When you hear the word psychopath, what is the first image that comes to mind? An iconic film character like Patrick Bateman from American Psycho, Hannibal Lecter from Silence of the Lambs, or Alex DeLarge from A Clockwork Orange? Or a real-life example like Dennis Rader (the BTK killer), Joseph James DeAngelo (the Golden State Killer), or Charles Manson? Whether your mental image is Hollywood or True Crime, chances are the word psychopath conjured a weapon-wielding, slavering serial killer consumed with one, single-minded purpose: to cause harm.
This is for good reason. Though many people with psychopathy do not engage in physical violence or cause grievous harm, the ones who do make the news and have movies and television shows made about them. Because we focus on the heinous and repeat the sensational, we do not perceive psychopathy as the spectrum disorder it is. Psychopathy occurs on a spectrum with infinite gradations and presentations. But it’s often perceived as just one thing; synonymous with evil. This public perception gets in the way of providing proper treatment. The public perception that “psychopath” = “serial killer” keeps many nonviolent people with psychopathy from not only seeking out treatment, but also stops them from speaking out about what it is like to live with this disorder for fear they would be branded a serial killer. A major barrier to treatment of this often harmful disorder is, I believe, the very word psychopath itself and the stereotypes it calls forth.
Although it is not yet included in the Diagnostic and Statistical Manual, psychopathy is a recognized clinical condition. There is a growing body of evidence that psychopathy is a neurodevelopmental disorder that impairs empathy, inhibition, executive functioning, and other neurocognitive processes. Just as is true for autism and schizophrenia, myriad physiological and neurological differences occur in people with psychopathy, making it a complex neurobiological condition. People with psychopathy have altered brain structure and functioning. Autonomic nervous and limbic systems dysfunction can be detected through things such as lower resting heart rates, reduced skin conductance, and reduced startle responses. Some, like my son, show a reduced pain response. Educating the public about the many manifestations of psychopathy is a long, complex task even if we didn’t have to combat decades of sensationalized misinformation, dehumanizing language, and stigma.
Educating the public about psychopathy requires deconstructing what we think we know about it. Each person’s understanding of psychopathy is different – dependent upon which books they have read; which TV shows, movies, and YouTube videos they’ve watched; which podcasts they’ve listened to; and how accurate each of these things were. I estimate somewhere between 30-60% of what people think they know about psychopathy is correct, with each person having a different set of inaccuracies that needs to be corrected.
Misinformation aside, psychopathy presents a unique challenge: the word psychopath is still a culturally acceptable insult. Though it is no longer okay to use disabilities as insults or punchlines, we ignore this rule when it comes to psychopathy. We fling the word psychopath around when we want to insult someone with the worst word we can think of. We pat ourselves on the back for no longer using the R word, yet have no qualms about calling someone a psychopath when they disagree with us politically or engage in behavior we don’t like. Calling someone a psychopath is an easy form of revenge. On TV, a character will use psychopath in a clinical manner, then a few scenes later use it as a punchline. TV shows incorporate diverse casting, culturally sensitive story lines, and inclusive language while also delivering oh-so-clever punch-lines with the word psychopath in them. Our consistent use of this word as a pejorative or a punchline sends a clear message: people with psychopathy don’t count.
When we say psychopath, what most people hear is monster or evil. Some articles outright use those words. I understand the emotional reaction. Because people with psychopathy hurt people, we feel justified in classifying them as sub-human, and decide it doesn’t matter how we treat them or what we say about them. We declare they deserve to be treated badly and don’t deserve to be considered human beings. We speak cruelly about them, and sometimes even wish violence on them. Again, I understand the emotional reaction and impetus behind these actions, but when we do this, we are guilty of the same behavior we condemn in people with psychopathy: we engage in the verbal violence, maltreatment, and dehumanization of people we feel superior to (in this case people with psychopathy). We wear our contempt for them on our sleeves, and wield our moral superiority like a weapon. We treat people with psychopathy in the very manner we tell them not to treat others.
We continuously ask people with psychopathy not to engage in harmful behaviors even though they do not feel empathy. I am asking you do the same. Regardless of how you feel about people with psychopathy, I am asking you not to use dehumanizing language when you refer to them. I am asking you to eliminate the word psychopath from your vocabulary. Dehumanizing language turns people into things and gets in the way of proper treatment. People get treatment, things do not. Our biggest barrier to the proper treatment and management of psychopathy is the dehumanizing language we use. It betrays the negative feelings we have for people with psychopathy. People with psychopathy already feel disconnected from the rest of us: their wiring makes it difficult to engage the parts of their brain that allow for human connection. On top of that, when we speak about them, they hear dehumanizing language, reminding them we don’t think they count as people. They already feel separate from us. The last thing we want is to highlight that separation.
You might feel that focusing on treatment rather than punishment of people who harm others is doing a disservice to those who have been victimized. But many people who have been hurt also want to make sure what happened to them will not to happen to anyone else. Our current strategy of waiting around to clean up the destruction after it happens and punish people after the fact just doesn’t work. Our best course of action is prevention. There is no substitution for never having been traumatized.
Did you know that many people with psychopathy actually want treatment? Some seek out treatment only to be denied help, be made to feel terrible for admitting to the desire to harm people (even if they have not yet engaged in harm), or both. How is a person with psychopathy supposed to interrupt their desire to engage in harm if we insist such desires are so monstrous they cannot be talked about in the first place? We need to be willing to talk about psychopathy in the face of the uncomfortable emotions it provokes. If we do not provide an environment free from judgment and stigma where people with psychopathy can seek help without being demonized and dehumanized for their disability, they won’t seek treatment.
People with psychopathy make up approximately 1% of the population, yet make up roughly 50% of incarcerated individuals. If any other demographic made up 1% of the population and 50% of our incarcerated population, everyone would be up in arms demanding treatment. But no one cares when the demographic in question is people with psychopathy. Treatment could greatly reduce the number of violent crimes. This will never happen until we begin to see people with psychopathy as human beings needing treatment. We will never see them as human beings as long as we continue to use the dehumanizing term psychopath.
Psychopathy impacts the ability to feel connected to other human beings. We then reinforce this lack of connection to humanity in the dehumanizing way we speak about people with psychopathy. Using the word psychopath makes this lack of human connection even harder for them to overcome.
Disability rights and person-first language are important to me. My son was raised in a household that used person-first language. He has never known any other way of relating or referring to people with disabilities. Once, when my son was a teenager and still engaged in criminal activity, he told me he hated being called a thief. I asked him why he minded being called a thief when he had, in fact, just stolen something. He said it sounded like a thief was what he was, rather than stealing being something he did.
Stealing is a behavior. Theoretically, if you don’t want to be called a thief, all you have to do is not steal. I found it curious, and was even a little annoyed, that my son was requesting person-first language around his criminal behavior. But for my son, requesting person-first language was a logical extension of his upbringing. I not only corrected others around me, I corrected my own speech and welcomed correction from others whenever I made a mistake. So, when I used dehumanizing language, my son took the time to correct it when it came out of my mouth.
About six months ago I was reading Psychopathy Is cofounder Dr. Abigail Marsh’s book The Fear Factor. She said you would never hear her call any of the children she worked with a psychopath. This phrase burrowed into my brain, gnawing at me. A few months later, it struck me: if a word is so terrible you should not refer to a child in that manner, maybe that word should not be used to refer to anyone. Then the memory of my son telling me he didn’t like being called a thief replayed in my mind. I realized I had been guilty of dehumanizing people with psychopathy by referring to them as psychopaths, and I knew I had to write this article.
The medical and mental health communities have collectively agreed person-first language is important. A person is a person first, even people who engage in persistent antisocial behavior. We can agree these behaviors are not acceptable while still acknowledging the humanity of the people who engage in them. Yes, many people with psychopathy do terrible things. But this does not mean they are not still human beings themselves.
Because person-first language is the direction we are all taking, it is important we include people with psychopathy in this, too. This current generation of young people with Conduct Disorder will become the next generation of adults with psychopathy and will notice we use person-first language with every disability except psychopathy. They will notice we relate to them only as their disability. Ironically, the primary reason for using person-first language is to build empathy for people with disabilities. How can we expect people with psychopathy to show other people empathy, when we show them none?
We have all been guilty of dehumanizing people with psychopathy. Referring to someone as a psychopath defines them by their condition, as if they just exist this way. Whereas once upon a time, you might have introduced your cousin by saying, “This is Sasha, she is a schizophrenic,” or introduced yourself by saying, “Hi, I’m Bill, I am dyslexic,” most people know we don’t use terms like this now. You say you or your cousin have these conditions.
Media and entertainment industries aside, some of the worst offenders are those of us who work in the area of psychopathy—including me. Every book and research paper about psychopathy I have ever read includes the word psychopath. All major psychopathy researchers use it (indeed it is in quite a few titles). I have used it in previous writings. We here at Psychopathy Is even titled some video segments “Ask a Psychopath” and “I Married a Psychopath” (it should be noted this word was used with the permission of the people these videos featured.)
We have come a long way in being inclusive of people with disabilities. But this is not so with psychopathy. We still use the word psychopath – a word that, at its essence, removes all humanity from the subject about whom we are speaking. Calling someone a psychopath makes them a thing you can deride, not a person.
We can do better. Especially the psychopathy research and advocacy community. Psychopath is a word that has been co-opted by the media and entertainment industries to be made frightening, used as a pejorative or a punchline, and ignores the scientific definition of the condition it refers to. If we agree psychopathy is a neurodevelopmental disorder—which the evidence clearly supports—we should stop using the word psychopath. Every time we use it we dehumanize the person about whom we are speaking. We “other-ize” them. We diminish them and define them by their disability; reducing them to a condition they did not ask to have. We cannot help people with psychopathy manage their disability if our only acknowledgement of it is a pejorative designed to dehumanize them. Treatment professionals, take heed. This is most important for you to remember.
We do an awful lot of talking about people with psychopathy, rather than talking to them. As Psychopathy Is Advisory Board member Armon Tamatea says in his TEDx Talk, Psychopaths and three reasons why we need them, “This is a group that is often talked about, but rarely talked with.” I make it a point to get feedback from people with psychopathy. I have friends with psychopathy whose brains I pick. From time to time I also ask my son for his opinion about things I am doing or thinking in the realm of psychopathy. I told him I was writing this article for Psychopathy Is and asked if he was willing to talk to me about person-first language and psychopathy. He consented. I asked him if he thought person-first language would make a difference for people with psychopathy. He said he thought it would. During our conversation, I confessed to him that ever since I realized I had been guilty of using the dehumanizing word psychopath it grates on me. I told him it seemed like everywhere I turned it was just, “psychopath, psychopath, psychopath, psychopath, psychopath, psychopath, psychopath, PSYCHOPATH.” I was watching him closely. With each repetition of the word psychopath his shoulders became a little stiffer, the muscles around his eyes drew a little tighter, and his entire body grew more tense. I might have missed it had I not been paying attention, but his physical reaction was there, no matter how slight. It seemed almost as if I had delivered a tiny emotional slap to his face with each repetition of the word psychopath. Remember: my son consented to a conversation about the word psychopath and person-first language. At no point did I call him one. I used the word abstractly. Yet he had a physical reaction. As I said, it was slight. I’m not even sure he noticed. But if my son had this reaction to a theoretical discussion he consented to, how much worse must it be for people with psychopathy when we use this word as an insult?
Now, I understand there may be readers out there who have psychopathy who are not offended by the word psychopath. That’s just fine. I’m not in any way suggesting you should be offended by the use of this word. But we are all trying to live in a society here, and that means we all have rules we agree to follow. And one of those rules, at the moment, is for us to use person-first language. So we need to do this around psychopathy as part of our commitment to a society that thinks of people as people, first and foremost.
One of the things I told my son when he was younger that made a difference for him was that sometimes people just have certain medical conditions that suck and make a lot of extra work for the person who has it. They might have to fight that condition their whole life. Sometimes it just is what it is and you have to make the best of it. I brought up some of my own medical conditions and told him that him managing his medical condition was no different than me managing mine. He seemed satisfied and this paradigm shift helped him reorient how he related to himself. Giving people with psychopathy an empowering lens through which to view their disability is imperative.
I dream of the day when a person can walk into a clinician’s office and say, “I think I have psychopathy” and get help before they hurt someone. I dream of a world where parents can obtain diagnoses and treatment for their child as soon as they present with symptoms, even (and especially) the children who present before preschool. But that isn’t going to happen until we change the way we speak about people with psychopathy and start treating them as human beings worthy of getting treatment for their disability. Again: people get treatment, things do not.
I am asking everyone (especially psychopathy professionals) to join me in changing the way we speak. No one “is a psychopath,” but a great many people have psychopathy. People with psychopathy deserve the same recognition of their humanity and clinical needs as everyone else. Only by treating them with the dignity all human beings deserve can we hope to provide an atmosphere where people with psychopathy feel free to seek help before they harm other people.
Remember: our best course of action is prevention.
Lillyth Quillan was the first parent to publicly use her name and her face and say she was the mother of a child with Conduct Disorder. In 2014, she created and founded Parents of Children with Conduct Disorder (PCCD), a Facebook-based support group for parents and other caregivers of these children. Over the last six years, Lillyth has personally spoken or communicated with thousands of families. She remains as dedicated to the cause of including non-intimate partner violence in the national Domestic Violence conversation, early treatment for our children, and political action as the day she started PCCD.