Psychopathy: traditional and clinical antisocial concepts

Advances in our knowledge about the concept of psychopathy and the repeated occurrence of antisocial behaviors in the face of adversity and punishment have been limited by a complex interplay of conceptual and methodological issues that have not yet been addressed adequately by psychosocial scientists. Foremost among the problems facing clinicians and researchers interested in this topic is the lack of agreement on the meaning and labelling of the construct. Scholars have not reached consensus in describing a category within a diagnostic system that distinguishes a relatively homogeneous group of individuals sharing a set of characteristics, or a class of persons that can be identified reliably from those who exhibit other perhaps closely related behavioral abnormalities and so-called normal individuals. Disagreements about the construct in question have been sufficiently problematic that some researchers and clinicians have decided that the notion of psychopathy or APD, taken to represent a mental disorder, is simply a myth or a judgment label concocted to justify societal management of offensive and repugnant behaviors (cf., Blackburn, 1988; Lewis & Balla, 1975; Pilgrim, 1987). Scholars such as Holmes (1991) and Wulach (1983) have called for elimination of the category as a mental disorder diagnosis, because it offers an opportunity for making value assessments rather than clinically appropriate decisions. Few disorders described in our psychopathology nomenclature are associated with such markedly negative attributions as is psychopathy, whether defined in the American or British traditions. The logical underpinning of much work in the field equates psychopathy or APD with heinous forms of criminality, lifestyle criminality, and special cases of antisocial behavior. In keeping with tendencies for society to conceptualize psychopathy as extreme misbehavior and to decry its consequences is a paper by Wells (1988), which exemplifies the emotion-focused thought and rhetoric that have been mobilized in writings explaining the behaviors that are often subsumed under the psychopathy label. Given that this type of persuasion is more common than might be expected in an empirical literature, it is not surprising that some scholars have concluded that the term psychopathy is really relatively useless. On the other hand, the appeal of the realist approach to disease conceptualization, or the notion that such a disorder exists and therefore must have underlying causes, has defied elimination over the years.(ABSTRACT TRUNCATED AT 400 WORDS)