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Painted Brain | Psychotic Or Psychopathic? Some Popular Misconceptions
We're bridging communities and changing the conversation about mental illness using arts and media.
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  • admin
  • April 1, 2014

Psychotic or Psychopathic? Some Popular Misconceptions

In the popular media, we often hear the clinical terms psychotic and psychopathic used almost interchangeably to describe individuals who indulge in violent criminal behavior. While it appears that some overlap may exist between these conditions as they are currently defined, they are not the same at all.

Let’s begin with a clear and concise definition of what it means to be psychotic.

According to the Freedictionary/Medical database, “Psychosis is a symptom or feature of mental illness typically characterized by radical changes in personality, impaired functioning, and a distorted or nonexistent sense of objective reality,” (emphasis mine). Psychosis, as such, is not a diagnosis, but a mental state symptomatic of an underlying condition or root cause. Psychosis, characterized by hallucinations (false sensory stimuli), delusions (faulty ideation not arising from objective reality) or both, may be caused by one or more factors: mood and/or personality disorders, schizophrenia, schizoaffective disorder, drug abuse, even organic brain damage or disease, such as head trauma or encephalitis. It is believed that most psychotic episodes are triggered by a hypersensitivity to real stimuli, both internal and external, giving rise to false stimuli (sensory information without a discernible cause) and the resultant confusion between the two. A person in a psychotic state of mind may become increasingly unable to differentiate between what is “real” or objective, and what is “not real” or purely subjective. Inner and outer reality become difficult to distinguish from one another, or in fact, indistinguishable altogether. The inability to screen out false stimuli leads to ineffective, inappropriate and unsuccessful social and environmental responses. This confusion between inner and outer reality is characteristic of many thought disorders, such as schizophrenia and schizoaffective disorder. The Dictionary of Psychology refers to a thought disorder as, “a disturbance in one’s ability to generate a logical sequence of ideas, as indicated by disordered speech and/or writing.”  It follows logically that confusion caused by hallucinatory stimuli and delusional ideation give rise to errors in communication. These difficulties and errors in communication have become the most easily-diagnosed features of psychosis.

On the other hand, psychopathy (pronounced “sy-KOP-uh-thee”) manifests itself as an extreme form of personality disorder. In simple terms, when normal patterns of thought and behavior become inflexible and maladaptive and cause serious problems with relationships and work, they become personality disorders. While the Diagnostic and Statistical Manual of Mental Disorders’ definitions for psychopathy, sociopathy and anti-social personality disorder have many significant and overlapping characteristics, a much clearer picture of the psychopath emerges when we apply the Psychopathology Checklist- Revised, or PCL-R. It is a list of twenty personality traits and/or behaviors characteristic of the psychopath. The diagnostician gives each item a score of 0 (not at all), 1 (sometimes, or in certain instances or situations) or 2 (always, or in most instances). A score of thirty and above is considered a good indicator of a psychopathic personality.

Revised Psychopathy Checklist

Glibness/superficial charm, grandiose sense of self-worth, need for stimulation/prone to boredom, pathological lying, conning/manipulative, lack of remorse or guilt, shallowness of affect, callous/lack of empathy, parasitic lifestyle, poor behavioral controls, promiscuous sexual behavior, early behavioral problems, lack of realistic, long-term goals, impulsivity, irresponsibility, failure to accept responsibility for actions, many short-term marital relationships, juvenile delinquency, revocation of conditional release/recidivism, criminal versatility

Professors Lilienfeld/Emory University and Arkowitz/University of Arizona, in an article in Scientific American in 2007 entitled, “Facts and Fictions in Mental Health,” describe the psychopath as, “superficially charming, (they) tend to make a good first impression on others and often strike observers as remarkably normal. Yet they are self-centered, dishonest and undependable, and at times they engage in irresponsible behavior for no apparent reason other than the sheer fun of it. Largely devoid of guilt, empathy and love, they have casual and callous interpersonal and romantic relationships. Psychopaths routinely offer excuses for their reckless and often outrageous actions, placing blame on others instead. They rarely learn from their mistakes or benefit from negative feedback, and they have difficulty inhibiting their impulses.”

Lilienfield and Arkowitz go on to debunk the three most common myths about psychopaths.

  1. All psychopaths are violent. In fact, while many psychopaths have a low threshold for frustration and a tendency to express extreme frustration through drama and violence, we must consider this behavior a last resort. Since violence, in most social settings, is considered totally unacceptable, and since psychopaths tend to be masters of social and interpersonal interaction and manipulation, it follows that they would resort to violence infrequently, lest they give themselves away.
  2. All psychopaths are psychotic. In contrast to people with psychotic disorders, such as schizophrenia, who often lose contact with reality, psychopaths are almost always rational. They are well aware that their ill-advised or illegal actions are wrong in the eyes of society, but shrug off these concerns with startling nonchalance. (Lilienfield and Arkowitz)
  3. Psychopathy is untreatable. Psychopathy is now broken down into two categories: primary psychopathy, considered genetic in origin; and secondary psychopathy, caused, in theory, by environment and/or socialization. Most psychopaths scoring high on  the PCL-R are thought to suffer from a combination of both primary and secondary types. While the underlying personality traits common to both are currently difficult-to-impossible to change with chemical intervention or therapy, their manifestations can be addressed through behavioral modification with varying degrees of success.

Interestingly, what we now call “psychopathy” was once referred to as “moral insanity.”

It must be noted that, from an evolutionary standpoint, callousness and self-serving behavior often result in increased survivability and reproductive success. Furthermore, the history of human society seems to suggest, strongly and implicitly, that Machiavellian social strategies are most likely to succeed in the most easily-measurable, material ways, such as fame, wealth, and social standing.

Perhaps the moral insanity of the psychopath is a direct result of the moral hypocrisy of society itself?

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