Psychopathy as a defense against psychosis? How?

February 15, 2015 5:55 AM

In the seminal work on psychopathy, writer Hervey Cleckley says this. I have tried hard to get my head around it. Can anyone shed some light?

I initially assumed he meant psychopathy was a defense against the psychopath's potential underlying psychosis, (inspite of the fact they are quite different things). Now I've read this and am even more confused.

Does he mean through projecting his/her split off (undesirable) traits onto a target/disowning them (the psychopath), the 'psychotic' paranoia subsequently generated in the target needs to be defended against by the psychopath?

posted by tanktop to Human Relations (4 answers total)

It looks like earlier in the paragraph, he outlines a situation in which a person is experiencing hallucinations and or delusions and the person acts violently in order to stop what the person believes is actually a threat. Schizophrenic symptoms cycle, as you may know, and it appears in this situation, the person is given anti-psychotic medication and their hallucinations and/or delusions recede, but they continue to exhibit psychopathic traits (intimidating the nursing staff is mentioned), which, as stated earlier in the citation from Hale on pg. 4, is believed to be in itself a prelude to a psychotic episode.

In this context, it seems like the author is trying to say that the nurses in charge of the patient are under the belief the patient does not actually suffer from schizophrenia, seeing that the patient's aggressive demeanor and current lack of any hallucinations or delusions (falling under Cleckley's definition of psychopathy) seem to suggest a diagnosis of psychopathy instead and provides a defense against the assertion that the patient is actually suffering from schizophrenia. The author goes on to state that Hale believes both diagnoses would be appropriate.

You may have read elsewhere that Cleckley believed psychopathy and psychosis were mutually distinct, and hence the existence of one would provide a defense against the assertion that one is suffering from the other. I included parts of an excerpt from The Mask of Sanity, by Hervey Cleckley, 5th edition, below:

Not only is the psychopath rational and his thinking free of delusions, but he also appears to react with normal emotions. . . .

There are usually no symptoms to suggest a psychoneurosis in the clinical sense. In fact, the psychopath is nearly always free from minor reactions popularly regarded as "neurotic" or as constituting "nervousness." . . .

It is true he may become vexed and restless when held in jails or psychiatric hospitals. This impatience seems related to his inability to realize the need or justification for his being restrained. What tension or uneasiness of this sort he may show seems provoked entirely by external circumstances, never by feelings of guilt, remorse, or intrapersonal insecurity. Within himself he appears almost as incapable of anxiety as of profound remorse.

If my reading was right, I think it was a poor choice of words seeing as the author in the previous page speaks on the patient "defend[ing] against psychotic anxieties with violence."
posted by sevenofspades at 8:06 AM on February 15, 2015 [1 favorite]

Isn't psychopathy generally seen these days as being nuerologically based? The differences from the normal population in the amygdala and the frontal lobe with the under-active fear center and decreased ability for executive planning making them act impulsively and without remorse?
posted by Che boludo! at 1:43 PM on February 15, 2015

Response by poster: There's a lot of theories - it's generally thought to be triggered by the interplay of genetic/neuro and environmental factors/triggers (a pro-social/healthy environment may buffer it coming into fruition at least to some extent).
posted by tanktop at 1:55 PM on February 15, 2015

Hi tanktop, I'm not sure if you mean wrapping your head around what his argument was supposed to be initially, but I can tell you that this is definitely not considered accurate in contemporary neuroscience/psychology. In fact, any mention of the word 'defense' is aligned with Freudian analytic thinking about psychopathology (the defense mechanisms), which are no longer considered useful explanations of symptomology. That is my understanding of what Cleckley means - that as a defense mechanism against disordered thinking, the individual develops callous, unempathetic and antagonizing behavior toward others, perhaps to externalize his disordered thinking. That there is some silly malarkey.

At this point in time, psychosis and psychopathy are not at all considered to have related roots by science or medicine. Is that helpful?
posted by namesarehard at 11:22 AM on February 17, 2015