Psychiatry and psychopathy:
In Hannibal's head
Ice cold, hard and emotionless. Such is the psychopath – we think. Until we get a glimpse behind the mask.
Published april, 2012
Behind the Hannibal mask, we find tenderness and pain, deep emotions and empathy.
I am meeting a psychologist at Brøset, a division of St. Olavs Hospital in Trondheim. The psychologist has studied criminal psychopaths and may shed light on what we have so far only seen as dark-minded insensitive killing machines.
We're supposed to meet at the entrance. It's cold and snowy, and the light is dusky. There's not a soul in sight. Behind the division's high fences lies a huge walled complex, which looks almost ghost-like in the low light. The building houses a variety of specialized services related to mental health care, courts, prisons, corrections and rehabilitation. It is partly hidden by white-clad scaffolding, so that not even the windows can be seen. You could almost see it a symbol of the need for a total renovation of our understanding of psychopathy that psychologist and researcher Aina Sundt Gullhaugen hopes will come.
Gullhaugen takes me into a building, an office and a world dominated by hard surfaces.
We are talking about cases where you and I would conclude that the only thing to do is to lock the perpetrators up and throw away the key. Cold-blooded killers and robbers that no one would ever want as a neighbour. Researchers have for decades been almost unanimous in their accord with the popular perception that psychopaths are made in a certain way, and will forever remain that way.
But Aina Gullhaugen disagrees.
Nature or nuture?
“A lot has happened over the past few years in psychiatry,” Gullhaugen says. “But the discipline is still characterized by the attitude that a certain group of people are put together in such a way that they cannot be treated. There is little in the textbooks that says that these people have had a hard life. Until now the focus has been directed at their antisocial behaviour and lack of empathy. And the explanation for this is based on biology, instead of looking at what these people have experienced.”
Through her experience as a psychologist, Gullhaugen has found, in fact, that there is a discrepancy between the formal characteristics of psychopathy and what she has experienced in meeting psychopaths.
Aina Sundt Gullhaugen has challenged the "gold standard" for the study of psychopaths. "Treatment is difficult but not impossible," she says.
Photo: Ole Morten Melgård
Gullhaugen thought if psychopathic criminals are as hardened as traditional descriptions would have it, you would not find vulnerabilities and psychiatric disorders among them. She wondered if perhaps we have asked the wrong questions, and studied the issue in the wrong way.
With the same intense desire to get behind the mask as Clarice had in her meeting with Hannibal Lecter in the movie “The Silence of the Lambs”, Gullhaugen has burrowed into the minds of psychopaths.
“Hannibal Lecter is perhaps the most famous psychopath from the fictional world,” says Gullhaugen. “His character in the books and movies is an excellent illustration of the cold mask some have thought that psychopaths have. Because it is a mask. Inside the head of the cannibal and serial killer were tenderness and pain, deep emotions and empathy.”
Author Thomas Harris is said to have based his Hannibal figure on real life serial killers, after he conducted research at the FBI's Behavioral Science Unit. Harris showed how Hannibal's behaviour was influenced by the psychological damage that occurred during his childhood. Such things, Gullhaugen says, can be treated.
Hannibal Lecter is fiction. But Gullhaugen has immersed herself in the scientific literature and made a comparison between the figure of Hannibal and individual studies of offenders who demonstrate a high degree of psychopathy. “I have gone through all the studies that have been published internationally over the past 30 years,” she says. “I have also conducted a study of the psychological needs of Norwegian high-security and detention prisoners.”
Every published study of these so-called worst offenders shows that they all have a background that includes grotesque physical and /or psychological abuse during childhood. The result of Gullhaugen's efforts can be found in her article, “Looking for the Hannibal behind the Cannibal: Current status of case research.”
“Without exception, these people have been injured in the company of their caregivers,” she says. “And many of the descriptions made it clear that their later ruthlessness was an attempt to address this damage, but in an inappropriate or bad way.”
Gullhaugen has wondered about the methods that have been used to study psychopaths. “One way to examine emotional reactions is to show people pictures of different situations, and then study the response,” she says.
“First the subject is often shown benign or neutral images, where you could be expected to be happy and relaxed. The physical reaction is a calm pulse, no sweat on the skin and the like. Then, suddenly there is a picture of a gun aimed at you. Most people will react to this, right? But when psychopaths do not respond in the expected way, we conclude that they have a biological defect,” she says.
“You don’t get given a personality disorder for your eighteenth birthday present.”
Aina Sundt Gullhaugen, PhD candidate
Gullhaugen wants us to put ourselves into the everyday lives that psychopaths often come from. Criminal gangs, perhaps, or a tough upbringing in which the need to be unaffected and strong is mandatory and always present. Perhaps guns are a part of everyday life. Perhaps a cold and almost emotionless reaction is
the only rational reaction, seen from their perspective, and is what they have got used to.
“I found that research on the psychopath's emotions was incomplete,” she says. “We need other tests and instruments to measure the feelings of these people, if there are feelings to measure.”
She has now done exactly that. While Gullhaugen has not replaced conventional survey methods, such as a diagnostic interview, use of a checklist for psychopathy and neuropsychological tests, she has added more methods to see if she might get other results. To this end, she has used questionnaires that measure a number of interpersonal and emotional aspects of Norwegian high-security and detention prisoners.
The results suggest that the so-called gold standard for the study of psychopathy should at best be changed, and at worst, be replaced.
Need and want closeness
“There is no doubt that these are people with what we call relational needs”, says Gullhaugen. “In the aforementioned case descriptions and my own study, it became clear that they both have the desire and the need for close relationships, and that they care. At the same time it is equally clear that they find it almost impossible to achieve and maintain such relationships.”
Psychopathy is characterized by a lack
of emotions, including empathy, and a
self-centred and ruthless style that
causes suffering in others.
Psychopathy is not an independent
diagnosis, but is included under the
dissocial personality disorder in today's
Psychopathy is considered to be an
accentuation of the interpersonal and emotional characteristics of an dissocial
Psychopathy has an incidence of 1 per
cent in the general population, and is
found in about 20 per cent of inmates in
Gullhaugen's study demonstrated that where the most common survey methods would have shown that individuals reported good self-esteem, low depression and a sense of general wellbeing, other methods show that psychopaths suffer from underlying psychological pain.
“Isn't it strange that someone who claims to have a great life can also answer that his or her life experiences have had a catastrophic or tremendous influence on him, or...?”
Gullhaugen's question is rhetorical, of course. She explains that in some cases, the interviewees were people who almost didn't dare to answer questions for fear that someone in prison would get access to the information.
“They may have a vested interest in appearing a certain way,” she says. “At the same time they reveal a little bit of what is behind the mask when they answer the various questions in private, without any of us present.”
Extreme parenting style
One of the features that characterizes criminal psychopaths is an abnormal upbringing, as they describe it. Gullhaugen's research reveals that psychopaths as children have experienced an upbringing, or parenting style, that is quite different from the so-called normal part of the population.
“If you think of a scale of parental care that goes from nothing, the absence of care, all the way to the totally obsessive parent, most parents are in the 'middle,' ” explains Gullhaugen. “The same applies to how we feel about parental control. On a scale from 'not caring' all the way to 'totally controlling', most have parents who end up in the middle.”
“But it is different for psychopaths. More than half of the psychopaths I have studied reported that they had been exposed to a parenting style that could be placed on either extreme of these scales. Either they lived in a situation where no one cared, where the child is subjected to total control and must be submissive, or the child has been subjected to a neglectful parenting style.”
This, says the researcher, is an example of how the psychopath's behaviour is not unrelated to his or her life experiences. And it provides the basis for a more nuanced picture of these people's feelings, and a starting point for treatment.
“The attachment patterns show that these children feel rejected. To a much greater degree than in the general population, their parents have an authoritarian style that compromises the child's own will and independence. This is something that can cause the psychopath to later act ruthlessly to others, more or less consciously to get what he or she needs. This kind of relationship – or the total absence of a caregiver, pure neglect – is a part of the picture that can be drawn of the psychopath's upbringing,” the researcher says.
Gullhaugen says that she has not studied enough cases to draw any final conclusions about this, but that three other studies show the same tendency.
Not exactly a birthday present
“It's hard to say exactly what has created the psychopath's rock hard mask,” says Gullhaugen. “But as others have said before me: You do not get a personality disorder for your eighteenth birthday present. I have seen what children and young people with these kinds of characteristics experience and what it is like for them, through my work in child and adolescent psychiatry. Of course, not all reckless behaviour is explained by a bad upbringing, but we do not inherit everything either. That is my main point.”
Gullhaugen reminds us that biology and environment mutually influence each other. The personality disorder that results can be seen as the sum total of a number of biological and psychological factors.
“The combination of the individual's biological foundation, temperament, personality, and vulnerability are important components,” said Gullhaugen. “The individual's relational vulnerability is the very essence of the personality disorder, in my opinion.”
“I see that these people are apprehensive when they meet me. I see a clear vulnerability in them through behaviour that betrays insecurity and discomfort on the inside. And now we have research that confirms the hurt, suffering and nuances of their feelings.”
Almost like you and me
Gullhaugen found few significant differences between psychopaths and her “normal” group when, in her own study of Norwegian prisoners, she examined the ability to experience a wide range of emotions. The differences that she found showed that psychopaths generally experience more negative emotions, such as irritability, hostility, and shame. But they do not feel guilty.
“They have more primitive emotions such as anger and anxiety,” says Gullhaugen. “This is what I found in the studies I conducted of strong psychopathic individuals who had committed serious criminal acts.”
When it comes to more positive feelings, however, there was little or no difference, suggesting that the psychopath's emotional life is more nuanced than first thought.
New diagnostic tools on the way
New diagnostic manuals are now under development and will likely be ready by 2013. Gullhaugen is pleased that the tools to be used in diagnoses are now being changed: Instead of assigning patients to strictly defined categories, the tools enable a more nuanced evaluation, where an individual’s diagnosis may be seen on a scale from normal to diseased. She believes this will make it easier to get a more accurate picture of the disorder.
“When we recognize that the psychopath's upbringing and relationships are important, and that the psychopath's emotional life is more complex than what we have previously believed, we reduce the stigmatization of these individuals. Meanwhile, we also have a starting point for treatment,” she says.
“I don't think we can get everyone back to a normal way of life. But it may be possible to help many to get on better with themselves and others. This in turn could reduce the risk of repeated serious crimes. Treatment is difficult, but possible,” she says.
She also believes that a risk assessment should be conducted before deciding whether a person can be returned to the community.
“When you understand the problem better, it will be easier to predict all types of behaviour,” Gullhaugen says. “Our evaluations will be more extensive because of this, and will give a more comprehensive and accurate picture.”
Hege J. Tunstad
CONTACT: Aina Sundt Gullhaugen, St. Olavs Hospital
PHONE: +47 73 55 08 64