The PCL-R's Significant Limitations, Overreaches,...

And Robert Hare's refusal to correct them

Let’s get into the criticism of the checklist list itself. The PCL-R is lauded as both the “gold standard” for diagnosing psychopathy by some, and viewed as an overreaching, overinclusive inaccurate list by others. It took a long time before people started to question the checklist. Along the way, Hare made quite a name for himself selling books about the inner workings of psychopaths. He more or less became known as “the expert” on psychopathy, and his word on the matter was basically law.

However, some people in psychology felt that the checklist itself had a lot of issues, and a few of them decided to publish a critique of it to generate conversation. This did not sit well with Hare. He did not like being challenged, and instead of reading through what their findings were in regards to the list, and seeing if they were right, he threatened to sue them for defamation, trying to keep the paper from seeing the light of day. It had a real ripple effect in the psychology community, and articles were written about it:

Fear Review: Critique of Forensic Psychopathy Scale Delayed 3 Years by Threat of Lawsuit

According to a document Hare has circulated to journalists and other researchers, Skeem and Cooke's original manuscript misrepresented Hare's work by incorrectly paraphrasing a 2005 paper published in Current Psychiatry Reports, taking words out of context from it and other papers to support the argument that researchers have viewed criminal behavior as "important" or "central" to psychopathy.

Based on this disagreement and others Hare and a colleague lobbied a senior editor of Psychological Assessment to get Skeem and Cooke to reexamine their paper, which had already passed peer review, and make revisions. But Hare says the subsequent revisions were minimal, and after consulting with his lawyer he threatened to sue for defamation if the paper was published in its then current form. The APA then appointed a new group of editorial reviewers, who requested additional changes from the authors. "It was [a] shock," Skeem says of Hare's legal threat. "This is not about Professor Hare, and it's only incidentally about the Psychopathy Checklist," she says. "The focus was really on how we could move the field forward." Skeem says she now worries that papers she submits for review will be labeled as biased.

This is not how the scientific method is meant to work at all, and in fact is more or less bullying people to not write things about Robert Hare, or his checklist, that he doesn’t like. This is not the only time he did something like this, which I will speak about later. First, we will have a look at what Hare got so worked up about. It is nearly impossible to find the whole paper anymore, it is behind paywalls everywhere I look. Fortunately for my good readers, I happen to have a copy of it.

One measure does not a construct make: directions toward reinvigorating psychopathy research--reply to Hare and Neumann (2010)

The main issues raised by the paper are as follows:

Toward Escaping Validation Tautologies 

Hare and Neumann’s (2010) substitution of the term antisociality, as if this were not an umbrella term prominently comprising violence and other criminal behavior, does not invalidate our point that the PCL–R both inventories criminal behavior and purports to explain criminal behavior. Inferring a trait from behavior and then using the trait to explain that behavior is tautological: Psychopathy cannot both embody and explain crime. The contribution of psychopathy to criminal behavior is “an empirical question that can only be answered if the two are identified independently” (Blackburn, 1988, p. 507). 

Removing indices of criminal behavior from the PCL–R measures will weaken their predictive utility for crime. For example, Walters, Knight, Grann, and Dahle (2008) found that the first three facets of the PCL measures “contributed minimally to predictions of recidivism and violence beyond what could be achieved with the [a]ntisocial facet alone” (p. 403). Hare and Neumann (2010) pointed out that the emotional detachment scale sometimes adds incremental utility to the antisocial behavior scale in postdicting or predicting instrumental violence specifically, but this effect is swamped in most research, where interest lies in the larger class of violence (much of which may be reactive) and recidivism. Moreover, even in the instrumental crime domain, circularity of reasoning is a threat: PCL–R ratings of emotional detachment include such features as “cold-blooded murder” (Hare, 1991, p. 22) and “schemes and scams motivated by a desire for personal gain (money, sex, status, power, etc.) and carried out with no concern for their effects on victims” (Hare, 1991, p. 20).

Several risk assessment tools, including tools that systematize ratings of chronic criminal behavior, are available to fill any gap in predictive utility created by divesting the PCL–R measures of criminality. If one’s goal is to understand psychopathy—what it is and how it relates to violence and other crime—the first step is to remove indices of the latter from measures of the former. 

The second step is to use more nuanced measures of violence and other criminal behavior. As noted in our article, validation hierarchies dictated by many theories of primary psychopathy will not feature prediction of criminal behavior per se. However, the motivation or goals for such behavior may well play a role. For example, would a complete measure of Cleckleyan psychopathy predict inadequately motivated criminal behavior or capricious, goalless, self-defeating crime with “a peculiarly aimless quality” (Patrick, 2006, p. 609)? Would measures of Karpman’s (1941) primary and secondary psychopathy predict instrumental and hostile reactive aggression, respectively? Researchers can answer such questions only if they measure psychopathy cleanly, use more nuanced measures of violence and other criminal behavior, and test theories about the relation between the two. 

As observed by Macdonald and Iacono (2006), “a great deal is known about antisocial personality disorder, criminality, and the psychopathic offender as defined by the PCL–R. Much less is known about psychopathy, especially outside prison populations” (p. 383). Despite the unquestioned contributions of the PCL–R and its derivatives, it is time to usher in the next generation of research of psychopathy— one that distinguishes between the domains of personality deviation and social deviance (Blackburn, 1988) to test alternative conceptualizations of psychopathy. Diversifying the study of psychopathy and increasing its rigor can only lead to further insights about the construct. 

Essentially, the PCL-R is chewing on its own tail. The PCL-R is used to diagnose psychopathy in prisons, where it is exclusively going to be used on criminals. It also presupposes that criminal traits are inherent to psychopathy, and the proof of that is that there are criminal traits in the PCL-R. Just as you can’t use a word to define itself, as the dictionary does with the word manipulation (look it up, you will amuse yourself), you cannot have a tool that diagnoses something based on a predestined finding. If you are assuming, without evidence, that all psychopaths are criminals, based on a tool that assumes all psychopaths are criminals, you haven’t made any progress. You cannot define an entire population on the bad acts of the small minority.

I often use the alien analogy for this one. If aliens came to this planet, found a prison, and assumed that was a reasonable cohort from which to judge the whole of humanity, what do you think their findings would be? Do you think that they would find the one person in prison that is incredibly smart, wrongly convicted, and a genuinely good individual, and say, wow, humans are pretty cool? Let’s get to know them?

Or, do you think that they would look at a prison engulfed in a riot, people on death row for heinous actions, and all the depravity encapsulated in a prison and say, “Don’t even stop for gas on that planet. Those things are insane and violent.”

I would guess it is more the latter than the former. Using the worst element to define the entirety of that element is an exercise in futility. The two people that authored that paper that upset Hare so much made this argument, and it was not one he was interested in hearing. Thus, the threats, and trying to circumvent the peer review process. It would put a large hole in the side of his SS Psychopathy of clout and money ship. We will get back to the money aspect in a little while, but first let’s talk about the use of the PCL-R itself, which of course will lead to more criticisms about it, many of which are far more recent than the paper above which was constructed in 2008.

The checklist requires specific training to use it. It isn’t a situation in which you sit down and ask the person across from you about the traits on the list and score what they say. It is also never meant to be a self-diagnostic tool. It cannot be used that way. The following is from Jon Ronson’s book, “The Psychopath Test” which we will get much more into in the next post:

It was nearly midnight. We drank whisky, on the rocks. Other business travelers— those with the key card to the executive bar— typed away on laptops, stared out into the night. I was a little drunk.

“It’s quite a power you bestow upon people,” I said. “The power to spot psychopaths.” Bob shrugged. “But what if you’ve created armies of people who have gone power mad,” I said. “who spot psychopaths where there are none, Witchfinder Generals of the psychopath-spotting world.”

There was silence.

“I do worry about the PCL-R being misused,” Bob said. He let out a sigh, stirred the ice around in his drink.

“Who misuses it?” I asked.

“Over here you have your DSPD program,” he said.

“That’s where my friend Tony is,” I said. “The DSPD unit at Broadmoor.”

“If thirty is the cutoff point, who gives the score?” Bob said. “Who administers that? Actually there is a lot of diligence in the UK. But in the US. we have the Sexually Violent Predator Civil Commitment stuff. They can apply to have sexual offenders ‘civilly committed.’ That means forever…”

Bob was referring to mental hospitals like the one at Coalinga, a vast, pretty, 1.2 million square foot facility in central California. The place has 320 acres of manicured lawns, and gyms, and baseball fields, and music, and art rooms. Fifteen hundred of California’s 100,000 pedophiles are housed there in comfort, almost certainly until the day they die (only thirteen have been released since the place opened in 2005). These 1,500 men were told on their release from jail that they’d been deemed re-offending certainties and were being sent to Coalinga instead of being freed.

“The PCL-R plays a role in that,” Bob said. “I had to train some of the people that administer it. They were sitting around, twiddling their thumbs, rolling their eyes, doodling, cutting their fingernails—these were the people that were going to use it.”

A coalinga psychiatrist, Michael Freer, told the Los Angeles Times, in 2007 that more than a third of Coalinga “individuals” (as the inmates there are called) had been misdiagnosed as violent predators and would in fact pose no threat to the public if released. “They did their time, and suddenly they are picked up again and shipped off to a state hospital for essentially an indeterminate period of time,” Freer said. “To get out they have to demonstrate that they are no longer a risk, which can be a very high standard. So, yeah, they do have grounds to be very upset.”

In the executive bar, Bob Hare continued, He told of an alarming world of globe trotting experts, forensic psychologists, criminal profilers, traveling the planet armed with nothing much more than a Certificate of Attendance, just like the one I had. These people might have influence inside parole hearings, death penalty hearings, serial-killer incidence rooms, and on and on. I think he saw his checklist as something pure—innocent as only science can be—but the humans who administered it as masses of weird prejudices and crazy predispositions.

We will get back to the part about “I think he saw his checklist as something pure—innocent as only science can be—but the humans who administered it as masses of weird prejudices and crazy predispositions.” in the next post, so try to remember it. It will be an interesting thing to juxtapose against Hare’s own words later on.

I may not have a great deal of respect for Robert Hare, scratch that, I have none, but tools have instruction manuals, and they are meant to be used accordingly. When they aren’t used properly, they can cause harm. Ever looked at a curling iron and wondered why it has a warning tag that says “Do not insert into any orifice?”

It’s there because some troglodyte decided that was a good idea, and sued the company that made the curling iron. They didn’t say, “That was my fault because I should have figured out that my dumb ass should not put a hot curling iron into any part of my body. No, this is somehow their fault, so I should get money because I have no ability to take responsibility for myself.”

PCL-R, same thing. It has an instruction manual, and Hare has repeatedly said, you cannot use this tool without being trained. It says this:

Professionals who administer the diagnostic examination should have advanced degrees (M.D., Ph.D., or D.Ed.) in a medical, behavioral or social science field; and registered with a reputable organization that oversees psychiatric or psychological testing and diagnostic procedures. Other recommendations include experience working with convicted or accused criminals or several years of some other related on-the-job training. Because the results are used so often in legal cases, those who administer it should be qualified to serve as expert witnesses in the courtroom. It is also a good idea, if possible, for two experts to test a subject independently with the PCL-R. The final rating would then be determined by averaging their scores.

The administration of the checklist is done in two parts;

The Hare PCL-R contains two parts, a semi-structured interview and a review of the subject's file records and history.

After semi-structured interview is completed, and the results are checked against records, and history, the score is arrived at. The score is on a scale of zero through forty. Above a thirty is considered a “psychopath”, though there are significant issues with the checklist itself in regards to its accuracy, and over reliance on criminal traits.

The score is what determines whether or not the criminal or forensic patient is psychopathic, and how psychopathic they are according to Hare’s image of psychopathy.

That is the minimum for using this checklist, but people who do not have the foundational degrees use it all the time to assess patients they are not qualified to assess. Remember in a past post:

Most Psychologists are Equipped to Diagnose Psychopathy...

what I said about the abnormal psychology training level of those that are just psychologists without a specialty in it? Let me repeat, one day.

One.

Yet people like this feel that they have the authority and expertise to use a tool that the guy who “created” the tool says is not even close to being the proper training. So, what happens when this tool is used by people that have no business using it in a professional environment?

1. Many criminals receive psychiatric evaluations prior to trial.

2. Many clinicians are not actually trained to assess psychopathy but do so anyway.

Many people who are not psychopathic will be assessed as psychopathic. This is not a rare occurrence, and it happens with regularity. Which results in this cycle:

1. The person might now receive more time on their sentence due to being “diagnosed” as a psychopath.

2. This perpetuates the criminal archetype of psychopathy

3. It makes psychopathy appear more prevalent than it is.

4. It stalls research into actual psychopathy

5. It drives the myths of psychopathy

6. It reinforces the “usefulness” of the checklist, thus making it be used more often.

7. This starts the cycle over again.

However, that is not the worst thing that happens when this tool is improperly used by people that have no business using it. No, it gets much worse, because this tool is used as evidence in death penalty trials, and can make or break a person being sentenced to death.

Let me say this loudly. THAT IS NOT WHAT THE PCL-R WAS EVER SUPPOSED TO DO.

However, it is used this way, and often. People are either held in prison for far longer than anyone else would be for the same crime based on their score delivered to them by a poorly educated hack who thinks that they are above the system that it is meant to be used in. Or, they are sentenced to die for a crime that someone else, either not assessed with the PCL-R, or who “passes” it, by not scoring high enough to be considered psychopathic, might get twenty-five years, and then parole for the same crime. Here is more on both of these issues:

“There’s a lot of stuff that looks like it’s junk and should be filtered out by the courts, but it’s not being filtered out,” said Arizona State University psychology professor Tess Neal, the lead author of the study.

“One controversial psychological test, the Hare Psychopathy Checklist—Revised (PCL–R), came under fire in the American Psychological Association’s journal, Psychology, Public Policy, and Law. In a joint statement first published on-line on January 30, 2020, thirteen expert psychiatrists and psychologists wrote that while the test may have general usefulness in measuring psychopathy “as a construct,” it is “inappropriate [to use] the PCL–R to draw conclusions about an individual’s risk for committing serious violence in high-security custodial facilities.” Such conclusions are often critical in capital sentencing determinations in states such as Texas in which finding that a defendant poses a continuing threat to society is a prerequisite to imposing a death sentence.

The experts criticize the PCL–R as plagued by adversarial allegiance — mental health witnesses called by the prosecution will rate a defendant’s level of psychopathy higher than defense experts will during “evaluations of the same person, made around the same time, and even when made on the same information base.” They also say that “the association between PCL–R scores and serious institutional violence is negligible,” making the test unreliable as an indicator of whether a defendant will actually commit violence in prison. The PCL–R “cannot make predictions that an individual will engage in serious institutional violence with any reasonable degree of precision or accuracy,” they say, “and should not be used for this purpose in capital sentencing evaluations.”

STUDIES — Junk Psychological Science Continues to Infect Death-Penalty Determinations

The results of this:

After 26 years in prison, he was due for a parole hearing. In California, before a "lifer" like Dixon appears before the parole board, a state psychologist must first evaluate whether he poses a risk of further violence if released. To do that, the psychologist administers a test — the PCL-R, or Psychopathy Checklist-Revised — designed to measure whether that inmate is a psychopath.

This test has incredible power in the American criminal justice system. It's used to make decisions such as what kind of sentence a criminal gets and whether an inmate is released on parole. It has even been used to help decide whether someone should be put to death.

Can A Test Really Tell Who's A Psychopath?

Does that seem like justice to you? It doesn’t to me. It seems very arbitrary regarding people's lives, and whether they get to keep living.

So far, what do we know? We know that the PCL-R is largely based on a list from a bygone era where it was still acceptable to lobotomize people, or put them into comas for the purposes of prolonged sessions of shock therapy. We know that the person that pilfered the list also has a grudge against people that he considers psychopathic. We know that the checklist was challenged, and Hare threatened to destroy two researchers' careers with a lawsuit. We know that the PCL-R has been further challenged since, with good reasons. We know that people that have no business using the PCL-R use it anyway, thus amplifying its reach, and reinforcing its credibility when in fact its credibility should be weakening. We know that it is used to keep people in prison, and we know it is used to condemn them to a lifetime in prison, or death.

All of that is pretty messy. At best, it is an old construct that people find serious flaws with that should be addressed. The checklist itself should be reassessed to see if it has any value at all, it certainly should never be used by people who do not have the training, and in circumstances in which it was never meant for. It should also not be the guidelines that define psychopathy, as it certainly fails at that objective. This would cut down about seventy-five percent of the problems when it comes to the PCL-R’s use.

It seems simple enough, just revamp the thing removing the criminal aspects, relegate it to a screening tool, and then do the actual work to confirm that the person that you are suspecting of psychopathy actually is one. Don’t believe just because they have a high PCL-R score, that they are automatically a psychopath. It is also time to start being more bullish on the implementation of brain scans for suspected criminals. I understand that they are very expensive, but without actually getting a consensus that is in the hard sciences (neurology in this case), the soft science is going to keep hockey pucking psychopathy around because they can. There is no reason that it can’t be used to malleably fill whatever hole they are seeking to fill in with answers. 

Remember this bit, “I think he saw his checklist as something pure—innocent as only science can be—but the humans who administered it as masses of weird prejudices and crazy predispositions,”?

That is how the PCL-R was constructed to begin with. It was constructed through the eyes of someone that has weird prejudices, and crazy predispositions. There is supposed to be this idea that we don’t have one aspect defining someone, but when you are a psychopath, that is all that is allowed to be used. There is nothing more than the psychopathy diagnosis that can even be looked at. Why? Because the PCL-R and all the research that it begot says so.

According to the acolytes of this way of thinking, there is nothing decent or valuable about a psychopath. Every single one is evil, pathologically lies, seeks to take the utmost advantage of the world around them, and all of that can be traced back to a single man, who got taken for a ride by a bunch of bored prisoners. A group of bored prisoners became the birthplace of what psychopathy is considered now.

For now, it is the monster diagnosis, but there is very little reasonable science to back that claim up. There are plenty of people that do terrible things, and there are plenty of people that are terrible people, but that doesn’t make them psychopathic, it makes them bad decision-makers. If you want to have a definable construct for psychopathy, being a bad criminal should not be it.

I mention my ex-brother-in-law frequently because his crime is heinous, but he is no psychopath. He is a neurotypical who did something atrocious. There are thousands of people just like him lining the cells in various prisons, and most of them are not psychopathic. However, just the nature of their crime often is enough for people to automatically assume that they are and will attempt to evaluate them for that very thing. You can bet my ex-brother-in-law was evaluated, however in his case, his was done by someone competent.

Poorly trained people conducting PCL-R evaluations are adding to this mess, and many people that are not psychopathic are evaluated as being so. In contrast, many psychopaths are not being evaluated at all, because they don’t fit the monster mold. 

The PCL-R has so many problems, it can’t be seen as a reliable tool in almost any capacity, but it certainly should not be the thing that is deciding people’s fates, nor should it be the defining basis for all the studies on psychopathy. It is not designed for it, and even if it were, it does not demonstrate itself to be remotely qualified to be in the position of power over others that it has currently. 

Part three of this series will be the last part, and it will cover Hare’s conduct as relayed by an author that wrote a book based on the PCL-R, called, “The Psychopath Test”. It is very revealing in regards to Hare’s own personal way of being. It casts light on some of his behavior discussed in this part. I am certain you will find it enlightening.