I've lately been thinking about the "continuous vs categorical" debate in relation to psychopathy. I just started reading a book called Thinking about Psychopaths and Psychopathy edited by Harvard professor Ellsworth Lapham Fersch. It's a collection of questions and answers from seminars he's given on psychopathy, with contributions by various academics. Based on Fersch's introduction, it looks promising and insightful.
However, I wonder if Fersch really "gets it". While he talks about the importance of psychopathy quite eloquently and identifies the problems inherent in the conflation of psychopathy with antisocial personality disorder, there is a question and answer in the first chapter that is puzzling. (It is possible one of his colleagues answered this question, as the individual author is not listed for each section.)
In this question on the debate between psychopathy as either categorical (i.e. you either have it or you don't, like Turner's syndrome) or continuous (the extreme end of traits shared by everyone, as in someone with very high intelligence), he firmly takes the "continuous" side. However, I get the impression that he does so without understanding the crux of the matter, or the implications of such a position.
He concludes that psychopathy is continuous because the PCL-R gives results on a spectrum, a score of "0" being least psychopathic and "40" being most psychopathic. Because non-psychopathic people can score low on the checklist and thus technically possess some "psychopathic" traits, Fersch concludes that psychopaths only have extreme degrees of more or less "normal" human traits. In other words, people in general are only "more or less" psychopathic. While technically correct, this argument is fairly weak and susceptible to distortion.
First of all, the fact that the PCL-R measures a spectrum of traits does NOT necessarily imply that it is measuring a disorder which is itself a "spectrum". The fact that there is no definite "cut off point" on the scale does NOT imply that psychopathy is not categorical. It could just as well mean that we do not yet have the means of identifying an exact cut off point, or that there could be two distinct taxons (normal and psychopathic) that can overlap on the scale.
It is also possible - and even probable, based on the evidence - that psychopathy is both categorical and continuous. That is, a person is either a psychopath or not, and psychopaths show a spectrum of indicators of psychopathy. Theoretically, all psychopaths possess each trait tested by the PCL-R. However, a mid to low score on the scale could mean nothing more that some traits are not detectable in the subject's known personal history and interview. The scale tests for traits (the category) and its accuracy depends on the truthfulness of the data analyzed (the continuity). Some psychopaths are more "noticeable" than others.
A thought experiment will make this clearer. Imagine that scientists create a robotic human with artificial intelligence, which will then be tested using a variation on the Turing test, which we will call the "human" test. Questions are asked to the robot which test for a checklist of "human" traits. A normal human, responding to the test, will receive a score of 30 to 40, just as psychopaths score 30 to 40 on the PCL-R, while primitive forms of AI will receive a low score. Severely mentally ill people will similarly score in the low- to mid-range.
Let us say that our new robot scores 26. It would be fallacious to say that, because the test is continuous, that this implies that the robot is "more or less" human. All it shows is that it shares traits with a human, and in the robot's case, these traits may be mere programs - they are algorithms, not real experiences with syntactical content. They only give the appearance of humanity.
In reality, one is either human or not. A human will tend to score mid- to high-range on the scale, depending on various factors. A non-human will score low- to mid-range. In addition to this categorical difference (human or not), there is a spectrum of how "close" to human a non-human can test. Some robots will test 0 on the scale, while those with complex programming may score fairly high. However, this just shows the limits of the method of testing. Conclusions about the nature of the phenomenon cannot be discerned from measurements of a limited test.
So how do we account for seemingly psychopathic traits in non-psychopaths? I think this can be explained fairly easily. Lobaczewski accurately describes psychopathy as a deficit, NOT an excess. That is, psychopathy is a lack of certain essential "human" qualities, and this lack gives rise to the peculiarities of psychopathy. This lack is syntonic (social) emotions: those instinctive programs and reactions responsible for bonding and empathy. Because of this lack, psychopaths see people as objects and a parasitic/manipulative lifestyle develops that makes use of these objects.
Lacking "other-centered" emotions, psychopaths are wholly self-centered, and thus unable to feel guilt. This accounts for their "excess" which is seen in their grandiosity and inability to take responsibility. Now, normal humans also possess the self-centered qualities so apparent in a psychopath, but they are tempered by other-centered emotions, to varying degrees. When compared to a psychopath, however, the psychopath will strike us as excessively self-centered.
For example, a psychopath, when confronted with the fact that he has committed a crime, will seemingly take any measure to avoid responsibility. He will deny he did it, perhaps even coming to believe his own lie. If this does not convince others, he may say he had a really good reason for doing it, saying that the victim had it coming.
Similarly, a non-psychopathic delinquent may show similar evasive techniques when confronted with his antisocial behavior. He will justify it and avoid responsibility. However, the rigidity of youthful maladjustment is not the same as psychopathic maladjustment. A youth may eventually develop a hierarchy of values after he is able to see that what he has done has caused another's pain. He may develop empathy, responsibility, the ability to see himself from a perspective outside himself, and to put himself "in another's shoes". A psychopath, on the other hand, lacks these potentials entirely.
The deficit is what categorically makes a psychopath a psychopath - the cause which gives rise to their psychopathic traits, which normal humans can and do share, to varying degrees. Dabrowski, a contemporary of Lobaczewski, and his concept of multilevelness of emotional functions, provides the necessary context here. Normal humanity DOES exist on a spectrum. Many exist with a low level of emotional development, that is, they are to a great degree self-centered, selfish, and live their lives primarily in the service of automatic and unconscious instincts such as self-preservation (the avoidance of harm). Dabrowski called this primary integration, the first level of his multi-leveled system of emotional development.
Thus, "normal" people can be extremely self-centered and even possess many psychopathic traits. As such, they too can have very poorly developed "other-centered" emotions, the difference being that while psychopaths lack the ability to experience these emotions, normal people on a low level have the potential to develop them. It is also possible that, as a result of physical and/or emotional trauma, normal humans at a low level of development may acquire what is called a characteropathy, or personality disorder, that leaves their personality rigid, altering their emotions and behavior - integrated at a low level. Just as a plant cannot grow without a seed, it will not grow if an essential portion of it is damaged beyond repair. Using this analogy, "bad seeds" are so either by their nature, or the influence of the environment.
Another group of humanity may "learn" psychopathic behavior, either as a result of the hypnotic "spellbinding" used by psychopaths, or their own admiration for the psychopath's allure, charm, self-certainty, decisiveness, and even ruthlessness. People with an underdeveloped hierarchy of values may find such traits admirable and may strive to embody them. Again, this does not make them psychopaths.
It is possible that these people may even achieve the same score on the PCL-R as a real psychopath, but those who take Fersch's stance don't seem to see this possibility: that the PCL-R is very effective, but it is not a perfect test for the presence of psychopathy. Again, the fact that the scale is continuous does NOT imply that the disorder is continuous.
That said, it seems that other factors may be responsible for the continuity within psychopathy. For example, socioeconomic status may play some role in determining the form psychopath takes in adulthood, perhaps accounting for the divide between violent criminal psychopathy and so-called "corporate psychopathy". Also, the size of the hippocampus seems to have some influence on this difference between the obvious criminal types and the sub-clinical types who go unrecognized.
Successful psychopaths are perhaps just better at masking their traits, so that an interview and personal history would not necessarily reveal these traits. In such cases, only an omniscient vantage point would ensure an accurate diagnosis. As such, a mid-range PCL-R score does not necessarily mean that a person is not psychopathic. It could simply be the result of insufficient or inaccurate data. "Garbage in, garbage out", as they say in computer science.
So it is important to make a distinction between the continuous nature of the PCL-R as an instrument of measurement, and the nature of psychopathy as a categorical disorder, or taxon. To ignore this distinction is dangerous. As Lobaczewski related from his experience in Poland, pathocratic authorities muddy the waters of psychopathy research so as to evade detection. As he says, "the problem of preventing such a psychiatric threat [i.e., a well-founded scientific understanding of psychopathy] becomes a matter of 'to be or not to be' for pathocracy. Any possibility of such a situation emerging must thus be staved off prophylactically and skillfully, both within and without the empire. At the same time, the empire is able to find effective preventive measures thanks to its consciousness of being different as well as that specific psychological knowledge of psychopaths... partially reinforced by academic knowledge. ... [A] purposeful and conscious system of control, terror, and diversion is thus set to work." (Political Ponerology, pp. 182-183)
The way in which this protection is achieved is in part by the creation of a "catchall" phrase for criminal deviance. "The essence of psychopathy may not, of course, be researched or elucidated. Darkness is cast upon this matter by means of an intentionally devised definition of psychopathy which includes various kinds of character disorders, together with those caused by completely different and known causes... One might admire how [these] definitions of psychopathy effectively block the ability to comprehend phenomena [within a pathocratic system]." (ibid, p. 186)
We have seen this phenomenon in American psychiatry where the official DSM-IV only recognizes "antisocial personality disorder", a catchall label that can apply to a wide range of disorders. Psychopathy is not included in the DSM-IV, and is thus not officially recognized as a valid personality disorder by the Manual.
Such muddying of the waters provides "cover" for psychopaths who do not fit the criminal diagnosis of "antisocial personality disorder". This might have been enough in pathocracies such as in the Soviet empire. However, the concept of psychopathy, thanks to researchers like Cleckley and Hare, seems too well established in the scientific literature to be so easily embargoed. Thus, a new tactic was needed. Viewing psychopathy as simply an "extreme" form of normality robs us of any real understanding of the disorder. It "levels the playing field", so to speak, creating an environment where there is no real distinction between psychopathy and normality.
The entire makeup of a psychopath is qualitatively different from a normal human: their thinking, their worldview, their behavior. It is this "otherness" that is responsible for their dreams of Empire and world domination. This world is seen as harsh and oppressive to them - a world of arbitrary and restrictive social conventions and rules. The only solution to this problem, in their eyes, is a world in which THEY rule. In which they are free to act as they see fit, and force everyone else to accept such an Orwellian nightmare. By bracketing the true nature of psychopathy from our awareness, we give up any hope of identifying the root cause of this social disease which threatens to choke humanity's life in the very near future.
