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“Psycho” – Psychopath? Psychotic? Psychological bullshit?

The Psychopath – favourite of Hollywood and tabloid journalism alike. This week’s Freudian Script attempts to clarify the definition of psychopathy, identify people wrongly called psychopaths, and uncover how you can write better psychopaths.

DISCLAIMER: This blog post is designed for writers of fiction. If you are concerned that you or someone you know has symptoms of mental health problems, please see your doctor instead of doing a test on the internet.

What is a psychopath?
Unlike other conditions I have detailed in this series, psychopathy is a murky concept at best and is often the subject of controversy. I will therefore digress into the details of classification to shed some light on the problem.

Psychopathy is considered a personality disorder, often sub-typed under either anti-social or dissocial personality disorder – depending on your classification system. The International Classification of Diseases (ICD-10), baby of the World Health Organisation and preferred by UK psychiatrists, bundles the term in under dissocial personality disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V), beloved child of the American Psychiatric Association and used by most psychologists, revised their classification this year and shuffled around their personality disorder categories to form Antisocial/Psychopathic personality disorder.

The reason I have bored you to tears with the minutiae of classification is the important distinction in criminal law. In the UK, psychopathy is not recognised as a distinct entity and those with dissocial personality disorder are more likely to wind up in prison than a secure psychiatric hospital. However, in the United States, the psychopath label affects sentencing, likelihood of bail, imprisonment, parole and whether a juvenile should be tried as an adult.

In both cases, whether or not you are a psychopath is determined by a test.

Are You A Psychopath?
The Hare Psychopathy Checklist-Revised (PCL-R) has recently garnered publicity in the UK when Channel 4 had a Psychopath Night. Part of their “celebrations” included a cute little test that you could take to see if you were a psychopath.

Some advice? Never take a test on the internet. They prove only that there is no limit to the number of morons who want to take tests on the internet.

The PCL-R is a specialist test for which practitioners need to take a course and involves a semi-structured interview. (Interesting aside: the threshold score in the UK is 25, but in the US, it’s 30). It is the best guide we have on the defining traits of a psychopath and is based on three categories:

> Boldness – increased risk-taking and self-confidence, with a very high fear and danger threshold.
> Disinhibition – poor impulse control, demand for instant gratification, difficulty resisting making fantasy reality
> Meanness – lack of social empathy, disdain for close attachments, exploitation and manipulation of others for their own ends

(Wiki has a nice breakdown of the sub-traits)

Not A Psychopath
Due to Hollywood and, that bane of mental health accuracy, tabloid journalism, let’s make a list:

sun-mental-patients-front-page

Psychopathy =/= Psychosis
These are two completely different things. Sadly, the word “psycho” has been used interchangeably with both psychotic and psychopath, all completely devoid of sense. Often, when you see any of these words in a newspaper, the implication is “mad and dangerous”. For more on the media’s role in perpetuating mental health stigma, I recommend the research of Mary O’Hara.

Psychopath =/= Murderer
Not all psychopaths are murderers and not all murderers are psychopaths. Not even all serial killers and mass murderers are psychopaths. While the definition doesn’t nail it to the mast, there is a high probability of criminality but it doesn’t need to be fatal or even violent.

Psychopath =/= Intellectual
In Hollywood, all psychopaths are smart, calculating and one step ahead of the good guys. They are also usually successful, cultured and middle class. This makes for interesting plotlines and witty banter. However, IQ is not part of the equation – some studies have even suggested that psychopathy is associated with low IQ.

The grandiosity associated with the disorder does not have to be remotely true. Charm, however, is very important – the cliché goes that if you walk into a room with a reportedly hideous person and leave feeling pleasantly inclined, you have just met a psychopath. Deception forms a large part of the personality, which includes the clinical and colloquial term “pathological liar”, and this can lead to a “con man” lifestyle.

There have been loud noises about psychopathic traits being beneficial to certain careers – corporate CEOs and surgeons foremost among them. There is a certain truth to this, but the emphasis here is on traits. Whether that crosses over into the pathology of psychopathy (remember that threshold?) is debatable.

And finally…

Sherlock =/= psychopath/sociopath/any such thing
I suppose we had better start with the difference between a psychopath and a sociopath. Bluntly, there isn’t really a distinction. Sociopathy and psychopathy are sometimes used interchangeably – the two terms came from parallel areas of research.

I imagine Sherlock may be referring to one of Hare’s distinctions that psychopathy is amoral and sociopathy is merely having right/wrong views that differ from the norm. He may also have fixated on the meanness element, using his lack of strong personal relationships as evidence (a theme built upon by the first season of Sherlock – “I don’t have a heart”, etc.)

However, I think John Watson’s assertion in Season 2 that Sherlock has Asperger’s Syndrome is closer to the mark (an area to be explored in an upcoming instalment of Freudian Script).

Writing psychopaths
My first question is this: does this person need to be a psychopath?

Hollywood is glutted with psychopaths. From Hannibal Lecter to Dexter, every man with a sideline in murder is a bloody psychopath. The danger with this default is that it can make for lazy writing. As Castle explains in his eponymous pilot: “At one death, you look for motive. At two, you look for a connection… At three, you don’t need motive because mentally unstable serial killers don’t usually have one.”

If you do want to write a psychopath, consider going against the grain. Think about focussing on a different strain of criminality – why so many heartless murderers and loveable con men? Consider Danny Ocean or Dominic Cobb as psychopaths. I’d like to see more characters like Simon from Trance – the antiquities trade is the biggest industry of organised crime, after all.

Also, if your character secretly has a heart of gold, he is not a psychopath. He is probably using an array on unhealthy defence mechanisms instead. Psychopathy is resistant to management and treatment, on the whole, though some people just learn to cover better – that charm, again.

I would also like to see more female psychopaths. Not a territory readily explored, because serial killer profile tends towards male and violence against women is endemic in Hollywood culture. Find me a psychopathic con woman and I will delight in watching that movie.

Who are your favourite fictional psychopaths? How do they measure up to the traits described? And how could you improve upon the depiction, armed with knowledge?


If you need advice or guidance on writing a character with a mental illness, please contact me by e-mail or in the comments below – I am always happy to help out!

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