'This is worth striving for'

Psychopathy is a dark topic and a brave choice for a BBC2 Horizon programme. This was to be a serious and not sensationalist account of this complex personality disorder. It is remarkable how often this topic has been aired and how regularly it appears in the movies. Was another documentary needed? Yes, because there is a great deal of new research. We also need to get rid of the entrenched idea that most violent criminals are psychopaths.

Director-producer Rebecca Harrison wanted to create a 'noir' feeling with a somber visual mood. I loved this idea. I also had to feel brave to be the presenter. This is not a field I am an expert in, but I wanted to learn more, and it was highly satisfying to be able to delve underneath the surface with the help of renowned researchers from different fields*. Here I talk to my friend Essi Viding, Professor of Developmental Psychopathology at UCL, whose advice I drew on continuously while making the programme. 

Uta: We asked 'What makes a psychopath?' Were we too ambitious to ask this question?

Essi: I don't think so. There are now widely agreed diagnostic criteria and you discuss them in the documentary. The documentary also touches on development and that is where I came in. What I am most interested in is what makes some children vulnerable to developing psychopathy. We can identify children who have so called 'callous and unemotional traits' and who share features with adult psychopaths. We now know more about the genetic and brain basis of these traits. We also know that not all children with these traits grow up to be adult psychopaths, so that is interesting and challenges us to find the right interventions.

Uta: I find it easy to believe that psychopathy is a neuro-developmental disorder just like autism. It took a massive effort to remove the blame from the parents in the case of autism and to get people to understand that these children are different from the start. I feel the same might need to be done for psychopathy.

Essi: Psychopathy is indeed a neuro-developmental disorder. Still, these children often grow up with many adverse social factors and this is why people are often keen to draw links with parenting – but it is not that simple. A problematic child can evoke problematic reactions. We need to keep in mind that the majority of the children from adverse social circumstances do not have a callous-unemotional traits, while a few children with loving parents and ample resources do.

Uta: Here is what I remember most from my involvement with the film: how different analysing the mind of the psychopath feels from analysing the mind of the person with autism. And yet there is the presumption that both conditions involve a profound failure of emotional development.

Essi: There is a glaring difference. Psychopaths excel in something that is lacking in autistic individuals. They have normal or even superior mentalising skills (the ability to track the invisible mental states of others – their desires, intentions, beliefs). It is clear that psychopaths use mentalising to manipulate, deceive and torment others.

But there is another social mechanism that seems to have failed in psychopaths – the normally strong desire for affiliation, that is, the wish to belong and to be part of a group.

Uta: Interesting! But this desire for affiliation has also been supposed to be missing in autism!

Essi: I think we both agree that this is absolutely not true for most individuals on the autism spectrum. There are too many observations that testify to empathy and a desire for inclusion. Also there is evidence from empirical studies documenting the ability to resonate with other people's emotions in autism.

Uta: So, simply put, mentalising failure captures autism, and failure to affiliate emotionally captures psychopathy?

But what is affiliation – and what cognitive mechanism would support it? Does it have to do with our liability to be infected by the behaviour of others?

Essi: We can think of it as a primitive capacity to resonate with others. Presumably it has its origin way back in our evolutionary history and is probably found in all group living animals. Affiliation gives us positive feelings of belonging to a tribe or a fan club. It imparts the meaning we find in identity and in loyalty.

Uta: I take we agree that the mechanisms that underlie ancient components of our social nature must have a basis in the brain. So it is conceivable that abnormal brain development might interrupt affiliation?

Essi: There is a lot of excellent work from multiple research groups that has shown difficulty in resonating with other people's distress in psychopathy. There is less work looking at positive affiliation, but it is something that my group and others are really interested to look at more closely. We want to know if cues that are known to support social cohesion and belonging, such as genuine laughter, are processed in a different way in children at risk of developing psychopathy. Laughter is one of the most contagious emotions. We join in when we hear genuine laughter and laughter is thought to promote bonding between individuals. There is reason to believe that processing of laughter is compromised in children at risk of developing psychopathy – you have to watch this space, as the study will only be out later this autumn.

Uta: We tend to hold on to other people when we feel fearful, and this seems to lessen our fear. Do you think that psychopaths in similar circumstances would not experience such benefits of affiliation?

Essi: That is an interesting suggestion. We would need to test it out. Some data suggest that individuals with psychopathy experience less fear themselves. If this is the case, they may need less support from others and that might reduce the motivational drive to affiliate.

Uta: I remember asking you before whether psychopaths can be found among gang leaders and mafia bosses, whether they can be particularly brave soldiers. You had some interesting arguments against this idea.

Essi: I think there probably are some who have high levels of psychopathic traits. These might be the ones who are highly narcissistic and shamelessly use others, without ever returning loyalty in any way. Psychopaths can happily dispense of other people the minute they cease to be useful. They don't have regret. The suffering of others means very little to them.

But I am not sure whether such individuals would make the most successful gang leaders, mafia bosses or soldiers. They are not team players. One of the hallmarks of psychopathy is that they tend to act in line with purely selfish urges. This is often not compatible with the best interests of the team.

Uta: I am still hoping to find the 'good' psychopath, untrammelled by emotions and with strictly utilitarian morality, but law abiding. Could it be that in times of extreme conflict and crisis it is the psychopath who can save the group? By carrying out the unspeakable deeds that nobody else would be prepared to perform?

Essi: I wonder why would they bother? I think doing a heroic deed would still require buying into ideology, putting yourself into danger or discomfort for others. These people do not typically do this.

Uta: For me, the bleak insight from making the programme is that we don't know how to change psychopaths. Will they ever be able to feel genuine remorse, empathy and belonging?

Essi: Changing ingrained emotional traits is very difficult. There is an example of a study of individuals with anxiety. In contrast to psychopaths they feel and worry a lot. There are interventions that help individuals with anxiety, but they will never become the most chilled out people on the planet. And these are individuals who feel so rotten that they have a huge motivation to change how they feel! Psychopaths don't feel bad themselves, so it will be harder to achieve motivation to change for them and the extent to which they can ever feel for and with others is going to be limited. On the other hand, I am confident that we can change their behaviour!

As shown in the documentary, there are some promising treatment approaches with young people. One important insight is that psychopaths do not learn well from punishment, but they can learn from rewards. In other words, we can capitalise on their desire to look after number one. That can be used to promote prosocial behaviour. It is something I would like to work on in the future. I hope that we might eventually be able to put the moral development and social behaviour on the right track from an early age. This is worth striving for on behalf of children at risk of developing psychopathy and their families.

Footnotes

Kent Kiehl, Jeremy Coid, Gregory van Rybroek, Molly Crockett, Scott Lilienfeld. I was fortunate also to draw on advice from James Blair and Estelle Moore.

If you want to read one book, Kent Kiehl's The Psychopath Whisperer: The Science of those without Conscience is fascinating. There is also an excellent short BBC iwonder guide by Claudia Hammond on the topic.

- This conversation was originally published on Professor Frith's website (with her husband Chris), 'Social Minds', and is reproduced here with kind permission.

Watch the BBC Horizon programme now.

Find much more from Uta Frith in our archive, including this interview; and also see our 'One on One' with Essi Viding.