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Psychopathy is a categorical psychological term describing chronic disregard for ethical principles and antisocial behavior. It is not a part of the DSM-IV and accordingly is not, strictly speaking, a mental disorder for the purposes of North American medical insurance or practice.

Although its medical status is somewhat muddled, psychopathy is of particular legal relevance because studies estimate that while only 1% of the general population could be described as psychopathic, up to 20% of the prison population may fall under this descriptor. It is popularly speculated that individuals who prove themselves capable of committing violent or horrendous crimes are in fact psychopathic. Categorization as a psychopath usually occurs through the use of a forensic assessment instrument such as Hare’s Psychopathy Checklist-Revised (Hare’s PCL-R).

New research by Joseph P. Newman at the University of Wisconsin suggests that an attention deficit, rather than an inability to feel emotion, may be what makes people psychopaths. Newman measured fear-potentiated startle (FPS) in a group of 125 prisoners, who were also assessed for psychopathy using the PCL-R. Each prisoner was hooked up to a device that measures how strongly they blink – in other words, FPS – and placed a screen in front of them. The subjects were warned that during tasks in which letters flashed on the screen, an electric shock would sometimes follow a red letter, but never a green one. Psychopathic subjects displayed normal FPS under these threat-focused conditions relative to the control. However, when they were told to indicate whether letters were capitals or lower-case, the psychopathic prisoners displayed significant deficits in FPS – they barely blinked upon seeing red letters, while the others continued to anticipate the mild shock.

Newman’s team hypothesizes that this might be because psychopathy, contrary to traditional belief, actually involves an “attention-related deficit that undermines the processing of peripheral information, including fear stimuli.”

Of course, as Newman notes in a New Scientist news piece, one of the hallmark problems surrounding psychopathy, aside from clinical definition, is that it is ostensibly untreatable. The implication here appears to be that if the Newman hypothesis proved correct, psychopathy would be treatable in a manner similar to a “learning disability”. Given the use of language such as “distraction” and “attention-related deficit” throughout the news piece, it would appear these researchers are suggesting that some ADHD-like symptoms are present in psychopaths with respect to moral feelings. This definitional move would then presumably make the condition treatable by stimulants such as Adderal and Ritalin. It will be interesting to see whether this implied turn into the pharmaceutical magisterium will be continued by further studies, and whether these taken collectively will result in psychopathy’s inclusion as a psychiatrically legitimated, treatable mental disorder in the upcoming DSM-V.

The proposed shift from the archetype of cold-blooded, calculating criminals to that of disabled, distracted moral learners is a remarkable one. As the researchers state, “The innate fearlessness of psychopathic individuals is arguably the most sacrosanct assumption in the field of psychopathy.” But do the results of Newman’s study provide grounds for this strong hypothetical shift?

First of all, even if we perceive a compelling link between higher cognitive processes such as attention and moral perception, whether persuaded by this study or not, should we move wholesale to a paradigm of psychopathy based on attention deficit, or simply qualify present theories accordingly? Secondly, more abstractly, should we accept the hypothesis that moral sentiments are grounded in fear? While it is surely true that fear compels some social conformity, are moral feelings such as guilt or moral apprehension necessarily connected with fear, and is the lack of this fear the hallmark of the psychopath, as is popularly supposed by current psychological theorists? Thirdly, is FPS in any way a good measure of the complex emotional state of fear? Is it possible that the behavior it measures carries many possible valences of purpose and habit in different individuals, and accordingly the correlation with fear is underdetermined on the basis of the available data?

Finally, a more speculative thought: the “fear” discussed in this context is presumably culturally bound to the social mores and punishments associated with them. Is attention not bound in such a way? If we suppose that it is, and the results of this study can be replicated and built upon, is it possible to imagine a world in which all undesirable beliefs are explained on the basis of attention and treated with stimulants? This disease market would presumably be much larger than that for categorical psychopaths. In what ways would this practice be different from the present use of atypical antipsychotics in the face of undesirable beliefs espoused by those diagnosed with schizophrenia?

– CJ Murdoch