Systems Need to be Challenged

A look at the larger impact of the PCL-R and it's proprietor...

This will be a three-part post sorting through some of the issues surrounding the PCL-R, and the expert that is largely responsible for driving the understanding about psychopathy that so many people take for granted because they are unaware of the problems surrounding that understanding.

Have you ever had an ulcer and been treated for it? If so, you may not be aware of the behind-the-scenes drama that finally led to you getting successfully cured of that ulcer, and why you aren’t living with it, and being lectured by doctors about keeping your stress levels down. Do you know what that ulcer really represents?

I don’t mean from a medical perspective. I am not here to tell you that your ulcer is somehow related to some other health concern that you may not have been informed about. Nope. Instead, it is about the belief system that surrounded ulcers, and how difficult it was to bring the entire medical community around to understand that what they believed, was wrong.

Helicobacter pylori, or H. Pylori, is the cause of ulcers. This is known medical science that seems to go without question. You might think, of course, that’s what causes ulcers. I had one and took antibiotics. It was fixed, and I got on with my life. However, back in the seventies, it was not understood that ulcers had anything to do with bacteria, and in fact, it was firmly believed that they were caused by stress. The more stress you had, the more severe in degree, or numerous the ulcers that you may have.

An Australian doctor had patients that had severe ulcers, and he watched them undergo treatments for them that seemed so extreme. In fact, some patients had their stomachs removed to treat ongoing ulcers, and he thought to himself, there has to be something more going on here, so he set out to prove it. You would think that taking a different approach would be welcomed. After all, medicine is a hard science, and science is all about having an idea and setting about to prove it wrong in all the ways that you can possibly conceive. If you cannot prove it wrong, then your idea must be correct. That is until someone else can prove it wrong, and then everything shifts to a new perspective.

That’s how it’s supposed to work, but that isn’t how it worked for internist, Dr. Barry Marshall. He believed with ulcers that there was something else going on, and he began working with a pathologist named Robin Warren. Dr. Warren had discovered in many samples that patients' guts were infested with this corkscrew-type bacteria called Helicobacter pylori.

The doctors cultured hundreds of samples and were able to demonstrate that indeed, H. Pylori was responsible for not only ulcers but stomach cancers as well. As it was a bacteria, it was treatable. Think of the patients’ lives that they would improve, and how many people wouldn’t have to suffer needlessly. With simple antibiotics, the whole mess could be avoided. The medical community would be elated with this news, right?

Unfortunately, that is not how the story goes at all. The medical community refused to hear any of it. There was nothing that either doctor could say to make any inroads with gastroenterologists. They were unwilling to hear anything other than the age-old, stress causes ulcers, no more, no less. Dr. Marshall was not one to give up easily, and when he hit a brick wall, being unable to make case studies with mice because H. Pylori only infects primates, he came to a rather dramatic decision.

He took a sample of H. Pylori from one of his patients, he mixed it into broth, and being the only human patient he could ethically experiment on, he drank it. Within a week, the effects were obvious. He developed gastritis, which is the prelude to developing an ulcer, and with it all the lovely side effects that it creates, vomiting, and bad breath. Now demonstrating symptoms, Dr. Marshall biopsied his own gut and was able to culture the H. Pylori, thus proving that indeed, it was the culprit. For this, eventually, Drs Marshall and Warren were awarded the Nobel Prize in 2005, but only after years of strife to get to the point where the medical community would admit, they were wrong.

Treating an ulcer with antibiotics is standard fare now. No one questions it, because the science is sound, and the results are inarguable. That’s an excellent outcome, and the right one as well, of course, but what happens when the same mentality creates roadblocks in other sciences? Soft sciences, like psychology, for instance? In that case, there is a much larger fight, but on the same battleground, which is not about truth, it is about reputation, ego, and money.

This brings me to the purpose of this post, which will be long, so no complaining. If you don’t want to read it, you can always nope out, no one is holding your feet to a fire. Believe me, I won’t get offended. It is one of those pesky emotions that I lack, so no worries. What we are going to talk about today is the PCL-R, Robert Hare, and the science that psychopathy has been based on. I have spoken about him in the past, but I haven’t really laid out the problems with Robert Hare’s work as diligently on Substack as perhaps I should have. As his work is foundational to the current structure of research surrounding psychopathy, so the lack of a deep dive on it is something that I must remedy.

I must first state, I have nothing against the man, as I don’t know him at all. He may well be a very affable fellow that is enjoyable to be around. I will also state that this is not meant to be an essay on him as a man, but rather a critique of his work, how he interacts with people in regards to his work, and how it has affected things on the current research grounds. His intentions may have been pure at some point, but my argument is that they ceased being so some time ago. That said, let’s get into this.

Robert Hare was first introduced to the notion of psychopathy while he was still getting his education as a psychologist. He was a trainee when he was a part of a program that was studying criminals. There is always a problem when it comes to the criminal element, in that they are frequently bored, and to them, participation in a study is not about factual results, but rather personal entertainment. When they were able to get Hare to do things for them, like bring them treats for answering questions in the manner they were able to glean he wanted, they took full advantage of this.

First and foremost, I don’t know why you would reward them for giving you the answers that you are seeking, considering you are simply tainting your research sample by doing so, but all the same, Hare was happy to oblige, until he was let in on their manipulation. It didn’t sit well with him, and in fact, it greatly angered him. It also formulated the basis for which he thought of psychopaths. Instead of researching them, and applying the scientific principle of trying to prove himself wrong, he went the opposite direction and sought to prove himself correct.

Where did that lead him? Well, he took a list that was created by Hervey Cleckley, back in the 1940s, and proceeded to modify it somewhat, in order to have it suit the criminal cohort that he was applying it to. He removed useful traits, and inserted ones that only a person that was criminally motivated, psychopathic or not. This did not improve the checklist in any way, and in fact weakened it significantly, which is saying something, considering the construct that it provided in its original form, was incorrect in many regards. The two lists will be below, and there will be an asterisk next to traits removed, and a double asterisk next to traits added or significantly changed by Hare. Here is Cleckley’s:

Hervey Cleckley’s List of Psychopathy Symptoms:

1. Considerable superficial charm and average or above average intelligence. **

2. Absence of delusions and other signs of irrational thinking. *

3. Absence of anxiety or other “neurotic” symptoms. Considerable poise, calmness and verbal facility. *

4. Unreliability, disregard for obligations, no sense of responsibility, in matters of little and great import. **

5. Untruthfulness and insincerity. **

6. Antisocial behavior which is inadequately motivated and poorly planned, seeming to stem from an inexplicable impulsiveness.

7. Inadequately motivated antisocial behavior.

8. Poor judgment and failure to learn from experience.

9. Pathological egocentricity. Total self-centeredness and an incapacity for real love and attachment. **

10. General poverty of deep and lasting emotions. *

11. Lack of any true insight; inability to see oneself as others do.*

12. Ingratitude for any special considerations, kindness and trust. *

13. Fantastic and objectionable behavior, after drinking and sometimes even when not drinking. Vulgarity, rudeness, quick mood shifts, pranks for facile entertainment. *

14. No history of genuine suicide attempts. *

15. An impersonal, trivial, and poorly integrated sex life. **

16. Failure to have a life plan and to live in any ordered way (unless it is for destructive purposes or a sham).

Here is Robert Hare’s stolen (we will get to this in a moment), and modified version of it:

1. GLIB AND SUPERFICIAL CHARM — the tendency to be smooth, engaging, charming, slick, and verbally facile. Psychopathic charm is not in the least shy, self-conscious, or afraid to say anything. A psychopath never gets tongue-tied. He can also be a great listener, to simulate empathy while zeroing in on his targets’ dreams and vulnerabilities, to be able to manipulate them better. **

2. GRANDIOSE SELF-WORTH — a grossly inflated view of one’s abilities and self-worth, self-assured, opinionated, cocky, a braggart. Psychopaths are arrogant people who believe they are superior human beings. **

3. NEED FOR STIMULATION or PRONENESS TO BOREDOM — an excessive need for novel, thrilling, and exciting stimulation; taking chances and doing things that are risky. Psychopaths often have a low self-discipline in carrying tasks through to completion because they get bored easily. They fail to work at the same job for any length of time, for example, or to finish tasks that they consider dull or routine. **

4. PATHOLOGICAL LYING — can be moderate or high; in moderate form, they will be shrewd, crafty, cunning, sly, and clever; in extreme form, they will be deceptive, deceitful, underhanded, unscrupulous, manipulative and dishonest. **

5. CONNING AND MANIPULATIVENESS: the use of deceit and deception to cheat, con, or defraud others for personal gain; distinguished from Item #4 in the degree to which exploitation and callous ruthlessness is present, as reflected in a lack of concern for the feelings and suffering of one’s victims. **

6. LACK OF REMORSE OR GUILT: a lack of feelings or concern for the losses, pain, and suffering of victims; a tendency to be unconcerned, dispassionate, coldhearted and unempathic. This item is usually demonstrated by a disdain for one’s victims. **

7. SHALLOW AFFECT:  emotional poverty or a limited range or depth of feelings; interpersonal coldness in spite of signs of open gregariousness and superficial warmth. **

8. CALLOUSNESS and LACK OF EMPATHY:  a lack of feelings toward people in general; cold, contemptuous, inconsiderate, and tactless. **

9. PARASITIC LIFESTYLE: an intentional, manipulative, selfish, and exploitative financial dependence on others as reflected in a lack of motivation, low self-discipline and the inability to carry through one’s responsibilities. **

10. POOR BEHAVIORAL CONTROLS:  expressions of irritability, annoyance, impatience, threats, aggression and verbal abuse; inadequate control of anger and temper; acting hastily. **

11. PROMISCUOUS SEXUAL BEHAVIOR: a variety of brief, superficial relations, numerous affairs, and an indiscriminate selection of sexual partners; the maintenance of numerous, multiple relationships at the same time; a history of attempts to sexually coerce others into sexual activity (rape) or taking great pride at discussing sexual exploits and conquests. **

12. EARLY BEHAVIOR PROBLEMS: a variety of behaviors prior to age 13, including lying, theft, cheating, vandalism, bullying, sexual activity, fire-setting, glue-sniffing, alcohol use and running away from home. **

13. LACK OF REALISTIC, LONG-TERM GOALS: an inability or persistent failure to develop and execute long-term plans and goals; a nomadic existence, aimless, lacking direction in life.

14. IMPULSIVITY: the occurrence of behaviors that are unpremeditated and lack reflection or planning; inability to resist temptation, frustrations and momentary urges; a lack of deliberation without considering the consequences; foolhardy, rash, unpredictable, erratic and reckless. **

15. IRRESPONSIBILITY: repeated failure to fulfill or honor obligations and commitments; such as not paying bills, defaulting on loans, performing sloppy work, being absent or late to work, failing to honor contractual agreements. **

16. FAILURE TO ACCEPT RESPONSIBILITY FOR OWN ACTIONS: a failure to accept responsibility for one’s actions reflected in low conscientiousness, an absence of dutifulness, antagonistic manipulation, denial of responsibility, and an effort to manipulate others through this denial. **

17. MANY SHORT-TERM RELATIONSHIPS: a lack of commitment to a long-term relationship reflected in inconsistent, undependable, and unreliable commitments in life, including in marital and familial bonds. **

18. JUVENILE DELINQUENCY: behavior problems between the ages of 13-18; mostly behaviors that are crimes or clearly involve aspects of antagonism, exploitation, aggression, manipulation, or a callous, ruthless tough-mindedness. **

19. REVOCATION OF CONDITION RELEASE: a revocation of probation or other conditional release due to technical violations, such as carelessness, low deliberation or failing to appear. **

20. CRIMINAL VERSATILITY: a diversity of types of criminal offenses, regardless if the person has been arrested or convicted for them; taking great pride at getting away with crimes or wrongdoings.**

Keep in mind, I don’t agree with Cleckley’s list either, but I will cut the man a little slack, he was practicing in the 1940s, and adding to that, this man wrote an entire book titled: “The Caricature of Love: A Discussion of Social, Psychiatric, and Literary Manifestations of Pathologic Sexuality.” which was basically saying that homosexual influences were destroying society, and also believed in coma shock therapy, which is as awful as it sounds. The man was not exactly the end all be all of psychology, or of understanding humans at large. He was certainly a product of his time, as was his psychopathy checklist.

Now for an interesting timeline of events. Hare was annoyed that there wasn’t a more streamlined process for recognizing psychopathy. He felt a diagnostic tool, similar to those that made up the DSM was a preferred way of diagnosing psychopathy. He began creating an idea for that and came up with one that was very similar to Cleckley’s. This was no coincidence, as he was in contact with Cleckley, during this time. You might think, oh, that’s why the checklist is so similar, he worked on it with Cleckley, he didn’t steal it. You are being so dramatic Athena… really.

Am I? In 1985 Hare redrafted, and released the checklist with a brand new name “Hare Psychopathy Checklist Revised”. This was just one year after Cleckley died. His body was barely in the ground, and Hare was right there with his bright, shiny, brand spankin new, stolen checklist, brandished proudly with his name. That is some underhanded BS right there, and that is coming from a remorseless psychopath. That is dirty business if I have ever seen it.

Around this time, about five years earlier, the writers of the DSM had decided to rename “sociopathic personality” to “antisocial personality disorder”, thus creating a massive mess that would only get worse. You see, while the DSM is a billing repayment manual for insurance companies, it has no effect on research, and Hare did not consider ASPD to be the same thing as his definition of psychopathy. A divide was formed, and people went forward on two paths. One that was regarding ASPD, and the other was regarding “psychopathy”, put in quotes, because the PCL-R is used to diagnose psychopathy and ASPD, without clearly delineating between them, defining them separately, or demonstrating the differences between them. As much as Hare claims that ASPD and his version of psychopathy are vastly different, his list does nothing to make that point.

Fun, right?

In general practice, ASPD is defined in the DSM with its own diagnostic criteria. It’s rather pointless, however, because insurance (what the DSM is for remember) does not pay out on ASPD diagnoses. It is considered untreatable, so nuts to whoever gets handed that label. The problem there is that ASPD can be applied to many people for many reasons, and several causes of it, are in fact treatable.

For instance, if you were abused, and because of this have developed a schizoid personality disorder, and also happen to be antisocial in nature, there are things that can be done for you through a therapeutic process. Insurance companies disagree, however, so if the psychologist is smart, they won’t include the ASPD part of the diagnosis.

So the DSM lords over general practice, and the PCL-R becomes the king of the prison system study network. As that is the only place psychopathy is studied, you might begin to see a bit of the problem, but probably not the extent of it yet. First, let me detail the issues with the checklist itself. Not only was it lifted from Cleckley with only a minor nod, but it’s also completely inaccurate. The PCL-R is very successful at identifying criminals. However, as it seems to me that anyone with a functioning brain would have little trouble doing so in a prison, it seems to not be particularly useful at its job.

Hare disagrees with this notion of course. He instead has extrapolated his PCL-R out into the general public, applying it almost entirely intact to people who are CEOs, and other people in powerful positions. There is some evidence that CEOs have higher psychopathic traits, but the percentage is only about six percent. It isn’t an overwhelming number, but that is not how Hare presents it. His book, Snakes in Suits, is about identifying psychopathy in people that are generally just very cutthroat business types. This doesn’t require them to be psychopathic, and in fact, only requires them to be greedy.

Now that we have established the baseline regarding what the PCL-R’s birthplace is, in the next post we will go into the actual issues with the list, where it falls down on the job, and Hare’s response to criticism regarding it, which may surprise you. Even people that have been in the field of psychology for years are unaware of the things that will be covered next time.