I was a happily married man with three kids whom I loved dearly. I had never been violent or manipulative or committed a dangerous crime. I wasn’t