Education

Psychopathy

The psychopath has the image of a cold, heartless, inhuman being. But do all psychopaths show a complete lack of normal emotional capacities and empathy?

Psychopathy is characterized by diagnostic features such as superficial charm, high intelligence, poor judgment and failure to learn from experience, pathological egocentricity and incapacity for love, lack of remorse or shame, impulsivity, grandiose sense of self-worth, pathological lying, manipulative behavior, poor self-control, promiscuous sexual behavior, juvenile delinquency, and criminal versatility, among others.As a consequence of these criteria, the image of the psychopath is that of a cold, heartless, inhuman being. But do all psychopaths show a complete lack of normal emotional capacities and empathy?

Like healthy people, many psychopaths love their parents, spouse, children, and pets in their own way, but they have difficulty in loving and trusting the rest of the world. Furthermore, psychopaths suffer emotionally as a consequence of separation, divorce, death of a beloved person, or dissatisfaction with their own deviant behavior

Sources of sadness

Psychopaths can suffer emotional pain for a variety of reasons. As with anyone else, psychopaths have a deep wish to be loved and cared for. This desire remains frequently unfulfilled, however, because it is obviously not easy for another person to get close to someone with such repellent personality characteristics. Psychopaths are at least periodically aware of the effects of their behavior on others and can be genuinely saddened by their inability to control it. The lives of most psychopaths are devoid of a stable social network or warm, close bonds.

The life histories of psychopaths are often characterized by a chaotic family life, lack of parental attention and guidance, parental substance abuse and antisocial behavior, poor relationships, divorce, and adverse neighborhoods.These persons may feel that they are prisoners of their own etiological determination and believe that they had, in comparison with normal people, fewer opportunities or advantages in life

Despite their outward arrogance, psychopaths feel inferior to others and know they are stigmatized by their own behavior. Some psychopaths are superficially adapted to their environment and are even popular, but they feel they must carefully hide their true nature because it will not be acceptable to others. This leaves psychopaths with a difficult choice: adapt and participate in an empty, unreal life, or do not adapt and live a lonely life isolated from the social community. They see the love and friendship others share and feel dejected knowing they will never be part of it

Psychopaths are known for needing excessive stimulation, but most foolhardy adventures only end in disillusionment because of conflicts with others and unrealistic expectations. Furthermore, many psychopaths are disheartened by their inability to control their sensation-seeking and are repeatedly confronted with their weaknesses. Although they may attempt to change, low fear response and associated inability to learn from experiences lead to repeated negative, frustrating, and depressing confrontations, including trouble with the justice system.

As psychopaths age, they are not able to continue their energy-consuming lifestyle and become burned-out and depressed while they look back on their restless life full of interpersonal discontentment. Their health deteriorates as the effects of their recklessness accumulate

Treatment

In the past decade, neurobiological explanations have become available for many of the traits of psychopathy. For example, impulsivity, recklessness/irresponsibility, hostility, and aggressiveness may be determined by abnormal levels of neurochemicals, including monoamine oxidase (MAO), serotonin and 5-hydroxyindoleacetic acid, triiodothyronine, free thyroxine, testosterone, cortisol, adrenocorticotropic hormone, and hormones of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes.

Other features, such as sensation-seeking and an incapacity to learn from experiences, might be linked to cortical underarousal.Sensation-seeking could also be related to low levels of MAO and cortisol and high concentrations of gonadal hormones, as well as reduced prefrontal gray matter volume.9 Many psychopaths can thus be considered, at least to some degree, victims of neurobiologically determined behavioral abnormalities that, in turn, create a fixed gulf between them and the rest of the world

It may be possible to diminish traits such as sensation-seeking, impulsivity, aggression, and related emotional pain with the help of psychotherapy, psychopharmacotherapy, and/or neurofeedback. Long-term psychotherapy (at least 5 years) seems effective in some categories of psychopaths, in so far as psychopathic personality traits may diminish

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