Dr. Robert Hare: Expert on the Psychopath

"Psychopathy is a personality disorder," Hare writes in Without Conscience, "defined by a distinctive cluster of behaviors and inferred personality traits, most of which society views as pejorative."

In other publications, he points out that among the most devastating features of psychopathy are a callous disregard for the rights of others and a propensity for predatory and violent behaviors.  Without remorse, psychopaths charm and exploit others for their own gain.  They lack empathy and a sense of responsibility, and they manipulate, lie and con others with no regard for anyone's feelings.

That description sounds plain enough, but over the decades the concept and definition of psychopathy have gone through many changes.  Unfortunately, some of these shifts have been the product of evolving fashion in the professional community rather than an attempt to better identify the members of a specific population.  While psychopathy was the first personality disorder that psychiatry formally recognized, it wasn't easy to crystallize a workable concept for behavioral analysis.  Hare has been at the forefront of those researchers who have identified just what a psychopath is.

  
Yet before his time, another professional was doing something similar, for similar reasons.  In 1941, Dr. Hervey Cleckley published The Mask of Sanity, a groundbreaking approach to psychopathy.  Up until that time, psychopathy had been referred to by such labels as "insanity without delirium," "moral insanity," and "psychopathic inferiority."  Having encountered this distinct personality type during the course of his work, Cleckley came up with sixteen traits that, in constellation, formed a specific pattern of perspective and behavior.  Among them were manipulativeness, irresponsibility, self-centeredness, shallowness, and lacking in empathy or anxiety.  As later research indicated, they also were likely to commit more types of crimes, and be more violent, more likely to recidivate, and less likely to respond to treatment than were other offenders.

Cleckley wrote introductions to successive editions of his book, commenting on the psychiatric community's hesitation to address this population.  Where clinical assessment and treatment were concerned, psychopaths appeared to be on a back burner.  

"This group," he wrote, "plainly marked off from the psychotic by current psychiatric standards does not find a categorical haven among the psychoneurotic  They are also distinguished practically by their ability to adjust without major difficulties in the social group."  Cleckley perceived that, because the syndrome was difficult to spot from outward symptoms, the psychiatric terminology simply failed to offer a way to understand and address such people.

To put the situation in perspective, in the fifth edition of The Mask of Sanity, published in 1976, Cleckley used the metaphor of electricity conductors.  A pair of copper wires carrying 2,000 volts of electricity, kept apart, offers nothing to indicate what the wires may do.  "When we look at them, smell them, listen to them, or even touch them separately, [they] may give no evidence of being in any respect different from other strands of copper."  However, connect these seemingly innocuous wires to a motor to make the circuit, and the unmistakable evidence of electricity appears.  "So, too, the features that are most important in the behavior of the psychopath do not adequately emerge when this behavior is relatively isolated."  To see the "symptoms" of psychopathy, they need to be "connected into the circuits of a full social life."  In short, we see the psychopath best, not in the clinic or prison, but in situations in which he can best operate as a manipulative con man.

Hares work was influenced by Cleckleys writings but, in turn, Cleckley was influenced by Hares research.  In their correspondence Cleckley described himself as a voice crying in the wilderness, and his work as having little impact on psychiatric thinking.  In a signed copy of The Mask of Sanity, Cleckley inscribed: For Robert Hare, whose impressive studies of the psychopath have encouraged and stimulated me over the years and have played an important part in enabling me, after long frustration, to complete this fifth edition. With profound gratitude.

Cleckley's book made a valuable contribution, but as the concept of psychopathy continued to evolve, the emphasis in assessment practices for most American clinicians moved away from a focus on personality traits and toward specific behavioral manifestations.

In 1952, the word psychopath was officially replaced in psychiatric nomenclatures with sociopathic personality, and these labels eventually came to be used interchangeably under the heading of personality disorder.  Then with the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II) in 1968, sociopathic personality yielded to personality disorder, antisocial type.

Yet there were no diagnostic criteria for the disorder, so researchers looked for ways to come up with some.  Hare and his colleagues emerged with the single best method, but not without a lot of work.