Psychopathy
is a fuzzy concept with an extensive pedigree in clinical psychology,
psychiatry, and medicine.  The Handbook
of Psychopathy is the first comprehensive textbook on the subject that I
have seen, and for that reason alone will be of substantial interest to
clinicians and researchers working with clients/patients/subjects at the
margins of the mental health/criminal justice system interface.  At 651 pages, large format, and small type,
it functions as a reference work, and will be read through by only a few — I
should confess that I could not read the whole book within the confines of my
review period.

The
book is edited with multiple authors, and the selection of authors is relevant
and authoritative.  The book is broken
into six sections, "Theoretical and Empirical Foundations," "Issues
in Conceptualization and Assessment," "Etiological Mechanisms," "Psychopathy
in Specific Populations," "Clinical and Applied Issues," and "Conclusions
and Future Directions." Each of these sections, with the exception of the
last, feature multiple chapters.

Overall,
the book is well-organized, carefully edited for typographical errors, (but not
so much stylistic ones), and covers most all one could desire, with important
exceptions.  The book exhibits the
character of the discipline of its author, a psychologist, in that the empirical
core of the work is R. D. Hare’s PCL-R instrument, and the psychopathy concept
is approached primarily from the empirical-descriptive perspective, rather than
a historical, philosophical, clinical, or etiological one.  This is not to say that the treatment of the
subject is skewed, however.  The
material here will be of substantive interest to clinical and research
psychiatrists as well as psychologists, and perhaps to criminologists,
specialists in mental health law, and others. 
I expect to turn to this book again and again.

The
flaws of this book reflect many of the problems with the psychopathy concept
and its surrounding literature.  Through
31 chapters one gets a dizzying array of ways to cut the psychopathy pie; the
use of Hare and Cleckley as benchmarks is helpful but can only accomplish so
much.  It is difficult to generalize
findings from one set of empirical data gathered under one version of the
construct, to other findings based on similar or only partially overlapping
constructs.  This is particular acute in
considering the etiological chapters. 
The "antisocial" and "psychopathy" concepts are
often used interchangeably; molecular strategems focus on aggressivity crudely
conceived with little to no relation to the more finely grained Hare or
Cleckley constructs.  It is clear from this
book that we are not on the same page with the "psychopathic" cluster
of phenomena.  There is a lot of
integrative and synthetic scientific work to do.

My
substantive criticisms of this book emerge from editorial interests as well as
from limitations in content.  As an
edited volume, the chapters are referenced individually, so one must search by
chapter for a particular citation without a comprehensive reference list at the
end.  Similarly, the index is of limited
use for reference purposes. While thoughtfully broken into a name and subject
index, the breakdown of entries is curtailed. 
For instance, the name index entry for R. D. Hare has 208 separate page
references noted, but no breakdown by subject within the entry.  In terms of content, a chapter on the
history of the psychopathy concept seems like a natural one to me, given the
rich heritage of the concept, and the shouting need for a perspective on the
mutations of the concept.  Moreover,
other than Patrick’s concluding chapter (which is very good within its own
constraints), there is little effort to help the reader trace the variations of
the protean psychopathy concept and link these variations to particular
research traditions, programs, and findings. Indeed, Patrick’s concluding
advocacy for a return to Cleckley casts doubt about the real gains of the
meticulously done empirical research reviewed throughout his preceding pages.
One is left with a lingering hunger for an executive intelligence to help guide
us toward what this all means, what we are sure of, what we aren’t, and what
impact these interpretations could have on practice and research.

©
2006 John Z. Sadler

John
Z. Sadler, M.D. is Professor of Psychiatry and Director of the Program in
Ethics in Science and Medicine at the University of Texas Southwestern Medical
Center at Dallas, and author of Values and Psychiatric Diagnosis (Oxford
University Press, 2005).

Categories: Personality, Psychology, Ethics