This series is reprinted with permission from my friend and fellow mental health nurse Felicity Stockwell. Her complete writings can be found on her website at http://www.felicitystockwell.com/

I’m grateful to Felicity for agreeing to let me publish her work here.

Psychopathic Personality

” The prototypical psychopath has deficits or deviances in several areas,  interpersonal relationships, emotion, and self-control. Psychopaths gain satisfaction through antisocial behavior, and do not experience shame, guilt, or remorse for their actions. Psychopaths lack a sense of guilt orremorse for any harm they may have caused others, insteadrationalizing the behavior, blaming someone else, or denying it outright. Psychopaths also lack empathy towards others in general, resulting in tactlessness, insensitivity, and contemptuousness. All of this belies their tendency to make a good, likable first impression. Psychopaths have a superficial charm about them, enabled by a willingness to say anything without concern for accuracy or truth. Shallow affect also describes the psychopath’s tendency for genuine emotion to be short lived and egocentric with an overall cold demeanor. Their behavior is impulsive and irresponsible, often failing to keep a job or defaulting on debts. Psychopaths also have a markedly distorted sense of the potential consequences of their actions, not only for others, but also for themselves. They do not, for example, deeply recognize the risk of being caught, disbelieved or injured as a result of their behaviour.”

The above passage is one of many similar ones, taken from the internet. There is a common understanding of the behaviours that psychopaths show, but no agreement as to their causation. There is also no understanding of what the experience of ‘being’ a psychopath is.

In 1959 I did my psychiatric nurse training at a hospital that was experimenting with socialising activities as a means of treating and caring for the mentally ill. In the training school we were taught ‘when mothers nurtured their babies, they set up a process whereby the babies ‘learned to need’ love’. The love is made up of approval and acceptance by other people, and affords self-esteem and self-confidence, and with all the physical needs being, met leads to feelings of contentment. But if the needs are not met it leads to anxiety, and mentally ill people are all anxious, therefore if they are given ‘ego’ enhancing care, with plenty of activity in a friendly environment, it should help them to recover. I saw this evidenced in practice, as a student and as a ward sister.

While doing my training I visited the unit that Maxwell Jones set up to try and socialise psychopaths. He explained that the main problem that psychopaths caused society was their rejection of authority and their inability to form relationships, and attempts to ‘treat’ them failed, because they did not ‘own’that they had problems. His solution was to admit thirty male and female people, who had been diagnosed as psychopathic, to a run down ward block at Belmont Hospital. There were to be no ‘staff’ to look after them – only some Swedish social workers to keep an eye on things, and there were only three rules:- They must attend the three daily group sessions; they must pay for the repair or replacement of anything they broke; they must be in the building at night from 10.0pm. One of the groups was for democratic decision making about running the unit and dealing with interpersonal difficulties, and deciding about people wanting to leave or needing to be pushed out. They also had the final decision about allowing new applicants to join them.

I  was among a group of students who were invited to sit in on one of the afternoon group sessions. These were set up specifically to encourage group cohesion among the residents, and people from all walks of life were invited to come. It was effective because whoever the visitors were, they were appalled at the dirt and squalour of the place and the surly, scruffy people scowling at them, who were adept at cutting them down to size. So the visitors would retaliate and so upset someone that they would rush from the room, quickly followed by a couple of their mates. A few minutes later they would return to a very warm sympathetic welcome from the rest of their group.                                                    

At the time I realised that something significant was happening, and it was only much later that I recognised that the incident provided a ‘real’ learning experience for the individual, of what it feels like when someone, and a group of people, really likes you and wants you to belong with them. It was not until much later that I understood the significance of  what I learned from those incidents, and this was to realise why conventional psychiatric teams were unable to help psychopaths, because they were always manoeuvered into being angry or patronising, and then much later to understand why this happened.

I have to type this section in green because although other people’s work has given me some corroborative facts, I have been unable to confirm the overall accuracy of my understandings of psychopathic/sociopathic personality disorder.

I suggest that, for whatever reason, some infants fail to have the Bonding Process initiated during the vital months of opportunity for it to be established. This may be for a variety of reasons, such as the mother or the baby being too ill, or a cultural practice of taking babies away from ‘unsuitable’ mothers. There may well be others to provide physical care and nourishment, but it is likely to be with limited time given by several people, and will not give the unstinted time and repetitive input of sight, sound touch that facilitates the bonding process.

The result is that the monitoring system that initiates pleasure when Social Needs are met, and distress when they are not, is not functional and the infant has to grow up without ever experiencing the pleasure of social approval and love. Equally they do not experience the negative feelings of humiliation, punishment and rejection. The only feelings they do have are the buzz of excitement that can come alongside fear, e.g. rollercoasters, and the physiological ‘high’ of sexual arousal. They may well realise that other people have something that they lack, and can try imitating behaviour that they see, but it is never rewarding or punitive.

Psychotic disorders

Schizophrenia, in its various manifestations, and ‘endogenous’ depression are still not fully understood, but it is accepted that they are caused by disorder of some neuro-chemicals, which can be countered in some degree with various drugs.

What is not always recognised is that, because the symptoms alienate other people, the sufferers Social Needs are not met, and there is an additional release of adrenalin and cortisol. This exacerbates the symptoms and the distress, makes communication more difficult, and makes medication less effective.

Understanding that this aspect is part of the problem, suggests that enabling social engagement with sufferers from psychotic disorders should have priority in management and care. To understand that inside every rejecting or withdrawn patient, there is a lonely frightened person, longing for comfort and help, can motivate the carers to learn the skills that can side-step the psychotic symptoms and enable them to make contact.

It is sad that ’mental illness’ is still stigmatised, - and calling it ‘mental health problems’ does not seem to have helped – because stigma makes it much more diffficult to enhance an individuals self- esteem and self- confidence. This can also make much well intentioned caring from professionals, come across as ‘patronising’, which does more harm than good. It is an ongoing dilemma, to persuade individuals and ‘the community’ to be more accepting and kind, and it is good to be able to say that in  some localised situations this is being achieved, so there is hope.