Impact News

Responding to Violence, Suicide, Psychosis and Trauma

A psychopath can go far

From , February 9, 2009

I must have been seven or eight. A circle of older boys had gathered in a corner of the park behind the war memorial, laughing and cursing. At the centre of the circle there was a brick and, lashed to the brick, a frog. Inside the frog’s mouth was stuffed a firework. I turned and ran as Vince, the unsmiling leader of the gang, was lighting the touch paper. You kept your distance from Vince. He was a psychopathic bully who took the pennies from your pocket and smacked your ears with catapult elastic. He enjoyed smashing windows. These days he would probably bear the label “conduct disorder”, no doubt graduating to “antisocial personality disorder” (APD) at the qualifying age of 18. But to my juvenile eyes he was evil personified.

The National Institute for Health and Clinical Excellence (NICE) recently published guidelines on the treatment, management and prevention of APD, which is found in 3 per cent of men and 1 per cent of women. It’s an admirable document, setting out a framework for care across mental health services, social care and the criminal justice system. But between the lines of constructive concern and optimistic practical advice one can’t help but read the chill signs of hopelessness. APD may be a problem without a solution. Characterised by exploitative and aggressive behaviour, reckless impulsivity and deceitfulness, and strongly associated with criminality (evident in around 50 per cent of the prison population), the condition is inherently difficult for clinicians to deal with. The causes are complex and poorly understood and it is not easily remediable through psychotherapy or drugs.

APD is a personality disorder – an enduring and troublesome pattern of experience and behaviour that deviates markedly from the expectations of the individual’s culture. The NICE guidelines set out some important principles of care. People with APD should not be excluded from health and social care services on grounds of being “difficult”. On the contrary, efforts should be made to engage with, and motivate, such people. Treatment interventions are more likely to be effective if relationships are optimistic and trusting as opposed to punitive. The need to identify children at risk of developing conduct disorder is also rightly emphasised.

I have no idea what became of Vince but, if they don’t land you in jail, certain psychopathic traits (superficial charm, grandiosity, pathological lying, etc.) can come in handy for a career in business, say, or politics. At least one young boy who liked to blow up frogs with firecrackers grew up to be President of the United States.

Filed under: Other Mental Health, Violence

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