Are Psychopaths Treatable?
Despite valiant efforts, the treatment of antisocial personalities by mental health professionals has been an abysmal failure. The shortest chapter in a psychiatric textbook is usually the one on the treatment of psychopaths. Psychopaths fear intimacy. They cannot accept criticism, though it might be constructive, or accept authority figures. They resent anyone who attempts to thwart their behavior, even though such thwarting might be in their best interest. Often the victim of inconsistent parenting and of a chaotic family environment, the psychopathic person cannot trust the therapist enough to establish a treatment alliance between them.
Robert E. Hare, Ph.D., a prominent researcher and expert on psychopaths, does not recommend treatment. He advises: “Don’t waste your time. Nothing you can do can make a difference at all.” Furthermore, Dr. Hare suggests that psychotherapy for psychopaths is an oxymoron. “What do you treat? They have no subjective distress, they don’t have low self-esteem, they are not dissatisfied with their behavior. Do you treat personality traits that they don’t want to change?” In fact, a number of studies have found that psychotherapy is likely to make psychopaths worse.
One of the great psychological paradoxes that forensic psychiatrists uncover in some psychopathic criminals is the presence of a sadistic, punitive conscience. Not having had appropriate models for behavior in their childhoods, many never mature past the eye-for-an-eye, harsh, primitive conscience of the child. If their own conscience struck them down, its punishment would be awful. To escape that possibility, these psychopaths reject all moral standards and ideals. Thus it becomes extraordinarily difficult for them to face the emotional pain of their own punitive consciences.
In the course of my forensic practice, I once examined a 38-yearold man in jail who was accused of murdering a friend in the course of an argument. I was seeing him at the request of defense counsel to determine his competency to stand trial. He had experienced a brief psychotic episode in jail, so his competency was in doubt. This man had a long history of antisocial behavior. A number of psychiatrists in the past had made the diagnosis of antisocial personality disorder, which clearly was correct. I spent many hours examining this articulate man and found no evidence of psychosis. I believed he was quite capable of understanding the charges against him and assisting counsel in his own defense.
I was struck, however, by a strong moralistic streak that he expressed openly. He went out of his way to harshly condemn other prisoners, particularly those charged with child abuse or wife beating. As a younger man, he had wanted to be a preacher. My sense of this prisoner was that he was burdened by a rigid, lashing conscience that was constantly threatening him with destruction. He was driven to commit antisocial acts as a means of expiating his burden of guilt. He subconsciously saw to it that he was caught and punished. As it happened, he was released shortly after I examined him when another person confessed to the crime. Soon after, he hanged himself. I had the distinct impression that his sadistic conscience viciously raged at him because of the “undeserved” good fortune of his release, which, he concluded, demanded his death.
Psychiatrists who work in a noncriminal setting are not ordinarily sought out for treatment by the psychopath unless the psychopath is in the midst of a legal crisis or some other sort of trouble. In difficult situations, the psychopath pressures the psychiatrist to remedy his situation, not himself. Medications are of little use with the psychopath and are likely to be abused. When a psychopath becomes depressed or anxious, however, medications may help these symptoms. If he or she is incarcerated and unable to act out, painful symptoms of anxiety, depression, or even psychosis may emerge that are more amenable to treatment.
Memberships in altruistic organizations such as the Guardian Angels or self-help groups such as Alcoholics Anonymous or Narcotics Anonymous may redirect a psychopath’s antisocial impulses into productive channels. For a few psychopaths, some improvement in their condition comes with age. Although re-arrest levels are high for criminal psychopaths, a decrease in the rate of recidivism does occur with increasing age. However, the psychopathic personality traits and the propensity toward violence continue unabated.
This finding gives little support to the theory that antisocial personality disorder is the result of delayed maturation. The notion that psychopaths are merely developmentally arrested children is badly flawed. Children who go through normal stages of development have a vastly different growing-up experience than do children who become psychopaths. On a sweltering summer day, the aforementioned normal, thirsty 10-year-old who thinks he would gladly exchange his baby brother for a cold soda is expressing a normal impulse toward immediate gratification. But he does not make the swap. He knows full well that he must do no such thing.
The child who grows up in an environment rife with child abuse, parental separation or loss, and many of the other deprivational factors mentioned above cannot be said to have had a developmentally normal childhood with merely arrested development as a consequence. These are the children who go on to delinquent behaviors such as cruelty to animals, fire setting, truancy, running away from home, and forcing others into sexual activity. Some who engage in these activities have precursors of antisocial personality disorder such as attention-deficit/hyperactivity disorder accompanying conduct disorder. These disturbed children should be distinguished from other children with attention-deficit/hyperactivity disorder or conduct disorder, who may act impulsively but display age-appropriate empathy, relatedness to others, and conscience.
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Why Do They Rape?
The Inner Life of Rapists
A sudden blow: the great wings beating still Above the staggering girl.
—William Butler Yeats
Vicious attacks on women along the beaches of San Diego began in the spring. In the wee hours of one morning, while a couple was sitting on the beach, a lone male gunman with a nylon stocking over his head robbed them and raped the woman. On the Fourth of July, a man of similar description raped a woman at another beach. Two weeks later, at another beach, the gunman approached two young girls, ages 13 and 14, and ordered them to tie up their somewhat older male consort. After this, he repeatedly raped the girls. During the assaults, the attacker asked one of the crying girls to become more sexually involved in the act. He asked the other if she was a virgin, and when she said yes, the rapist said he would change that soon.
The police had very little to go on and no definite leads. They staked out decoy teams, but the rapist eluded them. Police officials trying to understand his pattern noted that he would generally force the female to tie up the male and to create the appearance of a robbery, with the rape almost incidental to it. They thought this method had a fundamental psychological purpose: taking pleasure in terrorizing his victims.
In the early hours of another summer morning, two men and a woman, all in their twenties, went for a swim at Torrey Pines State
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Beach, near San Diego. Although they had heard about a rapist, they did not let the stories deter them from their fun. As they emerged from the water, they were accosted by a man wearing a nylon stocking to conceal his face, dressed in dark clothes, and carrying a pistol. He ordered the woman to tie up the men. When she hesitated, he rammed the pistol against her head. As she began to cry, the attacker handed her his heavy-duty flashlight so he could tie up the second man himself. The man being tied up lunged at the attacker and was shot in the chest. During the scuffle that ensued, the second man was shot in the abdomen. The attacker also received a bullet wound and a bite before running off. The three victims made their way to a convenience store and called for help.
A few hours later, a man and his wife arrived at the emergency room of a university hospital in San Diego, seeking help. The man’s hand was injured, he told the emergency room doctors, when he was jumped by some men after his car had broken down. He was treated but was also investigated. When sand was found on his clothes, the investigators became suspic
ious. Next, they turned to the bite marks on his back and ear: those were found to match the teeth of one of the male victims of the dawn rape attempt, who was still undergoing surgery at a nearby hospital. The final piece of evidence sealing the case was the heavy-duty flashlight that the female victim had brought to the convenience store. On it was engraved the name of the man with the injured hand, Henry Hubbard. He was the last man the police would have suspected as the predawn rapist: a 30-year-old, model police officer with numerous commendations.
As the case readied for trial, facts came out about Hubbard. A few years earlier, he had starred in a local television documentary, The Making of a Cop. Hubbard had even once played baseball in the San Diego Padres minor league system. Fellow police officers who worked with him were shocked to learn that he had been the vicious rapist responsible for attacking not only the three people on the Torrey Pines Beach but also the victims in the earlier incidents. To his fellow officers, he had always seemed “normal.”
However, a psychological evaluation revealed that Hubbard’s father had regularly humiliated and abused him. On weekends, the father would slip into drunken rages and hit the boy and his mother, sometimes while brandishing a gun. During the week, the father was a sober, respected school administrator and teacher, but as the week ended, he became a monster. Hubbard, too, followed this Dr. Jekyll and Mr. Hyde behavior pattern. In his model police officer character, he was very kind and caring toward women, whereas as a rapist he turned cruel and vicious, lacking any sense of compassion or empathy. To Hubbard’s friends and fellow officers, the scariest aspect of the entire affair was his ability to function in an apparently normal way in society by day, yet become a violent rapist at night. He pleaded either guilty or no contest to numerous counts of kidnapping, robbery, rape, and attempted murder and received a prison sentence of 56 years.
Rape: New Definitions, New Terror
During the past decade in the United States, rape has increased four times as fast as the overall crime rate. In 2005, there were 191,670 reported victims of rape, attempted rape, or sexual assault; these figures do not include victims age 12 or younger. There were also rapes of young boys and men. The definition of rape is also shifting and expanding as our understanding of this crime increases. Basically, rape is considered a penetration offense. The FB I defines rape as “carnal knowledge of a female forcibly and against her will.” This is the definition that the FBI was still using in 2005, the most recent year for which figures are available, in compiling its Uniform Crime Reports. As written, the definition is controversial, because carnal knowledge refers to penile-vaginal intercourse only. In the FBI definition, the only exception to that notion is homosexual rape. However, the rape of men is not always perpetrated by homosexuals. This is just one of the reasons some states are revising the old definition of rape.
Newer statutes define rape as nonconsensual penetration of an adult or adolescent obtained by physical force, by threat of bodily harm, or when the victim is incapable of providing consent because of mental illness, mental retardation, or intoxication. These redefinitions go beyond penile-vaginal intercourse to include oral and anal sodomy, as well as penetration by fingers or objects other than the penis. They progress beyond the previous definitions to expand our understanding of the methods that are used to gain compliance. Furthermore, the sex of the offender in this definition is not specified. The emphasis is placed on the perpetrator’s violent acts rather than on what the victim experiences. In such reformed statutes, female-female, female-male, marital, and acquaintance rape are recognized. Even with this greatly revised definition, there are still problems with the way the statutes delineate the concepts of force and consent.
The FB I Crime Classification Manual (1992) lists 13 different categories or types of rape, including stranger rape, acquaintance rape, date rape, multiple or group rape, and marital rape. There are many categories in which the attacker is known to the victim; perhaps that person is a coworker, a fellow student, a relative, a neighbor or friend of the family. Almost two-thirds of all rape victims know their assailants. The figures on acquaintance rape are likely to be incorrect because this category of rape is underreported. The victim’s embarrassment about the crime is a significant factor in underreporting.
Serial Rapists
Those who rape three times or more, like Henry Hubbard, are known as serial rapists. These are not brooding loners, as popular understanding would have it, but are often articulate, highly intelligent men who hold jobs, have wives or girlfriends, and generally get along easily with others. The majority of serial rapists were sexually abused as children. Because rapists are extremely likely to repeat their crimes, the category really represents the difficulty that the authorities have in catching rapists—a process that usually takes a long time. In other words, the serial rapist category contains intelligent, cunning men who know how to cover their tracks. To ensure their continued “success,” serial rapists work to protect their identity. Their methods of operation vary with their age and experience. For instance, they may improve their techniques with information gleaned from reading newspaper accounts of similar crimes, by watching expert panels on television, even by attending courses on criminal justice and psychology. Serial rapists also become more proficient over time and are able to learn from their mistakes.
Nonetheless, each rapist displays certain characteristics and ritual approaches to the crime—and in the expression of these, he invariably leaves his “signature” at the crime scene, and on the victim. For example, Henry Hubbard’s signature was to force the rape victim to first tie up the man who was with her. These ritualized behaviors provide the authorities with important clues about the rapist’s fantasy life and motivation. Law enforcement officers are then able to work backward: from the what—the behavior—they can deduce the why—the fantasy and motivation—in order to eventually discover and apprehend the who.
Acquaintance Rape
Although girls are generally raised to be wary of strangers, they often do not expect to fear their friends. An assault by a monstrous psychopath lurking in the shadows may account for only one out of five rapes. It is the boy in math class, the guy in the adjoining office, or the friend of the brother who is more likely to be that girl’s or woman’s rapist. Familiarity with this person causes the potential victim to let down her guard, so that, after the event, the victim may even wonder if she was really raped. Unfortunately, both men and women have been socialized to think that male aggression leads to female sexual arousal. That may have been a motivating factor in Henry Hubbard’s demand that the victim become more sexually involved. In this scenario, a woman’s no is really a yes. Stereotypical thinking confounds the category of acquaintance rape for both perpetrator and victim. Was James Bond a rapist, or was he merely forceful, and were the many women he encountered simply compliant?
Date rape is only one kind of acquaintance rape. The public tends to believe that acquaintance rapes arise from dating situations that are sexually ambiguous. Some do. But in the most accurate rape study, the National Women’s Study, 20% of rapists were described as friends. Husbands committed 16% of rapes, boyfriends committed 14%, and 9% were ascribed to non-relatives such as handymen, coworkers, and neighbors. The acquaintance factor reduces the likelihood that a woman will be able to successfully fend off a sexual assault, particularly after the perpetrator gains entrance into the home.
In a study funded by the National Institute of Mental Health (NIM H), researchers found that the behavior of women attacked by acquaintances differed in two basic ways from the behavior of women attacked by strangers. Only 11% of acquaintance-rape victims screamed for help, compared with more than 21% of stranger-rape victims; and only half as many acquaintance-rape victims ran away, compared with stranger-rape victims. The study further showed that almost 20% of women from both groups physically struggled against their assailant—a fact that shows acquaintance rape is not just the result of a misunderstanding between amorous partners.
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The principal investigator of the N IM H study notes that 20 years of research has shown that screaming and running more often lead to foiling a rape than struggling does. Despite these findings, the vagaries of assailant, victim, and situation are such that no stock prescription for avoiding rape can be given. Experts in acquaintance rape suggest certain preventive measures, such as following one’s instincts about danger, using alcohol only moderately, avoiding men who drink heavily, running if attacked (no matter what the state of one’s undress), and always reporting attempted or completed rapes.
Spousal Rape
Spousal rape was officially recognized by the law in 1982, when, for the first time, a Florida man was pronounced guilty of raping his wife while she was living with him. All 50 states now have laws against marital rape. A majority of states, however, to avoid wandering into the thicket of tangled marital relationships, place added legal burdens on women who accuse their spouses of rape.
Group Rape
The FBI defines group rape as that committed by three or more offenders. If there are only two in the group, each is considered an individual rapist. In the group, dynamics such as contagious behavior and the defusing of responsibility are common. In highly defined groups such as gangs, the subculture may foster gang rape. Twenty percent of all rapes are group or “multiple” rapes. Perhaps the most notorious gang rape was that of the Central Park jogger, which occurred in 1989. In addition to raping the victim, a gang of youths bludgeoned her, beat her senseless, and left her for dead. She was discovered and taken to a hospital. Her attackers were eventually put on trial and convicted.
Bad Men Do What Good Men Dream: A Forensic Psychiatrist Illuminates the Darker Side of Human Behavior Page 8