As individuals who allegedly lack capacities crucial to morality, psychopaths seem to offer significant potential insight into the relation between morality and the sentiments, the nature of moral justification and the boundaries of moral responsibility.  However, fruitful investigation of these issues requires a clear picture of what, exactly, distinguishes psychopaths from non-psychopaths.  While some general features seem to remain largely consistent across all descriptions of psychopathy (e.g., psychopaths lack empathy,  disregard the rights of others and display superficial charm) there is substantial disagreement over the precise nature of the condition.  Is psychopathy the result of a failure of feeling, or of understanding?   To what extent are the morally problematic characteristics of psychopaths explainable in terms of morally neutral characteristics?  Are psychopaths morally responsible for their actions?

This anthology includes a number of insightful papers dealing with these questions.  It is worthwhile for any reader interested in psychopathy as a psychiatric diagnosis, but it is likely to be of most interest to philosophers interested in metaethics, medical ethics and the philosophy of psychology.  The book would be appropriate for use in undergraduate courses focusing on ethics and psychiatry, particularly if accompanied by supplementary readings that provide some background on metaethical internalism and moral culpability.  

The first chapter is an introduction by editor Thomas Schramme, who does a fine job setting the stage for the essays that will follow.  Schramme notes that there are competing standards for psychopathy and substantial methodological and conceptual concerns about those standards.  His discussion raises serious questions about whether the individuals identified as “psychopaths” genuinely represent a single mental condition or character type.  These concerns are fruitfully addressed, although not settled, in the chapters to follow.  Schramme also provides useful context for the metaethical debates taken up in the book, clearly and concisely describing a number of philosophical issues relevant to psychopathy. 

Chapter 2, by Henning Sass and Alan Felthous, is an account of the history of the diagnosis of psychopathy, illustrating how the current usage of the term developed from a number of distinct diagnoses in the past, and how different disciplinary cultures and theoretical presuppositions contributed to the modern concept.  Sass and Felthous’s account is particularly interesting in its description of how the role of criminality became increasingly crucial to the concept of psychopathy over time.  Chapter 13, by Susie Scott, further investigates the role social forces play in diagnosis.  Her specific focus is on Dangerous and Severe Personality Disorder, a diagnosis established in the United Kingdom for the express purpose of providing a mechanism for controlling potentially dangerous individuals.  Based on extensive interviews with psychiatrists, nurses and social workers, Scott concludes that individual and disciplinary biases substantially influence which patients are labeled with DSPD, and hence subject to restraint by the state.  Although the diagnosis of DSPD requires particularly problematic evaluations of dangerousness, the substantial similarities between the criteria for the DSPD and common tests for psychopathy make her findings clearly relevant to the latter.   These findings suggest that diagnoses of psychopathy may be substantially influenced by factors such as instinctive personal reactions and professional incentives.  This apparent susceptibility to bias highlights the need for consistent standards of diagnosis, which in turn requires a clear conceptual grasp of what psychopathy is supposed to be.  Chapters 3-7 take up this question and attempt to provide analyses of how psychopaths differ from non-psychopaths. 

In one of the strongest contributions to the anthology, Heidi Maibom questions the claim that psychopathy is best explained as a lack of empathy.  She notes the ambiguity of the term “empathy” as used in the literature, and argues that many of the findings that purport to show reduced capacity for empathy fail to adequately distinguish among “a number of distinct emotions and attitudes, including sympathy, emotional contagion, perspective taking, personal distress, emotional reactivity to others, general arousal and social desirability.” (pg. 96)  By combining an insightful conceptual analysis of empathy and related attitudes with a careful review of empirical literature, Maibom convincingly argues that simplistic pictures of psychopathy as a straightforward emotional deficit are inadequate. 

In Chapter 3, Eric Matthews reaches similar conclusions to Maibom, arguing that psychopathy cannot be understood as merely a failure to experience certain emotions.  Rather, he argues, what allows psychopaths to count as distinct from non-psychopaths is a lack of moral rationality.  This lack is evident in psychopaths’ failure to distinguish moral rules from merely conventional rules, as well as their frequent inability to explain the moral character of their actions.  This latter type of expressive deficit is taken up in much more detail by Gwen Adshead in Chapter 5.  Adshead finds evidence of considerable narrative incoherence in interviews with individuals who meet diagnostic criteria for psychopathy.  She suggests that these individuals may be “incoherent moral reasoners” rather than “the amoralists so beloved of thought experiments.”  (pg. 129)

The question of whether or not psychopaths are capable of moral reasoning is central to a number of significant philosophical issues.   If psychopaths fully understand moral reasons, and do not act on those reasons simply because they do not care about them, then the existence of psychopaths might refute certain forms of metaethical internalism.  Furthermore, the question of whether psychopaths fully understand moral reasons is seen by a number of philosophers as central to determining the degree to which psychopaths should be held culpable for their actions.

Chapters 8 and 9 deal with questions of internalism. Walter Sinnott-Armstrong argues that the currently available research on psychopathy fails to support the claim that psychopaths refute internalism, because it does not clearly establish that psychopaths possess full rational understanding of moral claims, nor does it show that psychopaths lack all moral motivation.  Sinnott-Armstrong focuses on types of internalism that posit a link between motivation and morality on an empirical basis.  He notes that forms of internalism that understand this link as conceptual, rather than empirical, are not made vulnerable by empirical findings about psychopathy.  Thomas Schramme discusses such a form of conceptual internalism in Chapter 9, and asserts that caring about morality is integral to taking a moral perspective.  Gilbert Ryle noted that it seems inconceivable to forget the difference between right or wrong.  Schramme argues that this insight supports the notion that part of what it means for one to know the difference between right and wrong is that one takes a position of moral approval or disapproval.  On this view, psychopaths must be understood as incapable of full moral understanding, regardless of their apparent facility with reason in non-moral contexts.

A number of contributors address the moral culpability of psychopaths.  In chapters 11 and 12, David Shoemaker and Matthew Talbot come to significantly different answers to the question of whether psychopaths can be held morally responsible for their actions.  Shoemaker argues that psychopaths can be held criminally responsible for their acts, but not morally responsible, while Talbot argues that we can hold psychopaths morally responsible for their actions, even if certain types of related reactions, like resentment or the expectation of remorse, may not be appropriate.  In arguing for their positions on culpability, Shoemaker and Talbot raise a number of issues that are further evaluated in other contributions to the anthology.    Of particular interest is the debate over the degree to which psychopaths are appropriate targets of “reactive attitudes” of the sort discussed by Peter Strawson.    

 In his influential paper “Freedom and Resentment,” Strawson notes that in some cases of perceived wrongdoing, we suspend our “reactive attitudes” like resentment or indignation in favor of a “objective attitude” indicative of our refusal to consider the person in question to be a member of our moral community.  In light of this distinction, the question of moral culpability of psychopaths becomes whether or not we should adopt the objective attitude to such individuals.  This question is discussed in contributions by Piers Benn, John Deigh and Thomas Schramme.   These entries make clear that there is currently little consensus about the answer to this question, but they do provide an illuminating and useful guide to the sorts of considerations that must be addressed in order to formulate a well-informed view on the matter.   

In the concluding chapter, Schramme notes that “there is no real consensus among the authors regarding the explanation of psychopathy” (pg. 321) and suggests that this is representative of a general lack of consensus about psychopathy.  This might come as a surprise to readers who have in the past encountered authors making substantive claims supported by confident allusion to the “facts” about psychopaths.  However, it need not be taken as reason for wholesale skepticism about the utility of the diagnosis.  There is ample evidence that some individuals possess psychological features that result in a tendency to disregard moral considerations in their dealings with others.  Schramme argues, persuasively, that careful interdisciplinary debate over the nature and implications of psychopathy is an important step toward gaining a better understanding of these individuals and their relevance to ethics.  This anthology has indeed provided such a debate, and offers valuable insights for philosophy, psychology and medicine.   

© 2015 Timothy G. Murphy

Timothy G. Murphy, PhD, Dept of Philosophy, SUNY Potsdam.