Guilt in Psychopaths: When Morality meets Medicine

Yussef Al Tamimi, 30 March 2012

Psychopaths are responsible for a disproportionate amount of crime in our society. The aim of this paper is to give an overview of the literature and research that surrounds one of the reasons for crime among psychopaths: the lack of guilt. In what way do psychopaths experience guilt differently from non-psychopaths? Current issues concerning the clinical construct of psychopathy, as well as the concept of guilt within psychiatry, are discussed. Research findings tell us that psychopaths, just like non-psychopaths, do know when they are wrong, but the crucial difference is that the psychopath has a personality and neuropsychology that does not tolerate nor process a feeling of guilt. As a result, the psychopath externalizes the guilt by blaming someone or something else. The implications of this conclusion for our criminal justice system are discussed.

1. Introduction

Psychopaths are perhaps the single most interesting group of disordered individuals to look at from a criminological and forensic point of view. Although the prevalence of psychopaths in the general population is estimated at about 1%, estimates of the adult psychopathic prison population range from 11% to 25% (Hare, 1998; Simourd & Hoge, 2000). A 2009 study among British prisoners found a prevalence of 7.7% in men and 1.9% in women (Coid et al.). Even though these percentages vary quite a bit, it is clear that psychopaths are responsible for a disproportionate amount of crime in our community. Other studies have shown that psychopathic offenders commit more types of crimes, as well as more crimes of any type, than non-psychopathic offenders (Hare, Forth & McPherson, 1988); this is especially true for violent crimes (Kosson, Smith & Newman, 1990). Next to that, psychopathic offenders are far more likely to recidivate when released from prison (Blair, Mitchell & Blair, 2005). As much as 80% of psychopathic inmates will be convicted of an offense within five years of their release, compared to less than half of other inmates. Psychopaths also use substances at high rates; several studies have found elevated rates of alcohol and drug abuse among psychopathic offenders (Hemphill, Hart & Hare, 1994; Smith & Newman, 1990).

Yet, despite all these data, psychopaths seem to be in control of their actions, to do just what they want to do. They seem to be sane and they act rationally. Then why are psychopaths so often the ones responsible for committing crimes? What makes them more susceptible to the criminal circuit than other members of the community?

The aim of this paper is to lay down a brief overview of the literature and the research that surrounds one of the reasons for the dis-proportionate amount of crime among psychopaths, namely the lack of guilt. After dis-cussing old and present concepts of psychopathy and guilt, and exploring the scientific research concerning this topic, I will give an answer to the main research question of this study: In what way do psychopaths experience guilt differently from non-psychopaths?

2. What is psychopathy?

Among laypersons, psychopaths are generally known as people who have no feelings, no sense of morality or no conscience. In academia, though there is not one universal definition of psy-chopathy, most definitions do agree that psychopaths suffer of affective and behavioral abnormalities that distinguish them from the general population; they have a mental disorder that is characterized by a disregard for the rights of others and the rules of society.

The American psychiatrist Hervey Cleckley (1941) was one of the first to clearly outline the behavioral characteristics of psychopaths. He proposed 16 characteristics, derived from his work with psychiatric patients in a locked institution. According to Cleckley, psychopaths are characterized by traits such as manipulativeness, superficial charm, lack of guilt, irresponsibility, egocentricity, impulsiveness and arrogance. Over time, modern clinical descriptions have consistently followed Cleckley’s description (Hart & Hare, 1997).

ASPD versus psychopathy

The American Psychiatric Association (APA) has never listed psychopathy as an official term for a personality disorder in the Diagnostic Statistical Manual of Mental Disorders (DSM). According to the APA, psychopathy is currently most strongly correlated with DSM-IV-TR (APA, 2000) antisocial personality disorder (ASPD).

There is some significant overlap in the characteristic traits of ASPD and psychopathy. The origins of ASPD can be traced back to Pritchard’s concept of ‘moral insanity’ (1837; cited by Maughs, 1941 and Blackburn, 1988). Pritchard attempted to explain the inability to conduct oneself “with decency and propriety in the business of life” by referencing to the perversion of the moral faculty: moral insanity was the cause of socially objectionable behavior. Nowadays the label ‘ASPD’ is used by the DSM-IV-TR to define the person who has a “pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years”, as indicated by three or more specific criteria, including deceitfulness, consistent irresponsibility, impulsivity and a lack of remorse.

Although this description in DSM-IV-TR has a lot in common with psychopathy, various observers have questioned whether the ASPD-diagnosis is sufficient in identifying psychopaths. The DSM-diagnosis is primarily a list of antisocial or criminal behaviors. According to Hervé (2006), the DSM-diagnosis is too heavily weighted toward the behavioral aspects of the disorder, hence neglecting interpersonal and affective aspects, and that the requirement of three criteria is too small to distinguish psychopathy. To prove his claim, he cites several studies (Hare, 1983, 1985; Hare et al., 1991; Robins, Tipp & Przybeck, 1991) which show that, according to DSM criteria, 50% to 80% of criminal offenders are diagnosed as ASPD, whereas only 15% to 30% of the same people meet the PCL-R criteria for psychopathy, which will be discussed below. Another important point is that the empirical relation between psychopathy and ASPD is asymmetric; about 90% of offenders diagnosed as psychopaths by the PCL-R meet ASPD-criteria, but only about 25% of those diagnosed as ASPD meet PCL-R criteria (Hare, 1985; Hart & Hare, 1989).

Measuring psychopathy

Because of the lack of a universal diagnosis for psychopathy in the DSM (and in WHO’s ICD as well), several researchers have individually composed testing methods to evaluate the levels of psychopathy in patients.

Currently, the most popular instrument for measuring criminal psychopathy is the 22-item Psychopathy Checklist (PCL, Hare, 1980) and its 20-item revision (PCL-R, Hare, 1991, 2003), created by the influential Canadian researcher Robert Hare. The PCL-R consists of 20 items that index psychopathic traits as originally discussed by Cleckley (1941). Each item is scored on a 3-point scale (0 = consistently absent, 1 = inconsistent, 2 = consistently present) and scores are added up to a total score (range 0–40). Hare suggested a score above 30 would qualify an individual as a psychopath. Scores are based on assessments of emotional, interpersonal, behavioral and social deviance information derived from self-reports, interviews, observations, and other sources such as parents, friends, and arrest records. Only highly-trained examiners are qualified to run a PCL-R test and assess the information found. The PCL-R is currently the most widely used and validated instrument for assessing psychopathy (Edens et al., 2009; Anderson & Kiehl, 2011).

3. Guilt in psychopaths: psychoanalytic tradition and current research

The psychoanalytic tradition

Now, having examined the current issues concerning psychopathy, it is also important to say a word about the concept of guilt within psychiatry, before we move on to discuss guilt in psychopaths.

The concept of guilt can be looked at from multiple perspectives. In a juridical sense, guilt is the state of being responsible for committing a criminal offense. This is an objective condition which can be evaluated by an external judge. In contrast, the concept of guilt in psychiatry is applied in a more abstract sense, drawing attention to the amount of guilt someone feels.

In psychoanalysis, there is a long tradition of discussing the psychiatric concept of guilt. Theories on the relevance of guilt to psychological disorders date back to the writings of Sigmund Freud. From Freud’s (1923) perspective, feelings of guilt arise when forbidden wishes or deeds from the id and the ego clash with the moral standards of the superego. The superego uses guilt, along with other measures such as shame, as a retaliation tactic, which in turn can lead to serious psychological symptoms (see Lewis, 1971 and Tangney, 1994 for more detailed analyses of Freud’s view on guilt).

Nietzsche (1887) was especially fascinated by the connection between guilt and debt (the German word for both guilt and debt is Schuld). He regarded the connection as evidence of the inhumanity of civilized morality. Regarding guilt and debt as a form of suffering, Nietzsche asks: “Why can suffering be a compensation for ‘owing’?”. To which he answers: “Because the infliction of suffering produces the highest degree of happiness, because the injured party will get in exchange for his loss an extraordinary counter-pleasure: the infliction of suffering”.

A more recent and structured categorization of guilt in psychiatry is provided by Mooij (1998). He identifies three separate forms of Schuld, which he bases on the three translations that Schuld has in the Greek language: aitia (which reoccurs in ‘etiology’), hamartia and opheilomenon. The first form of guilt is causal guilt: someone is guilty of something, because he is directly or indirectly responsible for the occurrence of that thing. The second form refers to someone being guilty, because he does not reach a certain ideal or standard due to a deficiency, a lack or an error in himself. The final form of guilt covers debt: when someone owes something to someone else. This can be a financial debt, but also includes owing someone more respect or love.

Research findings

When discussing the lack of guilt in psychopaths, the first form of Mooij’s categorization applies: the causal guilt (Mooij, 1998). The characteristics of psychopaths as discussed in chapter 2 (items 6 and 10 in Cleckley, 1941; items 6, 7, 8 and 15 in the PCL-R, Hare, 2003) have shown that when psychopaths harm others, they lack any true sense of guilt. Instead, they rationalize their behavior and blame others, for example society, circumstances, friends, parents or the victim himself. Feelings of guilt are difficult to bear for a psychopathic personality because these feelings are contrary to their idea of their own grandiosity. Psychopaths see themselves as superior beings and they hate being in a position of inferiority (Hare, 1999), which means that they also hate being under the command of a troubling conscience.

To be able to feel guilt, it is important that one can relate to the pain or harm that he has inflicted on his victim (Kohlberg et al., 1987). However, several studies show that psychopaths have difficulty in processing emotional information. A 1995 study by Christianson et al. demonstrated that psychopaths do not show a narrowing of attention for negative events. Sixty-two inmates, of which 25 were psychopaths (PCL-R ≥ 30) and 37 non-psychopaths (PCL-R < 30), were shown 15 color slides. The content of the eighth (critical) slide was either emotional or neutral; in each case the critical slide contained a central detail (the color of a woman’s coat) and a peripheral detail (the color of a car in the background). There were no group differences in recall of the details of the neutral slide; in each case, the central and peripheral details were recalled equally well. The non-psychopaths recalled the central detail of the emotional slide far better than they did the peripheral detail, which means they showed the expected narrowing of attention with negative emotion. The psychopaths, on the other hand, failed to show this effect; their recall of the central and peripheral details was the same for the emotional slide as it was for the neutral slide.

An interesting, more guilt-specific, study by Blair et al. (1995) investigated the ability of psychopaths and non-psychopaths to attribute emotions to others. Twenty-five psychopaths and twenty-five controls, identified using the PCL-R, were presented with short images with happiness-, sadness-, embarrassment- or guilt-inducing contexts. They were asked to attribute emotions to the story protagonist. The psychopaths and controls did not differ in their emotion attributions to protagonists in the happiness, sadness and embarrassment stories. However, the psychopaths and controls did differ in their emotion attributions to the guilt stories. The dominant attribution of the controls to the story protagonist was, as expected, guilt. In contrast, the dominant attribution of the psychopaths to the story protagonist was happiness or indifference.

According to Kegan (1986), psychopathy reflects a failure of cognitive development. Prior to adolescence, the developing child has a concept of an independent self and is able to recognize that others have needs and take their role, but is unable to coordinate personal needs and feelings with those of another. Right action is what meets one’s own needs, and the child does not experience guilt as internal self-punishment. At this preadolescent stage, moral and self-serving values are not differentiated. Kegan suggests that psychopaths have a developmental delay at this stage; there is a disturbance in the ordinary process of growth beyond the preadolescent state. Interestingly, the quality of family environment barely seems to have an influence on the age of onset of criminality in psychopaths (De Vita, Forth & Hare, 1990). On average, those from a troubled family were first arrested about age 12, whereas those from less troubled families were first arrested at age 13. In contrast, family environment has a very big impact on non-psychopaths: non-psychopaths from troubled families were first arrested at age 15, compared to age 22 for those from less troubled families. Overall, psychopathic offenders are no more likely to have been raised in a poor family environment than non-psychopathic offenders.

Recent neuropsychological research (Kiehl, 2006; Shirtcliff et al., 2009; Bosse, Gerritsen & Treur, 2007) shows that psychopaths have several shared deviations in the brain. For feelings of guilt, it is relevant that the frontal lobes of individuals with psychopathy are disconnected from the limbic area. The frontal lobes are the area of the brain that are concerned with, among others, conscience, guilt and remorse. The limbic area generates feelings. Because of the disconnection, psychopaths are incapable of expressing their emotions in terms of feelings. They know the difference between right and wrong, but the difference does not matter to them. This way it is hard for a psychopath to understand or imagine the pain of other people. In line with these findings, multiple studies have discovered no theory of mind impairments in psychopaths (Blair et al., 1996; Richell et al., 2003), whereas still, they do show less arousal responses to the distress of others (Blair et al., 2004).

4. Conclusion and discussion

What does the research reviewed here tell us about the way psychopaths experience guilt in comparison to non-psychopaths? We may conclude that psychopaths, just like non-psychopaths, do know when they are wrong, but the crucial difference is that the psychopath has a certain personality and neuropsychology that does not tolerate nor process a feeling of guilt. As a result, the psychopath externalizes the guilt by blaming someone or something else.

This conclusion confronts our criminal justice system with a fascinating problem, namely whether psychopaths can be held legally responsible for their criminal behavior or not. Looking at the number of imprisoned psychopaths given in the introduction, it is clear that judges currently do not accept psychopathy as a legal form of insanity which rules out responsibility. The biggest argument for holding psychopaths responsible for their behavior is that they are aware of the prevailing moral and legal rules. They might not understand the point of these rules, but they do have the capacity to know that they will inflict pain or harm when they break them. For this reason, some people consider psychopaths to be even more evil and immoral than other offenders, and therefore deserving of punishment. Also, as the statistics discussed in the first chapter showed, psychopaths have a higher recidivism rate than non-psychopathic offenders, which is another reason to guard society from them.

The argument that psychopaths should not be held legally responsible for criminal conduct relies on a broader standard of responsibility; a standard that requires the capacity for moral understanding. In this sense, psychopaths are less responsible than normal offenders, because they lack moral knowledge. Psychopaths do not comprehend the point of morality, of concern for others, or of guilt. Without these emotions, which

Tangney (2002) calls the ‘moral emotions’, psychopaths have no reasons not to harm others. They are ‘morally insane’, or, as Greenacre (1945) candidly puts it, ‘moral imbeciles’. Psychopaths are not part of the moral community and therefore do not deserve punishment, not least because they can by no means be held responsible for becoming psychopaths.

A lot has been written on the debate between these two arguments, and there are still a lot of differences in opinion. Either way, a lesson to be learnt from this debate, is that psychopathy is a disorder where the philosophical concept of ‘morality’ plays a big role. The psychopath is largely defined in ambiguous terms not of abnormal psychological features, but of behavior that contravenes the norms of society (e.g. not feeling guilty). Because countries vary in their moral and legal rules, and even within countries morals and laws change over time, medicalizing these rules is an unsteady domain where abstraction is unavoidable. Therefore legislators and judges, as well as psychiatrists and other mental health professionals, should be very careful when operating on this field. They have the power to rule major classes of behavior under the psychopathic traits, by simply changing the law or adding a new characteristic to the diagnosis.


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One thought on “Guilt in Psychopaths: When Morality meets Medicine

  1. Beste heer Al tamimi,

    Ik heb weer iets interessants kunnen lezen.
    Maar bij dit stukje wil ik graag mijn gedachtes met je delen.

    Over schuldgevoel gesproken, een mens voelt zich pas schuldig als hij zelf beseft dat wat hij gedaan heeft verkeerd is. In geval van psychopaten zal dat moeilijk zijn. Ik geloof er wel in dat ze schuldgevoel voelen. Maar door hun superego, kunnen en willen ze het niet accepteren dat zij iets verkeerds hebben gedaan. Daardoor gaan zij dat gevoel zo goed mogelijk proberen weg te drukken of iemand anders de schuld geven van iets wat zij zelf hebben gedaan. Want in hun gedachten draait het alleen om hunzelf. Zij zijn goed en de rest niet, zolang zij het goed hebben boeit hun de rest niet . Waardoor het makkelijk voor hun is om andere mensen te beschuldigen voor hun eige daden.

    Over het stukje, psychopaten zijn onstrafbaar omdat zij er niks aan kunnen doen dat ze psychopaten zijn, ben ik niet mee eens. Want als dat zo is en dat toegepast wordt, zullen er veel criminelen vrij lopen in deze wereld en wordt criminaliteit niet geminimaliseerd. Met als gevolg dat het alleen maar onveiliger wordt.

    Hoor graag van je.
    Met vriendelijke groet,

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