Saturday, 21 June 2014

Can you quantify normality?

In the Broadmoor Psychiatric Hospital, there is a patient named Tony. Originally, he was arrested for grievous bodily harm, but on arrival to his designated prison, he decided to fake madness to get out of his sentence. He assumed he would have an easier and cushier life and expected to be moved to a local hospital, but instead was moved to Broadmoor – the hospital that has previously housed the Yorkshire Ripper and Ian Brady (the Moors Murderer). In a case similar to the Rosenhan Experiment (discussed in my post last week), Tony was admitted to Broadmoor immediately after discussing his symptoms, which he came up with by plagiarizing films like ‘A Clockwork Orange’ and ‘Blue Velvet’. However, upon arrival Tony realized he’d made a mistake and wanted to go back to his original prison – but the more he tried to convince doctors and nurses he was sane, the more they took this as evidence that he was not. That was more than 15 years ago, and he is still a patient at Broadmoor. It is definitely easier to convince someone you are insane than the other way around.

Ian Brady, the Moors Murderer and a fellow patient of Tony's at Broadmoor
Source: PA
The case of someone like Tony shows how thin the line between normality and abnormality can be. However, can you take Tony’s word for it? Should you? His story is described in Jon Ronson’s ‘The Psychopath Test’, and later it becomes clear that maybe this is not the case.

Ronson later emails the chief clinician that oversees Tony, Professor Anthony Maden, and brings up the fact Tony says he faked his way in. Maden replies that this was indeed the case, but this does not mean he is free from a mental disorder. In fact, it is quite the opposite. Maden’s reply reads, “most psychiatrists who have assessed him, and there have been a lot, have considered he is not mentally ill, but suffers from psychopathy”. It turns out, that faking mental illness to get out of a prison sentence is exactly what you “should expect” from a psychopath.

Brain scans of different people, one mentally healthy (top)
and one diagnosed with psychopathy (bottom).
Source: James Fallon
Psychopathy is defined as a personality disorder characterized by antisocial behaviour, reduced empathy or remorse and bold behaviour. An example of this is described by a neurologist named Essi Viding, who studies psychopaths. In Ronson’s book it states that she once showed a photo of a frightened face to one of her subjects and asked him to identify the emotion. The subject could not identify it, but said it was the face people pulled right before he killed them. This lack of empathy/emotional connection is typical of a diagnosed psychopath.

Interestingly, the Diagnostic and Statistical Manual of Mental Disorders (a book I have mentioned in previous posts) does not contain “psychopathy” as a disorder. This is due to the fact that traits such as empathy cannot be quantified. Instead, in an attempt to classify the disorder, the Canadian psychologist Robert Hare developed a checklist in the 1970s. The checklist (Hare Psychopathy Checklist-Revised, or PCL-R) contains 20 psychopathic characteristics, such as lack of remorse/guilt, early behaviour problems and pathological lying. When using the checklist on a potential patient, you give 0 points if the characteristic does not apply, 1 if it does somewhat, and 2 if it fully applies to the person in question. The PCL-R is used in conjunction with interviews and discussions with therapists, but the final score you receive greatly affects your diagnosis.

There are of course criticisms of this method of diagnosing psychopathy. For me, the acceptance and widespread use of Hare’s checklist raises issues. I agree completely with diagnosing physical issues with a checklist method – such as assessing the appearance or size of an affected area. But every brain and mind is entirely different, even if two people suffer from the same mental disorder, and therefore I think it would be unlikely that a condition as complex as psychopathy could be easily defined with a 20-point checklist. However, many conditions within the psychiatry/psychology world are diagnosed in this manner, and maybe the use of Hare’s checklist just brings to light the idea that maybe we are diagnosing mental disorders incorrectly.

What do you think?


  1. What an interesting and amazingly thought out post, Emily. I love how you used the study of a psychopath to explain the difference between psychopathy and mental illness. If a psychopath does not understand emotions, then do they realize that what they are doing is wrong? It is also weird that the psychopathy test is only a 20-point system. Do you know if they checked if he had a mental illness when he was moved to Broadmoor, or did they just take his word for it? This seems very well researched, is amazingly written, and is a great addition to your already fantastic blog.

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