Dr. Robert Hare: Expert on the Psychopath
Early Experience
Hare received his master's degree in psychology in the early 1960s, and before he could continue with his Ph.D., he needed to work for a while. Thus, he became the sole psychologist for the British Columbia Penitentiary, a maximum-security prison near Vancouver. He had no particular training in this area, or any keen interest in criminology, and to his chagrin, the prison gave him no introduction to his duties. "I started work completely cold," he writes in Without Conscience. He had to feel his way and hope he made the best of it.
Without Conscience by Dr. Robert Hare">
Some of the prisoners soon spotted Hare's naiveté, and they took subtle advantage of it by doing things like making him a prison uniform that did not quite fit and asking for unauthorized favors. The first prisoner to visit him was a man he calls "Ray." This inmate, who possessed an intense and direct manner, came into Hare's office with an issue that he needed to discuss. He then pulled out a knife, startling Hare, but said he was going to use it on another inmate.
This declaration immediately placed Hare in a bind: if he ratted, the word would get around that he couldn't be trusted. If he didn't, he'd be violating the prison rules. In other words, in that moment, he had lost his standing in one of those arenas. When he did not report the incident, he realized that he had been caught in Ray's clever trap. Ray knew that the new psychologist was a "soft touch," and his manipulations continued.
Hare remained at the prison for eight months, and during that time, Ray plagued him with requests for favors, offering reasons that generally turned out to be lies. "He lied endlessly, lazily, about everything, and it disturbed him not a whit whenever I pointed out something in his file that contradicted one of his lies." Whenever Hare resisted him, Ray turned nasty. It wasn't easy to know what to do with this man.
This was Hare's first extended encounter with what he would later realize was a psychopath. And it didn't stop there. Leaving the prison to return to the university to work on his doctoral degree, he eventually began to do research for his dissertation. That's when he came across publications that described the kind of person that Ray clearly was: a psychopath.
Still, Hare did not make the connection. At least, not then.
After finishing his degree and getting a teaching position at the University of British Columbia, Hare was seated at the pre-registration desk for classes when he heard a familiar voice. It was Ray.
This former inmate, now standing there in line with the other students, was bragging about how he'd been Hare's assistant and confidante at the prison, especially on difficult cases. Hare was astonished, so he confronted the imposter. To his further amazement, Ray never broke his stride. He greeted Hare and smoothly steered the conversation in a new direction.
Hare later wondered just what it was in this man's psychological makeup that allowed him to so effortlessly engage in manipulation and deception, without any apparent pangs of conscience or embarrassment.
It wasn't long before he was fully engaged in studying that very personality type, and it was to become his lifelong occupation. There were many more people like Ray, both in prison and outside.
What is a 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.
Hare's work was influenced by Cleckley's writings but, in turn, Cleckley was influenced by Hare's 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.
The PCL-R
"When I was working on my Ph.D.," Hare recalls, "I was interested in the effects of punishment on human behavior. My dissertation looked at the frequency, intensity, duration, and delay effects of punishment. Of course, I needed to start thinking about people who were resistant to the effects of punishment, so I started reading up on the psychopath. Hardly any empirical research on psychopathy was going on, so I started to publish some of my own results in 1965."
That led to an opportunity. At John Wiley & Sons, Inc., Brendan Maher was putting together a series of books on behavior pathology. He was impressed with Hare's work and asked him to write one of the books, so in 1970, Hare published Psychopathy: Theory and Research, which set forth some ideas that would guide much of the research on psychopaths over the next two decades. Just the year before, he had received a large grant from the Canadian Mental Health Association, and this provided funds to increase his research efforts.
He noticed throughout the early 1970s that other researchers in the same area were using different classification systems to address psychopathy, such as categories based on the Minnesota Multiphasic Personality Inventory and the California Psychological Inventory. That was a problem, however, because these were self-report inventories, and it's not difficult for clever psychopaths to figure out the test structures and to lie. Aside from that, researchers were going in too many different directions.
"Nothing was consistent," Hare says. "The results were all over the place. I began to realize that if you can't measure the concept, you can't study it."
He decided to experiment with different systems of assessment and measurement, using ratings based on clinical accounts, such as the detailed case descriptions of psychopaths that he had read in The Mask of Sanity. "Cleckley was the one who put it all together for me," Hare affirmed.
He and his assistant went through numerous files and did many interviews, trying to determine what makes one person a psychopath and another person not. He came up with a three-point rating system, and then a seven-point one. Yet neither satisfied him, and journal editors did not understand what he was actually measuring. Then, as with most discoveries, perseverance and the constant grind of trying different things finally paid off.
"One day," Hare remembers, "a research assistant who had been with me for a dozen years and I decided to quantify what we thought went into our assessments. First, we listed all the characteristics we thought are important. We had about a hundred different features and characteristics. Then we started to score these on people on whom we already had done the seven-point assessment. We were able to cut the list down to twenty-two items that we thought were useful for discriminating a psychopathic criminal from a non-psychopathic criminal."
Hare's first published work on this 22-item research scale for the assessment of psychopathy appeared in 1980.
That was the same year that the DSM-III came out.
Then the field began to divide.
Hare was acquainted with people who were on the DSM-III work committees and had some input into their discussions about the criteria they were devising for what they were calling antisocial personality disorder. However, he diverged significantly from American ideas about the disorder.
Dr. Lee Robins, an eminent sociologist whom Hare knew, was working to focus the antisocial diagnosis strictly on behavior. Hare recalls that it was her contention that clinicians cannot reliably measure personality traits such as empathy, so it was best just to drop them from the list of criteria and include only overt behaviors.
Hare saw a draft of what the committee was proposing and he spotted real problems. Of the list of 10 items, which consisted primarily of violations of social norms, a person needed to manifest only a few to be diagnosed with antisocial personality disorder. To his mind, that would encompass the entire prison population. Not only that, it would not be congruent with his understanding of a psychopath. He made suggestions for changes to bring antisocial personality disorder a little closer to psychopathy, but for the most part the committee members went forward with their own ideas.
With some adjustments, these criteria were continued over the next two decades in the DSM-III-R and the DSM-IV. Accordingly, clinicians who use these manuals look for symptoms in people over 18 and not otherwise psychotic who since age 15 have shown a pervasive pattern of disregard for, and violation of, the rights of others. Among these behaviors, the person has done at least three of the following:
- failure to conform to lawful social norms
- deceitfulness
- impulsivity or failure to plan ahead
- irritability and aggressiveness, as indicated by repeated physical fights or assaults
- reckless disregard for safety of self or others
- consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
- lack of remorse, as indicated by being indifferent about having hurt, mistreated, or stolen from another
So while there was now a list of explicit criteria for clinicians to use, APD (Antisocial Personality Disorder) proved to be unworkable for those who were researching psychopathy. Hare points out, "In forensic populations, diagnoses of APD have far less utility with respect to treatment outcome, institutional adjustment, and predictions of post-release behavior than do careful assessments of psychopathy based on the traditional use of both behaviors and inferred personality traits." While most psychopaths may fit the criteria for APD, the majority of people with APD are not psychopaths. In other words, there were now two different diagnostic instruments to assess two different populations that shared some but not all traits in common.
Hare had continued his work with the assessment scale, eventually called the Psychopathy Checklist, and in 1985, he revised it to include only twenty items. It was now known as the Psychopathy Checklist-Revised (PCL-R), and was completed on the basis of a semi-structured interview with the people being assessed, along with information from files. Person by person, each trait on the scale was rated on a scale from 0, meaning the person did not manifest it, to 2, meaning he or she definitely did. The total score was 40, and a person was diagnosed as a psychopath if his or her score fell between 30 and 40. (In some places, a cut-off score of 25 is useful.)
To help others with scoring, Hare put together a brief informal manual consisting of about twenty pages, and this was passed around. As more people used the scale and sent Hare their ideas and results, the manual grew in thickness. Finally in 1991, Hare formally published it with Multi Health Systems, which currently distributes it to qualified professionals. Throughout the rest of the decade, more researchers affirmed the PCL-R's reliability and validity with male forensic populations, and some branched off into work with adolescents and with females. Cross-cultural studies showed that the concept of psychopathy, as measured by the PCL-R, was generalizable.
According to Hare in an article published in 1998, "Psychopathy is one of the best validated constructs in the realm of psychopathology." The PCL-R generated a dramatic increase in basic research on the nature of psychopathy and on the implications of the disorder for the mental health and criminal justice systems.
Once it was clear that the PCL-R yielded such solid results, it was time to reach a larger audience than professional diagnosticians—people who might be the victims.
The Psychopath Defined
The work of Hare and his associates clarified a set of diagnostic criteria that offers a practical approach to both the assessment and treatment of psychopathy. The PCL-R items are grouped around two basic factors, affective/interpersonal features and socially deviant lifestyle (both of which have been divided further into four facets, two each for the two factors). Refocusing the idea of antisocial personality disorder, psychopathy is characterized by such traits as
- lack of remorse or empathy
- shallow emotions
- manipulativeness
- lying
- egocentricity
- glibness
- low frustration tolerance
- episodic relationships
- parasitic lifestyle
- persistent violation of social norms
It remained to translate the academic and professional work into a form that ordinary people could understand, so in 1993, Hare published Without Conscience. His purpose was to warn people about those predators who walked among them, and to provide a way for those with shattered lives as the result of an encounter with a psychopath to deal with it. He believes that, for their own protection, it's crucial that people learn to identify a psychopath who may be very close to them.
Too many people hold the idea that psychopaths are essentially killers or convicts. The general public hasn't been educated to see beyond the social stereotypes to understand that psychopaths can be entrepreneurs, politicians, CEOs and other successful individuals who may never see the inside of a prison and who don't commit violent crimes. However, they do often commit violations of another sort: They exploit people and leave them depleted and much the worse for the encounter. They prove to be treacherous employees, conniving businessmen, or immoral officials who use their position to victimize people and enrich themselves.
Hare says that we know little about these individuals in terms of systematic study about how the disorder manifests in the public at large. Nevertheless, there are indications that the personality structure and propensity for unethical treatment of others is common to both criminal and noncriminal psychopaths.
What's missing in psychopaths are the qualities that people depend on for living in social harmony. In this book, Hare estimated (conservatively) that there were more than two million psychopaths in North America. "Psychopathy," he insisted, "touches virtually every one of us."
Yet while not all killers are psychopaths, and not all psychopaths are killers, Hare does describe cases of conscienceless killers who appeared to show no human feeling for their victims. Among them, Hare listed:
John Wayne Gacy, who murdered at least 33 young men and buried most of them in the crawl space beneath his house
Ted Bundy, who murdered more than two dozen young women in the 1970s, going into several different states to claim his victims
Joe Hunt, who conned a gang of young men into a bogus money-making scheme that escalated into murder
Clifford Olson, who manipulated the Canadian government to pay him a substantial amount to show officials where he had buried his murder victims
Diane Downs, who shot her two children to attract a man who didn't want them, and then claimed that she was the victim
The type of violence in which they engage is qualitatively different from that of non-psychopathic offenders in that it is likely to be more predatory, motivated by identifiable goals, and carried out in a calculated manner without an emotional context. They tend not to commit crimes of passion, such as during a domestic dispute or extreme arousal. Some theorists believe that psychopaths may be motivated by weak emotions breaking through weaker restraints. They may simply be reacting, showing off or exerting control as a means of proving themselves. For the most part, their crimes are cold-blooded, and they felt excited by them rather than guilty. In those who are serial killers, there appears to be a strong tendency toward sadism.
The point is, these offenders find victims easily because they were glib, charming, manipulative, and predatory, while their victims are generally naïve. Psychopaths would realize less success if their targeted victims were savvier.
But what can people really do? Can this objectionable behavior be eradicated, or is there something biologically amiss with psychopaths that may give them an enduring place among us?
Psychopathy and the Brain
In a segment of "The Mind," a PBS documentary that looked at many aspects of behavior and the brain, Hare assessed "Al," a middle-aged man with 46 convictions for criminal acts from drugs to bank robbery. Using a neurological diagnostic test to eliminate obvious brain damage, Hare's team then gave Al tests that measure the processing of language. The question under investigation was whether or not there is something measurably different about the brain of a person who has been so socially deviant.
In a clinical interview, Al admitted to being extraordinarily good at lying; said he was never diagnosed as hyperactive; grew up in a violent area of Vancouver, BC, in Canada; and recalled incidents in which he had acted out in anger or in irrational ways, just to prove something about his macho self-image. He felt no concern for his victims, he says, or any remorse.
By the time he was 15, he was in prison, where he mingled with hardcore prisoners. He became more sensitive to how others treated him, and more reactive. He ended up stabbing someone.
Hare first tested Al on a dichotic listening device, through which words came to him via alternating ears. The results appeared to be consistent with the evidence that psychopaths may not process words primarily by left hemisphere activity, but instead involve both hemispheres equally.
The next test was even more revealing. Al watched different words come onto a monitor screen. Some of the words were generally considered to have emotional associations and others were considered neutral. Whereas most people respond more quickly to emotional words, Al's response time was the same to both emotional and neutral words.
"The impetus for this research," Hare says for the documentary, "is the clinical observation that psychopaths can say one thing and do something else. This has perplexed a lot of people. Is it simply lying, dissimulation, or hypocrisy? Probably not. There's more than that involved in it."
Hare points out that some people have described psychopaths as somewhat robotic, two-dimensional, emotionally shallow, and lacking in conscience. They may know intellectually they should not do something, but without the feeling component there could be less motivation to respond to the moral imperative. Their inhibitions for antisocial or violent behavior are much weaker than in normal individuals, and they readily learn and adopt behavior patterns that involve manipulation, deception, and violence to attain their own ends.
Because they don't understand the feelings of others and don't feel remorseful for harming them, psychopaths can easily rationalize their violence or deception as acceptable behavior.
Hare and his colleagues continued this research to learn more about the brain's involvement in psychopathic behaviors. They used whole brain functional magnetic resonance imaging (fMRI) to see if there were neurological manifestations of the way psychopaths process different types of words. When non-psychopaths processed negative emotional words (e.g., rape, death, cancer), activity in the limbic regions of the brain increased. For psychopaths there was little or no increased activity in these regions. Curiously, however, there was increased activity in other areas. In short, the emotional word does not have the same limbic implication for psychopaths that it does for normal people.
"They seemed to be like Spock or Data on Star Trek," Hare explains, "What I thought was most interesting was that for the first time ever, as far as I know, we found that there was no activation of the appropriate areas for emotional arousal, but there was over-activation in other parts of the brain, including parts of the brain that are ordinarily devoted to language. Those parts were active, as if they were saying, 'Hey, isn't that interesting.' So they seem to be analyzing emotional material in terms of its linguistic or dictionary meaning."
Yet Hare does not think that psychopathy is caused by brain damage. Instead, he says, "there are anomalies in the way psychopaths process information. It may be more general than just emotional information. In another functional MRI study, we looked at the parts of the brain that are used to process concrete and abstract words. Non-psychopathic individuals showed increased activation of the right anterior/superior temporal cortex. For the psychopaths, that didn't happen."
Hare and his colleagues then conducted an fMRI study using pictures of neutral scenes and unpleasant homicide scenes. "Non-psychopathic offenders show lots of activation in the amygdala [to unpleasant scenes], compared with neutral pictures," he points out. "In the psychopath, there was nothing. No difference. But there was overactivation in the same regions of the brain that were overactive during the presentation of emotional words. It's like they're analyzing emotional material in extra-limbic regions."
Does this mean they're trapped in a certain way of being? Is treatment even possible?
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